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HomeMy WebLinkAboutBUSINESS PLANHazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Permit ID #:: 015-000-000981 ALBERTSONS INC #649 LOCATION: 4200 MING AVE Thl; _oermit is Issued for the followin_o: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment ELD Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES  1 715 Chester Ave., 3rd Floor Bakersfield, CA 93301 r Voice (661) 326-3979 FAX (661) 326-0576 Approved by: k.. nmp; y, ,rj:~-~.....,: Office of Evironm~tff[Services Issue Date Expiration Date: June 30; 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-021000981 ALBERTSONS INC LOCATION 4200 MING -Issued by: This permit is issued for the following: Materials Plan round Storage of Hazardous Materials Program Waste Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: ~ITE/FACILITY Dil'AGRAM FORM 5 NORTH SCALE:(zz/6~p' / BUSINESS /~Z~~O'NAME: t~/C~ FLOOR: (CHECK ONE) SITE DIAGR.%~! t/ FAC IL ITY D IAGR.a~M Inspector's Comments): -OFFICIAL USE ONLY- STATEMENT OF ACCOUNT CITY DF BA~ERSFiELD P 0 BOX 2057 BAKERSFIELD, CA 93303-2057 CUSTOMER NO: LiC~NBiN~ DEPARTMENT PO BOX 20 BOISE, ID 837~& 3214 DATE: CUSTOMER TYPE: ES/ 5/01/02 3214 CHARGE DATE DESC, RIPT;~0N ....... "' ...... - .... [ [.] I AL' A"MOUIq] 183.00 FOR QUESTIONS OR CHAN~ES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP~,OF THiS STATEMENT. CURR~NT OVeR 30 OVER &O OVeR gO DU'-~ DATE' 5/3i/0"" -- 183.00 PAYMENT DUE: TOTAL DUE: ~183.00 $183.00 O ALBERTSONS INC #649 Manager : MARTHA GIBBONS Location: 4200 MING AVE City : BAKERSFIELD BusPhone: Map : 123 Grid: llA CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code: DunnBrad: SiteID: 015-021-000981 (661) 833-9090 CommHaz : Moderate FacUnits: 1 AOV: Emergency Contact / Title MARTHA GIBBONS / STORE DIRECTOR Business Phone: (661) 833-9090x 24-Hour Phone : (661) 664-8734x Pager Phone : ( ) - x Emergency Contact DENNIS JOHNSON Business Phone: 24-Hour Phone : Pager Phone : / Title / GROCERY MANAGER (661) 833-9090x (661) 834-9675x ( ) - x Hazmat Hazards: React ImmHlth DelHlth Contact : CYNTHIA FORSCH MailAddr: PO BOX 20 City : BOISE Phone: (208) 395-6339x State: ID Zip : 83726 Owner ALBERTSONS INC Address : 250 PARKCENTER BL City : BOISE Phone: (208) 385-6200x State: ID Zip : 83726 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory --Alphabetical Order Hazmat Common Name... AMMONIA SOLUTION CHLORINE BLEACH POOL ACID (HYDROCHLORIC) POOL CHLORINE (HYPOCHLORITE) One Unified List Ail Materials at Site ISpecHazlEPA HazardsI Frm R IH L R IH DH L R IH L R IH L DailyMax Unit MCP 60.00 GAL Mod 400.00 GAL Hi 60.00 GAL Hi 60.00 GAL Hi -1- 09/06/2001 ALBERTS ONS INC #649 ~/~/~/~/~~/~~ S iteID: 015-021-000981 i i~ Notif./Evacuatio~Medical ~~~~~~ Overall Site i~ Agency Notification ~~~~~~~ 01/24/1995 o CALL 911 IN CASE OF EMERGENCY. o ~ Employee Notif./Evacuation ~~~~~ 01/24/1995 o STORE POSTS DESIGNATED EXCAPE ROUTES. 5 PERSON SAFETY COMMITTEE MEETS MONTHLY. MONTHLY SAFETY INSPECTIONS ON RECORD AT GENE~L OFFICE. EXTINGUISHERS LOCATED IN UNIT AND TAGGED FOR PROPER USE. o o i~ Public Notif./Evacuation ~~~~~~ 04/02/1999 O PUBLIC EVACUATION POSTED, ORGANIZED WITH PUBLIC ADDRESS SYSTEM BY MGMT. O i~ Emergency Medical Plan ~~~~~~ 01/24/1995 o EMERGENCY MEDICAL CARE PROVIDED BY MERCY HOSPITAL (OLD RIVER RD). o -2- 09/06/2001 ALBERTSONS INC #649 ~~~~~ SiteID: 015-021-000981 Mitigatio~Prevent/Abatemt ~~~~~ Overall Site i i~ Release Prevention ~~~~~~~ 04/02/1999 o STOCK CREW INFORMED OF PROPER HANDLING OF HAZARDOUS MATE~ALS IE LOOSE CAPS, o DENTED CANS, ETC. o ~ Release Contai~ent ~~~~~~ 04/02/1999 o SMALL CONTAINERS FOR RETAIL SALES. o o i~ Clean Up ~fi~~~6~~6~~~6~ 04/02/1999 O STOCK CREW INFORMED OF CO~ECT CLEANUP AND DISPOSAL OF PRODUCTS STOC~D IE o BLEACH, AMMONIA, POOL ACID, AND INSECTICIDES. O i~ Other Resource Activation o o -3- 09/06/2001 ALBERTSONS INC//649 isi~i~i~eis~eisis~e~i~isisee~i~i~eis~isise~ SiteID: 015-021-000981 i Site Emergency Factors ~~~~~~ Overall Site i~ Special Hazards ~~~~~~~~~i O o i~ Utility Shut-Offs ~~~~~~~ 04/02/1999 o A) GAS - NW CORNER OF BLDG o B) ELECT~CAL - REAR INTE~OR ALLEY WAY CENTER OF BLDG o C) WATER - NW CORNER IN PLANTER BOX 30' S D) SPECIAL- NONE · o E) LOCK BOX - NO O i~ Fire Protec./Avail. Water ~~6~6~~~6 04/02/1999 o PRIVATE FIRE PROTECTION - COMPLETE SP~NKLER SYSTEM, PRESSURE TESTED MONTHLY. o o o O i~ Building Occupancy Level o O -4- 09/06/2001 ALBERTSONS INC//649 Trai~ng ~~~~~~~~ Overall Site Employee Training ~~~~~~~ 04/02/1999 i o WE HAVE 75 EMPLOYEES AT THIS FACILITY. o o WE HAVE MATE~AL SAFETY DATA SHEETS ON FILE. o O B~EF SUMMARY OF T~INING: T~INING DONE IN MONTHLY SAFETY MEETINGS HELD BY o MGMNT PERSONNEL. o o o o i6~ Held for Future Use 0 o i~ Held for Fumre Use o o -5- 09/06/2001 ALBERTSONS INC #649 ~~~~~ SiteID: 015-021-000981 Full Format ~/3~/~/~/~ Type + Category + Sub-Category +Date2(ASC) Order o °Reference Dates Summary Description ° °GAMBILL 12/02/1996 OK ° o o DELTE POOL ACID & CHLORINE o °GAMBILL 11/14/1995 OK ° o o °HUEY 12/27/1994 SEND BUSINESS PLAN FOR REVISION. o o o °GAMBILL 11/17/1994 FOLLOW UP CHANGES IN INVENTORY. ° o o 11/15/1988 FOLLOW UP ° o o o o o O °Reference Dates Summary Description o °COOPER 11/09/1993 OK o o o o °COOPER o o o o o o 0 11/13/1991 OK ° ° NO RECORD FOR HAZ MAT TRAINING FOR EMPLOYEES o o O o -6- 09/06/2001 i ALBERTSONS INC//649 66666666666666686666~8~88~8 SiteID: 015-021-000981 i6 Full Format ~6~6~6~6~88~688 Type + Category + Sub-Category + Date2(ASC) Order i~6~6~~66~6~6~6~6~6~6~6~ One Unified List i o o ~aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa~aaaaaaaaaaaaaaaaaa~aaaaaaaaaaaaaaaaaaaaa(~ °Reference Dates Summary Description o °NAGLE 11/18/1992 OK o o o O o O O o O O O °Reference Dates Summary Description ° °COHEN 11/14/1990 OK ° o o 12/04/1989 FOLLOW UP ° o o o °COHEN O o o o o O o o °BUSINESS PLAN PROGRAM ROUTINE INSPECTION °Reference Dates Summary Description ° °LUKEN 09/22/2000 OK ° o o o o 11/30/1999 OK ° 12/16/1998 OK ° o o o o °BORJON o o o o °BORJON o o o o o o o o -7- 09/06/2001 PJbertsons' September 26, 2000 Ralph E. Huey Hazardous Materials Coordinator City of Bakersfield Fire Department 1715 Chester Ave., 3ra Floor Bakersfield, CA 93301 RE: Hazardous Materials Management Plan Update - Albertsons Bakersfield Locations Dear Mr. Huey: The following corrections need to be made to the corresponding Hazardous Materials Management Plans. Store #6379 - 8200 Stockdale Hwy Grocery Manager - Lorie Davenport No other changes ~$):~Store #6358 -2691 Mt. Vernon Ave. ?~.~No changes Store #6349 - 4200 Ming Ave. Grocery Manager - Dennis Johnson No other changes Store #6325 - 7900 White Lane Grocery Manager - Sylvia Cruz No other changes Store #6381 - 2705 "H" No changes Emergency/Home Phone#: 661-664-6920 Emergency/Home Phone#: 661-834-9675 Emergency/Home Phone #: 661-665-1760 If you should have any questions, or require additional information, please do not hesitate to contact me at 208/395-6339. Sincerely, ALBERTSONS INC. aura A Kidwai /t~au.n . Environmental Projects Specialist /lark FAC YNTH IAkEN V I RONM\ALDSTORI~\Bkrsfld3.doc ALBERTSON'S, INC. / GENERAL OFFICES'/250 PARKCENTER BOULEVARD / P.O. BOX 20 / BOISE, IDAHO 83726 / 208-395-6200 Albmlsons® MAR 3 0 1999 March 26, 1999 Ralph E. Huey Hazardous Materials Coordinator City of Bakersfield Fire Department 1715 Chester Ave., 3rd Floor Bakersfield CA 93301 RE: Business Plan Update - Bakersfield Sites Dear Mr. Huey: Enclosed are the Revised/Updated Business Plans and Hazardous Chemical Inventories for the following four (4) Albertson's Bakersfield locations: # 649 - 4200 Ming Avenue #1625 - 7900 White Lane #1658 - 2691 Mount Vernon Avenue #1679 - 8200 Stockdale Hwy If you should have any questions, or require additional information, please do not hesitate to contact me at 208/395-6339. Sincerely, ALBERTSON'S INC. Cynthia A. Forsch Environmental Affairs Manager CF/lar~ fi/c~a~nvironm/all/bkrsfld.doc cc: Steve Hilton Ken Gacs, #1625 Fred Hayward, #1679 John Arias, #1658 Martha Gibbons, #649 ALBERTSON'S, INC. / GENERAL OFFICES / 250 PARKCENTER BLVD. / BOX 20 / BOISE, IDAHO 83726 / 208-395-6200 ALBERTSONS INC::"cAn't----' Manager : Martha Gibbons Location: 4200 MING AVE City : BAKERSFIELD BusPhone: Map : 123 Grid: llA CommCode: BAKERSFIELD STATION 07 EPA Numb: SiteID: 215-000-000981 661 (~) 833-9090 CommHaz : Moderate FacUnits: 1 AOV: SIC Code: 5411 DunnBrad: Emergency Contact / Title ~T~I.~--A. ~."J~e~lqq~ / Store Di rector Business Phone~6~) 833-9090x 24 -Hour Phone ~6~ 8~X~) ~kg~0~ Pager Phone : ( ) 664 - 8734x Emergency Contact / Title ~Y~~ /Grocery Manager Business Phone$61(~) 833-9090x 24-Hour Phone Pager Phone : ( ) Hazmat Hazards: React ImmHlth DelHlth Contact : Cynthia Forsch MailAddr: ~L~~AV~ City : BAICIER~F~EDD P 0 Box 20 Boise Phone: ~08 ) 395 - 6339x State: ~ ID Zip : ~ 83726 Owner ALBERTSONS INC Address : 250 PARKCENTER BL City : BOISE Phone: (208) 385-6200x State: ID Zip : 83726 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory --As Designated Order Hazmat Common Name... IspecHazlEPA HazardsI Frm R IH DH L R IH L R IH L R IH L Do hereby certily that ~ have CHLORINE BLEACH AMMONIA SOLUTION POOL ACID (HYDROCHLORIC) POOL CHLORINE (HYPOCHLORITE) ), Cynthia Forsch One Unified List Ail Materials at Site DailyMax I Hnit I MCP 4OO Gg~ Hi 60 GAL Mod 60 GAL Hi 60 GAL Hi reviewed the attached hazardous materials manage- ment plan ior. Alb. er_ts.~9s.Ji49_.and that it sior~ with (Name e, uu~incas) any corrections constitute a complete and correct man- agement Can (ortn~cili~o Cynthia /~.t~"6~rsch ~ Environmental Affairs Manager 03/01/1999 F ALBERTSONS INC SiteID: 215-000-000981 Inventory Item 0001 Facility Unit: Fixed Containers on Site ~UiVHVlUN N~Vl~ / ~H~2 ~--kJ..~ N~Vl5 CHLORINE BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: AISLE~ 0~ CAS#, F STATE T TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 400.00 GAL Daily Average 200.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS Sodium Hypochlorite HAZARD ASSESSMENTS { Radioactive/Amount I EPA Hazards No/ Curies R IH DH NFPA /// USDOT# MCP Hi -- Inventory Item 0002 Facility Unit: Fixed Containers on Site %313iviivl%y£%{ l%{Z-.k{.Vl~'; / ~.~i'21-'~lVl£ ~j~-k.i.J l~4_;-.klvl~'. AMMONIA SOLUTION Days On Site 365 Location within this Facility Unit Map: Grid: STATE ~ TYPE Liquid { Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum I 60.00 GAL Daily Average 30.00 GAL %Wt. 10.00 HAZARDOUS COMPONENTS Ammonium Hydroxide · RN~oRS CAS#1336216 TSecret No oRSIBi°Haz N No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies R IH NFPA /// USDOT# I MCP Mod -2- 03/01/1999 F ALBERTSONS INC SiteID: 215-000-000981 Inventory Item 0003 Facility Unit: Fixed Containers on Site POOL ACID (HYDROCHLORIC) Days On Site 365 Location within this Facility Unit Map: Grid: CAs# FSTATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 30.00 GAL HAZARDOUS COMPONENTS %Wt. I 38.50 Hydrochloric Acid I CAs#7647010 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards NFPA l USDOT# I MCPI No/ Curies R IH . / / / Hi Inventory Item 0004 Facility Unit: Fixed Containers on Site %,:UlVllVlU/%l /~4Z,.~/v.[l"; / ~.;Z'~;lv! J. ~.;~.~ POOL CHLORINE (HYPOCHLORITE) Days On Site 365 Location within this Facility Unit Map: Grid: q CAs# STATE [ TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 30.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS Sodium Hypochlorite 7681529 HAZARD ASSESSMENTS { Radi°active/Am°unt I EPA HazardsNo/ Curies R IH NFPA/// I USDOT# 3 03/01/1999 ALBERTSONS INC &~&&~&&~&~~~&~ SiteID: 215-000-000981 i~ Notif./Evacuation/Medical ~&~~~~~~~ Overall Site i~ Agency Notification ~~&~~~~~&~&~~ 01/24/1995 CALL 911 IN CASE OF EMERGENCY. £~ Employee Notif./Evacuation ~~~~&~&~~~ 01/24/1995 STORE POSTS DESIGNATED EXCAPE ROUTES. 5 PERSON SAFETY COMMITTEE MEETS MONTHLY. MONTHLY SAFETY INSPECTIONS ON RECORD AT GENERAL OFFICE. EXTINGUISHERS LOCATED IN UNIT AND TAGGED FOR PROPER USE. PUBLIC EVACUATION POSTED, ORGANIZED WITH PUBLIC ADDRESS SYSTEM BY EMERGENCY MEDICAL CARE PROVIDED BY MERCY HOSPITAL (OLD RIVER RD). ALBERTSONS INC ~~~~~~~~ SiteID: 215-000-000981 i~ Mitigation/Prevent/Abatemt ~~~~~~~ Overall Site i~ Release Prevention ~~~~~~~~~ 09/02/1992 STOCK CREW INFORMED OF PROPER HANDLING OF HAZARDOUS MATERIALS I.E. LOOSE CAPS, DENTED CANS, ETC. SMALL CONTAINERS FOR RETAIL SALES STOCK CREW INFORMED IN CORRECT CLEANUP AND DISPOSAL OF PRODUCTS STOCKED I.E. BLEACH, AMMONIA, POOL ACIDE, INSECTICIDES. -5- 03/01/1999 ALBERTSONS INC ~&~A~&~~&~&~&~&~&&~&~&~ SiteID: 215-000-000981 i~ Site Emergency Factors ~~~~~~~~ Overall Site ~e~eeeee~eeeeee~ee~ee~eee~eeeeee~eee~eeeee~eeeee~eeeeeeeee~e~ee~e~eeee~ee~f i~ Utility Shut-Offs ~~~~~~~~~ 09/02/1992 A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - REAR INTERIOR ALLEY WAY CENTER OF BUILDING C) WATER - NORTHWEST CORNER IN PLANTER BOX 30' SOUTH D) SPECIAL - NONE E) LOCK BOX - NO i&&&& Fire Protec./Avail. Water &&&&&~&&&&&&&&&&&&&&&&&&&&&&&&~&&&~ 09/02/!992 PRIVATE FIRE PROTECTION - COMPLETE SPRINKLER SYSTEM, PRESSURE TESTED MONTHLY. -6- 03/01/1999 ALBERTSONS INC ~~~&~&~~~~ SiteID: 215-000-000981 i& Training ~~~&~~&~~&~&~&~~ Overall Site i&~ Employee Training ~~~&~~~&~~&~~~ 09/02/1992 WE HAVE EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: TRAINING DONE IN MONTHLY SAFETY MEETINGS HELD BY MANAGEMENT PERSONNEL. I ypical Albertson's Store Hazardous Materials for Resale Listing by Common Name Ouanity Common Name Chemical Name CAS # Material Form Stored Measurement Quantity in Use Location Hazard Class Combustible Liquid Class I1, Malathion 50 Insect Spray Malathion 121755 Liquid Mixture 6 Qts All for sale Interior Irritant Mineral Oil Mineral Oil 8042-47-5 Liquid Mixture 10 Gal All for sale Interior Combustible Liquid Class IIIB Motor Oil Refined Petroleum Distallates 64:741-88-4 Liquid Mix~ture 270 Qts All for sale Interior Combustible Liquid Class IIIB Heavey parrofin petrolum Motor Oil Treatment distillates 6474-26-50 Liquid Mixture 20 Pts All for sale Interior I Combustible Liquid Class IIIB Muriatic Acid H~ydrochloric Acid 07647-01-~0 Liquid Mixture 20 Qts All for sale Interior Corrosive Octane Booster Middle Distillates 8008-20-6 Liquid Mixture 15 Pts All for sale Interior !Combustible Liquid Class Ilia Paint Thinner Aliphatic Hydrocarbon 8052-41-3 Liquid Mixture 24 Qts All for sale Interior__ Combustible Liquid Class II Power Steering Fluid paraffinic petroleum oil 64742-54-7 Liquid Mixture 1.25 Gal Ail for sale interior ~Combustible__ Liquid Class IIIB Propane liquified petroleum gas 74-98-6 Gas 16 Lbs All for sale Interior Flammable Gas Clasps 2.1~ Ready Spray Lawn Weed Killer DMA Salt of 2, 4-D 13791929 Liquid Mixture 6 Qts All for sale Interior Irritant Rubbing Alcohol Isopropyl Alcohol 67-63-0 I Liquid Mixture 2 Gal All for sale Interior Flammable Liquid Class lB__ ~hock Calcium Hypochlorite 07778-54-3 Solid Mixture 10 Lbs All for sale Interior Corrosive, strong oxidizer Silcone Spray aliphatic petrleum distllates 8052-41~-3 Liquid Mixture 12 Qts All for sale Interior Flammable Liquid Class lB Snail ~Slug Pellets Metaldehyde 9002919 Solid Mixture 5 Lbs All for sale Interior Irritant __ ~-PA Cleaner Sulfuric Acid 7% 07664-93-9 Liquid Mixture 10 Qts All for sale Interior Irritant Sodium Bisulfate Anhydrous SPA Kern Bromating Tabs Globular 07~681-381 Solid Mixture 10' Lbs All for sale Interior__ Irritant Sodium Bisulfate Anhydrous SPA Kern Floating Bromine Globular 107681-381 Solid Mixture 10 Lbs All for sale Interior Irritant SPA Kem granules Sodium Hypochlorite 07681-52-9 Solid Mixture 10~ Lbs All for sale Interior Corrosive, strong oxidizer SPA KEM pH Minus Hydrochloric Acid 8.7% 07647-01-0 Solid Mixture 10 Lbs All for sale Interior Irritant SPA Kern T Tablets ~-richloro-s-triazinetrone !00087-90-1 Solid Mixture 10 Lbs Ail for sale Interior Corrosive, strong oxidizer SPAKEM or KEMEX Sodium Dichloro-s- Chlorinating Granules triazinetrione 02893-78-9 Solid Mixture 10 Lbs All for sale Interior Corrosive, strong oxidizer Glyphosate, Isopropylamine Spot Weed & Grass Killer Salt 38641__ 940 Liquid Mixture __61Qts All for sale Interior Flammable Gas Start Fluid Carbon dioxide 124-38-9 I Liquid Mixture 161Pts All for sale Interior Combustible Liquid Class IA St--erno Canned Heat Ethyl alcohol 84-17-5 Liquid Mixture 24 Oz All for sale Interior Flammable Liquid Class IA Stop Leak Naphtenic Petroleum Oil 64742-53-~6 ILiquid Mixture 11 i Pts All for sale Interior__ Combustible Liqui_d Class IliA Swimming Pool Acid Sulfuric Acid/Hydrochloric Acid 07664-93-9 !Liquid Mixture 10 Qts All for sale Interior_ Corrosive Tile Cleaner~ Sulfuric Acid 7% 07664-93-9 !Liquid Mixture 10 Qts All for sale Interior Irritant Tomato & Vegetable Insect Flammable Liquid Class IA, Spray Pyrethrins 8003347 !Liquid Mixture 6 Qts All for sale Interior Irritant Vegetation Killer Oxyfluorfen 42874033 ~Liquid Mixture 6 Qts All for sale Interior Irritant WD 40 aliphatic petrleum di~tllates 8052-41-3 !Liquid Mixture 72 Oz All for sale Interior Combustible Liquid Class Ilia Hazbycls { 3/19/99 Typical Albertson's Store Hazardous Materials for Resale Listing by Common Name Quanity Common Name Chemical Name CAS # Material Form Stored Measurement Quantity in Use Location Hazard Class Ant Killer Dust Chlorpyrifos 2921882 Solid Mixture 5 Lbs All for sale Interior Irritant Antifreeze Ethylene Glycol 107-21-1 Liquid Mixture 44 Gal All for sale Interior Flammable Liquid Class IA Armor All silcone 50-70-4 Liquid Mixture 24 Pts All for sale Interior Combustible Liquid Class IIIB Bleach Sodium Hy~chlorite 5.25% 7681-52-9 Liquid Mixture -- 300 Gal All for sale Interior Oxid~er Class III Poly Glycol ethers & Brake Fluid Po_ly_glycols Propriatary Liq~uid Mixture 26 Pts All for sale Interior _ Combustible Liquid Class IIIB Brand Carbaryl Insecticide Carbaryl 63252 Liquid Mixture 6 Qts All for sale Interior Irritant Cai Chlor Calcium Hypochlorite 07778-54-3 Solid Mixture 10 Lbs All for sale Interior Corrosive, strong oxidizer Carburetor Cleane~ carbon bichloride 127-18-14 Liquid Mixture 16 Pts All for sale Interior Flammable Liquid Class IA Irritant, possible senitizer, Charcoal Briquets Char Dust 16291-96-61 Solid Mixture 4000 Lbs All for sale Interior combustible Charcoal Lighter Fluid Aliphatic Petroleum Solvent 64742-88-7 Liquid Mixture 120 Qts All for sale Interior Combustible Liquid Class IIA Chlori Buoy Trichloro-s-triazinetrone 0087-90-1 Solid Mixture 10 Lbs All for sale Interior Corrosive, strong oxidizer Chlorine Tablets Trichloro-s-triazinetrone 00087-90-1 Solid Mixture 10 Lbs All for sale Interior Corrosive, strong oxidizer Coleman Fuel Solvent blend 64742-89-8 Liquid Mixture 15 Gal All for sale Interior Flammable Liquid Class IA Diazinon Granules :Diazinon 333415 Solid Mixture 5 Lbs All for sale Interior Irritant Combustible Liquid Class II, Diazinon Plus Insect Spray I Diazinon 33415 Liquid Mixture 6 Qts All for sale Interior Irritant Drain Cleaner Sodium Hydroxide 1310-73-2 Liquid Mixture 30 Gal All for sale Interior Corrosive Dry Acid !Hydroch oric Acid 7647-01-0 Solid Mixture 20 Lbs All for sale Interior Flammable Liquid Class IA Engine Cleaner 'aliphatic petrleum distllates 68476-34-6 Liquid Mixture 12 Qts All for sale Interior ,Combustible Liquid Class Feeder Tablets Sodium Bisulfate 07681-381 Solid Mixture 10 Lbs All for sale Interior Irritant Fuel Injection Cleaner Middle Distillates 8008-20~ Liquid Mixture 24 Pts All for sale Int~erior Combustible Liquid Class IliA Gas Treatment Aliphatic Petroluim Distillates 68476-34-6 Liquid Mixture 1.25 Gal All for sale Interior Combustible Liquid Class Ilia Granular Algaecide -- !Trichloro-s-triazinetrone 00087-90-1 Solid Mixture 10 Lbs All for sale~__ Interior Corrosive, strong oxidizer Granulated Chlorine Calcium Hypochlorte 7778-54-3 Solid Mixture 10 Lbs All for sale Interior Combustible Liquid Class IIIB Grass Killer =Fluazifop-Butyl 69806504 Liquid Mixture 6 Qts All for sale interior Irritant Grub & Insect Control Chlorpyrifos 2921882 Solid Mixture 5 Lbs All for sale Interior Irritant Heet Plus Mineral spriits 64742-88-7 Liquid Mixture 36 Pts All for sale Interior Flammable Liqu~id Class IA Combustible Liquid Class II, Home & Graden Insect Killer Tetramethrin 7696120 Liquid Mixture 6 Qts All for sale Interior Irritant -- 2-(1-Methylethoxy)Phenyl Flammable Liquid Class IA, Hornet & Wasp Killer Methylcarbamate 114261 Liquid Mixture 6 Qts All for sale Interior Irritant Insect Killer Formula II Acephate 30560191 Liquid Mixture 6 Qts All for sale Interior Flammable Liquid Class lB Insecticide acephate 3056-01-91 Liquid Mixture 6 Qts All__f°r sale Interior Combustible Liquid Class IIIB KEM KLOR I~--- Sodium Hypochlorite 07681-52-9 Liquid Mixture 6 Gal All for sale Interior Corrosive, strong oxidizer KEM KLOR I'~-~ Sodium Hypochlorite 07681-52-9 Liquid Mixture 6 Qts All for sale Interior Corrosive, strong oxidizer Lighter Fluids Isobutane 75-28-5 Liquid Mixture _2 Gal All for sale Interior Flammable Liquid Class IA NOI-Compounds NON- Liquid Algecide Chelated Copper 82027-59-6__ Liquid Mixture 6 Gal __All for sale Interior Hazardous Liquid Chlorine ~Sodium Hypochlorte 10.5% 7681-52-9 Liquid Mixture 50 Gal All for sale Interior Oxidizer Class III Liquid Shock Sodium Hypochlorite 07681-52-9 Liquid Mixture 6 Gal All-for sale Interior Corrosive, strong oxidizer Hazbycls 3/19199 12/27/94 ALBERTSONS INC 215-000-000981 Overall Site with 1 Fac. Unit General Information JAN 8 1995 By Location: 4200 MING AV City : I Map:123 Haz:3 Type: 3 I Grid: llA F/U: 1 AOV: 0.0 Contact Name Title. DAVID VOGE~%_~ /~ /~~, Business Phone: (805) 833-9090x 24-Hour Phone : (805) ~5~4~913x Pager Phone : ( ) Contact Na~e, ,/ Title Business Phone (805) 833-9090x 24-Hour Phone : (805) Pager Phone : ( ) Administrative Data Mail Addrs: 4200 MING AV City: BAKERSFIELD Comm Code: 215-007 BAKERSFIELD STATION 07 D&B Number: State: CA Zip: 93309- SIC Code: Owner: ALBERTSONS INC Phone: (208) 385-6200 Address: 250 PARKCENTER BL State: ID City: BOISE Zip: 83726- Summary I%~.~ .~~_ Do hereby certify that I have reviewed the attached hazardous materials ma: .age- ment plan forW~'/~,~.;,~/;~..',~_-F. _and that it along with ' {Nameof Buabe~) any corrections constitute a complete and correct man- agement plan for my facility. 12/27/94 Pln-Ref Name/Hazards ALBERTSONS INC 215-000-000981 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Form Max Qty Page MCP 2 02-001 CHLORINE BLEACH ~ Reactive, Immed Hlth, Delay Hlth Liquid 400 GAL High 02-003 POOL ACID (HYDROCHLORIC) ~ Reactive, Immed Hlth Liquid 60 GAL High 02-004 POOL CHLORINE (HYPOCHLORITE) ~ Reactive, Immed Hlth Liquid 60 GAL High 02-002 AMMONIA SOLUTION ~ Reactive, Immed Hlth Liquid 60 GAL Moderate 12/27/94 ALBERTSONS INC 215-000-000981 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-001 CHLORINE BLEACH · Reactive, Immed Hlth, Delay Hlth Liquid 400 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL 400 I Daily Average GAL 200.00 Annual Amount GAL 10,400.00 Storage PLASTIC CONTAINER Press T Temp IAmbient~Ambient IAISLE 7 Location -- Conc 100.0% ISodium Hypochlorite Components MCP ---/Guide High ! 45 02-003 POOL ACID (HYDROCHLORIC) · Reactive, Immed Hlth Liquid 60 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT Daily Max GAL 60 I Daily Average GAL 30.00 Annual Amount GAL -- 2,184.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlLOBBY Location -- Conc 38.5% IHydrochloric Acid Components MCP ---TGuide IHigh ~ 15 02-004 POOL CHLORINE (HYPOCHLORITE) · Reactive, Immed Hlth Liquid 60 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT Daily Max GAL 60 I Daily Average GAL 30.00 Annual Amount GAL -- 2,184.00 Storage PLASTIC CONTAINER Press T Temp I Ambient~Ambient I LOBBY Location -- Conc 100.0% ISodium Hypochlorite Components MCP ---%Guide IHigh { 45 12/27/94 ALBERTSONS INC 215-000-000981 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 4 02-002 AMMONIA SOLUTION · Reactive, Immed Hlth Liquid 60 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL60 I Daily Average30.00GAL Annual Amount GAL 2,392.00 Storage PLASTIC CONTAINER Press T Temp IAmbient/Ambient IAISLE 7 Location -- Conc 10.0% IAmmonium Hydroxide Components MCP Guide IModerate I 60 12/27/94 ALBERTSONS INC 215-000-000981 00 - Overall Site <D> Notif./Evacuation/Medical Page 5 <1> Agency Notification CALL 911 IN CASE OF EMERGENCY. <2> Employee Notif./Evacuation STORE POSTS DESIGNATED EXCAPE ROUTES. 5 PERSON SAFETY COMMITTEE MEETS MONTHLY. MONTHLY SAFETY INSPECTIONS ON RECORD AT GENERAL OFFICE. EXTINGUISHERS LOCATED IN UNIT AND TAGGED FOR PROPER USE. <3> Public Notif./Evacuation PUBLIC EVACUATION POSTED, ORGANIZED WITH PUBLIC ADDRESS SYSTEM BY MANAGEMENT. <4> Emergency Medical Plan EMERGENCY MEDICAL CARE PROVIDED BY BAKERSFIELD ~ ~~L 12/27/94 ALBERTSONS INC 215-000-000981 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 6 <1> Release Prevention STOCK CREW INFORMED OF PROPER HANDLING OF HAZARDOUS MATERIALS I.E. LOOSE CAPS, DENTED CANS, ETC. <2> Release Containment SMALL CONTAINERS FOR RETAIL SALES <3> Clean Up STOCK CREW INFORMED IN CORRECT CLEANUP AND DISPOSAL OF PRODUCTS STOCKED I.E. BLEACH, AMMONIA, POOL ACIDE, INSECTICIDES. <4> Other Resource Activation 12/27/94 ALBERTSONS INC 215-000-000981 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - REAR INTERIOR ALLEY WAY CENTER OF BUILDING C) WATER - NORTHWEST CORNER IN PLANTER BOX 30' SOUTH D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - COMPLETE SPRINKLER SYSTEM, PRESSURE TESTED MONTHLY. FIRE HYDRANT - BEHIND MARKET ON STINE RD. <4> Building Occupancy Level 12/27/94 ALBERTSONS INC 215-000-000981 Page 00 - Overall Site <G> Training <1> Employee Training WE HAVE 59 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: TRAINING DONE IN MONTHLY SAFETY MEETINGS HELD BY MANAGEMENT PERSONNEL. <2> Page 2 <3> Held for Future Use <4> Held for Future Use Business Name: Location: Business Identification No. 215-000 Station No. .~' Shift ~lkersfieid Fire Dept. Ha'Z~lt'dous Materials Division Date Completed Arrival Time: Comments: Number of Employees: Comments: (Top of Business Plan) Inspector ~r:_~/1,'/~ !/--/--- Departure Time: Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Matedal Comments: Verification of MSDS Availability Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Inspection Time: Adequate Inadequate Emergency Procedures Posted Containers Properly Labeled All Items O.K Correction Needed Verification of Facility Diagram Special Hazards Associated with f~is Facility: 8usine~ ~er~anager PRINT ~ME ~ SIGNATURE ~" White-Haz Mat Oiv Yell0w-Stat~on Copy Pink'-Business Copy F ALBERTSONS INC = Hazmat Inventory List of 4 Materials Hazmat Name / Hazards <1> CHLORINE BLEACH · Reactive, Immed Hlth, Delay Hlth Fac. Unit: Fixed Containers on Site IForm IDly Max/UnitlMCP/Ref#I Liquid 400 High GAL 02-001 <2> AMMONIA SOLUTION Liquid 60 Moderate · Reactive, Immed Hlth GAL 02-002 <3> POOL ACID (HYDROCHLORIC) Liquid 60 High · Reactive, Immed Hlth GAL 02-003 <4> POOL CHLORINE (HYPOCHLORITE) Liquid 60 High · Reactive, Immed Hlth GAL 02-004 I<N> Add New Hazmat <Key> Modify Existing Hazmat <O> Find/Order/Focus <PgUp/Dn> Scroll <R> Delete a Material <C> Fac. Units <P> Print <Esc> Exit 07/27/92 ALBERTSONS INC 215-000-000981 Page Overall Site with 1 Fac. Unit General Information Location: 4200 MING AV Map: 123 Hazard: Moderate Community: BAKERSFIELD STATION 07 Grid: llA F/U: 1AOV: 0.0 Contact Name DAVID VOGEL MIKE HESSLER Mail Addrs: 4200 MING AV City: BAKERSFIELD Comm Code: 215-007 BAKERSFIELD STATION 07 Title Business Phone 24-Hour Phone- 1(805) 833-9090 x ~(805) 835-0913/ (805) 833-9090 x (805) 871-557~ Administrative Data D&B Number: State: CA Zip: 93309- SIC Code: Owner: ALBERTSONS INC Phone: (~3~)~ -~ Address: 250 PARKCENTER BL State: ID City: BOISE Zip: 83726- Summary RECEIVED t AUG 3 t 1992 HAZ. MAT. DIV. .~'p d', ~ Do hereby cer~i~ thru t have reviewed .the ~,.,~h~:--~~:~.~ ..... ~.~ c:'(:,~.~s materials m~egeo glen ~or~~/~ ~nd ~hm i~ along wi~h 07/27/92 ALBERTSONS INC 215-000-000981 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 CHLORINE ~LEACH' · Reactive, Immed Hlth, Delay Hlth Liquid 400 High GAL CAS #: Form: Liquid Trade Secret: No Type: Pure Days: 365 Use: CLEANING% Daily Max GAL 400 Daily Average GAL 200.0O Annual Amount GAL 10,400.00 Storage PLASTIC .CONTAINER Press T Temp AmbientJAmbientlAISLE 7 Location -- Conc 100.0% ISodium Hypochlorite Components MCP High 02-002 AMMONIA SOLUTION · Reactive, Immed Hlth Liquid -. 60 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL 60 I Daily Average GAL ~ Annual Amount GAL -- 30.00~ 2,392.00 Storage PLASTIC CONTAINER Press T Temp Ambient~AmbientlAISLE 7 Location - Conc 10.0% I Ammonium Hydroxide Components iMCP ----/List ModerateI 02-003 POOL 'ACID (HYDROCHLORIC) · Reactive, Immed Hlth Liquid 60 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT -- Daily Max GAL Daily Average GAL 30.00 Annual Amount GAL 2,184.00 Storage PLASTIC CONTAINER Press T Temp IAmbientlAmbientlLOBBY Location -- Conc 38.5% IHydrochloric Acid Components MCP IHigh IList 07/27/92 ALBERTSONS INC 215-000-000981 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 3 02-004 POOL CHLORINE (HYPOCHLORITE) · Reactive, Immed Hlth Liquid 60 High GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT Daily Max GAL Daily Average GAL 30.00 Annual Amount GAL -- 2,184.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlLOBBY Location -- Conc 100.0% ISodium Hypochlorite Components MCP High iList 07/27/92 ALBERTSONS INC · 215-000-000981 00 - Overall Site <D> Notif./Evacuation/Medical Page 4 <1> Agency Notification <2> EmployeeNotif./Evacuation STORE POSTS DESIGNATED EXCAPE ROUTES. 5 PERSON SAFETY COMMITTEE MEETS MONTHLY. MONTHLY SAFETY INSPECTIONS ON RECORD AT GENERAL OFFICE. EXTINGUISHERS LOCATED IN UNIT AND TAGGED FOR PROPER USE. <3> Public Notif./Evacuation <4> Emergency Medical Plan EMERGENCY MEDICAL CARE PROVIDED BY BAKERSFIELD MEMORIAL HOSPITAL 07/27/92 ALBERTSONS INC 215-000-000981 Page 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention STOCK CREW INFORMED OF~,Q~E~ OF ~~%~ALS-~ .F~OOSE CAPS, DENTED CANS, ETC.~ STOCK CREW INFORMED IN CORRECT CLEANUP AND~ DISPOSAL ~~CT~ BLEACH, AMMONIA, POOL ACID, INS <2> Release Containment / \ <3> Clean~ ~ / <4> Other Resource Activation '07/27/92 ALBERTSONS INC 215-000-000981 00 - Overall Site <F> Site Emergency Factors Page 6 <1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - REAR INTERIOR ALLEY WAY CENTER OF BUILDING C) WATER - NORTHWEST CORNER IN PLANTER BOX 30' SOUTH D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ??????????? FIRE HYDRANT - ?????????? <4> Building Occupancy Level 07/27/92 ALBERTSONS INC 215-000-000981 00 - Overall Site <G> Training Page 7 <1> Page 1 WE HAVE 59 EMPLOYEES AT THIS FACILITY / ~D~L SAFETY DATA SHEETS ON FILE? /~---~-~.. / BRIEF SUMMARY OF TRAINING: ' / ~ ,~.~/~ . <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Business Name: Bakersfield Fire ept. Hazardous Materials Inspection Date Completed RECEIVED Location: £] ~' 0 0 ~ / ]t.I (~ plan ID # 215-000 q~l (Top right comer Business Plan) Station No. ~'~ Shift /~" Inspector Ha~..~AT. DIV. Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Cotangents: Verification of MSDS Availability Number of Employees Verification of Haz Mat Training comments: o D I~Im o lV l t~I Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram · Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office HAZARDOUS MATERIALS INSPECI'ION NOV 1 ~ 1988 ~I~'~1. ........... INSPECTION DATE: VERIFICATION OF INVENTS, RY MATERIALS VERIFICATION OF QUANTITIF. S VERIFICATION OF LOC~TION P. ROPER SEGREGATION OF MATERIAL VERIFICATION OF HAZ MAT TRAIN~ VERIFICATION OF M~)S AVAZLABT-I~ VERIFICATION OF ABAT~IT S[TPpT. I'F_,~ & Lc~t:X:~DI:/R~ EI"IEIIGEI1C'Y PROCEDOI~S POSTED CONTAI~IE~S PROPEI~LY L~m~T.~r~ VERIFICAT~(]~ OF FA(IILIT~ DIAGRAM ~ SPECIAL Bi~ZARDS ASSOCIATED NITH THIS FACILITY: VIOLATIONS: BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 BUSINESS NAME OFFICIAL USE ONLY ID~ HAZARDOUS lVIATE R I 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 IDENTIFICA~0N DATA A. BUSINESS NAME: AU; 2 6 1987 A,s'd ............ 000981 B. LOCATION / STREET ADDRESS: CI~: ~,~Y,,'~'~ d4 ~ zip: BUS. PHONE: .SEcTION'2: EMERGENCY NOTIFICATIONS In case of an emergenc~ involving the release or threatened release of a · hazard6~s ~aterial, call 011 and 1-800-852-7550 or 1-01g-427-4341. Th~s ~ill notif~ your local fire department and the State Ofgice o~ E~er~enc~ SerT~ces as required la~. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: N~E AND TITLE A. ~,,~jIa~/~) r-,/z:~m~7_.~ JY'~/P/,g~-/-D~ Ph~ D5qlING BUS. HRS. Ph~ Ph# AFTER BUS. HRS. ECTION3: LOCATION OF UTILITY SHIrr-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: ~ot~7-~iD~%'-c' ~ueq~- I~ ~u~O-~Ok D. SPECIAL: 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 2A - SECTION 4: PRIVATE RESPONSE TE~'4 FOR BUSINESS AS A WHOLE ECTION 5: LOCAL EMERGENCY MEDICAL ASSISTanCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES ~MPLOYEES WITH INITIAL REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...- .................................... ~E~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~'~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. E~S NO D. EMERGENCY EVACUATION PROCEDURES: ................. NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ REFRESHER ~ No NO ~0 YES (~ SECTION 7: HAZARDOUS ~4ATERIAL CIRCLE ~S OR NO ---DOES 'YOUR-BUSfNESS HANDLE-HAZ-ARDDUS ~TER!AL--tN-QUA.N~-~tES--LES~--T-HAN-$.0.0-ROUNDS~F SOLID, ~ ~A~LONS O~ _A ~IQ~I~, OR ~00 C~IC ~EET OF I, ~//D- ~.~r~ , 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 A~/ and that inaccurate information constitutes perjury. BAKERSFIELD CITY FiRE DEPAR~!ENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFiCiAL USE ONLY BUSIN-ESS 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 be!o~v for THE FACILITY UNiT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY b~IT~ d ,~ FACILITY b~IT N~ME: SECTION1: MITIGAT!ON~ PREVEN~!ON~ ABATEMEh~ PROCEDD~ES SECTION 2: NOTIFICATION .%\~D EVACUATION PROCEDL~ES AT THIS L~.'IT ONLY BAKERSFIELD CITY FIRE DEPARTMENT I .D. # FORM 4A-1 Page /'_ of _/ NON--TRADE SECRETS HAZARDOUS MATER'[ ALS INVENTORY FACILITY UNIT #:~ FACILITY UNIT BUSINESS NAME: ~ff-Y~/-f /~/(~. OWNER NAME: ADDRESS: ~ ~/~ ~ ADDRESS: ~ CITY, ZIP: ~;~ Cd. ~9 CITY,ZIP: ~/~ /~ ~~ . PHONE ~:~$ ~OqO ' PHONE ,: C~ ~3~ &~' [OFFICIALONLY USE CFIRS CODE 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS 9~ BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE ..... ,, ..... _ ........ ~./t, ~ _..~ NAME: ~m- ~'///'2f:m~F-~~ TITLE: SIONATURE: ~ ' 'x'/ ' '~' DATE: EMERGENCY CONTACT: m/~ ~:[~ TITLE: ~ f~ b~ AFTER BUS HRS: PHONE # BUS HOURS: AFTER BUS HRS: