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Home My WebLink AboutBUSINESS PLAN 7/8/1987 E~FACI LI T~ D] FOR~4 ~$ G R~kM NORTH FLOOR: / OF (CHECK ONE) SITE DIAGR.~M ~ FAC!LI~ DIAGR.~ (.Inspector's Comments): -OFFICIAL USE ONLY- - SA - ORTH SITE/FACILITY D FORM 5 SCALE: /~ /~c BUSINESS NAME: ~/2 /~'.~ ~,~M'o,t,Z FLOOR:. / OF (CHECK ONE) sITE DIAGRAM · FACILITY DIAGR.a~W OF I I( .L Inspector's Comments BAKERSFIELD CITY FIRE DEPART~IENT 2130 "O" STREET BAmERSFIELD, CA 9330~ (805) 326-3979 IUSINESS NAME OFFICIAL USE ONLY HAZARDOUS MATERI ALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. 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 B. LOCATION / STREET ADDRESS: ~.~ ~/.,; ~/~) CITY: ZIP: 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. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: S. ELECTRICAL:'~C-~Z5~,~"~ C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION:_~,7'I~ ~/~f)~ ~.~{c,z~P;M~ IF.YES, ~OES IT CONTAIN SITE PLANS? (~)/ ~_~._ ~S~SS? ~/ NO FLOOR PLANS? YES /~ KEYS? ~'-/~ - 2A - SECTION 5: LOCAL EMERGENCYMEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND -~E~-RESHER TRAINfN~- IN THE' F~LL0~NG ~E~. CIRCLE YES OR N0 INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...~ .................................... .~ NO ~NO B. PROCEDURES FOR COORDINATING ACTIVITIES :' C. PROPER USE OF SAFETY EQUIPMENT: ...... ' ............ ~ ~ NO ~ NO D. EMERGENCY EVACUATION PROCEDURES:. ......... ....... ~,$~ NO ~ NO · E. DO YOU MAINTAIN EMPLOYEE TRAI~G ~ECOR~DS: ....... ~ NO ,~) NO · ' CIRCLE YES OR NO ~ ' ' ' DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN ~00 POUNDS~OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS ...... g~'~, I, /~/~ , certify that-the.above information is,accurate. I understani/d that this infO~t'ion Will'~e~used to fulfill my fiFm's obligations unde~ 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. GENERAL OUTLINE OF EMPLOYEE TRAINING PROGRAM Initial training will be provided for new employees. Quarterly safety meetings with training logs wiii be kept on ail employees and will address the following: Quarterly review of MSDS for safe handling of hazardous mater i al s Bm Oral and hands on training to safely dispense propane, diesel, and gasoline. Initial and periodic training provided as needed. Emergency response procedures. Phone numbers and addresses of emergency response organizations visibly posted near phone. Dm Training for the proper use of safety equipment. It will cover the use of fire extingishers, first aid kits, safety goggles~ eyewash solutions~ and fire drill procedures. Roger A. Poe Exxon Dealer ROGER POEIS EXXON DATE: TOPIC: ROGER POE' S ~EXXON SAFETY MEETING ATTENDANCE ROSTER TRAINING CLASS ATTENDANCE ROSTER INSTRUCTOR: EMPLOYEES MAME -EMPLOYEES SIGNATURE 1. Roger Poe 2. John Carter 3. Eric Jensen 4. 5. 6. INSTRUCTORS COMMENTS/DISCUSSION: ROSTER EMERGENCY CALL LIST Roger Poe 01an Poe 393-7897 399-0005 Davies 0il Company 323-6063 3305 Gulf St Hall Ambulance Service/Paramedics ----- 327-4111 · Golden Empire ~ulance 327-9000 1003 Niles st 801-18th St Kern Medical Center ........ 