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Home My WebLink AboutBUSINESS PLAN 3/24/1992 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ~,~,?~,'¢~?ii:'?'7!;i~? !~,~ ~,~,;~ ........ This permit is issued for the following: ~ ~,¢'~'iifi~'?:¢, =~',;:iii:::;ii:::;i~;~i;~::~;i;;?;ili~:.i::¥:!~.~Hazardous Materials Plan PERMIT ID# 015-0214)01398 ,,~¢f~[. '*, iJ:Ei[i,~E~i!i~!~ ~!!~.'::!:~;: ii: !:i::i::i;::,:~:!!!::::,~';~&,~i:[~ok;Management Program ' :~'".:.. "-,~ ~=,. ~ ~!:':¢ ." ~'~'":;~,~,,.,,.., 5;;;:'.,,,,~;,;,~;~4~,,,:~.,,..,~i~!~'-:;~J 'r"~ ..... '!,;:;.'~;~ ..... 't~, :' '--..::iii ,i~;('"-'. ;"~' ' ......... ¢"? .......'";~'"'-"~':~'...:;,Z!;!:;i:.~'"'"'~(~iii'' ] ¢ i~ ~ i"'~?'~'"¢~ ....... '~..:i~ ~iiii'"'"'""~ ~.;"-.::'"iii *~....~. '.!** ",¢~ ~ .4 %' ~ ~ .4:/ ~, '", ",. ii* Issued by: Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: June 30, 2000 03/18/92 THRIFTY DRUG 215-000-001398 Page Overall Site with 1 Fac. Unit General Information I Location: 1721 GOLDEN STATE' 376 Map: 102 Hazard: Low I Community: BAKERSFIELD STATION 01 Grid: 24D F/U: 1 AOV: 0.0 '1 Contact Name Title Business Phone. 24-Hour Phoneq BRUCE HOLLAND IMANAGER -1(805)324-9815 x (805) 832-4264! JERRY SPURGIN ASSISTANT MANAGER (805) 324-9815 x (805) 832-0250/ Administrative Data Mail Addrs: 1721 GOLDEN STATE AV 376 D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215~001 BAKERSFIELD STATION 01 SIC Code: 5912 Owner: GEORGE EUCINS COMPANY Phone: (805) 324-9815 Address: 499 N CANON DR State: CA City: BEVERLY HILLS Zip: 90210- Summary RECEIVED HA7 ~a47.' DIV. '1, ,/o~-.,.._._ /Z/o/~ Do hereby ce.~y that I have ~Type ~,' Print ~me) - - - re;¢ieweC d~e attached hazardous materials manage. ment plan ,~or__~.;.".~---2_.._ and that it along with / any ¢ormc:ior~s cons~i'~ute a complete and correct man- ~~) ~-..~agement Plan lor my facilily. 03/18/92 THRIFTY DRUG 215-000-001398 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 MOTOR OIL · Fire, Delay Hlth Liquid 300 GAL Minimal CAS 9: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL 300 I Daily Average GAL 250.00 Annual Amount GAL -- 900.00 Storage PLASTIC CONTAINER Press T Temp Location IAmbientJambientlNORTHWaLL STOCKROOM W -- Conc~ Components 100.0% IMotor Oil, Petroleum Based MCP lList IMinimal 02-002 'CHLORINE BLEACH · Reactive, Delay Hlth Liquid 100 High GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WASHING Daily Max GAL 100 I Daily Average GAL 75.00 Annual Amount GAL 1,000.00 Storage PLASTIC CONTAINER Press T Temp IAmbientJAmbient IWEST WALL Location Conc 100.0% IBleach MCP List Components IHigh I 02-003 ANTIFREEZE · Fire, Immed Hlth, Delay Hlth Liquid 100 Low GAL CAS #: 107-21-1 Form: Liquid Type: Pure Daily Max GAL 100 Storage PLASTIC CONTAINER -- Conc 100.0% Trade Secret: No Days: 365 Use: COOLANT/ANTIFREEZE i Daily Average GAL Annual Amount GAL 50.00 I 500.00 Press T Temp Location Ambient~AmbientlNORTH WALL AND STOCKROOM WEST Components I MCP iList IEthylene Glycol ~Low 03/18/92 THRIFTY DRUG 215-000-001398 00 - Overall Site <D> Notif./E~acuation/Medical Page 3 Agency Notification HAZ MAT OFFICE 326-3979 AND CALL 911 <2> Employee Notif./Evacuation USE STORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT EMPLOYEES AND DIRECT THEM TO EMERGENCY EXITS <3> Public Notif./Evacuation USE STORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT CUSTOMERS AND DIRECT THEM TO EMERGENCY EXITS <4> Emergency Medical Plan VALLEY INDUSTRIAL MEDICAL GROUP 03/18/92 THRIFTY DRUG 215-000-001398 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 4 <1> Release Prevention WILL NOT STACK OVER LIMIT SUGGESTED ON CONTAINER WILL NOT STORE NEAR SHARP OBJECTS NOR OPEN FULL CASES WITH SHARP OBJECT <2> Release Containment <3> clean Up USE SWEEPING COMPOUND TO CLEAN UP FOLLOW CLEAN UP INSTRUCTIoN'oN LABEL OR MATERIAL SAFETY DATA SHEETS. <4> Other Resource Activation )3/.18/92 THRIFTY DRUG 215-000-001398 00 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE BUILDING - 10 FEET SOUTH OF BACK DOOR B) ELECTRICAL - NORTHWEST WALL BACK HALL C) WATER - WEST SIDE BUILDING 10 FEET SOUTH OF BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO <3>' Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 9 POWDER FIRE EXTINGUISHERS FIRE HYDRANT - WEST SIDE OF BUILDING IN SIDEWALK <4> Building Occupancy LeVel 03/18/92 THRIFTY DRUG 215-000-001398 00 - Overall Site <G> Training .Page <1> Page 1 WE'HAVE 20 EMPLOYEES WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE INFORMATION'FROM MATERIAL SAFETY DATA SHEETS DISCUSSED SEMI ANNUALLY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ]]verall ~,ite'with 1 Fac. Ger~eral Ir~format i Lc, catic, rj: 1721 GOLDEN STATE Map: 102 Hazard: Low Ident Number: 215-000-001398 Grid: 24D Area c,f Vul: 0.0 Cnr, t act BRUCE HOCLAND JERRY SPURGIN Mail Cc, rnm Cc, de: 24 Hc, ur Ph,-,r,e~. Name Tit 1"~ ~ - Busir, ess Phor, e · 'F ' ~ ASSISTANT MAN (805) 324-9815 x ( . . . Adrnir~rstrat ive Data Addrs: 1721 GOLDEN STATE AV~'~/~ D&B Number: City: BAKERSFIELD State: CA Zip: 93301- 215-001 BAKERSFIELD STATION 01 SIC Code: 5912 Owr, er: GEORGE EUCINS COMPANY Phc, ne: (8('~.)~) 324-9815 Address: 499 N CANON DR State: CA City: BEVERLY HILLS Zip: 90210- SLimnlary ~], _/:94~,/~~ Do hereby c~rtify that I have '(Typa or print n~e) - reviewed the attached ' - ~-~ ,-- n~-~aj~ .C',.~5' m~t3rj~b manage- ment plan fcr~,_~_ ~..~ ,-J '~h:~t ff along with (N~me ,'.,, ~ .... any correct~cns cons[;~ute a compi~:~ and correct man- agement plan for my facility., ,RECEIVED APR 2 9 1991 Ans'd ............ ~)3 / 27 ? 91 P 1 rs- Re f Nar~e/Haz ards ~'HR IFTY. DRU~G 215-000-0010 Hazr~at Ir~ver~tory List ir~ MCP O~der (])2 - F£xed Contair~ers on Site Forr,~ Quar~t ity Page MCP CHLORINE BLEACH Reactive, Delay Hlth Liquid 100 GAL High 02-003 ANT I FREE Z E Fire, Ir,~r,~ed Hlth, Delay Filth Liquid 100 GAL Low 02-001 MOTOR OIL Fire, Delay Hlth Liquid 300 GAL Mi rs i r~a 1 03127191 I FTY DRU~ 215-000-00 O0 - Overall Site <D> Notif. /Evacuation/Medical Page <1> Agency N,-,tification HAZ MAT OFFICE 326-3979 AND CALL 911 <2> En~ployee Notif. /Evacuatior, USE S'FORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT EMPLOYEES AND DIRECT THEM TO EMERGENCY EXITS <3> Public Notif./Evacuation USE STORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT CUSTOMERS AND DIRECT THEM ~0 EMERGENCY EXITS <4> En~ergency Medical Plan VALLEY INDUSTRIAL MEDICAL GROUP' 27'~ 91 'HRIFT¥ DR~ 215-000-001 00 - Overall Site <E> Mit~igat ior,/Prever, t/Abmtemt Page <1> Release Prevent i or, WILL NOT STACK OVER LIMIT SUGGESTED ON CONTAINER WILL NO]' STORE NEAR SHARP OBJECTS NOR OPEN FULL CASES WITH SHARP OBJEC"[ <2> Release Cor, tair, mer, t <3> Clear, Up ~'O~OA/ C~c'~N' MP ~/;~S/-~7£~ OA/ ~'~L USE SWEEPING COMPOUND TO CLEAN ~P <4> Other Resource Act i vat i or, F'FY DRL~G 215-C)C)C)-O01 OC) - Overall Site <F> Site Emerge~scy Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST' SIDE BUlL_DING - 10 FEET SOUTH OF BACK DOOR B) ELECTRICAL - NORTHWEST WALL BACK HALL C) WATER - WEST SIDE BUILDING 10 FEET SOUTH OF BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 9 POWDER FIRE EXTINGUISHERS FIRE HYDRANT - WEST SIDE OF BUILDING IN SIDEWALK <4> Held for Future use o~$3/2~/91 ~T~ DRUG ~15-000-001 00 - Overall Site <G> Trair, ir~g Page <1> Page 1 WE HAVE 20 EMPLOYEES WE HAVE MATERIAL SAFETY DATA SHEETS ON FII_E <2> Page 2 as r~eed~d INFORMATION FROM MATERIAL SAFETY DATA SHEETS <3> Held for Future Use <4> Held for Future Use ClI'Y of BAKERSFIELD F ..... ~_ HAZARDOUS MATERIALS INVENTORY arm andAg~iculture II standard 8usiness~ ......... ;_ ~ ..... ~ '. REFER TO~N~~D~~R~ CODES Trans Tilde Nax Av.erage Annual. Neasure I .Oy.s C~nt 9 : Cont Cont l Use Locqtion.~hece. .C. ode come Ami; Rmt i Est Un,ts on 51ce Type Press Temp: Code Storeo In I-aC)/icy Physical and Health Hazard !' C.A.S. Number '7~,~/-~Z--~ Component D Fire Hazard ~eac[ivi[y. ~qg,ayed D Sudden Eelease ' Hem [th of Pressure Componen[ ~1~1 ~oo.I I I~ll ~1 /o1.~ I ~1o~ I Physical and Health Hazard C.A.S. Number ~T~ tCheck ~1/ that apply) ~ ~?, ,,,,r~ ~ ,.~t~v~t~ ~ ~:t~t~ ~ su~t~gt#~ ~ ~'%~?~t co,,on.~ ,~ ,.e, c.~,s. ,u,Ue~ Com~oneP[ 13 Name Physical and Health Hazard C,A,S. Number ~~2 (Check all that apply) ~o~ 0/~ ire Hazard O Reactivity~ ~ ~ Sudden Release U Im~i~ ComponepL 12 Name ~ C,A.S. Number ~ of Pressure } Component 13 Name & C,A.S. Number Phvsical'eod Health ~alard ~ C,A.S. Number Component I1 ~a~e t ~.A,S, Number (Check al1 that aPP/H " ComponenL 12 Name ~ C,A,S. Number B Fire Hazard. B Reactivit~ B OelayedHealth B SuPerior Pressure Release ~ Component 13 Name ~ C.A.S. Number E"ER~ENCY CONTAOIS "1 /~)/~W2 fertifi;atioq,(Repd a.,n.d,~ign, af~pr com~l~ti~9,all sec~i,ons.) tort]tX unoer oena~cX glJaF cnqt l navepe~sonaj~y, examln~o8qo~m tamil~arAitb the intormac~on ~u~mittCd in this.~nd all at~ached.dQcgmen:~, anq cpac oaseo on.my inquiry 9r.cnose ~nolvlouafs responsiofe tot ob:atning the ~nTor~ac?on. J believe Chat the ' suom,Cteo~mormac,pn ,s ~e~ accurace~ ano ~Omplece. . ~ ~~ THRIFTY DRUG STORE $376 215-000-001398 Overall Site with 1 Fao. Unit General Information Page OCT 1 71 0 liAZ. MAT. DIV. Location: 1721 GOLDEN STATE Ident Number: 215-000-001398 Mail ~ddrs: 172i GOLDEN STATE AV Oit¥: BAKERSFIELD Oomm Ood~: ~5-OOL B~KERSFIELD STATION Oi Title .. Administrative Data Map: 102 Hazard: Low Grid: 24D Area of Vul= 0.0 ............ ....... Business Phone ---T 24 Hour Phone. (805) 324-9815 x /(805) ~ (805) 324-9815 x D&B Number: State: CA Zip: 95301- SIC Code: 5912 Owner= GEORGE EUOINS COMPANY Phone= ~O~)~ Address: 499 N. CANON DR State: CA City: BEVERLY HILLS Zip: 90210- Summary I,~.~,/,~/~,~F' ~ De hereby certify thet I have reviewed the attached hazardous materials mar~age- ment plan for ~,~../~,/~'~ and that it along with any corre~ions constitute a complete and correct man- agement plan for my facility. 10/17/90 Pln-Ref THRIFTY DRUG STORE ~376 215-000-001398 Hazmat Inventory List in MOP Order 02 - Fixed Containers on Site Name/Hazards Form Quantity Page MOP 02-002 CHLORINE BLEAOH Reactive, Delay Hlth Liquid 100 GAL High 02-001 MOTOR OIL Fire, Delay Hlth Liquid 300 GAL Minimal 10/17/90 I THR; DRUG STORE ~576 215-00C~=~01598 02 - Fixed Oontainers on Site Hazmat Inventory Detail in MOP Order Page 02-002 CHLORINE BLEACH Reactive, Delay Hlth Liquid 100 High GAL OAS ~: 7681-52-9 Trade Secret: No Form: Liquid Type: Pure Days: 565 Use: WASHING Daily Max GAL 100 Daily Average GAL Annual Amount GAL 1,000 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientIWEST WALL Location - Cone ..... 100.0% IBleach Components MOP ist High --~ 02-001 MOTOR OIL Fire, Delay Hlth Liquid 500 Minimal GAL CAS ~: Trade Secret: No Form: Liquid Type: Pure Days: 565 Use: LUBRICANT Daily Max GAL 500 "' I "' Daily Average GAL 250 Annual Amount GAL 900 Storage PLASTIC CONTAINER Press T Temp I Location AmbienttAmbientJNORTHWALL STOCKROOM W -- Cone 100.0% IMotor 0il Components i, MOP ---TList Minimal 10/17/9o THRIFTY DRUG STORE ~576 215-000-001398 O0 - Overall Site <D> Notif./Evaouation/Medioal Page <1> Agency Notification <2> Employee Notif./Evacuation USE STORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT EMPLOYEES AND DIRECT THEM TO EMERGENCY EXITS <5> Public Notif./Evacuation USE STORE PUBLIC ANNOUNCING SYSTEM TO CONDUCT CUSTOMERS AND DIRECT THEM TO EMERGENCY EXITS <4> Emergency Medical Plan VALLEY INDUSTRIAL MEDICAL GROUP 10/17/90 T~ DRUG STORE ~576 215-000~501598 O0 - Overall Site <E> Mitigation/Prevent/Abatemt Page <l> Release Prevention WILL NOT STACK OVER LIMIT SUGGESTED ON CONTAINER WILL NOT STORE NEAR SHARP OBJEOTS NOR OPEN FULL CASES WITH SHARP OBJECT <2> Release Containment <5> Clean Up USE SWEEPING COMPOUND TO CLEAN UP <4> Other Resource Activation lo/17/9o THRIFTY DRUG STORE ~376 215-000-001398 O0 - Overall Site <F> Site EmeFgency FaotoFs Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE BUILDING - 10 FEET SOUTH OF BACK DOOR B) ELECTRICAL - NORTHWEST WALL BACK HALL C) WATER - WEST SIDE BUILDING 10 FEET SOUTH OF BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO <5> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 9 POWDER FIRE EXTINGUISHERS FIRE HYDRANT - WEST SIDE OF BUILDING IN SIDEWALK <4> Held for Future use 10/17/90 THR DRUG STORE ~576 215-000~D01598 O0 - Overall Site <G> Training Page <1> Page 1 WE HAVE 20 EMPLOYEES WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE INFORMATION FROM MATERIAL SAFETY DATA SHEETS <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY Of BAKERSFIELD HAZARDOUS HATERTALS TNVENTORY FarB and Agriculture Standard Business /~4~/7'-- ~i'RA_D, E S~CRETS' P~qe ...... oF ItAME. T,/~,.z~<~/",.J.. /~/L~..~7- OWNER NAME: '-/-/~,'z,~/. [:?,-,~-,.?..--,'-..) HAME OF THIS FACILITY: BUSII!ESS 1.0C^T]0fl; .,~7~?Z~.~J,F,',.(~ /'7,,t/___~ ?/,~.,~ ~,~ ADDRESS; .3~t~.¢/ c,J,'l~¢ ,~lx,/~'",.¥z.~ STANDARD IND, CLASS CODE[ CITY. ZIP.;-~'j?.~?,~r~ij~_ ,'c..~ q~]~,7 - CIIY. ZIP;. /..j ~c,'~ ~,~;,,o ' DUll Arid BRADSTREEI UIJHBER .......................... -- REFER I O-~NSTRUCTION:~-'FOgROPER CODES -- frans !YOm Ham Average lC•de code Act Amt JPhysJcal And Health Hazard l~ck All the[ apply) ~ Fire Hazard ~ Reactivity Annum1 NeAsure ~ ~ont ~ont ~ont Us tocati~.Wh~(L . Est Units on e mype Press /emp Cote In Faclttcy Stored See Instru~t~ons I.~p I~, I~/,,,- I/~---I / ! ~ I '~ I~,'~-~,a,,,, ~'. Physical and Health Hazard (Check al/ that app/yJ C.A.S, Humber Component II Hame I C.A.S. Humber Component 12 Hame I C,A,S. Number Delayed ~ Sudden Release 0 Immediate Health of Pressure Health Component 13 Name I C.A.S, Number C,A.S. Number Component II Name I C.A,S. Number [-] Fire Hazard [] Reactivity ri Delayed n Sudden Release Hem Itn of Pressure I '1 I Physical and Health Ualard ICheck all that apply) Fire Hazard Component 12 Name I C.A,S. Number Component I] Name I C.A,S. Number Component II Name I C.A.S. Number ! I Physical and Health Ualard (Check ail that app/yl ,~C] Fire HAzard ri Reactivity C.A,S. Humber EHERGENCY COUTACTS Component I~ Name I C,A,5, Number FI Reactivit)' [] Delayed [] Sudden Release ~ Immediate Healt~ of Pressure Health Component I~ Name I C.A.S, Number C,l.S, Number Component II Hame I C.A,S, Number Co~ponent U Name I C,A.S. Number Component 13 Name I C,A.S. Number O~t.a-Sici~d ~- [] Delayed [] Sudden Release O ImmHeedailatthe Health of Pressure 21 ',Hi'-P~i6~ ' ~--~~.x~ ~v~ ~P.~ . .~Bakersfield Fire Dept. !;~'~ ~ /-HAZARDOUS MATERIALS DIVISION ~~ ~ ~~ Date Completed Business Name: '~ ~ I FTY ~~ ~~ Location: [ 7 ~ I ~ ~ ~ ~ ~ ~' Business Identification No. 215-000 oo t:~ ~ ~ (Top of Business Plan) Station No. I Shift ~ Inspector ~----,~T,-T--.~7'.% RECEI~/FD 1990 Adequate Inadequate Verification of Inventory Materials I~ ~ Verification of Quantities ~ ~ Verification of Location ~ ~ Proper Segregation of Material~' ~ Comments ~tu-r7-f::F---[c£.ZE NO1' L~>ff~:z~ - C?z~V-T'I-1"IF_~ OU_r--~ Verification of MSDS Availablity ~ ~ s " 15 Verification of Haz Mat Training ~ ~ comments: Verification of Abatement Supplies & Procedures Comments: Comments: Emergency Procedures Posted Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: Business Owner/Manager All Items O.K. Correction Needed FD 1652 (Rev, 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy iUS BAKERSFIELD CITY FIRE 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-39?9 u01398 OFFICIAL USE ONLY ID= HAZA~RDOUS BUS I NESS PLAIN' FORM INSTRUCTIONS: M_D~TE R I ALS 2YA WHOLE ~ NtY 0 4 19 9 !. To avoid further action, return this form by ~A~R&A~ 0.~/. 2. TYPE/PRINT ANSWERS IN ENGLISH. ' ...... 3. Answer the questions below for She business as a whole. 4. Be as brief and concise as possible. SECTION !: BUSL%'ESS IDE~FrIFICAT!ON DATA B. LOCATION / STREET ADDRESS: ~%k ~q~~ SECTION 2: EMERG~'~I.C~ NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 91! and 1-800-8S2-TS50 or 1-916-427-4341. This will notify yeur 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 BUS. HRS. AFTER BUS. I{RS. Ph~ SECTION 3: 50CATION OF UTILIT~f SHUT-OFFS FOR BUSINESS AS A W~OLE C. WATER: ~-~1%w6~ CA' -,/~t, ~,~ O. SFECfAL: -~ E. LOCK BOX: YES /,z~O-P IF YES. LOCATIO:~: rF YES, DOES IT CONTAD: SiTE PLANS? FLOOR PLANS? YES / 2fO MSDSS? YES ./ MO YES / MO KEYS? YES / NO / · "'~ ~: ..~.u ..... ASSiSTA~{CE FOR YOUR 3VSi.YESS AS ~ ~ ~= SEC~0,~ ~: LOCAL E~.~ERGENCI' ,~=~r :~HC~ SECTION S: . :Er~QSYE__ TR~INI.~G EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES ~ITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS ~ATERIALS. NUMBER OF EMPLOYEES AT THIS FACILITY?' DO YOU HAVE MSDS (:I=T~'RIAL SAFETY DATA SHEETS~ FOR EACH HAZARDOUS MATERIAL YOU HANDLE? ~ xf GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAI~,,I..~ PROGRAM. ?>~,/:m /~t~ ,/~5/~_~C SECTION 7: F~ZARDOUS ~ATER!AL CIRCLE YES OR NO OR NONE DOES YOUR BUSINESS HANDLE HAZARDOUS ~&TER!AL iN QUANTITIES 2ESS THAN ~00 ?0U.YD~S~F A SOLID. $~ GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A CO>..'??ESSED GAS: ...... ~ ::0 , cert_,¥ that the above information is :Iccttr,-tte. [ understand that this information will be used to fulfill 'n!:' flrm~s ob![~ar, ions under the new California Health and Safer. y code Gu Hazardous Aar, eriais (Div. 20 Chapter ~.Dg Sec. ~.500 Et Ai.) and that inaccurate information constituces perjury. S IG~ATbR 2~ CITY of BAKERSFIELD N O N -- 'I.' R A D E S E C R g T S ' %qe Z. of CITY, ZiP: ~~~x~%~. ~UX CITY, ZIP:~~~ X~,,~, ~* ~q>X~ DUN AND BRADSTRtKT NUMBZR'~ ~lth of Pm~ ~lth ~lth ~ltk of ~ ~lth ~t 13 kIC.A.S, i r -- ~ -- r -- ~ -- r-- ~ CWt 12 ~ & C.A.S. ~ H~lth o~ Pe~ure ~lth Certification (Read and sign after colpJetJng si] sections] I certify u~der penalty of la t~t I ~ve ~vs~lllyex~in~ ~ am fNililr vtth t~ tnfor~ti~ su~itt~ tn this ~ I11 IttK~ ~tl. ~ t~t ~S~ ~ ~ i~1~ of t~l. IMtvIMll m~ltbll for ~Stainm9 t~ inf~Nttm, I ~lilve~t t~ su~ittK info~ti~ is t~. accurate, md ~ete. __ _ / IBAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS Nk~E: OFFICIAL USE ONLY iD# 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, ABATEMENT PROCEDURES ~fNoN-o~. O~x'% SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS ¥~ATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... E~ NO If YES, see B. If NO. continue with SECTION 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 (white form ~4A-1) 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 SI{UT-OFFS AT TEIS UNIT ONLY. A. NAT. GAS/PROPANE': D SPECIAL: E LOCK BOX: YES / e IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS9 YES / NO MSDSs? YES / NO YES / NO KEYS? YES / NO - 3B -