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Home My WebLink AboutES-BUSINESS PLAN 10/26/2001Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT O.N REVERSE SIDE PERMIT ID# 015-0214)01821 VONS 0420 LOCATION 9000 MING Issued by: Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: June 30, 2000 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Permit ID #:: 015-000-001821 · VONS #2420" :.-' LOCATION: 9000 MING'AVE- This ~ermit is Issued for the following: [] H--=rdous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approged by: ISSUC Datc ,ExpimtionDate: ' June 30. 2003 i*~.,.,~'. ~ ..'_*' ',.J' . : ITE DIAGRAM Business Name: Business Address: FACILITY DIAGRAM FACILITY NAME ADDRESS ~ O00 FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE lO//,~.~,/O PHONE NO. ~q -- BUSINESS ID NO. ~r~l~- OIS'- NUMBER OF EMPLOYEES Section 1: ~Routine Business Plan and Inventory Program [] Combined {~ Joint Agency [] Multi-Agency Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contadt information accurate Visible address , ,, Correct occupancy C... Verification of inventory materials Verification of quantities V erification of location cz / c,,. /;':- Proper segregation of material ~, Verification of MSDS availability Verification of Haz Mat training (~. Verification of abatement supplies and procedures C. Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: ~.J/qS'-/~ ~<~TOA~ ig' ~ ~ ~Yes [] No Questions regarding this inspection? Please call us at (661) 326-3979 White o Env. Svcs. Yellow - Station Copy Pink - Business Copy Business Site Responsible Party Inspector: (~,Tff ~~' VONS.# Manager : DALE OKAMOTO Location: 9000 MING AVE City : BAKERSFIELD tAPR.2 CommCode: BAKERSFIELD STATION 09 EPA Numb: SiteID: 215-000-001821 BusPhone: (805) 663-0595 Map : 123 CommHaz : Low Grid: 05C FacUnits: 1 AOV: SIC Code:5411 DunnBrad: Emergency Contact / Title DALE OKAMOTO / STORE MANAGER Business Phone: (~T) 663-0595x 24-Hour Phone : (~T~387-9144x Pager Phone : Emergency Contact / Title KELLY GREENE _~ ASSISTANT MGR Business Phone: [6~!i) 663-0595x 24-Hour Phone : ~6~] 324-0763x Pager Phone : Hazmat Hazards: Fire React ImmHlth DelHlth MARCELLA GELMAN, FOOD Contact : SAFETY & ENV. AFFAIRS MailAddr: P.O. BOX 513338 City : ' LOS ANGELES, CA 90051- 1338 Owner VOo~, Address : P.O. BOX 513338 City : LOS ANGELES, CA 90051- 1338 Period : to Preparer: -F~ ~>e~+, Certif'd ~ Emergency Directives: Phone: ("G~) 663-0595x State: CA Zip : 93311 Phone: (/6~1) 663-0595x State: CA Zip : 91007 TotalASTs: = TotalUSTs: = RSs: No Gal Gal = Hazmat Inventory --As Designated Order Hazmat Common Name... BLEACH WASTE KODAK FIXER DEGREASER , Po~ ,~,r:~ ~ ,5'- ~ 0 5 · One Unified List Ail Materials at Site SpecHazI EPA Hazards Frm DailyMax Unit MCP F IH L R IH L IH DH S 200 GAL Hi · i % ~O GAL Min ~D ~Q GAL Mod 1 03/01/1999 VONS #420 SiteID: 215-000-001821 Inventory Item 0001 Facility Unit: Fixed Containers at Site ~U~IU~ ~Vl~ ! ~1~ · ~,l-.~.J..~ ~Vl~ BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: E SIDE AISLE 11 CAS# STATE -- TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Containerl.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 200.00 GAL Daily Average 150.00 GAL %Wt. 100.00 Bleach HAZARDOUS COMPONENTS RNo~ CAS#7681529 TSecretNo N~S BioHazNo HAZARD ASSESSMENTS I Radi°active/Am°unt I EPA Hazards INo/ Curies IH NFPA /// USDOT# ' MCP = Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME WASTE KODAK FIXER Location within this Facility Unit OFFICE IN NE CORNER OF STORE Facility Unit: Fixed Containers at Site Map: Grid: Days On Site 365 CAS# 7783-18-8 FSTATE ~ TYPE Liquid /Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container30.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 50.00 GAL Daily Average 40.00 GAL I'"LZ-A_~.Z-.LL'~UU~ ~UIVI~U~ 1'~ %Wt. RS CAS# 40.00 Ammonium Thiosulfate No 7783188 10.00 Sodium Acetate No 127093 ITSecret ~SIBioHaz No N No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies R IH NFPA USDOT% /// MCP Min 2 03/01/1999 VONS #420 = Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME DEGREASER OXFORD CLEANER DEGREASER Location within this Facility Unit NE ENTRAi~CE TO BACK STORE ROOM SiteID: 215-000-001821 Facility Unit: Fixed Containers at Site Map: Grid: Days On Site 365 CAS# F STATE TYPE I PRESSURE Solid Pure Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container, 1.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 50.00 GAL HAZARDOUS COMPONENTS %Wt. Alkyl 5.00 Dimethylbenzylammonium Chloride NoRs CAS# 8001545 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# i MCP Mod 3 03/01/1999 F VONS #420 SiteID: 215-000-001821 Fast Format ~ Notif./Evacuation/Medical --Agency Notification Overall Site ~ 10/27/1997 PRODECURE MANUAL IN OFFICE. POCKET GUIDES ON PERSON. WHAT AGENCIES ARE YOU GOING TO NOTIFY IN CASE OF AN EMERGENCY???????? -- Employee Notif./Evacuation PA SYSTEM OR VERBAL AS PER SITUATION. 10/27/1997 Public Notif./Evacuation AS PART OF~PROCEDURE MANUAL. 10/27/1997 Emergency Medical Plan MERCY SOUTHWEST OR BAKERSFIELD OCCUPATIONAL MEDICAL GROUP. 10/27/1997 4 03/01/1999 F VONS #420 SiteID: 215-000-001821 Fast Format Mit igat ion/Prevent/Abatemt Overall Site Release Prevention ~ Release Containment OPER STORAGE & SEPARATION OF INCOMPATIBLES. 10/27/1997 -- Clean Up SELF-CONTAINED SPILL KITS & PERSONAL PROTECTIVE EQUIPMENT. 10/27/1997 Other Resource Activation -5- 03/01/1999 F VONS #420 SiteID: 215-000-001821 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - W SIDE OF BLDG B) ELECTRICAL - NW CORNER OF BLDG C) WATER - NW CORNER OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO 10/27/1997 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLERED. 10/27/1997 NEAREST FIRE HYDRANT - NE CORNER OF LOADING DOCK IN BACK. Building Occupancy Level 6 03/01/1999 VONS #420 &~&&&&~&~&~&&~&&&&&&&&&&&&&~&&&&&&&& SiteID: 215-000-001821 'i~~~&&&~~~~&~&~~~~&~~~&~ Fast Format i~ Training ~~A~A~A~~A~~A~A~~~~ Overall Site i~ Employee Training ~~~~~~~~~ 10/27/1997 WE HAVE 85 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN THE OFFICE. BRIEF SUMMARY OF TRAININ PROGRAM: ORIENTATION FOR NEW ASSOCIATES. RECORDS ARE AVAILABLE ON REEEQUEST BY FAX. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 2. 3. 4. SECTION 1' BUSINESS IDENTIFICATION DATA To avoid further action, remm this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. BUSINESS NAME: C:ZA.R, oooo LOCATION: ~000 t~ ,,,-/C~ ,6,d MAILING ADDRESS: CITY: DUN & BRADSTREET NUMBER: PRIMARY ACTIVITY: /~¢-7~,~_ OWNER: STATE: Z~: 5'~3 t! PHONE: SIC CODE: MAII.INGADDRESS: ~o t~2~ fi/~ ,C4~ ILt..,,,oO~, A-V ~t"<.C.ZlOII~ ~ ~1007- SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3' TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: 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 EXCEED THE ,MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION 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. TITLE u DATE 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES AGENCY NOTIFICATION PROCEDURES: Bo EMPLOYEE NOTIFICATION AND EVACUATION: Co PUBLIC EVACUATION: EMERGENCY MEDICAL PLAN: 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: RELEASE CONTAINMENT AND/OR MINIMIZATION: Co CLEAN-UP PROCEDURES: SECTION 8: UTII.ITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)_ NATURAL GAS/PROPANE: cO ELECTRICAL: /~c0 C_ to. CC WATER: ~d b0 C~t'Jrt-- ocr SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: Bo WATER AVAILABILITY (FIRE HYDRANT): ~d ~ C/~/,/~. ~ Co~,o,,,./~ 4 OUS ,MATERIALS INVENT~Y BusmcssNam¢ V(-~5~-'~ZO Address Page of__ CHEMICAL DESCRIPTION I)INVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[ ] CheekifchemiealisaNONTradeSeeret[ ]TradeSeeret[ 2) Common Name: A/" ~-~, 3) DOT it (optional). Chemical Name: AHM [ ] CAS 4) Physical & Health PHYSICAL HEALTH HazardCategones Fire[ ]Reactive~SuddenReleaseofPre~sure[ ] Immediate Health (Acute) [ c~'-] Delayed Health (Chromc) 5) WASTE CLASSn~ICATION O-digit code fstau DHS Form 8022) USE CODE 6) PHYSICAL STATE SoLid [ ] Liquid 7) AMOLrNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amonnt Largest Siz~ Container it Days on Site c-as { ] i~re [ ] Mixture,~_] Waste [ ] l~iion~ive [ ] UNITS OF lVlEASURE 8) STORAGE CODES Lbs[ Curies [ ] b) lh'essure: t c) Temperature 4-- Circle Which Months: All Year, I, F, M, A, lVl, $, I, A, $, O, N, D 9) MIXTURE: List the three moat hazardous chemical components or' _ COMPONENT CAS# % WI' AHM l) -5~D'7~,~,x .,49/F'oe-~coa, ve_ [ ] 2) [ ] 3) [ ] 10)LOCATION 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trade Secra [ ]Tr-deS~a~t[ ] 2) Common Name: L~ 0~q'''~ ~4-ffC~~~¢ C-- ~'~ )e~-- t2.. 3) DOT # (optional) Chemical Name: AI-IM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hmnrd Calegones Fire [ ] Reactive [:~] S~dd~ Release of Pressure [ ] Immediate Health (Acute) [ '?.C ('O~ Doll 5) WASTE CLASSIFICATION ~ ~ I (3<ligit code from DHS Form 8022) USE CODE ] Delay~l Health (Clmmic) 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure[] Mixture[] waste[~ m~uo~ive[ ] 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount % Average Daily Amount ~ Annual Amount ~ Largest Size Container ~O it Days on Site '5 (o Lbs[ ] C,m ~] fa [ cures [ ] Circle Which Months: 8) STORAGE COD~__ a) Contam~ b) Pressure: c) Temperature AIl Year, J, F, M, A, M, I, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the thr~ most hazardous 1) [ ] chemical components or 2) [ ] any AFIM components 3 ) [ ]. 10)LOCATION I certify under penalty, of law, that I have personally examined and am familiar with the intbrmalion on this and all attached documents. I behcve the submi~ informa~on is true, accurate and complete. Business Name ~RDOUS MATERIALS Addr~s I V NTO Page of _ CHEMICAL DESCRIFrlON I)INVENTORYSTATUS:Nc~v[ ]Addition[ ]Revision[ ]I~letion[ ] Ch(~kifclumucalisaNONTrad~Sex:~t[ ]Trad~S(~t~[ 2) Common Name: O)~ ~-cY~C) ~/_~'~N~o.. ~')~~<~Ed~- 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] S,_,dd~ R¢leas~ of Pressure [ ] Immediate H~alth (Acut~)~.']'D~layed Html~ (Chwuic) [ 5) WASTE CLASSIFICATION O-digit cod~ ~,,, DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~ Gas [ ] Pure [ ] ~ [,~] Waste [ ] Radioactive [ ] 7) AMOUNT AND ~ AT FACILITY Maximum Daily ,amount ~, Average Daily Amount ~ Annual Amount [ c0o Largest Siz~ Container ~ # Days on Site 'Ma ~'~ UNITS OF lVIEAS~ 8) STORAGE CODES Lbs[ ]Gal[ ]ft3[ ] a)Containm~. /O Curies [ ] b) Pressure: ! c) T ~emperamm Circle Which Months: AIl Year, J, F, IVl, A, M, $, $, A, S, O, N, D 9) MIXTURE: List the three most hazardous chemical components or COMPONENT CAS % WT AHM 2) [ ] 3) [ ] 10)LOCATION 1) INVENTORY STATUS: New [ 2) Common Name: ] Addition [ ] Revision [ ] Deletion [ ] Ch~ck if chemical is a NON Trade Sec~ [ ] Trade 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH HazardCategones Fire[ ]Reactive[ ]SuddenReleaseofPressure[ ] ImmediateHealth(Acut-')[ ]DelayedHealth(Chromc)[ ] 5) WASTE CLASSIFICATION O-digit cod~ flu,.. DHS Form 8022) USE CODE 6) PHYSICAL STATE Solidi ] Liquid[ ] Gas[ ] Pure[] Mimre[ ] Wa.~[ ] Radioactive[ ] 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amount Largest Siz~ Container # Days on Site 9) MIXTURE: List the three most b~ardous I) chemical components or 2) any AKM components 3) LrNITS OF MEASURE 8) STORAGE CODF_.~ Lbs[ ]Gal[ ]1t3[ ] a)Contam~:. Curies [ ] b) Pressure: c) Te~peratu~ Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D COMPONENT CAS# % WT [ I [ 1- 10)LOCATION I certify under penalty of law, that I have personally examined and am familiar with the illformation on this and all attach~ docmnmts. I ' believe the submitted inlbnnation is true, accurate and complete. ,VONS Stores Dale Okamoto Store Manager 9000 Ming Avenue Bakersfield, Califomia 93311 Telephone: (805) 663-0595 Fax: (805) 663-0502 ~NS