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HomeMy WebLinkAboutBUSINESS PLAN l~A~ DIAGBAM D May 3,2001 FIRE CHIEF · RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 · VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Mr. Pankja Patel Downtown Deli Mart 1800 H Street Bakersfield, CA 93301 Dear Mr. Patel: Enclosed, please find the Site and Facility Diagram Instructions packet. When your Hazardous Materials Management Plan and Inventory were submitted it was lacking the diagram portion. Please ,draw and submit the diagram(s) of your facility by June 8, 2001. The diagram should include the following: 1) 2) 3) 4) 5) 6) 7) 8) 9) name of your business; business address; indicate which direction is North; the cross streets neighboring business addresses (within 300 feet) entrances and exits location of utility shut-offs; location of the nearest fire hydrant; portions of the building protected by automatic sprinkler system; and most importantly the location of the hazardous material(s). If you have any questions, please feel free to call me at (661) 326-3658. Thank you for your assistance. Sincerely, RALPH E. HUEY, DIRECTOR OFFICE OF ENVIRONMENTAL SERVICES Esther Duran, Accounting Clerk II Office of Environmental Services ED\db Enclosures DOWNTOWN DELI MART Manager : Location: 1800 H ST City : BAKERSFIELD SiteID: 215-000-001265 BusPhone: (805) 323-1820 Map : 102 CommHaz : Low Grid: 25D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 EPA Numb: SIC Code:5541 DunnBrad:- Emergency Contact / Title PANKAJ PATEL / OWNER Business Phone: (8'05) 323-1820x 24-Hour Phone : (805) 327-3409x Pager Phone : ( ) - x Emergency Contact SMITA PATEL Business Phone: 24-Hour Phone : Pager Phone : / Title / PARTNER (805) 323-1820x (805) 327-3409x ( ) - x Hazmat Hazards: Fire" .ImmHlth DelHlth Emergency Directives: = Hazmat Inventory -- MCP+DailyMax Order Hazmat Common Name... REGULAR GASOLINE UNLEADED GASOLINE PREMIUM UNLEADED GASOLINE One Unified List Ail Materials at Site F IH DH L . F . IH DH L F IH DH L DailyMax IUnit MCP 10000 GAL Mod 10000 GAL Mod 10000 GAL Mod agement plan for my 02/12/1998 DOWNTOWN DELI MART SiteID:~ 215-000-001265 = Inventory Item 0001 Facility Unit: Fixed Containers on Site REGULAR GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SOUTHWEST CORNER CAS# 8006-61-9 F STATE ~ TYPE Liquid ~Pure .PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum · . 10000.00 GAL Daily Average 5000.00 GAL %Wt 100.60 Gasoline HAZARDOUS COMPONENTS  S CAS# N 8006619 TSecret N~S BioHaz No No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards. No/ CUries F IH DH NFPA/// I USDOT# MCP Mod Inventory Item 0002 Facility Unit: Fixed Containers on Site ~UIVUVlU~ ~Vl~ / ~ 1 ~.~--~1.