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Home My WebLink AboutBUSINESS PLAN 8/3/2004 MBP PLAN MAP BUSINESS NAME: CHEVRON STATION #98109 FACILITY D!AGRAM ~ NORTH, NAME OF AREA: FAClLITY'AS A WHO~,E Oak. Street #98109 Manager : Location: 1131 OAK ST' City : BAKERSFIELD CommCode: BAKERSFIELD STATION 03 EPA Numb: SiteID: 015-021-000183 BusPhone: (661) 324-7621 Map : 102 CommHaz : Low Grid: 35B FacUnits: 1 AOV: SIC Code: DunnBrad:09-140-0559 Emergency Contact / Title INFO CENTER / STAFF Business Phone: (800) 231-0623x 24-Hour Phone : (800) 231-0623x Pager Phone : ( ) - x Emergency Contact / Title MAINT DISPATCH / STAFF Business Phone: (800) 423-6911x 24-Hour Phone : (800) '423-6911x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : MailAddr: 1131 OAK ST City : BAKERSFIELD phOne: '(661) 324-7621x State: CA Zip : 93304 Owner CHEVRON PRODUCTS COMPANY Address : PO BOX 6004 City : SAN RAMON phOne: (925) 842-9002x State: CA Zip : 945,83 Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency ,~D~rect ives: ' ' (Type or print name) reviewed the attached hazardous materials m~n~®- (?,,J"i(~VY'~ .... .and ~h~ it ~lc~rl~ ~h ment plan for - (N~e of B~) any corre~ions cons[~u~s a comPls~ 8nd ~rr~ men- agement plan for. my facility. -1- 08/02/2004 CITY OF BAKERSFIELD SYMBOL LEGEND GAS ELECTRIC WATER SPRINKLER FIRE DEPT. CONNECTION FIRE HYDRANT- PUBLIC FIRE HYDRANT- PRIVATE AUTOMATIC SPRINKLER BUILDING OR AREA FIRE ALARM MATERIAL SAFETY DATA SHEET STORAGE EVACUATION AREA FENCE ALL TYPES) INDICATE HEIGHT GATE IN FENCE" STANDARD DOOR UNDERGROUND STORAGE TANKS - LIST CAPACITY' ABOVEGROUND STORAGE TANKS. RAILROAD TRACKS PESTICIDE STORAGE AREA TYPES' OF HAZARDOUS MATERIALS FLAMMABLE ~ LIQUID CORROSIVE ~ SOLID WATER REACTIVE ~GAS EXPLOSIVE RADIOLOGICAL WASTE POISON EXAMPLE: FLAMMABLE LIQUID EXPLOSIVE GAS: Bal(e,rstiel(:l, L;alltOrnia, unitect 3tates oLendco CA 93~0~ 'Omi 0.~' 0.4' 1' '1,2 ITE DIAGRAM X :UII ¥ UI-I~ARI:I'(~b!I::LU HMBP PLAN MAP BuSIN EsS NAME: :CHEVRON STATION #98t09 FACILITY D!AGRAMi / ':,' NORTH ! ........... Yen Cheng. Restaurant Pa[king LOt:: NAME OF ·AREA·: :FACILITY AS~ A.WHQ. gE Oak:Street CITY :OF BAKERSFIELD :SYMBOL LEGEND GAS ELECTRIC WATER :SPRINKLER: FIRE DEPT. CONNECTION' 'FIRE HYDRANT - PUBLIC: FIRE: HYDRANT-PRIVATE AUTOMATIC SPRINKLER .BUILDING OR AREA .FIRE ALARM MATERIAL SAFETY DATA SHEET STORAGE EVACUATION AREA 10K ~ FENCE(ALL TYPES) .INDICATE' HEIGHT" GATE IN FENCE STANDARD DOOR UNDERGROUND STORAGE TANKS - LIST CAPACITY ABOVEGROUND STORAGE: TANKS RAILROAD TRACKS PESTICIDE .... STORAGE AREA ~PES'OF HAZARDOUS'MATERIALS FLAMMABLE: LIQUID ~ CORROSlVE ~': SOLID :WATER REACTIVE ~GAS EXPLOSIVE ~ RADIOLOGICAL WASTE :~ POISO'N EXAMPLE: FLAMMABLE ~ LIQUID EXPLOSIVE GAlS.. ~ IIII illlllllllllllI II T T3E~ / F,~.C I '1'. T "17¥ F O l~I~f 5 D ~'~G SCALE: BUSINESS NAME: DATE:~ / ~"/F7 FACILITY NAME: FLOOR:. ! OF / UNIT ~ ~: OF (CHECK ONE) SITE DIAGRAM FACILITY D I AGR.a~M Inspector's Comments): -OFFICIAL USE ONLY- SITE DIAGRA~ (Requi }l~eaa) 1. Address: Identify ~e principle buildings by the Street numbers. Street(si, Allays, Driveways, and Parking Areas adjacent to the property. Include the street names. 3. Storm Drains, Culverts, Yard Drains 4. Drainage Canals. Ditches. Creeks, 5. Buildings a. Frame construction b.'Masonry construction c. Metal construction . . d. Access Door 6. Uti-lily Controls' a. Gas b. Electricity c. Water ?. Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkl;~ Connections c. Fire Standpipe Connections d. Water Control Valves for protection s~teea e. Fire Pu~p 8. Flee Oepa~taent Access 9. Lock (key)'Box IO. NSDS Storage-Box lt. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry 'c, Wood d. Gates 13. Powerllnes 14. Guard Station 15. Storage Tanks: Identify the capacity In gal. a. Above'g~ound b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area: Identify the location where employees will 19. Outside Hazardous Waste Storage lO. Outside llazardous Material Storage 21. Outs/d~ Hazardous Material Use/Randllng 22. Type of Hazardous Material/Masts ~tored or Used (See i~mlow) TYPE OF HAZARDOUS MATERIA~ F - Flammable g - ~xplosive L - Liquid C - Corrosive 0 - Oxidizer G - Gas M - Water Reactive .T - Toxic 9 - Solid D - Waste B - Etiological Exaaple: Flauable Liquid - FL FACILITY DIAGRA~ (Required items in addition to the above) 1: Risers for Sprinklers Partitions Stairways: Indicate the levels served from highest to lowest. Escalator: Indicate the levels served from highest to lowest. 5. Elevator 6. Attic Access 7. Skylights R - Radlologlcal P - Poison H · Cryogenic 8. Fire Escapes g. Alu Conditioning Units IO. Windows il. Inside Hazardous Waste Storage 12. Inside Hazardous Materials Storage 13. Inside Hazardous Materials Uae/Handling 14.'Sewer Drain Inlets ITE/FACI LITY FORM D I AG RAM NORTH SCALE: BUSINESS NAME: FACILITY NAME: (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM top s Comments): -OFFICIAL USE ONLY- - SA - SITE DIAGRAM (Requ items) Address: Identi principle buildings by the Street numbers. Street(s), Alleys, Driveways, and Parking Areas adjacent to the property. Include the street names. 3 Storm Drains, Culverts, Yard Drains 4 Drainage Canals, Ditches, Creeks, Bnildings a. Frame construction b, Masonry construction Metal construction d. Access Door 6 Utility Controls a. Gas b. Electricity c, Water Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkler Connections c. Fire Standpipe Connections d. Water Control Valves for protection systems e. Fire Pump 8. Fire Department Access 9. Lock (key) Box 10. MSDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d. Gates 13. Power] ines 14. Guard Station 15. Storage Tanks: Identify the capacity In gal. a. Above ground b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area: Identify the location where employees will meet. 19'. Outside Haza_rdous Waste Storage~ 20. Outside Hazardous Material Storage 21. Outside Hazardous Material Use/Handling 22. Type of'Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOU~ MATERIAL F = Flammable E = Explosive L = Liquid C = Corrosive 0 ='Oxidizer 0 = Gas - W = Water Reactive T = Toxic S = Solid D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAGP~ (Required items in addition to the above) 1. Risers for Sprinklers 8. 2. Partitions 9. 3, Stairways: Indicate the 10. levels served from highest to lowest. 11. 4. Escalator: Indicate the levels served from lZ. highest to lowest. 13. 5. Elevator 6. Attic Access 14. R = Radlologlcal P = Poison H = Cryogenic Fire Escapes Air Conditioning Units Windows Inside Hazardous Waste Storage Inside Hazardous Materials Storage Inside Hazardous Materials Use/Handling Sewer Drain Inlets ~HEVRON #98109 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: CHEVRON #98109' Cross Street : Business Type: Org Type: Total Tanks : 4 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : MAINT DISPATCH Phone: Address: City : Type : Name : MAINT DISPATCH Address: City : Type : State: Zip: TANK OWNER INFORMATION Phone: State: Zip: SiteID: 015-021-000183 (800) 423-6911x (800) 423-6911x BOE UST Fee# : 031913 Financ'l Resp: SELF INSURED Legal Notif : Tank Owner Mailing Address Date:04/12/2000 Phone: (805) 986-5527x Name:HAL OREAR Ttl:ESH SPECIALIST State UST # : 1998 Upg Cert#: 00712 -2- '08/02/2004 CHEVRON #98109 ~ Hazmat Inventory --MCP+DailyMax Order Hazmat Common Name... UNLEADED PLUS GASOLINE UNLEADED GASOLINE SUPREME GASOLINE DIESEL FUEL #2 MOTOR OIL CARBON DIOXIDE SiteID: 015-021-000183 By Facility Unit Fixed Containers on Site' ~ ]SpooHazlEPA HazardsI Frm DailyMax [UnitlMcP F IH DH, L F IH DH L F IH DH L F IH DH L F DH L F P IH G 10000 00 GAL Mod 10000 00 GAL' Mod 10000 00 GAL Mod 10000 00 GAL Low 200 00 GAL Min 163 00 FT3 Min -3- 08/02/2004 ~HEVRON #98109 SiteID: 015-021-000183 Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit MaP: Grid:· 20' WEST OF MINI MART CAS# 8006-61-9 F STATE T TYPE PRESSURE Liquid Mixture Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10'000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 5000'00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTs RN~oRs CAS#8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH / / / Mod Ag.Definedl: Ag.Defined5: Ag. Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag. Defined6: Ag. Defined9: Ag.Defined4: Ag.Defined7: Ag.Definel0: -4- 08/02/2004 CHEVRON #98109 SiteID: 015r021-000183 ~ Inventory Item 0001 Facility ~Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: 20' WEST OF MINI MART TANK DESCRIPTION Tank ID#: 1 Mfr: OWENS CORNING Compart Tank: N Installed: 07/1985 Capacity: 10000 Gals 'No. Of Comparts:~ Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: PREMIUM UNLEADED Marl Name:UNLEADED PLUS GASOLINE Cas~ #: 8006-61-9 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1996 Alarm : Exempt: No Drop Tube : 1998 Ball Float : Striker Plate: 1998 Sgl Wa~l: Fill Tube~S/0:1998 TANK LEAK DETECTION Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: ~ Was Filled: 'No -5- 08/02/2004 ~HEVRON #98109 SiteID: 015-021-000183 Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B'and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : AO. SMITH Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : UnderGround Piping AUTOMATIC LEAK DETECTORS PIPING LEAK DETECTION' AboveGround Piping Installed: 02/01/1996 Date: 04/12/2000 Name:HAL OREAR Prmt Number: 0183 TANK/LINE TEST :08/17/1994 CP CERT. : MANWAY INSP. :09/28/1900 UST MONIT. CERT:08/15/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:ESH SPECIALIST Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED STORAGE CONTAINER DATA (UST' FORM C) Installer Certified by tank/piping manufacturer: Yes Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes .Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/12/2000 Name:HAL OREAR Ttl:ESH SPECIALIST -6- 08/02/2004 CHEVRON #98109. ~ Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within, this Facility Unit 20' WEST OF MINI MART SiteID: 015-021-000183 Facility Unit: Fixed Containers on Site Map: Grid: · Days On Site 365 CAS#. 8006-61-9 ~ TYPE ~LiquidSTATE ~Mixture PRESSURE Ambient TEMPERATURE CONTAINER TYPE ~ Ambient I UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 6000.00 GAL 100.00 Gasoline HAZARDOUS COMPONENTS HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# Mod Ag.Definedl: Ag.Defined5: Ag.Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Definel0: ? o /o /2oo,4 ~HEVRON #98109 SiteID: 015-021-000183 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: ~ Location In Site: 20' WEST OF MINI MART TANK DESCRIPTION Tank ID#: 2 Mfr: OWENS CORNING' Compart Tank: N Installed: 07/1985 Capacity: 10000 Gals No. Of Comparts: Additional Info: Tajk Use: MOTOR VEHICLE FUEL Marl Name:UNLEADED GASOLINE TANK CONTENTS Petrol Type: UNLEADED PLUS/MIDGRADE Cas #: 8006-61-9 TANK CONSTRUCTION Installed: Installed: : : Fill Tube S/O: 1998 TANK LEAK DETECTION Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED PLASTIC Spill Cnt : 1996 Alarm Drop Tube : 1998 Ball Float Striker Plate: 1998 Sgl Wall: Exempt: No Dbl Wall: INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -8-. 08/02/200' ~HEVRON #98109 SiteID: 015'-021-000183 Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const:'DOUBLE WALL Mfgr : AO SMITH Mti : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/01/1996 Date: 04/12/2000 Name:HAL OREAR Prmt Number: 0183 TANK/LINE TEST :08/17/1994 CP,CERT. : MANWAY INSP. :09/28/1900 UST MONIT. CERT:08/15/2003 DISPENSER CONTAINMENT Type: DISP.. P.AN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:ESH SPECIALIST Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: yes Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/12/2000 Name:HAL OREAR Ttl:ESH SPECIALIST -9- 08/02/20.04 CHEVRON #98109 SiteID: 015-021-000183 -- Inventory Item 0004 Facility Unit: Fixed Containers on Site SUPREME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: 20' WEST OF MINI MART CAS# 8006-61-9 FSTATE ~ TYPE Liquid/Mixture PRESSURE Ambient TEMPERATURE IAmbient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 6000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS RNo~' CAS#8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/. Curies F IH DH NFPA I USDOT# I MCP / / / Mod Ag.Definedl: Ag.Defined5: Ag:Defined8: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag.Defined3: Ag.Defined6: Ag.Defined9: Ag.Defined4: Ag.Defined7: Ag.Definel0: -10- 08/02/2004 ~HEVRON#98109 SiteID: 015-021-000183 Inventory Item 0004 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED)Page 1 of 2 Last Action Type: Location In Site: 20' WEST OF MINI MART TANK DESCRIPTION Tank ID#: 3 Mfr: OWENS CORNING Installed: 07/1985 Capacity: 10000 Gals Additional Info: Tank Use: MOTOR VEHICLE FUEL Marl Name:SUPREME GASOLINE Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED compart Tank: N No. Of Comparts: TANK CONTENTS Petrol Type: REGULAR UNLEADED Cas #: TANK CONSTRUCTION 8006-61-9 Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1996 Alarm : Exempt: No Drop Tube : 1998 Ball Float : Striker Plate: 1998 Fill Tube S/O: 1998 TANK LEAK DETECTION Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -11- 08/02/2004 ~HEVRON #98109 SiteID: 015-021-000183 Inventory Item 0004 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : AO SMITH Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/01/1996 Date: 04/12/2000 Name:HAL OREAR Prmt Number: 0183 TANK/LINE TEST :08/17/1994 CP CERT. : MANWAY INSP. :09/28/1900 UST MONIT. CERT:08/15/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:ESH SPECIALST Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: Yes Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/12/2000 Name:HAL OREAR Ttl:ESH SPECIALST -12- 08/02/2004 CHEVRON #98109 = Inventory Item 00051 -- COMMON NAME / CHEMICAL NAME DIESEL FUEL #2 Location within this Facility Unit 20' WEST OF MINI MART siteID: 015-021-000183 Facility Unit: Fixed COntainers on Site Map: Grid:. Days On Site 365 CAS# 68476-34-6 F STATE I TYPE PRESSURE Liquid .Mixture Ambient TEMPERATURE IAmbient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 4500.00 GAL HAZARDOUS COMPONENTS %Wt. I 100.00 Diesel_ Fuel No. 2 ' N 68476302 HAZARD ASSESSMENTS IRadioactive/Amount EPA Hazards I No/ Curies F IH DH NFPA /// USDOT# I MCP Low Ag.Definedl: Ag. Defined5: Ag. Defined8: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined6: Ag-.Defined9: Ag.Defined4: Ag. Defined7: Ag.Definel0: -13- 08/02/2004 f'~HEVRON #98109 SiteID: 015-021-000183 = Inventory Item 0005 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last ACtion Type: Location In Site: 20' WEST OF MINI MART TANK DESCRIPTION/ Tank ID#: 4 Mfr: OWENS CORNING Installed: 07/1985 Capacity: Additional Info: Tank Use: MOTOR VEHICLE FUEL Marl Name:DIESEL FUEL #2 Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED 10000 Gals Compart Tank: N No. Of Comparts: TANK CONTENTS Petrol Type: DIESEL Cas #: TANK CONSTRUCTION Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1996 Alarm : Drop Tube : 1998 Ball Float : Striker Plate: 1998 Fill Tube S/O: 1998 TANK LEAK DETECTION Sgl Wall: 68476-34-6 Exempt: No Dbl Wall: INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -14- 08/02/2004 ~HEvRON #98109 SiteID: 015-021-000183 Inventory Item 0005 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type .: PRESSURE Const: DOUBLE WALL Mfgr : AO SMITH Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/01/1996 · Date: 04/12/2000 Name:HAL OREAR Prmt Number: 0183 TANK/LINE TEST :08/17/1994 CP CERT. : MANWAY INSP. :09/28/1900 UST MONIT. CERT:08/15/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:ESH SPECIALIST Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: Yes Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes~ · Approved Alternate methods: Date: 04/12/2000 Name:HAL OREAR Ttl:ESH SPECIALIST -15- 08/02/2004 CHEVRON #98109 ~ Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit WEST SIDE OF LOT SiteID: 015-021-000183 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# STATE ~ TYPE Liquid/Mixture PRESSURE Ambient TEMPERATURE. Ambient CONTAINER. TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 200.00 GAL Daily Average 50.00 GAL I%Wt. 100.00 HAZARDOUS COMPONENTS Motor Oil, Petroleum Based 8020835 .TSecretNo N~SIBi°HaZNo HAZARD ASSESSMENTS Radioactive/Amount I EPA Hazards No/ CuriesI F DH NFPA/// I USDOT# Min ' Ag.Definedl: Ag.Defined5: Ag.Defined8: -'Ag. Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag.Defined3: Ag. Defined6: Ag.Defined4: Ag. Defined7: Ag.Defined9: Ag. Definel0: -16- 08/02/2004 ,% CHEVRON #98109 siteID: 015-02.1-000183 = Inventory Item 0006 Facility Unit: Fixed Containers on Site CARBON DIOXIDE Days'On Site 365 LocatiOn within this Facility Unit Map' 'Grid: STORAGE AREA UNDER CANDY COUNTER CAS# 124-38-9 F STATE ~ TYPE Gas /Pure PRE S SURE TEMPERATURE A/Dove Ambient I Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container 163.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 163.00 FT3 Daily Average I 82.0o FT3 100.00 Carbon Dioxide HAZARDOUS COMPONENTS. TSecret No HAZARD ASSESSMENTS RS BioHazI Radioactive/Amount I EPA Hazards No , No No/ Curies F P IH NFPA/// I USDOT# Min Ag.Definedl: Ag. Defined5: Ag.Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag. Defined3: Ag. Defined6: Ag.Definedg: Ag.Defined4: Ag.Defined7: Ag.Definel0: -17- 08/02/2004 06/10/2003 13:44 FAX 877795t · ~ DESK 001 FAX TO: County of Kern CUPA Ralph E. Huey Director of the office of Environmental Service Fire Department Phone 661-G26.3979 Pax 661-326-0576 J Date 6/10/2003 I Nurnber of pages includin(t cover sheet I FROM: Josephine Wong INCIDENT DESK Environmental Safety & Health Chevron Produc~s Company P. O. Box 6004 San Ramon, CA 94583-0904 Phone (925)842-0755 (877) 795-8400 -REMARKS: [] Urgent [] For your review [] Reply ASAP [] Please Comment Supreme Unleaded spill -06/07/2003 Chevron Station 98109 - 1131 Oak Street, Bakersfield, CA 93304 Customer was pumping gasoline, the nozzle that goes into the breakaway came unscrewed, the hose popped off and approximately 1 gallon of gasoline was spilled onto the pavement and onto customer. Employee cleaned up the gasoline with absorbent. Fire Department was notified. No gasoline went into storm drain. Please let me know if you have any additional questions. BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM I--I BUSINESS NAME Chevron Stations Inc. #98109 FACILITY NAME Chevron Stations Inc. #98109 SITE ADDRESS 1131 Oak Street CITY Bakersfield STATE NATURE OF BUSINESS Gasoline Station/Mini-Mart ZIP 93304 OWNER/OPERATOR Chevron Products Company MAILING ADDRESS P.O. Box 6004 City. San Ramon STATE CA. ZIP 94583 PHONE (661) 324-7621 NAME Chevron Emergency Information Center EMERGENCY CONTACTS TITLE Staff BUSINESS PHONE (800) 231-0623 24-HOUR PHONE (800)231-0623 NAME Chevron Maintenance Dispatch BUSINESS PHONE (800)423-6911 TITLE Staff 24-HOUR PHONE (800) 423-6911 BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS INVENTORY Page ! of 3 Business Name: Chevron Stations Inc. #98109 Address: 1131 Oak Street ' Bakersfield 93304 CHEMICAL 1) INVENTORY STATUS: New [] Addition I'1 Revision r-I Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Chevron Reaular Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 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 19 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECK ALL THAT APPLY 7) AMOUNT AND TIME AT FACILITY. UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] fl3 [] a) Container: 1 5000 curies [] b) Pressure: 1 unknown c) Temperature:~4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 10000 365 Circle Which Months: ~-~ Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# %WT AHM the three most hazardous 1 ) Methyl Tert Butyl Ether 1634-04-4 1..