Loading...
HomeMy WebLinkAboutBUSINESS PLAN ORM .5 NORTH SCALE: BUSINESS NAME: HoWARb~ FLOOR: UNIT" OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGR.~M W PART (Inspector's Comments): -OFFICIAL USE ONLY- MONITOR WELLS Well Number Well De Depth to Water Product Detected AMOUNT in inches Standard Symbols for diagram below: OV.R. / Ball Float w (~) Ball Float r~ Manway Site# ~/ O Fill (~) Monitor Well (Outside Tank Bed Area) Q Tank Gauge ' lroncross, Q va, por Recovery QObservation ,Well. (Inside Tank Bed Area), O Vent r-~ Turbine.,, Locatio n DiagramTin.ciu.de .the. Vapor. Re. coyery System: C~.~ ~. L~ . ¢ 0 Vapor Recovery System & Vents were tested with which tank? Parts and Labor used General Comments When OWNER or local regulations require immediate reports of system failure-Complete the following: Phone# I OWNER or Regulatory Agency FILE NUMBER Prin~: Certified Testers Name Certified Testers Signsture Number Date Testing Completed SITE DIAGR~uq )items) 1. Address: Identify the principle buildings by the Street numbers. 2. Street(s), Alleys. Driveways, and Parking Areas adJacent to the property. Include the street names. 3. Storm Drains, Culverts, Yard Drains 4. Drainage Canals, Ditches, Creeks, 5.'Buildings a. Frame construction b. Masonry construction c. Metal construction d. Access Door 6. Utility Controls a. Gas b. Electricity c. Water 7. Fire Suppression Systems: a. Fire Hydrants b. Fire Sprinkler 19. Connections c. Fire Standpipe 20. Connections d. Water Control Valves for protection systems e. Fire Pump 22. 8. Fire Department Access 9. Lock (key) Box 10. NSDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Rasonry c. Wood d. Oates 13. Powerllnes 14. Guard Station 15. Storage Tanks: Identify the capacity In gal. a. Above ground b. Underground 16. Diking or Berm 17. Evacuation Route 18. Evacuation Area: Identify the location where employees w111 meet, Outside Hazardous Waste Storage Outside Hazardous Material Storage 21. Outside Hazardous Material Use/Handling Type of Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOUS FJ~TERIAL F = Flammable E .= Explosive L = Liquid R = Radtological C = Corrosive 0 - Oxidizer O = Oas P = Poison W - Water Reactive T = Toxic S - Solid H - Cryogenic O = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAOP,~Y4 (Required items in addition to the, abo~e) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest, ll. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage §. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets ?. Skylights ~ 3200 Panama Lane IiHOWARD,$ I l~ MARKET GROCERIES, DELI, GAS Ronald Seuferer Richard Golledge Katherine Seuferer Diane Golledge HOWARDS MINI MARKET #4 Manager : CHONG TAE CHOW & UNKYONG CHOW Location: 3200 PANAMA LN City : BAKERSFIELD SiteID: 015-021-000706~ BusPhone: (661) 833-1561 Map : 123 CommHaz : Low Grid: 24C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 EPANumb: SIC Code:5541 DunnBrad:17-364-9625 Emergency Contact / Title CHONG TAE CHON / OWNER Business Phone: (661) 833-1561x 24-Hour Phone : (~Ei) 397 5~12x~)~ Pager Phone : (EEl) Hazmat Hazards: Emergency Contact / Title DAVID PALMER / OPERATIONS MGR Business Phone: (661) 393-7000x ~4-Hour Phone : (661) 393-7000x Pager Phone : ( ) - x Fire ImmHlth DelHlth Contact : DAVID PALMER MailAddr: PO BOX 1807 City : BAKERSFIELD Phone: (661) 393-7000x State: CA Zip : 93303 Owner CHONG TAE CHON & UNKYONG CHON Address : 310~E RD /~o City : BAKERSFIELD Phone: (661) State: CA Zip : 933~;! Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: ~, ~~c~ DO hereby cetti'h7 ~ha~ ~ have r~v~,;;,~,',~;u ~ha at~ach~d h~ardous mmerials man~e- ~ ~d ~ it slong wi~h (N~e ~ ~) any corrosions ~n~i~u~e a~mpls~e and ~rr~ man- 1 07/22/2004 HOWARDS MINI MARKET #4 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: HOWARDS MINI MARKET #4 Cross Street : Business Type: Org Type: Total Tanks : 4 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : DAVID PALMER Phone: Address: City : Type : Name : DAVID PALMER Addre s s: City : Type : State: Zip: TANK OWNER INFORMATION Phone: State: Zip: SiteID: 015-021-000706 (661) 393-7000x (661) 393-7000x BOE UST Fee# : 019753 Financ'l Resp: SELF INSURED Legal Notif : Property Owner Mailing Address Date:04/28/2000 Name:JOHN KERLEY State UST # : Phone: (661) 393-7000x Ttl:VP 1998 Upg Cert#: 00774 -2- 07/22/2004 F HOWARDS MINI MARKET #4 ~ Hazmat Inventory --MCP+DailyMax Order Hazmat Common Name... REGULAR GASOLINE UNLEADED REGULAR PREMIUM UNLEADED MID GRADE GASOLINE ISpecHazI EPA HazardsI F IH DH F DH F DH F IH DH SiteID: 015-021-000706 By Facility Unit Fixed Containers on Site Frm DailyMax IunitlMCP L 12000.00 GAL Mod L 12000.00 GAL Mod ,L 12000.00 GAL Mod L 12000.00 GAL Mod -3- 07/22/2004 ~OWARDS MINI MARKET #4 ~ Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME REGULAR GASOLINE Location within this Facility Unit UNDERGROUND SiteID: 015-021-000706 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 F STATE ~ TYPE Liquid/Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average I 5000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS IRSI CAS# No 8006619 HAZARD ASSESSMENTS Radioactive/AmountNo/ Curies I EPAF HazardsiH DH NFPA /// USDOT# I MCP Mod Ag. Definedl: Ag. Defined5: Ag. Defined8: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag. Defined3: Ag. Defined6: Ag. Defined9: Ag. Defined4: Ag. Defined7: Ag. Definel0:. -4- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 = Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND TANK DESCRIPTION Tank ID#: 1 Mfr: MOSIER BRO. Compart Tank: N Installed: 11/1983 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANKS LINED IN 1998 TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: REGULAR UNLEADED Matl Name:REGULAR GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Corr Prot: CATHODIC PROTECTION Spill Cnt : 1998 Drop Tube : 1998 Striker Plate: 1998 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: Installed: Installed: Alarm : Exempt: No Ball Float : Fill Tube S/O: 1998 Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -5- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 = Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type': PRESSURE Const: SINGLE WALL Mfgr : UNKNOWN Mtl : GALVANIZED STEEL & : Corr : CATHODIC PROTECTION Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 07/24/2003 Date: 04/28/2000 Name:JOHN KERLEY Prmt Number: 0706 TANK/LINE TEST :07/23/2003 CP CERT. :06/21/1999 MANWAY INSP. :12/22/1998 UST MONIT. CERT:08/13/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:VP Approved: Yes AGENCY DEFINED Expiration Date: 06/30/2006 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/28/2000 Name:JOHN KERLEY Ttl:VP -6- 07/22/2004 HOWARDS MINI MARKET #4 ~ Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME UNLEADED REGULAR Location within this Facility Unit UNDERGROUND SiteID: 015-021-000706 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE TYPE PRESSURE Liquid I Pure I Ambient -- TEMPERATURE lAmbient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average 6500.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS N 8oo 619 HAZARD ASSESSMENTS ITsecret RS BioHazl Radioactive/Amount EPA HazardsI No No No No/ Curies F DH NFPA /// USDOT# I MCP Mod Ag.Definedl: Ag. Defined5: Ag. Defined~: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined6: Ag.Definedg: Ag.Defined4: Ag.Defined7: Ag.Definel0: -7- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND TANK DESCRIPTION Tank ID#: 2 Mfr: MOSIER BRO. Compart Tank: N Installed: 11/1983 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANKS LINED IN 1998 TANK cONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: REGULAR UNLEADED Matl Name:UNLEADED REGULAR Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Corr Prot: CATHODIC PROTECTION Spill Cnt : 1998 Drop Tube : 1998 Striker Plate: 1998 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: Installed: Installed: Alarm : Ball Float : Fill Tube S/O: 1998 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -8- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: SINGLE WALL Mfgr : UNKNOWN Mtl : GALVANIZED STEEL & : Corr : CATHODIC PROTECTION Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 07/24/2003 Date: 04/28/2000 Name:JOHN KERLEY Prmt Number: 0706 TANK/LINE TEST :07/23/2003 CP CERT. :06/21/1999 MANWAY INSP. :12/22/1998 UST MONIT. CERT:08/13/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:VP Approved: Yes AGENCY DEFINED Expiration Date: 06/30/2006 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: No Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/28/2000 Name:JOHN KERLEY Ttl:VP -9- 07/22/2004 F HOWARDS MINI MARKET #4 SiteID: 015-021-000706 ---- Inventory Item 0003 Facility Unit: Fixed Containers on Site ~iv~viu~ H~vi~ / ~H~£~ H~Vl~ PREMIUM Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 F STATE ~ TYPE Liquid{Pure PRESSURE Ambient TEMPER3tTURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION I Daily Maximum · 12000.00 GAL Daily Average { 3000.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS DIESEL FUEL NO. 2 HAZARD ASSESSMENTS Radioactive/Amount I EPA Hazards No/ CuriesI F DH NFPA/// { USDOT# MCP Mod Ag.Definedl: Ag.Defined5: Ag. Defined8: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag. Defined6: Ag. Definedg: Ag.Defined4: Ag. Defined7: Ag.Definel0: -10- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 = Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 -- Last Action Type: Location In Site: UNDERGROUND TANK DESCRIPTION Tank ID#: 4 Mfr: MOSIER BRO. Compart Tank: N Installed: 11/1983 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANKS LINED IN 1998 TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: PREMIUM UNLEADED Matl Name:PREMIUM Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Corr Prot: CATHODIC PROTECTION Spill Cnt : 1998 Drop Tube : 1998 Striker Plate: 1998 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wal'l: Installed: Installed: Alarm : Ball Float : Fill Tube S/O: 1998 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -11- 07/22/2004 ~OWARDS MINI MARKET #4 SiteID: 015-021-000706 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: SINGLE WALL Mfgr : UNKNOWN Mtl : GALVANIZED STEEL & : Corr : CATHODIC PROTECTION Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 07/24/2003 Date: 04/28/2000 Name:JOHN KERLEY Prmt Number: 0706 TANK/LINE TEST :07/23/2003 CP CERT. :06/21/1999 MANWAY INSP. :12/22/1998 UST MONIT. CERT:08/13/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:VP Approved: Yes AGENCY DEFINED Expiration Date: 06/30/2006 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: No Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/28/2000 Name:JOHN KERLEY Ttl:VP -12- 07/22/2004 HOWARDS MINI MARKET #4 ---- Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME UNLEADED MID GRADE GASOLINE Location within this Facility Unit UNDERGROUND SiteID: 015-021-000706 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE -q-- TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I 12000.00 GAL Daily Average 3000.00 GAL 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards I No/ Curies F IH DH NFPA /// USDOT# I MCP Mod Ag.Definedl: Ag.Defined5: Ag. Defined8: -- Ag. Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag. Defined3: Ag. Defined6: Ag.Definedg: Ag. Defined4: Ag.Defined7: Ag.Definel0: -13- 07/22/2004 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND TANK DESCRIPTION Tank ID#: 3 Mfr: MOSIER BRO. Compart Tank: N Installed: 11/1983 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANKS LINED IN 1998 TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE Marl Name:UNLEADED MID GRADE GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Corr Prot: CATHODIC PROTECTION Spill Cnt : 1998 Drop Tube : 1998 Striker Plate: 1998 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: Installed: Installed: Alarm : Ball Float : Fill Tube S/O: 1998 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -14- 07/22/2004 MOWARDS MINI MARKET #4 SiteID: 015-021-000706 ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PREssURE Const: SINGLE WALL Mfgr : UNKNOWN Mtl : GALVANIZED STEEL & : Corr : CATHODIC PROTECTION Prot : UnderGround Piping AUTOMATIC LEAK DETECTORS PIPING LEAK DETECTION AboveGround Piping Installed: 07/24/2003 Date: 04/28/2000 Name:JOHN KERLEY Prmt Number: 0706 TANK/LINE TEST :07/23/2003 CP CERT. :06/21/1999 MANWAY INSP. :12/22/1998 UST MONIT. CERT:08/13/2003 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:VP Approved: Yes AGENCY DEFINED Expiration Date: 06/30/2006 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: No Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/28/2000 Name:JOHN KERLEY Ttl:VP -15- 07/22/2004 HOW~DS MINI ~RKET SiteID: 015-021-000706 Manager :~~._.~~-..~7.~f~{~"3~/~~ BusPhone: (661) 833-1561 Location: 3200 P~AMA LN ~ ' Map : 123 Com~az : Low City : BAKERSFIELD .~%%' Grid: 24C FacUnits: 1 AOV: CommCode: BA~RSFIELD STATION 13 SIC Code:5541 EPA Nu~: DunnBrad:17-364-9625 Emergency Contact / Title ?~7~ .... ~ ~ .... ~ / OWNER Business Phone: (661) 833-1561x 24-Hour Phone : (661) 397-5813x Pager Phone : (661) 637-7525x Emergency Cont%qt~ /~_ Title =7~~ f~z~ OPEKATIONS MGR Business Phone: (661) 393-7000x 24-Hour Phone : (661) 393-7000x Pager Phone : ( ) - x Hazmat Hazards: Contact ~ %--r~6~'~ ~j///~-z' MailAddr: PO BOX 1807 City : BAKERSFIELD Fire ImmHlth DelHlth Phone: (661) 393-'7000x State: CA Zip : 93303 Owner JACO-HILL Address : 3101 STATE RD City : BAKERSFIELD Phone: (661) 393-7000x State: CA Zip : 93308 Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: ~--'~.-~, A~.~-~,-'- Do hereby certify that i have (TyI~ ~' print rifle) r~iew~ ~he a~ached h~ar~ou~ materials manag~ agement plan for my facility. -1- 08/14/2003 · D~ Post~ge ~ ~.. cedm~d Fee Return Reclept Fee [~3 (Endorse,re, ertl Required) r-1 Resbtc~ Delivery Fee ~ (Endomement Required) Postma,-k Here D July 8, 2003 CERTIFIED MAIL FIRE CHIEF ROH FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. B,[~kersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Howards Mini Market 3200 Panama Lane Bakersfield, CA 93313 REMINDER NOTICE' Re: Deadline for Dispenser Pan Requirements December 31, 2003 Dear Underground Storage Tank Owner/Operator: A revieW of our files indicate that you have been receiving qUarterly reminders from April of 2002 to December 2002. Our files further show that since January of this year you have been receiving monthly reminders. The purpose of this letter is to remind you of the necessary retrofit of your fueling system. Current code requires that you install under dispenser containment pans prior to December 31, 2003. You will not be allowed to pump fuel after December 31, 2003 unless you have completed the upgrade requirements. Contractors are already scheduling 8-10 weeks in advance. I urge you to retrofit your facility as soon as possible. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, Ralph Huey Director of Pryention Services By: Steve Underwood Fire Inspe6tor/Environmental Code Enforcement Officer Office of Environmental Services SU:db D June 5, 2003 Howard's Mini Market 3200 Panama Lane Bakersfield CA 93313 REMINDER NOTICE F(RE CHIEF ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES · ENV~ONMENTAL SERV1CE$ 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Deadline for Dispenser Pan Requirements December 31, 2003 Dear Underground Storage Tank Owner: A review of our files indicate that you have been receiving quarterly reminder notices since April of 2002. Effective January 2003, you can expect them monthly. The purpose of this letter is to remind you of the necessary retrofit of your fueling system. Current code requires that you install dispenser pans prior to December 31, 2003. You will not be allowed to remain open after December 31, 2003 unless you have completed the upgrade requirement. Contractors are already scheduling work 6-8 weeks out. I urge you to start planning to retrofit your facility as soon as possible. Sincerely, Steve Underwood Fire Inspector/Environmental Services Office of Environmental Services SBU/rs CORROSION- ~"~ ELECTRICAL SER VICES~ INC. ANNUAL CATHODIC PROTECTION SYSTEM SURVEY (_HOWARD'S MINI MART #351 _~ "~ANAMA LANE~_/' ~B~SF~IELD, CALIFOR~ ' Prepared For: Jaco Oil Company PO Box 1807 Bakersfield, California 93303 Prepared By: Corrosion-Electrical Services, Inc. 14020 Maryton Avenue Santa Fe Springs, California 90670 December 2002 14020 MARYTON AF'F. NUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: ($62) 921-9522 FAX: (562) 921-6885 CA. LICENSE C-10 684718 CORROSION- , ELECTRICAL SERVICE$~ INC. TABLE OF CONTENTS INTRODUCTION BACKGROUND SURVE~ PROCEDURES SURVEY ANALYSIS CONCLUSIONS AND RECOMMENDATIONS TABLES Potential Survey Data Sheet Cathodic Protection System Maintenance Record Sheet Rectifier Data Sheet 1 1 2 2 14020 M,4RYTON A VENUE, SANTA FE SPRINGS, CALIFOIL~fl,4 90670 PHONE: (562) 921-9522 FAX: ($62~ 921.6885 CA. LICENSE C-lO 684718 CORROSION- ELECTRICAL SERVICES, INC. INTRODUCTION This report contains information pertinent to the successful operation of the cathodic protection system located at Howard's Mini Mart #351, 3200 Panama Lane, Bakersfield, California, including present and historical data, system specifications, survey procedures and recommended maintenance program. The cathodic protection system is designed to protect four 12,000-gallon underground storage tanks, and associated subsurface metallic piping and vents. BACKGROUND The impressed current cathodic protection system installed at this facility in 1998 consists of the following items: Four 3-inch diameter x~ 60-inch long graphite anodes installed in one 10-inch diameter x 40-foot deep cathodic protection well (CPW). The well is backfilled with petroleum coke breeze and vented to the surface via PVC piping. A traffic-rated road-box is placed over the anode well. The anodes are connected to the rectifier by a header cable. · One J.A. Electronics rectifier rated at 50 volts and 12 Amperes (DC). · Cathodic protection test box that includes wire test leads for each underground storage tank. · Miscellaneous electrical fittings and cathode header cable. SURVEY PROCEDURES The following procedures were followed during the annual survey: · The rectifier was inspected and the operating voltage and amperage were noted. Structure-to-soil potentials were measured with a digital voltmeter connected between the structure and a saturated copper-copper sulfate reference electrode in contact with the earth. Test point locations are listed on the attached data sheets. During the above procedure the tap settings on the rectifier were adjusted as needed to ensure that sufficient protective current is being applied to the underground metallic structures at this facility. 14020 MAR YTON A VENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 F/L(: (562) 921-6885 CA. LICENSE C-lO 684718 I CORROSION- ELECTRICAL SER VICES INC. SURVEY ANALYSIS Structure to soil potential measurements for each test point are above National Association of Corrosion Engineers (NACE) design criteria of 850 millivolts (mV) with cathodic protection applied. Rectifier output (DC volts and amperes) and potential measurement data for each test location are shown on the enclosed data sheets. CONCLUSIONS AND RECOMMENDATIONS Based upon our visual inspection and the data obtained during the survey, Corrosion- Electrical Services, Inc., concludes the following: · The cathodic protection system is operating as designed and the underground tanks and associated piping are receiving adequate protective current. Corrosion-Electrical Services, Inc., recommends that the rectifier data (volts and amps) be recorded weekly on the attached Rectifier Data Sheet and mailed or faxed to Corrosion-Electrical Services, Inc., on a quarterly basis. If any significant changes are observed in the volts and/or amperes on the rectifier, Corrosion-Electrical Services, Inc., should be notified immediately. Along with the above Corrosion-Electrical Services, Inc., recommends, that in order to protect your investment, an annual survey is performed by a qualified individual. We will forward a letter approximately one year from this date requesting your authorization to perform this service on your behalf. 14020 MARYTON AVENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 FAX: (562) 921-6885 CA. LICENSE C-lO 684718 2 CORROSION- ELECTRICAL SER VICES, INC. This annual survey was conducted in accordance with the procedures described in the National Association of Corrosion Engineers (NACE) Standard Recommended Practice RP0285-95, Corrosion Control of Underground Storage Tank Systems by Cathodic Protection and American Petroleum Institute (API) Recommended Practice 1632, Cathodic Protection of Underground Petroleum Storage Tanks and Piping Systems. Thank you for the opportunity to assist you in this phase of your cathodic mitigation program. If you have any questions please feel free to contact us at your convenience. Respectfully, CORROSION-ELECTRICAL SERVICES, INC. Latricia J. Brewis President 14020 MARYTON AVENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 ELY: (562) 923!-6885 CA. LICENSE C-lO 684718 CORROSION- ELECTRICAL SER VICE$ INC. CLIENT: HOWARD'S MINI MART TEST DATE: SYSTEM LOCATION: CES NO: 12-7-02 SERVICE STATION NO: 351 3200 PANAMA LANE. BAKERSFIELD. CALIFORNIA S2226 ENGINEER: TECHICIAN: 'L. BRI~WI$ RECTIFIER DATA MANUFACTURER: J.A. ELECTRONICS SERIAL NO.: 97503 RATING: 50 VOLTS: 12 AMPERES: VAC: 115 OUTPUT: 24 VOLTS: 2 AMPERES: MONITOR CHECK: SETTING: B - 4 HOURMETER READING: 24693.1 HRS LAST READING: 15030.0 HRS DATE: 6-13-00 CHANGE IN READING: 9663.1 HRS ACTUAL HOURS: 21768 HRS DAYS OFF: 504 FIELD TEST DATA STRUCTURE-TO-SOIL TEST LOCATION POTENTIAL (MV) I (on) I (off) FUEL TANK #1 - PLUS UNLEADED -1006 -448 FUEL TANK #2 - DIESEL -1002 -448 FUEL TANK #3 - REGULAR UNLEADED -1000 -447 i FUEL TANK #4 - SUPER UNLEADED -999 -446 !FUEL TANK #5 - FUEL TANK #6 - VENTS - -999 -471 DISPENSER - 1 - 3 -996 -459 DISPENSER - 4 - 6 -999 -465 DISPENSER - 7 - 9 -998 -455 DISPENSER - 10 - 12 -999 -452 DISPENSER - DISPENSER - WATER LINES - GAS CO. METER - ELECTRICAL CONDUIT - -918 -480 CuCuSO4 REFERENCE LOCATION @: PLANTER BY SIGN, REMARKS: (FIELD) ANNUAL SURVEY. SYSTEM IS OPERATING AS DESIGNED. ALL POTENTIALS ARE ABOVE THE NACE CRITERIA OF -850 MILLIVOLTS. 14020 MARYTON AVENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 FAX: (562) 921-6885 CA. LICENSE C-10 684718 CORROSION- ELECTRICAL SER VICES, INC. CATHODIC PROTECTION SYSTEM MAINTENANCE RECORD SHEET LOCATION OF RECTIFIER UNIT: IN RESTROOM TYPE OF RECTIFIER: AIR COOLED WALL MOUNTED TYPE OF ANODES: GRAPHITE RECTIFIER MANUFACTURED BY: RECTIHER AC INPUT: RECTIFIER DC OUTPUT: DATE SYSTEM TURNED ON: QUANTITY: 4 SIZE: 3 X 60 [.A. ELECTRONICS SERIAL #97503 115 VOLTS 1 PHASE 50 VOLTS 12 AMPERES [ANUARY 14t 1998 RECTIFIER READINGS LONG 60 CYCLE RECTIFIER SETTING DC OUTPUT BY DATE REMARKS COARSE FINE VOLT AMPS B 3 21 3 GS 6-21-99 ANNUAL SURVEY B 4 24.5 2 GS 6-13-00 ANNUAL SURVEY B 4 24 2 LB 12-7-02 ANNUAL SURVEY 14020 MARYTON,4VENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 FAX: (562) 921-6885 CA. LICENSE C-lO 684718 CORROSION- ELECTRICAL SER VICES INC. RECTIFIER QUARTERLY RECORDING SHEET RECORD WEEKLY OWNER HOWARD'S MINI MART #351 LOCATION JOB # S2226 3200 PANAMA LANE, BAKERSFIELD, CA. UNIT D.C. OUTPUT DATE TIME REMARKS BY NO. VOLTS AMPS I 24 2 12-7-02 ANNUAL SURVEY LB UNIT NO. UNIT NO. UNIT LOCATION: IN RESTROOM UNIT LOCATION: NORMAL RANGE: UNIT NO. 1 VOLTS 21 - 27 AMPS UNIT NO. VOLTS AMPS 0.5 - 5.0 NOTE: IF UNIT STABILIZES OUTSIDE NORMAL, NOTIFY YOUR ENGINEER !!! MAIL TO CORROSION-ELECTRICAL SERVICES, INC. QUARTERLY 14020 YlARYTON AVENUE, SANT~4 FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 FAX: (562) 921-6885 C,4. LICENSE C-lO 684718 HOWARDS MINI MARKET Manager : Location: 3200 PANAMA LN City : BAKERSFIELD CommCode: BAKERSFIELD STATION 13 EPA'Numb: SiteID: 015-021-000706 BusPhone: Map : 123 Grid: 24C FacUnits: (805) 833-1561 CommHaz : Low 1 AOV: SIC Code:5541 DunnBrad:17-364-9625 Emergency Contact / Title SHNG TAE AHN & RYAN / OWNER Business Phone: (805) 833-1561x 24-Hour Phone : (805) 397-5813x Pager Phone : (805) 637-7525x Emergency Contact / Title JOHN KERLEY / OPERATIONS MGR Business Phone: (805) 393-7000x 24-Hour Phone : (805) 393-7000x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : MailAddr: PO BOX 1807 City : BAKERSFIELD Phone: ( ) State: CA Zip : 93303 X Owner JACO-HILL Address : 3101 STATE RD City : BAKERSFIELD Phone: (805) 393-7000x State: CA Zip : 93308 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: (Type or print n~me) reviewed the attached hazardous materials manage- ment p!an fo~~$ and that it along with (Name of Business) any corrections constitute a complete and correct man- agement fac '11 -I -00 Sifln~ture Date 1 10/31/2000 HOWARDS MINI MARKET #4 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: HOWARDS MINI MARKET #4 Cross Street : Business Type: Org Type: Total Tanks : 4 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : JOHN KERLEY Phone: Address: City : Type : Name : JOHN KERLEY Address: City : Type : State: Zip: TANK OWNER INFORMATION Phone: State: Zip: SiteID: 015-021-000706 (805) 393-7000x (805) 393-7000x BOE UST Fee# : 019753 Financ'l Resp: SELF INSURED Legal Notif : Property Owner Mailing Address Date:04/28/2000 Name:JOHN KERLEY State UST # : Phone: (661) 393-7000x Ttl:VP 1998 Upg Cert#: 00774 F Hazmat Inventory [--As Designated Order Hazmat Common Name... REGULAR GASOLINE UNLEADED REGULAR PREMIUM UNLEADED MID GRADE GASOLINE ISpecHazI EPA HazardsI One Unified List Ail Materials at Site Frm DailyMax UnitIMCP F IH DH F DH F DH F IH DH L 12000.00 GAL Mod L 12000.00 GAL Mod L 12000.00 GAL Mod L 12000.00 GAL Mod 2 10/31/2000 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Inventory Item 0001 Facility Unit: Fixed Containers on Site ~Zv~vl~ ~vl~ / ~1 ~_~.1_~ ~v~ REGULAR GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 F STATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient' CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average 5000.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 TSecretINO N~S BioHazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards NFPA I USDOT# t MCP No/ Curies F IH DH . / / / I IMOd Inventory Item 0002 Facility Unit: Fixed Containers on Site UNLEADED REGULAR Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 STATE TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average 6500.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS 8006619 TSecret No HAZARD ASSESSMENTS RS BioHazI Radioactive/Amount EPA Hazards No NoI No/ Curies F DH NFPA/// I USDOT# Mod 3 10/31/2000 HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Inventory Item 0003 Facility Unit: Fixed Containers on Site PREMIUM Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 STATE -- TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION I Daily Maximum I 12000.00 GAL Daily Average 3000.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS DIESEL FUEL NO. 2 68476302 TSecret No HAZARD ASSESSMENTS RS BioHaz[ RadioaCtive/Amount EPA Hazards No NoI No/ Curies F DH NFPA/// [ USDOT# MCP Mod Inventory Item 0004 Facility Unit: Fixed Containers on Site UNLEADED MID GRADE GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 FSTATE -- TYPE Liquid Pure PRESSURE TEMPERATURE Ambient --~ Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average 3000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS 8006619 No NoRS No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# Mod -4- 10/31/2000 F HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Fast Format ~ Notif./Evacuation/Medical --Agency Notification CALL 9-1-1 IF NEED CALL STATE EMERGENCY OFFICE 1-800-852-7550 OR 1-619-262-1621 Overall Site 12/01/1994 Employee Notif./Evacuation A. DIAL 9-1-1. B. SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER. C. EVACUATE THEMSELVES & ANYBODY IN OR AROUND PREMISES. D. NOTIFY NEIGHBOR(S) TO EVACUTATE IF NECESSARY. 03/11/1998 -- Public Notif./Evacuation NOTIFY NEARBY RESIDENTS & SURROUNDING FACILITIES. 12/01/1994 Emergency Medical Plan CALL 9-1-1 MEMORIAL URGENT CARE - 6501 MING AVE - 397-4004 OR MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371. 03/11/1998 5 10/31/2000 F HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 03/11/1998 AREAS ARE KEPT CLEAR OF COMBUSTIBLE PRODUCTS. PUMPS HAVE EMERGENCY SHUT OFF SWITCH(S). ABSORBENT MATERIALS KEPT ON PREMISES. --Release Containment 03/11/1998 SMALL SPILLAGE, SHUT DOWN MAIN SWITCH, CLEAN AREA, DISPOSE (IF NEEDED) OF HAZARDOUS MATERIAL MAJOR SPILLAGE, NOTIFY FIRE DEPARTMENT FOR ASSISTANCE, CALL OPERATIONS MANAGER 393-7000. -- Clean Up 12/01/1994 VEHICLE OVERSPILLS, SMALL SPILLAGE: CLEAN AREA, IF NEEDED DISPOSE OF MATERIALS AS INSTURCTED. DRIVE-OFF WITH NOZZLE: SUBSTANTIAL SPILL, SHUT ENTIRE SYSTEM. VEHICLE DAMAGE TO PUMP(S): SHUT DOWN POWER TO PUMP(S), CLEAN AREA IF POSSIBLE, CALL OPERATIONS MANAGER. ADJACENT BUILDING(S) ON FIRE: SHUT DOWN ENTIRE GAS ISLAND(S) EMERGENCY CONTROL SHUT-OFF, FIRE DEPARTMENT WILL ADVISE TO RESUME NORMAL OPERATIONS. Other Resource Activation 12/01/1994 NOTIFY DISTIRCT (OPERATIONS) MANAGER TO CALL OUT RESPONSE EMERGENCY 6 10/31/2000 ~ HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SE CORNER OF BLDG C) WATER - SE CORNER OF BLDG D) SPECIAL - GASOLINE SHUT OFF INSIDE BLDG ON GAS CONSOLE E) LOCK BOX - NO 03/11/1998 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. 03/11/1998 FIRE HYDRANT - NE CORNER OF PANAMA & WIBLE. Building Occupancy Level 7 10/31/2000 F HOWARDS MINI MARKET #4 SiteID: 015-021-000706 Fast Format Training -- Employee Training Overall Site 03/11/1998 WE HAVE 8 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: (1) SHUT OFF (IF POSSIBLE) THE MAIN BREAKER (2) EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES (3) DIAL 9-1-1 (4) NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY AND (5) NOTIFY EMERGENCY RESPONSE TEAM Page 2 Held for Future Use Held for Future Use 8 10/31/2000 HOWARDS MINI MARKET #4 Manager-: Location: 3200 PANAMA LN City : BAKERSFIELD CommCode: BAKERSFIELD STATION 13 EPA Numb: SiteID: 215-000-000706 BusPhone: (805) 833-1561 Map : 123 CommHaz : Low Grid: 24C FacUnits: 1 AOV: SIC Code:5541 DunnBrad:17-364-9625 Emergency Contact / Title SHNG TAE AHN & RYAN / OWNER Business Phone: (805) 833-1561x 24-Hour Phone : (805) Pager Phone : (~3~)~ Emergency Contact JOHN KERLEY Business Phone: 24-Hour Phone : Pager Phone : / Title / OPERATIONS MNGR (805) 393-7000x (805) 393-7000x ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Emergency Directives: = H~zmat Inventory --MCP+DailyMax Order Hazmat Common Name... ISpecHazI REGULAR GASOLINE UNLEADED REGULAR PREMIUM UNLEADED PREMIUM One Unified List Ail Materials at Site EPA HazardsI Frm I DailyMax Unit MCP F IH DH L 12000 GAL Mod F DH L 12000 GAL Mod F DH L 12000 GAL Mod F IH DH L 12000 GAL Mod v.o~,.,~,.~.~) Do hsreby certify that I have r~vi®wed ~h~ a~achsd h~ardous materials m~ plan for ~~ ~.,' ~~and that it along with any ~rrections cor~sfi~'ut~ a comp,ere and correct man- -1- 02/26/1998 HOWARDS MINI MARKET #4 SiteID: 215-000-000706 Inventory Item 0001 Facility Unit: Fixed Containers on Site REGULAR GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 STATE TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily Average 5000.00 GAL 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 HAZARD ASSESSMENTS ITsecretl oRSIBioHazI Radioactive/Amount I EPA HazardsI NFPA No N No No/ Curies F IH DH / / / USDOT# I MCP Mod Inventory Item 0002 Facility Unit: Fixed Containers on Site ~lVUVl~ ~Vl~ / ~£ ~Z-~..~ ~Vl~ UNLEADED REGULAR Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND CAS# 8006-61-9 STATE T TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I 12000.00 GAL Daily Average 6500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS No CAS#80066191 TSecretNo N~S BioHazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F DH NFPA/// I USDOT# MCP Mod 2 02/26/1998 HOWARDS MINI MARKET #4 ~ Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME PREMIUM Location within this Facility Unit UNDERGROUND SiteID: 215-000-000706 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK LarGest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily AveraGe 3000.00 GAL HAZARDOUS COMPONENTS %Wt. I 100.00 DIESEL FUEL NO. 2  S CAS# N 68476302 TSecretINO NoRSIBi°HaZNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F DH NFPA /// USDOT# MCP Mod ~ Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME UNLEADED PREMIUM Location within this Facility Unit UNDERGROUND Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 FSTATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK LarGest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL Daily AveraGe I 3000.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// I USDOT# MCPI Mod 3 02/26/1998 F HOWARDS MINI MARKET #4 SiteID: 215-000-000706 Fast Format : Notif./Evacuation/Medical -- Agency Notification CALL 9-1-1 IF NEED CALL STATE EMERGENCY OFFICE 1-800-852-7550 OR 1-619-262-1621 Overall Site 12/01/1994 -- Employee Notif./Evacuation A. DIALL 9-1-1. B. SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER. C. eVACUATE THEMSELVES & ANYBODY IN OR AROUND PREMISES. D. NOTIFY NEIGHBOR(S) TO EVACUTATE IF NECESSARY. 12/01/1994 Public Notif./Evacuation NOTIFY NEARBY RESIDENTS & SURROUNDING FACILITIES. 12/01/1994 Emergency Medical Plan CALL 9-1-1 MEMORIAL URGENT CARE 6501 MING AVENUE 805-397-4004 MERCY HOSPITAL 2215 TRUXTUN AVENUE 805-327-3371 12/01/1994 -4- 02/26/1998 F HOWARDS MINI MARKET SiteID: 215-000-000706 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 12/01/1994 AREAS ARE KEPT CLEAR OF COMBUSTIBLE PRODUCTS PUMPS HAVE EMERGENCY SHUT OFF SWITCH(S) ABSORBENT MATERIALS KEPT ON PREMISES. -- Release Containment 12/01/1994 SMALL SPILLAGE, SHUT DOWN MAIN SWITCH, CLEAN AREA, DISPOSE (IF NEEDED) OF HAZARDOUS MATERIAL MAJOR SPILLAGE, NOTIFY FIRE DEPARTMENT FOR ASSISTANCE, CALL OPERATIONS MANAGER. 805-393-7000. -- Clean Up 12/01/1994 VEHICLE OVERSPILLS, SMALL SPILLAGE: CLEAN AREA, IF NEEDED DISPOSE OF MATERIALS AS INSTURCTED. DRIVE-OFF WITH NOZZLE: SUBSTANTIAL SPILL, SHUT ENTIRE SYSTEM. VEHICLE DAMAGE TO PUMP(S): SHUT DOWN POWER TO PUMP(S), CLEAN AREA IF POSSIBLE, CALL OPERATIONS MANAGER. ADJACENT BUILDING(S) ON FIRE: SHUT DOWN ENTIRE GAS ISLAND(S) EMERGENCY CONTROL SHUT-OFF, FIRE DEPARTMENT WILL ADVISE TO RESUME NORMAL OPERATIONS. Other Resource Activation 12/01/1994 NOTIFY DISTIRCT (OPERATIONS) MANAGER TO CALL OUT RESPONSE EMERGENCY -5- 02/26/1998 F HOWARDS MINI MARKET #4 SiteID: 215-000-000706 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - SOUTHEAST CORNER OF BUILDING D) SPECIAL - GASOLINE SHUT OFF INSIDE BUILDING ON GAS CONSOLE E) LOCK BOX - NO 12/01/1994 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. 12/01/1994 FIRE HYDRANT - NORTHEAST CORNER OF PANAMA & WIBLE Building Occupancy Level 6 02/26/1998 F HOWARDS MINI MARKET #4 SiteID: 215-000-000706 Fast Format Training -- Employee Training Overall Site 09/21/1993 WE HAVE 8 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING - ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: (1) SHUT OFF (IF POSSIBLE) THE MAIN BREAKER (2) EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES (3) DIAL 9-1-1 (4) NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY AND (5) NOTIFY EMERGENCY RESPONSE TEAM -- Page 2 --Held for Future Use Held for Future Use -7- 02/26/1998 215-000-000706 Overall Site with 1 Fac. Unit General Information Page Location: 3200 PANAMA/LN ~ Contact Ngme Titl~ ISHNG TAE AHN fR~W / OWNER Business Phohe: (805) 833-1561x 24-Hour Phone : (805) 664-7870x Pager Phone : ( ) - Map:123 Haz:2 Type: 3 Grid: 24C F/U: 1 AOV: 0.0 Contact Name _ ~Title Bu.~iness Phone: (805) 24-Hour Phone : ( Pager Phone : ( ) - x Mail Addrs: City: Conma Code: Administrative Data BAKERSFIELD ' ~' --' 215-013 BAKERSFIELD STATION 13 State: Owner: JT~O~?_'~ -' Address: City: BAKERSFIELD D&B CA SIC Code:~~/ Phone: State: CA Summary RECEIVED ~, _,.~'~, KEELE (/Do hereby c~r~fy ~hat ! hav~ (Ty~ or print n~e)~ reviewed ~he attached h~e~ous ma~edais manage= men~ plan f°r~and ~hat J~ ~long wi~h (~~ ~eme~ p~an ~r ~y fa~lJ~. 10/~8/94' HOWARDS MINI MARKET 215-000-000706 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Page Pln-Ref Name/Hazards Form Max Qty MCP 02-003 PREMIUM' Liquid 12000 Moderate ~ Fire, Delay Hlth GAL 02-001 REGULAR GASOLINE Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-004 UNLEADED PREMIUM Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-002 UNLEADED REGULAR Liquid 12000 Moderate ~ Fire, Delay Hlth GAL 10/~8/94 HOWARDS MINI MARKET 215-000-000706 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-003 PREMIUM · Fire, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL --Daily Max GAL 12,000 Daily Average GAL 3,000.00 Annual Amount GAL 80,000.00 Storage UNDER GROUND TANK Press T Temp Location I Ambient I Ambient I UNDERGROUND -- Conc 100.0% IGASOLINE Components iMCP ---/Guide ModerateI 0 02-001 REGULAR GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 5,000.00 Annual Amount GAL 160,000.00 Storage UNDER GROUND TANK Press T Temp Location I AmbientlAmbient l UNDERGROUND -- Conc 100.0% IGasoline Components MCP ---~Guide IModerateI 27 02-004 UNLEADED PREMIUM · Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS 9:8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 3,000.00 Annual Amount GAL 80,000.00 Storage UNDER GROUND TANK Press T Temp Location I Ambient I AmbientlUNDERGROUND -- Conc 100.0% IGasoline Components iMCP ---~uide ModerateI 27 lo/ 8/9¢ HOWARDS MINI MARKET 215-000-000706 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 4 02-002 UNLEADED REGULAR · Fire, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 6,500.00 Annual Amount GAL 700,000.00 Storage UNDER GROUND TANK Press T Temp Location I Ambient I AmbientlUNDERGROUND -- Conc 100.0% IGasoline Components IMCP ---~uide ModerateI 27 10/18/94 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <D> Notif./Evacuation/Medical Page 5 <1> Agency Notification CALL 9-1-1 <2> Employee Notif./Evacuation -' "' -- 2D//~"/-- .q--/-~ / .'.'-'i .... ~ - '>-~--' ' -~ -" :='-'-- " '. -' · <3> Public Notif./Evacuation <4> Emergency Medical Plan HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page Release Prevention <2> Release Containment <3> Clean Up <~> o~n~r .~so~rce ~c~a~on '~b~/~- ~ ~~~ ~~~ ~F~~ 10/18/94 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - SOUTHEAST CORNER OF BUILDING D) SPECIAL - GASOLINE SHUT OFF INSIDE BUILDING ON GAS CONSOLE E) LOCK BOX - NO <3> Fire Protec./Avail. Water FIRE HYDRANT - NORTHEAST CORNER OF PANAMA & WIBLE <4> Building Occupancy Level 10/18/94 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <G> Training Page <1> Employee Training WE HAVE 8 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING - ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: (1) SHUT OFF (IF POSSIBLE) THE MAIN BREAKER (2) EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES (3) DIAL 9-1-1 (4) NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY AND (5) NOTIFY EMERGENCY RESPONSE TEAM <2> Page 2 <3> Held for Future Use <4> Held for Future Use Memo From: .~.,~ ~'. BAKERSFI ELD CITY FI RE DEPARTMENT INSTRUCTIONS FOR BUSINESS PLAN SINGLE FACILITY UNIT GENERAL INFORMATION The use of this form is required only if your business has been requested to by the Bakersfield City Fire Department or your business is complex/large enough that sufficient detail cannot be provided on a Business Plan (For.i 2A by itself. The number of separate facility uuits will be provided by the Bakersfield City Fire Depart,tent. Contact the department for additional guidance prior to proceeding with this form. Type/print in facility unit number and name. Give each facility unit a common name, and a one or two digit number. Example : South #2. NOTE: An inventory form (4A-l, 4A-2, or 4A-3, as appropriate) must be made for each separate facility unit. SECTION 1: . MITIGATION, PREVENTION~ ABATEMENT Explain procedures to prevent ,the re]ease or spill of nazdrd)us materials in ~his facility mit. Describe plan to cont. ain a~d clean up if a spill should oocur. #O dA/ b //M£/LEK P 'A vA zA /F SECTION 2: NOTIFICATION AND EVACUATION Describe procedures for immediate notification and evacuation of this facility SECTION 3: HAZARDOUS MATERIAL ~ Circle Yes or Xo ' SECTION 4: PRIVATE FIRE PROTECTION Describe on--site fire protection for this facility unit, including sprinklers, extinguishers, alarm systems and private response teams, SECTION 5: LOCATION OF WATER Give the location of the clos~s~, fire d¢,pa.-tment water >:uppty. ~/~ C~/V£/f ?4,,~',~/n/t -- /~ '/--RO,~I- E),~ z~cI£/~/~s5 ~/~/~ BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSINESS NAME: ID# BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Ans~qer the questions below for THE FACII, ITY UNIT LISTED BELOW 4. Be as BRIEF and C0NCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: SECTION 1: MITIGATION,' PREVENTION, ABATEMENT PROCEDURES 1774J~ GI].~ 5'Ndr OF~ ZOdATI~D //U~/DE ~i SH/'~L O o/U' ~ o5 ~ . SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNiT ONLY (.o//E £/--/ZZ_ tA/~ ~/l $OZ /ZJ £' ,'/I: / ~u pPz - 3A - SECTION 8: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A, Does this Facility UnJ. t con.rain Hazardous MaterJ :,.o f~-~ .... x~ a ......... ~ ~ES I ~0 If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separat~ hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form ~4A-2) in a,.lditJon to the non--trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF MATER SUPPLY FOR USE BY EMERGENCY RESPONDERS N d,/ SECTION 6: LOCATION' OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. B. ELECTRICAL: C. WATER: O. SPECIAL: E. LOCK P, OX: V.['.'S .," .YO IF *,;ES, [.OCXTION YES, SiTE PLANS.'? FLOOR PLANS? YES / NO MSOSs? YES ." XO YF.S ,,' NO :<E'YS? YES " .":0 BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page __"' NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: /~/0~/9~/~-~ /'~///,/~' /'~F,~'~e'/'" OWNER NAME: ~/~,~Z) ~~ FACILITY UNIT ADDRESS: ~00 ~'~ ~'~ ADDRESS:iI~/~ ~/~'D~ ~/~ FACILITY UNIT NAME: PHONE ~: .... ~3~/5~/ PHONE ~: s~ 9~/~ IOFF]C]AL USE CFIRS CODE I ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.1 CODE AMOUNT AMOUNT UNIT CODE COOE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDI: NAME: Ro~'4zp 54'/..,//¢~£~"/¢._ TITLE: ¢~0,¢'~/L. SIGNATURE: /~.~).;~¢.- x.~z.~.f./.4,_.j. DATE: EMERGENCY CONTACT: ~-/5'~/ ~ ~/~ TITLE: PHON~ ¢ BUS HOURS: ~55-/~/ AFTER 8US HRS: EMERGENCY CONTACT: ~T~/~ ~~ TITLE: ~L4.)Ai~ PHONE ~ BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: ~,'~'i ~CK'~ AFTER BUS HRS: ~-.~'~ 09/09/93 HOWARDS MINI MARKCT 215-000-000706 Overall Site with 1 Fac. Unit SEP g 1 1993' By~ e General Information Location: 3200 PANAMA LN Map: 123 Hazard: LOw I Community: BAKERSFIELD STATION 13 '~ Grid: 24C F/U: 1AOV: 0.0 Contact Name KATHY SEUFERER IDIANE GOLLEDGE. OWNER OWNER Mail Addrs: 3200 PANAMA LN City: BAKERSFIELD Comm Code: 215-013 BAKERSFIELD STATION 13 Title · Business Phone 24-Hour Phoneq [ I(805) 834-4446[ (805) 833-1561 x (805) 833-1561 x (805) 833,1868[ Administrative Data D&B Number: State: CA Zip: 93313- SIC Code: Owner: DIANE GOLLEDGE Phone: (805) 833-1561 Address: 3200 PANAMA LN State: CA City: BAKERSFIELD Zip: 93313- Summary ,,~AiJ ~; ~/Pr~l .~; Oo hereby Certify that , have reviewed ~h ' ' ~ , e retouched hazardous materials mar;age- merit plan fo nd that it along with any correction.~constitute.aa complete and correct man- agement pl,a/n fo'~ my f~ty I HAZARDOUS MATERIALS INSPECTION Business Name: Location: Bakersfield Fire Dept. Hazardous Materials Division Date Completed Business Identification No. 215-000 ~ C) 0 7 ~) ~ (Top of Business Plan)/ , "Shitt- ~------ ' ,~/, ,' Station No.. _.L.,; ~_.. _ Inspector ArrivalTime' /~'r''rT~ OepartureTime: /0.~ InspectionT~e: ~'.~ / Comments; Number of Employees: Verification of Inventory Materials Verification of Quantifies Verification of Location __Proper Segregation of Material Verification of MSDS Availability' Verification of Haz Mat lraining Adequate Inadequate RECEIVE© HAZ. MAT. DIV. Comments: Verification of Abatement Supplies & Procedures [:3 Comments: Comments: Emergency Procedures Posted Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: ~/~n / D Violations: Business Owner/Manager PRINT NAME All Items O.K Correction Needed White-Haz Mat Oiv Yellow-Station Copy Pink-Business Copy · SEP gl ~993 ~) By__ F~), c~ bbOr-!~-1o. 09/09/93 Pln-Ref 'HoWARDS MINI MARKET 215-000-000706 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Name/Hazards Form Max'Qty Page MCP 2 02-003 PREMIUM · Fire, Delay Hlth Liquid 12000 Moderate GAL 02-001 REGULAR GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL 02-004 UNLEADED PREMIUM · Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL 02-002 UNLEADED REGULAR · Fire, Delay Hlth Liquid 12000 'Moderate .GAL 09/09/93 HOWARDS MINI MARKET 215-000-000706 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-003 PREMIUM · Fire, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Da~ly Average GAL 3,000.00 Annual Amount GAL 80,000.00 Storage UNDER GROUND TANK Press T Temp IAmbient IAmbient I UNDERGROUND Location -- Conc 100.0% IGasoline Components MCP ---7Guide ModerateI 27 02-001 REGULAR GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 5,000.00 Annual Amount GAL 160,000.00 Storage UNDER GROUND TANK Press T Temp Location I Ambient I AmbientlUNDERGROUND -- Conc 100.0% IGasoline cOmponents MCP ---TGuide IModerateI 27 02-004 UNLEADED PREMIUM '· Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade SeCret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 3,000.00 Annual Amount GAL 80,000.00 Storage UNDER GROUND TANK Press T Temp Location I AmbientlAmbient UNDERGROUND -- Conc 100.0% IGasoline Components MCP --TGuide IModerateI 27' 09/09/93 HOWARDS MINI MARKET 215-000-000706 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-002 UNLEADED REGULAR · Fire, Delay. Hlth Liquid. 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 Daily Average GAL 6,500.00 Annual Amount GAL -- 700,000.00 Storage UNDER GROUND TANK PreSs T Temp Location Ambient~AmbientlUNDERGROUND -- Conc 100.0% IGasoline Components MCP --~Guide IModerateI 27 09/09/93 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <D> Notif./Evacuation/Medical Page 5 <1> Agency Notification CALL 9-1-1 <2> Employee Notif./Evacuation 3A SEC 2) ~ANY SPILLS OR OVERFILLING OF GASOLINE IN STORAGE TANKS. FIRE DEPT IS CALLED, ALSO JACO OIL COMPANY, WHICH IS SUPPLIER ARE CONTACTED IMMEDIATELY. <3> Public Notif./EvaCuation STORE MANAGER (PERSON IN CHARGE OF THE SHIFT) WILL CONSULT WITH RESPONDING EMERGENCY AGENCY AS TO THE BEST WAY TO DO PUBLIC EVACUATION IF NECESSARY. <4> Emergency Medical Plan 2A SEC 5) WHITE LANE EMERGENCY CENTE~R. 09/09/93 HOWARDS MINI MARKET 215-000-000706 Page 00 - Overall Site <E> Mitigation/Prevent/Abatemt 6 <1> Release Prevention MAIN GAS SHUT OFF LOCATED INSIDE ON GAS CONSOLE. OFF WITH VAPOR SHIELF ON HOSE. EACH PUMP HAS AUTO SHUT <2> Release Containment <3> Clean Up 'KITTY LITTER ABSORBANT IS LOCATED BEHIND COUNTER FOR USE ON GASOLINE SPILLS <4> Other Resource Activation 09/09/93 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <F> Site Emergency Factors Page 7 <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - SOUTHEAST CORNER OF BUILDING D) SPECIAL - GASOLINE SHUT OFF INSIDE BUILDING ON GAS CONSOLE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ????????????????? FIRE HYDRANT - NORTHEAST CORNER OF PANAMA & WIBLE <4> Building Occupancy Level ?09/09/93 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <G> Training Page 8 <1> Page 1 WE HAVE 13 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING - ALL EMP~0YEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: (1) SHUT OFF (IF POSSIBLE) THE MAIN BREAKER (2) EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES (3) DIAL 9vl-1 (4) NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY AND (5) NOTIFY EMERGENCY RESPONSE TEAM <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use MEMORANDUM OCTOBER.i, 1991 TO: VALER E PENDERG. SS, HAZARDOUS TER LS × SUBJECT: HAZARDOUSMATERIALSACC~ . _ HM 419001 -///H-~oward s Mini Mart - 3200 Panama Lane.~ / For your information the bulk sale was / completed on 9-24-91. The new owners are: / ( - Sung Tae Ahn & Ryan Sung Ahn .~ . 11495 Riverside Drive, #108  N. Hollywood, CA HM 691201 - California Coach Works - 4312 Wible Road I have changed mailing address to: c/o Darryl Jones 2205 Watson Bakersfield, CA 93308 HM 405201 - Broadway filed .Chapter 11 Bankruptcy on 2-10-91. Close existing account and open 02 account. New mailing address is: ATTN: Accounting Taxes 3880 N. Mission Road Los Angeles, CA 90031 Ail needed adjUstments have been made. (See attachment). krc MDS.27 BAKERSFIELD CI/"Y FIRE DEPARTMENT 2130 "O" STREET BAKERSFIELD, CA 93301 (805) 326-3979 IUS INESS NAME OFFICIAL USE ONLY ID# HAZARDOUS MATER I ALS BUSI NESS PLAN AS A WHOLE FORM 2A 00 706 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 A. BUSINESS NAME: HOWAg 5 B. LOCATION / STREET ADDRESS:. 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: NAM~AND TITLE DURING BUS. HRS. AFTER BUS. HRS. Ph# ~':::B:5 /8¢.,0 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~" A B. ELECTRICAL: C. WATER: IZA.'tl [)lA,'... D. SPECIAL: (~/\_f~C,t Ik,'L _c_~tl',,:q' ~',t tA,'LtlSl.' [%(.'lz lO lA: f.-. ('A E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSS? YES ,/ NO KEYS? YES / NO 'N SECTION 4: PRIVATE RESPONSE TE~M FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS YE~ MATERIALS: ....................................... ~ ..... ' NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO C. PROPER USE OF SAFETY EQUIPMENT: ................... ~i~, NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~ NO REFRESHER (~E S'I .~O Y.~ NO . ~ NO No SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I ;~.,~'/l~--b ~' , ' .._-.~L'¢II:'~ , certify that the above information is accurate. I understand 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 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. (_)4/[)5/91' H~ARDS MINI MARKET 215-(:)(:)( )706 Overall Site with 1 Fac. Ursit Ger~era 1 I rs format i ors RECEIVED ~Ur-- 2 ! 1991' Page Lc, cat icm: 3200 PANAMA LN Map: 123 HA~ ibiS[ :D L~_,w Ident Number: 215-000-000706 Grid: 24C .Area of Vul: r~ Contact Name KATHY SEUFERER DIANE GOLLEDGE Admir, istrative Data Mail Addrs: 3200 PANAMA LN City: BAKERSFIELD Comm Code: 215a013 BAKERSFIELD SI'ATION 13 l ......... Business Plnc, r,e - i~- 24 Hour Ph,,,rse] ~ (8(])5) 833-1561 x I (8(')5) 834-4446~ 1(805) 833-1561 x 1(805) 833-1868~ D&B Number: St ate: CA Zip: 9331~- SIC Code: Phone: (805) 833-1561 State: CA Zip: 933(:)9- Summary reviewed the attached hazmrd°~s materials . and that it ~ong with meat plan for any corre~ionS constitute a ~mpt~e and co~ man- ~eme~ plan for my tacility. 04 / 05/91 P 1 r,-Ref Name/Hazards HOWARDS MINI MARKET 215-000-000706 Hazmat Inver~tory List in MCP Order 02 -'Fixed Cor, tair, ers on Site Forr~ Quar, t i t y Page MCP 2 02-003 PREM I UM Fire, Delay Hlth Liquid 12,000 GAL Moderate 02-001 REGULAR GASOLINE Fire, Immed Hlth, Delay' Hi'th Liquid 1 .-, 000 GAL Moderate 02-004 UNLEADED PREMIUM Fire, Irnmed Hlth., Delay Hlth Liquid 12, 000 GAL Moderate 02-002 UNLEADED REGULAR Fire, Delay Hlth Liquid 12,000 GAL Moderate 04/0~/91 I-'~ARDS MINI MARKET 215-O00eOOTOG ~')0 - Overall Site <D> Not if. /Evacuatiorl/Medical Pa g e <1> Agency Notification Call 911 .~ <2> Emplnyee Notif./Evacuatior, 3A SEC 2) ANY SPILLS OR OVERFILLING OF GASOLINE IN STORAGE TANKS. FIRE DEE']' IS CALLED, ALSO JACO OIL COMPANY, WHICH IS SUPPLIER ARE CONTACTED IMMEDIATELY. <3> Public Notif. /Evacuation Store Manager (person in charge of the shift) will consult with · responding emergency agency as t'o the best way to do public evacuation ~if necessary. <4> Emerger, cy Medical Plat, 2A SEC 5) WHITE LANE EMERGEN[]Y CENTER. 04/05/91 Page 4 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <E> Mi t i gat i on/Preverlt/Abat erst <1> Release Preverltion MAIN GAS SHUT OFF LOCATED INSIDE ON GAS CONSOLE. OFF WITH VAPOR SHIELF ON HOSE. EACH ,PUMP HAS AUTO SHUT <2> Release Cor, tair, r~er, t <3> Clean~ Up KITTY-LITTER ~ABSORBANT IS .LOCATED BEHIND COUNTER FOR USE ON GASOLINE SPILLS <4> Other Resource Activation 04/0~/91 ~ARDS MINI MARKET 215-00~.~)C)706 O0 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <,=> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - SOUTHEAST CORNER OF BUILDING D) SPECIAL - GASOLINE SHUT OFF INSIDE BUILDING ON GAS CONSOLE E) LOCK BOX - NO <3> Fire Protec. /Avaii. Water PRIVATE FIRE PROTECTION - ????????????????? FIRE HYDRANT - NORTHEAST CORNER OF PANAMA & WIBLE <4> Held for Future use 04/05/91 HOWARDS MINI MARKET 215-000-000706 00 - Overall Site <G> Trair, ing' Page 6 < 1> Page 1 WE HAVE 13 EMPLOYEES AT '[HIS FACILITY ~' MATERIAL SAFEYY SHEETS ON FILE? YES DO YOU HAVE DATA BRIEF SUMMAR'Y OF '[RAINING: iii employees are trained and aware that in the eyen~ of an emergency they are to: (1) Shut off (if possible) the main breaker ~ (2) Evacuate themselves and anybody in or,around the premisies (3) Dial 911 ~ , (4) Notify close neighbors to evacuate if necessary (5) Notify Emerency response team <2>, Page 2 as needed <3> Held fc, r Future Use <4> Held for Future Use Farm and Agriculture Fl' Standard Business CT'I'Y of BAKER,St-.ILELL) [ HAZARDOUS MATERIALS INVENTORY NON--TRADE SECRETS il Page _ / .... of %/... BUSINESS NAME:~-/,~,,~e.~'c ~z'~.'~'r 'v'/~R'i~ OWNER NAHE: LOCATION; ~oo P~~ ~ ADDRESS; CI]Y. Z]P:~K~c.:,A ' ?.~3,~ C/TY. ZIP~ ~~,'~/~ PHONE fl: - ~3.~- I~l '- I - PHONE I 2 ]~ix i' Annual Heasure I~ny, Cent Cent Cent USed Loc,tion.¥heEe. i ~,~Yc Ha,es of ,ixture/ComDoflents Trans !yqe N Av~rpge ': i; See Instructions . Code loom' Ant Amc Est Units on Ite Type Press Temp Co e Stored in Peri/ICy ? ~h~sical 8nd Health'HAzard ~ C'A~S' Humber ~/¢ C0mponenC II Name I C,A.S. Humber [~ · (Check 811 that apply) t. Component ,2 Name, C.k.S, Number [~ ~ Fire Hazard ;~g Reactivity ? Delayed D Sudden Release U lm~i~ ~--~' Health of Pressure Component 13 Name I C,A.S. Humber L PhysicAl Iod HeAIth'~Pazard C,A,S.. Number ~y~GI ~ Component II Name I C.A.S. Number [ ICheck ali that ApP/II ~ ComponenL t2 Name I C.A.S. Number ~ Fire Hazard ~a Reactivity ~ DelaYed ~ Sudden Release ~ ]'~i~ ~ , ~ Hem/Ch of Pressure Component I~ Name I C.A,S. Number ~. Physical and Health'Hazard ~' C.k.S. Number ~bG/9 Component II Name I C,k.S. Number , , [Checkallthat?lY) . .~ j. ' Reac[ivity~ ~ Delayed ~ Sudden Release ~ Immediate ComPonent 12 Name I C.A.S. Number j; O[ Pressure Heal[h Physical'lpd Healt~ UAlard i. C,A.S. Humber ~GG l? Component II Name I C.A,S. Number j' (Check 411 that App/H ~ i ' Component 12 Name I C,A.S. Number r ~Fire H~zard ~ ~ Reactivit~ p Oelayed ~ Sudden Release ~ lm~i~' ~ Hes/th . of Pressure Componen~ 13 Name & C.A.S. Number City of Bakersfield TIt~NSMITTAL SLIP Date ....~.'-~ ' ~/ For Your: ~'lnformation ~ File [] Signature [] Action Please.'-- [] Return I-1 See Me [] Follow Up [] Prepare Answer Copy to: ......................................................................................................... BUSINESS NAME BULK TRANSFER (Business) Howard' s Mini Mart SITE LOCATION 3200 Panama Lane 'OLD OWNER NAME NEW' OWNER NAME NEW OWNER ADD. ACCOUNT NUMBERS INVOLVED SG175301 HM419001 SS579301 BL08849 APPROX..DA~/~~R ~21, 1991 Golledse-Seuferer Mini Marts, Inc. SunS Tae Ahn and Ryan Sung Ahn 11495 Riverside Drive #108 North Hollywood. California THIS INFORMATION IS TAKEN FROM THE DAILY REPORT AND SHOULD BE VERIFIED PRIOR TO ANY CHANGES. DISTRIBUTION: Sanitation Wastewater Business Licenses .Hazardous Materials BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 BUSINESS NAME OFFICIAL USE ONLY ID# 7oG INSTRUCTIONS: HAZARDOUS MATER I ALS BUSINESS PLAN AS A WHOLE FORM 2A 00U. 706 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: ~O~,~D~ ' ~[~;t' B. LOCATION / STREET ADDRES. S: 3~0 CITY: ~AKER~F~EL~ zzP: 955 BUS. PHONE: (~,5) B-~5 J 5~. / SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7580 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. OAS/PROPANE: ~/A B. ELECTRICAL: S~ CO~F.H OV ~(31LOf~'<~ C. WATER: ~ ~O~E~ ~C ~OitO,~ D. SPECIAL: ~A~O£/~d SHUT CF i~5~ba E. LOCK BOX: YES / NO IF YES, LOCATION: CO~sGzF_. IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING, EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM 'WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS ' ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: ......... . ................. YES NO C. PROPER USE OF SAFETY EQUIPMENT: ................... ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO REFRESHER' NO YES NO NO NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I, ~N~D ~F~ , certify that the above information is accurate. I understand 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 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. 128 05/95 RALP~ £ 91 002 "'9 51 3099 tBAKERSFIELD CA JOAGUIN BANK:! { FOLIO/OHECK NO. R~AIN FOR YOUR RECORDS : DEPT. OESCRIFTION' , Qt)A,N~ UNIT COST J AMOUNT I '1, ~:-~1 su..I , I I ., ITOTALI · J , I ;1'~'~"1 ': .: J.; '., . : ~ WATERBED WAREHOUSE & MATTRESS OUTLET 2530 Chester Avenue BAKERSFIELD, CA 93301 (805) 861-6000 NAME SOLD BY,~,~ CASH I C.O.D. I CHARGE '1 ON ACCT. I MDSE. REI~D.' PAID OUT ! DE,S~hiPTION ~ :~ ~hl~E ~.' AMOUNT ' ~ ~?~ ~Vo -- ~ ~' ~' ' ---' ......... ................. ~ .... , ~ .......... ~_ .......... ..................... ~ .............................................................................................................. ~ ............................ ~ ................... ..................... ~ ............................. ~ ~ ................. ............. :.~_::~ ........ : ........ .~: ............ : :L..~ ............................... ~ .................................................. '.J .................... ...................... ~ .................................. ~ ............... ................. ~ ~ ............................................................ ~ .................... , TOTAL I All claims and returned goods BAKERSFIELD CITY FIRE DEPARTMENT INSTRUCTIONS FOR BUSINESS PLAN SINGLE FACILITY UNIT GENERAL INFORMATION lne use of'this form is required only if Your business has been requested to by the Bakersfield City Fire Department or your business is complex/large enough that sufficient detail cannot be provided on a Business Plan (Form }A) by itself. The number of separate facility units will be provided by the Bakersfield City Fire Department. Contact the department 'for additional guidance prior to proceeding with this form. Type/print in facility unit numbDr and name. Give each facility unit a common name, and a one or two digit number. Example : South #2. NOTE: An inventory form (4A-1, 4A-2, or 4A-3, as appropriate) must be made' for each separate facility unit. SECTION 1: . ~ITIGATION, PREVENTION~ ABATEMENT Explain procedures to prevent the release or spill of hazardous materials in this facility unit, Describe plan to contain and. clean up if a spill should occur, lfow,4Rb SECTION 2: NOTIFICATION AND E~ACUATION Describe procedures for immediate notification aud evacuation of this 'facility t . t{ONA D SECTION 3: HAZARDOUS ~TERIAL SECTION 4: PRIVATE FIRE PROTECTION Describe on-site fire proteqtion for this faci].ity unit, including sprinklers, extinguishers, alarm systems and private response teams, SECTION 5: LOCATION OF WATER Give the location of the closest .,.z,. deoartment water supply - 3 - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSINESS NAME: H~A~Z~ ~ ~ZK~'~ ID# BUSINESS PLAN SINGLE FACILITY UNIT FORM SA 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: SECTION 1: MITIGATION,' PREVENTION, ABATEMENT PROCEDURES ~ H /'EL D o ~ H O~ ~ . ~/AP~ ~ SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES 'AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT ONLY . A. Does this Facility Unit con.rain Hazardous Materials? ...... NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yell. ow 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: LOCATION OF WATER SUPPLY FOR USE BY EMER6ENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS./PR0t:'AN~!] B. ELECTRICAL: C. WATER: K£ V D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES,. SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSs? KEYS? YES / NO YES ./ NO - 3B - . BAKERSFIELD CITY FIRE DEPARTMENT ,,~" I.D. # FORM 4A-1 Page o'f,':!: NON TRADE SECRETS ~? HAZARDOUS MATERI ALS INVENTORY .,~ BUSINESS NAME: /'~0~#~)_~ /))//f,f~ f2f~,~-'~'f" OWNER NAME:. ~~ ~~ FACILITY UNIT ~: ADDRESS: ~0~ ~'~ A~ ADDRESS:iiG{~ ~i~~ ~ FACILITY UNIT NAME: CITY, ZIP:_ ~ff g ~'/~g ~ q~/3 CITY,ZIP: ~ g~fgg~ O~ PHONE Z: ~/Sg/ PHONE ~: ~0~ ~g~ [OFFICIAL USE CFIRS CODE ~ U~¥ 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T .~ODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. 'CHEMICAL OR COMMON NAME CODE GUIDE NAME: /~>O/O,~zO .~f../~"tff,~,~/'f.-- TITLE.: dO3,1)~fO S GNATURE: ~~ ~.-t_...,/ DATE: EMERGENCY CONTACT: ~-/~/ ~ ~-~/~ TITLE: PHON~ ,~ BUS HOURS: AFTER BUS HRS: ~ F$/~ EMERGENCY CONTACT: ~PHEp/~I~ ~E~ TITLE: ~~ PHONE ~ BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: ~/~i ~~f AFTER BUS HRS: - 4A-1 - Business Phone: (~--!.~--~( ID # --fO~ DATE__ INSPECTION SUMMARY: ANNUAL .~E×EMPTION ALL ITEMS OK: [ '~VIOLATIONS NOTED: [ 0 - Does Not Apply ! - In Compliance 2 - Correction Needed 4 - N.O.V. 5 - Citation KERN~OUNTY FI RE D~IPARTMEN'I~ECEIVED HAZARDOUS MATERI AL~ BUREAU INSPECTION REPORT F~B 2 5~2 Vi~or Strut, 6a~field, CA 93308 (805) 861-2161 ~ / ~ / VD ~ey ~ap ~ sec. RE-INSPECTION __ COMPLAINT ] 3 Verbally Warned 6 - Referred To (Specify) EMERGENCY RESPONSE PROCEDURES A. Local Agency Notification Plan B. Employee Notification & Evacuation C. Release Mitigation Procedures D. Emergency Medical Assistance PREVENTION & CLEANUP PROCEDURES E. Housekeeping & Work Area Safety ~.. F. Fire Extinguishers & Fixed Systems G. Minimization & Cleanup Equipment H. Emergency Fire Water Supplies .__L HAZARDOUS MATERIALS TRAINING I. Employee Training Records j. MSDS Availability & Familiarity K. Personal Protective Equipment L. Hazardous Material Permits INVENTORY & DIAGRAM VERIFICATION M. Utility Connections & Shutoffs 4 N. Aboveground Tank & Container Labeling .~ ..... O. Quantities, Locations, & Separations ~ . P. Other ([:1 Comments: ~m~~ ~~r,~- Clearance Granted Started I ( · ~:}D ~f-f ~o,:c t o r - Miles on Inspection [ p~ Re-Inspection Required [ ] Total Time Completed Ii : 36 HAZARDOUS MATE~:~.T ALT` BUREAU Business Name: ~/~.1~ ~,~JI Business Phone: ~-- !~I II) g ~O~ DATE~ INSPECTION SU~RY: ANNUAL ALL [TENS OK: [ ~VIOLAT[ONS'NOTED: [ 0 ' Does Not Apply , ~ - In Compliance 2 - Co~Pection Needed T NS~=~EO.r-r ON 5~2 W~or Strut, 8a~ie]d, CA 9~0~ (805) 861-2161 Z / ~ / ~O Key ~ap [Z~ Sec. RE-J,[ NSPECT [ ON 4 - N.O.V. COMPLAINT ] 3 - Verbally Warned 5 - Citation 6 - Referred To (Specify) 24c EMERGENCY RESPONSE PROCEDURES PREVENTION & CLEANUP PROCEDURES A. Locai Agency Notification Plan .;B. Employee Notification & Evacuation C. Release Mitigation Procedures D. Emergency Medical Assistance E. Housekeeping & Work Area Safety F, Fire Extinguishers & Fixed Systems O. Minimization & Cleanup Equipment [. H. Emergency Fire Water Supplies HAZARDOUS MATERIALS TRAINING I. Employee TrWining Records J. MSDS Availability & Familiarity K. Personal Protective Equipment L. Hazardous ~aterial Permits Comments: INVENTORY & DIAGRAM VERIFICATION M. Utility Connections & Shutoffs N. Aboveground Tank & Container Labeling O. Quantities, Locations., & Separations _~_ P. Other ~ Clearance Granted [ Star.ted [_ l, : ~O Insoector Mi les on Inspection Completed Re-Inspection Required [ ] On__/__/ D.E. Tolal Time~<re~e~nta~.i~F_~.~ ~.~ : ~0 No. of Fa,cilities ' ....... BUSINESS NAME HOWRRIg~IIIIINI MARKET LOCATION 3Z00 PRNRM~ LN ID HIGH HAZARD RATING 2 1, OVERVIEW L~ST CHANGE 04/22/8B BY ESTER JURIS CODE 215-00S JURIS BAKERSFIELD STATION MAP PAGE 123 GRID 24C · FACILITY UNITS 1 HAZARD RATING Z RESPONSE SUMMRRY ZR SEC 4)'NO PRIVATE RESPONSE 'TERM EMERGENCY CONTACTS ZR SEC 2) ......... ,9 SEUFERER - 833-15G! ORiSOnS DIRNE GOLLEDG. E - 1~33-15~1 OR UTILITY SHUTOFFS ZR .SEC 3) A) GAS -' N/R B) ELECTRICAL - SE CORNER OF BLDG C) ~RTER - SE CORNER'OF BI_DG 0) SPECIAL - GASOLINE SHUT OFF INSIDE BLDG ON GnS CONSOLE E) LO'CK BOX- NO 2., NOTIFICATION / PUBLIC EVACUATION LRST CHANGE / / ,BY < NO INFORMRTION RECORDED FOR THIS SECTION > PIqGE 1 05/0t/B~ 08:Z0 MRI'ERIRL SAFETY DRTR SYSTEMS, tNC, (BOB) 64B-GA00 BUSINESS NAME HOYAROS MINI MARKET LOCATION ~Z00 PANAMA LN '~, HRZ 'MAT TRAtNIN$ SUMMARY ID NUMBER 215--OO~,~O7OB HIGH HAZARD RATING LAST CPIRNGE / / BY SE,~TI ON > < NO INFORMATION RECORDED FOR THIS '~' 4. LOCAL EMERGENCY M~DICAL ASSISTANCE LAST CHANGE 04/2Z/8~ BY ESTER SEC S) YHITE L~NE EMERGENCY CENTER. PAGE 0S/01/89 08:20 MATERIAL SAFETY OR'FA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME HOWAR~INt MARKET LOCATION ~00 PANAMA LN FACILITY UNIT 01 A. OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 04./ZZ/88 BY ESTER ID ~15.-000-00070G HIGH HAZARD RATING ID TYPE NAME MAX AMT UNIT HAZARD .LOCATION CONTAINMENT USE PURE, REGULAR GASOLINE NE .CORNER UNDERGROUND ID PERCENT COMPONENTS 1t82,00 100.0 Gasoline PURE UNLEADED REGULAR NE CORNER UNDERGROUND ID PERCENT COMPONENTS 1t8~o00 100.0 Gasoline UNDERGROUND TANKS UNDERGROUND TANKS 120¢~ GAL HIGH FUEL HAZARD LIST MODERATE 12000 GAL HiGH FUEL HAZARD LIST MODERATE PURE PREMIUM NE CORNER UNDERGROUND ID PERCENT COMPONENTS 7182.O~ 1'OO.O Gasoline UNDERGROUND TANKS 1Z~O 6AL HIOH FUEL HAZARD LIST MODERAT[ 4 PURE UNLEADED PREMIUM NE CORNER UNDERGROUND ID PERCENT COMPONENTS 118Z,00 100.0 Gasoline UNDERGROUND TANK 1. ZOOO GAL HIGH FUEL, HAZARD LIST MODERATE B. FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 04/ZZ'I88 BY ESTER SEC 4) SEC S) FIRE HYDRANT LOCATED NE CORNER OF PANAM~ & WIBLE P80E 3 0S/0i/8B 08:Z0 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME HOgRRDS MINI MARKET LOCATION 3200 PANAMA LN EMPLOYEE NQTIFICRTION / EYACURTi'QN ID NUMBER Zt5-(~-000708 HIGH HAZARD RATING Z LAST CHANGE 04/ZZ/88 BY ESTER 3R SEC Z) ANY SPtLL~ OR OVERFILLING OF GRSOLINE IN STORAGE TANKS. FIRE DEPT IS CRLLED, RLSO ,IRCO Oil.. COMPANY, WHICH IS SUPPLIER ARE CONTACTED IMMEDIRTELY. ~/ E. MITIGRTION / PREVENTION / RBATEMENT LAST CHANGE 04/ZZ788 BY ESTER SEC 1) MRIN GAS SHUT OFF LOCATED INSIDE ON GAS CONSOLE. EACH PUMP HAS AUTO SHUT OFF. tJITH VAPOR SHIELF ON HOSE. PAGE 4 05/01/89 OB:ZO MATERIAL SflFETy DR'TA SYSTEMS, INC, (805) ~48-B800