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Home My WebLink AboutBUSINESS PLAN TE/FACI LITY FORM $ DIAGRAM NORTH SC.:\LE: BI~S INESS NAME: '~'~"~:~t '~1~" ~.~cI~T¥ NAME: UNIT ~: OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM Ihspector's Comments): -OFF~CiAL USE ONLY- - 5A - SITE DIAGRAM (R~ ced items) 1. Address: Ide, the principle buildings by the Street numbers. Street(s), Alleys, Driveways, and Parking Areas adjacent to the property. Include the street names. 3. Storm Drains, Culverts, Yard Drains 4. Drainage Canals, Ditches, Creeks, 5. Bni ldings a. Frame construction b. Masonry construction c. Metal construction d. Access Door 6. Utility Controls a. Gas b. Electricity c. Water 7. Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkler Connections c. Fire Standpipe Connections d. Water Control Valves for protection systems e. Fire Pump 8. Fire Department Access 9. y) Box 10, MSDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d. Gates 13. Powerllnes / 14. Guard Station 15. Storage Tanks: Identify the capacity in gal. a. Above ground b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area: Identify the location where employees will meet. 19. Outside Hazardous Waste Storage 20. Outside Hazardous Material Storage 21. Outside Hazardous Material Use/Handling 22. Type of Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid C = Corrosive 0 = Oxidizer O = Oas W = Water Reactive T = Toxic S = Solid D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAGR~ (Required items in addition to the above) 1. Risers for Sprinklers 2. Partitions 3. Stairways: Indicate the levels served from highest to lowest. 4. Escalator: Indicate the levels served from highest to lowest. 5. Elevator 6. Attic Access R = Radiologtcal P = Poison H = Cryogenic 8. Fire Escapes 9. Air Conditioning Units ' 10. Windows 11. Inside Hazardous Waste Storage 12. Inside Hazardous Materials Storage 13, Inside Hazardous Materials Use/Handling 14. Sewer Drain Inlets TE/FACI LITY DIAGRAM FORM NORTH SCALE: BUSINESS NAME: FkOOR: OF /¢~ DAT~: ' FACILITY NAME: UNIT ~:~ OF ~ (CHECK ONE) SITE DIAGRAM FACILITY DIAGR.aM ~ Inspector'~s Comments): -OFFICIAL USE ONLY- SA - SITE DIAGRAM (R, red items) l. Address: Ide: the principle buildings by the Street numbers. 2. Street(s), Alleys, Driveways, and Parking Areas adjacent to the property. Include the street names. 3. Storm Drains, Culverts, Yard Drains 4. Drainage Canals, Ditches, Creeks, 5. Buildings a. Frame construction b. Hasonry construction c, Hetal construction d. Access Door 6. Utility ConTrols a. Gas b. Electricity c. Water ? Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkler Connections c. Fire Standpipe Connections d. Water Control Valves for protection systems e. Fire Pump 8 Fire Department Access 9. Box 10. ~SDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d, 6ares 13. Powerllnes 14. Guard Station 15, Storage Tanks: Identify the capacity in gal. a. Above ground, b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area: Identify the location where employees will meet. 19. Outside Hazardous Waste Storage 20. Outside Hazardous Raterial Storage 21. Outside Hazardous Material Use/Handling 22. Type of Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = 'Explosive L = Liquid C = Corrosive 0 = Oxidizer 6 = Oas W = Water Reactive T = Toxic S = Solid D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAOP~ (Required items in addition to the above) 1. Risers for Sprinklers 8. 2. Partitions 9, 3. Stairways: Indicate the 10. levels served from highest to lowest. 11. 4. Escalator: Indicate the levels served from 12. highest to lowest. 5. Elevator 13. 6. Attic Access R = Radtologlcal P = Poison H = Cryogenic Fire Escapes Air Conditioning Units Windows Inside Hazardous Waste Storage Inside Hazardous Materials Storage Inside Hazardous Materials Use/Handling Sewer Drain Inlets · P~.EASE.MAKE CHECKS PAYABLE,TO: .. · ' :'" ~'~:'" . ..