~5 [] chemical components or any 2) Toluene 108-88-3 <1 [] AHM components 3) Xvlene 1330-02-7 <1 [] 10) Location UST westside of station between restroom building and canopy CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Chevron Plus Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 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 19 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] ft3 [] a) Container: 1 5000 curies [] b) Pressure: 1 unknown c) Temperature: 4 10000 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 365 Circle Which Months: [] Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % w'r AHM the three most hazardous 1 ) Methyl Tert Butyl Ether 1634-04-4 1._~5 [] chemical components or any 2) Toluene 108-88-3 <~1 [] AHM components 3) Xvlene 1330-02-7 <1 [] Location UST. westside of station, between restroom buildin.q and canopy I certi~ under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and complete. Kathy Norris Compliance Marketing Assistant Print Name & Title of Authorized Company Signature Date BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS INVENTORY Page 2 of 3 Business Name Chevron Stations Inc. #9-8109 Address 1131 Oak St. Bakersfield 93304. CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check ifchemical is a NON TRADE SECRET I~ TRADE SECRET [] 2) Common Name: Chevron Supreme Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire I~ Reactive [] Sudden Release of Pressure [] Immediate Health (Acute) [] Delayed Health (Chronic) [] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 1.~9 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECKALL THATAPPLy 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] fl3 [] a) Container: 1 5000 cudes [] b) Pressure: 1 c) Temperature:~4 Maximum Daily Amount: Average Daily Amount: Annual Amount: unknown Largest Size Container: 10000 # Days On Site: 365 Circle Which Months: [] Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# %WT AHM the three most hazardous 1) Methyl Tert Butyl Ether 1634-04-4 1.~5 [] chemical components or any 2) Toluene 108-88-3 <..~1 [] AHM components 3) X¥1ene 1330-02-7 <1 [] 10) Location UST. west side of station, between restroom buildinR and canopy CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Diesel Fuel 3) DOT # (optional) 1203 Chemical Name: Diesel Fuel No. 2 AHM [] CAS # 68476-34-6 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Firel-I Reactive [] Sudden Release of Pressure [] Immediate Health (Acute) [] Delayed Health (Chronic) [] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 1._~9 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNTAND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] ft3 [] a) Container: 1 5000 cudes [] b) Pressure: 1 unknown c) Temperature: 4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: · # Days On Site: lOOOq 365 Circle Which Months: ~-~ Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List ' COMPONENT CAS # % WT AHM the three most hazardous 1) Diesel Fuel 68476-34-6 10._.Q0 [] chemical components or any 2) [] AHM components 3) [] Location Storaae area behind cooler, inside convenience store certify under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and complete. ,~.~~.~----- Kathy Norris Compliance Marketing Assistant _ Pdnt Name & Title of Authorized Company Signature Date BAKEP IELD CITY FIRE DEPAP ENT "'~,AZARDOUS MATERIALS INVENTORY 'Page 3 of 3 Business Name Chevron Stations Inc. #9-8109 Address 1131 Oak St. Bakersfield 93304 CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Carbon Dioxide 3) DOT # (optional) 1013 Chemical Name: Carbon Dioxide AHM [] CAS # 124-38-9 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 99-Pressurized Soda Fountain System 6) PHYSICAL STATE Solid I-I Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECK ALL THAT APPL¥ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 20 lbs [] gal [] ft3 [] a) Container: 03 10 cudes [] b) Pressure: 2 unknown c) Temperature:~4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 20 365 Circle Which Months: ~[[Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1 ) Carbon dioxide 124-38-9 10.._.Q0 [] chemical components or any 2) [] AHM components 3) [] 10) Location Storage area, under candy counter and inside restroom which is in the convenience store CHEMICAL 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 [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [] gal [] fi3 [] a) Container: Average Daily Amount: cudes [] b) Pressure: Annual Amount: c) Temperature: Largest Size Container; # Days On Site: Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [] chemical components or any 2) [] AHM components 3) [] Location certify under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and complete. Kathy Norris Compliance Marketing Assistant ~"~'-r~ i.~~'~ ""~ I-~° [ Print Name & Title of Authorized Company Si.~n~t~r~" ~"'~ - ~ Date BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 2. 3. 4. To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: Chevron Stations Inc. #98109 LOCATION: 1131 Oak Street Bakersfield MAILING ADDRESS: P.O. Box 6004 CITY: San Ramon STATE: CA DUN & BRADSTREET NUMBER: 09-140-0559 PRIMARY ACTIVITY: Gasoline Station/Mini-Mad OWNER: Chevron Products Company MAILING ADDRESS: P.O Box 6004 ZIP:94583 San Ramon 93304 PHONE: (661)324-7621 SiC CODE: 5541 CA. 94583 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE 1..Chevron Emergency Information Center Staff 2. Chevron Maintenance Staff BUS. PHONE (800) 231-0623 (800) 423-6911 24 HR. PHONE (800) 231-0623 (800) 423-6911 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: 1-8 MATERIAL SAFETY DATA SHEETS ON FILE: Yes BRIEF SUMMARY OF TRAINING PROGRAM: Training includes but is not limited to: a. Hazard Communication Program, written and audio/video program including MSDS review. b. HAZVVOPER, written and audio/video program--Awareness Level. ¢. At a minimum, all employees are trained initially (upon hire) and training is refreshed annually. 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 HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEEDTHE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: ! Kathy Norris 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 HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. Compliance Marketing Assistant SIGNATURE TITLE DATE Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: Chevron Stations Inc.#98109 SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: AGENCY NOTIFICATION PROCEDURES: a. In any incident that jeopardizes human health and safety: 1) Activate appropriate emergency shutoff; 2) Evacuate personnel from facility using safest routes available according to the situation; and 3) Go to an upwind area and maintain a safe distance. b. Coincident with evacuation, notify emergency response agencies by dialing 911 if incident represents an immediate threat. c. Deny entry to the area by anyone other than 911 emergency response personnel until area is declared safe. d. Standby to assist emergency response personnel. Any incident involving a fire, release, or threatened release of a hazardous material must also be reported to the Station Manager. The Station Manager will notify the CSI Territory Manager and Chevron Maintenance Dispatch immediately. Chevron Maintenance Dispatch will: 1) dispatch Company/Contractor assistance if necessary; and 2) notify Chevron Compliance Marketing Assistant for proper notification to regulatory agencies. EMPLOYEE NOTIFICATION AND EVACUATION: Notification will be accomplished verbally (shouting) and via the intercom system. PUBLIC EVACUATION: a. The Staff Duty Clerk will announce "There is an emergency. Please leave the Station on foot immediately." b. If evacuation from the area is deemed necessary, the neighboring properties listed below will be notified if possible. Hampton Inn Yen Cheng Restaurant Do EMERGENCY MEDICAL PLAN: MEDICAL FACILITIES: Mercy Medical Center Bakersfield Heart Hospital 2215 Truxtun Ave. 420 34th Street 632-5050 334-2784 ]0 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: a. Barriers installed to prevent vehicle collision with pumps. b. Vapor Recovery Systems used when filling underground tanks. c. Antilock nozzles on pumps. d. No sales to unauthorized containers. e "No Smoking" signs posted. Self-serve instructions posted. f. Monitoring Program implemented. g. Double walled tanks with leak detection system B. RELEASE CONTAINMENT AND/OR MINIMIZATION: a. Stop source of release as necessary and safe. If gasoline, stop source of release by activating emergency pump shutoff switch. b. Evacuate all nonessential personnel from area. c. Extinguish or remove all ignition sources. Use fire extinguisher if necessary. d. While using proper personal protective equipment, contain and absorb spill with inert absorbent. Avoid breathing gasoline vapors by approaching from upwind. C. CLEAN-UP PROCEDURES: a. Keep nonessential personnel away from area. b. Notify Chevron Maintenance Dispatch (800) 423-3528 for coordination with Hazardous Material Contractor to remove contaminated absorbent materials if required. c.. Materials involved in cleanup will be disposed of in accordance with all applicable Federal, State, and Local regulations. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: Natural Gas- North side of restroom building ELECTRICAL: Main: North side of store building, North side of .restroom building WATER: East side of site, meter in sidewalk SPECIAL: Ememencv Pump Shutoff- Cashier console and outside north wall of store building LOCK BOX: YES [] NO [] IF YES, LOCATION: ~,ECT!ON 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: PRIVATE FIRE PROTECTION: Fire extinguishers are kept throughout the facility. WATER AVAILABILITY (FIRE HYDRANT): A) On West side of Oak St., directly to the east of Chevron Station, in sidewalk ]! Chevron Chevron CERTIFIED MAIL Chevron Products Company P.O. Box 6004 San Ramon, CA 94583 July 30, 2001 Bakersfield City Fire Department Office of Environmental Services 1715 Chester Ave., 3rd Floor Bakersfield, CA 93304 K. L. Norris Environmental, Safety & Health Best Practice Team Operations Services Phone 925-842-5931 Dear Sir or Madam:' 'Re: CheVron 98109, 1131 Oak Street, Bakersfield, CA Enclosed are the foil. owing updated dOcuments for our Chevron Station listed above: UPCF UST-Facility (Formerly SWRCB Form A) UPCF UST-Tank (Formerly SWRCB Form B) UPCF UST-Installation (Formerly SWRCB Form C) UPCF Business Activities Underground Storage Tank Monitoring Plan UPCF Business Plan & Emergency Response Plan Consolidated Contingency~ Plan If you have any questions please give me a call at 925-842-5931. Sincerely, Kathy L. Norris Marketing Assistant Cc: Chevron Station - Please place this copy in your Compliance Workbook under section 7 Emergency Response Section. file HAZARDOUS MATERIAL BUSINESS PLAN (BUSINESS PLAN) CHEVRON RETAIL ENVIRONMENTAL, SAFETY AND HEALTH UST Agency: City of Bakersfield STEVE R THORNE, INC. CHEVRON STATIONS INC#1920 STEVEN R. THORNE,INC. CHEVRON STATIONS INC.1830 LUBE MANAGEMENT CORP CHEVRON STATIONS INC#1842 CHEVRON STATION INC 1857 CHEVRON STATIONS INC 1849 91536 3 Party 98109 Co-Op 997O2 3 Pa, rty 201527 Co-Op 201921 3 Party 203576 Co-Op 205673 Co-Op 206561 Co-Op 2700 OSWELL ST 1131 OAK ST · 5201 OLIVEDR 6601 MING AVE 6601 MING AVE 1125 COFFEE RD 13003 ROSEDALE HWY 3360 PANAMA LN BAKERSFIELD, CA 93306-2702 BAKERSFIELD, CA 93304-1063 BAKERSFIELD, CA 93308-2919 BAKERSFIELD, CA 93309-3446 BAKERSFIELD, CA 93309-3446 BAKERSFIELD, CA 93308-5747 BAKERSFIELD, CA 93312-0000 BAKERSFIELD, CA 93313-3695 (661) 871-1200 (661) 324-7621 (661) 399-9056 (661) 831-1270 (661) 588-9066 (661) 587-9593 (661) 396-7047 Chevron Chevron April 30, 2001 City of Bakersfield Fire Department 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 Chevron Products ComPany,. Inc. PO Box 6004 San Ramon; CA 94583-0904 Carmelita Garcia Licenses/Permits Specialist Phone. No. 925-842-9002 Fax No. 925-842-9585 RE: FINANCIAL RESPONSIBILITY FOR uNDERGROUND STORAGE TANKS Dear Sirs: Please find enclosed the following documents: 1) prOof of Financial Responsibility 2) Certificate of Financial Responsibility 3) Chevron Facility List under your jurisdiction These documents meet the financial responsibility requirements for all USTs owned by Chevron and have previously been submitted directly to the State. If you have any questions feel free to contact me. Sincerely, Carmelita P. Garcia Licenses/Permits Specialist Permit Desk Enclosure: as stated Chevron Chevron Corporation 575 Market Street San Francisco, CA 94105-~856 John S. Watson Vice, President, Finance April 23,2001 UST FINANCIAL ASSURANCE To Whom It May Concern: I am the Chief Financial Officer of Chevron Corporation, 575 Market Street, San Francisco, CA. This letter is in support of the use of the financial test of self-insurance and guarantee to demonstrate financial responsibility for taking corrective action and compensating third parties for bodily injury and property damage caused by sudden accidental releases and/or nonsudden accidental releases in the amount of at least $1,000,000.00 per occurrence and $2,000,000.00 annual aggregate arising from operating underground storage tanks. Underground storage tanks at the following facilities are assured by this financial test or a financial test under an authorized State program by this guarantor -- all underground storage tanks owned by Chevron U.S.A. Inc. in the United States are assured by this financial test. A financial test and guarantee are also used by this guarantor to demonstrate evidence of financial responsibility in the following amounts under other EPA regulations or state programs authorized by EPA under 40 CFR parts 27-1 and 145: EPA REGULATIONS AMouNT Closure ({}{}264.143 and 265.143) ' Post-Closure Care ({}{}264.145 and 265.145) Liability Coverage ({}{}264.147. and 265.147) Corrective ActiOn ({}264.101 (b)) Plugging and Abandonment ({} 144.63) $ 116,960,130.00 $ 56,990,555.00 $ 8,000,000.00 $ -0- 145631 / F:UULMk34DB01 !.DOC Califomia State Program Closure Post-Closure Care Liabil.ity Coverage Corrective Action Plugging and Abandonment Louisiana State Program Closure Post-Closure Care Liability Coverage Corrective Action Plugging and Abandonment Total 202.890.00 $ 719,850.00 $ 66.000.000.00 4,808,560.00 826,500.00 $ 1,000,000.00 $ -0- $ 255,508,485.00 This guarantor has' not received an adverse opinion, a disclaimer of opinion, or a "going concem" 'qualification from an independent auditor on his financial statements for the latest completed fiscal year. Page 2 of.4 ALTERNATWE II 1. Amount of annual UST aggregate coverage being assUred by a test and guarantee 2. Amount of corrective action, closUre and post-closmT, e 'care costs, liability coverage, and plugging and abandonment costs covered by a financial test and guarantee 3. Sum of lines 1 and 2 4. Total tangible assets 5. Total liabilities 6. Tangible net worth 7. Total assets in the U.S. 8. Is line 6 at least $10 million? 9. Is line 6 at least 6 times line 3? 10. Are least 90% of assets located in the U.S.? (If"No", complete line 11.) 11. Is'line 7 at least 6 times line 3'.9 12. cUrrent assets 13. Current liabilities 14. Net working capital (subtract line 13 from line 12). 15. Is line 14 at least 6 times line 3? 16. Current bond rating of most recent bond issue 17. Name of rating service 18. Date of maturity of bond $ 2,000.000.00 $ 255.508.485.00 $ 257,508,485.00 $ 41,116,000,000.00 $ 21,339.000,000.00 $ 19,777,000,000.00 $ 20,673,000.000.00 Yes No X X X X N/A $ N/A $ N/A $ N/A AA Standard & Poors October 1, 2004 Page 3 of 4 19. Have financial 'statements for the latest fiscal year been filed with the SEC, the Energy Information Administration, or the Rural Electrification Administration? Yes : No X · I hereby certify that the wording of this letter is identical to the wording specified in 40 CFR part 280.95(d) as such regulations were constituted on the date shown immediately below, 'except that information concerning California and Louisiana was added to make disclosUre more complete. Vice President, Finance April 23, 2001 page 4 of 4 GUARANTEE Guarantee made this April 23, 2001, by CHEVRON,CORPORATION, a business entity organized under the laws of the State of Delaware, herein referred to as guarantor, to Ep.A Regional Administrators and/or state agencies implementing underground storage tank regulation for the states listed in Paragraph 2 (hereinafter collectively referred to as the "implementing agencies").., and to any and all third parties, and obligees, on behalf of CHEVRON U.S.A. INC. ("CUSA"), of 575 Market Street, San Francisco, CA. RECITALS 1. Guarantor meets or exceeds the financial test criteria of 40 CFR 280.95(b) or (c) and (d) and agrees to comply with the requirements for guarantors as specified in 40 CFR 280.96(b). 2. CUSA owns or operates the following underground storage tanks covered by this guarantee, underground storage tanks at various facilities in the states of: Alaska Arizona California Florida Georgia Hawaii Louisiana Nevada Oregon Texas Utah Washington This guarantee satisfies 40 CFR part 280, subpart H requirements for assuring funding for taking corrective action and compensating third parties for bodily injury and property damage caused by either sudden accidental releases or nonsudden accidental releases or accidental releases arising from operating the above-identified underground storage tanks in the amount of $1,000,000.00 per occurrence and $2,000,000.00 annual aggregate. On behalf of our subsidiary, CUSA, guarantor guarantees to implementing agencies and to any and all third parties that: In the event that CUSA fails to provide alternative coverage within 60 days after receipt of a notice of cancellation of this guarantee and the Director of the implementing agency has determined or suspects that a release has occurred at an underground storage tank covered by this guarantee, the guarantor, upon instructions from the Director, shall fund a standby trust fund in accordance with the provisions of 40 CFR 280.108, in an amount not to exceed the coverage limits specified above. iix tile event that the Director determines that CUSA has failed to perform corrective action for releases arising out of the' operation of the above-identified tanks in accordance with 40 CFR 280; subpart F, the guarantor upon written instructions from the Director shall fund a' Page 1 of 3 7. standby trust in accordance with the provisions of 40 CFR 280.108, in an amount not to exceed the coverage limits specified above. ' If CUSA fails to satisfy a jiidgement or award based on a dete. rmination, of liability for bodily injury or property damage to third parties caused by sudden and/or nonsudden