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HomeMy WebLinkAboutBUSINESS PLAN M.~P PLAN~: MAP SITE DIAGRAM Business Name: Business Address: For Office Use only First In Station: Inspection Station: Area Map # of NORTH ITE DIAGRAM Business Name: Business Address: FACILITY DIAGRAM ~~,~-~-~ For Office Use Only First In Station: Inspection Station: Area Map # of NORTH C C -5© ~ DATE NEW ACCOUNT i ADDRESS CHANGE CLOSE ACCT FINANCE CHARGE OTHER ADJ CUSTOMER NAME MAILING ADDRESS ZIP CODE SITE ADDRESS PARCEL NUMBER (IF APPLICABLE) ADJUSTMENT CHG DATE /-- /-/-¢? CHARGE CODE ¢./,,~ ~f/)'/ ADJUSTMENT AMOUNT BAKERSFIELD August28,1996 QUALITY CATERING JOHN GHYSELINCK 300 OLD YARD RD BAKERSFIELD CA 93307 FINAL NOTICE, ;TMENT :IELD ~NIA 93303 REQUESTED Mr. Ghyselinck: Our record show your environmental services (hazardous material and/or underground tank) account, 3579-ES, is ninety (90) days or greater past due. This account needs to be paid in full immediately. The balance due on the account is $144.03. Until this-account is cleared of the past due balance, you are violating the Municipal Code and are subject to legal action. Please call me at the number listed below if you have any questions regarding your account or if you are unable to pay the entire balance due. Sincerely, Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" 'Street B~kersfield, CA. 9~3301 fl 5b oo HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1, To avoid further action, return this~form within 30 days of receipt. 0% k 3. Answer the questions below for the business as a whole. '-- L 4. Be brief and'concise as possible. 5-~--~ . SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION:' ~c~ MAILING ADDRESS: CITY: STATE: C/~ ZIP' q33c,~ PHONE: ~o~'- ~'$~-33~ PRIMARY ACTIVITY: OWNER' MAILING ADDRESS: DUN & BRADSTREET NUMBER' SIC CODE: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR, PHONE Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION $: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: A--~,o~ S SECTION 4: EXEMPTION RE.QUEST: 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 TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: i~O~x~ (/~ul ~ t'~)(--~V--- CERTIFY THAT THE ABOVE INFOR- bATION IS AC-CUR,~TE. I uNDEI~STAND 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. (,,_) ~IGNATURE ! TITLE DATE FD1590 Bakersfield Fire Del~ Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: EMPLOYEE NOTIFICATION AND EVACUATION: PUBLIC EVACUATION: V'er b~.l I,_.t EMERGENCY MEDICAL PLAN' 3. ~Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: RELEASE PREVENTION STEPS: RELEASE CONTAINMENT AND/OR MINIMIZATION: GLEAN-UPPROGEDURES: ~~ i~ ~ SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL' /q~& ' LOCK BOX: SECTION 9: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILA'BILITY: PRIVATE FIRE PROTECTION: WATER AVAILABILITY (FIRE HYDRANT): 4. FD1590 CITY Farm and Agriculture~--]Standard Business LOCATION: CITY, ZIP: PHONE #: OF BAKERSF I Ef-D HAZARDOUS MATERIALS INVENTORY NON - TRADE SECRET OWNER NAME :' CITY, ZIP: REFER TO INSTRUCTIONS FOR PROPER CODES Pac NAME OF THIS FACILITY: ~6~ STANDARD IND. CLASS CODE: DUN AND BRADSTREET NUMBER/FEDERAL ID # 1 2 3 4 5 6 ' 7 8 9 10 11 12 13 14 Trane Type Max Average Annual Measure # Days Cent Cent Cent Use Location Where % by Names of Mixture/Components Code Code Amt,,, Amt Amt Uni~' on Site Type Press Temp Code Stored in Facility w~ /~/ee Ins~ions Physical and Brealth Hazard C.A.S. Number C, ~, ~ QC,~ ' Component # i Name & C.A.S. Number (Check all that apply) ~ Component # 2 Name & C.A.S. Number [] Fire Hazard ~ Sudden Release '~ Reactivity ~ Immediate ~-~ Delayed ~_-- of Pressure ~L, ~ Health Health Component # 3 Name & C.A.S. Number Physical and H~lth lazard C.A.8. Nu~er %(~Ot~ Co~po~ent ~ I Nam & C.A.S. Nu~er (Check all that apply) Co~onent ~ 2 Na~ a C.A.S: N~er ~ Fi=' HaZ=d ~Sudden Release ~ Reac~ivi~y- ~ :~iate ~ of Pressure H~lth Health Component ~ 3 Na, & C.A.S. Nu~er I I I I I I I I I I Physical and H~lth Hazard C.A.S. Nu~er Componen~ ~ i Na~ & C.A.S. N~er (Check all that apply) ~ ~ir..~d ~ Sudde~ Re~.~.. ~ R~=~i~ ~ ~.diat. ~ D.l~ Z°mP°~""~ ~ 2 ~am~ ~ ~.a.S. ~u~ of Pressure H~lth H~lth Component ~ 3 N~ & C.A.S. Nu~er Physical and H~lth Hazard C.A.S. N~er Component ~ 1 Na~ & C.A.S~ N~er (Check all t~t apply) Component ~ 2 Na~ & C.A.S~ N~er of Pressure Health H~lth Component J 3 N~'& C.A.S. Nu~er E~RGENCY CONTACTS %1 J2 ' Na~ TttlJ 24 ~. Phone N~e TitlJ 24 Hr Phone 'ertification (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I hayer personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those individuals responsible for obtaining the information. I believe ,that the submitted information is true, accALrate~ and compleX, a NAME AND OPFICIAL TITI~ OF OWNER/OPERATOR OR OWNER/OPERATOH'S AS"I~ORIZED REPRESENTATIVE DATE SIGNED