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Home My WebLink AboutBUSINESS PLAN ITE/FACI LI TY FORM (CHECR ONE) SITE DIAGRAM ~/ FACILITY DIAGRAM -f (Inspector's Comments): -OFFICIAL USE ONLY- 5A - DATE MISCELLANEOUS RECEIVABLES ADJUSTMENT NEVV.ACCOUNT ~ ADDRE$SCHANGE CLOSE ACCT "FINANCE CHARGEi ~oTHERADJ' CUSTOMER NAME MAILING ADDRESS STATE ZIP CODE SITE ADDRESS PARCELNUMBER (IF APPLICABLE) ADJUSTMENT CHG DATE CHARGE CODE ADJUSTMENT AMOUNT APPROVED MR430101_ · ~Customer ID .'. . Last statement .~ : Last invoice ~... : ,'Current balance : Pending .... ~. : Previous balance :' Deposit balance Type options, press Enter. l=Select, Opt Code Description HM009 HAZ MAT HANDLING FEE CITY OF BAKERSFIELD' .laneous Receivables Inquiry . 3445 '1/01/97 0/00/00 '.158.00 .00 158.00 Name: TYNER, HAROLD .Addr: 3609 SILVERADO 'BAKERSFIELD, CA.~93306 A ACTIVE '.00 open Activity '-' Current I .158.00 1/08/97. 12:.48:54 'ENVIRONMENTAL SERVICES- OverdUe Total due - .00 158.00 F3=Exit F10=Combined detail F14=Deposit detail F7=Pending activity Fll=Invoice inquiry F21=Other tasks F8=Charge hs.ty F12=Cancel F9=Payment hSty )6/12/92 TRUCK/RV CAR WASH 215-000-001417 Overall Site with 1 Fac. Unit JUL ,14:1'992 ~ge General Information Location: 148 S OSWELL ST Map: 124 Hazard: Moderate,I Community: COUNTY.STATION 41 'Grid: 02A F/U: 1 AOV: 0.0 I Contact Name Title Business/ Phone 24-Hour Phone1 BONNIE TYNER (805) 871-6965 x 805 ( )/ '- x - Administrative Data ~Mail Addrs: 3609 SILVERADO City: BAKERSFIELD Comm Code: 215-041 COUNTY STATION 41 D&B Number: State: CA Zip: 93306- SIC Code: 7542 Owner: H G TYNER Phone: (~O~<')~I/ Address: 3609 SILVERADO State: CA City: BAKERSFIELD' Zip: 93306- - S~mmary '~~~-~ Do hereb¥ ce~y th a~ i have r~vie~d the attached hazardous ma~.'eria~$ ',~,: ~,~A~;~"and .~ha~' i~ along any ~rrections cons~tute a Complete and ~rre~ agement Plan for my faciJity. 06/12/92 TRUCK/RV CAR WASH 215-000-001417 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 PROPANE Gas ~ Fire, Pressure, Immed Hlth, Delay Hlth 18195 High FT3 CAS #: 74-9~8r6 Trade Secret: No Form: Gas Type: Pure Days: 365 use: FUEL Daily Max FT3 18,195 Daily Average FT3 8,000.00 Annual Amount FT3 -- 109,170.00 Storage FIXED PRESS. CYLINDER Press T Temp Location Iabove IAmbientlSOUTHWEST CORNER OF PROPERTY -- Conc 100 0% IPropane Components iMCP Extreme List 06/12/92 TRUCK/RV CAR WASH 215~000'001417 00 - Overall Site <D> Notif./Evacuation/Medical Page <1> Agency Notification <2> Employee Notif./Evacuation ' ENTRANCE AND EXIT - 45 FEET OSWELL OPENING <3> pUblic Notif./Evacuation <4> Emergency'Medical Plan NEAREST HOSPITAL- KERN MEDICAL CENTER 1830 FLOWER STREET BAKERSFIELD (805) 326-2000 06/12/92 ' TRUCK/RV CAR WASH 215-000-001417 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page <1> Release Prevention ! <2> Release Containmen~ <3> Clean Up <4> Other Resource Activation 06/12/92 TRUCK/RV cAR WASH '215-000-00,1417 00 - Overall~ Site <F> Site Emergency Factors Page 5 <1> special Hazards <2> Utility Shut-Offs A) GAS/PROPANE - VALVE ON TANK (500 GAL) B) ELECTRICAL - BOX ON BUILDING C) WATER - NORTHEAST CORNER D) SPECIAL -*NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water NO PRIVATE FIRE PROTECTION FIRE HYDRANT - OSWELL STREET ENTRANCE <4> Building Occupancy Lewel 06/12/92 .~k TRUCK/RV CAR WASH 215~000-001417 00 - Overall Site <G> Training Page 6 <1> Page 1 WE HAVE'NO EMPLOYEES ~WE DO NOT HAVE MATERIAL SAFETY DATA SHEETS ON FILE (8-3-89) WE HAVE NO TRAINING PROCEDURES <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ,;. ;':!i'I'RUCK/RV CAR lASH. '.,.",:'! BAKERSFIELD.. CA :' 9330? FiRE DEPAR i MEN-i 2130 ,'G' STREET BAKERSFIELD, CA, 933ffl (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NAME INSTRUCTIONS: HAZARDOUS MATERIALS BUSINESS PLAN. AS A WHOLE" FORM 2A RECEIVED ~AY 1 9 198~ HAZ. MAT. DiV. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 8e as brief and concise as possible. SECTION 1: To avoid further action, return this from within 30 days of receipt. BUSINESS IDENTIFICATION DATA 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# PH# PH# SECT]~ON 3; kOCAT~ON OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE D. SPECIAL: / N~ E. LOCK BOX: YES 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 WHOLF SECTION 5' LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUS[NESS AS A WHOLE SECTION 6: EMPLOYEE'TRAINING EMPLOYERS ARE REQUZRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS HATER[ALS. A. NUMBER OF EMPLOYEES'AT THIS FACILITY B. "~O YOU HAVE MSDS (MATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL, YOU~ HANDLE o, , C. GIVE A,BRIEF SUHMARY OF YOUR HAZARDOU~MATERIALS TRAINING PROGRAM: ; SECTION 7: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE CALIFORNIA HEALTH AND SAFETY 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 8:/ ~ER..T~,FICATION , .,'certify that the above information is accurate. ~[derstand that this, in~ormal~ion w~i, ll be used to fulfill my, firm's oblig~ions under the new California Health .and Sai~ety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury.~-''7'~ (805) 326-3979 OFFICIAL USE ONLY BUSIN=SS N^h~E ID# 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 the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible FACILITY UNIT ' '~ FACILITY UNIT NAME: j~4./~/~.~ ~A_ ~x~J~ SECTION 1: MITIGATION, PREVENTION, ABATEMENT. PROCEDURES SECTION 2: NOT[F]~GATION 'AND EVACUATION PROCEDURES AT THE UNIT ONLY SECTION 3: X o HAZARDOUS MATERIALS FOR THIS UNIT ONLY Does this Facility Unit contain Hazardous Materials? ...... If Yes, see B. If NO, con'tinue with SECTION 4 Are any of the hazardous materials a bona fide Trade Secret? If NO, complete a separate Hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-1) If YES, complete a hazardous materials inventory form marked: (NO YES ~' TRADE SECRETS ONLY (Yellow form ¢4a-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: I]O~AT]~ON OF WATER 'SUPPLY FOR USE BY EMERGENCY RESPONDER~ (Fire Hydrant) SECTION 8" LOCATION OF U?ILITY SHUT-OFFS AT THIS 'U~IT ONEY. A. NATURAL GAS/PROPANE' D. SPECIAL: E. LOCK BOX: YES ~ ~F YES, LOCATION: IF YES, SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSs? YES / NO KEYS? YES / NO - 3B- CITY, ZrP ~__~. ~ STANDARD IND. CLASS COD~ PHONE ~: PHONg ~:~ ' DUN AND BRADSTRg~T ~ ~ ~~~ POR PROP~ COD~ - -- - - -- -- lrens Ty~ ~x Average ~nuai ~asu~ I ~ Cmt ~t ~t L~att~ N~e ~N~~ ~ of C~e C~e Mt ~t Est Units ~ Stte TyM Pr~l TMp C~e ., Stor~ tn Facility ~ Inst~ctims - -- .. Z~ ~_~ ~~:_~ ..... Ph~ical and H~lth Hazard C.A.S. ~_ Cwt I1 h & C.A.S. ~ Health of P~surl H~lth .... .... [ .... 1, ......... 1 .............. 1. L-I ...... IL,.~._LJ..:~. I . ............. ~.~_. :P~iCa~ ~d H~lth Hazard C.A.S. ~ .... (C~k all t~t apply) ~t II Xm i C.A.$. ~ ~ ~ Fire Hazard ~ ~ ~ctivtty L--J ~la~ ~--~ ~m Rei~ ~--J i~late H~lth of P~su~ ~lth :._L_[ ........ L_._, ....... L. L ..... I ___[~~1_:: I ~ ~ ;ire Hazard ~ ~ Reactivity ~ ~ ~la~ ~--J ~ddm Rel.se ~--J I~iate Health of Pr~sure H~lth - I [ ,J L I J_ t J: ~ I 2 ---- ' ' -- P~ical ~ H~lth Hazard C.A.S. iue~e ....................... (C~k all t~t apply) Cm~t I! tm t C.~.S. I~ L__. Fire Hazard ~ ~ R.ctivity ~ ~ .~iay~ L_. ~dd. Release ~ ~ I~iate Health of Pr~sure Health .............. ~_~ ............................................ ~at 13 ~ & C.A.S. ~MERGENCY C~TACTS I1 "' ' "" --- .__ _ ~ ]~ ................. 12~i~ TT~ CITY of BAKERSFIELD <:' ~'~,,~ and agriculture '~--~ StanUard eusiness AZARDOUS MACLJlaT-RT ALS ~ NV~NT.ORY' ;. NO N-- ~r RAD E S E C RE T ~ ' Page.~of_~ "(' NAME OF T~ g FACILITY: tion (Reed and sign after compJetJng all sections) I certify under penalty of law that I have personally examined and am familiar with the informationy ed t his and a11 attached d u , inquiry of those individuals responsible for oJ~tainina the information. I believe that the subleted information is true, accurate, F:gd~ oc merits and that based on my ~-i~-~t;~]",~'~-~7~$;~;'0~ o;e~?~$~'~'~Y~-~i~iii~[i~;i / 5~i~i'~ ..... '~' .................................. ~ ................