~ ~Vl~ UNLEADED GASOLINE Days On Site 365 Location within'this Facility Unit Map: Grid: SOUTHWEST CORNER CAS# 8006-61'9 F STATE ~ TYPE Liquid /Pure PRESSURE Ambient· TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 5000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS RNo~ CAS#8006619 TSecretINO N~S BioHazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# MCP Mod 2 02/12/1998 DOWNTOWN DELI MART SiteID: 215-000-001265 = Inventory Item 0003 Facility Unit: Fixed Containers on Site PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SOUTHWEST CORNER CAS# 8006-61-9 Liquid * UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION *Daily Maximum 10000.00 GAL Daily Average J 5000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS CAS# 8006619 TSecretNo NoRSBi°HazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// JUSDOT# MCP Mod 02/12/1998 DOWNTOWN DELI MART = Notif./Evacuation/Medical --Agency Notification SiteID: 215-000-001265 Fast Format Overall Site 05/02/1991. CALL 911 Employee Notif./Evacuation · TELL EVERYONE TO LEAVE IN A LoUD VOICE 05/02/1991 Public Notif./Evacuation TELL EVERYONE TO LEAVE IN A LOUD VOICE '05/02/1991 Emergency Medical Plan. CALL 911. BAKERSFIELD FAMILY MEDICAL CENTER SAN JOAQUIN HOSPITAL ~ 05/02/1991 02/12/1998 DOWNTOWN DELI MART SiteID: 215-000-001265 Fast Format ~ Mitigation/Prevent/Abatemt --Release Prevention Overall Site 04/17/1992 GAS PUMPS HAVE NOZZLES AND ARE EQUIPPED WITH A VAPOR RECOVERY~SYSTEM. --Release Containment~ UNDERGROUND STORAGE TANKS 04/17/1992 ~ Clean Up 04/17/1992 WE HAVE INSTALLED 5 GALLONS OF EMERGENCY CLEAN UP MATERIAL THAT WOULD HANDLE SMALL RELEASES. · Other Resource Activation .02/12/1998 DOWNTOWN DELI MART .Sit'eID: 215-000-001265 Fast Format. 9 Site EmergenCy Factors Special Hazards Overall Site -- UtilityShut-Offs A) GAs - NONE B) ELECTRICAL - INSIDE NORTH WALL C) WATER - INSIDE WEST WALL D) SPECIAL - EMERGENCY SHUT-OFF GASOLINE ON SOUTH WALL E) LOCK BOX - NO 10/09/1990 -- Fire Protec./Avaii'. Water PRIVATE FIRE PROTECTION - ~ FIRE EXTINGUISHER / FIRE HYDRANT - CORNER AT ALLEY AND H ST DIRECTLY BEHIND THE STORE. 10/09/1990 Building Occupancy Level -6- 02/12/1998 DOWNTOWN DELI MART SiteID: 215-000-001265 Fast Format Training -- Employee Training WE HAVE 3 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS.ON FiLE BRIEF SUMMARY OF TRAINING: MONTHLY SAFETY MEETINGS Overall Site 05/02/1991 -- Page 2 -- Held for Future Use Held for Future Use -7- 02/12/1998 BAKERSFIELD- CFf'Y FIRE- DP...PARTNIFNT OFFICE OF ENVIRONMENTAL $cMvlCE$ 1715 CHESTER $WENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS ,NAME ~ O ~/xl .".'T¢/",.-'")/'~ FACIU ~"F¢, NAME ~ O ),,,J).2'N '7-(') ;Kg/N.] S~T~ ADDRESS 1,s-'Co.~'H '~ ' 7-,'~EET'- C;TY ,/~/'~:)~_..,,~',~_.¢/,~,~?/Z.~ STATE ~""~ NATU,=,E CF =USINESS ~'-&./'~! ~"~"/"",./¢-~-7.,-~'¢,~:~---~ % '~""O,/"~-/4:::~~ SiC CODE DUN & BRADSTREET NUMBER STATE BAKERSFiIi LD CITY FIRE DEPARTMENT HAZARI:)OUS MATERIALS INVEN'I ORYPage_of._ CHEMI~L DES;CRI~ON ~ - '~ · '~ ~ 'Z "~ ' .... Common Name: 3) DOT · (omenel. ChemlCaJ Name: CAS i~' PHYSICAL Reective { ] Sudden Release of Pressure ( ] AHa4[ ] PHYSICAL & HEALTH HEALTH HAZARD CATEGORIES Fire [ ] ImmeOiate Health (Acute) ( ] Oela~ HeaIU~ (ChromcJ [ ] WASTE CLASSIRCAllON (3-cligit cc)cie from OHS Form 8022) USE CODE PHYSICAL sTATE Solid [ ] Liquid ( ] Gas [ ] Pure [ ] Mixture [ ] Win're ( ] RedieacUve [ ] 7) AMOUNT AND TIME AT FAC[UTY MazJmum DaJN Amount: AverlKje Daily Amount: AnfluaJ Amount: Lazges! Size'Contmnec -* Oa~ On Site UNITS OF MEASURE tunes {] 8) STORAGE CODES a) Contmner. b) Preasure: c) Tempera~Jm: Circle Which Momhs: All Yea/. J. F. M. A. M. J. J. A. S. O, N. O' MIXTURE: List :he three most nazamous chem,caj comcxmen~ or any AHM comCM3nents 1) COMPONENT CAS # AHM [] [] [] i O) Loc, at,on CHEMICAL DESCRIPTION INVENTORY STATUS: New { ] ,~daition ( ] ~eWSion ( ] Deletion { ] ChecJ( if chemical i~ ,, NON TRADE SECRET [ ] TRADE SECRET [ ] Common Name: 3) DOT # (op4tonai) ~-) PHYSICAL & HEALTH H ,a,,?JUq O CATEGORIES PHYSICAL Fire ( ) ~eactrve( ] Suaaen Release of Pressure { ] HEALTH Immecii~te HeaJm (Acutel ( ] [h~leyea HeeJU1 (Chronic) [ ] WASTE CLASSIFICATION /,3-clicj~ coae from OHS Form 8022) USE CQDE PHYSICAL STATE Solid [ I LJauici [ ] Gas { ] Pure ( ] M~ure [ ] Waste [ ] Radioactive [ ] AMOUNT AND TIME AT FACIUTY M~x~mum O~,ly Amount: AveracJe {3mN Amount: AnnuaJ Amount: La/cjest Size Container: ~* Oev~ On Site UNITS OF MEASURE tunes (I STORAGE CODES a) Contmner. b) Pressure: c) Tempem~Jre: WhichMonms: AJIYea/. J. F. M. A. M. J. J. A. S. O. N. O MIXTURE: list the three most haza/oou$ cnermc, aJ comDonents or any A~M components COMPONENT CA~ # % w'r - AHM [] [ I OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFII'"LD, CA 93301 (805) 326-3979 " HAZARDOUS MA'rERIALS MANAGEMENT PLAN INSTRUCTIONS: 7o avoiC runner action, re~urn this form within 30 days of receiot. WPE/PRINT ANSWERS IN ENGLISH. Answer t,he cues?ions below for t,he business as o wnote. Be brief cna conclse as SECTION ]' ~USINESS1DENTIFtCATION DATA BUSiNF,SS NAMF-:,.DtO !,~/',/'-/-¢k9/'.1 .,O~-~'Z._%- ~Y)/~/~-7-- LC C ATIO N:,..,._'h)C!'~ ],,?.A,/-7--(~ ~3 ,,,, ..... /Cs, cc x,q CITY: ~~~Z~/ ~ STATE~?~ ZIP: ~~/PHONE; SIC CODE' SECTION 2: EMER®ENCY NOTIFICATION' CONTACT -'-i:::.z- BUS, ,SHONE 24 HR. PHONE ~2.V-- .E,4,-o ~amers~eze :'Ire Dept. lazardous ,~[a:erials Division HAZARDOUS MA?ER~A[$ MANAGEM~N? PtAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION J.: EXEMPTION REQUEST: ! ....... ?ENALTY '-"F s:s ~u:,,~ .... ,._.ax I ir-f IINOER . ~ ,,~, ........ THAT'MY BUS~N~.,-~ IS EXEMPT FROM THE REF.C, RTING ~:~.,U x,...~v~,._NTS ',...,.F CHA;ZTE~ '5..95 OF THE :'CALIFORNIA HEALTH & SAF:'v COCE" FOR :? '= :, _. , , m...., SLLQWING REAS(.Of'4S: 'V/ ""'"",,,: '"" ~_,,.~ NOT ""' "' '"'""' .... " ..:':C C US n~'~u~.~, nA~-. MATERIALS. vIE 30 HANOL-- ' '-' ......... :,,A.x..,~,,~_,~rj.._, MATERIALS, BUT iH: QUANIIItE-.., AT NO -'x 1'--'~'~-'-'' -" .".,'ti . _. .,;.::.',~cz~ inE NIMUM ~::CRTiNG QUANTFTIES. SECTION 5: CERTIFICATION: MATION IS,--,~.,..,~,,,--," "'"" ,o^'r=,,_. i UNDERSTANC THAT THIS INFORMATION WILL BE USED TO ruCZtL_ MY FiRbl'S OBLIGATIONS UNDER THE "'-',._.,-,~.,," mm~'r~'n^,..,,,,.,,,.--, HEALTH AND SAFE','Pf CODE" _~ :...~,~.~T~_R 6.95 SEC. 25500 ET AL.) AND THAT ON HAZARDOUS MATERIALS (DTV, cn -"' :; "'. INACCURATE INFORMATION CONSTITUTES PERJURY. TITLE DATE. oa~ersne!a ~2'e IJeD~,. Hazardous Materials Di-,ds~.on HAZARDOUS MATERIALS MANAGEMENT PLAN F(:cilify U'nit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: AGENCY NOTIFICATION PROCEDURES: .~7 L--foN p,';, >~o o/'V Co E:".,1PLr"'...;YEE NCTIFiCATiCN AND EVACUATION: ?UBLiC :',/ACUAT(CN: -:vlr-:~C-z:NC'f N, IED~C,--,~. ?LAN .t',.l © C, ff ,G ~'-t 4£ Bakersfield Fire Dept. Hazardous ~ateriats Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: RELEASE PREVENTION STEPS: x~_,-'.k,~.C~N-IAINMENT ANO/OR MINIMIZATION: ~'L:- _,-." N-UP ,': RC C ED U x :,, SECTION $: UTILITY SHUT-,OFFS (L'SCATiQN ,""-- SHUI-,,.~rr~ AT YOUR FACILITY) 3FEC;AL: -'~,CK :C',x. , SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: ?RIVATE FiRE PROTECTION: / / WA;ER AVAILABILtTY (FIRE HY~RA~: Hazardous 1V~aterials HAZARDOUS MATERIALS MANAGEMENT PLAN Facilify Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: Ao AGF_NCY NOTIFICATION ?.qOCEIDur~Es: / ~:'vIPL©Y~5 NOTIFICATION AND EVACUATION: ?UBLIC E."/A C..,-, ~ ,O N. -' " ' "' ?LA z:vl c[RG E:xIC'? M ED,C,-~. N ITE[ DIAGFL~M Business Name: ,~usiness ACtress: FACILITY DIAGRAM Office U~e Only First In Station: lnsc;ec:ian Stction: Area Mca .~ ct NORTH L ' ADDRESS ZiP CODE FEE BUSINESS LICENSE NO. PERMIT. R~QUIRED PERMIT  YES ~ NO ~, ~ ~ BUSINESS NAME '~~OW~ BUSINESS MGR./RESPONSIBLE BUSINESS PHONE ~'~ PHONE NO. OF FLOORS SQUARE FOOTAGE O~6R DATE~F REINSPECTION (1~' (2) (3) INSPECTOR STATION/SHIFT/STATION PHONE BULK TRANSFER (Business) BUSINESS NAME SITE LOCATION OLD OWNER NAME NEW' OWNER NAME NEW OWNER ADD. ACCOUNT NUMBERS INVOLVED TRANSFER APPROX. DATE OF THIS INFORMATION IS TAKEN FROM THE DAILY REPORT AND SHOULD BE VERIFIED PRIOR TO ANY CHANGES. DISTRIBUTION: S~nitat ion Business Licenses Hazardous Ma=erial$ 02/24/92 DOWNTOWN DELI MART 215-000-001265 Overall Site with 1 Fac. Unit Page -General Information Location: 1800 H ST Map: 102 Hazard: Low I ICommunity: BAKERSFIELD STATION 01 Grid: 25D F/U: 1AOV: 0.0 iContact Name THOMAS WATKINS RUSSEL KEIM IOWNER Mail Addrs: 1800 H ST City: BAKERSFIELD Comm Code: 215-001 BAKERSFIELD STATION 01 Title · Business Phone/--~124-H°ur Phoneq (805) 323-1820' x 805) 644-1180! (805) 832-5905 x 805) 832-5905/ Administrative Data D&B Number: State: CA Zip:. 93301- SIC Code: 2251 Owner: THOMAS WATKINS Phone: (805) 644-1180 Address: 1800 H ST State: CA City': BAKERSFIELD Zip: 93301- Summary 02/24/92 DOWNTOWN DELI MART 215-000-001265 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 REGULAR GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily. Max GAL 10,000 Daily Average GAL 5,000.00 Annual Amount GAL 40,000.00 Storage UNDER GROUND TANK Press T Temp Location ambient~AmbientlSouTHwEsT CORNER -- Conc 100.0% IGasoline Components MCP List IModerate I 02-002 UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 10,000 '1 Daily Average GAL 5,000.00 Annual'Amount GAL 40,000.00 Storage UNDER GROUND TANK Press T Temp Location I AmbientlAmbientlSOUTHWSST CORNER - Conc 100.0% IGasoline Components MCP ~ List IModeratel 02-003 PREMIUM UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #:.8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL DailyMax GAL 10,000 Daily Average. GAL 5,000.00 Annual Amount GAL 40,000.00 Storage UNDER GROUND TANK Press T Temp Location I Ambient~mbient I SOUTHWEST CORNER -- Conc 100.0~ IGasoline Components MCP List I Moderate I 02/24/92 DOWNTOWN DELI MART 215-000-001265 00 - Overall Site <D> Notif./Evacuation/Medical Page 3 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation TELL EVERYONE TO LEAVE IN A LOUD VOICE. <3> Public Notif./Evacuation TELL EVERYONE TO LEAVE IN A LOUD VOICE <4> Emergency Medical Plan CALL 911. BAKERSFIELD FAMILY MEDICAL CENTER SAN JOAQUIN HOSPITAL 02/24/92 DOWNTOWN DELI MART 215-000-001265 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page <1> Release Prevention GAS PUMPS HAVE NOZZLES AND ARE EQUIPPED WITH A VAPOR RECOVERY SYSTEM. <2> Release Containment UNDERGROUND STORAGE TANKS <3> Clean Up <4> Other ResoUrce Activation 02/24/92 DOWNTOWN DELI MART 215-000-001265 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - INSIDE NORTH WALL C) WATER - INSIDE WEST WALL D) SPECIAL - EMERGENCY SHUT-OFF GASOLINE ON SOUTH WALL E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 1 FIRE EXTINGUISHER FIRE HYDRANT - CORNER AT ALLEY AND H S~ DIRECTLY BEHIND THE STORE. <4> Building Occupancy Level 02/24/92 DOWNTOWN DELI MART 215-000-001265 00 - Overall Site <G> Training Page <1> Page 1 WE HAVE 3 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: MONTHLY SAFETY MEETINGS '<2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 04/09/91 Page 6 ONTOWN DELI MARKET 215-0(0}01265 (1)0 .- Overall Site <G> Trair~ing <1> Page 1 WE HAVE 3 EMPLOYEES AT THIS FACILITY ......... ~ZL~HEL]S ON FILE? D~l~ HAVE i'iATERiAL BRIEF SUMMARY OF TRAINING: ~r <2) page 2 as needed Held fo~' Futu~e, Use <4> Held f,-,r Future Use 04/09/91 Pa~e 5 DOWNTOWN DELI MARKET 215-000-001265 00 - Overall Site <F> Site Ernergerlcy Factors <1> Special Hazards <2> Utility Shut-Offs A) 'GAS - NONE B) ELECTRICAL - INSIDE NORTH WALL C) WATER - INSIDE WEST WALL D) SPECIAL - EMERGENCY SHUT-OFF GASOLINE ON SOUTH WALL E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - 1 FIRE EXTINGUISHER FIRE HYDRANT - CORNER AT ALLEY AND H ST DIRECTLY BEHIND THE STORE. <4> Held fc, r Future use 04/09/91 NTOWN DEL1 MARKET 215-0(I)01265 O0 - Overall Site '~' <E> Mit igat iorJ/Prever, t/Abatemt Page 4 <1> Release Prever, ti GAS PUMPS HAVE NOZZLES AND,ARE EQUIPlPED WITH A VAPOR RECOVERY SYSTEM. <2> Release Corltairm~er, t <3> Clearl Up <4> Other Resource Activation, 04/09/91 DOWNTOWN DELI MARKET 215-(])(i)(i)-(])(1)1265 Page 3 O0 - Oweral i Site ~ <D> Not if./Evacuat ior~/Medical <1> Age~,cy Notificatior~ <2> Er,lpl,:,yee Not if. /Evacuat ior, TELL EVERYONE TO LEAVE IN A LOUD VOICE. <S> Public_ Notif. /Evac_u_~a~.~ <4> Emergency Medical Plar, 0~/09/91 Pl~-Ref Name/~azards a NTOWN DELI MARKET 215-0(~}01265 zr~at Ir~verltory List irl MCP~Order 0.- - Fixed Cor,tainers or, Site Form Quar~t i t y Page MCP 2 02-003 PREMIUM UNLEADED GASOLINE 10, 0 (iO GAL Moderate 02-001 REGULAR GASOLINE 10,000 GAL · Moderate 02-002 UNLEADED GASOLINE 10,000 GAL Moderate 04/£)9/91 DOWNTOWN DELI MARKET 215-0¢)0-001265 Page 1 Overall Site with 1 Fac. Unit General Ir, formatior, Number: ....... Cc, hr act Narne Mail Addrs: City: COrllrll Code: RECEIVED ~ iviATT. O~V, H S'T Map: 1(:)2 Hazard: Low 215-00Ci-001265 Grid: 25D Area ,z,f Vul: Title Admir~istrat ive T--- Bus{ness Ph,_-,r,e I ( ) '~"" .... '(' I ( ) ~x ( Data · D&B Number: 'State: CA Zip: 24 Hour Phone] ) ~~11 ) {-/ '-/ .--_ 18(')(-') H. ST BAKERSF I ELD 933(]) :1. - 215-(])01 BAKERSFIELD STATION O1 SIC Code: H-. ABBAbi ~ 8R ~M~NbiZKHAi'~i- Phone: ( ) ............. -,~,.~_ State: CA BAKERSFIELD Zip: ~ Owr~er: Address: City: S U nl nl a r y !',, Z~,~//' ~/z~ Do hereby cedih/that ~ have (Typ~ or print ne. me) ment plan any corrections oonstib~e s comptete and co~recl h aQement plan for my facility. ITE/FACILITY D I AGR;%~I ~ORM S NORTH ,DATE :~r '" " FAC[r-[TY NAME: -" (CHECK ONE) SITE ~nspectoc's Co~ent$): -OFFICIAL USE ONLY-. - SA - HAZARDOUS MATERI ALS Farm and ~grJculCure Staneard Business ;hysical and Health Hazard fire Huird L_~ ~eiC[iVtCy L--~ hlay~ L--J ~dd~ ~eleis8 L--J I~Iul 'l~hvsicil and Health Hazard C.I.S. lubber (~heCK dl) thit lp~iy) ;hysical and Health Ha:ard ' C.A.S. Nuihr CM~MC Il lin i C.A.a. lumber t(~.Kk iii Chic 4ppJy) Fire Hazard ~--~ Neaccivi(y L_J Oel~y~ L--J ~dd~ Relemsl L--J I~Jatm dddith mi Pressure Hidicn ;~s~caJ ~nd Health H~zard C.A.S. NuBble (Lheck ill thdc apply} ., . .......................... Il NlM & C.A.S. Number Fire Hazard [ ] Reactivity Hedlth of Pressurl IleMcn C=G~C Ij NlM & C.A.S. Nu.ber . ~ ...... l} 14 % by Names of Nixtura/Co.oofle~(l Ut See Instruct ions ? ........................... ) ,:~rtilicacion IRead and slKn after co,.pletiflg all sections) certify under penalty of la. that I hive pers~illy examined lfld lB faitlioP .ith tho Infor~ttm,su~td In thll ~ I11 Ittic~ d~uaKI, ~d ~ht based ~ ~y Inquiry of t~se Individuals resp~siblo BULK TRANSFER (Business) BUSINESS NAME SITE LOCATION OLD OWNER NAME NEW OWNER NAME NEW OWNER ADD. (%~_~ ! ACCOUNT NUMBERS INVOLVED APPROX. DATE OF TRANSbFER ge~ THIS INFORMATION IS TAKEN FROM THE DAILY REPORT 'AND SHOULD BE VERIFIED PRIOR TO ANY CHANCES. DISTRIBUTION: Sanitation ~siness Licenses FIRE FiRE 'SBIEF Dear Business Owner: CITY W' BAKERSF'I£LD "IRE CARE" 2:0', ,~ ST,~EET ~AKERSFiELD: 9330: 326-3911 This packet contains immortant in?ormacion regarOlng your business and the requirements of ~azardous Materials Inventory Regulations. Both State and Federal laws may require thac your business complete a Hazardous .Materials Management Plan (HMMP). Please read all the enclosed information carefully, failure to comply wl~n any. por%2on of the Bus%ness 'Plan requiremen:s may result in Oivil Liabilities of u~ to $2,000 for each day in ~hiph the violation OCCURS. ':~. -' WHAT BUSINESSES MUST COMPLY If you handle, use, store or dismose of Hazardous Substances at any time during the year in excess of the minimum re~orting quantities you must suDmit a Plan. Tyoical everyday Hazardous Materials you may find in youm facility may include, but ars, not limlted to: compressed gasses; fuels - all types including pmoDane; solvents - most $olvemts would ~e Hazardous Materials: oils - new. and waste; thinners; caustic or corrosive materials; poisonous or toxic materials, and ¢adioactive materials. Minimum State Re~orting- cluantltzes for al~ hazardous materials are: 55 500 200 gallons for liquids pounds for sollc;s cuDic feet (at standard temoerature and fo? passes) For all acutely Hazarclous Materials the minimum reporting quantities are 'found on the lis;t o~ Extremely Hazardous SuOs~ances on the current EPA List (Vol 52 Nc, 77 of the Federal Register.) This llst is availaOle at the Hazardous Materials Division of the Bakersfield F~re Deoartment, 21~0 G STreet, BaRers~ield, Ca. 9~01. Your reporting requirements are either the State quantities or the Federal (threshold planning; Quantity) -- WHICHEVER IS LOWER If your facility is exemo~ or handles Hazardous Mateclals in quantities less than tbs minimum reOorting quantities please fill out and nezurn to this office Sec,,ion (1) one, (4) foun, and (5) five of the Hazardous Mate¢lals Management Plan. Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION Date Completed Business Name: Location: ~ ~'r;~ ~[ Business Identification No. 215-000 Station No. / Shift ~ 5'''~ (Top of Business Plan) Inspector ~/~::: ~ff~E~ Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: Number of Employees Verification of MSDS Availablity Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 1-90) All Items O.K. Correction Needed White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 06/08/90 ? LU~ 7 MARKET ~$5 215-C)00-00/5 []~erall Site with 1 Fac. Ur~i~l~~ Page GerJeral I r, format i or, I ~ Looatior,: 1800 H ST Map: 102 Hazard: Low Ident NumbS'r: 21~-J00-001~65= ('' --' ] Grid: 25D Area c,f Vul: 0.0 Tit le Contact Name SR--eHAN~ I ..... Business Phone - ( ) .~o-18~0 x ( ( ) 323-1820 x ( 24 I.-I,-,u.r Phc, ne] ) - / I Administrative Data Mail Addrs: 1800 H ST City: BAKERSFIELD Corm Code: 215-001 BAKERSFIELD STATION 01 D&B Number: State: CA Zip: 93301- SIC Code: Owr, er: M. P~B~-I--Sr-~R-~WAN~I-Z44H~t-=. Phor, e: ( ) - Address: ~ State: CA City: BAKERSFIELD Zip: 93313- Sur,lmary BAKERSFIELD CITY FIRE DEPAR17~T ~EC'i~[V~'~ B~ERS~IELD, CA 93301 MAY 9 (805) 326-3979 IUSINESS NAME OFFICIAL USE ONLY HAZARDOUS MATE ~{ BUSINESS PLAN AS A WHOLE · ~'~ 0 RM~. SA INSTRUCTIONS: 1. To avoid further action, return th!is form by 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 A. BUSINESS NAME: f~.~ ?~ / :!; B. LOCATION / STREET ADDRESS: CITY: ZIP: BUS.PHONE: (~",'~i) ,' 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 1-916-427-4841. This will notify your 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. H~S. . <,'~ SECTION 3: LOCATION OF UTILI~. f SHB~-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: sox: vzs IF YES, DOES IT CONTAIX SITE PLANS? FLOOR. PLANS? YES / YES ./ X0 MSOSS? YES / N0 KEYS? YES ,/ NO - 2A - SECTION" L~.~M FOR BUSI>;ESS AS A WHOLE ,~: P~IVATE RESpfl~ISE "'=~ SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOLK BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE'A ?ROGRAM WHICH PROVIDES EHPL0¥EES WITH iMiTIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR >~0 ' ~ i~<iTiAL REFRESHER A. METHODS FOR SAFE HA~DLiNG OF HAZARDOUS MATERIALS:.... .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES; WITH RESPONSE AGENCIES: .......................... YES NO YES XO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. - YES NO YES E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES - NO - NONE DOES YOUR BUSINESS HAXDLE HAZARDOUS HATEEIAL IN QUANTITIES LESS THA.Y $~0 ?OU:'~DS 0F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUEtIC FEET OF A COMPRESSED GAS: ...... YES :~u / I, .,.. ' ~ '~,~ certify that the above information is accurate. I under'stand,that this information wi'!! be used to fulfill my firm's obliyations under the new California Health and Safety code on Hazardous ~,!a~erials (Div. 20 Chapr. er 6.95 Sec. 2~$00 Et Al.) and that inaccurate information constitutes perjury. BAKERSFIELD CI1~ FiRE DEPARTMEXT 2130 "G" STREET BAKERSFIELD, CA 93301 BUS L~ESS NAME: Orr ~,.rAi' USE oNr.¥ BUSINESS PLAN SINGLE F,~kCILITY UNIT FORM SA INSTRUCTIONS I. To avoid further action, this form must be re'turned by: 2. TYPE/PRINT YOUR ANSWERS tN ENGLISH. .~. Answer the questions below for THE FACII, ITY UNIT LISTED BELOW ~. Be as BRIEF and CO~C~S~ as possible. SECTION 1: MITIGATION, PR~N~IONr ~BATEMEN~ PROCEDt~ES SECTION 2: NOTIFiCATiON Ah'D .... "* EVAC~,~ON PROCEBt~ES AT THIS L~iT OYLY - SA - SECTION 3: HAZARDOUS MATERIALS FOR THIS f~iT ONLY A. Does this Facility Unit contain ~ YES, see B. ~f NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No r'om'~i~ -~ se~arnte hazardous materis, is inventory form marked: NON-TRADE SECRETS ONLY (white form =4A-I) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS OXLY (yellow form =4A-2) in addition to ~he non-~rade secre~ fo~m. List only the tr'ade secrets on form 4A-~. ~CTION 4: ~RIVATE FIRE SECTION $: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONI]ERS SECTION 6: LOCATION OF 571L!_.'~f Sh~7.-OFFS AT THIS UNIT 03~Y. B. ELECTRICAL: C. WATER: D. SPECIAL: ~. LOCX BOX: YES .'~};~ iF YES, LOCATIOX: ~Y VES, SiTE FEOOR ':"r':S :.:0 YES" ?',IS D S s'? '~'E2 "n.,., :'ERS "~ .... :':0 ..... '.'LO BAKERSFIELD CITY FIRE DEPARTMENT .. I.D. # FORM 4A-1 Page NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVI~--NTORY' BUSINESS NAME: {.~,~/ ~-~ ~r~/C~'- ~:~'~'- OWNER NAME: /~. F~J~/~.~'t /~/~.~-~/x~/?~.~'/' FACILITY UNIT ADDRESS:... ]~'D~) -/~--~f / ADDRESS: ~:~bD9 ~;/~,~,~r~ F~CILiTY UNIT NAME: CITY, ZIP: ~¢,~.~-~'~.~,e_/~J ~,~3~)/ .. CITY,ZIP: '_Y~,~_~YS~7~J~,~ ~-~/--~' ..- __oq PHONE #: ~?-] ~/'~ PHONE #: ~-~2-~ ~l OFFICIA~ USE CFIRS CoD-E 'ONLY 1 2-3 4 5 6 7 8 " 9 -' '1'0' TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D,O.T CODE AMQUNT AMOUNT UNIT CODE _C. 9DE FACILITY UNIT .W.T., ..... CHE.MI~AL OR COMMON NAM.E CODE GUIDE S GNATURE: <~~~" DATE: NAME: ~R$OI.~/ ~J)~X-$,' TITLE: ~F/,,~ffo EMERGENCY'CONTACT: ~O~ ~~i .~:23-5~-/)! TITLE: ~ PHONE # BUS HOURS: ~ AFTER BUS HRS:. EMERGENCY CONTACT: ~. p. ~~,~/~.z_~, TITLE: ~'q/'Yl.~_.~"' PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: ~O~- -O~A~ AFTER BUS HRS: iTE/F_~CI LIT¥ F O R.~<[. ~ D T_ z-XG ..5'7-' SCALE: BUSINESS :',:AY.E: , ~,/A,~ 7 DATE: j~ F;",.C iL lTV h~a:,'[E: (Cf{ECl( ONE) SITE / 1 i~lspe{:tor'~s CommellES): -OFFiCiAl, USE ONLY-