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HomeMy WebLinkAboutBUSINESS PLAN E/FACILITY FORM NORTH SCALE: ~AT~: ~ (CffEC~ OffE) BUSINESS NkME SITE DIAGRAM FLOOR: UNIT,-,~'. OF FACILITY DIAGRAM Inspector's Comments) -0FFICIAL USE 0NLY- - 5A - 03/09/93 TOYS R US #5605 215-000-000784 Overall Site with 1 Fac. Unit RECEJVED General Information Location: 3793 MING AV Map: 123 Hazard: Moderate CommunitY: BAKERSFIELD STATION 07 Grid: llB F/U: 1 AOV: 0.0 1 Contact Name Title i Business Phone i 24-Hour_Pn~neq STORE DIRECTOR (805) 832-9002 x (805~~J~ ASSIST STORE DIR (805) 832-9002 x (80~ Administrative Data Mail Addrs: 3793 MING AV D&B Number: 13-515-9250 City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-007 BAKERSFIELD STATION 07 SIC Code: 5945 Owner: TOYS R US #5605 Phone: (805) 832-9002 Address: 3792 MING AV State: CA City: BAKERSFIELD Zip: 93309- Summary !, ..9~¢,,,~-,,,, £,,,,~,,-,~.:-,- DO nereoy'c~rtify that I have ~ ' (Type or p~int name) reviewed the attached hazardous materials manage- ment plan for ~yc ~ Ur and that it along with ---' (Rame oi' Bus~9~) any corrections constitute a complete and correct man- agement plan for my facility. 03/09/93 TOYS R US #5605 215-000-000784 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site Pln-Ref Name/Hazards 02-002 CHLORINE/POOL CHEMICA~L~'~-''~ · Reactive, ~th, Delay Hlth 02-001 CALCIU .~RIDE j~,Re~ctive, Immed Hlth, Delay Hlth Form Quantity / 'MCP Liquid ~ High Solid ~.~S Moderate 03/09/93 TOYS R US #5605 215-000-000784 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-002 CHLORINE/POOL CHEMICALS · Reactive, Immed Hlth, Delay Hlth Liquid 25'0 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER %TMENT Daily Max GAL 250 I Daily Average GAL 125.00 Annual Amount GAL -- 500.00 Storage PLASTIC CONTAINER Press Temp I Ambient Location FLOOR NE CORNER -- Cone 1'00.0% IHydrochloric Acid ~nts MCP ----~uide. IHigh ! 15 02-001 CALCIUM CHLORIDE · Reactive, Immed Hlth, Hlth Solid 500 Moderate LBS CAS #: 7778543 Secret: No Form: Solid Pure Days: 365 Use: WATER TREATMENT Daily Ma~ DRUM 'e 500 I Daily Average LBS 250.00 Annual Amount LBS -- 750.00 Press T Temp Location I AmbientlAmbient SALES FLOOR NE CORNER --C Calcium Hypochlorite Components MCP Guide IModeratel 45 03/09/93 TOYS R US #5605 215-000-000784 00 - Overall Site <D> Notif./Evacuation/Medical Page 4 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL OR PA SYSTEM AND CALL 911. <3> Public Notif./Evacuation NONE LISTED <.4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371. 03/09/93 TOYS R US $5605 215-000-000784 Page 00 - Overall Site <E> Mitigation/Prevent/Abatemt 5 <1> Release Prevention TRAINING REGARDING PROPER HANDLING AND STORAGE PROCEDURES ARE GIVEN BY STORE MANAGEMENT TEAM. ~ <2> Release Containment <3> Clean Up <4> Other Resource Activation 03/09/93 TOYS R US #5605 215-000-000784 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST CORNER B) ELECTRICAL - INSIDE PICKUP DOOR ON SOUTHWEST CORNER C) WATER - OUTSIDE NORTHEAST CORNER D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE SPRINKLER & FIRE EXTINGUISHERS FIRE HYDRANT - ON LYMRIC STREET <4> Building Occupancy. Level 03/09/93 TOYS R US #5605 215-000-000784 00 - Overall Site <G> Training Page 7 > Page 1 WE HAVE 60 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: MONTHLY SAFETY MEETINGS <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use. Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION ,/ Date Completed Business Name: ~f ~ ~ ~=~ Business Identification No. 21~000 ~ Fop of~usiness PI~) // ~' ~ Station No. ~~ Shift ~ Inspe~or ' ', ~ ............ ] Adequate Inadequate ~/~. Veri~ ~ I' ~' i ~ _ Verif~ of Quantities ~ I~ ' ~[k,~ ~ ~ I~ Verification °f Location ~ ~_ I' / " ~ Proper S~regation of Materi~~ ~ Comm.n,s: Verification of MSDS Availabli~ ~ ~ Number ~ployees Verification of Haz Mat Training Comments: Verification Supplies & Procedures Comments: Emergency Posted Containers Pro Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: ""~E"'g'~ .~/~ Business Owner/Manager All Items O.K. Correction Needed FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy ~ ~~d Fire Dept. O HTRDOUS MATERIALS DIVISION ~ Date Completed Business Name: --~ ~5 ~ L~5 '~g'~ (Top of Business Plan) Inspector Location: Business Identification No, 215-000 Station No. '~ Shift Adequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material '~ Number of Employees Comments: J'U¢¢ ~L verification of MSDS Availablity 6© RECEI_VED ~99~1 HAZ. I~AT. Inadequate Verification of Haz Mat Training Verification of Abatement Supplies & Procedures Emergency Procedures Posted Comments: Comments: Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: Business Ow, l~r/~lanag~r All Items O.K. Correction Needed FD 1652 (Rev. 1-90) Whita-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 05/20/90 TOYS R US :~5605 215-000-000784 Page Overall Site witlq i Fao. Unit General Information Location: 5795 MING AV Map: 123 Hazard: Moderate Ident Number: 215-000-000784 Grid: 118 Area of Vul: 0.0 RIOK LODERMEIER !(805) 832-9002 X 8(35) ~66-0245 8(35 1269 MARK ARMS Administrative Data Mail Addr$: 3793 MING AV D&B Number:~ ............. -.~ City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-007 BAKERSFIELD STATION 07 SIC Code: Owner: TOYS R US ~5605 Phone: (805) 852-9002 Address: 3792 MING AV State: CA City: BAKERSFIELD Zip: 93509- Summary i, ,~(z/._~ ~c~..~,~.~ Do hereby certify that I have ravia, wad th,,- ~'-.'".,'"--'~,.,,.=,,, .,¢.~ hazardous materi~,lsm,....."'-' merit pian for__~__.C~g_.and ' a. ny cormct!o~ cormt~,¢.e e complete and corr. ec~ m~n- agement plan for my fa~ilily. o5/2o/9o Pln-Ref Name/Hazards TOYS R US ~5605 215-000-000784 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Form Quantity Page MOP 02-002 CHLORINE/POOL CHEMICALS Reaotive, Imrned Hlth, Delay Hlth Liquid 250 GAL High 02-001 CHLORINE Reactive, Immed Hlth, Delay Hlth Solid 500 LB S Moderate 03/20/90 T()YS R US ~5605 215-000-000784 02 - Fixed Oontainers on Site Hazmat Inventory Detail in MCP Order Page 02-002 CHLORINE/POOL CHEMICALS Reactive, Immed Hlth, Delay Hlth Liquid 250 High GAL CAS ~: Trade Secret: No Form: Liquid Type: Pure Days: 565 Use: WATER TREATMENT Daily Max GAL 250 Daily Average GAL 1 I Annual Amount GAL -- 50O Storage PLASTIC CONTAINER Press T Temp --] Location AmbientIAmbientlSALES FLOOR NE CORNER -- Cono] lO0.Omo Hydrochloric Acid Components FMCP List igh 02,-001 CHLORINE Reactive, Immed Hlth, Delay Hlth Solid 500 Moderate LBS CAS ~: Trade Secret: No Form: Solld Type: Pure Days: 565 Use: WATER TREATMENT Daily Max LBS 500 I Daily Average LBS T I 25o I Annual Amount LBS - 750 Storage DRUM/BARREL-NONMETAL Press T Temp i Location AmbientlAmbientlSALES FLOOR NE CORNER -- Coho iOO.O~ Calcium Hypochlorite Components MCfaCe~ st FodePi o~/2o/so TOYS R US ~5605 215-000-000784 O0 - Overall Site <D> Notif./Evacuation/Medical Page 4 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL OR PA SYSTEM AND CALL 911. <5> Public Notif./Evacuation NONE LISTED <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371. 05/20/90 TOYS R US ~5605 215-000-000784 Page O0 - Overall Site <E> Mitigation/Pmevent/Abatemt 5 <1> Release Prevention TRAINING REGARDING PROPER HANDLING AND STORAGE PROCEDURES ARE GIVEN BY STORE MANAGEMENT TEAM. <2> Release Containment <3> Clean Up <4> Other Resource Activation o~/2o/9o TOYS R US ~5605 215-000-000784 O0 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST CORNER B) ELECTRICAL - INSIDE PICKUP DOOR ON SOUTHWEST CORNER C) WATER - OUTSIDE NORTHEAST CORNER D) SPECIAL - NONE E) LOCK 8OX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ?????? FIRE HYDRANT - ??????????? <4> Held for Future use o~/2o/~o TOYS R US ~5605 215-000-000784 O0 - Overall Site <G> Training Page 7 <1> Page 1 WE HAVE ~)EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: Page 2 as needed <3> Held for Future Use <4> Held for Future Use BAKERSFIELD CITY FIRE DEPARTMENT 2130 "O" STREET BAKERSFIELD, CA 93301 (805) 326-3979 RECEIVED JUL B 1987 Anfd ............ BUSINESS NAME OFFICIAL USE ONLY ID# HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCT I 0NS: 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 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,~ A~D ZIT~E ' DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE B. ELECTRICAL :.-..~,,y~/9/~ /'],e~ (-/p '~oo R. C WATER: ~5/d~ ~D~ ~5/ CO~e~ D SPECIAL: ~/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 - 2A - 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: . . .' .................................... YES B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... REFRESHER YES NO YES NO 'YES NO YES NO YES NO SECTION 7: HAZAI~OUS ~ATERIAL ...... CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUND~F A ' I, /~'//- / /J~,~,~e~' , 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 DATE BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFICIAL USE ONLY 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. Answer the questions belotw for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# ~'d~ FACILITY UNIT N~ME: SECTION 1: MITIGATION, PREVENTION, ABATEMEN-r PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS U?TIT ONLY SECTION 3: HAZARDOUS ,MATERIALS FOR THIS UNIT ONLY A. Does this 'Facility Unit contain Hazardous Materials? ...... YES NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (~hite form ~4A-1) If Yes, complete a hazardous materials inventory form ,larked: 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 EMERGENCY RESPbNDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. :iAT. GAS/PROPANE% B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS? YES / NO MSD~s? YES /' NO YES / NO KEYS? YES / NO BAKERSFIELD CITY FIRE DEPARTMENT I,D. # FORM 4A-1 Page ~of _ NON--TRADE SECRETS IMATERT ALS INVENTORY HAZARDOUS BUSINESS NAME: ~ ~ ~ OWNER NAME.: FACILITY UNIT #: S60~ ADDRESS: ~p~ /~t;~ ~C ADDRESS: FACILITY UNIT NAME: " CITY, ZI~:~ke~$~,~.C--~d.;~. 73~ CITY,ZIP: P.ON~ #:~o~) ~a:~o&& P.ONE #: {OFFICIAL USE CFIRS'CODE I ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT' CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE 'NAME: ! TITLE: S IONA~TURE: f tt~ ~ DAT'E :...-6/t~ 7 I~itERGENCY CONTACT: TITLE: "~/~-eO~P<)~ ' PHONE * BUS HOURS: ~J~-~?~ . "x AFTER BUS HRS: ~.-~ ~E'ROENCY CONTACT:_ ~*~ ~$ . __ TITL~ ~F ~~Z , PHONE ~ BUS HOURS: e~Z-?oOK ~RINClPAL BUSINESS ACTIVITY: ~{~/~ ~e~ -- /Of~ AFTER BUS "RS: ~3-/~ -~' ~ ' - 4h-1 -