accidental releases arising from the operation of the above-identified tanks, or fails to pay an amount agreed to in settlement of a claim arising from or alleged to arise from such injury or damage, the guarantor, upon written instructions from the Director, shall fund a standby trust in accordance with the provisions of 40 CFR 280.108 to satisfy such judgement(s), award(s), or settlement agreement(s) up to the limits of coverage specified above. Guarantor. agrees that if, at the end of any fiscal year before cancellation of this guarantee, the guarantor fails to meet the financial test criteria of 40 CFR 280.95(b) or(c) and (d), guarantor shall send within 120 days of such failure, by certified mail, notice to CUSA. The guarantee will terminate 120 days from the date of receipt of the notice by CUSA, as evidenced by the 'remrn receipt. Guarantor agrees to notify CUSA by certified mail of a voluntary or involuntary proceeding under Title 11 (Bankruptcy), U.S. Code naming guarantor as debtor, within 10 day~ after commencement of the proceeding. Guarantor agrees to remain bound under this guarantee notwithstanding any modification or alteration of any obligation of CUSA pursuant to 40 CFR part 280. Guarantor agrees to remain bound under this guarantee for so long as CUSA must comply with the applicable financial responsibility requirements of 40 CFR part 280, subpart H for the above-identified tanks, except that guarantor may cancel this guarantee by sending notice by certified mail to CUSA, such cancellation to become effective no earlier than 120 days after receipt of such notice by CUSA, as evidenced by the remm receipt. 8. The guarantor's obligation does not apply t° any of the following: (a) Any obligation of cuSA under workers' compensation, disability benefits, or unemployment compensation law or other similar law; (b) (c) (d) Bodily injury to an employee of CUSA arising from, and in the course of, employment by CUSA; Bodily injury or property damage arising from the .owm:-ship, maintenance, use, or entrustment to others of any aircraft, motor vehicle, or watercraft; Property damage to any property 'owned, rented, loaned to, in the care, cUstody, or control of, or occupied by CUSA that is not the direct result of a release from a petroleum underground storage tank; Page.2 of 3 (e) Bodily damage or property damage for which CUSA 'is obligated to pay .damages by reason of the assumption of liability in a Contract or .agreement other than a contract or agreement entered into to meet the requirements of 40 CFR 280.93. 9. Guarantor expressly waives notice of acceptance of this guarantee by the implementing agency, by any or all third parties, or ~by CUSA. . : I hereby certify that the wording of this guarantee is identical to the wording specified in 40 CFR 280.96(c) as such regulations were constituted on the effective date shown immediately below. Effecti~,e date: April 23, 2001 CHEVRON CORPORATION By ('f~tn S. Watson 'Vice President, Finance By Assistant Secretary Page 3 of 3 CERTIFICATION OF FINANCIAL RESPONSIBILITY CHEVRON U.S.A. INC. hereby certifies that it is in. compliance with the requirements of subpart H of 40 CFR part 280. The financial assurance mechanism used to demonstrate financial responsibility under subpart H of 40 CFR part 280 is as follows: Corporate guarantee of Chevron Corporation in the amount of $1 million per occurrence, $2million annual aggregate, for the period commencing .April 18, 2001 and which is anticipated to be renewed annually, with the next renewal scheduled to occur during the' first 120 days of 2002. Said guarantee covers taking corrective action and compensating th/rd parties for'bodily injury and property damage caused by either sudden accidental releases or nonsudden' accidental releases or accidental releases. April 18, 2001 CHEVRON U.S.A. INC. By Counsel Judith L. Geisler Legal Analyst CUSA UST FINANCIAL RESPONSIBILITY April 23, 20.01 J. M. Bauer L. T. Brown J. P. Casey R. Cochran H. P. Davis Jr. K. J. Diaz A. G. Fredeluces C. P. Garcia (2 copies) M. Leong P. T. Liang* S. E. Merritt A. R. Mora D. A. Newell I. O. Ng W. C. Ishimoto J. M. Randall A. M. Rutter D. T. Sherman S. W. Strader ArizOna Dept. of Environmental Equality UST Section Attention Brian Kelley (replaced Jeff Schmidt) 3033 N Central Avenue Phoenix, AZ 85012 (602) 207-2214 April 30, 2001 RE: - CERTIFICATE OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND TANKS- To Whom It May Concern: Chevron Corporation hereby certifies that it is in compliance with the requirements of Underground Storage Tank financial responsibility regulations. This certificate covers all tanks in the States of California, Alaska, Arizona, Florida, Georgia, Hawaii, Louisiana, Nevada, New Mexico, Oregon, Texas, Utah and Washington owned by Chevron Corporation. The financial assurance mechanism used to demonstrate financial responsibility required under State and Federal regulations is as follows: Corporate guarantee of Chevron is the amount of $1Million per occurrence, $2 Million annual aggregate.. Said guarantee covers taking corrective action And compensating third parties for bodily injury and property damage caused By either sudden accidental releases and non sudden accidental releases or Accidental releases. This guarantee is renewed annually (within the first 120 days of the year): Copies of the renewed certificate and a complete list of the facilities are sent to the governing agencies yearly. Notarized by: Sincerely, By: ~a Licenses/Permits Specialist Susan R. Weber, Notary April 25, 2001 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 Mr. Mark Magargee, CHG, RG Holguin, Fahan & Associates 2820 Pegasus Drive, Suite 1 Bakersfield, CA 93308 RE: Work Plan for Chevron Station at 1131 Oak Street, Bakersfield, CA 93304 Dear Mr. Magargee: This is to notify you that the work plan for the above.stated address is satisfactory. Verbal aPproval to commence work was provided on February 15, 2001. Please be advised that any work' performed under direct oversight by this accepted, unless previously approved. done that is not office will not be If you have any questions, please call me at (661) 326-3979. Sincerely, Howard H. Wines, I1[ Hazardous Materials Specialist Office of Environmental .Services HHW/db S:~,PRIL 2001~1131 Oak St UST. L3. wpd CERTIFIED MAIL September 7, 2000 RECENED SEP 2 5 2000 Chevron Chevron / chevron Products Company P.O. Box 6004 San Ramon, CA 94583 K. L. Norris Environmental, Safety & Health Best Practice Team Operations Services · Phone 925-842-5931 San Diego County Health Services Dept. Environmental Health Protection PO Box 129261 San Diego, CA 92112-9261 ENVIRON-~ERV~CES RE: Hazardous Materials Business Plan , Dear Sir or Madame: Please find enclosed our Hazardous Materials Business Plan for our facility located at: Chevron 98109, 1131 Oak Street, Bakersfield, CA 93304 if you have any questions please feel free ~o contact me at 925-842-593 Sincerely, K.L. Norris Compliance MA Enclosures cc: Site Copy File HAZARDOUS MATERIAL BUSINESS PLAN (BUSINESS PLAN) CSI Station #98109 CHEVRON RETAIL ENVIRONMENTAL, SAFETY AND HEALTH BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 9330,1 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [--1 BUSINESS NAME Chevron Stations Inc. #98109 FACILITY NAME Chevron Stations Inc. #98109 SITE ADDRESS 1131 Oak Street CITY Bakersfield STATE NATURE OF BUSINESS Gasoline Station/MiniMart ~.,~Ju~c bb4 i CA ZIP 93304 DUN ~ i::Ji"~i)~ i Kri- i Og-iq'0-Obb9 OWNER/OPERATOR Chevron Products Company MAILING ADDRESS P.O. Box 6004 City San Ramon STATE CA. ZIP 94583 PHONE (661) 324-7621 NAME Chevron Emergency Information Center EMERGENCY CONTACTS TITLE Staff BUSINESS PHONE (800) 231-0623 24-HOUR PHONE (800)231-0623 NAME Chevron Maintenance Dispatch BUSINESS PHONE (800)_423-6911 TTI'LE Staff 24-HOUR PHONE (800) 423-6911 BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS INVENTORY Page ! of 3 Business Name: Chevron Stations Inc. ¢FJ8109 Address: 1131 Oak Street Bakersfield 93304 CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Chevron Regular Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 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 19 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECK ALL THAT APPLY 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] fl3 [] a) Container: 1 5000 curies [] b) Pressure: 1 unknown o) Temperature:.~4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 10000 365 Circle Which Months: ~Year, J, F, M,A, M, J, J,A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1 ) Methyl Tert Butyl Ether 1634-04-4 1._~5 [] chemical components or any 2) Toluene 108-88-3 <1 [] AHM components 3) Xylene 1330-02-7 <1 [] 10) Location UST, westside of station, between restroom building and canopy CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Chevron Plus Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 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 1._~9 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] ft3 [] a) Container: 1 5000 cudes [] b) Pressure: 1 unknown c) Temperature: 4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Countainer: # Days On Site: 10000 365 Cimle Which Months: ~Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) Methyl Ted Butyl Ether 1634-04-4 1~5 [] chemical components or any 2) Toluene 108-88-3 <__.