~cIT~y,iO.F~BAKERSFIELD RE'~URN THIS COpY WITH PAYMENT February 3, 1992 Mr. Robert Burns Burns Geological Exploration, Inc. P.O. Box 1268 Temecula, Ca. 92593 RE: Hazardous Materials Handling Fee for Fiscal Year 1991-92. Dear Mr. Burns: Per your recent phone call of January 27, 1992, you closed your Bakersfield operation as of NoVember, 1991. However, because you were in operation until November you are still responsible for the current billing. I will take your business out of the computer for the new year and you will receive no future bills. I have enclosed the current billing for you to pay, after that you will be exempt. Sorry for any inconvenience this may cause you. any further assistance please don't hesitate to call 3979. If you need (805) 326- Sincerely, Valerie Pendergrass Hazardous Materials Division BAKER;ai~i=LD CITY-FIRE DEPAR~vlENT ~E130 'G' STREET t~ BAKERSFIELD, CA. 93301 /~ (805) 326-3979 BUSINESS NAME OFFICIAL USE ONLY ID# INSTRUCTIONS;. HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A RECEIVED ~APR 1 4 1989 HAZ. MAT. DIV. 2. 3. 4. To avoid further action, return this from 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: BU$]~NESS~IDENTIFICATION DATA A. BUSINESS NAME:'~;~-~'-~ C__-_-=~Lo~,,.~..L B. LOCATION / STREET ADDRESS: ,A,.~L C_->~--~%%o..,.,~ BUS. PHONE SECTION ~; 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 departmen~ and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. PH# G(~Z~- SECTION 3: A. NATURAL GAS/PROPANE: ~J-~-~-~ B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION' IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? AFTER BUS. HRS. PH# pH# LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE YES / NO MSDSS? YES / NO KEYS? YES / NO YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MATERIALS. A. NUMBER OF EMPLOYEES AT THIS FACILITY B. 'DO YOU HAVE MSDS (HATERIAL,SAFETY DATA SHEETS)-FOR EACH HAZARDOUS MATERIAL YOU HANDLE o C. GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM: SECTION 7: 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 AND 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 ~/~ 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 new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. SIGNATURE ~.-~%k,~ ~1'~. ~ kk,~.s TITLE ~-~'- DATE BAK BUSINESS !LD CITY FIRE DEPA~rMENT 2130 'G' STREET BAKERSFIELD, CA. 93301 (805) 326-3979 OFFICIAL USE ONLY ID# HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE 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 4. Be as BRIEF and CONCISE as possible FACILITY UNIT # A FACILITY UNIT NAME: BELOW SECT[ON 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES BOB BURNS REG. GEOL. NO. 1164 RES: (714) 676-4477 LES COLLINS REG. GEOL. NO. 3907 az$: (805) 589-4775 Burns GX ~- Geological Exploration, Inc. WELL LOGGING · CHROMATOGRAPHY SERVING THE INDUSTRY SINCE 1954 30112 SANTIAGO RD. P.O. BOX 1268 TEMECULA, CA 92390 (714) 676-5699 4551 GRISSOM SUITE A BAKERSFIELD, .CA 93313 (805) 589-6633 SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THE UNIT ONLY ~ECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY Does this Facility Unit contain Hazardous Materials? ...... If Yes, see B. If NO, continue with SECTION 4 (~NO B. Are any of the hazardous materials a bona fide Trade Secret? YES NO I¢ 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 (Fire Hydrant) O~~,,.,-~s ~c~.r-~,~_~O ~ ~'-~"~-L~. ~...,~'~t~ SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT TH~S UNIT ONLY. A. NATURAL GAS/PROPANE: ~~~ D. SPECIAL: E. LOCK BOX: YES /~IF YES, LOCATION: IF YES, SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSs? YES / NO KEYS? YES / NO - 3B - CITY of BAKERSFIELD Fare and Aqrieulture c._a Standard Business HAZARDOUS MATERI ALS I NVlgNT.O RY' NON--TRADE SECRETS Page .