HomeMy WebLinkAboutHAZARDOUS WASTEBAKL: SFIELD CITY FIRE D I ARTMENT
HAZARDOUS MATERIALS DIVISION
17'15 CHESTER AVE.
BAKERSFIELD, CA. 93301
(805) 326-3979.
HAZARDOUS MATERIALS INVENTORY
RECEIVED
~.H~I 1 1994
HAZ. MAT. DIV.
FACILITY DESCRIPTION
CHECK IF BUSINESS IS A FARM
BUSINESS NAME
FACILITY NAME
SITE ADDRESS
CITY
NATURE OF BUSINESS'
[]
STATE
SIC CODE
DUN & BRADSTREET NUMBER
owNER/OPERATOR
MAILING ADDRESS
PHONE
STATE
ZIP ~,,.J,¢o f
NAME
BUSINESS PHONE
NAME
BUSINESS PHONE
EMERGENCY CONTACTS
TITLE kl&~ ¢-_~--~
24-HOUR PHONE ,¢
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TITLE 0 ~ n -~
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REGION¥ LEPC STA/~OARD F
BAKERSFIELD CI'i' FIRE DEPAI: MENT
HAZARDOUS MATERIALS INVENTORY Page_of__
.'. ~ CHEMICAL DESCRIPTION '
1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion{ ]
2) Common N~rne: 0~ ~ j
Check if chemical is a NON TRADE SECRET [ ]
3) DOT # (optional)
TRADE SECRET [ ]
Chemical Name:
AHM [ ] CAS #
4) PHYSICAL & HEALTH' PHYSICAL HEALTH
HAZARD CATEGORIES Fire ~ Reactive~X~ . Sudden Release of Pressure ['] Immediate Health (Acute) [] Delayed Health (Chronic)~..
s) WASTE CLASSIF,CATION (3-d g t code from DHS Form 8022) USE CODE i q -- e.-i
6) PHYSICAL STATE Solid [ ] Liquid .! ] Gas ~ Pure ~ Mixture [ ] Waste [ ]. Radioactive [ ]
Maximum Daily Amount:
Average Daily Amount:
Annual Amount:
Largest Size'Container:
# Days On Site
UNITS OF MEASURE
~bs [ ] gal [ ] ~3
curies
9) MIXTURE: List
the three most hazardous 1 )
chemical components or
any AHM compor~ents 2)
COMPONENT
8) STORAGE CODES
a) Container: ~
b) Pressure: ,,~ _,
c)/emperature:. ~.~j~, ·
M, J, J, A, S, O, N, D
CAS # % WT AHM
[]
[]
3) [ ]
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ]
Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET' [ ]
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION ,(3-digit code from DHS Form 8022) USE coDE
6) PHYSICAL STATE Solid [ ] ,Liquid [ ] Gas [ ] Pure [ ] 'Mixture [ ] Waste' [ ] -Radioactive [ ] ......
7) AMOUNT AND TIME AT FACIUTY
Maximum Dally Amount:
Average Daily Amount:
Annual Amount:
Largest Size Container:
# Days On Site
UNITS OF MEASURE 8) STORAGE CODES
lbs [ ] gal [ ] fl3 [ ] e) Container:
cudes [ ] b) Pressure:'
c) Temperature:
CircleW~ich Months: All Year, J, F, M, A, M, J, J, A, S.-O, N, D
9) MIXTURE: Ust
the three most hazardous
chemical components or
any AHM components
'*~ COMPONENT CAS # %WT * AHM
~) []
2) [ ]
3). [ ]
10) Location · ., ;;~
, cerbfy unOer penalty of law, mat'l have personally examined and am familiar with the infomafion submitted on this and all at~acheo c~ocuments. I believe th~
submitted information is t~ue, accurate, and complete. ..
PRINT Name & Title of Authorized Company Representative Signature Date
]usiness ~e,~ne __~
BAKERS ELD CITY FIRE DEP. TMENT
HAZARDOUS MATERIALS INVENM RY
Address
Page_of__
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New[ ] Addition [ ] Revision [ ] Deletion[ ] Check ifchemicalis a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH
HAZARD .CATEGORIES
PHYSICAL
Fire [ ] Reactive[ ] Sudden Release of Pressure [ ]
HEALTH
Immediate Health (ACute) [ ] Delayed Health (Chronic) [ ]
5) WASTE cLAssIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FAClUTY
Maximum Daily Amount:
Average Daily Amount:
Annual Amount:
Largest Size Container:
# Days On Site
UNITS OF MEASURE 8) STORAGE CODES
lbs [ ] gal [ ] ~3 [ ] a) Container:
cudes [ ] b) Pressure:
· . c) Temperature;
Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: list
the three most hazardous
chemical components or
any AHM components
COMPONENT CAS # %W'F AHM
~) []
2) [ ]
3) [ ]
10) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is aNON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: 3) DOT # (option-I)
ChemiceJ Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] ~quid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FACILITY
Maximum Daily Amount:
Average Daily Amount:
Annual Amount:
L~rgest Size Container:
# Days On Site
UNITS OF MEAsuRE
lbs [ ] geJ [ ] ft3 [ ]
curies [ ]
8) STORAGE CODES
a) Container:
b) Pressure:
c) Temperature:
Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: List
the three most haz,~rdous
chemicaJ components or
any AHM components
COMPONENT CAS # %WT AHM
~) []
2) []
[]
3) ,
10) Location
cer~fy under penalty of law, that I have personally examined and am familiar with the infometon submitted on this and all attached documents. I believe
submitted information is ~rue, accurate, and complete.
PRINT Name & Title of Authorized Company Representative Signature Date
BAKERSF LD CITY FIRE DEPAI ' MEN'T
HAZARDOUS. MATERIALS INVENTORY
Business Name · Address
Page_of_
CHEMICAL DEscRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision[ ]' Deletion[ ] Check if chemical is a NON TRADE SECRET [ ] TRADE sECRET
2) Common Name: ,3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] '
5) WASTE CLASSIFICATION .(3-digit code from OHS Form 8022) USE CODE
6) PHYSICAL STATE Solid ['] L/quid [ ] Gas { ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
AMOUNT AND TIME AT FAClU'P(
Maximum Daily Amount:
Average Daily Amount:
Annual Amount:
Largest Size'Container:
# Days On Site
UNITS OF MEASURE
~bs [] ga [] ~t3 []
curies [ ]
8) STORAGE CODES
a) Container:
b) Pressure:
c) Temperature:
Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, 0
9) MIXTURE: List
the three most hazardous
chemicaJ components or
any AHM components
COMPONENT CAS # %WT AHM
~) ( ]
2). I ]
3). [ ]
10) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ I Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET
2) Common Name: ' 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE cLAssIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] , Liquid [ ] ' Gas [ ] Pure [ ] Mixture [ ] Waste [ ] RadioactJve [ ]
7) AMOUNT AND TIME AT FACILITY
Maximum Daily Amount:
Average Daily Amount:
Annual Amount:
Largest Size Container:
# Days On Site
'UNITS OF MEASURE.
lbs [ ] ga/ [ ] ~t3 [ ]
curies [ ]
8) STORAGE COOES
a) Container:
b) Pressure:
c) Temperature:
Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: Ust
the three most hazardous
chemical components or
any AHM components
COMPONENT CAS # % WT AHM
~). []
"~) [ ]
3) [ ]
10) Location
cerbfy under penaiP/ of law, that I have personally eXamined and am' famifiar With the infomatJon submitted on this and all attached documents. I believe the
submitted informabon is l~ue, accurate, and complete.
PRINT Name & Title of Authorized Company Representative Signature Date
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
1715 CHESTER'.A~/E.~
BAKERSFIELD, CA. 93301
'HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
To avoid further action, return this form within 30 days of receipt.
'2¢PE/PRINT ANSWERS IN ENGLISH.
Answer the questions below for the business as a whole,
Be brief and concise as possible.
SECTION
BUSINESS NAME'
LOCATION:
MAILING ADDRESS'
BUSINESS IDENTIFICATION DATA
STATE: ~ ZiP:
DUN & BRADSTRE'ET NUMBER:
PRIMARY ACTIVITY: ,
OWNER: /~
MAILING ADDRESS:
SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE
BUS. PHONE
24 HR. PHONE
-. Bakersfield Fire Dept.
~azardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYEES: c~
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
/
SECT[ON 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 &
WEDO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTIFIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, 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 HAZARD~.US MATERIALS (DIV.. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND TR,~T
'.~.~.
INACCURATE INFORMATION.CONSTITUTES PERJURY.
SIGNATURE TITLE DATE.
Bakersfletcl Fire Dept.
" PIaZardous ~aterials Divisio~I
HAZARDOUS I~ATERIALS MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES'
Ao
AGENCY NOTIFICATION PROCEDURES:
~o~.~' ~ ~¢.
EMPLOYEE NOTIFICATION AND EVACUATION:
PUBLIC EVACUATION:
- Bakersfiel& Fire Dept.
Hazardous l-V~aterials Division.
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7:
MITIGATION, PREVENTION AND ABATEMENT PLAN:
AD
RELEASE. CONTAINMENT AND/OR MINIMIZATION: ·
CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACiLITY) : Ii
SPECIAL' '~,~ ,..,. O.j
LOCK BOX: YES/NO IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FtRE PROTECTION: ~7.-,..e. ~:~'"~,~,,Z~e,~$
'B. WATER AVAILABILITY (FIRE HYDRANT): '
Utilities General Account Maintenance 02/28/94 PUTLS801
Acct Nbr: 765801 Bill stat: NO
Cyc Stat: CL Acct Cyc Stat:'CL
Transfer-from:
Trans fer-to:
Page 1 of 6
Due: 268.00
2.
4. Service Address: 1420 N ST
5. Service City: BAKERSFIELD
8. Parcel ID:
9. Bill Cycle: 5
10. Route Nbr: .1
11. Comments :
12. Prev Acct: HM00391
13. Service Date: 09/17/92
14. Fund no:
15. Billto Adl:SAM LEE
16. Billto'Ad2:P.O. BOX 40786
17. Bill-to City:
Customer Name: EVERGREEN RECYCLING (COORS)
Social Sec Nbr: 3. Telephone: 805-325-3508
6. State: CA
20. Water Svc Class:
7. Zip: 93301
23. Misc Services: 23.1 Fl3 HAZ MAT HANDLING
·23.3
23.4
24. Closing Date:
BAKERSFIELD 18. State:' CA 19. Zip: 93384
Enter SaVe(S), Cancel(XX), Next Page(/), or Field # to Change XX
02/28/94
-~V~XCX~ RE CYC-~;G 1( COOR~ 215-000-000391
· Overall Site with .I Fac. Unit
Page
General Information
Location: 1490~ ST Map:103 Haz:3 Type: 1
Community: COUNTY STATION 66 G~id: 30C F/U: 1 AOV: 0.0
Contact Namq Title Business Phone 24-Hour Phone-
....... BoO 4-e.e- ~ MANAGER (805) 325-3508 x (
x (
~A-'-3'-~ O~o OWNER (805) ~~
Admin~strative~ta
Mail Addrs: . . {z~ ,~ ', ~-~-~.~ D&B Number: ,~ 031742~
City: ~AKERS~iELD ok State: CA Zip: ~-~o~
Co~ Code: 215-066 COUNTY STATION 66 SIC Code:~n
........ OWner~~ ~ ~ - ~ Phone: (805) ~
Address: -P.O. DOX ~078~ {~o ~" ~~ State: CA
City: BAXERSriELD ~,~'~(~ Zip:
Sugary 7&~
CHANGED N~E FROM COORS RECYCLING
--~~o~.~.~ hereby
reviewed the attached hazardous matorials manage-
ment plan ,or~ that it a~ong with
any corrections constitute s ~mpiete and corm~ man-
agement plan for my facili~.
Rce e g Co.
2101 White Lane Mailing Address:
Bakersfield, CA 93304 P.O. Box 40786
(805)834-2363 Bakersfield, CA 93384
January 14, 1994
Ralph Huey
Hazardous Materials Division
Attached with this letter is our bill for our yearly
HaZardous Materials Handling Fee. ~vergreen Recycling.no longer
operates a business or handles Hazardous Mater~.als at 1420 "N"st.
However the ne~ company that is doing business at 1420 "N" st does
handle Hazardous Materials. Evergreen Recycling so].d all rights
to the business to Ne~ World Recycling on September ~, 1992.
Evergreen Recyolin.,z is in no way affiliated ~ith New World Recyc-
ling so I would Appreciate it if you would start billimg them
~at their adress of '1~+20 'NU st.
EVERgREEN/COORS RECYCLING
BAKERSFIE~,.CA~._ 9_3304__ __ ~