HomeMy WebLinkAboutBUSINESS PLAN
SERV
VALLEY
PUMPING
UNIT
ICES, INC.
P. O. Box 70832 · Bakersfield, CA 93387 · (805) 589.8322
January 29, 1992
CITY OF BAKERSFIELD
2130 "G" Street
Bakersfield, CA 93301
RE: HAZARDOUS MATERIALS FEE
To Whom It May Concern:
On September 30, 1991, we moved our offices to 12700 Rosedale HWY,
Bakersfield, California 93312. Therefore, effective October 1, 1991,
our new address is as stated above.
Should you have any questions, please call our office at (805)589-8322.
Sincerely,
Alice Newton
AN/lm
CITY-OF BAKERSFIELD '- *
P.O. BOX 2057
, BAKERSF!ELD,";~A~!FORNIA 93303-2057
ADDRESS CORRECTION REQUESTED ' DO NOT FORWARD
' ' .I ' 201 MT VERNON AVE
'J '. EIAKERSFIELD. CA 9:3307
V'ICES Hl~2 0 0.1.
BAKER~I:ID
Ci~fY FIRE DEPAHfMbNi
~ 2130 "G' STREET ~
BAKERSFIELD, CA. 9330-I
(805) 326-3979
OFFICIAL USE ONLY
' ID #
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
INSTRUCTIONS;
.RECEIVED
,JUN Z t i959
HAZ, MAT, OIV.
1. To avoid further action, return this from within 30 days of receipt.
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 o ,
B. LOCATION / STREET ApDRESS: 'dO~~/
SECTZON ~; EMERGENCY NOTZFZOATZON8
Zn case o¢ an emergency involving ~he release or ~hrea~ened- release
a'hazardous material, call 911 and 1-800-852-7550 or 1-918-427-4341. This
will no, iCy your local ¢ire depar~men~ and ~he S%a~e 0¢¢ice o¢ Emergency
Services as required by law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAME AND TITLF o DURING BUS. HRS. AFTER BUS. HRS.
SECTION 3; LOCATION OF UTILITY sHuT-oFFS FOR BUSINESS AS A WHOLE
A. NATURAL GAS/PROPANE;
B. ELECTRICAL'
C. WATER'
D. SPECIAL:
E. LOCK BOX:
YES /~IF YES, LOCATION'
IF YES, DOES IT CONTAIN SITE PLANS?
FLOOR PLANS?
YES / NO
YES / NO
MSDSS?
KEYS?
YES / NO
YES / NO
SECTION 4:
PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
SECTION 5:
LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
SEC T I Og1/)6t: T.~ EM p:E'(3¥ E E TRAINING
EHPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES
WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS
MATERIALS.
A. NUMBER OF EMPLOYEES AT THIS FACILITY
B, 'DO YOU HAVE MSDS (MATERIAL SAFeTY_DATA ·SHEETS) FOR EACH HAZARDOUS
MATERIAL. YOU HANDLE ? ,.
c. GIVE A' BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM:
SECTION 7: 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 AND SAFETY
CODE FOR THE FOLLOWING. REASONS:
WE DO NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, ~UT THE QUANTITIES AT NO
TIME EXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 8:~ CERTIFICATION
I, ~I~ ~/ecJ'1~' -- , certify that the above information is
accurate. I ~nderstand that this information will be used to fulfill my
firm's obligations under the new California Health and Safety code on
Et Al,) and that
Hazardous'Materi~ls (Div. 20 Chapter 6.95 Sec. 25500
inaccurate infoCnation constitutes perjury.
SIGNATURE TITLE
DATE
2130 'G' STREET
BAKERSFIELD, CA. 93301
(805) 326-3979
OFFICIAL USE ONLY
77-..D/?yOy2.
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 3A
INSTRUCTIONS
1. To avoid further action, %his form mus~ be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible
FACILITY UNIT ~ FACILITY UNIT NAME:~
SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES
SECTION 2:
NOT[FICAT][ON 'AND EVACUATION PROCEDURES AT THE UNIT ONLY
~ECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this Facility Unit contain Hazardous Materials? ......
YES NO
If Yes, ~ee B. :
If NO, continue with SECTION 4
~%any of the hazardous materials a bona fide' Trade
If NO,, complete a separate Hazardous materials i
form ~'arked- NON-TRADE SECRETS ONLY (white
If YES complete a hazardous materials invert'
TRADE RETS ONLY (Yellow form ¢4a-2).in
secret ~, List only the trade secrets
ret?
Y
form marked-
YES NO
tion to the non-trade
form 4A-2.
SECTION 4' PRIVATE
rECTION
SECTION"5:'
LOCATION OF
(Fire Hydrant)
UPPLY
SECTION 6:
LOCATION OF UT
NATURAL GAS/PROPANE:"
)FFS AT THIS' UNIT ONLY,
B. ELECTRICAL'
'4. ,
C. WATER:
D. SPECIAL:
E. LOCK BOX:
YES / NO IF YES, LOCATION:
IF YES, SITE PLANS? 'YES / NO
FLOOR PLANS? .YES'/ NO
MSDSs?
EYS?
"YES / NO
YES / NO
- 3B -
CITY of BAKERSFIELD
CTTY, ZIP: j~~(~.(~o ~,~,)'~ DUN AND BRADSTREET NUHBER
~ ~ 3 4 5 6 T
~rnns Ty~ ~x Avenqe ~nual ~asu~ I ~ .Cmt ~t Cmt he L~att~ N~e tN~~ N~ of
C~e C~e ~t ~t Est Units m S~te Ty~ ~ l~ C~e ..' Stor~ ~n Fac~11ty ~ Inst~ct~ms
Ntxtuq/~tl
Ph~ical and Health Hazard C.l.S.
/C*k .11 t~t apply)
~ Fire Hazard ~--, Reactivity a~ ~
Health of ff~sure flNIth ..... . .....
ical ~d H~lth Hazard ~ r A c ~. - ' ...........
HHitN ..... , of P~ H~lth .............
P~i~al ~d H~lth Hazard
~C~k ah t~t apply)
~--~ F~e Haz4ed ~--~ Reactivity ~ ~ ~la~ ~--~ ~ddm RelHse
Health
,--~
_L_ __L .:_ ._ ~_1._~_ _
p~ic~l ~ H~lth Hazard C I S Num~ CM~M~ tI U~ t ~ I · U.~. ' / ~'
t~K a11 t~t apply) - ·
-- r--~ ~--~ ~--~ -- C~t
~-~ F~ee Hazaed ~--~ Reactivity ~--~ ~1~ ~--~
Hflith of hflsure Health .............. ~ ................... , ...... ~ ..................
~.~-,~,~ ,,.~_~~ ................... ~.~ ,~,~_~~~ ......... ,; ,,__ ........
,. ~ ................... .~i:~'~-;- ~¢~j~_.~ ..... ; ~:x~ '
Certification (Reed and siKn after compJetSnR aZ] sec£ions)
I certify under Nnalty of law that I have ~ersonaltyexamined and am familiar with th~ information su~it~ in this a~ ell Ittac~ d~ts, ~d t~t ~s~ m ~ inqui~ of t~e i~ivi~als r~sible
(or ob~ni]glt~ mfor~U~, t ~lieve t~t~ su~itt~ info~ti~ is true accurate, and cmpJete4/~]~ ·
~FSi~ ..........................
CITY of BAKERSFIELD
NO N-- 'I.'RAD E . S E'C R E TS
BT'SI'HESS HAME: ~dl/~ll~d~ ,~,,~ ~i~'~. OHHE. HAME: HAME 0~' T~""~$ F'ACIT'ITY: ~-..
CITY, ZIP: d~l~)~erS~(~(l ,C,~1-. - ~'J]~7' CITY, ziP: - ' . . DUN AND BRADSTREET NUHBER '. '
(~e ~we , ~t ~ Est ~its m Site I~ ~ Il ~ .. St~ In FKiltty~- ~ I~t~tt~ ·
P~icil ~ NNIth ~ll~ C A S. ~ Wt II ~ & C.A.S. i
Hazard ~--~ ~ttvf~y [ I--Ih him L--" IMtite
~lth of P~ Mlth ...........
Wt 83 ~&C.A.S. ~
..... L_.J ............ 1 .............. 1 .......... l .... I__LI_,,~LJ,~ ,_:
P~ic~l ~ ~lth Hlll~ C.A.S. ~ ~t Il ~ & C.A.S. ~
~--~ ~t ~ ~&C.A.$.~
~lth of ~ ~lth
..... L.I L .......... L I I I I I I .,, [, , ...... ...... ·
..... ~t ~ ~ $ C.A.S. ~
P~*c,I ~ ~lth ~8~ C.A.S. ~ ~t Il h i C.A.S. ~
(C~k ii1 t~t ~ly) ,_
H~lth of Pr~sure ~lth
.... : ..... ' ...... :2.: · ....
.... .,r~ ,
~[ertfficatto~ (Read and sign after coaplet]ing all sections/
i certtfv trade penalty of 1~ t~t I. ~ve Wrs~all examn~ ~ ii fNiliir vtth t~ tnf~mti~ su~itt~ tn thts ~ttK~ ~ts; ~ tbt hs~ m ~ i~t~ of t~e i~tvtMll
for obtamm~dnf~Mttm.d ~l~eve t~t ~ su~ttK mfo~ti~ *s t~. accurate. ~d c~le[e, m/ iJ
,.~..a , ~.~, ~, ~ ~,,'s,~ ....... '
' ..... ~"~ .... ~"7'~ .... ['i~[~"}~"[B~{~{l~[ Si~{3~[ .........................................