326-2000 1830 Flower California Highway Patrol -- Dial ,,0,' ask for Zenith 1-2000 City Police Dept 327-7111 1601 Truxtun Ave County Sheriff Dept 327-3392 1415 Truxtun Ave city Fire Dept -- 324-4542 2101 'H' St Poisen Control Center ...... 209-445-1222, Collect Call List BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NA~[E: OFFiCiAL USE ONLY BUS I NESS PLAN SINGLE FACILITY UNIT F O l~2Vl 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 b~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible."- ' FACILITY UNIT~ FACILITY UNIT NAME: SECTION 1: MITIGATIONr PREVENTION, ABATEMEN'r PROCEDURES SECTION 2: NOTIFICATION .%%~ EVACUATION PROCEDL~ES AT THIS L%'IT ON-LY I.D. BAKERSFIELD,CIty FIRE DEPARTMENT FORM 4A-1 NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY Page ,_~.__"of ADDRESS:__~ ~ f~._~LI~/~/_.~ FACILITY UNIT #: ADDRESS: ~1.7 ~t..c?~i~Z;~t~ ar FACILITY UNIT NAME: ~.o~ ~:_~_ '~W'g~'/ -~.o~ ~: 3q3- 7~ [o~c~A~ us~ c~s coD~ . AFTER BUS HRS: EMERGENCY CONTACT: !~c~k K. ~¢¢-6.-- TITLE:_~_~v}'¢~mevt~/ "r'ecff~. ~PHONE { BUS HOORS: PRINCIPAL BUSINESS ACTIVITY: ~t'/ ~C~<~/Mm. AFTER BUS - 4A-1.- ~(~- ' : f' SIGNATURE: /~~ t"//,, /¢2/~-~--- DATE:_ EMERGENCYuCONTACT: -~l~w K. ~ TITLE: -L=-~plo~c_e_~ ~ PHOI~E #' BUS. HOURS: ~¢Of---rY71-2~.5-/ ' { ONLY 1 2 3 4 5 US6E 7 8 9 10 TYPE MAX ANNUAL CONT LOCATION IN TI{IS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY U,NIT. 'WT. CHEMICAL OR COMMON NAME CODE GUIDE BAKERSFIELD CITY FIRE DEPARTMENT I.D. # · FORM 4A-1 Page ~..0f NON--TRADE SECRETS ' HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: ~O~,,f-pO~_.~ ~'"XXOV~ OWNER NAME: Ko~C ~- Po~ FACILITY UNIT ADDRESS:~2~O~ ~c/~ ADDRESS: ~IV ~e<~]~ <~. FACILITY UNIT NAME: CITY, ZiP: ~kf.~5~(~.(~, [~ 733~ CITY,ZIP: ~kg$5~,k{~ C~ PHONE ~:_~-~7/-"~)~1 - PHONE ~: ~m*--~?M-7~f7 ~0FFIClAL USE CFIRS C0UE { ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME COD~ GUID~; EMERO CONTACT:-~[&M_ ~. ~0~ TITLE: [~[o~e~. ~ PHONE ~ BUS HOURS:.GD~-_RVl-21~I EMERGENCY CONTACT:' ~ek K-~ TITLE': ~AVl'rO~eJa/ W~~ PHONE t BUS HOURS: P"'~NClPA~ BUSINESS ACTIVITY: D,') FFo~¢/~A , · · AFTER BUS HRS: fof-OY~-/5-~$ - 4A-1. - - . BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 9-3301 ~US INESS NAME OFFICIAL USE ONLY ID# HAZARDOUS MATERIALS BUSINESS PLAN AS A. WHOLE FORM 2A /- INSTRUCTI 0NS: 1. 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: ' B. LOCATION / STREET ADDRESS: .~f.e O~ BUS.PHONE: (~) 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 Four local fire department and the State Office of Emergency Services as required by law. .'.. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE B . '7-//"I /Z~f, ~f ~lG IF. Ph~ DURING BUS. HRS. 7 AFTER BUS, HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE E. LOCK BOX: YES / NO IF YES, LOCATION:_-~;~-~ IF YES, DOES IT' CONTAIN SITE PLANS? ~3/ ~O MSDSS? ~/ NO FLOOR PLANS? YES /~ KEYS? ~ /~ · - 2A - SECTION 4: PRIVATE RESPONSE TE,a34 FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EI~ERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A I~IOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO ~ A PROG~ WHICH PROVIDES EMPLOYEES WITH ~NITIAL ~D REFRESHER TRAINING IN THE FOLLOWING AREAS. . CIRCLE YES OR NO ' INITI~ REFRESHER .. A. METHODS FOR SAFE HANDLING OF HAZARDOUS TERIALS:...- .................................... B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... NO E ) NO C. PROPER USE OF SAFETY EQUIPMENT: .................. NO ' NO D. EMERGENCY EVACUATION PROCEDURES: ................. 'NO E~'" NO' E. DOYOU ~INTAIN EMPLOYEE TRAINING ~ECORDS: ....... NO NO SECTION 7: ~ZARDOUS ~RI~ CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN $00 POL~DS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... "Y~ I, /~f~//~- , certify that the above info~mation is accurate. I understan~t 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 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. SIGNATURE TITLE .~ t.C?~' DATE BAKERSFIELD CITY FIRE DE?ARTMEXT 2130 "G" STREET.· BAKERSFIELD, CA 93301 BUSINESS N~IE: 0FFrC[AL USE ONLY ID# BUS I NESS PLAN. SINGLE FACILITY UNIT F 01:t3,I 3A INSTRUCTIONS 1. To avoid furt.her action, this form must be returned bM: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 8. Answer the questions below for THE FACILITY b~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible.'- ' ................. FACILITY UNIT~ FACILITY UNIT N~E: SECTION I: MITIGATION, PREVENTION~ ABATEMEN-F PROCEDURES O.z::>/~ - ~/,tee.e' e~/?''' SECTION 2: NOTIF!CATION ~%~ EVACUATION PROCEDL~ES AT T~IS US'IT 05~Y I.D. HAZARDOUS MATERI ALS BUSINES~ NAME': '"~('"~Cg~/~ ~F__,..',5 ~".>z~x/O/,-/ OWNER NAME:~M~ ADDRESS :_<} ~0 ~ /D'~/z I(~f / ' IP:' ~;-'~ .~ _:'~L~ , , ADDRESS: BAKERSFIELD 'Y FIRE DEPARTMENT M 4A-1 NON--TRADE SECRETS FACILITY UNIT #: 4 5 6 7 ~ 9 ~ TYPE MAX 10 ANNUAL CONT USE LOCATION IN THIS ~; BY HAZARD D.O.1 CODE AMOUNT AMOUN___.~__T UNI~T CODE COD.____~_E _ FACILITY UNIT WT. CHEM---~J-~AL OR COMMON NAM~ CODE ~UID, ~ o ~ . EMEROENCY CONTACT: ?{~k r. ~. ~ TITLS':, ~Avf~nme~ka/ ~. ~ PHONE * BUS HOURS:~o~_7~z_ pRINCIPAL BUSINESS ACTIVITY: 0[/ Pro',~<~/~_ AFTER BUS HRS: PHONE t:_ ~0~-- ~7/-'?! ?! PHONE #: OFFICIAL USE CFIRS CODE NAME: Page ._/__"ofN.~-- FACILITY UNIT BAKERSFIELD FY FIRE DEPARTMENT · i.D. ~, ~RM '4A-1 Page . NON--TRADE~ SECRETS HAZARDOUS MATERI ALS INVENTORY' BUSINESS NA~E: ~Oo~' ~QC'% ~--~ ~XO~ OWNER NAME: : K~V ~. PO~ FACILITY UNIT ADDREss:__ ~0~' ~ /~ __ ADDRESS: 7;~ ~+~e~,~ <~, FAOILITY' UNIT NAME: PHONE ~:~m~-mT/-~/r; PNONE ~: mm~--5~-7~7 IOFFIClAL USE CFIRS CO0~ · ! NATURE: ~,~,o,~._-.. ~ /~.,..~., DATE EMERG CONTACT: ~)lOv~_ K. ~o~ TITLE: ~o~ ~ PHONE ~'. BUS HOURS:.~O~-RT/'2/~C; . AFTER Bus HRS: E~ERGENCY CONTACT: N~W~. K-~ ~ITLE ~Au"~"~eJ"/:W~ PHONE 8 BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: ~'~') ~°C~C~/~ AFTER BUS ~RS: { 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 AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIqAL OR COMMON NAME CODE GUID~; r.,.7 .1.'. ,..:..:.~lq, moa ~¢a Gl 1~ ~n~r ~ ~ ~ ,~lCS~/. ~ I ~hrc ~" "' "' NAME: