HomeMy WebLinkAboutHAZMAT MANAG. PLAN FORMS 5/16/2003 H _~_ GEMENT PLAN
pg.~
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
SITE DIAGRAM" ~=. ./ FACILITY DIAGRAM
Business Address: J-.~ ~) [ ~ ~) ~(~, '~ ¥C_.
¢~CC0 r~.' NORTH
3725 SOUTH H STREET · BAKERSFIELD, CA 93304-6538 · (661)396-2400
May 28, 2003
BAKERSFIELD DISTR)T
~4 r~o o I
Bakersfield Fire Department
Environmental Services
1715 Chester Avenue
Bakersfield, CA 93301
To Whom It May Concern,
Attached you will find Hazardous Materials Management Plans for 5 water utility facilities. We have
revised our chemical inventory for our field operations center and added four new facilities. If you have
any questions regarding any of these plans, please feel free to call me at 661-832-3765 Ext. 1049.
Thank you,
Tamara Johnson
Maintenance Supervisor
California Water Service Company-Bakersfield
DISTIIIC'I' OFFICES: ANTELOPE VALLEY · BAKERSFIELD · BEAR GULCH · CHICO · DIXON · DOMINGUEZ · EAST LOS ANGELES · HERMOSA-REDONDO · KERN RIVER VALLEY · KING CI~' · UVERMORE ·
LOS ALTOS SUBURBAN · MARYSVlLLE · MID-PENINSULA · OROVlLLE · PALOS VERGES · REDWOOD VALLEY. SALINAS · SELMA · 5OUTH SAN FRANCISCO · STOCKTON · VISALIA · WESTLAKE · WILLOWS
HAZARDOUS TORY
CHEMICAL DESCRIPTION
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
(one form per material per building or area)
~DNEW ~ ADD (~ DELETE [~ REVISE 200 Page1 of
I. FACILITY INFORMATION
CHEMICAL LocATION I
, CONFIDENTIAL (EPC~) ~ Yes ~ No
FAClLI~ ID No. ~ 1 MAP No. (optiona~ 203 GRID No, (optiona0 204
I
II. CHEMICAL INFORMATION
CHEMIC~ NAME 205 T~DE SECRET ~ Yes~ No 20~1
-t~ 207 EMS* ~ Yes ~ No
COMMON
NAME
CAS No. 209
"If EHS is"Yes,' all amounts ~low must be
FIRE CODE H~RD C~SSE8 {Complete if ~que~ted by Io~1 ~m chia~ 210
211 2~2 OURIES 213
~PE ~ p PURE ~ m MI~URE ~ w WASTE RADIOACTIVE ~ yes ~ No
214 ~RGEST CONTAfNER 215
~.~s,c.~ s~.~E ~ ~ souo 9, uo.,o 3. ~AS
216
FED H~RD CATEGORIES ~ I FIRE ~ 2 REACTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~LTH ~ 5 CHRONIC HEAL~
(Che~ all that apply)
ANNUAL WASTE 217 M~IMUM 218 AVENGE ~0S ~ 219 STATE WASTE [ ~ 220
UNITS' ~ ga GAL ~ cf CU ~ ~ lb LBS ~ tn TONS 221 i DAYS.~__ON SITE~ 222
'If EHS ...... t must ~ in lbs.
223
STORAGE CONTAINER ~a ABOVEGROUND TANK ~ f CAN ~ k BOX ~ p TANK WAGON
(Check afl that apply)
~ b UNDERGROUND TANK ~ g CARBOY ~ I CYLINDER ~ q ~IL CAR
~ c TANK INSIDE BUILDING ~ h SILO ~ m G~SS BO~LE ~ r OTHER
e P~ST~C/NONMETALUC D.UM ~ i B*G ~ o TOTE mN
224
STOOGE PRESSURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIENT
225
STOOGE TEMPE~TURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIENT ~ c CRYOGENIC
%WT H~RDOUS COMPONENT EHS CAS
2 230 23~ ~ Yes ~ No 232 233
3 234 235 ~ Yes ~ No 236 237
4 238 239 ~ Yes ~ No 240 241
5 242 243 ~ Yes ~ No 244 245
III. SIGNATURE
PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246
BUSINESS OWNER / OPERATOR FORM
Page I of
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
I. FACILITY IDENTIFICATION
FACILITY ID No 1 Year Beginning,~{~)5 , 1~0
BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) ~ ILII ~,':~. IV-J~ ~
CITY
Year Ending 101
BUSINESS PHONE
ZIP
SIC CODE
(,,D~t,,
1CE
la5
COUNTY
OPERATOR NAME 109 OPERATOR PHONE 110
0_a._l ,T~,,-,~ ,'a._ Se,,',,, ~c~ 0~ ~,.~,~ 6~1- :.Sq~- 2_4oo
II, OWNER INFORMATION
OWNER NAME
OWNER MAILING ADDRESS
" ,.~r e,e?c
OWNER PHONE
(o(~. 6qe- 27oo
1!4 STATE
,,, z,PCsso4
III. ENVIRONMENTAL CONTACT
112
113
CONTACT NAME
"TT m
117 CONTACT PHONE
~ol-S(tc~ - 2,4-00
1t8
CONTACT MAILING ADDRESS
ux~e.r
-PRIMARY-
NAME
119
120 STATE~ 121 ZIPqs.~4 122
IV. EMERGENCY CONTACTS -SECONDARY-
125 130
TITLb
BUS,.ESSI%'haP.o.E
24-HOUR PHONE
PAGER NO
126
127
128
TITLE
BUSINESS PHONE
(.oLot- 5qco- zq-oo
131
24-HOUR PHONE
132
PAGER No
133
V. CERTIFICATION
Certification: 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 in this inventory and believe the information is tie, accurate, and complete.
135
N~F OWN EPJOPE RATOR-[pri@t )
136
134 L.~.~OF DOCUMENT PREPARER
TITLE OF OWNEPJOPER,~H~R '
137
rd2090
HAZARDOUS MATERIALS M EMENT
PLAN-FORMS
Section Discovery and Notification
Page I of 2
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
INSTRUCTIONS
1. To avoid further action, return this form within 30 days of receipt.
2. TYPE/PRINTANSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
SECTION I: FACILITY IDENTIFICATION
BUS, ESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
ADDRESS (For local use.~ly)
FACILITY ID No. 1
SECTION I1.1: DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
11o%
B. EMPLOYEE AND AGENCY NOTIFICATION:
SECTION 11.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESMENT AND PREVENTION MEASURES:
B. RELEASE CONTAINMENT AND/OR MITIGATION:
C. CLEAN-UP AND RECOVERY PROCEDURES:
L r ,m C.
fd2085
, "Pag~ 2 of 2
SECTION 11.2: RELEASE RESPONSE PLAN--CON"i".
UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROPANE:
LOCK BOX: ~3 YES ~NO IF YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
WATER AVAILABILITY (FIRE HYDRANT):
SECTION II1: TRAINING
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personnaly
examined and am familiar with the information submitted and belieVe the information is true, accurate, and complete.
DATE 477
SIGNATURE OF OWNER / OPERATOR OR DESIGNATED REPRESENTATIVE
NAME OF SIGNER (print) 47[
TITLE OF SIGNER
479