~1 [] AHM components 3) Xvlene 1330-02-7 <__~1 [] I Location UST, westside of station, between restroom building and canopy I certify under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and complete. Kathy Norris Compliance Marketing Assistant Print Name & Title of Authorized Company Signature Date BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS INVENTORY Page 2_ of 3_ Business Name Chevron Stations Inc. #9-8109 Address 1131 Oak St. Bakersfield 93304 CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Chevron Supreme Unleaded Gasoline 3) DOT # (optional) 1203 Chemical Name: Gasoline AHM [] CAS # 8006-61-9 4) PH';'SICAL & 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 1~9 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECK ALL THAT APPLY 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] ft3 [] a) Container: 1 5000 cudes [] b) Pressure: 1 unknown c) Temperature:_~4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 10000 365 Circle Which Months: ~ Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) Methyl Tert Butyl Ether 1634-04-4 1._~5 [] chemical components or any 2) Toluene 108-68-3 <1 [] AHM components 3) Xylene 1330-62-7 <1 [] 10) Location UST, west side of station, between restroom building and canopy CHEMICAL 1) INVENTORY STATUS:' New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Diesel Fuel 3) DOT # (optional) 1203 Chemical Name: Diesel Fuel No. 2 AHM [] CAS # 68476-34-6 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 1_~9 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 10000 lbs [] gal [] ft3 [] a) Container: 1 5000 curies [] b) Pressure: 1 unknown c) Temperature: 4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 10000 365 Circle Which Months: ~Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) Diesel Fuel 68476-34-6 100 [] chemical components or any 2) [] AHM components 3) [] Location Storage area behind cooler, inside convenience store I certify under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and comPlete. Kathy Nords Compliance Marketing Assistant Print Name & Title of Authorized Company Signature Date BAKE ]i FIELD CITY FIRE DEPA T[MENT '~'I-IAZARDOUS MATERIALs INVENTORY Page 3 of 3 Business Name Chevron Stations Inc. ~-8109 Address 1131 Oak St. Bakersfield 93304 CHEMICAL 1) INVENTORY STATUS: New [] Addition [] Revision [] Deletion [] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [] 2) Common Name: Carbon Dioxide 3) DOT # (optional) 1013 Chemical Name: Carbo~ Dioxide AHM [] CAS # 124-38-9 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 99-Pressurized Soda Fountain System 6) PHYSICAL STATE Solid [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] CHECK ALL TYA T APPLY 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES 20 lbs [] gal [] £t3 [] a) Container: 03 10 curies [] b) Pressure: 2 unknown c) Temperature:__4 Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site: 20 365 Circle Which Months: ~ Year, J, F. M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# %WT AHM the three most hazardous 1 ) Carbon dioxide 124-38-9 100 [] chemical components or any 2) [] AHM components 3) _ [] 10) Location Storage area, under candy counter and inside restroom which is in the convenience store CHEMICAL 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 [] Liquid [] Gas [] Pure [] Mixture [] Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [] gal [] ft3 [] a) Container: Average Daily Amount: curies [] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site: Cimle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [] chemical components or any 2) [] AHM components 3) [] Location certify under penalty of law, that I have personally examined and am familiar with the information submitted on this and all attached documents. I believe the submitted information is true, accurate, and complete. Kathy Nords Compliance Marketing Assistant Print Name & Title of Authorized Company Signature Date 5 BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: Chevron Stations Inc. #98109 LOCATION: 1131 Oak Street Bakersfield 93304 MAILING ADDRESS: P.O. Box 6004 :CITY: San Ramon STATE: CA DUN & BRADSTREET NUMBER: 09-140-0559 PRIMARY ACTIVITY: Gasoline Station/Mini-Mart OWNER: Chevron Products Company MAILING ADDRESS: P.O Box 6004 ZIP:94583 San Ramon PHONE: (661)324~7621 SIC CODE: 5541 CA. 94583 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE 1. Chevron Emergency Information Center Staff 2. Chevron Maintenance Staff BUS. PHONE (800) 231-0623 (800) 423-6911 24 HR. PHONE (800)231-0623 (800) 423-6911 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: 1-8 MATERIAL SAFETY DATA SHEETS ON FILE: Yes BRIEF SUMMARY OF TRAINING PROGRAM: Training includes but is not limited to: a. Hazard Communication Program, written and audio/video program including MSDS review. b. HAZWOPER, written and audio/video program--Awareness Level. c. At a minimum, all employees are trained initially (upon hire) and training is refreshed annually. 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 HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEEDTHE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: Kathy Norris 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 HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. Compliance Marketing Assistant SIGNATURE TITLE DATE Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: Chevron Stations Inc.#98109 SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: AGENCY NOTIFICATION PROCEDURES: a. In any incident that jeopardizes human health and safety: 1) Activate appropriate emergency shutoff; 2) Evacuate personnel from facility using safest routes available according to the situation; and 3) Go to an upwind area and maintain a safe distance. b. Coincident with evacuation, notify emergency response agencies by dialing 911 if incident represents an immediate threat. c. Deny entry to the area by anyone other than 911 emergency response personnel until area is declared safe. d. Standby to assist emergency response personnel. Any incident involving a fire, release, or threatened release of a hazardous material must also be reported to the Station Manager. The Station Manager will notify the CSI Territory Manager and Chevron Maintenance Dispatch immediately. Chevron Maintenance Dispatch will: 1) dispatch Company/Contractor assistance if necessary; and 2) notify Chevron Compliance Marketing Assistant for proper notification to regulatory agencies. EMPLOYEE NOTIFICATION AND EVACUATION: Notification will be accomplished verbally (shouting) and via the intercom system. PUBLIC EVACUATION: a. The Staff Duty Clerk will announce "There is an emergency. Please leave the Station on foot immediately." b. If evacuation from the area is deemed necessary, the neighboring properties listed below will be notified if possible. Hampton Inn Yen Cheng Restaurant EMERGENCY MEDICAL PLAN: MEDICAL FACILITIES: Mercy Medical Center Bakersfield Heart Hospital 2215 Truxtun Ave. 420 34th Street 632-5050 334-2784 10 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: a. Barriers installed to prevent vehicle collision with pumps. b. Vapor Recovery Systems used when filling underground tanks. c. Antilock nozzles on pumps. d. No sales to unauthorized containers. e "No Smoking" signs posted. Self-serve instructions posted. f. Monitoring Program implemented. g. Double walled tanks with leak detection system B. RELEASE CONTAINMENT AND/OR MINIMIZATION: a. Stop source of release as necessary and safe. If gasoline, stop source of release by activating emergency pump shutoff switch. b. Evacuate all nonessential personnel from area. c. Extinguish or remove all ignition sources. Use fire extinguisher if necessary. d. While using proper personal protective equipment, contain and absorb spill with inert absorbent. Avoid breathing gasoline vapors by approaching from upwind. C. CLEAN-UP PROCEDURES: a. Keep nonessential personnel away from area. b. Notify Chevron Maintenance Dispatch (800) 423-3528 for coordination with Hazardous Material Contractor to remove contaminated absorbent materials if required. c. Materials involved in cleanup will be disposed of in accordance with all applicable Federal, State, and Local regulations. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: Natural Gas- North side of restroom building ELECTRICAL: Main: North side of store building, North side of restroom building WATER: East side of site, meter in sidewalk SPECIAL: Emergency Pump Shutoff- Cashier console and outside north wall of store building LOCK BOX: YES [] NO [] IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: Fire extinguishers are kept throughout the facility. B. WATER AVAILABILITY (FIRE HYDRANT): A) On West side of Oak St., directly to the east of Chevron Station, in sidewalk ]! Ba!<erstleld, ~al!torn~a, umtect: states fl:31 Oak;:St ....... CA 9330~ OAK STREET CHEVRON Manager : Location: City : CommCode: EPA Numb: 1131 OAK ST I NIAR_~Z 1998 | BAKERSFIELD S TATiON--U3 SiteID: 215-000-000183 BusPhone: (805) 324-7621 Map : 102 CommHaz : Low Grid: 35B FacUnits: 1 AOV: SIC Code: DunnBrad:77-020-9549 Emergency~Contact PHIL WELCH Business Phone: 24-Hour Phone : Pager Phone : / Title / MANAGING PARTNE (805) 324-7621x (805) 872-1245x ( ) - x Emergency Contact / Title TOM SCOTT / PARTNER Business Phone: (805) 366-5541x 24-Hour Phone : (805) 366-4563x Pager,Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Emergency Directives: ~ Hazmat Inventory --MCP+DailyMax Order Hazmat Common Name... UNLEADED PLUS GASOLINE UNLEADED GASOLINE SUPREME GASOLINE DIESEL FUEL #2 MOTOR OIL ISpecHazI EPA HazardsI Frm F IH DH L F IH DH L F IH DH L F IH DH L F DH L One Unified List All Materials at Site DailyMax Unit MCP 10000 GAL Mod 10000 GAL Mod 10000 GAL Mod 10000 GAL Low 200 GAL Min ~'~rD(~~ hereby cerViX/~hat I hav~ rsvie~ ~hs a~h~ h~a~ous m~edals mana~e- m~n~ pla~ ~or~~ ~ha~ ~ aio~ wJ~h any ~rr~ions ~nsfi~u~ a complete and co~t ~n- ~me~ plan for my ~cili~, 1 03/12/1998 F ~AK STREET CHEVRON SiteID: 215-000~000183 -- Inventory Item 0001 Facility Unit: Fixed Containers on Site ~UtvuvIU~ ~Vl~ / ~±~Z-.LL, ~vt~ · UNLEADED PLUS GASOLINE Days On Site' 365 Location within this Facility Unit Map: Grid: 20' WEST OF MINI MART CAS# 8006-61-9 FSTATE = TYPE Liquid /Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 'GAL Daily Average 5000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS 8006619 TSecretNo N~SIBi°HaZNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA USDOT# /// Mod Inventory Item 0003 Facility Unit: Fixed Containers on Site UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: 20' WEST OF MINI MART CAS# 8006-61-9 F STATE TYPE PRESSURE Ambient Mixture |Liquid TEMPERATURE IAmbient · CONTAINER TYPE UNDER GROUND TANK Largest Container ~GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 6000.00 GAL ' I %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS I CAS# N 8006619 .HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# MCP Mod 2 03/12/1998 ~0AK STREET CHEVRON ----- Inventory Item 0004~ -- COMMON NAME / CHEMICAL NAME SUPREME GASOLINE Location within this Facility Unit 20' WEST OF MINI MART SiteID: 215-000-000183 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 ~ TYPE STATE /Mixture Liquid PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum I 10000.00 GAL Daily Average 6000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS 8006619 TsecretI RS I BioHaz No No No HAZARD ASSESSMENTS Radioactive/Amount I EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# Mod = Inventory Item 0005 -- COMMON NAME / CHEMICAL NAME DIESEL FUEL #2 Location within this Facility Unit 20' WEST OF MINI MART Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 68~76-34-6 STATE 7 TYPE PRESSURE Ambient Mixture Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Cdntainer GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 4500.00 GAL HAZARDOUS COMPONENTS %Wt. I 100.00 Diesel Fuel No. 2 N 68476302 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# MCP Low -3- 03/12/199'8 ~OAK STREET CHEVRON ~ Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit WEST SIDE OF LOT SiteID: 215-000-000183 Facility Unit: Fixed Containers on Site~: Map: Grid: Days On Site 365 CAS# FSTATE ~ TYPE Liquid {Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 200.00 GAL Daily Average I 50.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS Motor Oil, Petroleum Based NoRS CAS#8020835 N S BioHaz No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F DH NFPA/// I uSDOT# Min -4- 03/12/1998 OAK STREET CHEVRON siteID: 215-000-000183 Fast Format ~ Notif./Evacuation/Medical --Agency Notification CALL 911 Overall Site 05/13/1992 -- Employee Notif./Evacuation 05/13/1992 EMPLOYESS ARE INSTRUCTED TO NOTIFY THE OWNERS, THE HAZARDOUS MATERIALS OFFICE AND CHEVRON USA. EMPLOYEES ARE INSTRUCTED TO HIT ALL EMERGENCY SHUT OFFS, CALL 911, EVACUATE ALL CUSTOMERS AND THE EVACUATETHEMSELVES -- Public Notif./Evacuation 05/13/1992 OWNERS AND/OR EMPLOYEES TO VERBALLY NOTIFY ALL CUSTOMERS FACE TO FACE AND/OR VIA OUR INTERCOM (TO THE ISLANDS, LOCATED .IN THE MINIMART IN CASHIERS CUBLICLE) TO IMMEDIATELY VACATE THE PREMISES. WE HAVE SEVERAL ORANGE CONES STORED ON THE CENTER PUMP ISLAND TO BLOCK THE ISLANDS WITH AND TO ALERT THE Emergency Medical Plan MERCY HOSPITAL 2215 TRUXTUN AV BAKERSFIELD, CA. (805) 327-3371 05/13/1992 -5- 03/12/1998 F ~AK STREET CHEVRON SiteID: 215-000-000183 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 05/13/1992 ALL GAS AND DIESEL IS STORED UNDERGROUND IN FIBERGLASS DOUBLE WALLED TANKS (10,000 GAL). ALL PUMPS ARE EQUIPED WITH EMERGENCY SHUT OFF VALVES. ALL OIL IS STORED IN PLASTIC CLOSED QUART CONTAINERS. --Release Containment 05/13/1992 A BUCKET OF ABSORBENT SANDY MATERIAL IS ALWAYS KEPT ON THE PUMP ISLANDS WITH A BROOM AND DUSTPAN, WHICH IS ADEQUATE TO CONTAIN MOST SPILLS OF FUEL OR OIL. EXTRA ABSORBENT MATERIAL IS ALWAYS ON HAND IN OUR STOREROOM. THE SAND IS SPREAD OVER THE SPILL AND THEN SWEPT UP. -- Clean Up 05/13/1992 EMPLOYEES ARE INSTRUCTED IN THE USE OF ABSORBENT MATERIAL TO CLEAN UP SPILLS. IN THE EVENT OF A LARGE SPILL, WE WOULD HIT THE EMERGENCY SHUT-OFF, CALL 91i, AND CONTAIN IT AS BEST WE CAN, WITH ABSORBANT SAND, UNTIL EMERGENCY HELP ARRIVES. Other Resource Activation 6 03/12/1998 OAK STREET CHEVRON SiteID: 215-000-000183 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - NONE B) ELECTRIAL - SOUTH'END OF MINI MART - BUILDING KEY NEEDED C) WATER - NEAR SIDEWALK ON OAK ST UNDER LARGE CHEVRON PRICE SIGN D) SPECIAL - NONE E) LOCK BOX - NONE 05/13/1992 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS 05/13/1992 FIRE HYDRANT - OAK ST APPROXIMATELY 10 YDS FROM THE EAST PUMP ISLAND -- Building Occupancy Level -7- 03/12/1998 STREET CHEVRON SiteID: 215-000-000183 Fast Format = Training -- Employee Training WE HAVE 5 EMPLOYEES. WE HAVE MSDS SHEETS ON FILE FOR EACH H~ZARDOUS MATERIAL WE HANDLE. EMPLOYEES ARE INSTRUCTED TO HIT EMERGENCY SHUT OFFS, CALL 911, EVACUATE ALL CUSTOMERS AND THEN EVACUATE THEMSELVES. Overall Site 01/07/1990 Page 2 Held for Future Use Held for Future Use 8 03/12/1998 041'1'4/92 OAK STREET CHEVRON 215-000-000L83 Overall Site with 1 Fac. unit General Information Page Location: 1131 OAK ST .CommUnity:'BAKERSFIELD STATION 03 Map.: 102 Hazard: Low / .Grid: 35B F/U: 1AOV: Contact Name Title ' Business Phone TOM SCOTT ~ --.I-~~ ~805) 366-6~'~. x ' Administrative-Data Mail Addrs: 1131 OAK ST City: BAKERSFIELD Comm Code: 215-003 BAKERSFIELD STATION 03 0o0' 24-Hour Phoneq (805) 872-1245. (805) ~_~ D&B ~Number: 77-020-9549 State: ,C'A ZiP: 93304- SIC Code: L~ MA~LZe~E Owner: Address: B3~DS DR City.: · Summary Phone: (~O5) ~q~ £/~' State: CA Zip: 9330~- RECEIVED ~PR 3 0 1992 rsv~swsd ~h® '~ached hazardous materials manage- me~ plan for~ ~. ~v~ and Ihai i~ along wi~h (~e of ~ ~rr~ions ~n~u~s a comple~ and corre~ mah- 04/14/92 OAK STREET CHEVRON 215-000-000183 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 UNLEADED PLUS GASOLINE · Fire, Immed Hlth, Delay Hlth~. Liquid 10000 Moderate GAL -CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL Daily Max GAL 10,000 Storage UNDER GROUND TANK -- Conc 100.0% IGasoline Daily Average GAL 5,000.00 AnnUal Amount GAL 179,000.00 Press T Temp Location IAmbientlAmbientl20' WEST OF MINI MART Components MCP iList Moderate 02'002 MOTOR OIL · Fire, Delay Hlth Liquid 200 Minimal GAL CAS #: Trade Secret: N© Form: Liquid Type: Mixture Days: 365 Use: LUBRICANT Daily Max GAL Daily Average GALT Annual Amount GAL 200 I 50.00 ! 610.00 Storage PLASTIC CONTAINER Press T Temp Location IAmbient~AmbientlWEST SIDE OF LOT -- Conc ~ Components 100.0%IMotor Oil, Petroleum Based MCP List IMinimal I 02-003 UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Daily.Max GAL 10,000 Storage UNDER GROUND TANK -- Conc 100.0% IGasoline Type: Mixture Days: 365 Use: FUEL Daily Average GAL 6,000.00 Annual Amount GAL 980,000.00 Press T Temp Location IAmbient~Ambientl20' WEST OF MINI MART CompOnents MCP iList Moderate 04/14/92 OAK STREET CHEVRON 215-000-000183 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order· Page 3 02-004 SUPREME GASOLINE ~ Fire~ Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: .Mixture Days: 365 Use: FUEL Daily Max GAL 10,000 Daily Average GAL ! Annual Amount GAL 6,000.00 {I 704,000.00 Storage UNDER GROUND TANK Press T Temp Location IambientlAmbientl20' WEST OF MINI MART -- Conc 100.0% IGasoline Components · MCP iList. Moderate 02-005 DIESEL FUEL #2 ,~ Fire, Immed Hlth,.Delay Hlth Liquid 10000 Low GAL CAS #: 68476-34-6 Trade Secret: No Form: Liquid Type: ·Mixture Daily Max GAL 10,000 I Storage UNDER GROUND TANK -- Conc I 100.0% IDiesel Fuel No.2 Days·: 3'65 Use: FUEL Daily Average GAL 4,500.00 Annual Amount GAL 210,00.0.00 ComPonents MCP List Press T Temp ' Location IAmbient~Ambientl20' WEST OF MINI MART 04/i14/92 OAK STREET CHEVRON 215-000-000183 00'- Overall Site <D> Notif./Evacuation/Medical page 4 <1>I Agency Notification' CALL 911 <2~ Employee Notif./Evacuation EMPLOYESS ARE INSTRUCTED TO NOTIFY'THE OWNERS, THE HAZARDOUS M~ATERIALS OFFICE AND CHEVRON USA. EMPLOYEES ARE INSTRUCTED TO HIT ALL EMERGENCY SHUT OFFS, CALL 911, EVACUATE ALL CUSTOMERS AND THE~EVACUATE THEMSELVES <3>i. Public Notif./Evacuation . . . , / . , . ~ -' "-'r ~ ~ '-~ .. . ~ ·. 2:215 TRUXTUN AV ~AKERSFIELD, CA. (1805) 327-3371 04/14/92 OAK STREET CHEVRON 215-000-000183 00 - Overall Site <E> Mitigation/prevent/Abatemt Page 5 <1> Release Prevention ALL GAS AND DIESEL IS STORED UNDERGROUND IN FIBERGLASS DOUBLE WALLED TANKS (10,000 GAL). ALL .PUMPS ARE EQUIPED WITH EMERGENCY SHUT OFF VALVES. ALL OIL IS STORED IN PLASTIC CLOSED QUART CONTAINERS. <4> Other Resource Activation 04/14/92 OAK STREET CHEVRON 215'-000-000183 00 ~ Overall Site <F> Site Emergency,Factors Page 6 <1> Special Hazards <2> Utility Shut-Offs A) GAS~- NONE B) ELECTRIAL - SOUTH. END OF MINI MART - BUILDING KEY NEEDED C) WATER - NEAR SIDEWALK ON OAK ST UNDER LARGE CHEVRON PRICE SIGN D) SPECIAL - NONE E) LOCK BOX - NONE <3> Fire Protec./Avail. Water NO PRIVATE FIRE PROTECTION LISTED. LOCATION OF FIRE HYDRANT? <4> 04/14/92 OAK STREET'CHEVRON 215-000-000183 00 Overall .Site <G> Training Page <1> Page 1 WE HAVE 5 EMPLOYEES. WE HAVE MSDS SHEETS ON FILE FOR EACH HAZARDOUS MATERIAL WE HANDLE. EMPLOYEES ARE INSTRUCTED TO HIT EMERGENCY SHUT OFFS, CALL 911, EVACUATE ALL CUSTOMERS AND THEN EVACUATE THEMSELVES. ,~ <2> P. age 2 aS needed <3> Held for Future Use <4> Held for Future Use BAKER~rI=LD CiTY PIHE UEFAHiM=Ni 2130 'G' STREET ~ BAKERSFIELD,, CA. 93301 (805) 326-3979 OFFICIAL USE ONLY BUSINESS NAME . ~, INSTRUCTIONS: HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A RECEWED MAZ. MAT. DIV, 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 ,. B. LOCATION / 3TREET ~DDRESS.: f /%f O&~ ~S~--~-- SECTION 2; EMERGENCY NOTIFICATIONS In case o¢ an emergency involving th® releas® or threatened release of a hazardous material, ¢all 911 and 1-800-852-7550 or 1-918-427-4341. This will notify your lo¢al fire department and th~ Sta~e Office of Emergency .Services as required by EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND T[TLE DURING BUS. HRS. AETER BUS. HRS. PH# <~ 1~r7~L-/o~ ~7 SECTION 3; B. C. D. E. kOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE NATURAL GAS/PROPANE: SPECIAL: LOCK BOX: YES / NO IF YES, LOCATION: /~//~- IF YES, DOES IT CONTAIN SITE, PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES /.NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5' LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLF SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING.PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MATERIALS. B. 