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Home My WebLink AboutBUSINESS PLAN (2) Hazardous Materials/Hazardous Waste Unified Permit . CONDITIONS. OF PERMIT ON REVERSE SIDE Permit ID #:: 015-000-001490 HENLEYS PHOTO INC LOCATION: 2000 H ST ' · This oermit is issued for the follQwinq; El Hazardous Materials Plan E] Underground Storage of Hazardous Materials El Risk Management Program [3 Hazardous Waste On-Site Treatment IsSUed by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' i"~ 1715 Chester Ave., 3rd Floor ~Appmvedby: Bakersfield, CA 93301 Voice (661) 326-3979 " FAX (661) 326-0576 Expiration Date: · Ofl~c¢ of E'v-~ices'-.J · ~June 30; 2003 Issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-0214)01490 HENLEY'S PHOTO INC LOCATION 2000 H Issuedby: ......... ,,,,~ ,~:~,~?~,~,~,,~,~,~=~,,~,,~,~,,~,~ .......... This permit is issued for the following: ¢¢i~'??i'.:~i~,i:!i;'?:~*'"~:~::;iii iiiii!i!ii,~; ii,: iiliil i;;:::: i?,ii~:i~e:[ground Storage of Hazardous Materials -~ '~ ' ~ ~. ", h"h~' ~h~..h&~ .,~ ~ ,, ~'~"~',~ ~ ~' ~.-_" E'=':'... "{ h=.. ~i...[[ V...'"" .............. :~{~ ' . 'Jh~. ~ ~F' ,E ~ r~? ~ ~ ~' ,' = ~ ~, ~ ... :: '~'"-----:~ ~ ~:~' %'" :':~'~.,..7~ ;~' .?' .¢', '--. % ~' %: ........ ;~ ~ ~,;" ~ .... "'*.."~ ~ %/' cq', ",. '~,,i~ 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: Office of I~-~?¢ntal ServiCes Expiration Date: June 30, 2000 HENLEYS PHOTO INC Manager : Location: 2000 H ST City : BAKERSFIELD CommCode: BAKERSFIELD STATION 01 EPA Numb: CAL000082255 SiteID: 015-021-001490 BusPhone: (661) 324-9484 Map : 102 CommHaz : Minimal Grid: 25B FacUnits: 1 AOV: SIC Code:5946 DunnBrad:02-787-6093 Emergency Contact / Title THOMAS F BURCH / PRESIDENT Business Phone: (661) 324-9484x 24-Hour Phone : (661) 832-1439x Pager Phone : (661) 329-6599x Emergency Contact / Title PAUL J COOPER / VICE PRESIDENT Business Phone: (661) 324-9484x 24-Hour Phone : (661) 399-1986x Pager Phone : (661) 632-3264x Hazmat Hazards: React Contact : MailAddr: 2000 H ST City : BAKERSFIELD Phone: (661) 324-9484x State: CA Zip : 93301 Owner THOMAS BURCH Address : 2724 LAYTON DR City : BAKERSFIELD Phone: (661) 324-9484x State: CA Zip : 93309 Period : to TotalASTs: = Preparer: TotalUSTs: = Certif'd: RSs: No Gal Gal Emergency Directives: THIS IS A WASTE TREATMENT SITE AND REQUIRES A JOINT INSPECTION. ENV SVCS TO SCHEDULE THIS ~INSPECTION WITH HOWARD WINES. PLEASE CALL ~ Hazmat Inventory --Alphabetical Order One Unified List Ail Materials at Site Hazmat Common Name... SpecHazlEPA HazardsI Frm DailyMax IUnitlMCP WASTE DEVELOPER R L -8.00 GAL Min . ~ nc,)reby cedify that I~ hays reviewed the a[tached h~ardous ' rna.~enats 01/30/2003 HENLEYS PHOTO INC SiteID: 015-021-001490 Inventory Item 0001 Facility Unit: Fixed Containers at Site WASTE DEVELOPER Days On Site PHOTOGRAPHIC DEVELOPER WASTE 365 Location within this Facility Unit Map: Grid: SE CORNER OF B/W DARK RM CAS# STATE ~ TYPE Liquid /Waste PRESSURE Ambient TEMPERATURE IAmbient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8.00 GAL Daily Average 4.00 GAL %Wt. Silver HAZARDOUS COMPONENTS RNo~ CAS#7440224 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies R NFPA /// IUSDOT# Min 2 01/30/2003 F HENLEYS PHOTO INC SiteID: 015-021-001490 Fast Format = Notif./Evacuation/Medical --Agency Notification LOCAL FIRE DEPT,TELEPHONE NUMBER 911. Overall Site 11/lO/1998 -- Employee Notif./Evacuation BY VOICE OVER TELEPHONE PAGING SYSTEM. Ol/18/2ooo Public Notif./Evacuation BY VOICE OVER TELEPHONE PAGING SYSTEM. 01/18/2000 Emergency Medical Plan SAN JOAQUIN HOSPITAL EMERGENCY. 01/18/2000 -3- 01/30/2003 F HENLEYS PHOTO INC SiteID: 015-021-001490 Fast Format ~ Mitigation/Prevent/Abatemt --Release Prevention Overall Site 1/lO/1 s DIKING WITH ABSORBENT/OTHER MATERIAL. BERM IN STORAGE/WORK AREA(S). -- Release Containment -- Clean Up ii/iO/iSS8 ABSORBENT MATERIAL. DILUTE/FLUSH (ONLY THOSE CHEMICALS ACCEPTABLE TO THE SANITARY SEWER). LICENSE HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY. Other Resource Activation -4- 01/30/2003 F HENLEYS PHOTO INC SiteID: 015-021-001490 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - MID TO SE END OF BLDG IN ALLEY B) ELECTRICAL - MID BACK OF OUR BLDG IN ALLEY C) WATER - NE CORNER OF OUR BLDG D) SPECIAL - NONE E) LOCK BOX - NO o /18/2ooo -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 4 PORTABLE FIRE EXTINGUISHERS. oi/18/2ooo NEAREST FIRE HYDRANT - 20TH ST AT ALLEY BEHIND OUR STORE. Building Occupancy Level 01/30/2003 f HENLEYS PHOTO INC SiteID:' 015-021-001490 Fast Format Training -- Employee Training WE HAVE 17 EMPLOYEES AT THIS FACILITY. Overall Site 01/18/2000 WE DO HAVE MSDS SHEETS ON FILE. GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: SEMI SAFETY TRAINING. -- Page 2 Held for Future Use Held for Future Use -6'- 01/30/2003 FACIL1TY NAME ADDRESS FACILITY CONTACT ~SPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAI~I INSPECTION CHECKLIST 1715 Chester Ave., ya F]oor, Bakersfield, CA 93301 INSPECTION DATE ./J- oZ~ -. cf;L- PHONE NO. ~'//~ j_ ? q BUSINESS ID NO. 15-210- /q NUMBER OF EMPLOYEES section 1: Business Plan and Inventory Program /~ Routine Combined 1~ Joint ~ Multi-Agency ~ Complaint [21 Agency Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials !/ Verification of quantities Verification of location Proper segregation of material if Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Site Diagram Adequate & On Hand J [~ No Any hazardous waste on site?: ~i Yes Explain: g").x, fat:=., e- d~.~/ ~.Z.g-~'''=- O~ Questions regarding this inspection? Please call us at (66 I) 3,26-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy /'-' B~siness 'site~esponsiglq~Party Inspector: 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 May 3, 2001 Mr. Thomas Burch Henley's Photo, Inc. 2000 H Street Bakersfield, Ca 93301 Dear Mr. Burch: 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 shin-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 HENLEY'S PHOTO INC Manager : Location: 2000 H ST City : BAKERSFIELD CommCode: BAKERSFIELD STATION 01 EPA Numb: CAL000082255 SiteID: 215-000-001490 BusPhone: Map : 102 Grid: 25B (805) 324-9484 CommHaz : Minimal FacUnits: 1 AOV: SIC Code:5946 DunnBrad:02-787-6093 Emergency Contact THOMAS F BURCH Business Phone: '24-Hour Phone : Pager Phone : / Title / PRESIDENT (805) 324-9484x (805) 832-1439x (805) 329-6599x Emergency Contact PAUL J COOPER Business Phone: 24-Hour Phone : Pager Phone : / Title / VICE PRESIDENT (805) 324~9484x (805) s~a-4~aax ~:/-I~ (805) 632-3264x Hazmat Hazards: React Contact : MailAddr: 2000 H ST City : BAKERSFIELD Phone: (805) 324-9484x State: CA Zip : 93301 Owner THOMAS BURCH Address : 2724 LAYTON DR City : BAKERSFIELD Phone: (805) 324-9484x State: CA Zip : 93309 Period : to TotalASTs: = Preparer: TotalUSTs: = Certif'd: RSs: No Gal Gal Emergency Directives.: THIS IS A WASTE TREATMENT SITE AND REQUIRES A JOINT INSPECTION. ENV SVCS TO SCHEDULE THIS INSPECTION WITH HOWARD WINES. PLEASE CALL = Hazmat Inventory --MCP+DailyMax Order Hazmat Common Name... WASTE DEVELOPER ISpecHaz I EPA HazardsI R One Unified List Ail Materials at Site Frm I DailyMax Iunit'MCP L 8.00 GAL Min i,--r-~mA._% FT~uf~_. Do hereby certify ~ha~ ~ hav~ ~y~ or print reviewed ~he a~ached h~ardous materials mere plan ~or~~~ ~ ~nd ~hm i~ along ~i~h (Na~ of any corr~ons consfi~u~ ~ ~mP~ ~nd co~m~ m~n- a§ernsr~ plsr~ for m7 ~cili~,. 12/20/1999 HENLEY'S PHOTO INC = Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME WASTE DEVELOPER PHOTOGRAPHIC DEVELOPER WASTE Location within this Facility Unit SE CORNER OF B/W DARK RM SiteID: 215-000-001490 Facility Unit: Fixed Containers at Site Map: Grid: Days On Site 365 CAS# STATE TYPE PRESSURE Ambient Waste Liquid TEMPERATURE Ambient CONTAINERTYPE DRUM/BARREL-NONMETAL Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8.00 GAL Daily Average 4.00 GAL %Wt. Silver HAZARDOUS COMPONENTS N 7440224 HAZARD ASSESSMENTS I Radi°active/Am°unt I EPA HazardsINo/ CuriesR NFPA /// USDOT# MCP Min -12- 12/20/1999 HENLEY'S PHOTO INC SiteID: 215-000-001490 Fast Format = Notif./Evacuation/Medical --Agency Notification LOCAL FIRE DEPT TELEPHONE NUMBER 911. Overall Site 11/10/1998 Employee Notif./Evacuation 11/10/1998 HOW ARE YOU GOIN~ TO NOTIFY YOUR EMPLOYEES TO EVACUATE????????????? Public Notif./Evacuation 11/10/1998 HOW ARE YOU GOING TO NOTIFY THE PUBLIC INSIDE YOUR FACILITY TO EVACUATE????? Emergency Medical Plan 11/10/1998 WHAT MEDICAL FACILITY ARE YOU GOING TO GO TO FOR MEDICAL ATTENTION? ? ? ? ? ? ? ? ? -3- 12/20/1999 HENLEY'S PHOTO INC SiteID: 215-000-001490 Fast.Format ~ Mitigation/Prevent/Abatemt --Release Prevention Overall Site 11/10/1998 DIKING WITH ABSORBENT/OTHER MATERIAL. BERM IN STORAGE/WORK AREA(S). --Release Containment -- Clean Up 11/10/1998 ABSORBENT MATERIAL. DILUTE/FLUSH (ONLY THOSE CHEMICALS ACCEPTABLE TO THE SANITARY SEWER). LICENSE HAZARDOUS ~%STE TREATMENT, STORAGE, AND DISPOSAL COMPANY. Other Resource Activation -4- 12/20/1999 HENLEY'S PHOTO INC SiteID: 215-000-001490 Fast Format Site Emergency Factors Special Hazards Overall Site .1 -- Utility Shut-Offs A) GAS - ~ ~VL~ C) WATER - ~0~ D) SPECI~- E) LOCK BOX - PLEASE LIST THE LOCATION OF ALL OF YOUR UTILITY SHUF-OFFS. 11/10/1998 -- Fire Protec./Avail. Water WHAT DO YOU HAVE IN PLACE FOR PRIVATE FIRE PROTECTION - ?????????? (IE. FIRE EXTINGUISHERS OR SPRINKLERED BLDG) GIVE THE LOCATION OF YOUR NEAREST FIRE HYDRANT - ??????????? 11/10/1998 Building Occupancy Level -5- 12/20/1999 HENLEY'S PHOTO INC siteID: 215-000-001490 Fast Format Training -- Employee Training Overall Site 11/10/1998 HOW MANY EMPLOYEES DO YOU HAVE AT THIS FACILITY????????????? l~ Do YOU HAVE MSDS SHEETS ON FILE?????????????? y~£ GIVE a BRIEF sUMMARy OF YOUR TRAINING PROGRAM: ~dgA4{ ~u%L ~~-~-[-~4'~' Page 2 -- Held for Future Use Held for Future Use 12/20/1999 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 1. To avoid further action, return this form within 30 days ofrecei 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 l' BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAIl.lNG ADDRESS: PRIMARY ACTMTY: DUN & BRADSTREET NUMBER: M~mtNG ADDRESS:~'7~4-& S~C~[ON 2: ~G~NC~ NO~ICA~[ON O ~ -? %~7- (-:'o93 sic CODE: CONTACT l.Tb, TITLE BUS. PHONE 24-,I-IR. PHONE.. HAZA~OUS MATERI/~LS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER. OF EMPLOYEES: MATERI~ 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 HAZAKDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMIJM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5:-CERTIFICATION I ..... --~q/~m~--~ F- ~ ~~ , 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 ~ s~-~r¥ COD~." ON Z-~Z~,WOUS MA:mmALs (rev. 20 cz-re'TEa 6.95 SEC. 25500 ET AL.) a~rD THaT XNACCta~TE INVOV, MATION CONSTITUTES PEaJU~Y. CITY OF BAKERS LD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per material per building or area) ~ ADD [] DELETE [] REVISE 200 Page __ of __ "i:' i. :' ".' i. FACILITY INFORMATION ::i" '"" ' .i i'/.i' ::'~' .. FACILITY NAME or DBA - Doing Business As) 3 BUSINESS NAME.,~.~_~j(.Same as(.. ~"~ ~";'"/ t,~ 201 CHEMICAL LOCATION [] Yes [] No 202 CONFIDENTIAL (EPCRA) 203 GRID # (optional) 204 II CHEMICAL INFORMATION 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME ~'~([~ 'C.)"'~ F/f~h~.,~'*~ S' ,-J'l~ ~-~'~ If Subj~ to EPC~, cef~ to iinstru~ions;i 207 COMMON NAME EHS* ~ Yes ~ No 208 CAS ~ 209 lbs.~ EHS is'V~', a, am~n~ b~~ m ~:~ FIRE CODE H~RD C~SSES (Complete if r~u~t~ by I~1 fire ~i~ 210 ~PE ~ p PURE ~ m MIXTURE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 CURIES 213 PHYSICAL STATE ~ s SOLID ~1 LIQUID ~ g ~S 214 ~RGESTCO~AINER ~ 215 FED H~RD CATEGORIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE D 4 ACUTE H~LTH ~ 5 CHRONIC H~LTH 216 (Ch~ alt that apply) 217 ~IMUM DAILY AMOUNT ANNUAL WASTE ~ 218 AVERAGE AMOUNT (~ DALLY AMOUNT STATE WASTE CODE 220 UNITS' ~ ga GAL [] cf CU FT I.~-] lb LBS [] tn TONS 221 DAYS ON SITE 222 * If EHS, amount must be in lbs. *'~- ~'- STORAGE CONTAINER [] a ABOVEGROUND TANK ~e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM ' [] m GLASS BO'I-rLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BO'i-rLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o ~ TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 226 230 234 238 :::_ .. PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE 227 [] Yes [] No 228 231 []Yes []No 232 235 [] Yes [] No 236 239 [] Yes [] No 240 243 [] Yes [] No 244 cAs #. : . 229 233 237 241 1 245 SIGNATURE DATE 246 DES FORM 2731 (7/98) P:~OES2731.TV4.wpd SPILL RES~NSE PLANS For: Henley' s~, Photo Inc.? .... 200,0 H ~_t. Bakersfield, CA 93301 Facility Primary Contact: _(Name of Manag..e~.l, .. To.TM _BUr_ch: P re sideD t ~' P, aul.,.Copper. Vice__~res. Chemical Spill Reporting and Nofificatior In the event of a spill the following photolab perSonnel will be contacted Tom Burch President : _.,~ _= ............. _ __., and ? ~u ]:£lCxaOp~'~:~o-~? ro_.~ .... "'.' iL:.:'~ :.'., :,. to determine the best method of spill response and mitigation. Emergen.cy Assistance For emergency health, safety, and environmental assistance for Eastman Kodak Company products call (716) 722-5151. (See BUSINESS EMF~G~CY RESPONSE', PLAN) Local Fire Department Telephone Number 911 Protective F_,~uipment Review the product Material Safety Data Sheet{s) for the proper safety equipment requirements for perSonnel protection and controls, contact Eastman Kodak Company, Emergency Health, Safety, and Environmental Hot-Line for Kodak products at (716) 722-5151. 2 Small Spills, One liter or less of a photoprocessing solution would not constitute an emergency. For small spills, the immediate area should be evacuated and the spill should be mopped-up and/of flushed with cold water to a floor drain connected to an approved or permitted municipal sewer system. If there is no acct..ss to an approved municipal sewer system, the spill should be mopped-up, absorbed a~ad containerized for off-site disposal according to Federal, State, and local regulations. For large spills, immediately evacuate the ;affected area and notify the designated personnel responsible for spill response and mitigation. In most cases the procedures listed under 'small spills' apply, however, if you have a spill of a chemical concentrate, the spill may require neutralization (pH adjustmenO prior to management of the waste. F_,MF~RGF. NCY RFSPONSE PLAN Date: I. Buslne~LIV_rormatiou Business Name Address Zip Code Parcel Number Owner: Hame Address City BusinessHome Phone Phone Responsible Party/Responsible O_verator,q'echnleal Resourte Address Zip Code Business Phone Home Phone :2 H. REPORTING AND NOTIFICATION A. On-site Notification (describe,, the chain of notifications) 0 Decision Ma.kef: This person has the authority to make decision regarding the classification of the release and determine the appropriate response. Department/Telephone Position Internal Hazardous Materials Response Team Notification Procedures: This depends on the size of your operation. The response team may range from one person who knows how to clean-up a spill to a fully equipped team. Alarm Public Address System Telephone Voice List proe~ures for notification of employees who could be exposed to haTardous conditions by release. Public Address, System [ ] Telephone [~] Voice List procedures for notifying neighboring residence, businesses, schools, etc. which can be affected by a release. Document list of those to be notified. Public Addres:~ System [~,,1 Telephone voice Designate an individual who will perform the notification: ~IGHBOR NOT[FICATION LIST Address Telephone Contact Person e Address I ~ / ? /4 ~, 7-- Telephone ~..~. i --- z'!~-}'O0 Contact Person /4-g/~/~,~" e Address Telephone Contact Person Name ~ A- S C~ Address /(~ ~/~ ~-~ ~---~--~ ~'r-'- Telephone ~ E. Y - (~ :.~.~'_~ Contact Per,on ~..D/z,~O e Nme Address Telephone Contact Person 4 F_~fERGENCY RF_~PONSE NUMBERS Ambulance Service County Hazardous Material (24 hours) Fire Department Medical Facility (nearest hospital) Sheriff Departm~t State Highway Patrol STATE AGENCY NUMBE~ State Office of Emergency Services State Department of Toxic Substances Control State Department of Fmvkonme:atal Protection Environmental Protection Agency (EPA) National Response Center 1,800-424-8802 OTFIER IMPORTANVl' NUMBERS IVIITIGATION CResponse. Clean-Up. Recove~l List of Emergency Responze Equipment [~1 [1 Telephone Broom Mop and Pail Fire Extinguisher Ab~orben! Material (Vermicul[ite, Kitty Litter, Rice, Hull, Ash, Sand) Shovel and Pail Water Hose Decontamination Shower Eyewash Fountain Personnel Protective F-quipment [~ Face Shields, Safety Goggles, Glasses [~'] Rubber Gloves [~] Rubber Boots [x/] Respirator [~] Protective Clothing [ ] O~her B. Containment Procedures [] 'Blocking drains Diking with nbsorbent/other material Bem in storage/work area(s) Other 6 Ce Clean-Up Procedures {] 11 l] Absorbent Material Evaporation Dilute/Flush (Only those chemicals acceptable to the Sanitary Sewer.) License Hazardous Waste Treatment, Storage, and Disposal Company Recycling Recycling Company Name Address. Zip Code Telephone EPA Number. List personnel who will give tl.~nlcal advice to off-site emergency responder (fire, police) in case of spill. [1 [] [] [] Manager Supervisor Other EVACUATION AO List l'roce~ures for Spreaalng t~e Alarm [ ] Alarm [ ] Public Address System [ I Telephone Voice Def'mefPost Evacuation Routes On your site diagram draw arrows or use the ftre evacuation routes showing the sz~e way out of the facility. Del'me Procedures for Accounttng for AU Employees and Visitors After Evacuation. On your site map designate a safe c~llection point for evacuees. Designate a responsible person to accoun! for them. 8 TRA~G PLANS AND PROCEDURES A written plan outlining the information to be used to train new employees and an annual review course for all employees. In CA this is a mandatory requirement see Chapter 6.95 for the California Health and Safety Code). Itis suggested that thc Business Emergency Plan be used in conjunction with the Material Safety Data Sheets for each chemical aa the core of this ~aining. Include proper handling, ~xf'ety, and p:rsonal protective procedures. Proof of training is also required;, a sign-off sheet stating the date, the names of the participating employees, and the material covered on that date will meet the requirements. Please submit a copy of the lesson, and where the proof of training can be reviewed with the Business Emergency Plan.