HomeMy WebLinkAboutBUSINESS PLAN M~P
PLAN
MAP
SITE DIAGRAM
Business Name:
Business Address:
FACILITY DIAGRAM
For Office Use Only
First In Station:
Inspection Station:
Area Map # of
NORTH
KERN AUTM REPAIR
FOREIGN& DOMESTIC '
~ ENGINE AND TRANSMISSION REBUILDING
· BRAKES · TUNE UP · AIR CONDITIONING
:' 4551 GRISSOM ST. #A
- . ~(8~5) 834-4074 BAKERSFIELD, CA 93313 ..
Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
HAZARDOUS MATERI.,~-S-'lgYA'NAGEMENT PLAN
INSTRUCTIONS:
2.
3.
4.
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 brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME' ~ E P,, h~ AUTo
LOCATION' "~~/ ~ ,~! $S¢,~2"/ ~'15.
MAILING ADDRESS'
'CITY: ~;;L~A~/2-q//-~.'~LD STATE: E'Ct- zlP:¢3313
PHONE:Lf°%Z'-) ~'.3 q- (../O7 q
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY:
SIC CODE:
OWNER' :1 't ~~' ~ ~ J C/ ~~U y ~~
MAILING ADDRESS:' ~-~ Off' -~-"~Ig,,X~ ~l~,; ----~f'~i~--,-
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS.. PHONE
24 HR. PHONE
FD159
Baker,sfield Fire Dept.
Hazardous Materials Division
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
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, "-F~/-~{4, /'{J~~.) CERTIFY THAT THE ABOVE INFOR-
!
MATION 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.
TITLE DATE
FD1590
Bakersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility UnitName:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
AGENCY NOTIFICATION PROCEDURES:
EMPLOYEE NOTIFICATION AND EVACUATION:
'"~-~..~ BLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN:
Bakersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
Bo
RELEASE CONTAINMENT AND/OR MINIMIZATION:
C. CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE:
ELECTRICAL: .SO-F_../~'i" ,_q. ID~. otz.. FAu~b~OiL./~
WATER: ~"A%~ ~Of_, (PP-O,~,) ~7l, O~,,~t,J M~T'
SPECIAL:
LOCK BOX: YES/NO IF YES, LOCATION:
SECTION 9:. PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
PRIVATE FIRE PROTECTION:
WATER AVAILABILITY (FIRE HYDRANT):
FD1590
Farm andAgticuiture [l Standard Business
BUSINESS NAHE:
LOCATION; ~,-~'.~'i ~o~
CITY. ZIP:~p
PHONE W:
CITY of BAKERSFIELD
AZARDOUS MATERIALS INVENTORY
NON--TRADE SECRETS Page
CITY. ZlP~_~zf~'~L~-w:~-~. ~.,~-- 0,;2. ~q~ DUN AND BRAD§TREET NUMBER
FO--INSTN~U'~FI~N5 bOM PROPER CODES
.I 2 3 4 5 . 6 I 8 ~ I0 Il 12 ~l~y Nares of
Trans !yl)e NaA Xv.erage Annual Measure I Dy.s Cent Cent Cent Us Locatjon.Whece
Nixtu[elCoeponen:s
Code cooe Amt Amt Est Un)ts on site Type Press lemp Co~eStoredWt See Instruct)ohs
tn raci/tLy
Physical aod He~)thH~zard C,A,S, ~u~ber Component Il ~a~e t C,A,S, ~u~ber
(Check al/ thmt
Component 12 Name I C,A.S, Number
~ Fire ,azsrd n Reactivity ~DelaYed ~ Sudden Release g
Health of Pressure
Component. 13 Na~e S C,A.S. Number
Physical Iod Health Uazard C.A.S. Number Component I1 Name I C.A.S. Number
(Check al/ that app/yl
Component ~2 Name & C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate
Health of Pressure Health
Component 13 Name I C.A.S. Number
Physical and Health Hazard C.A.S, Number Component l1 Name & C,A.S. Number
(Check all that apply)
Component ~2 Name & C,A.S. Number
~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate Health
Health of Pressure
Component ~3 Name & C.A.S. Number
Physical end Health Ualard C.A.S. Number Component I1 Name I C.A,S. Number
(Check al/ that apply)
Component 12 Name ~ C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate
Health of Pressure Health
Component 13 Name a C.A,S. Number
EMERGENCY CONTACTS ~I~F'~~ )itme Tit)e 2~r Phone
Name
erti.fiatioq.(Rep(Y a,n.d.~ign after compl~tiog.all secti.ons.)
..cer~ty unoer pena~c) o)!a)~ Tn~ ~ naveper, sonajly, examlnqoaqo Qm ramim]ar.~itb the information Su~mittpd in this and all
at~acned.dQcueent~, an~ :~a~ oaseo on.my ~nqu~ry Q~.~nose ~no~vloua)s respons]ome ror obta)nin9 the ]ntormac~on. I believe that the
suDmltteo in,ormatlon IS ,rue, accur,[e, ,no co'pmece. ~~~
.
~e ~,doficiai ~leot ownertopera~oru~owner/oper~tor's au~or}ze representative
CITY OF' BAKERSFIELD
~AZARDOUS ~ATERIALS INV~NTORY
Farm and Agriculture~Standard Business
NON - TRADE SECRET
CITY, ZI~:~~Q4fei~ ~
Page / of~'i~,
o
STANDARD IND. CLASS CODE:
DUN AND BRI~STR~ET NUMBER/FEDER3~ ID ~
CODES:
i 2 3 4 5 6 7 8 9 Cont10 Use11 Location12.~h % 13by Names of 14
Mixture/Components
Trane T~pe Max Average Annual Measure # Days Cont Cont wn~re
Code Code Amt Amt Amt Units on Site Type Press Temp Code Stored in Facility wt See Instructions
Physical and ' ' Component # I Nam8 '& C.A.S. Number
(Check all that apply) Component # 2 Name ~ C.A.S. N~mber
~] Fire ,aza~d ~ Sudden Release ~] Reactivity ~[ I~nediat. '[~ Delayed
of Pressure . Health . Health : Component # 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number Component # 1 Name:& C.A.S. Number ~U~"~Fu'~c~ A~'~0
(Check all the1: apply) . , Component # 2 Name & C.A.S. Number
~ Fire Haza=d [] Sudden Release '~ Reactivity ~ Ir~mediate' ~ Deiayed .
of Pressure ~ealth Health Component # 3 Name & C.A.S, Number
r,,,,, -''--ica' and Health Hazard C.A.S. Number '' Component # 1 Name & C.A.S. Number, -- ~---~/rW0~'~/~~
(Check all that apply)
: Component # 2 Name & C.A.S. Number
~ Fire Hazard [] Sudd,, ReZease ~ ReactiVity [] Immediate ~ Delayed
of Pressure Health Health Component #3 Na~e& .C'A'S' ,umber , O~1~.~ ~ '' ~
~-,~,,~..,.~'--~ca' and Health Hazard C.A.S. Number Component # i Name & C.A.S. Number /
(Check all that apply) Component # 2 Name & C.A.S. Numberk J ~
of Pressure Health Health Component # 3 Name & C.A.S. Number .
Name ' Title 24 Hr. Phone Name .. Title 24 Hr Phone
Certification (READ AND SIGN AFTER COMPLET~
I certify under peanlty of law that I hayer personally examined end am familiar with the informat~on submitted in this end all attached documents end that based on my inquiry of those
~ndividuals responsible for=obtaining the information. I believe that the submitted information is true, accurate, and complete.
A/ o v " '... o _ cz_
NAME AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED ~FaES~'~ATIVE SIGNATURE ~ -~// ?o.' DA~fE SIGNED
f'
PLEASE MAKE CHECKS PAYAB[.E TO!
· .CITY OF-BAKERSFIELD
' ' RET. URN PAYMENTS TO:
~ CITY OF BAKERSFIELD
P.O.'BOX 2057 '
:~" BAKERSFIELD, CA 93303-2057
- - · ' ' ~ ' ~ '
INQUIRIES CONCERNING'THIS BILL, PL~SE pHoNE:
...
· . , ~.~; ~ -~
STATEMENT'OF AC~OUNI-'
ACCOUNT NO..~..,,::,: ,~. '? ~ ~ .,
· PLEASE.MAKE. CHECKS.., PAYABLE :lC),:':
CITY OF BAKERSFIELD
:~i:' ..:. -: ' :'
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