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Home My WebLink AboutBUSINESS PLANHazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This ~ermit is issued for the followin~l; [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials ID Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002209 BAKERSFIELD LOCATION 2601 Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: June 30. 2003 MAY 7 ZOO/ Issue Date x.. ITE DIAGRAM Buainesa Name: Bu~ne~ Address: FACILITY DIAGRAM CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MAT,,E M.3-M r}NAGEMENT PLAN INSTRUCTIONS: ~ -~,~ t,~(~ ~ f 7 2. 3. 4. 5. To avoid further action, return this form within 30 days of receipt, r2 TYPE/PRINT ANSWERS IN ENGLISH. ,~_(~O''[.- Answer the questions below for the business as a whole. Be as brief and concise as possible. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAILING ADDRESS: CITY: PRIMARY ACTIVITY: STATE: ~..(-,k- ZIP: ~3 { PHONE: OWNER: m LrNO ^D P SS: PHONE: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1' DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Bo EMPLOYEE AND AGENCY NOTIFICATION: Co ENVIRONMENTAL RESPONSE MANAGEMENT: EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION I1.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Bo RELEASE CONTAINMENT AND/OR MITIGATION: Co CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) WATER: .6'Z& -~ I~'~ LOCKBOX: Y~S~ IF ~S, ~OC~tO~: ' P~VATE FI~ PROTECTION~ATER AVAILABILITY Ao Bo WATER AVAILABILITY (FIRE HYDRANT): / HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: ~k~ 6 b4'~' MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING FROGRAM: CERTIFICATION I, ~~/},~),/~-~'-,~,~ CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PEPJURY. SIGNAT-Ut~ TITLE DATE 4 CITY OF BAKERSFIEi OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION [] NEW [] ADO r"] DELETE [] REVISE 200 one form l~er mater~al l~er budding or area) Page __ of __ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) CHEMICAL LOCATION , ! , P (op,io,a0 20, 201' CHEMICAL LOCATION [] Yes. [] No 202 ' CONFIDENTIAL (EPCRA) GRID # (optional) 204 II. CHEMICAL INFORMATION If Subj~l to EPC~, refer to instm~i~s COM~N NAME ~ 207 EHS* ~ Y~ ~ No 208 CAS # 209 'if EHS is'Yes,' ~ a~ota~ below must be ir, lbs. FiRE CODE HAZARD CLASSES (Comptete if requested by local fire ct~iet~ 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] S SOLID Eli LIQUID [] g GAS · 214 LARGEST CONTAINER ~_~{~.__'~ 215 FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH' [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 I MAXIMUM :--"Y~: i i 218 i AVERAGE 219 STATE WASTE CODE 220 AMOUNT . DAILY AMOUNT ~:::~ ~ '~ DAILY AMOUNT DAYS ON SITE 222 UNITS' [] ga GAL [] cf CU FT' [] lb LBS [] tn TONS 221 · If EHS. amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUNO TANK [] e PLASTIC/NONMETALLiC DRUM [] i FIBER DRUM [] m GLASS BO'rTLE [] q RAIL CAR 223 (Check all that apply) j UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT '--~U aa ABOVE AMBIENT '-'"!._J ba BELOWAMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 ::.i:, .: EH'S'i - :'i". CAS# '" '. , 229 227 J []Yes []No 228 2~3 3 ; 234 237 4 i 238 ~ 241 5 ; 242 245 · '"" ..' ~ ~,'~..: "III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED C~PANY REPRESENTATIVE SIGNATURE DATE 246 231 []Yes []No 232 235 [] Yes [] No 236 239 []Yes []No 240 243 [] Yes [] No 244 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION [] NEW [] ADD [] DELETE [] REVISE BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) (one form/)er matedal ~er butldt~g or area) 200 Page of I. FACILITY INFORMATION CHEMICAL LOCATION 201' CHEMICAL LOCATION ~ CONFIDENTIAL (EPCRA) MAP # (optional) 203 GRID # {optional) [] Yes [] No 202 204 II. CHEMICAL INFORMATION CHEMICAL NAME COMMON NAME 205 TRADE SECRET [] Yes [] No 206 If Subjecl ID EPCRA. refer to instructions 207 EHS' [] Yes [] No 208 CAS # 209 'If EHS is'Yes,' ali amoums I~Iow must ~ ia lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chie0 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE 1'-] s SOLID ~'-], L,QUID r"~ g GAS . 214 LARGEST CONTAINER . .~,~ [ 215 FED HAZARD CATEGORIES [] I FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH (Check all that apply) 216 ANNUAL WASTE 217 ~ MAXIMUM ~,,.~_..,_~_.~ ~ 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT DALLY AMOUNT DALLY AMOUNT UNITS* [] ga GAL [] cf CUFT [] lb LBS [] tn TONS 221 ' DAYS ON SITE 222 * If EHS, amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] q RAIL CAR 223 (Check all that apply) [] m GLASS BO'FrLE [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BO'I-FEE [] r OTHER ,d TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 1 226~1 230 i 3 234 J 4 238 5;I; 242 x 227 231 [] Yes [] No ~2B ~ []Yes []No 232 235 [] Yes [] No 236 239 [] Yes [] No 240 243 [] Yes [] No 244 233 237 241 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE :, ::,~, III. SIGNATURE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd c x¥ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material per building or area) [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LOCATION '~'ACILITY ID # I 201l CHEMICAL LOCATION [] Yes [] No ! CONFIDENTIAL (EPCRA) MAP # (optional) 203 , GRID # (optional) 202 2O4 II. CHEMICAL INFORMATION 2O5 TRADE SECRET [] Yes [] No 206 If Subject to EPCRA, refer to instructions 207 CHEMICAL NAME COMMON NAME [] Yes [] No 208 CAS # 209 *if EHS is'Yes,' all amotmts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] s SOLID []1 LIQUID 214 215 EHS* [] g GAS LARGEST CONTAINER FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 i MAXIMUM (,.~ ~,.~-'- 218 I AVERAGE 219 STATE WASTE CODE 220 AMOUNT ' DAILY AMOUNT ! DAILY AMOUNT UNITS* [] ga GAL [] cf CU FT [] lb LBS [] tn TONS 221 DAYS ON SITE 222 * If EHS, amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTFLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER /~'C TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] aAMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT [] c CRYOGENIC 225 226 1 2 230 229 231 [] Yes [] No 232 233 3 I 234 235 [] Yes[] No 236 237 4 I 238 239 [] Yes [] No 240 241 5 ! 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AuTHoRIZED coMpANY REPRESENTAT'IVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .'lW4.wpd FACILITY NAME ADDRESS ~0 FACILITY CONTACT_ INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 PHONE NO. (~f.d ~-r._-~.. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program {3~outine ~ Combined [~ Joint Agency [~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~:~C¥1/ ,~...~ /~t3z.' Verification of quantities "'~ I ~ ~?--~'4 / _q~)4:f-. Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes ~]~o Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: FACILITY NAME ~E- ADDRESS '7-~0 FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~ UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE '~/Z! /~! PHONE NO. ~f~/ g '~-~.- BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~j,~Routine 12] Combined I~ Joint Agency [21 Multi-Agency [...] Complaint [21 Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~ :~.~) / ,~--~ ~ / ~/'L~ r.' Verification of quantities '~5' 1 [ ~--~ ~ 4 / ~"0'~ Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate ' Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes .~o Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: