HomeMy WebLinkAboutBUSINESS PLAN (2)TU,NE~-'PS
LUBES-,
OSMOG
Service Makes the Difference
KEVIN McCALL
(805) 326-8250 1431 'N' Street
Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakers~
HA.. MAT. DIV,
HAZARDOUS MATERIALS MANAGEMENT PLAN
1. To avoid further action, return this 'form within 30 days of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be brief and concise as possible.
SECTION 1:
BUSINESS IDENTIFICATION DATA
BusINESS NAME'. ,~ t~ ,~L.(..._,..;, p'~ d.._
STATE:'¢~ ZIP: ~':~0/' PHONE:
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY:
SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
TITLE BUS. PHONE 24 HR. PHONE
;akersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION $:: TRAINING:
'..! ~ : :i ':':':.i ..:. ' :'~ ':.,, ~.. NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE: ~)
BRIEF SUMMARY OF TRAINING PROGRAM'
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OIE 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 HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. ,
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USEDTO
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 '
FD1590
Bakersfield Fire l~t.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
FaCility Unit Name:
SECTION 6:
AGENCY NOTIFICATION PROCEDURES:
NOTIFICATION AND EVACUATION PROCEDURES:
EMPLO"(EE NOTIFICATION AND EVACUATION:
PUBLIC EVACUATION:
p~o r~
EMERGENCY MEDICAL P~_AN:' E'}"~.C
~akerSfield Fire Dept.
Hazardous Materials DivisiOn
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7:' MITIGATION, PREVENTION AND ABATEMENT PLAN:
RELEASE PREVENTION STEPS:
RELEASE CONTAINMENT AND/OR MINIMIZATION: ~'~ f b ~". /
CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE:
SPECIAL:
LOCK BOX: yEses)
IF YES,. LOCATION:
SECTION 9:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
PRIVATE FIRE PROTECTION:
WATER, AVAILABILITY (FIRE HYDRANT): y/bO
4, FD159o
~ Farm and Agriculture ~ Standard BuE
LOCATION:
PHONE ~:
iness
CITY OF BAKERSFIELD
HAZARDOUS MATERIALS INVENTORY'
NON -. 'IRADE SECRET
ADDRESS: /~'~'~/ /~, ~ ~ ~".~,- ~.,
NAME OF THIS"'/FACILITY:
STANDARD IND.-CLASS CODE:
DUN AND BRADSTREET NUMBER/FEDERAL ID #
REFER TO INSTRUCTIONS FOR PROPER CODES
I 2 3 4 5 6 '[ 7 8 9 10 11 12 13 14
Trans Type Max Average Annual Measure # Days Cont Cont Cont Use Location Where % by Names of Mixture/Components
Code Co~e Amt Ami Amt Units!i on Site Type Pres's: Temp Code ^ &Stored in Facility let See Instructions.
'
Phlmteal and lt~lth ltazard C.A.a. ~ er Componant# 1 Nam~ }, CoA.a. lq'umb~r
k ail that apply) ::., Component # 2 Name & C.A.S. NUmber
~ Fire Hazard ~ audden Release ~ Reactivity !nnnediate layed .; .- ,...
Health , Health .~ h '.~' Component # 3 Name & C.A.S. Number
of Pressure ' ~ 'i
Physical and Health Hazard C.A.S. Nu=)er Component # 1 Name i~ C.A.S. Number
(Check all that apply)~
~Ftre Hazard [] Sudden Release 'L~ Reactivity I~nediate' yeti . ~,Component # 2 Name & C.A.S. Number
of Pressure :. ~ Health Health Component # 3 Name '& C.A.S. Number
Physical and Health Hazard C.A.S. Number .... Component # i Name & C.A.a, Number
(Check all that apply) ..~
· ~ of Pressure Health Health Component # 3 Name & C.A.S. Number
Physt,al and Health Ha,ard; C.Aoa. Number Componant# 1 H-n~, & C.A.a. NUmber
(Check all that apply) ;
.. . , Component # 2 Name & C.A.S. Number
~ Fire Hazard ~ Sudden Release [] Reactivity ~ i~nediate ~ Delayed .'
of Pressure Health Health Component # 3 Name & C'.A.S. Number
Nam~ ~itle , 24 Hr. Phone Name . : Title- 24 Hr Pho6~
,,, . '; ' .,. '
)
I certify under peanlty of law that I haver personally examined end am familiar with the infor~ation submitted in this and all attached documents and that based on my inquiry of those
tndtviduala responsible for obtaining the information. I believe that the submitted information ia true, ac~curate, and complete..'.
NI~E AND OFFICIAL TITLE OF OWNER/OFERATOR OR OWNER/OPERATOR'S AUTHORIZED REPRESENTATIVE SIGNATURE , ~.,, DATE 810NED