The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM [FORM ~ BUSINESS NAME: / / ._: ." : DA~. [L[TY NAME: UNIT ~: OF (CHECK ONE) SITE DIAGRA)I ~ FACILITY DIAGRk~ ' I ',, ' / '~ :' ' ' --L. 1 ~s7'~ ~/~ (Inspector's Comments): -OFFICIAL USE ONLY- SITE DIAGRAM (Re( ;d items) '~ 1. Address: Idea' ~ 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, Vard Drains c. Wood 4. Drainage Canals. Ditches, d. Gates Creeks. 13. Powerllnes 5. Buildings a. Frame construction 14. 6uard Station b. Masonry construction IS. Storage Tanks: Identify the c. Metal construction capacity in gal, a. Above ground ,1' " '' ''" ': ' 'd. Access Door 6. Utility Controls a. Gas 16. Diking or Berm c. Water 18. Evacuation Area: ' Identify the Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous ..:. .',~'~,,~,:.,~ ...,,...'.,.,. :~,' .. *'./.. fo~ protection.systeas .::...-"?,.: ,.':. :.'. ~ -,'.-. . . Material .-.' .".,. .... .j'!.':.-.-' Use/Handling e. Fire Pump 22. Type o~ Hazardous Material/Waste Stored 8. Fire Department Access or Used (See Below) '::'*"{~'~''"'**;'~'::/~':~"~' :.":'~':'.~":* <:":"'*':*~"'**'*-'+*~'*": ........... "'."**"~*:':'"'*~."""*="!**~fpE OF"H~ZARDOUS-~T£R~A~ '"'*';: f''~ *'~'..';;:"'~i':"'"*~ "*'i":"*: ....... : ..... '~".'~"': '~:'*'~'"':' F = Flammable E = Explosive L = Liquid R = Radiological C - Corrosive 0 - Oxidizer O = Oas P = Poison W = Water Reactive T = Toxic S - Solid H = Cryogenic D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAORAM (Required Items 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. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets D~ O ~o~ o~£ . ~YMEN~__ ~TO: ,-,. PLEASE MAKE CHECKS PAYABLE TO: ,TYOFBAKER~IELD HAZAR l$ MAI. ERIALS DIVISION BOX 2057 CITY OF BAKERSFIELD kKERSFIELD, CA 93303-2057 ACCOUNT NO, ~N ,raous :~et'eriats Hanati'ng. Fees Prevtous.'B'ateflce ;9.Od ~AT HANDLING FEE ............... ' CENUMBER *=61 GOLDEN S~ATa 8AaERSFIELD. CA MUST ~ETU~N THIS OOPY WITH PAYMENT Utilities General Account Maintenance 02/28/94 PUTLS801 Acct Nbr: 473601 Bill Stat: NO Transfer-from: Page 1 of 6 CYc Stat: CL Acct Cyc Stat: CL Transfer-to: Due: 160.00 1. Customer Name: QUALITY SMOG LUBE AND'TUNE 2. Social Sec Nbr: 3. Telephone: 4. Service Address: 601 GOLDEN STATE AVE 5. Service City: BAKERSFIELD 6. State: CA 7. Zip: 93301 8. Parcel ID: 9. Bill Cycle: 5 '20. Water Svc Class: 10. Route Nbr: 11. Comments : 12, Prev Acct: HM01372 23. Misc Services: 23.1 F05 HAZ MAT HANDLING 13. Service Date: 23.2 Fl7 INSPECTION FEE 14. Fund no: 23.3 15. Billto Adl:601 GOLDEN STATE AVE 23.4 16. Billto Ad2: 24. Closing Date: 17. Bill-to City: BAKERSFIELD 18. State:.CA 19. Zip: 93301 Enter SaVe(S), Cancel(XX), Next Page(/]i, or Field # to Change HM473601 AccountrNumber ACCOUNTS RECEIVABLE ADJUSTMENT January 13, 1995 Date New Account New Address Esther Dumn Closs Account From Service Change Other AdJustmente X Fire Department- Hazardous Materials Division Department/Division QUAUTY SMOG LUBE & TUNE Bi#lng Name 601 GOLDEN STATE Billing Address Site Address Parcel # (If Applicable) Landlord Name & Address (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effective Date of Biffing Change. <37.97> 1-11-95 Remarks: MR. DOWDING HAS AGREED TO PAY HIS BILL FOR THE PRIOR YEAR IF WE WRITE OFF THE FINANCE CHARGES. OK PER REH. .... :.~,iI, RECE'IVEDPage 09/20/91 QUALITY SMOG LUBE AND TUNE 215-000-001372 1 Overall Site with 1 Fac. Unit 0CT15 1991 General Information ~l!8'1~ ............ Location: 601 GOLDEN STATE Map: 103 Hazard: Low Ident Number: 215-000-001372 Grid: 30B Area of Vul: 0.0 Contact Name __ Title , Business Phone 24 Hour Phone- ~~-- [~0~o~ ~ I~ ......... DAN DOWDING ~~ --OP~l~ (805)o322-5105 x (805) ~-~ Administrative Data Mail Addrs: 601 GOLDEN STATE D&B Number:~-O~]D6~4D City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 5541 BERT KITTS Phone: ~ate: CA ~FIELD Zi~: 93308- Summary .... tt~o,.=.~..,iT-- Do hereby certify that l'have reviewed the attached hazardous materials merit p~an for any corrections constitute a complete and correct man- e, gement plan for my facility. ' ' Signature " ~.,:'~ , .~,~,~ . , FR AREACODE ~ ' , ME ~ ~ 777. ?~7 ' ' ' 0 t.! _ IS~a~[D~___.~ BACK ~r~ CALL SEEYOU AGAIN 09/20/91 QUALIT~MOG LUBE AND TUNE 215-0 013'72 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards' Form Quantity MCP 02-001 WASTE OIL Liquid ~ Low Fire, Delay Hlth $~ GAL 02-002 NEW OIL Liquid 110 Minimal Delay Hlth GAL 09/20/91 QUALIT~MOG LUBE AND TUNE 215-00~01372 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification OUTSIDE FIRE ALARMS EAST AND WEST SliDE OF BUILDING EAST AND WEST BAY DOORS OPEN DURING ALL BUSINESS HOURS CALL 911 <2> Employee Notif./Evacuation <3> Public Notif./Evacuation ,Uo ~uOc~ ~.. ,,~ 3.,-foP- <4> Emergency Medical Plan 09/20/91 QUALIT~iMOG LUBE AND TUNE 215-00~01372 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention - ;-:A3T.-. CIL I S _STOP. ED I~ UND.~.?.GRCUND TA'~'.=.- NEW OIL STORED IN CLOSED METAL CONTAINERS <2> Release Containment OIL DRAIN <3> Clean Up DRY SWEEP USED ON OIL SPILLS <4> Other Resource Activation 09/20/91 QUALIT~MOG LUBE AND TUNE 215-00~01372 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE IN BUILDING B) ELECTRICAL - WEST WALL INSIDE OF BAY AREA C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water FIRE ALARMS ON EAST AND WEST SIDE OF BUILDING FIRE EXTINGUISHERS AND WATER HOSES FIRE HYDRANT - 200 FEET SOUTHEAST OF BUILDING ACROSS 24TH STREET <4> Building Occupancy Level 09/20/91 QUALIT~MOG LUBE AND TUNE 215-00~01372 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 2 EMPLOYEES AT THIS FACILITY WE HAVE MATERIALS SAFETY DATA SHEETS ON FILE. ALL FIELD EMPLOYEES AND MANAGEMENT PERSONNEL HAVE BEEN GIVEN SPECIAL TRAINING SESSIONS BY QUALIFIED INSTRUCTORS IN SAFETY FOR HANDLING EMERGENCIES THAT COULD ARISE WITH THE CHLORINE GAS CONTAINERS OR EQUIPMENT THESE TRAINING CLASSES ARE REPEATED AND UPDATED EVERY MONTH. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use C I ~['Y O]F BAKERSFIELD HAZARDOUS MATERIALS INVK~RY Farm and Agriculture andard Business Page_ of,~ ~ NON - TRADE SECRET ~t ~ ~ ~t ~ Units on Bite ~ Press Te~' Code S~red tn Facility ck 7~-~- Co~onent ~ 2 N-- & C.A.S. N~er that apply) of Pressure H~lth H~lth Co~onent 9 3 Na~ & C.A.S. N~ Physical and H~lth Hazard C.A.~. N~er--7'-g__~--~- L ~ Co~onent . i N-- & C.A....~r (Check all t~ appZy)_ ' Co~onent ~ 2 N~ & C.A.S. ~er ~r, Haz=d ~udden Relea,e ~ R,ct~v~y. ~ /=~i,~ U Delay~ of Pressu~ H~lth H~lth Co~onent ~ 3 N~ & C.A.S. Physical and Hmlth Hazard C.A.S. N~ Co~on~t ~ i N~ & C.A.S. N~r (Check all t~t apply) Co~on~t ~ 2 Na~ & C.A.S. N~er ~ F~r. Hazed ~ Sudden Release ~ R~ct~vit, ~ I~"~ ~ Delay~ of Pressure H~lkh H~lth Co, orient ~ 3 Na~ & C.A.S. Ph~ical and g~lth Hazard C.A.S. N~er Co~onent ~ 1 N~ & C.A.S. N~er (Check all t~t apply) co~sn% ~ 2 N~ & C.A.S. N~er of Pressure H~lth H~lth Co~on~ ~ 3 N~ & C.A.8. N~ Title ~4 ~. Phone N~e Title 24 ~ Phone Certification ' (~ ~D SIGN AFTER COMPLETIN~ ~L SECTIONS) certify ~der p~nlty of law t~t I ~ver ~rsonally ~n~ ~d ~ f~il~ with the ~nfo~tion su~[tted ~n th~s ~d all attached d~ts ~d ~at ~sed on individ~ls res~ible for obtaining the info~tion. I ~l~eve ~t ~e su~it~d ~nfo~tion ~s t~e, acc~ate, and c~plete. ~~ Date Completed ~- I ~ 0 ( Business ~)~(~ ~,~<~ ~0~ + To~'~ RECEIVED Identification No. 215000 t% ~ ;~ Cop of Business Plan) ~S'~ ............ Adequate Inadequate Verification of Invento~ I~aterials Verification ~ Quantities Verification of Locaion Proper Segregation of Materi~ Verification of MSDS Availabli~ Number of Employees Verification d H~ Mat Training Comments: Verificaion of Abaement Supplies & Procedures Oomments: Emergency Procedures Posted Containers Properly Labeled omments: ~~ Verification of Facility' Diagram ~po~ards ~ssociated with this Facility:. ~__ All Items O.K. ~] ~ ~, ~ Correction Needed ~ Business Owner/Manager FD 1652 (Rev, 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy QUALITY SMOG LUBE AND TUNE Fac. Unit: Fixed Containers on Site ~ Hazmat Inventory ~ Inventory Details CONV 01/07/90 Name r WASTE OIL I [SecretNo ] r CAS/Waste Code ~ Hazards: Fire, Delay Hlth MCP: Low Form: Liquid Type: Waste Days: 365 Use: LUBRICANT Daily Max GAL Daily Average GAL Annual Amount GAL I 250.0.0 ]l 110.00 1,000.00 Storage - Press -- Tem~, Location UNDER GROUND TANK Ambient Am'bient OUTSIDE - WEST <S> S.P.T.L. <C> Components <N> Notes <I> Inventory List <P> ~'rint <Fl> Help <Esc> Exit ~ ~ ~ ~ Bakersfiield Fire Dept. ~ ~~ HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301 ,~ ~ (805) 326-3970 UNDERGROUND TANK QUESTIONNAIRE RECEIVED JUN 1991 I. FACILI~/SITE No. OF TANKS O~ Afls'd ............ NAME OF OPERATOR DBA OR FACILIW NAME QUALI~ ~ ttJ~E ~ TUNE ADO"E~ ~t G~ 8t~e Aven~ N~.[S~ CEO~ STRE~ PARCEL No. COPTIONAL) ClW NAME (80~) 322'51 ~O. RE 1538~ STATE ZIP CODE ~ 8OX TO INDICATE ~ CORPORATION ~INDIVIDUAL ~ PARTNERSHIP ~ LOCAL AGENCY DI$~IC~ ~ COUN~ AGENCY ~ STATE AGENCY ~FEDERAL AGENCY EMERGENCY CONTACT PERSON (PRIMAE~ EMERGENCY CONTACT PERSON (SECONDAE~ optioncl DAYS: NAME (~SL FIRS~ PHONE No. WITH AE~ CODE DAYS: NAME (~ST. FI~D PHONE No. WITH AE~ CODE NIGHTS: NAME (~ST. FIESD PHONE ~. WITH AE~ CODE NIGHTS: NAME (~S% FI~D PHONE No. WITH AE~ CODE II. PROPEE~ OWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADD~E~ INFORMATION MAILING O~ STEE~ ADDRESS ~ BOX ~DIVIDUAL ~ LOCAL AGENCY ~ STATE AGENCY CI~ NAME STATE ZIP CODE ~ PHONE No. WITH A~EA CODE ,L ~N~OW~E~ ~N~O~m~O~ (~US~ ~E COMPlEtED) NAME CARE OF ADD~ESS INTO~MATION ~u~o o~ ~T~EEY~DDR~OO ~O~ LUBE ~ YUN~ / Box ~Du~ D~oc~L ~oE~cY DOT~TE ~E~CY ~O~ OOldOn ~t~t~ AV~D~O TO ~ND~CAT~ ~ PARTNeRSHiP ~COUN~ AGENCY ~F~DERA~ AGENCY CA ~0 ~ (- ~OC-- 3~-~0~ OWNER'S DATE VOLUME PRODUCT IN TANK No, INSTALLED STORED SERVICE Y/N Y/N Y/N Y/N Y/N DO YOU HAVE FINANCIAL RESPONSIBILITY? Y/N ~PE ~,' '~ Fill one segment ~Oe~Or each tank, unless all lks and piping are constructed of t~ 'me materials, style and then only fill one segment out. please identify tanks by owner ID #. I. TANK DESCRIPTION COMPLETE ALL ITEMS .- SPECIFY IF UNKNOWH A. OWNER'S TANK L D.# ~J' A B. MANUFACTURED BY: ~ ~ .~ ~ / ~,~ / C. DATE INSTALLED (MO/DAY/YEAR) ~ '"'" t "~ ~ ~ O. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. ANOC, ANDALLTHATAPPLIESINBOXD A. TYPE OF [] I DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [~'2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK [] 99 OTHER B. TANK [] 1 I~,RESTEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEELCLAD W/FIBERGLASSREINFQRCEDPLASTtC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100'/,, METHANOL COMPATIBLE W/FRP (PrimaryTank) [] 9 BRONZE ~'~0 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING J~UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO~ O. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING ' [] 3 VlI~L WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE '' J~UNKNOWN [] 99 OTHER IV, PIPING INFORMATION C,RCLE A IFABOVEGROUNDOR U IFUNOERGROUND,'BOTHIFAPPLICABLE A. SYSTEM TYPE a U 1 SUCTION A [J 2 PRES~IlRE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 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 'U 2 STAINLESS ,~TEEL A U 3 POLYVlNYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE CORROSION A [J 5 ALUMINUM A U 6 CONCRETE A IJ 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A lJ 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 I.INE TIGHTNESS TESTING [] 3 INTERSTtTtAL MONUORING [] 99 OTHER V. TANK LEAK DETECTION [] 6 TANK TEST,NG [] 7 ,N RST,T,ALMON,TOR,NG [] NONE [] UNKNOWN [] OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # 8. MANUFACTURED BY: C. DATE INSTAl. LED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. ANDC, ANDALLTHATAPPLIES1NBOXD A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) ~ g90~ER B. T~K ~ , SAR~STEEL ~ 2 STA,NLESS ST~:L ~ 3 F,a~,~S ~ 4 STEELCLAO W/F,SERGLASS RE,N~ORCEOP~STIC MATERIAL ~ 5 CONCRETE ~ 6 POLWINYL CHLORIDE ~ 7 ~UMINUM ~ 8 1~ ME~ANOL COMPATIBLEW~RP (p,J~r~Tank) ~ 9 BRON~ ~ 10 ~LVANI~D S'rEEL ~ ~5 UNKNOWN ~ 1 RUBBER LINED ~ 2 ~g LINING ~ 3 EPO~ LINING ~ 4 PHENOL~ LINING C. INTERIOR LINING ~ 5 GLASS LINING ~ 6 .UNLINED ~ g5 UNKNOWN ~ ~ O~ER IS LINING MATERIAL COMPATIBLE WITH 1~. ~EmANOL ? YES__ NO__ D. CORROSION . ~ 1 POLYETHYLENE WRAP ~ 2 COATING ~ 3 VINYL WR~ ~ 4 FIBERGLAS REINFORCED P~STIC PROTECTION ~ 5 CATHODIC PROTECTION ~ 91 NONE ~ 95 UNKNOWN ~ ~ DINER IV. PiPiNG INFORMATION C~RC~ A IFABOVEGROUNDOR U IFUNOERGROUND. BO~ IF APPLICABLE A. SYSTEM TYPE A u 1 SUCTION A U 2 PRESSURE A ~ 3 GRAVt~ A g g90~ER B. CONSTRUCTION A U. 1 SINGLE WALL A ~ 2 DOUBLE WALL A ~ 3 LINED TRENCH A U 95 UNKNOWN A U ~ OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POL~INYL CHLORIOE (PVC)A ~ '4 FIBERGLAS PIPE CORROSION A U 5 ~UMINUM A U 6 CONCRE~ A U 7 STEEL W/ COATtNG A U 8 1~/~ ME~ANOL COMPATiBLEW/FRP PROTE~ION A ~ 9 ~LVANI~D STEEL A ~ 10 CATHODtCPROT~CT~ON A ~ 95 UNKNOWN A ~ 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE T~HTNESS TESTING ~ 3 MON~ORINGINTERST~TIAL ~ 99 O~ER V. TANK LEAK DETECTION ~ ~,-'~ 1 VISUAL CHECK ~ 2 INVENTORY RECONCILIATION ~ 3 VAPORMONITORJNG~ 4 AUTOMATIC TANK GAUGING ~ 5 GROUND WA~R MONITORING J [ . I. TANK DESCRIPTION COMPLETE -- SPECIFY IF UNKNO~NN t A. OWNER'S TANK I. D. # I B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) I D. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES ~ B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF [] 1 DOUBLE WALL [] 3 sINGLE WALL WITH EX'FERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAUL'FEDTANK) [] 99 OTHER B. TANK [] .1. BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CI-ILORIDE [] 7 ALUMINUM [] 8 lOm/o METHANOL COMPATIBLE W/FRP (PrimaryTank) [] 9 BRONZE []-10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] , RUBBER LINED [] 2 ALKYD LaNmNG [] 3 EPOXY UNmNG [] 4 PHENOUC LINING C. INTERIOR LINING [] 5 GLASS LINING [] 6 UNLINED [] 85 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANC~L ? YES_ NO__ D. CORROSION [] I 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 & IFABOVEGROUNDOR U IFLINDERGROUND, BOTH IF APPLICABLE ~' -' *- .:~* A. SYSTEM TYPE A U 1 suCTION ...... A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 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. 1 BARE STEEL -A U 2 STAINLES.~; STEEL A U 3 POLYVINYL CHLORIDE(PVC)A IJ 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETF 'A U 7 STEEL Wl COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U B GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U g9 OTHER O. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERS'ITrlAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] ~ WSUA. CHECK [] 2 ~NWNToRY RECONC,U^TION [] 3 V^PORMON~TOR~NGr---] 4 *UTOMATICTANKGAUG~NG [] ~ GROUND WATER MON~TOR,NG [] 5, TANK TESTING [] 7 .NTERST,T,ALMONITOR,NG [] g', NONE [] ~ UNKNOWN [] 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # B. MANUFACTURED BY: C, DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXO A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) ~-~. 9 BRONZE [] 10 GALVANIZED STEEL [] 95, UNKNOWN [] 99 OTHER [] ~ RUBBER L,NED [] 2 ALKYD LIN,NG [] ~ EPOXY LI.~NG [] ~ P.ENOL~ L,N,NG C. INTERIOR [] 5 GLASS LINING [] 5, UNLINED' [] 95, UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 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 CIRCLE A IFABOVEGROUNDOR U ~FUNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A [J 3 GRAVITY A IJ 99 OTHER B. CONSTRUCTION A U 1 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 U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETe-- A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPAT[BLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHOOICPROTECTION A U 95 UNKNOWN A !J 99 OTHER D. LEAK DETECTION · [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIALMoNITORiNG ~ gg OTHER V. TANK LEAK DETECTION ~ 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUNDWATER MONITORING [] 6 TANK TESTING ~] 7 ,NTERSTITIALMONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER Farm and Agticultule Fl' Standard Business ~AZARDOUS HATER'rALS INVENTORYii [ flUS I NESS NAME: ~:~ (jCl c/A'~ ~r'~f [LOCAT[0N;~i? ~~ ~V~ ~. ADDRESS; ~ff~z ~d~¢ ~, ' STANDARD IND, CLASS CODE~' [CITY. ZIP~O, c~ ~53o/ CITY. ZIP~~, c~ ~3/~ DUN AND BRADSTREET NUMBER . - : REFER TO~NSTRUC~ONS FUR PROP~ CODES ~-~- - frans [y~e ~ex Averege'; Annual N~aspre Con[ Use _ ~ toc~don?e[e. ~,r. ~y tla~es of Hixture/Cc~oonents Code ~ooe AaL ~m[ = EsL un,cs on ~ 4YPe )~ss fe~0 Code/ Storea ~n ~ac~[y ! See ZnsLrucLtons Physical and ,,al~h Nazard ¢ C.A.S. Numb,~4~ ~,(% ~/ Componeot ~1 Name I C.A.S. Number (Check all that apply) ', ' Component 12 Name I C.A.S, Number ~e Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate . Nee/th 0¢ Pressure Health , ~. Component 13 Naeet C,A.S. Number ~ Physical lcd HealLh~azard J. C,k,~. Number Component II Name I C.A.S, Number°~ff IChec~ all that app~i ~ , q Cn~nnn~nt I~ Name I C:A.S. Number '~re Hazard .~ Reactivity ~ Oelayed 'Heal~h ~ Sud~enof PressureRelease ~ ]a~i~ ............ ~ Componen~ 13 Name I C,A.a, Number ~hysical and Health Hazard :' C,A.S, NuAber Componen~ II Name I C,A.a. Number ~ (Check 811 that apPlyJ .~ B Fire Hazard ~B Reactivity~ ~ Delayed B Sudden Release B lmmedia:e CompoAefl: 12 Name t C,A,a. Number /N W 2 6 1991 ' ~eaKh of Pressure Healkh ~;~' . Component 13 Name I C,A.S, Number ; H~ Physical'lpd He81t~ Ualard ~ C,A,S. Number Component II Name t C.A,S, Number ~ (Check all that ap~/H ~ ~ : ~ ~ ComponenL I~ Nam8 I C,A.S, Number ~ Fire Hazard ~ ~eacLivi~ ~' Delayed ~ Sud~eA Release ~ lA~i~ · ~ ~ Hem/Ch o[ Pressure ~ ~ Component 13 Name I C.A,S, Number ~ :ertifi atio ~ Re an f naf r corn 1 ting ~11 s ct fons) ~[[aeed.doc~eenthfafl~ t~ac DaSe~.OA.ey IAqu~r~ g~.tnose Inolylouals responsioJe tot obtalnin9 the Information. I believe the[ the ~= kUOmlttea .inlormatlOfl IS true, accurate, a~o complete, - BAKEI~IELD CITY FIRE DEPAI~tMENT 2130 'G' STREET BAKERSFIELD, CA. 93301 /~¢,3 (805) 326-3979 /03-3o OFFICIAL USE ONLY U81372 , ID# BUSINESS NAME HAZARDOUS MATERIALS RECEIVED BUSINESS PLAN AS A WHOLE FORM 2A "- " HA ..... ~ -DIV. To avoid fur~hep action, r~s~urn this fpom ~ithin 3e days of peceig~. 2. TYPE/PRINT ANSWERS IN EN6LZSH. 3. Rnswe~ the questions below for the business as a whale. 4. Be as b~ief and concise aa possible. SECTION ): BUSINESS IDENT)F)ChT'ION OATh SECTION 2: E~ER6ENCY NOTIF[~ATIDN~ In case of an emePgency involving the Pelease o~ threatened Peleese of a hazardous maieriaI, cai] 911 and I-8ee-BS2-?SSe or 1-~]B-427-4341. This ~ill noiify your local fire department and the State Office of Emergency SePvices as Pe~uired by law. " E~PEOYEE$ TO NOTZFY IN CASE OF ENER6ENCY= " NR~E AND TITLE OURIN6 BUS. HRS. AFTER SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSZNESS ~S ~ WHOLE B. ELECTRICAL: ~~ ~/~.~ /~ .~[~ C. g~TER: D. SPECIAL: E. LOCK BOX: YES I IF YES, LOCATION: iF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES /.NO FLOOR PLANS? YES / NO KEYS? YE~ / NO SECTION 4: PRIURTE RESPONSE TERM FOR BUSINESS RS R WHOLE SECTION S: LOCRL EMERGENCY MED!.~L hSS!STaNCE FOR YOUR BUSINESS RS h I~HOLE ',, ' " '" ""';' ' ' "] '" ' ~';~ ',. "~'. ," .' '" ' ,. · ' ". · ' ~ ".' ,.' .;';'~,:'' '.'.; '-"'.. ',; ' '.~', '' '(O*'SEOTION ~: EMRLgYEE TR~ININB EMPLOYERS ~RE RE~U!RED TO H~VE ~.TR~INING PROGRAM ~,~H!CH PROVIDES EMPLOYEES glTH INITIAL ~ND REFRESHER TRS!NIN6 IN THE S~FE HSNDL!N6 OF H~ZARDOUS M~TER ! RLS. ~. ~o YOU .~s ~sos <.~TSm~L S~¢~TV. O¢~T¢~TS)~0~ ~C.--~Z~OOUS. ._ O. 6[~E ~ BRIEF SU~HhRY OF YObR HRZSRDOUS H~TER~ALS TRhZNZN6 SECTION ?: EXEmPTiON REQUEST '! CERT;FY .]NDER PEH~LTY OF PERJURY ~H~'T HY B~JSZNESS !S E'X~r-~PT FROH THE REPORTING REQUZREMENTS OF' CHAPTER 8.95 OF THE C~LZFORNI~ HEALTH aND · ' CODE FSR THE FOLLOkI!N6 RE~SONS',:' WE DO NOT HANDLE HaZ5F'.BOUS M~TERZ~LS. WE DO H~NDLE H~Z~RDOUS M~TERZ~LS, BUT THE qUaNTITIES RT NO TZME EXCEED THE M~NZMUM REPORTZN6 OTHER (,SPECIFY RESSON~ . Z, . _ . , cedt.~fy t, ha~ ~he above' ~nfer~a~on . n.s ~nfo~ma&~on ~ be used to fui'¢~'~ firm's obligations under the ne~ Ca!ifornia Hea!th and Safety code on Hazardous Materials (Div.. 20 Cha~ter ~.95 Sec. =~_~cc~O Et ~].. ,~ and that inaccurate in¢ocmation constitute5 perjury. BfiRER%?iEiD CiTY FiRE DEPARTME.YT 2130 "G" STREET BAKERSFIELD, CA 93801 O~ i,'? T!tl. USE NAME: BUSINESS PLAN SINGLE ]FACILITY UNIT t;' O RM 3A INSTRUCTIONS 1. To avoid further action, tills form must be returned,~b¥: . ...... 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. ~ ...... ""3. ~nswer 'the:questions'below for'THE FACILITY' UNiT LISTED BELOW ..... 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: SECTION I: MITIGATION, PREVENTION,, ABATEMENT PROCEDURES ';!?" ........ '" ' ........SECTION'2: 'NoTiFICRTION ~ EVACUi(TION 'PROCEDURES AT' THIS UNIT Olay '"" ...... "' SECTION 3: HAZARDOUS MATERIALS FOR TH[IS UNIT ONLY A, Does thi. s Facility Unit contain Hazardous Mate?~als? ..... ~ NO If YES, see B. ~f Na, continue with SECTiOY 4, B..M'e any of the hazm'dous mater'iais a bona fide Trade Secpet YES ~ If No, complete a-separate hazardous materials inventory -..., -.:,~,: .. form marked: NON-TRADE SECRETS ONLY (white form ~A-1) If Yes, complete a hazardous materials inventory form marked} T~DE SECRETS ONLY (Fellow form ~4A-2) in addition to the non-trade SECTION 4: PRIVATE FIRE PROTECTION ' SECTION 5: LOCATION OF WATER S~PLY FOR USE 'BY E~RGEN~ RESPO~ERS C. WATER: D. SPECIAL: E. LOCK BOX: YES ,,/~ IF YES, I, OCAT~ON: IF YES, SITE PLANS? YES / NQ MSDSs? YES "NO FLOOR PLANS? YES /' NO KEYS? YES /' NO CITY of BAKERSFIELD For, omi Aqrieulture ~ Standard Business ~ ~Z~~O~ ~~~ ~~ ~ ~~~OR~ NON-- ~TRADE SECRETS ' P,ge .... of Mlth of P~. Mlth Mlth of Pw~ Mlth ...... (C~k ~11 t~t e~ly) r ~ ~t ~ ~EC.A.S. ~ H~lth of P~sure ~lth ~ (C~k ~11 t~t rely) -~ .... C~t 12 ~&C.A.S. ~ H~lth of Pv~suee Health Certlfi~atim (Read and sign after coepletJng ail sections) for obtaining t~ inf~Mti~. I ~lieve tMt t~ su~itt~ info~ti~ is t~, accurate, ~d c~plete. ~ . ~ ,~ /.