HomeMy WebLinkAboutBUSINESS PLANHazardous Materials/HaZardous ~waste Unified' Permit
Permit ID #:!-- 015-000-001840
CONDITIONS OF .PERMIT ON REVERSE SIDE
MOBILE AUTOMOTIVE
This .ermit is issued for the following:
[] Hazardous Materials Plan
[3 Underground 'Storage of Hazardous Materials
[3 Risk Management Program
[3 Hazardous Waste On-Site Treatment
LOCATION:' 1313 GOLDEN STATE
Issued by:
Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SER VICES'
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 326-0576
Approved by:
Office of Evimnmenl~lServices
Issue Date
Expiration Date:
June 30. 2003
ITE DIAGRAM [
Business Name~
Business Address~
FACILITY DIAGRAM
'~.~7.-:0.-_-:+~0~? lhh.,,,Ih,,ihlh,,,,ih,,l,lih,,,hhh,.,hhhh,,hlh,i
STATEMENT OF ACCOUNT
CITY OF BAKERSFIELD
P 0 BOX 2057
BAKERSFIELD, CA g3303-2057
1313 QOLDEN STATE
CUSTOMER ND: '19204
CHARGE
DATE D=S~'nlPTION
9/01/00 BE~INNIN~ BALANCE~:i
FOR
CALL THE
DATE'
)MER TYPE: ES/
lUMBER DUE DATE
OR CHANGES TO YOUR ACCOUNT PLEASE
AT THE TOP OF THIS STATEMENT.
i0/01/00
23202
TOTAL AMOUNT
170.00
DUE DATE' 10/31
3O
OVER 60
OVER 90
i~-O~.-O0
PAYMENT DUE:
TOTAL DUE:
170.00
$i70.00
1'920~
(66t) 326-3979
CUSTOMER TYPE: ES/
TOTAL DUE:
~3202
$170.00
HAZARDOUS MATERIALS IN
'Bakersfield Fire Dept.
\
OF ENVIRONMENTAL ..gER VICES
1715 Chester Ave.
Bakersfield, CA 93301
Date Completed
Business Name: /"/~ = ~' C ~- /~,_,/~) ¢,'z--,,.a ]7 c/~-c
Location: I'"~ ~_'~ COE)/(~p_..A,x ~O~-~
Business Identification No. 215-000 j ~'L(O (Top of Business Plan)
Station No. C(. Shift /'~ Inspector ~ U,,~(~5/7
Departure Time:
Inspection Time:
Ardval Time:
Address Visable
Correct Occupancy
Verification of Inventory Materials
Verification of Quantities
Verification of Location
Proper Segregation of Material
Adequate Inadequate
O []
[] []
[] []
[] []
[] []
Comments:
Verification of MSDS Availablity
Number of Employees:
[] []
Verification of Haz Mat Training []
Comments:
Verification of
Abbatement Supplies and Procedures
[] []
Comments:
Emergency Procedures Posted
Containers Propedy Labled
Comments:
Adequate Inadequate
[] []
[] []
Verification of Facility Diagram [] O
Housekeeping [] []
Fire Protection [] []
Electrical [] []
Comments:
UST Monitoring Program []
Comments:
Permits [] []
Spill Control [] []
Hold Open Device [] []
Hazardous Waste EPA No.
Proper Waste Disposal [] []
Secondary Containment [] []
Security [] []
Special Hazards Associated with this Facility:
Violations:
Business Owner/Manage' PRINT NAME SIGNATURE
White-Haz Mat Div,
Yellow-Station Copy
All Items O.K
Correction Needed
Pink-Business Copy
[]
[]
MISCELLANEOUS RECEIVABLES ADJUSTMENT
CUSTOMER NAME
MAILING ADDRESS
CITY
SITE ADDRESS
NEWACCOUNT ;
ADORES8 CHANGE
CLOSE ACCT
· FINANCE CHARGE
OTHER ADJ
ZIP CODE
PARCEL NUMBER
tqF APPUCAeLE)
ADJUSTMENT
CHG DATE
CHARGE CODE
ADJUSTMENT AMOUNT
REMARKS:
/
APPROVED BY
FD 1916 (Revised 8-15-86)
OCCUPANCY I DISTRICT BLOCK NO.
TO:
FIRE DEPARTMENT'~=~-
DATE
FIRE ORDINANCE VIOLATION
574
TITLE
ADDRESS:
FIRM OR D.B.A.
CORRECT ALL
VIOLATIONS
CHECKED BELOW
Violation No.
Combustible waste /
dry vegetation
Combustible Storage
Extinguishers
· Signs
Fire doors/fire Separations
Exits
.
Storage --
Electrical Appliances
8
9
10
11
12
13
14
15
16
LOCATION OF VIOLATION
REQUIREMENTS
Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
Provide noncombustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.)
Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.)
Relocate fire extinguishe~(s) so that they will be in a conspicious location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. ( N. F.P.A. # 10)
Provide and install approved (type It size) podable fire extinguishm
to be immediately accessible for use in (area). (U.F.C.)
Recharge all fire extinguishers. Fire extinguishers shall be serviced at lease once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.)
Provide and maintain "EXIT" sign(s) with letters 5 or more inches in heioht over each required exit (door/window) to fire escape. (U.F.C.)
Provide and maintain appropriate numbers on a contrasting background and .visible from the street to indicate the correct address of the building. (B.M.C.) (U.F.C.)
Repair ail (cracks/holes/openings) in plaster in (location). Plastering shall return the surface to its original fire resistive condition. (U.B.C.)
(Remove-Repair) (item 8 location). Self-closing doors shall be designed to close by gravity, or by the action of a
merchanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the c osin,o device. (U.F.C.)
Remove ail obstruction from hallways. Maintain all means of egress frae of any storage. (U.F.C.)
Provide a contrasting colored and permanently installed electdc light over or near required exit (location)
to clearly indicate it as an exit (U.F.C.)
Remove all storage and/or other obstructions from (fire escape landings and stairways stair shafts). ( Fire escapes/stair shafts are to be maintained free from obsb'uctions at all times.) ( U. F. C.)
Extension cords shall not be used in lieu of permanent approved widng. Install additional approved electrical outlets where needed. (N.E.C.) (U.F.C.)
Remove mulil~ple attachment cords from specified electrical convenience outlet (one plug per outlet). (N.E.C.) (U.F.C.)
REQUIREMENT
.E ,.A.. ,..0 CO,...A.C..
COURT ACTION MAY BE INITIATED.
~ ~ers~receiving not, Lc_e of violau~n:
AFTER VIOLATIONS ARE CORRECTED, RETURN
THIS NOTICE BY MAIL, OR IN PERSON, TO:
2101 "H" Street
Bak~ersfield, CA 93301
Phons 326-3951
/ BY ORDER OF THE FIRE CHIEF I Date Completed:
INSPECTOR INSPECTOR
LEGEND: U.F.C. Uniform Fire Code
U.B.C. Uniform Building Code
B.M.C. Bakersfield Municipal Code
N.F.P.A. National Fire Protection Association
N.E.C. National Electric Code
Mobile (sos), ~-1027
1313 Golden~e Ave.
Automotive Bakersfield, CA 93301
~ Service
,r~.,_._- Foreign & Domestic
Low Rates, Quality Workmanship, 23 years exp.
~1~t Belts · Alternators · Tune-ups · Brakes
Hoses * Starters * Batteries ,, Electrical
Gregg M. Pierucci Air Conditioning Service & Repair
Owner In Shop & Mobile Services
INSTRUCTIONS:
2.
3.
4.
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave.', Bakersfield, CA (805) ;526-;5979
To avoid further action, return this form within 30 days of receipt.
TYPE/PRINT ANSWERS IN ENGLISH.
Answer the questions below for the business as a whole.
Be as brief and concise as possible.
