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HomeMy WebLinkAboutBUSINESS PLAN ITE~'FACI LITY NORTH SCALE: BUSINESS NAME: DATE: ./O/Iq/~ FACILITY NAME: (CHECK ONE) SITE DIAGRAM FLOOR: OF UNIT ~: OF FACILITY DIAGRAM I To ~ ~o5 e s ~o ot,~s~T ~T ~'oo 2~P'~ (InspeCtor' s Comments): -OFFICIAL USE ONLY- - 5A - SiTE DIAGRAM (Requl~ltems) 1. Address: Identlfy"'t~he 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 Connections c Fire Standpipe Connections d Water Control Valves for protection systems e Fire Pump 8. Fire Department Access 9. Lock (key) Box 10. MSDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d. Gates 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 will meet. 19. Outside Hazardous Waste Storage 20. Outside Hazardous Material Storage 21. Outside Hazardous Material Use/Handling 22. Type of Hazardous Material/Waste Stored or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid R = Radlologlcal C = Corrosive 0 = Oxidizer O = Gas P = Poison W = Water Reactive T = Toxic S = Solid H = Cryogenic D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAGRAM (Required items in addition to the above) 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. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets LoT' Lo~ HM472701 Account Number ACCOUNTS RECEIVABLE ADJUSTMENT January 13t 1995 Date Esther Duran From Fire Department- Hazardous Materials Division Department/Division ORANGE BELT STAGES N~w Account New Address Close Account Service Change Other Adjustments X Billing Name 2301 L ST Billing Address Site Address Pamel # (If Applicable) Landlord Name & Addms8 (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effective Date of Billing Change 377.00 0 <377.00· 1-11-95 Remarks: BUSINESS MOVED MARCH 1994 ~AKERSFIELD FIRE' DEPARTMEi HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY O~6E ~£[r ADDRESS ~%mt ~ s, OWNER ©~^~+,~ PERMIT TO OPERATE# CONTRACTOR ~Jj CONTACT PERSON ~%,~ ~ . LABORATORY ~1~ ~ # OF SAMPLES.. I~1 [~ ~.~,~ ~l ~.~o~ ~-~ ~ TEST METHODOLOGY ~A~e~ ~ ~,~ ~%'e ~,~ ~ ..... ~u,,~ PRELIMANARY ASSESS~ENT CO.~I~,~,~CONTACT PERSON CO~ RECIEPT ~% <~ / PLOT PLAN CONDITION OF PIPING 9~.~ CONDITION OF SOIL DATE INSPECTOP~ NAME SIGNATUBE o ~ ~T ~_ ...... 3~t~ ,~ ~0/ CITYOF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD, CALIFORNIA 93303-2057 ADDRESS CORRECTION REQUESTED DO NOT 'FORWARD C~TY OF BAKERSFIE LO P.O. BOX 2057 BAKERSFIELD, CALIFORNIA 93303-2057 ADDRESS CORRECTION REQUESTED DO NOT FORWARD RETUR . '~-~TAGES RETURN ORANGE- BELT STAGES UT7583 250:). L ST BAKERSFIELO~, CA 93301 .. II.,1,,,,ll,,,tl,ll,,,,,,ll,,ld,,ll,..ll,,,il,ll,,,,;';llhl,ll 02/27/92 ORANGE BELT STAGES 215-000-001363 Overall Site with 1 Fac. Unit General Information ~ECEIYE~I Page Location: 2301L ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 01 Grid: 30A F/U: 1 AOV: 0.0 Title Contact Name MICHAEL HAWORTH AL GARDEN Business Phone (805) 327-4878 x (805) 327-4879 x 24-Hour Phone- ( ) - (805) 322-1175 Administrative Data Mail Addrs: 2301L ST City: BAKERSFIELD Comm Code: 215-001 BAKERSFIELD STATION 01 D&B Number: 02-961-2587 State: CA Zip: 93301- SIC Code: 4142 Owner: MICHAEL HAWORTH Phone: (805) 327-487~ Address: P.O. BOX 949 State: CA City: VISALIA Zip: 93279- Summary ~vi~w~ ~h~ ~h~ h~ardous ~a~dals manag~- ~ ~rr~o~ ~s~u~ ~ ~mp~ and corr~ 02127/92 ORANGE BELT STAGES 215-000-001363 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 02-001 MOTOR OIL · Fire, Delay Hlth Liquid 480 Minimal GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL 480 Daily Average GAL 200.00 Annual Amount GAL 480.00 Storage DRUM/BARREL-METALLIC Press T Temp Location I Ambient/AmbientlCENTER BLDG -- Conc ~ Components 100.0%I'Motor Oil, Petroleum Based MCP ~List IMinimal 02-002 DIESEL FUEL · Fire, Immed Hlth, Delay Hlth Liquid 10000 Low GAL CAS #: 68476-34-6 Form: Liquid Type: Pure Daily Max GAL 10,000 I Storage UNDER GROUND TANK -- Conc 100.0% Trade Secret: No Days: 365 Use: FUEL Daily Average GAL 5,000.00 Annual Amount GAL 100,000.00 IDiesel Fuel No.1 Components MCP iList Low Press 7 Temp Location Ambient/AmbientlN SIDE PROPERTY 02/27/92 ORANGE BELT STAGES 215-000-001363 00 - Overall Site <D> Notif./Evacuation/Medical Page <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911 <3> Public Notif./Evacuation CALL 911 <4> Emergency Medical Plan NEAREST HOSPITAL 02/27/92 ORANGE BELT STAGES 215-000-001363 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 4 <1> Release Prevention FUEL IN UNDERGROUND STORAGE. NATIONAL SAFETY FEATURES <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/27/92 ORANGE BELT STAGES 215-000-001363 00 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - WEST WALL INSIDE SHOP C) WATER - WEST SIDE BUILDING IN ALLEY D) SPECIAL - MANUAL ELECTRICAL - SOUTH SIDE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER INSIDE SHOP AREA ON NORTH WALL FIRE HYDRANT .- ??????????, <4> Building Occupancy Level 02~27~92 ORANGE BELT STAGES 215-000-001363 00 - Overall Site <G> Training Page 6 <1> Page 1 WE HAVE 15 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? DIESEL FUEL AND MOTOR OIL USED ONLY <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use BUSINESS NA~E: LOCATION: CITY, ZIP: PHONE ~: C I TY OF'?~,j;i BAKE RS F I ELD Standard Business· · .; Page of ~' ADDRESS: p. ~, ~o~ ~ ~q . ,~,.: .!,.,.; /STANDARD .IND~~ ~CLASS CODE: ~ - CITY,~ZIP: %JI~.~L.I~I ~R'I9 ~,~ /. DUN AND BRADSTREET NUMBER~FEDERAL ID REFER TO INSTRUCTIONS FOR PROPER CODES :<" I 2 3 4 . 5 6 7 8 9 10 11 12 . 13 14 Trane Type Max Average Annual Measure # Days Cont ' Cont ;, Cont ',' Use Location Where ':: ',.'-i?. % by Names of MilCcure/Componentn Code Code i%mt Amt Amt Units on Site ~ Press Tem~ Code · Stored in Facility' . .'f?::' w~ . /' See Instructions Physical and Realth Hazard C.l.S. Number Component # i Name C~A.S. N '~ Fi~ ltaza~d ~ S"dden Release ~ Reactivity ~ I~ediat. ~ Delayed Physical and Realth Hazard C.A.8. Number ' ~ ~7 ~ L ~ ~ - ~ '! . : .., Component # 1 Name ~i C.A.S. Number ..... ~ Fi~e Hazard ~] Sudden Release '[''~ Reactivity [] I~nediate eiaye~ ..:~: ! , r~;.,i ' ~' of, Pressure Health Health ., Component # 3 Na~ '~'C.A.S. Number Fhymioal~'and Health Hazard C.A.8o Number :.'" Component ~' 1 lt'am~ &'C.A.8. Number of Pressure l~ealth Health Component ~ 3 Name & C.A.S. Number Phyai=al"and Health Hazard C.A.S. Number Component # ! Name & C.A.S. Number (Check all that apply) ;-~/·, . : Component 9 2 Name & C.A.8. Number' ~ F~re aazard' ~ Sudden Release [] ;eactivit¥ ~ Immediate [] ~ela~ed , / .... of Pressure aealth Health - Component 9 3 Name & C~A.S. 'Numb~ , , EMERGENCY CONTACTS Il ~a ~'~u-~ ~z{G~ ~-~t~f #2 it=- ~0~. ! Name Title 24 Hr. Phone Name ~i:.,,; ..;. Title 24 Hr Phone Cer~ifical2ion . (READ AND SIGN AFTER COMPLETING ALL SECTIONS) ~ertify trader 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. Z believe that the submitted information is true, accurate, and complete... ,. , ,: ';, .... ,~-15-?z.... · AND OFFICIAL TITI2~ OF OWNER/OFER/tTOR OIl OWNER/~TOR S AUTHORIZED I~PRI~ENTATIVI~ BI~N/tTURR ; ,r...' DATE SI~NED '~ Bakersfield Fire Dept. ~// ~~~~. Hazardous Materials Inspection ~ /'5 ..-- Date Completed ,,.5"o.~ l - ~O / Business Name: ~W.g,a,~,a,, ~,~' ~7- ~,~r' Location: Verification of Inventory Materials Plan ID # 215-000 O~/3~.~ (Top right comer Business Plan) Station No. 9 Shift ~ Inspector '"7~a~.,/,~ ~5 Adequate Inadequate Verification of Quantities Verification of Location Proper Segregation of Material Comments: ,~~ of MSDS Availability N~.u~fl:~e~ of Employees ,~ _V~_erification of Haz Mat Training (~ Comments: Verifcafion of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office CfTY of BAKERSFIELD "II,"£ C,4 RE" (~,v~e or Drink name Do hereb3~ certify that I have reviewed RECEIVED ,!Aiq 1 8 1989 Aris'ti ............ the attached Hazardous Materials business plan for o ~'~c.~ ra~-c¥ (name of business) and that it along with the attached additions or ,corrections constitute a complete and correct Business Plan for mM facility. signature - date CiTY of BAKERSFIELD and A4v~cultura ~ Standard Bu~mes~ HAZARDOUS MATERI ALS INVENTORY NON--TRADE SECRETS , BUSINESS NAME: 0~MG[ 6~LT- SF~G~ OWNER NAME: ~1~ ~W0~rlH -?~5. NAME OF T~$ FACILIT¥:or~q¢6 BaLT iT-~¢~ ~'~{~: 25ol a $~'- ADDRESS: ?,07 8o~ ~ STANDARD IND. CLASS CODE CITY, ZIP: ~K~-a~I~L~ ~]~o~ CITY, ZIP: Yt~ ~99 DUN AND BRADSTREET NUMBER (~e C~e Mt Mt Est Units m Site T~ ~s T~ ~ .. St~ in F~tllty ~ ~ I~t~ti~ .~1_~__1.__~_~_~___1 2o0 1. ~o I~s~l ~ 1o~ I , I ~ 1~. I ~-~ o~ o~x~~: .._ ~ ,~ Ph~ical ~ HNIth ~za~ C.A.S. ~ Wt Il ~ & C.A.S. ~ (C~k ~11 t~t a~ly)  ~-~ ~-~ ~-~ - ~t a2 ~ &C.A.S. ~ h of Pm~q ~lth Wt II M&C.A.S. (C~k all t~t a~iy) ~lth of Prom ~lth ..... ..... l__L ........ L .......... 1 I I I J I~ I ! (C~k all t~t a~ly) _ _ ~- ~ ,-~ ~-~ ~ ~ Ytre Hazard ~--] R~ct~vity ~--~ ~la~ ~ ~ Rel~e -- I~tote H~lth of P~su~ HNith .............. ~t 13 ~ &C.A.S. ~ P~ical ~ HNlth ~tl~ C.A.S. ~ ~t II ~ & C.J.5. ~ (C~k all t~t mly) Cwt 12 ~ & C.A.S. H~lth of Pv~sure ~lth ........... - 3 2 ~ - '- m2 .L°,~ ~ ~. R~ ...................................................... T~1i" ~F'~g .... £ert+ficat~o. (Read and siEn after coJpJet~nE al] sections) [ certdfv under p~m)ty of lp t~t I ~ve ~rs~allyexemin~ I~ am f~i)ilr .tth t~ tnfor~ti~ su~itt~ tfl this ~ for ob(~]ining t~ inf~ti~. [ ~lieve t~t ~ ~u~itt~ in~o~ti~ i~ tr~, eccura~e, ~nd .... sq~ ...... ~_~.~.c~ ............... mi.sqm_t~J=~.l ................ or~ ~. I BUSINESS NAME ORANGE'=~EL'r STAGES LOCATION 2301 L ST ID 215-000-4~1363 HIGH HFt2ARO RATING 2 l, OVERVIEW LAST CHANGE tZ/08/88 BY VAL JURIS CODE ZlS-.001 JURIS BAKERSFIELD STATION MAP PAGE 103 'GRIO 30A. FACILITY UNITS I HAZARD RATING Z RESPONSE SUMMARY ZA SEC NO PRIVATE RESPONSE TEAM EHERGENCY CONTACTS Z~ SEC Z> MICHAEL HAWORTH - 327-4878 OR <Z09>733-4408 AL GARDEN - 327-4879 OR 322-,1175 UTILITY SHUTOFFS ZA SEC 3) A) GAS - NONE B) ELECTRICAL W WALL INSIDE SHOP C) WATER -, W SIDE 13L[~ IN ALLEY D) SPECIAL ,- MANU~L, ELECTRICAL. - S SIDE E) LOCK BOX - NO NOTIFICATION / PUBLIC EVACUATION LAST C H(~,NGE / / BY (_ ~4 LL ~ll < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 1ZlZ3/88 tl:44 MATERIAL SAFETY DATA SYSTEMS, INC. (805) B48-'E1800 BUSINESS NAME ORANGE BELT STAGES LOCATION 230! L. ST ~. HAZ MAT '[RAINING SUMMARY tO NUMBER ZIS-O~-rz~1363 HIGH HAZARD RATING Z LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 12/08/88 ElY VRL. SEC S) NEAREST HOSPITAL PRSE 2 1Zt£3/88 lt;44 MATERIAL SAFETY DATA SYSTEMS, INC. (8~5) [~48-B800 BUSINESS NAME ORANGE'm[~ELT STAGES LOCATION 2301 L Sl' FACILITY UNIT 01 ~15-000-001383 HIGH HAZARD RATING 2 ,OVERALL HAZf~IRDOUS MATERIALS INVENTORY LAST (]H~INGE 12/08/88 BY VA[.. ID TYPE NAME MAX AMI' UNIT HAZARD LOCATION CONTAINHENT USE PURE MOl'OR OIL CENTER BLI]6 I0 PERCENT COMPONENTS ~808.~V2> 100.0 MOTOR OIL Z PURE DIESEL FUEL 10000 GAL N SIDE PROPERTY LINDERGROUND TANKS FUEL ID PERCEN'F COMPONENTS 1t78.03 100.0 DIESEL FUEL NOel 480 GAL. DRUMS OR BARRELS MET.. LUBRICANT UNKNOWN HAZARD [,.IS'[' UNKNOWN MODERATE HAZARD LIST ~OI]ER~'rE FIRE PROTECTION / WATER SUPPLIES LCtS'r CHANGE IZI08t88 BY VRL. SEC 4) FIRE EXTINGUISHER INSIDE SHOP AREA ON NORTH WALL. SEC S) FIRE HYDRANT - ? PAGE 3 12/23f88 11:44. M~TERIAL S~FETY DATA SYSTEMS, IN[:. (80B) G48--68(;i~l~ BUSINESS NAME ORANGE BELT STAGES LOCATION Z30! L ST EMPLOYEE NOTIFICATION / EVACUATION ID NUMBER ZlS.-OOO-/~1383 HIGH HAZARD R~TING 2 LAST CHANGE 12/08/88 BY VEIL. SEC Z) VERBAL. AND CALL 911 E. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE l Z/OB/Fi8 BY VAL SEC t) FUEL IN UNDERGROUND STORAGE, NATIONAL. SAFETY FEATLIRES P~GE 4 IZ/Z3/BB 11:44 MATERIAL. SAFETY DATA SY,~IE.M~ IN(i;. (805) G4.8--G800 IUSINESS NAME B~ERSFIELD CITY FIRE DEP~T~ENT 2130 "G" STREET B~ERSFIELD, CA 93301 (805) 326-397~0S"~*~'A OCT20 ~988 ' ........... OFFICIAL USE ONLY ID# HAZARDOUS I~,TERI ALS '/~ ~/~ BUSINESS PLAN AS A WHOLE FORM 2A 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: B. LOCATION / STREET ADDRESS: ~ Fo ~ ,~ ST- CITY: BUS.PHONE: SECTION 2: EI~ERGENCY 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: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. Ph~ g~7-~7 f Ph# 3~,2.-117 ~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL:O~ vo~-r gO~LL /~O~ sHO~~ ~-~ ~'r ~,~ oF ~/~ C. WATER:~sT s~DE 6~ 8~bo. /~ ~a~7 -~o~ ~r~ cc. ~,~ v~/~ D. SPECIAL:~Num~k~cv~c~L-~ourH S/Da O~ ~uo~'r ~u'F ~,q ~.~J, cI.4~. ('~ PRoP~ E. LOCK BOX: YES / ~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO MSDSS? YES / NO YES / NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM 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 A. METHODS FOR SAFE HANDLING OF HAZARDOUS INITIAL ~TERIALS: ....................................... YES/N~t~ YES tl B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES N~NO{ YES C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES E, DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES SECTION 7: HAZARDOUS MATERIAL REFRESHER CIRCLE YES OR NO OR NONE 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: ...... 5'ES ~ I, ~ ~~-/q , 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. SIGNATURE ~ ~c~.~c~--~ TITLE C~f~-~. FPtG-~. DATE - 2B - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFICIAL USE ONLY ID# BUSI NESS 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. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT N~d~E: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS NATERIALS FOR THIS UNIT ONLY Does this Facility Unit contain Hazardous Materials9... 'If YES, see B. If NO. continue with SECTION 4. ~-~ NO Are any of the hazardous materials a bona fide Trade Secret YES~ If No, complete a separate hazardous materials inventory furm marked: NON-TRADE SECRETS ONLY (white form :4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow 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 E~ERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPANe% HOT -geu'TH ~; i'l) E ~,["- ~iJi LDi~,JG D SPECIAL: E LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS9 YES / NO YES / NO MSDSs9 KEYS? YES / NO YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT ]I.D. ~ : FORM 4A-1 Page of NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVENTORY ' BUSINESS NAME: O~{q¢,a- /SC~T ~71+C-~' OWNER NAME: MI~-H~qCL H~dO%7-~ FACILITY UNIT ~: ~ ADDRESS: 23o/ ~ ST. ADDRESS: P.O.. ~0~ ~ FACILITY UNIT NAME: ~ CITY, ZIP: ~~F/~LD; ~. 933oi CITY,ZIP: V/~Li~ ~. ~3~ ~0 PIIONE ~: 3~2-117~ PHONE ~: ~oo-q~3-q~o~ IOFFICIAL USE CFIRS DE I ONLY I. 2 3 4 5 6 7 8 9 i0 I'VPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T :ODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIqAL OR COMMON NAME CODE. GUIDE FLL~ '~AME: ~z. ~Rr~M TITLE: oe~-r~. ~t~ SIGNATURE: ~.~ ~ c,.~.~ DATE: EMERGENCY CONTACT: ~L ~'~l~ TITLE: off~. ~. PH~E ~ BUS HOURS: 3~-119~- AFTER BUS HRS: IEMERGENCV CONTACT: ~;c/~m~L ~o~ff TITLE: ff~l~a-h~T PHONE { BUS HOURS: ]PRINCIPAL BUSINESS ACTIVITY: ~s~o~.rmT/o~ AFTER BUS HRS: 4A-1 -