'DO YOU HAVE MSDS (MATERIA~ SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL YOU HANDLE ~ .y~ S C. GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM: SECTION 7: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT NY 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, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION_.~f.8: CERTIFICATiOn./_. ~ ~ .acqBra~9, ~ understand' ~ha~ %h~s. ~nforma%~on W~33 be used ~o full, II my f~rm's obligations under ~h~ new Ca]~forn~a Health and 'Safe~y code on Hazardous Materials (D~v. 20 Ch,%er 6.95 Sec. 25500 E~ A].) and ~ha~ inaccurate infor.mation consg,g~s perjur~~. ~//~/~ BAKERSFIELD CITY FIRE DEPARTMENT 2130 ,'G' STREET BAKERSFIELD. CA. 93301 (805) 326-3979 BUSIN--SS NAi~tE I O # HAZARDOUS MATERIALS BUSINESS PLAN 'AS A WHOLE FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer 1;he questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible ~c~:,, u.~,, ~c:~,, u.:, .~..: 05~<~ SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES ~ECTION 2; NOTIFICATION IANO ~VACU^TION PROCEDURES AT THE UNIT ONLY SECTION 3: HAZARDOUS ERIALS FOR THIS UNIT ONLY 'Does this Faci ;y Unit contain Hazardous Materials? ...... If Yes, see If NO, continue wi Are any of the bazar If NO, complete a se SECTION 4 s materials a bona fide Trade Secret? Hazardous materials inventory form marked: NON-TRADE lETS ONLY (white form #4A-1) Zf YES, complete a hazardo~ materials inventory form marked: .TRADE SECRETS ONLY (Yellow secret form. List only the SECTION 4: PRIVATE FIRE PROTECTION YES NO YES NO -m ¢4a-2) in addition to the non-trade ade secrets on form 4A-2. SECTION ~OCATION OF WATER SUPPLY FOR ISE (Fire Hydrant) NCY RESPONDERS' SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT A. NATURAL GAS/PROPANE: B. ELECTRiCAL~ C, WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO FLOOR. PLANS? YES / NO MSDSs? KEYS?' YES / NO YES / NO - 3B - CITY of BAKERSFIELD ' F,r, a.d Agricultu,e ~ Standard e.si..s ~ HAZAI:q~DOUS MAT]~:]:~:I ~~ ~ ~~~.OR~ .~ ~O~ T~AD~ ~EC~T~ ............... r-/-~?% '~( ' /7 ' ADDRESS. ,,~z-VO / ~'f.~~/~ c~vv, zzv=~ ~~gL?),,~,., ~.y~3q' - _ -.~ ,~,? STA~A~ X~. CLASS eo~z -~<~? C~TY. Z~P: l~.~,~~>~/, ~ , ~ ~ ~ DUN AND BRADSTREET NUHBER~ PHONE ~: ~-~'7~( PHONE ~:_. ~O~C ~7~/'~ ' . Trans Ty~ ~x Average ~nua] ~asu~ I ~ Cmt ~t ~t ~l L~lttm W~re ~ ~ NI~ Of fltxtu~/~tl C~e C~e ~t ~t Est Units m Site Ty~ Pr~l ~ T~p C~e 5tor~ tn Faci]tty Nt ' ~ Inst~tims Physical and Health Hazard C.A.S. ~ C~t I1 ~ & C.l.S. ~r IC~k all t~t apply) r--n r--n r ~t 12 '~&C.A.S. ~ Health' of Pr~sure j H~lth .... . ...... / l ~t t~ ~&C.4.S. ~ P~ical ~d H~lth Hazard u~ Fire Hazard u_J ~activtty ~la~ ~--~ ~m RIIN~ u--J I~tate ~t 13 ~&C.A.S. P~ical md H~lth Hazard C.A.S. ~ ~t ll ~ & C.A.S. ~ 7 Hazard [--J Reactivity ~--a ~le~ [ J ~dd~ Rel~se [' ~t 12 N~ & C.l.S. ~ -- tare Health of Pr~sure Health ,.,,, - < .... {C~k all t~t apply) r r--- r --, C~t 12 Nm & C.A.S. ~ Hazard ~_a Reactivity ~-- ey~ L_J ~dd~ Release tare Health of Pr~sure Health ..... ~ ......... ~ .............................................. ~t I~ N~ & C.A.S. N~r ..-: ............. ~ ..................... ..p.~,_~ ............ ~I~4~_~_.. .. ................. ..~ ...................... Certificati~nun~.er(Read and sign after completing aZ] sections) //~ //~ ]' I c,rtify ,.lty of la. that ] have persm, lly,xa.ined and ,. f,.iliar with t, tnfor~ti~u,~~,~ ,11 ~ d.,~.777j. ~th ' of t', J~du,ls~,,sib,.. / for ob amlfl t~ lflfor~tl~ I 11eve t~t Su~ltt~ lnforlatl~ ~ - t~t ~S~ ~ in~. __' ' . I ~ ' at ~7 ' _' ' 's true. accurate, and ~~ //~ ~?"~Y -X ~ inquiry (~, , CITY of BAKERSFIELD '~ = HAZARDOUS MATERI ALS I NVENT.ORY Farm and Aoricu)ture Standard Business NON--'I:RADE SECRETS ~ ~ XWS~UCTIO~ FO~ PROP~ COD~ Code C~e ~t ~t Est Units m Site ly~ Prfll l~p C~e .. Stor~ in Facility Nt ~a Fire Hazard u_d Reactivity ~la~ ~dd~ Release [--n_a I~tatl ~t I~ ~ & C.A.S. ~ Health of Pr~sure H~ Ith ............ P~ical and Health Hazard C.A.S. ~ at II Mm & C.A.S. ~ (C~k ell t~t apply) ' ~- ] Fire Hazard u_ a Reactivfty ~la~ ~d~ Rml~se I~mte H~lth of Pr~su~ HNlth P~ical ~d H~lth Hazard C.A.S. ~ ~t II h & C.A.S. ~ (C~k all t~t aauiy) ~ J Fire Hazard [ ~ Reactivity [ ~ ~laV~ ~ ~ ~dd~ Release [ ~ I~(ate · Health of Pr~sure Health ' ~ ....... P~ical ~d Health Hazard C.A.S. Numar Ca.mt II Nm & C.A.S. N~ (Ch~k all t~t mealy) ........................ -J Fire Hazard [--~ Reactivity ~ ~ ~lay~ ~ ~ ~dd~ Release ~_d Health of Pr~sure Health ............... ~ ............................................. Ctrtificati~n (Read and sJRn after compietJn£ ali sections) ' ~.1 =ertH¥ un~ler'ueneJ~y o.f~la, that_~ ~ve ~rs~alJy~xaain~ and ~ faeiliar }o~ obtaini~ ~fo~ty~/~yieve t~t t~/~itt~ infor~ti~ is true. accurate, and cm~. ............................................... ~=.:_~.=.._: ............. · ~,.. .~.,,.a ...,,,..~,~,. s~-~ BAKERSFIELD CITY FIRE,DEPARTI~ENT 2130 "O" STREET BAKERSFIELD, CA 93301 (805) 326-3979 RECEIVED JUN 1 I 1987 Anid ............ IUSINESS NAME OFFICIAL USE ONLY 000183 HAZARDOUS MATERIALS BUSINESS PLAN 'AS A WHOLE FORM 2A INSTRUCTIONS: l~'To avoid further action, return this form by 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 A. BUSINESS NAME: ~/~,~" ,~. .5~A,~/,//C~ . /-dC . B. LOCATION / STREET ADDRESS: //_?/ ~' .,c~, CITY: (~/~5.~/'m/~/ ZIP: ~,.~.~ ~ BUS.PHONE: (~D,S'). ~,~ ~'/- .,~,F/ SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS~ B..-~'..,, .~:-/~/-~~ Ph~ ~a~- 7~ ~ / AFTER BUS. HRS-. Ph# ~/- ~ ~/~:; SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BusINESS AS A WI~OLE A. NAT. GAS/PROPANE: B. ELECTRICAL: ~a~,~o,.~ 'C. WATER: ~/ a~ ~ /~ D. SPECIAL: ~:~ ~/~ .~ E LOCK :BOX: YES'~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO MSDSS? YES / NO YES / NO KEYS? ' YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE' A PROGRAM WHICH PROVIDES. EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO' INITIAL A. METHODS FOR SAF~ HANDLING OF HAZARDOUS .MATERIALS:...- .................................... YES ~0~ B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: YES ~ C. PROPER USE OF SAFETY EQUIPMENT: .................. YES d~ D. EMERGENCY EVACUATION PROCEDURES: ................. YES ~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES SECTION ?: HAZ~d~DOUS NATERIAL REFRESHER YES ~ YES f~ YES ~ · YES ~ YES (~ CIRCLE~OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS ~RTERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... ~ NO I, ~,j, ~ j,/')~,4/-/~',,-'3,,,,z~__ , certify that the above information is accurate. I understand that this information.will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. "BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G"~STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFiCiAL USE'0NL¥ ID# -BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To.avoid further action, this form must ~be returned by: 2. ~YPE?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: z O/ SECTION 1: MITIGATION,. PREVENTION, ABATEMENTPROCEDURES SECTION 2: NOTIFICATION ~N~ EVACUATION PROCEDURES AT THIS b%T!T ONLY SECTION 3: HAZARDOUS MATERIALS .FOR THIS UNIT ONLY A. Does this Facility Unit contain~Hazardous Materials? ' ~ NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES(~ If No, complete a separate hazardous materlals inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) 'If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS. ONLY (yellow form #4A-2) in ~addition to the non-trade secret form. List °nly the trade secrets, on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION ,.5: LOCATION OF WATER SUPPLY FO~ USE BY EMERGENCY 'RESPONq)ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPANe': B. ELECTRICAL: C. WATER: E. LOCK BOX: YES ~ IF YES, LOCATION: IF YES, SITE PLANS? .FLOOR PLANS? YES / NO MSDSs? YES / NO YES / NO KEYS? YES / NO - 3B - I.D. # BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A- 1 NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVENTORY ADDRESS: //.~,/ ~.~./,~ $~, ADDRESS: CITY, ZIP: ~~.~/~/, q~O~ CITY,ZIP: Page / FACILITY UNIT '~': FACILITY UNIT NAbtE: OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 -TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~; BY HAZARD D.O'.T ,CODE AbIOUNT ANOUNT UNIT CODE CODE FACILITY UNIT . WT. CHEMICAL OR COMMON NAME CODE DUIDE NAME: ,~.~)~'x'~' ~O~/~'- TITLE: ~_rY,~_x.~ SlONATURE: EMERGENCY CONTACT: ~x's ~.~/~,~.~_ TITLE:. PRINCIPAL BUSINESS ACTIVITY: - 4A-1 - DATE: # BUS HOURS: ~-~/ AFTER BUS HRS: PHONE # BUS HOURS: AFTER BUS HRS: