HomeMy WebLinkAboutBUSINESS PLAN 10/29/2007~.~
~ a
~ J.
a
~'
d
I'~, ~~ LESLIES POOL SUPPLY
- -- - - ~~ _ _ a, 2651 OSWELL ST STE F _ _
cui°~
~~~~
au~ 3 0 ~~
Hazardous Materials/Hazardous Waste, Unified Permit
CONDITIONS OF,PERMIT ON REVERSE SIDE
Permit ID#:: 015-000-001801
.LESLIES POOLSUPPLY
~LOCATION: 2651 osVVELL ST F '
Thi~ I~rmit is issued for the f°llowin_.:
[] Hazardous Materials Plan
[] Underground Storage of HazardOuS Materials
[] Risk Managemmat 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
'!
OffiCe ofEv~Services ~
',June 30. 2003
Issue Date
LESLIES POOL SUPPLIES 261
SiteID: 015-021-001801
Manager JOE FERRERA
Location: 2651 OSWELL ST
City BAKERSFIELD
BusPhone:
Map : 103
Grid: 23A
(661) 873-8880
CommHaz : High
FacUnits: 1 AOV:
CommCode: BFD STA 08
EPA Numb:
SIC Code: 5999
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
GREG CANFIELD / DISTRICT MGR MIKE JENNINGS / REG AFFAIRS MGR
Business Phone: (559) 307-9815x Business Phone: (602) 366-3946x
24-Hour Phone : (559) 307-9815x 24-Hour Phone : (480) 227-9249x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards:
Fire Press React ImmHlth
Contact : MIKE JENNINGS
MailAddr: 3925 E BROADWAY RD 100
City : PHOENIX
Period :
Preparer:
Certif'd:
ParcelNo:
to
Phone: (602) 366-3946x
State: AZ
Zip : 85040
Phone: (602) 366-3999x
State: AZ
Zip : 85040
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Owner
Address
City
LESLIES POOLMART
: 3925 E BROADWAY RD
: PHOENIX
Emergency Directives:
PROG A - HAZMAT
I~~
/
lol -Z.f1 { d 1
~
-1-
10/22/2007
, .
F LESLIES POOL SUPPLIES 261
F Hazmat Inventory
p= MCP+DailyMax Order
SiteID: 015-021-001801
By Facility Unit
Fixed Containers at Site
Hazmat Common Name...
I SpecHazIEPA Hazards I Frm I
CHLORINE BLEACH/R/L/250.00 GAL/ HI
MURIATIC ACID/R/IH/L/200.00 GAL/ HI
TRICHLORO-S-TRIAZINETRIONE/S/8000.00 LBS/MOD
SODIUM DICHLORO-S-TRIAZINETRION/S/6000.00 LBS/MOD
CALCIUM HYPOCHLORITE/S/4500.00/LBS/MOD
SODA ASH/F/IH/S/800.00 LBS/LOW
SODIUM BICARBONATE/R/IH/S/800.00 LBS/MIN
FRESH AND CLEAR/S/1000.00 LBS/UNR
SEE ATTACHED INVENTORY SHEET
-2-
10/22/2007
F LESLIES POOL SUPPLIES 261
F Inventory Item 0002
COMMON NAME / CHEMICAL NAME
Location
SiteID: 015-021-001801 9
Facility Unit:
Facility Unit
Map:
Grid:
F Inventory Item 0006
~ COMMON NAME / CHEMICAL NAME
CHLORINE BLEACH
Facility Unit: Fixed Containers at Site 9
Location within this Facility Unit
NW CRNR BACK RM
Days On Site
365
Map:
Grid:
CAS #
7681-52-9
STATE - TYPE
Liquid Mixture
PRESSURE ---- TEMPERATURE
Ambient Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
1. 00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
250.00 GAL
Daily Average
200.00 GAL
%Wt. RS CAS #
10.00 Sodium Hypochlorite No 7681529
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R / / / Hi
HAZARD ASSESSMENTS
-4-
10/22/2007
F LESLIES POOL SUPPLIES 261
F Inventory Item 0005
i== COMMON NAME / CHEMICAL NAME
MURIATIC ACID
SiteID: 015-021-001801 ;
Facility Unit: Fixed Containers at Site;
Days On Site
365
Location within this Facility Unit
N END BACK RM
Map:
Grid:
CAS #
7647-01-1
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
1 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
200.00 GAL
Daily Average
120.00 GAL
HAZARDOUS COMPONENTS
%Wt. RS CAS #
32.00 Muriatic Acid Yes 7647010
HAZARD ASSE SMENT
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R IH / / / Hi
S S
F Inventory Item 0003
= COMMON NAME / CHEMICAL NAME
TRICHLORO-S-TRIAZINETRIONE
CHLORINATOR TABLETS
Location within this Facility Unit
CTR SALES FLR
Facility Unit: Fixed Containers at Site;
Days On Site
365
Map: Grid:
CAS #
STATE - TYPE
Solid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
40.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
8000.00 LBS
Daily Average
4000.00 LBS
HAZARDOUS COMPONENTS
%Wt. RS CAS #
100.00 Trichloro-s-triazinetrione No 87901
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Mod
-5-
10/22/2007
F LESLIES POOL SUPPLIES 261
p= Inventory Item 0004
F== COMMON NAME / CHEMICAL NAME
SODIUM DICHLORO-S-TRIAZINETRIONE
SiteID: 015-021-001801 9
Facility Unit: Fixed Containers at Site 9
DIHYDRATE
Days On Site
365
Location within this Facility Unit
E END SALES FLR
Map:
Grid:
CAS #
STATE - TYPE
Solid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
6000.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
6000.00 LBS
Daily Average
3000.00 LBS
HAZARDOU COMPONENT
%Wt. RS CAS #
100.00 Sodium Dichloro-s-triazinetrione Dihydrate No 2893789
S
S
HAZARD ASSE SMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Mod
S
p= Inventory Item 0001
= COMMON NAME / CHEMICAL NAME
CALCIUM HYPOCHLORITE
Facility Unit: Fixed Containers at Site 9
Days On Site
365
Location withi~ this Facility Unit
N CTR SALES FLR/BACK ROOM
Map:
Grid:
CAS #
STATE - TYPE
Solid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
100.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
4500.00 LBS
Daily Average
2000.00 LBS
%Wt. RS CAS #
> 65.00 Calcium Hypochlorite No 7778543
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Mod
HAZARD ASSESSMENTS
-6-
10/22/2007
F LESLIES POOL SUPPLIES 261
F Inventory Item 0007
F== COMMON NAME / CHEMICAL NAME
SODA ASH
SODIUM CARBONATE
Location within this Facility Unit
NE CTR SALES FLR
SiteID: 015-021-001801 1
Facility Unit: Fixed Containers at Site 1
Days On Site
365
Map: Grid:
CAS #
497-19-8
STATE
Solid
TYPE
Pure
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
50.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
800.00 LBS
Daily Average
600.00 LBS
HAZARDOUS COMPONENTS
%Wt. RS CAS #
100.00 Sodium Carbonate No 497198
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH / / / Low
F Inventory Item 0008
= COMMON NAME / CHEMICAL NAME
SODIUM BICARBONATE
ALKALINITY VP
Location within this Facility Unit
NE CTR SALES FLR
Facility Unit: Fixed Containers at Site 1
Days On Site
365
Map: Grid:
CAS #
STATE
Solid
TYPE
Pure
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
30.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
800.00 LBS
Daily Average
600.00 LBS
HAZARDOU COMPONENTS
%Wt. RS CAS #
100.00 Sodium Bicarbonate No 144558
S
HAZARD ESSMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R IH / / / Min
ASS
-7-
10/22/2007
-L _.
ay
LESLES POOL SUPPLIES 261-OSWELL
Manager JOE FERRERA
Location: 2651 OSWELL ST
City BAKERSFIELD
CommCode: BFD STA OS
EPA Numb:
~~~i
SiteID: 015-021-001801
BusPhone: (661) 873-8880
Map 103 CommHaz High
Grid: 23A FacUnits: 1 AOV:
SIC Code:5091
DunnBrad:
Emergency Contact / Title
-f-
~~
~
` Emergency Contact f Title
Business s
G : ~ u
~
~
L~.,.~,'r,~ rrt / ~c~.,~r,, f'.~
Phone: (-6
) -
7~~
0 I~-'~e3'E~;D s
~~iness P~o~ie: / `~~gr~.
4~8
(-6.6z) `~
~
~
~
~~
~
~ ~
.
_
-1~
•
2 4 -Hour Phone (
-1--) 3
~3 2 4 -Hour Phone x
8
()
Pager Phone (~~) 3`~~ - `~~~~-~ Pager Phone (K~~) 4L~ - CjL~(~
Hazmat Hazards: Fire Press React ImmHlth
Contact MIKE JENNINGS Phone: (602) 366-3999x ~9~!(.t
MailAddr: 3925 E BROADWAY RD 100 State: AZ
City PHOENIX Zip 85040
Owner LESLIES POOLMART Phone: (602) 366-3999x
Address 3925 E BROADWAY RD State: AZ
City PHOENIX Zip 85040
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
F^Sased on my inquiry of those individuals
ible for obtaining the information, I certify
respons
under penalty of lave that I have personally
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
z .who ~ ~N~'b ~~~'
~ ~
Sig
-1- 02/02/2007
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers at Site ~
Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP
SODIUM PERSULFATE F P S 1500.00 LBS Hi
CHLORINE BLEACH R L 250.00 GAL Hi
MURIATIC ACID E R IH L 120.00 GAL Hi
TRICHLORO-S-TRIAZINETRIONE S 8000.00 LBS Mod
SODIUM DICHLORO-S-TRIAZINETRION S 6000.00 LBS Mod
CALCIUM HYPOCHLORITE S 4500.00 LBS Mod
SODA ASH F IH S 800.00 LBS Low
SODIUM BICARBONATE R IH S 800.00 LBS Min
-2- 02/02/2007
-3- 02/02/2007
J ~
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~
COMMON NAME / CHEMICAL NAME
SODIUM PERSULFATE Days On Site
OXIDIZER II 365
Location within this Facility Unit Map: Grid:
N CTR SALES FLR CAS#
~SolidE TMixture~mbient~E ~ AmbientT~E ~PLASTICTCONTAINERE
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
45.00 LBS 1500.00 LBS 1000.00 LBS
t1HGKKLVUJ 1:V1~lYV1V1;1V1.7
oWt. RS CAS#
100.00 Oxone Monosulfate Compound No 70693628
t11~GF~KL E~JJ~JJ1~11",1V1~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P / / / Hi
~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~
COMMON NAME / CHEMICAL NAME
CHLORINE BLEACH Days On Site
365
Location within this Facility Unit Map: Grid:
NW CRNR BACK RM CAS#
7681-52-9
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixture ~ Ambient ~ Ambient _~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
1.00 GAL 250.00 GAL _ 200_.00 GAL
ntiGtltCL V U .7 1, V1~lY V1V P~1V 1 J
oWt. RS CAS#
10.00 Sodium Hypochlorite No 7681529
l11-~GHiCL HJ .7P~J.71~11;1V 1.7
TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R / / / Hi
-4- 02/02/2007
F LESLIE5 POOL SUPPLIES 261-OSWELL
~ Inventory Item 0005
COMMON NAME / CHEMICAL NAME
MURIATIC ACID
Location within this Facility Unit
N END BACK RM
STATE TYPE PRESSURE
Liquid TMixtur~ Ambient
SiteID: 015-021-001801 ~
Facility Unit: Fixed Containers at Site ~
Days On Site
365
Map: Grid:
CAS#
7647-01-1
TEMPERATURE CONTAINER TYPE
Ambient -~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Co120~00rGAL Daily M20100m GAL I Daily 120r00e GAL
r1~~r~.c1~VU~ wlnrVivrivla
oWt. RS CAS#
32.00 Muriatic Acid Yes 7647010
t1F~GLiKL Ij~J~JJ1~1~1V 1
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R IH / / / Hi
~ Inventory Item 0003
COMMON NAME / CHEMICAL NAME
TRICHLORO-S-TRIAZINETRIONE
CHLORINATOR TABLETS
Location within this Facility Unit
CTR SALES FLR
Facility Unit: Fixed Containers at Site ~
Days On Site
365
Map: Grid:
CAS#
STATE TYPE PRESSURE
Solid TMixture ~mbient
TEMPERATURE CONTAINER TYPE
Ambient -~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
40.00 LBS 8000.00 LBS 4000.00 LBS
riliGEitCLVU~J 1..V1~lYV1VL"1V1~
%wt. Rs cAS#
100.00 Trichloro-s-triazinetrione No 87901
ru~aricu~ r~a ~l;~~l~il;ivla
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies j / / Mod
-5- 02/02/2007
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~
COMMON NAME / CHEMICAL NAME
SODIUM DICHLORO-S-TRIAZINETRIONE DIHYDRATE Days On Site
365
Location within this Facility Unit Map: Grid:
E END SALES FLR CAS#
~SolidE TMixtur~AmbRent~E ~ AmbientT~E ~ PLASTOICTCONTAINERE
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
6000.00 LBS 6000.00 LBS 5000.00 LBS
HAZARDOUS COMPONENTS
%Wt. RS CAS#
100.00 Sodium Dichloro-s-triazinetrione Dihydrate No 2893789
ri1'aGEjtCL E~, 7.7.C~.7Jl~lrJ1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Mod
~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~
COMMON NAME / CHEMICAL NAME
CALCIUM HYPOCHLORITE Days On Site
365
Location within this Facility Unit Map: Grid:
N CTR SALES FLR CAS#
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Solid Mixture Ambient Ambient PLASTIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
100.00 LBS 4500.00 LBS 4500.00 LBS
Ila`~GL~ICLVU.7 l.Vl"lYV1VU'1V 1~7
~Wt. RS CAS#
65.00 Calcium Hypochlorite No 7778543
tu~Gtu[L ti~ ar,a5l~ll:,lvla
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Mod
-6- 02/02/2007
t
F LESLIES POOL SUPPLIES 261-OSWELL
~ Inventory Item 0007
COMMON NAME / CHEMICAL NAME
SODA ASH
SODIUM CARBONATE
Location within this Facility Unit
NE CTR SALES FLR
STATE TYPE PRESSURE
Solid TMixture Ambient
SiteID: 015-021-001801 ~
Facility Unit: Fixed Containers at Site ~
Days On Site
365
Map: Grid:
CAS#
497-19-8
TEMPERATURE CONTAINER TYPE
Ambient -~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
50.00 LBS 800.00 LBS 600.00 LBS
nx~H.tcL~ua ~vrirulv~iv,~~
%Wt. RS CAS#
100.00 Sodium Carbonate No 497198
tu~~tattt~ r-~5 5~aai~i~ly l a
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH / / / Low
~ Inventory Item 0008
COMMON NAME / CHEMICAL NAME
SODIUM BICARBONATE
ALKALINITY VP
Location within this Facility Unit
NE CTR SALES FLR
STATE TYPE -~-~ PRESSURE
Solid. TMixture I Ambient
Facility Unit: Fixed Containers at Site ~
Days On Site
365
Map: Grid:
CAS#
TEMPERATURE CONTAINER TYPE
Ambient l~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest-Con30100rLBS Daily 800100m LBS I Daily 600r00e LBS
t1L~G1-ucJJVUJ w1~1ru1vL'1v1~
%Wt. RS CAS#
100.00 Sodium Bicarbonate No 144558
t11~L,LiKL 1~~ J~JJ1~1~1V1~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R IH / / / Min
-7- 02/02/2007
F LESLIES POOL SUPPLIES 261-OSWELL SitelD: 015-021-001801 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 10/06/1997 ~
3 PHONES AVAILABLE TO CALL 911.
Employee Notif./Evacuation
04/19/2006
VERBAL IN STORE. REGULATORY AFFAIRS FOR CORPORATION 800-275-5882 X-3946.
