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HomeMy WebLinkAboutBUSINESS PLAN 11/7/2007 i I __~ i ' 1 V V ~~ U h • ~~ ' t Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID # 015-021-002091 CALIFORNIA WATER LOCATION This oermit is issued for the followin~lr [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment 93301 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 Approved by:. Expiration Date: Office ofEv~ervices~''d ~OV I 2000 Issue Date June 30:2003 ITE DIAGRAM Business Name: (_..-_~ ~.~- ~'~ ~ Business Address: ~ ~- 'z.- ~ c~ FACILITY D~ [ L ,.42-02 ----STA.39- 02 ITE DIAGRAM Business Name: ~_. Business Address: FACILITY DIA~ ! ~ ! CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 Manager TIM TRELOAR Location: 1623 Q ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: BusPhone: (661) 837-7200 Map 103 CommHaz High Grid: 30D FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact TIM TRELOAR Business Phone: 24-Hour Phone Pager Phone Hazmat Hazards: / Title / DISTRICT MGR (661) 837-7200x (661) 837-7200x _ ( ) - x RSS Contact BILL ROSICA MailAddr: 3725 S H ST City BAKERSFIELD Owner CALIFORNIA WATER SERVICE CO Address 3725 S H ST City BAKERSFIELD Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Phone: (661) 837-7200x State: CA Zip 93304 TotalASTs: = Gal TotalUSTs: = Gal RSs: Yes ENfiD Jt~~L ~ ~ ~~~~ Ba.~Qd on my inquiry of those individuals raspon4ible for obtaining ±he information, I certify under penalty of law that I have personally ermined a.nd am familiar with the information submitted and believe the information is true, accurate, and complete. Q m-0. ~7 17 S' azure Datd Emergency Contact RUDY VALLES Business Phone: 24-Hour Phone Pager Phone / Title / ASST DIST MGR (661) 837-7271x (661) 837-7271x ( ) - x Fire Press ImmHlth Phone: (661) 837-7278x State: CA Zip 93304 -1- 07/10/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 07/10/2007 -3- 07/10/2007 F CALIFORNIA WATER SRV 002-10 ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Location within this Facility Unit FENCED ENCLOSURE NEXT TO PUMP STATE TYPE PRESSURE Liquid TMixtur~ Ambient SiteID: 015-021-002091 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 7681-52-9 TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL tiAGAttLVUJ w1~lrVlvr~ly 17 $Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 titiGl~tCL I~JSriAJ1~1L"1V1a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F P IH / / / Hi -4- 07/10/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/30/2000 ~ CALL 911. Employee Notif./Evacuation 02/26/2007 UNMANNED SITE Public Notif./Evacuation 10/05/1992 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan 08/07/2006 MERCY HOSPITAL, TRUXTUN AVE. -5- 07/10/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/27/1994 ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 05/11/2006 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD BE MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS A BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/11/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. Other Resource Activation -6- 07/10/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, uj/c~.lal nac~a.LUa Utility Shut-Offs 02/26/2007 ELECTRIC AT PANEL. Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. 08/07/2006 Building Occupancy Level UNMANNED SITE. 02/27/2006 -7- 07/10/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/11/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rayc ~ Held for Future Use Held for Future Use -s- o~/l0/200 ~~' ' J CALIFORNIA WATER SRV 002-10 Manager TIM TRELOAR Location:. 1623 Q ST City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: SiteID: 015-02.1-002091 BusPhone: (661) 837-7200 Map 103 CommHaz High Grid: 30D FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact TIM TRELOAR Business Phone: 24-Hour Phone Pager Phone Hazmat Hazards: / Title / DISTRICT MGR (661) 837-7200x (661) 837-7200x ( ) - X RSS Contact BILL ROSICA MailAddr: 3725 S H ST City BAKERSFIELD Emergency Contact RUDY VALLES Business Phone: 24-Hour Phone Pager Phone / Title / ASST DIST MGR (661) 837-7271x (661) 837-7271x ( ) - X Fire Press Phone: State: Zip ImmHlth (6 61) 8 3 7 -~6$~c ~ 72 7~ 93304 -. Owner CALIFORNIA-WATER SERVICE CO Phone: (~@$~ 4.5' °~-- Address ~-Zb r~~'Inu ~ 3?Zj .Sov~ H S~ State: CA~°~ X37-72vp City SST-d$SIs '~d~et„r, n hi~ Z ip 9~~2-~ 3 3 og Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of these individuals responsible for obtaining the information, !certify under penalty of la4v that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. nature D to TotalASTs: _ TotalUSTs: _ RSs: Yes ®®~ Gal Gal -1- 01/26/2007 .~ . _. -. F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name.:. SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 01/26/2007 -3- 01/26/2007 o , F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days-On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL - t1AGtitcLVU~ c.:1J1~1r~lv~lv~1~~ %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 ru~~titcL ti~~~55in~ly 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F P IH / / / Hi -4- 01/26/2007 F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/30/2000 ~ CALL 911. = Employee Notif./Evacuation UNMdNNed 5~a~'itlN Public Notif./Evacuation 10/05/1992 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan 08/07/2006 MERCY HOSPITAL, TRUXTUN AVE. -5- 01/26/2007 ~. F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/27/1994 ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 05/11/2006 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD BE MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS A BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/11/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. V1.11C1 1CC~VULC.:C HC;l,1Vdl.1CJ11 -6- 01/26/2007 ~.. ; F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ ~ Fast Format ~ ~ Site Emergency. Factors Overall Site ~ w7~JCC:1d1 17dGdl U.S' VL111Ly 7llrUL-VLLS lUo~aS: E~ecT~cdl ~ }~dN~~ Fire Protec./Avail. Water 08/07/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. Building Occupancy Level .02/27/2006 iTNMANNED SITE. -7- 01/26/2007 .; F CALIFORNIA WATER SRV 002-10 SiteID: 015-021-002091 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/11/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rage ~ nciu l.ui ru~uic u5c nciu iui ru~uiC u~c -8- 01/26/2007 Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST' A F R S r, ._„ 9ooTruxtunAve., suite 210 - FIRE Bakersfield, CA 93301 :-SE£TION 1:_ Business Plan and Inventory Program i°erM T Tel.: (661) 326-3979 Fax: (661) 872-2171 ~ FACILITY/ NJA/~y'1E INSPE9CTI N DAT/~/ :INSPECTION TIME I -1 i-1 o r ~e ~ V' /' ~ ! r~C4 ~ ~ Q - DDRESS PHONE NO. NO OF EMPLOYEES ~ ~ ~. FACILITY CONTACT BUSI ESS ID NUMBER ~ ~ flip 15-021- UGZC1~ ~ i ,. - Section 1 Business Plan and Inventory Program r ~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ~ i C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS i '^ U ,~/ 12f ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES i ^ VERIFICATION OF LOCATION ^ ROPER SEGREGATION OF MATERIAL _ ~ 9 ,( ^ VERIFICATION OF MSDS AVAILABILITY ~ ^ -VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED j ^ HOUSEKEEPING n r~o~ ^ SITE DIAGRAM ADEQUATE & ON HAND ~~ ANY HAZARDOUS WASTE ON SITE? ^ YES Dr /NU EXPLAIN: QUEST NS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~ /// ~~ I pector (P se Print) Fire Prevention / 1" In /Shift of Site/Station # si ess Site esponsib a Part White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 T'. + CALIFORNIA WATER SRV 002-10 _________________________ SiteID: 015-021-002091 + Manager Location: 1623 Q ST City BAKERSFIELD ~3 7~ 7 zo© BusPhone : ( 6 61) ~y-9fr--2-~89~ Map 103 CommHaz High Grid: 30D FacUnits: 1 P.OV: CommCode: BFD STA O1 SIC Code:4941 1 EPA Numb: DunnBrad:00-691-3578 Emergency Contact / Title Emergency Con act. / Title TIM TRELOAR / DISTRICT MGR h~v~~ Vd ~IeS / ASST DIST MGR Business Phone: (661) "'^' ^"^^___v3~-7~OO Business Phone: (661) ~"~-~-i.~~~3~-~2 ~ 2 4 -Hour Phone ( 6 61) - ~3~ '7 ZCC; 2 4 -Hour Phone ( 6 61) 3-9b-~A~637- 72 1 Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards.: RSs Fire Press ImmHlth Contact r j ( ~;5i~ Phone : ( 6 61) 8~ `'-pox MailAddr: 3725 S H ST State: CA v37-727~j City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (408) 451-8200x Address 1720 N FIRST ST State: CA City SAN JOSE Zip 95112 Period to TotalASTs: = Gal Preparers- TotalUSTs: = Gal Certif ' d: RSs : Yes ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK CONTACT PERSON: 832-2141 ~NT~ q~ c~ ®~ ~oO 6 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~ ~ Z ~~~ Si lure Date ~~~ -1- 05/11/2006 + CALIFORNIA WATER Manager : MELVIN BYKD Location: 1623 Q ST City : BAKERSFIELD BK2 - 10 CommCode: BAKERSFIELD STATION 01 EPA Numb: SiteID: 015-021-002091 + BusPhone: (661) ~-3~5 7128 Map : 103 CommHaz : Minimal Grid: 30D FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title / Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Hazmat Hazards: RSs Emergency Contact / Title Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Fire Press ImmHlth I Contact : Phone: (. · MailAddr: PE~B~--~:~ / State: ~ City : SA~ / Zip : 9~t~8-- Owner CALIFORNIA WATER SERVICE COMPANY Phone: (408) 451-8200x Address : 1720 N FIRST ST State: CA City : SAN JOSE Zip : 95112 Period : to Preparer: Certif'd: ParcelNo: Emergency Directives: CONTACT PERSON ~EDRIC~ 832-2141. TotalASTs: = Gal TotalUSTs: = Gal RSs: Yes -+ += Hazmat Inventory One Unified List + +== Alphabetical Order Ail Materials at Site + ................................ + ....... + + ..... + .......... + .... +- - -+ Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax IUnitlMCPl ................................ + ....... + + ..... + .......... + .... +- - -+ CHLORINE E F P IH L 200.00 GAL Ext District Manager-Tim Treloar Asst. District Manager-Bill Harper Contact Person-Tamara Johnson Same Phone Numbers Mailing Address Change: 3725 South "H" Street Bakersfield, CA 93304 07/28/2003 CITY OF BAKERSF~D OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MA GEI T PLAN 1. To avoid further action, rctum this form hin ~ccipt. 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. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: $o. ~ ~+. MAILING ADDRESS: CITY: ~. v..~.- · PRIMARY ACTIVITY: STATE: c.~. ZIP:q33oq- PHONE: OWNER: ~,e~ e. MAILING ADDRESS: PHONE: EMERGENCY NOTIFICATION CONTACT A4 ~_l,~,'~ TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN .SECTION II. 1: DISCOVERY AND NOTIFICATIONS Ao LEAK DETECTION AND MONITORING PROCEDURES: ~,-~,. {;~,-', I;t-../ ,':, ,,~,o,,, ko,.,_J Ad, I.-t k~ EMPLOYEE AND AGENCY NOTIFICATION: Co ENVIRONMENTAL RESPONSE MANAGEMENT: '/.4' EMERGENCY MEDICAL PLAN: ' 2 I~-IAZARDOUS MATERIALS MA~EMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN Ao HAZARD ASSESSMENT AND PREVENTION MEASURES: Bo RELEASE CONTAINMENT AND/OR MITIGATION: Co CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: ~-"'~'L'- go. WATER: "//~, SPECIAL: .~t/s, LOCK BOX: YES/~ IF YES, LOCATION: pRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: WATER AVAILABILITY (FIRE HYDRANT): HAZAR~US MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 4 o.,,~ - t_t,,,.~, a.,,, MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I, Z~4-& ,a-~a¢-~.', ~ 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. RE TITLE D<~-'4 ~*~ -e~ ~ DATE 4 oOFFICE OF ENVIRONMEN~iL SERVICES 1715 Chester Ave., CA 93301'~561) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION · .:~. ~: I. FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) SITE ADDRESS DUN & Page O! Year Ending BUSINESS PHONE (,~,~.Q .~ .~,.~.~_~_.o ................ · mo6 SIC CODE (4 Digit #) 103 105 COUNTY I~. OPERATOR NAME (-~.t~[-~,-~,t;~, t.~te.[-~.~- ~e,-,z~.~ ~ . ~o~ OPE~TORPHONE (~%~t~t ~o . OWNER NAME ~ I~ ~_~, ~__~_~ ~¢~, ~ ~ ~o . ~ [ OWNER PHONE ~.~5.~_~.~..~.~ .... ,,2 OWNER ~ILING ADDRESS ~5 ~ O. ~ ~ ~. 113 CONTACT.. NAME ~ ~ ~ ~ ~ ~ ~ ~7 j CONTACT PHONE - 118 CONTACT MAILING ADDRESS 119 CITY ~ 120 ~23 NAME "T~, ~ NAME TITLE -PRIMARY.',"' BUSINESS PHONE 24-HOUR PHONE 126 127 PAGER # ....--.- ~28 BUSINESS PHONE 24-HOURPHONE ~v,~ ...................................... PAGER# 122 129 130 131 t32 133 Cerfificalion: Based on my inquiry of those Individuals responsible for obtaining the Information, I certify under penalty of law that I have personally examined and am familiar wilh the information submitted In Ibis Inventory and believe the Information is true, accurate, and complete, UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fotrn per mate#al per budding or ama) Page ~ of __ ]~NEW F'*I ADD [] DELETE [] REVISE 200 BUSINESS ~ME (Same ~ FAClLI~ ~ME m D~ - ~ing Bu~n~ ~) 3 CHEMICAL LOCATION CHEMICAL LOCATION [] Yes CONFIDENTIAL (EPCRA) O ~ ~ ~ · e.. , ' * ,~:.~, ,.~'~ · ;'.~',;~'~:c' :':*~ c,,~ *,. * .... ~ 'z~V.~=.' ~ ~* ~ /;~ " ' .......... .... '. * .... .':~, ,'~ ~: .... ,- "~. ~*'~,~ II, CHEMICAL INFORMA~ON 205 T~DE SECRET ~ Y~ ~ No 206 207 If Subject to EPCRA. refer to inslructions EHS* I'-Iyes ~i~No 208 Ii ' !,If EHS is'Yin,' all ~_,~a_ ,,~ I~loW must be i. lbs. CHEMICAL NAME COMMON ~ME ' CAS ~ 2O9 FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 2t0 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE []Yes [~]No 212 ! CURIES~ 213--i PHYSICAL STATE [] s SOLID ~J~l LIQUID [] g GAS 214 LARGEST CONTAINER'Z..z~/'~ ~ [ 215 FED HAZARD CATEGORIES [~ 1 FIRE [] 2 REACTIVE ~i~ 3 PRESSURE RELEASE ~].4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 I MAXIMUM 218 I AVERAGE 219 AMOUNT "/'/¥" I OAILYAMOUNT '~OO ~0,~. , DAILY AMOUNT '~.OO 30. t o ! STATE WASTE CODE 220 UNFrS* I~ ga GAL [] cf CU FT [] lb LBS [] tn TONS 221 I DAYS ON SITE '222 * If EHS. amount must be In lbs. , STORAGE CONTAINER I~ a ABOVEOROUND TANK ~] e PLASTIC/NONMETALLIC DRUM [] I FIBER DRUM [] m GLASS Bo'n'LE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER ~ C TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 [] c CRYOGENIC 225 STORAGE TEMPERATURE 1 226 2 AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 230 234 238 227 [] Yes [] No 228 231 [] Yes [] No 232 235 [] Yes [] No 236 239 [] Yes [] No 240 i5 242 , 243 []Yes [] No 244 I ' . · ". ,,: i; C~'~:~74~.?:~;;.~:~;;, ,.~,': :",, ':.. :'; .~ 1: ~:':'~ ' ' ....... __ 229 233 237 241 245 DA t E 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd