HomeMy WebLinkAboutBUSINESS PLAN'ZIc~ c~e,~ Foot
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~-~ltt.) ~ 'T'I/~IJ I/-- t> ~ Discount Party Stores ~'
Tom Martin, General Manager
Phone (661) 837-8096 · Fax (661) 837-1749
4440 Ming Avenue · Bakersfield, CA 93309
Hazardous Materials/Hazardous Waste Unified Permit
.~ CONDITIONS OF-PERMIT ON REVERSE SIDE
Permit ID #:: 015-000-001930
PARTYWORKS #2
LOCATION: 4440 MING AVE
IELD
This _permit is Issued for the followin_.:
E] Hn~,~rdous Materials Plan
[3 Underground Storage of Hazardous Materials
[] Risk Management Program
[] Hazardous Waste On-Site Treatment
Issued by:
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (66'1) 326-3979
FAX (661) 326-0576
Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SER I~CES'
Approved by:
Expiration Date:
· '!. ":':~ i'
Office of Ev~Scrviccs ~
· June 30; 2003
Issue Date
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
INSTRUCTIONS:
2.
3.
4.
To avoid further action, remm this form within 30 days of receipt.
TYPE/PRINT ANSWERS IN ENGLISH.
Answer the questions below for the business as a whole.
Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
LOCATION:
MA II.ING ADDRE S S:
SrAm ~Z~:~~O~: f(37~O?b
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY: //~:
OWNER:~ 0 O~
SECTION 2: EMERGENCY NOTIFICATION
SIC CODE:
q yA 7 7
CONTACT_
TITLE BUS. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING
NUMBER OF EMPLOYEES: l
MATERIAL SAFETY DATA SHEETS ON
BRrF~F SUMMARY OF TRAINING PROGRAM:
SECTION 4: EXEMPTION REQUEST
I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM
THE REPORTING KEQ~S OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH
& SAFETY CODE" FOR THE FOLLOWING REASONS:
,~ WE DO NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT
NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION
INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE
USED TO FULFILL MY FIKM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH
6ND SALTY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTEK 6.95 SEC. 25500
,ET AL.)/41ND ,THAT II~.ACCUR~TE INFORMATION CONSTITUTES PERJUKY.
K ' SIGNA~m/F.-- TITLE DATE
2
CITY OF BAKERS ELD
OFFICE OF ENVIRONMEI ITAL SERVICES
1715 Chester Ave., CA 93301 (805) 326-3979
HAZARDOUS MATERIALS INVENTORY
Chemical Description Form
(one form ~er material per butlding or ama)
[] ADD ['"].DELETE [] REVISE 200 Page __ of __
· - .. '1. FAClMTYINFORMATION'I'.''':' ' '
3i
BU/~NESS NAME (Same as FACILITY NAME or DBA ..Dang Business As)
'.: . . .A II. CHEMICAL INFORMATION
COMMON NAME
201 CHEMICAL LOCATION [] Yes ~o
202
CONFIDENTIAL (EPCRA)
203 GRID # (opllonal) 204
I
205 TRADE SECRET [] Yes ~No
206
If Su0ject to EPCRA. refer to iinstructions
207
EHS' []Yes []No 208 '
CAS# 209 .*If EHS is'Yes', all amounls below mUSt be'M
lbs. · - ."
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief}
TYPE "[~p PURE [] m MIXTURE
[] w WASTE 211
PHYSICAL STATE [] s SOLID l-ll LIQUID :~g GAS 214
RADIOACTIVE [] Yes
LARGEST CONTAINER T
FED HAZARD CATEGORIES r-] 1 FIRE [] 2 REACTIVE
(Check all that apply)
'1~ PRESSURE RELEASE
[] 4 ACUTE HEALTH
210
[No CURIES 213
212
[] 5 CHRONIC HEALTH 216 1
219 I STATE WASTECODE 220 !
DAYS ON SITE 222
ANNUAL WASTE ~ 217. MAXIMUM
AMOUNT ~ DALLY AMOUNT
UNITS*
218 I AVERAGE
DALLY AMOUNT
[] ga GAL [] ct' CU FT [] lb LBS [-[ tn TONS
· If EHS. amount must 0e in lbs.
STORAGE CONTAINER
(Check all that apply)
[] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FISER DRUM
[] b UNDERGROUND TANK [] f CAN [] j BAG
[] c TANK INSIDE BUILDING [] g CARBOY [] k BOX
[] d STEEL DRUM [] h SILO ~ CYLINDER 5
[] m GLASS BOTTLE [] q RAIL CAR 223
[] n PLASTIC BOTTLE [] r OTHER
[] o TOTE BIN
[] p TANK WAGON
STORAGE PRESSURE [] a AMBIENT
[] aa ABOVE AMBIENT
[] i0a BELOW AMBIENT
224
STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba 8ELOWAMBIENT [] c CRYOGENIC
....,. . . .. ., ..... ,. : · ~.,: ......',:,:,,<,.:c.:,~,~.::.~.~.>~¥::~: ,.:,~ ~;;!:~. i ;" '.d :,:~:~:~.¥g: ::.~'%~?~?:~ :
. '..'::-,;,::'~,.'? :,~::.:~ ........ ::,.:::' ::: .: ,'. ~...:.',. ~:.,' ...... ........ ;'' .'.'"~'"" ' ........ ":: .':' ~:<',i~?:li:: ,, ~ :f ~.:,~,% i?i!i (~i!?!ii!i:::~H~ ':!':i:i:( ::!:.'::: ' ::i.;'::i'"' ' ::':"CAS #'
, ¥.WT :.::. :':::i!i~'!: :.".':c.! i.,: :::..' '..::':': :? !. I'IAZARDO~S~?~NENT ': '. '~::.:-?'~:c~:~ i:;~:~:',:~[~: .:~"~:. ·
1
226
230
234
238
242 243
.' · ,~ : ." . . IlL SIGNATURE
[]Yes []No 228
225
PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE
SIGNATURE
229
233
[]Yes IJ--INo 232
r-]Yes[]No 236 237
[--]yes I'--~No 240 241
r-lyes []No 244 245
DATE 246
P:\OES2731.TV4.wpd
DES FORM 2731 (7198)
ADO (~. DELETE r-] REVISE
FFICE OF ENVIRONMErqI ,L SERVICES
1715 Chester Ave., CA 93301 (805) 326-3979
i. FACILITY INFORMATI°N. '-/
BUSINESS NAME (Same as FACILITY NAME ~ DBA - Doing Business AS)
HAZARDOUS MATERIALS INVENTORY
Chemical Description Form
(one form per matetYal l~er building or ama)
Page ~ of ~
201 :
CHEMICAL LOCATION CHEMICAL LOCATION [] Yes [] No 202 1
CONFIDENTIAL (EPCRA)
'"~ACl---~iY~'iD # ~ ~] -1 MAP # (opt~Dna/) 203 GRID # (o;)t/ona/) 204,
'¥ : - .... '*" II. CHEMICAL INFORMATION
CHEMICAL NAME
COMMON NAME
CAS #
205
207
TRADE SECRET [] Yes [] No 206
If Suhjec~ to EPCRA, refer to iinstruc~ions
[]Yes [:]No
lbs. ' . · ' .' :: :i
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
TYPE {~ p PURE [] m MIXTURE [] w WASTE 211
RADIOACTIVE [] Yes [] No 212 CURIES
210
213
LARGEST CONTAINER 215
PHYSICAL STATE [] s SOLID 1-11 LIQUID .,~ g GAS 214
FED HAZARD CATEGORIES [] 1 FIRE E] 2 REACTIVE al~3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216
(Chec~ all that.apply)
UNITS' [] ga GAL ~ cf CU FT [] lb LBS [] tn TONS 221 · If EHS, amount must be in lbs.
DAYS ON ~TE
STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] 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 [] 11 SILO '~1 CYLINDER [] p TANK WAGON
STORAGE PRESSURE [] a AMBIENT 41~aa ABOVE AMBIENT [] ba BELOW AMBIENT 224
STORAGE TEMPERATURE .J~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225
226
230
234
238
242
PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE
227
231
235
239
243
IlL SIGNATURE
SIGNATURE
[]Yes []No 228
[]Yes []No 232
[]Yes[]No 236
[]Yes []No 240
[]Yes []No 244
229
233
237
241
245
DATE 246
OES FORM 2731 (7/98) P:~OES2731.'r~4.w~d