Public Notif./Evacuation
04/19/2006
OUT MAIN ENTRANCE TO WEST. EMERGENCY EXIT AT NORTHEAST CORNER OF SHOWROOM.
Emergency Medical Plan
07/19/2006
COMPANY-DESIGNATED URGENT CARE/HOSPITAL AND FIRST AID KIT IN STORE.
-8- 02/02/2007
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt Overall Site ~
~ Release Prevention 04/19/2006 ~
SEPARATION OF INCOMPATIBLES. PRODUCT IN FINAL CONSUMER PACKAGING.
Release Containment 10/06/1997
OVERPACK BUCKETS AND NEUTRALIZATION MATERIALS.
Clean Up
CHEMICAL BROOM AND DUST PAN FOR BUCKETS.
10/06/1997
Other Resource Activation 04/19/2006
EMERGENCY RESPONSE CONTRACTOR: EMI 800-510-8510.
-9- 02/02/2007
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
Fast Format ~
~ Site Emergency Factors Overall Site ~
.7~JeC:1dl tld"GdlUS
Utility Shut-Offs 04/19j2006
A) GAS - OUTSIDE E DOOR BACK RM
B) ELECTRICAL - INSIDE NE CRNR BACK RM
C) WATER - OUTSIDE E DOOR BACK RM
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 12/14/2006
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLERS.
Building Occupancy Level
5 EMPLOYEES
03/10/2006
-10- 02/02/2007
aI' ~~ ~~~
a
F LESLIES POOL SUPPLIES 261-OSWELL SiteID: 015-021-001801 ~
Fast Format ~
~ Training Overall Site ~
~ Employee Training 07/19/2006 ~
MSDS SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: SAFETY MEETINGS AND TRAINING UPDATES.
rayC 4
nc.iu Lvi r u~uic vac
nciu ivi r u~ul.c vac
-11- 02/02/2007
UNIFIED PROGRAM INSPECTION CHECKLIST
.. ~ _ _.
.: -SECTION 1: Business.Plan and Inventory Program
•
C
Prevention Services'
R E R s F_, 900 Truxtun Ave., Suite 210
FIRE Bakersfield, GA 93301
ARTM r . Tel.: -(661) 326-3979 '
Fax: (661) 872-2171
FACILITY NAME ~ - ~
~S ~t mss' ~eso' SGI !l ~S (o INSPECTION DATE
%f- / 3 -ate INSPECTION TIME
~~66
ADDRESS
~ S DSrt/c 5-f , PHONE NO.
~ ~3 - ~~ro NO OF EMPLOYEES
~
FACILI TY CONTACT
~~'!/~ t/'Gt BUSINESS ID NUMBER
15-021- 00/ SOr
f
~ - - -_ __ _ ____ - ~ - --
Section 1: Business Plan and Inventory Program ~ ~LJ~
ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ( C=Compliance) OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
l~i ^ BUSIIIeSS PLAN CONTACT INFORMATION ACCURATE f"? (~ ~ 0 ~ ~,OO~
~J tJ
~ ^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
fLl ^ VERIFICATION OF QUANTITIES
® ^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
® ^ VERIFICATION OF MSDS AVAILABILITY
® ^ VERIFICATION OF HAZ MAT TRAINING -
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
® ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
® ^ HOUSEKEEPING
`yl. ^ FIRE PROTECTION
{~ ^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ^ YES ~ NO
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 32.6-3979
• J [ Ir~lr~ t ~ ~ etrli~t
Inspector (Plea Print) Fire revention / 1s~ In /Shift of Site/Station # Bus' es ite Responsible Party (PI a Print)
White -Prevention Services Yellow -Station Copy ~ - Pink -Business Copy - FD 2155 (Rev. 09)05
.. ;
~,ar
,~
+ LESLIES POOL SUPPLIES 261 ___________________________ SiteID: 015-021-001801 +
2 ~-~~r~r
Manager E~-I3~- BusPhone: (661) 873-8880
Location: 2 WELL ST ~' ~ ~~I o~watt 5-F - Map 103 CommHaz High
City B IELD ~~~~>~.rr,~rlt Grid: 23A FacUnits: 1 AOV:
CommCo BFD STA 08 SIC Code:5091
EPA Numb: DunnBrad:
Emergency Contact
JOE FERRERA / Title rgency Con cN / ~~ Ti~tl~ . ~.c, ~~
~ ~" ~ ~' S~i2~D~2 ~
/ MA
