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: