HomeMy WebLinkAboutBUSINESS PLANIIBEN AUTOMOTIVE
3951 SO. "H" STREET, SUITE A {
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
PERMIT ID # 015-021-002199 ~
B & N AUTOMOTIVES
LOCATION 3951
· This permit is issued for the followina:
[] Hazardous Materials Plan
FI Underground Storage of HazardOus Materials
[] Risk Management Program
[] Hazardous Waste On-Site Treatment
5304
Issued by:
Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SER VICES'
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 326-0576
Approved by:
Expiration Date:
June 30; 2003
Issue Date
usiness Name:
Business Address:
CUST
NO. ~ %o
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE
NEW ACCOUNT
ADDRESS CHANGE
CLOSE ACCT
FINANCE CHARGE I
OTHER ADJ ~
CUSTOMER NAME ~) ~. ~
MAILING ADDRESS ~-~)~1
SITE ADDRESS
STATE
ZIP CODE ~"~~
PARCEL NUMBER
(IF APPLICABLE)
ADJUSTMENT
CHG DATE
CHARGE CODE
ADJUSTMENT AMOUNT
CiTY OF BAKERSFIELD
~K=:.~.F.E~u,=.A~ ~3303-~0~'7
TO:
= N AUTQ~i. 0TTVES
3'=,'51 S H ST
=~ ...... -ITM D CA 9330~
DATE: 3/15/04
,,P~' ~S --ENVIRONMENTAL SERVICES
CHARGE
R~, ,4.¢M~=R DUE DATE TOTAL AMOUNT
HHO01
HMO!S
SSOOi
3/0i/04 ~EOlNNINg ~ALANCE
3/15/04 HAZ MAT FEE gROUP 1
STATE MANDATED FEE
3/i5/04 SM ~UANTITY HAZ WASTE gEN
THiS FEE IS FOR SMALL ~UANTiTY gENERATORS OF HAZARDOUS
WASTE.
5/i5/04 CA STATE SURCHARGE
· O0
84. O0
58. O0
24.00
ANNUAL HAZ-MAT BiLLiNg FOR FISCAL YEAR 7/01/03
THROUGH 6/30/04-iF RECEIVED iN ERROR CALL 326-3658
"URRENT
166.00
OVER 30 OVER 60 OVER 90
DUE DATE' 4/14/04 PAYMENT DUE' 166.00
TOTAL DUE' $i66.00
DATE: 3/15/04 DUE DATE: ',4/14/04'
CUSTOMER NO: 26245/43017 . .. TYPE:iEs ' ENVIRONMENTAL SER'VI%'k~'""'""'/i~'
REMIT AND MAKE CHECK PAYABLE TO:
CITY OF BAKERSFIELD
~AK~RSFIELD CA 93303-2057
(661) 326-36D8
TOTAL DUE:
$166.00
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
1. To avoid furtker action, retum/th~form within 30 da~f~)eceipt.
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.
5. You may als0 att~/ch Business own-er-/ope'rator F6rm and Chemibal DescriptiOn Form(s)
to the front of this plan instead of completing SECTION I. below for initial submission.
SECTION I: BUSINESS IDENTIFICATION DATA
BUSINESS NAME:
LOCATION: ~.~, t_JT~) H _~O COl 14-T h 14
MAILING ADDRESS: 3q,f l ~ o t4 S F -- ~ '
STATE: (" .~, ZIP:ql7o .6t- PHONE: ~_/,/,-Jff~-- 2-.2~_ 2_'
PRIMARY ACTIVITY:
MAILING ADDRESS:/--/. G~ O ? Z~, ~T/~. OO~-O>
EMERGENCY NOTIFICATION
CONTACT TITLE
BUS. PHONE
cHR. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1: DISCOVERY AND NOTIFICATIONS
Ao
LEAK DETECTION AND MONITORING PROCEDURES:
EMPLOYEE AND AGENCY NOTIFICATION:
Co
ENVIRONMENTAL RESPONSE MANAGEMENT:
Do
EMERGENCY MEDICAL PLAN:
(mc_.
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II.2: RELEASE RESPONSE PLAN
Ao
HAZARD ASSESSMENT AND PREVENTION MEASURES:
Bo
RELEASE CONTAINMENT AND/OR MITIGATION:
CLEAN-UP AND RECOVERY PROCEDURES:
UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACi-LITY)
NATURAL GAS/PROPANE:
WATER:
SPECIAL: ~k~ ,p~
LOCK BOX: YES~_~ IF YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
Ao
PRIVATE FIRE PROTECTION:
WATER AVAILABILITY (FIRE HYDRANT):
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
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.
SIGNATURE ~-'~ TITLE DATE
4
OF E OF ENVIRONMENTAL VICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER / OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page Of
BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As)
S~TE ADDRESS
104 i CA
Year Ending
BUSINESS PHONE ,02
~'6/- 3~7-
103
z,P ~ 3 ~ ~ ,o~
107
(4 Digit ~)
DUN & lo6 SIC CODE
BRADSTREET
COUNTY 108
OWNER MAILING'.,.
1,, OWNERPHONE ~61,- $??L&b~o ~:'
113
CONTACT MAILING. ~ 19
^DDRESS ¢&oqz.h /rrB ¢F
BUSINESS PHONE &~/ --JY2~ ~~T 126 BUSINESS PHONE
24-HOUR PHONE g &/' 7~7- ~0 127 24-HOUR PHONE 132
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined
and am familiar with the information submitted in this inventory and believe the information is true. accurate, and complete.
SIGNATURE OF OVVN~R/O~ERATOR
NAMES OF OWNER/OPERATOR (pdnt)
DATE ~34I NAME OF DOCUMENT PREPARER
)/---- i 5'----'
136 TITLE OF OWNER/OPERATOR
135
137 ~
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