AGER ~TE`S•S
N
f
Business Phone: (661) 873-8880x Busi s hone: (661) ~~-~-r~Ox
2 4 -Hour Phone (6 61) -3-9~' - 3~3-8~ 2 4 - H hone (-8-8~-) 8~-~ 3~-1~--~
Pager Phone ( ) ~ ~ `~ ~ Zy3 ~ P r Pho (~~) 3 ° 7 - `/S f Sx
Hazmat Hazards: Fire Peres-s~ React ImmHlth
om` ~` ~ Z ~~tl °" ~ Y
n
~
~
~
=
~
f
~
Contact
G~ N
~
8 7
~
Phone :
6-1)
Mai lAddr : 2-6-7~. L--53-1F' 3 yZ~ ~- ~a.E~ ~w~( ~~ • State : -G~,: ,f9Z
City ~az„,~; ~- Zip 93.3.0.6 ~ ~-~~.-(~~p
O
S ES •.i.~cc. Ph
P 6LMAR'~' L-esrr~ e`er y~'o~~vvcaf~
8~~3=~2-1~~
• (>
wner ,
one
-
Address 20630 ER ST 3925 ~, ys-oc~r~~w~ /~vt'• State: ~: ~Z-
City CHAT OR ~~oP~+ ~ Zip 9-331 ~ S~'-t ~
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif ' d: RSs : No
ParcelNo:
~ Emergency Directi ves: ~
PROG A - HAZMAT
E3ased on rrty Ihc~uiry gf those individuals
responsible for obtainlnQ 4he informetian, I certify
undar penally of law that I have personally
examined ar~d am 4amlllar with the Information
submitted and bollpve the information is true,
accurate, and complete.
y O Gl
a ure Date
ENr~ A ~R ~ 9-.Zoos
-1- 03/10/2006
LESLIES POOL SUPPLY
Manager : MIKE HIBLER
Location:. 2651 OSWELL ST F
City : BAKERSFIELD
CommCode: BAKERSFIELD STATION
EPA Numb:
SiteID: 015-021-001801
BusPhone:
Map : 103
Grid: 23A FacUnits:
'(661) 873-8880
CommHaz : Moderate
1 AOV:
SIC Code:5091
DunnBrad:
Emergency Contact ~.f~ T~le
Business Phone: (661) 873-8880x
24-Hour Phone : (661) 397-3'938x
Pager Phone : ( ) - x
Hazmat Hazards:
Emergency Contact / Title
STEVE NESS / SUPERVISOR
Business Phone: (661) 873-8880x
24-Hour Phone : (888) 876-9321x
Pager Phone : ( ) - x '
Fire Press React ImmHlth
Contact :
MailAddr: 2671 OSWELL ST F
City : BAKERSFIELD
Phone: (661) 873-8880x
State: CA
Zip : 93306
Owner LESLIES POOLMART
Address : 20630 PLUMMER ST
City : CHATSWORTH
Phone: (818) 993-4212x
State: CA
Zip : 91311
Period :
Preparer:
Certif'd:
ParcelNo:
to
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Emergency Directives:
Hazmat Inventory
Alphabetical Order
// Hazmat Common Name...
ALSTAR II CHLORINATING LIQUID
CALCII/M HYPOCHLORITE
MURIATIC ACID
SODA A:
SODIUM
ODIUM
'ODIUM
RICHL(
ISpecHazI
EPA HazardsI
R
R IH
One Unified List
Ail Materials at Site
Frm I ~n~l~Max IUnitlMCP
250.00 GAL Hi
1900.00 LBS Mod
L %~O ~.00 GAL Hi
ASH
BICARBONATE
DICHLORO-S-TRIAZINETRION
PERSULFATE
DRO-S-TRIAZINETRIONE
F IH
R IH
F P
800.00 LBS Low
800.00 LBS Min
6000.00 LBS Mod
1500.00 LBS Hi
1800.00 LBS Mod
1 07/18/2003
p LESLIES POOL SUPPLY
SiteID: 015-021-001801
Fast Format
~ Notif./Evacuation/Medical
--Agency Notification
3 PHONES AVAILABLE TO CALL 911.
Overall Site
10/06/1997
-- Employee NOtif./Evacuation 10/06/1997
VERBAL IN STORE. REGULATORY AFFAIRS FOR CORPORATION (800) 275-5882 X 3880.
-- Public Notif./Evacuation
OUT MAIN ENTRANCE TO W. EMERGENCY EXIT AT NE CORNER OF SHOWROOM.
03/24/20001
Emergency Medical Plan
SOUTHWEST URGENT CARE AND 2 FIRST AID KITS IN STORE.
03/24/2000
~, .I.."'~ ~1~ ,~or~ lc'/ .0o hereby certify that I have
(Type or print name)
reviewed the attachea hazardous materials rnanags-
ment plan forL~.._sL~.~ ~o~. m,',~.4'and that it along with
(Name of Business}
any corrections cor~sti~ute a complete and correct man-
agement plan for myfadlitlf. '
2 07/18/2003
UNIFIED PROGRAM INt~PECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
BakerSfield Fire Dept.
Enh'onment~l Semrlces
1 ? 15 Chester Ave
Bakersfield, CA 03301
~.. Section 1: Business Plan and Inventory Program
Routine -~Combined ~ Joint Agency ~ Multi-Agency ~1 Complaint ~ Re-inspection
(C=Com~,a~oe'~ OPERATION
~, V=Violation
APPROPRIATE PERMIT ON HAND
BUSINESS PLAN CONTACT INFORMATION ACCURATE
VISIBLE ADDRESS
COMMENTS
~//[~ CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS
~'~-"-~.,~,-c-~,-o~'-o-;~-o~-~;,';~- ......................................................................................................................................
'-~---~~;~;~--~;~;~: ................................................................................................................
~D VERiFiCaTiON OF MSDS AVA~LAa~U~E ..................................................................................................
-~--~;~.,o" ;~'~~ ....................................... ~ ..................................................................................
i~----~:;~-;;.~--~-~;~~ ........... ~ ....................................
I'~- ....... ~ ~,;~'~:~?-~N-~-~ ....................... 1- ................... :- ........................... ........... ~ ......... · ......................
ANY HAZARDOUS WASTE ON SITE?: i'1 YES ~ NO
EXPLAIN:
QUEST~O/~REGARO~t~LZ.~" ~,~s ,NSPECT, ON. PLEASE CALL US AT (661) 326-3979
Ins~ctor Badge No,, le Pa~
White - Environmenlal Services Yellow - ~lalion Copy Pink · Business Copy
LESL]IES POOL SUPPLY ,,~ |~· -- SiteID: 215-000-001801
~ 2::~( ,~.~ ~ I 'MAR :~4.;'000 / ~(
Manager : ~ '~,k~,~ I/'~ Bu~Phone: (~) 873-8880
Location: ~OSWELL ST ~ ~l~r.~- Ma~ : 103 Com~az : Moderate
City : B~ERSFIELD ~1~¥ G~Id: 23A FacUnits: 1 AoV:
CommCode: BAKERSFIELD STATION 08
EPA Numb:
SIC Code:5091
DunnBrad:
Emergency Contact / Title
-SEA~--~PE ~,k~tb~c~,/ MANAGER
Business Phone: (8~M3) 873-8880x
24-Hour Phone : (~ff5) 397-3938x
Pager Phone : (&~,) - x
Emergency Contact / Title ,~0~¢~
~~z ~ / ~AGER
Business Phone: (~-0~-~--8-7-3= $88Ox
24-Hour Phone : ~5-~x
Pager Phone : (~) ~qG -~XI x
Hazmat Hazards:
Fire Press React ImmHlth
Contact :
MailAddr: 2671 OSWELL ST E
City : BAKERSFIELD
Phone: (805) 873-8880x
State: CA
Zip : 93306
Owner LESLIES POOLMART
Address : °n~--P~I.,.~D4~ ~
City : CHATSWORTH
Phone: (818) 993-4212x
State: CA
Zip : 91311
Period :
Preparer:
Certif'd:
to
TotalASTs: =
TotalUSTs: =
RSs: No
Gal
Gal
Emergency Directives:
I, ..-~--t~,.~J~, ~..~ ,Do hereby certify that I have
· ' (Type or print name)
reviewed the attached hazardous materials manage-
ment plan for .~(.~-'~'=~[~:>~,~.~-~and that it along with
(Name of Business)
any corrections constitute a complete and correct man-
agement plan for my facility,
1 02/29/2000
F LESLIES POOL SUPPLY
~ Hazmat Inventory
--Alphabetical Order
Hazmat Common Name...
ISpecHazI
EPA HazardsI
SiteID: 215-000-001801
By Facility Unit
Fixed containers at Site
Frm I DailyMax IUnitlMcP
ALSTAR II CHLORINATING LIQUID
CALCIUM HYPOCHLORITE
MURIATIC ACID
SODA ASH
SODIUM BICARBONATE
SODIUM DICHLORO-S-TRIAZINETRION
SODIUM PERSULFATE
TRICHLORO-S-TRIAZINETRIONE
F
F P
R
R IH
IH
R IH
L
S
L
S
S
S
S
S
250 00 GAL
1900 00 LBS
300 00 GAL
800 00 LBS
800 00 LBS
6000 00 LBS
1500 00 LBS
1800 00 LBS
Hi
Mod
Hi
Low
Min
Mod
Hi
Mod
2 02/29/2000
F LESLIES POOL SUPPLY
= Inventory Item 0006
-- COMMON NAME / CHEMICAL NAME
ALSTAR II CHLORINATING LIQUID
Location within this Facility Unit
NW CORNER OF BACK RM
SiteID: 215-000-001801
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
365
CAS#
STATE I TYPE PRESSURE
Ambient
Mixture
Liquid
-- TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
1.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
250.00 GAL
Daily Average
200.00 GAL
%Wt.
10.00
HAZARDOUS COMPONENTS
Sodium Hypochlorite
S CAS#
N 7681529
TSecretl RS BioHazI HAZARD AiSESSMENTSI
Radioactive/Amount EPA Hazards NFPA
No No No No/ Curies R / / /
USDOT#
MCP
Hi
= Inventory Item 0001
-- COMMON NAME / CHEMICAL NAME
CALCIUM HYPOCHLORITE
Location within this Facility Unit
N OF CENTER OF SALES FLOOR
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
365
CAS#
STATE -- TYPE PRESSURE
Ambient
Pure
Solid
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
75.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
1900.00 LBS
Daily Average
1500.00 LBS
HAZARDOUS COMPONENTS
%Wt.
65.00 Calcium Hypochlorite
7778543
HAZARD ASSESSMENTS
Radioactive/Amount EPA Hazards
No/ Curies
NFPA I USDOT# I MCP
/ / / Mod
-3- 02/29/2000
LESLIES POOL SUPPLY
Inventory Item 0005
COMMON NAME / CHEMICAL NAME
MURIATIC ACID
Location Within this Facility Unit
N END OF BACK RM
SiteID: 215-000-001801
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
365
CAS#
7647-01-1
rSTATE TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
1.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
300.00 GAL
Daily Average
250.00
GAL
%Wt.
32.00 Muriatic Acid
HAZARDOUS COMPONENTS
Yes
CAS#
7647010
ITSecret
No
HAZARD ASSESSMENTS
I RS Bi°HazlRadi°active/Am°unt EPA HazardsNo No No/ Curies R IH
NFPA
///
USDOT#
MCP
Hi
= Inventory Item 0007
-- COMMON NAME / CHEMICAL NAME
SODA ASH
SODIUM CARBONATE
Location within this Facility Unit
NE OF CENTER SALES FLOOR
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
365
CAS#
497-19-8
STATE TYPE PRESSURE --[ TEMPERATURE
Solid ~Pure Ambient Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
50.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
800.00 LBS
Daily Average
600.00
LBS
I%Wt.
100.00
HAZARDOUS COMPONENTS
Sodium Carbonate
CAS#
497198
ITSecretI RSIBioHaz
No No No
HAZARD ASSESSMENTS
I Radioactive/Am°unt IEPA HazardsNo/ Curies F IH
NFPA
///
USDOT#
MCP
Low
-4- 02/29/2000
LESLIES POOL SUPPLY
~ Inventory Item 0008
-- COMMON NAME / CHEMICAL NAME
SODIUM BICARBONATE
ALKALINITY VP
Location within this Facility Unit
NE OF CENTER OF SALES FLOOR
SiteID: 215~000-001801
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
365
CAS#
F STATE T TYPE PRESSURE
Ambient
Pure
Solid
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
30.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
800.00 LBS
Daily Average I
600.00 LBS
HAZARDOUS COMPONENTS
I%Wt. I
100.00 Sodium Bicarbonate
N~S CAS#
144558
ITSecret N~SIBioHaz
No No
HAZARD ASSESSMENTS
Radioactive/Amount EPA Hazards
No/ Curies R IH
NFPA
///
USDOT#
MCP
Min
~ Inventory Item 0004
-- COMMON NAME / CHEMICAL NAME
SODIUM DICHLORO-S-TRIAZINETRIONE
Location within this Facility Unit
E END OF SALES FLOOR
Facility Unit: Fixed Containers at Site
Map: Grid:
Days On Site
3¢5
CAS#
~ TYPE
STATE ~Pure
Solid
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
6000.00 LBS
Daily Average
5000.00 LBS
%Wt.
100.00
HAZARDOUS COMPONENTS
Sodium Dichloro-s-triazinetrione
N 2893789
ITSecretI RSIBioHaz
No No No
HAZARD ASSESSMENTS
Radioactive/AmountNo/ Curies I EPA Hazards
NFPA
///
USDOT# I MCP
Mod
-5- 02/29/2000
LESLIES POOL SUPPLY SiteID: 215-000-001801
Inventory Item 0002 Facility Unit: Fixed Containers at Site
SODIUM PERSULFATE Days On Site
OXIDIZER II 365
Location within this Facility Unit Map: Grid:
N OF CENTER OF SALES FLOOR CAS#
STATE -T- TYPE PRESSURE
Ambient
Pure
Solid
-- TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
50.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
1500.00 LBS
Daily Average
1000.00 LBS
%Wt.
75.00
HAzARDous COMPONENTS
Sodium Persulfate
RN~oRS CAS#7775271
HAZARD ASSESSMENTS
TSecret oRSlBioHazI Radioactive/Amount I EPA HazardsI NFPA
No N No No/ Curies F P / / /
USDOT# IHiMCP
Inventory Item 0003 Facility Unit: Fixed Containers at Site
~lv~vl~ ~vl~ / ~£ ~-Ll~ ~Vl~
TRICHLORO-S-TRIAZINETRIONE Days On Site
CHLORINATOR TABLETS 365
Location within this Facility Unit Map: Grid:
CENTER OF SALES FLOOR CAS#
F STATE ~ TYPE
Solid /Pure
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
pLASTIC CONTAINER
Largest Container
40.00 LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
1800.00 LBS
Daily Average
1500.00 LBS
HAZARDOUS COMPONENTS
I%Wt. I
100.00 Trichloro-s-triazinetrione
I
CAS#
87901
ITSecretI ~S BioHaz
No N No
HAZARD ASSESSMENTS
Radioactive/Amount EPA Hazards
No/ Curies
NFPA
///
IUSDOT#
MCP
Mod
6 02/29/2000
LESLIES POOL SUPPLY ~/~/~/~/~5/~/~/~/~/~~ SiteID: 215-000-001801 i
i~ Notif./Evacuation/Medical ~~~~~~ Overall Site i
i~ Agency Notification ~~~~~~~ 10/06/1997 i
o
3 PHONES AVAILABLE TO CALL 911. °
o
i~ Employee Notif./Evacuation ~~~g~~~ 10/06/1997 i
O
VERBAL IN STORE. REGULATORY AFFAIRS FOR CORPORATION (800) 275-5882 X 3880.
o
i~ Public Notif./Evacuation ~~~~~~ 10/06/1997 i
o
OUT MAIN ENTRANCE TO W. °
EMERGENCY EXIT AT NE CORNER OF SHOWROOM. °
o
i~ Emergency Medical Plan ~~~~~~ 10/06/1997 i
o
SOUTHWEST URGENT CARE. °
2 FIRST AID KITS IN STORE. °
o
aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee~~f
-7- 02/29/2000
LESLIES POOL SUPPLY/~/~/5/5/~/~/~6/5/~/~/5/5/5/5~6/5/5/5/~/~6/5~6~6 SitelD: 215-000-001801
Mitigation/Prevent/Abatemt ~~~~~ Overall Site
i~ Release Prevention ~~~~~~~ 10/06/1997
O
SEPARATION OF INCOMPATIBLES. °
O
i~ Release Containment ~~6~~~6~6~~6~ 10/06/1997
o
OVERPACK BUCKETS AND NEUTRALIZATION MATERIALS.
o
i~ Clean Up ~6~66~6~~6~~~ 10/06/1997
o
CHEMICAL BROOM AND DUST PAN FOR BUCKETS. °
o
i~ Other Resource Activation
o
O
-8- 02/29/2000
LESLIES POOL SUPPLY ~~~~~ SitelD: 215-000-001801
i~ Site Emergency Factors ~~~~~~ Overall Site
O
i~g Utility Shut-Offs EEE~EE~EEEE~E~EE~E~~ 10/06/1997
A) GAS - OUTSIDE E DOOR TO BACK RM °
B) ELECTRICAL - INSIDE NE CORNER OF BACK RM °
C) WATER - OUTSIDE E DOOR TO BACK RM °
D) SPECIAL - NONE °
E) LOCK BOX - NO °
i~ Fire Protec./Avail. Water ~~~~~ 10/06/1997
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS °
NEAREST FIRE HYDRANT - SPRINKLERED BLDG o
ii~i~ Building Occupancy Level
-9- 02/29/2000
i LESLIES POOL SUPPLY ~/~/~gi~/~/~/~~i~/~~ SiteID: 215-000-001801
i~ Tra~ng ~~~~~~~~ Overall Site i
i~ Employee Tra~g ~~~~~~~ 10/06/1997 i
O
o WE ~VE 5 EMPLOYEES AT THIS FACILITY.
o
o WE DO ~VE MSDS SHEETS ON FILE.
o
o B~EF SUM~RY OF T~INING PROG~M:
O
0
0
o
o
o
SAFETY MEETINGS AND TRAINING UPDATES.
O
-10- 02/29/2000
FACILITY NAME
ADDRESS ~
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 ~/"7-'g//oO
PHONE NO.
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES
Section 1: Business Plan and Inventory Program
[~1 Routine [~1 Combined [~ Joint Agency I~ Multi-Agency I~ Complaint {~1 Re-inspection
OPERATION C V COMMENTS
ApprOpriate permit on hand ~ <2:c/~_ (["-crr_j~ Cr~o
Business plan contact information accurate /'d'~-~,) 5o ~ ~'~ t-Dc
Visible address
Correct occupancy
Verification of inventory materials
Verification of quantities
Proper
segregation
of
material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
C--Compliance V~Violation
Any hazardous waste on site?: l~l Yes ~.~1o
Explain:
/ -
Questions regarding this inspection? Please Call us at (805) 326-3979
White - Env. Svcs. Yellow - Station Copy Pink - Business Copy
B(..~ness Sit[ ~t~s~onsible Party
Inspector: ~'/~-
JOE FERRARA
STORE MANAGER
(66 t ) 873-8880 · FAX (66 ! ) 873-8882
2651-E OSWELL ST. #F 0 BAKERSFIELD, CA 93306
INSTRUCTIONS;
CITY OF BAKERSFIELD,
~E OF ENVIRONMENTAL
GROUND STORAGE TANK?
ester Ave., Bakersfield, CA (805) 326-3979
· . ..... . /~c),/~ '.-,~EE-z~
- ': 'ff ' ', F'/o
2.
3.
4.
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.
SECTION l' BUSINESS IDENTIFI~ATION DATA
BUSINESS NAME': L.
LOCATION:.-:3..~:~-..-
M~H.ING ADDRESS:
'~ ",C" /,"
CITY: :"
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY:
OWNER:
MARLING ADDKESS:
SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION
CONTACT .... TITLE
BUS. PHONE
24 HR. PHONE
3S2'- :z~-3 ~-'
~.~, -? - 3~3~v