~_ of _J_ CITY, ZIP: ~~t~%~ ~{~ CITY, ZIP: - ~&~O~ , ~%qD DUN AND BRADSTREET NUMBER ~ ~ ZNS~UC~ZO~ ~OR PROP~ COD~ ~ 2 ] 4 S ~ 7 8 g 10 11 T~ans Ty~ ~x Average ~nual ~su~ I ~ Cmt ~t ~t he L~ttm N~e ~ ~ ~m of H~xtu~/~ts C~e C~e ~ ~ ~t Est Un,ts m Stte Ty~ Pr~s T~ C~ St~ tn Feciltty Nt ~ inst~ct~ms Health of P~re ~lth HHlth of P~ HNIth P~ical ~ H~lth Hazard C.A.S. ~ Health of PP~sure Health ..... m P~icel ~ HHJth Hlzard C.A.S. Numar Cm~mt I! Nm & C.A.S. N~ ~--~ Fine Hazard ~ ~ RHctivity ~--~ ~layK ~ ~ ~ddK Release ~--~ Health of PPusure Health ............ b~t Certificatio~ (Read and sign after compJeting aZ] sections) I certtfy under ~e~alty of law that I have oersonaIly examined and ai familiar with the informatia~/d~ this~ all~c~ts, and t~t ~s~ ~ ~ inqui~ of t~e tndJvi~ajs r~sible 4551 GRISSOM STREET SUITE A BAKERSFIELD: (805) 398-2204 BAKERSFIELD, CA. 93313 TEMECULA: (714) 676-5699 WELL LOGGING HYDROGEN FLAME CHROMATOGRAPHY FLAME IONIZATION GAS DETECTION M~~. R. E. Huey Baker's~ield Fi~'~e Depa~tment 2130 G St. Bake~.~s+ield~ CA 93301 IRe: INSPECTION - 10-2E-89 Deaf M~. Huey., Enclosed you will +ind the necessa~y in~:o~*~mation to cor'~'~ect the p~-~oblems noted UF, On date o~ inspection. As r~e!.~..~ar'ds the labelin~_~ and postinF, t o~ in¥o~mation ~eoa~clin..c) haza~.~dous chemicals, ,~e have posted and labeled all items acco~dino to the enclosed MSDS DATA SHEETS. I~ ther'e a~e any ~uestions or. -~.~ur~the~'~ p~.~obIems., please contact me at 398-2204. R S B: s 1 a: 17 F%rm and Agriculture L_ J Standard Business c _ ~ HAZARDOUS KERN COUNTY FIRE DEPARTMENT MATERI ALS INVENTORY DUN AND BRADSTREET N.IM~IER 4 BUSINESS NAME: RTIRN~ ~R~T.O~TCAT. E×PT.OR. OWNER NAME: RORRRT LOCATION: 4551GRISSOM (Al ADDRESS: 30112 SANTIA~Q_.i~ CITY, ZIP:RA~RR~pTRT.D' CA 93313 CITY, ZIP: TRMRCHT.A. CA 92qg0 PHONE #: (805) 398-2294 PHONE #: (714) 676-5~99 STANDARD IND. CLASS CODE: NAME OF THIS FACILITY: REFER TO INSTRUCTIONS FOR PROPER CODES Page ....~..._ of ...... 1 2 3 a 5 6 ? 8 9' 10 Trans Type Max Average Annual Measure Cont Cont Cont Use % by Code Code Amt Amt Est Units lype Press Temp Code 55 [ ....[ ..... ......... I o ~--J Immediate . Health u--J Fire c--J Delayed Health C.A.S. Number r--~ r--', 13) ~ Days L_J Reactivity ~-- -~ Sudden Release of Pressure on Site 12 Names of Mixture/Components See Instructions TRIcHLOROTHENE']::-.~.-,':-'. (located on south wall) 55- ---2~ 55 ............ 0 ........ GL¥-COL "--~ ~ (located on south wall) L___I Immediate , ~ Health r--~ u--J Fire L__J Delayed Health C.A.S. Number r---, ,----~ 13) ~ Days i u--~ Reactivity u-- j Sudden Release of Pressure on Site ~_36__5~ 300 150 300 0 1__4. L-- J Immediate Health (located on south wall) ~---J Fire u ..... ~ Delayed Health C.A.S. Number r----~ r'---, r---'~ 13) t* Days i 365! L__J Reactivity L.-~ Sudden Release of Pressure on Site L ..... - ' ' n ~ = ~][ 0 F-r - "lb 0 -T~A~ ~ D" ................ ~ {% ~2~'~ -Is - ~ -r~ ~m(~[~ ~ .................................~.~ ~5~ ........... tMERUENCY CONTACTS ~1 -..._~AR~N. ~E~EN ....... ~haD_~a~ ......................................... 3.9~=~Z4_t .............. marne ) ltle zaHr ~none m~ Certification (~ead and sJR7) al(er oompletYn~. ~J [ certify under penalty of law that I have personally examined and am familiar with the infor~ubmi~ed i~i~lt attached documents, and that based on my ~~~--- , .............. ~' ........ inquiry of those individuals responsible for obtaining the information, I believe that~~~ac~ate, ~d complete. INVENT O RY CODE SHEET Trans Code (Column l) Use Codes (Column 10) A = Add This Item D = Delete This item R = Revised Information T%rpe Code (Column 2) P = Pure Material M = Mixture of Substances W = Waste (Must Also: Add Appropriate Waste code from "Waste Code Sheet") Measure Units (Column 6) LBS = Pounds TON = Tons (2,000 lbs) GAL = Gallons BBL = Barrels (42 gals) Ft3 = Cubic Feet CUR = Curies Container TYPe (Column 7) 01. 