SECTION 1' BUSINESS IDENTIFICATION DATA
-:..o¢'
8USrNESS NAME: /1/10
LOCATION:
MAILING ADDRESS:
CITY:
DUN & BRAI)STREET NUMBER:
STATE:
ZIP: ~[ PHONE:
SIC CODE:
PRIMARY ACTIVITY:
OWNER:
MAILING ADDRESS:
SECTION 2: EMERGENCY NOTIFICATION
CONTACT
~ .;>1~'~,¢_.,~(_0,
TITLE
BUS. PHONE 24 HR. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING
NUMBER OF EMPLOYEES:
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 TIME EXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION
I, CERTIFY THAT THE ABOVE
INFORMATION 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 CONSTITUTES PERJURY.
SIGNATURE TITLE DATE
2
HAZARDOUS MA~~S MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES
ho
AGENCY NOTIFICATION PROCEDURES:
B. EMPLOYEE NOTIFICATION AND EVACUATION:
Co
PUBLIC EVACUATION:
Do
EMERGENCY MEDICAL PLAN:
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN
A. RELEASE PREVENTION STEPS:
RELEASE CONTAINMENT AND/OR MINIMIZATION:
Co
CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)_
NATURAL GAS/PROPANE:
ELECTRICAL: /tO_S ~ O~
WATER:
SPECIAL:
LOCK BOX: YES/NO IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
B. WATER AVAILABILITY (FIRE HYDRANT):
4
Business Name
H~RDOUS MATERIALS INVENTO~
Address
Page
CHEMICAL I)ESCRnvrION
! ) INVENTORY STATUS: New [
2) Common Name:
Chemical Name:
4) Physical 8: Health
Hazard.Categories Fire [n~ Reactive [
] Addition [ ] Revision [ ] Deletion [ ]
PHYSICAL
] Sudden Release of Pressure [
Check if chemical is a NON Trade Secret [ ] Trade Sec~t [ ]
3) DOT # (optional)
AH~[ ] CAS#
] Immediate Health (Acute) [~-']'Delayed Health (Chnmi¢) [ ]
5) WASTE CLASSIFICATION '~-~ [ (3-digit code from DHS Form 8022)
USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [~ Gas [ ]
Pure[] Mixture[ ] Waste[,~4-aadioacave[ ]
7) AMOUbrr AND TIME AT FACILITY
Maximum Daily Amount
Average Daily Amount
Annual Amount 1~5~0
Largest Size Container
# Days on Site
UNITS OF MEASURE
Lbs[ ] Gal [,-'] fl3 [
Curies[ ]
Circle Which Months:
8) STORAOE CODES
a) Container:
b) Pressure:
c) Temperature
All Year, $, F, M, A, M, $, J, A, S, O, N, D
9) MIXTURE: List
the three most hazardous 1)
chemical components or 2)
any AHM components 3)
COMPONENT
CAS# % w'r
[ ]
[ ]
[ ]
1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ]
2) Common Name:
Chemical Name:
4) Physical & Health PHYSICAL
Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022)
6) PHYSICAL STATE Solid [ I Liquid [ I Cas [ I Pure [ ]
7) AMOUNT AND TIME AT FACILITY uNrrs OF MEASURE
Check if chemical is a NON Trade Secr~t [ ]TradeSeeret[ ]
3) DOT'# (optional)
~aiM[ ] CAS#
] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
USE CODE
Mixture [ ] waste [ I Radioaedve [ ]
8) STORAGE CODES
Maximum Daily Amount Lbs [ ] Gal [ ] fl3 [ ] a) Container:
Average Daily Amount Curies [ ] b) Pressure:
Annual Amount c) Temperature
Largest Size Container
# Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS# % WI' AHM
the three most hazardous 1) [ ]
chemical components or 2) [ ]
any AHM components 3) [ ]
10)LOCATION
I certify under penalty of law, that I have personally examined and am familiar with the information on this and ' .~t*,,ag~d documents. I
PRINT Na~e~ Titl¢'ofAuthorized Company Representative ~ ~"/]' Signfiture "Date
Haz Mat Incident Notification Sheet
Date
Time
OES Staff Contact
Location of the Incident
Description [ (l~(
Has the Haz Mat team been dispatched?.~
data from Haz Mat Team
Contact Haz Mat Team at
N
322 - 7865 (Van Cellular)
Has an OES number been obtained
Y N Number
Description of the Incident
Probable Hazardous Waste clean up
Discussion and Disposition
Responding to Call
N