02. 03. 04. 05. 06, 07. O8 09 10 11 12 13 14 15. 16, Underground Tank Aboveground Tank Fixed Pressurized Cylinders Portable Pressured Cylinders Insulated Tank (Includes Cryogenics) Drums or Barrels - Metallic Drums or Barrels - Non- Metallic Carboy(s) Glass Container(s) Plastic Container(s) Box(es) Bag(s) Metal Containers (Not Drums) In Machinery or Processing Equipment Bin(s) Unlined Sumps Container Pressure (Column 8) 1 = Ambient Pressure 2 = Greater Than Ambient Press 3 = Less than Ambient Press Container Temperature (Column 9) 4 = Ambient Temperature 5 = Greater than Ambient 6 = Less than Ambient Temp but not Cryogenic 7 = Cryogenic Conditions 01 02 O3 04 05 O6 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 2'/ 28 29 SO 31 32 33 34 35 36 37 38 39 4O 41 42 43 44 45 46 47 48 49 5O 51 52 53 54 55 99 Additive Adhesive Aerosol/Inflation Anesthetic Bactericide Blasting Catalyst Cleaning Coolant/Antifreeze Cooling Drilling Drying Emulsifier/Demulsifier Etching Experimental/Analytical Fabrication Fertilizer Formulation/Manufacturing Fuel Fungicide Grinding Heating Herbicide Insecticide Instructional Lubricant Medical Aid or Process Neutralizer Painting Pesticide Plating Preservation Refining Sealer Spraying Sterilizer Storage/In Storage Stripper Washing Waste Water Treatment Welding Soldering Well Injection or Service Oil Treatment Resale Aircraft Systems Battery/Electrolyte Breathing Air Drafting Aid Finished Product Fire Protection Hydraulic Equipment Road/Hwy Maintenance Testing Wholesale Chemicals OTHER-Specify on another page Farm and Agriculture ~-- ~ Standard Business ~ -- ~ KERN COUNTY-FIRE DEPARTMENT HAZARDOUS MATE'RI ALS INVENTORY BUSINESS NAME: 1 2 3 Trans Type Max Code Code Amt ~ .... ~ Immediate Health ~ Fire L_~. ~, ,Ly°eac~v;~- Average Annual Measure Cont Cont Cont Use Amt Est Units Type Press Temp Code L__.J Delayed Health Sudden Release of Pressure C.A.S. Number 13) ~ Days ~365J on Site .... Page ........ of ......... '11 12 I % by Names of Mixture,/Component~ See instructions (front near door) Immediate Health Fire Reactivity Delayed Health Sudden Release of Pressure _ZO-Og___ C.A.S. Number ............. F~:;::~- .......... 13) ~ Days [365I on Site '. ..... : (front near . door 4 ~ ---' Immediate Health L ...... ~ Fire Reactivity "---J Delayed Health Sudden Release of Pressure C.A.S. Number 13) ~ Days i I on Site ~ ...... ~ L--U Immediate Health L _.u Fire L--J~ ~, ,~y°eac~v~' L -- J Immediate Health L ..... u Fire Oelayed Health C.A.S. Number 13) ~ Days Sudden Release of Pressure on Site L----~ Delayed Health Sudden Release of Pressure C.A.S. Number 13) ~ Days On Site ' INVENTORY CODE SHEET Trans Code (Column 1) A = Add This Item D = Delete This item R = Revised Information TyDe Code (Column 2) P = Pure Material M = Mixture of Substances W = Waste .(Must Also: Add Appropriate Waste Code from "Waste Code Sheet") Measure Units (Column 6) LBS = Pounds TON = Tons (2,000 lbs) GAL = Gallons BBL = Barrels (42 ga]s) Ft3 = Cubic Feet CUR = Curies Container Type (Column 7) 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14. 15. 16. Underground Tank Aboveground Tank Fixed Pressurized Cylinders Portable Pressured Cylinders Insulated Tank (Includes Cryogenics) Drums or Barrels - Metallic Drums or Barrels - Non- Metallic Carboy(s) Glass Container(s) Plastic Container(s) Box(es) Bag(s) Metal Containers (Not Drums In Machinery or Processing Equipment Bin(s) Unlined 'Sumps Container Pressure (Column 8) 1 = Ambient Pressure 2 = Greater Than Ambient Press 3 = Less than Ambient Press Container Temperature (Column 9) 4 = Ambient Temperature 5 = Greater than Ambient 6 = Less than Ambient Temp but not Cryogenic 7 = Cryogenic Conditions Use Codes (Column 10) 01 02 03 O4 O5 06 O7 O8 09 10 11 12 13 14 15 16 17 18 19 20 21 22. 23. 24. 25. 26. 2?. 28. 29. 30. 31. 32. 33. 34. 35/ 36. 37 38 39 4O 41 42 43 44 45 46 47 48 49 5O 51 52 53 54 55 99 Additive Adhesive Aerosol/Inflation Anesthetic Bactericide Blasting Catalyst Cleaning Coolant/Antifreeze Cooling Drilling Drying Emulsifier/Demulsifier Etching Experimental/Analytical Fabrication Fertilizer Formulation/Manufacturing Fuel Fungicide Grinding Heating Herbicide Insecticide Instructional Lubricant Medical Aid or Process Neutralizer Painting Pesticide Plating Preservation Refining Sealer spraying Sterilizer Storage/In Storage Stripper Washing Waste Water Treatment Welding Soldering Well Injection or Service Oil Treatment Resale Aircraft Systems Battery/Electrolyte Breathing Air Drafting Aid Finished Product Fire Protection Hydraulic Equipment Road/Hwy Maintenance Testing Wholesale Chemicals OTHER-Specify on another page ITE/FACILITY DIAGRAM FORM DATS~ FACILITY XAME: /i/~.~ L'~'[T ~:~ OF ~/ CHECK ONE) SITE DIAGRAM FACILITY DIAGR.~M / (Inspector's Comments): -OFFICIAL USE ONLY- - SA - SiTE DIAGRAM (Required items) Address: Identify the principle buildings by the Street numbers. Street(s), Alleys, Driveways, and Parking Areas adjacent to the property, Include the street names. 3. Storm Drains, culverts, Yard Drains 4. Draioage Canals, Ditches, Creeks, 5. 8oi ldin~s a. Frame construction b. Masonry constructinn c. Metal construction d. Access Door 6. Utility Controls a. Gas b. Electricity c. Water ?. Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkler Connections c. Fire Standpipe Connections d. Water Control Valves for protection systems e. Fire Pump 8. Fire Department Access 9. Lock (key) Box i0. MSDS Storage Box II. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c, Wood d, Gates 13. Powerlines 14. Guard Station 15, Storage Tanks: Identify the capacity In ~al. a. Above grouhd b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area; Identify the location where employees will meet. 19. Outside Hazardous Waste Storage 20. Outside Hazardous Material Storage 21. Outside Hazardous Material Use/Handling 22. Type of Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid C = Corrosive 0 = Oxidizer O = Gas W = Water Reactive T = Toxic S = Solid D = Waste B - Etiological Example: Flammable Liquid = FL FACILITY DIAGRAM (Required items tn addition to the abo~e) 1. Risers for Sprinklers 2. Partitions 3. Stairways: Indicate the levels served from highest to lowest. 4. Escalator: Indicate the levels served from highest to lowest. 5. Elevator 6. Attic Access R = Radiologtcal P = Poison H = Cryogenic 8. Fire Escapes 9. Air Conditioning Units 10. Windows 11. Inside Hazardous Waste Storage 12. Inside Hazardous Materials Storage 13. Inside Hazardous Materials Use/Handling 14. Sewer Drain Inlets Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed Plan ID ~ 215-000~~ (Top right comer Business Plan) Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Verification of MSDS Availability . 5 I Number of Employees Verification of Haz Mat Training Comlllents: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled ComlTlents: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office I NOT~CE . The Bakersfield Fire E apartment requires all businesses operating in the City of Bakersfield to meet the following fire safety reduirements as set forth in the Uniform Fire Code, the Bakersfield Municipal Code, and/or the State of California Health and Safety Code. 27' 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. If you handle, store, use, 'Or dispose of any hazardous substances you are required by California law io complete a hazardous materials business plan. Forms can be obtained from the Bakersfield Fire Department Hazardous Materi- als Division 2130 "G" Street. Typical every day hazardous materials you may find in your facility may include, but not be limited to: compressed gases- oxygen, acetylene, etc.; fuels- all types, solvents, oils (new and waste), thin- ners, caustic or corrosive m,aterials, poisonous or toxic materials, and radioactive materials. ~ Failure to complete a hazardous materials business plan can result in fine§lof up to five thousand dollars ($5,~00.00)per day. Address of building must be visible and easily read from the street. Provide exit signs with lett(rs five or-.more inches in height over each re(~uired exit. Keep all hallways, stairwells, fire escape landings and exits free of storage or other obstructions. Ii ' ' Property must be kept free ~)f dry vegetation and combustible waste. Provide non-combustible containers with dght fitting lids for storage of combusti- ble waste and rubbish pending its safe disposal. Extension cords shall not b~ used in place of permanent approved wir[ng. Install additional approved electric;? outlets where needed. Multiple electrical outlet devices must be equipped with an overload/breaker switch. Provide at least three (3) fobt clearance around any electrical panel, fuse box, or door. /' Repair any cracks or holes lin walls or ceilings in order to maintain fire resistive condition. Hotels and apartment housle~s shall provide at lease one 2A 10BC extinguiSher within 75 feet of travel and on each floor. All other occupancies shall provide a minimum of one 2A 10BC extinguisher for each 3,000 feet of floor area with a minimum of 75 feet of trav(~l distance. Additional requirements as to size, type, and placement of extinguishers may be made upon inspection of premises by Fire Department personnel. All fire extinguishers shall )e serviced once a year, and after each use,',by a person having a valid licen: e. 13. Locate fire extinguishers in a c~)nspicuous'location, hanging on brackets with the top no more than five (5) feet from the floor. 14. Fire Extinguishing System Requirements: A. All sprinkler systems shall have a maintenance inspection at least quar- terly (to be conducted by a person designated by the building owner or occupant). The building or system owner shall insure immediate correction of any deficiencies during the maintenance inspect!on. Records of all maintenance shall be retained for a five (5) year period by system or building owner. B. All standpipes shall have a maintenance inspection at least semi-annually (to be conducted by a person designated by the building owner or oc- cupant). The building or system owner shall insure immediate correction of any deficiencies found during the maintenance inspection. Records of all maintenance shall be retained for five (5) years by the building owner or Occupant. C. All pre-engineered and engineered fixed systems shall be serviced annually. Servicing of Systems: ':- A. Automatic fire sprinkler system shall be serviced at least every five (5) years. 1. Records of all service shall be retained for five (5) years by the.buildin9 or system owner. 2. The building or system owner shall insure immediate correction of any deficiencies noted during the service. A service tag shall be applied to the system when completed. 3.All service on automatic 'fire extinguishing systems as set forth in the · Health and Safety Code shall be performed by concerns licensed by the State Fire Marshal. B. All standpipe systems shall be serviced at least every five (5) years..(1) (2), and (3) same as above. Failure to comply with requirements stated above in Items 2-14 shall constitut~ a misdemeanor which may result in a fine of up to ten thousand dollars ($10,000.00) by imprisonment for not more than six~:(6) months, or both. OFFICIAL USE ONLY BUSINESS NAME / ID# HAZARDOUS MATERI ALS 'BUS I NESs'~-:''PL:AN' ~S '. A WHOL'E .... : .... · FORM INSTRUCTIONS: ' 1. To avoid further action, return this form by ~5 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 B, LOCATION / STREET ADDRESS:~-~O BUS.PHONE: (~0~'-) "~CL~D~'~_.'-~Oz~ 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, EMPLOYEES TO NOTIFY 'IN CASE OF 'EMERGENCY: NAME AND TITLE . .DURING BUS ', HRS. s~cvzo~ s: ~oc~vzo~ o~ ~z[xw S~-o~S ~ou ~usi~ss ,~s ~ ~o[~. A. NAT. GAS/PROPANE: AFTER 'BUS..HRS. Ph#~-~'~- B. ELECTRICAL:t~z. C, WATER: ~^~_~,~ D. SPECIAL: E. LOCK BOX: YES /(~ IF YES, LOCATION: IF YES, DOES IT CONTAIN'siTE'PLANS?" YES'/ NO" MsDsS? FLOOR PLANS? YES / NO KEYS? YES / NO YES / NO' -Over- HMCU-4 SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERs ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A, METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: ~NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO (~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES (~ YES NO I understand that this information will be used to fulfill my firm's oblizations 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. S!GNATURE'~ DATE HMCU-4 KERN COUNTY FIRE DEPARTMENT 5642 VICTOR STREET BAKERSFIELD, CA 93308 BUSINESS NAME: OFFICIAL USE ONLY ID# BUSINESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS __ ~. To a~o~ ~u~e~ action, t~i~ ~o~ .us~ be ~tu~ne~ b~: 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: ~ITIGATION, PRE~ION, ABATE~ PROCED~BS s~c~o~ ~: ~o~c~o~ ~ ~v~c~o~ ~oc~s ~ ~n~s ~ HMCU-6 SECTION 3: HAZARDOUS ~IATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... ~N0 If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret as defined by Section 6254.7 of the Government Code? ......... YES N~ If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) 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 Cz-3 /-- SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY ENERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT oNLY. A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E. L0CK BOX: YES /~ IF YES, LOCATION: IF YES, SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSs? KEYS? YES / NO YES / NO HNCU-6 I.D. # BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A- 1 Page __ of ~, NON--TRADE SECRETS ~ ~-" HAZARDOUS MATER'{' ALS NVENTORY BUSINESS NAME:~'~)~I~'e.~ '~'"~t,~_~O~_~I'/~.ER NAME: __~~ ~,~O~ FACILITY UNIT ~:~ ADDRESS: ~0 ~{~~ ADDRESS: ~o11~ ~~r~ '~. FACILITY UNIT NAME: CITY, Z I P :.~~~~ ~~ CITY,ZIP PHONE ~: .~~~--~2~ PHONE ~: ~14--~--~qq OFFICIAL USE CFIRS CODE 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE OUID~E -y - NAME · ~ TITLE: SI6 : ' PHONE # BUS HOURS: ~/'~/-~'-~ AFTER BUS HRS: PHONE # BUS HOURS: _.~'~'~--~~ AFTER BUS HRS: ~~ ~ EM :ONTACT: EMERGENCY CONTACT: '.PRINCIPAL BUSINESS ACTIVITY: ~Y~__~_. ;11E 11 i 12~i~r~ '1 ~$ ~ ~ /~/ _r~__'~_ O~t B~d. ., , 6~11~' 110 109 108 1~ 1~ 105 1~ 1~ 1~ 89' 116' 89' 89' DISTRICT BOULEVARD North IBAKERSFIELD Min Ave BB~ISINESS (ENIEII 5510-5550 District Blvd., Bakersfield Nortlt Office, R L A Warehousing & Manufacturing Space 680 SQ FT AND UP · Each unit has office area equipped with central heating and air conditioning · Tilt-Up Construction · Individual Restrooms · Loft areas are available in some units · 100-amp., 3-phase power · Extensive Landscaping · Easy freeway access via White Lane · Some units are fire sprinklered for safet~ · FOR LEASING INFORMATION PLEASE CALL: (805) 398-8888 ALSO, WE HAVE OTHER PROJECTS IN SAN DIMAS, VENTURA, WESTLAKE VILLAGE AND NEWBURY PARK BAKERSFIELD This information has been furnished from sources which we deem reliable, but for which we assume no liability.