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Home My WebLink AboutBUSINESS PLANCUST MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT FINANCE CHARGEi OTHER ADJ CUSTOMER NAME MAILING ADDRESS · ~C STATE SITE ADDRESS ZIP CODE PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT CHG DATE CHARGE CODE ADJUSTMENT AMOUNT ,? CITY OF BAKERSFIELD P~.~ ~0~ 2057 BAEERSFIELD, CA 93303-2057 iL J: (661 iSAiAHS & ORS AUTO REPAIR 632 DR MARTIN LUTHER KIND BAKERSFIELD, CA 93~04 DATE: 3/i5/04 NO' 469~4/56434 TYPE: ES -.ENVIRONMENTAL SERVICES DATE ~==~=IPTION' R~, ,4UMBER DUE DATE TOTAL AMOUNT HMO18 SSO0! 3/0i/04 BEgiNNiNg ~ALANCE 3/15/04 SM ~UANTITY HAZ WASTE gEN THIS FEE IS FOR SMALL ~UANTITY gENERATORS OF HAZARDOUS WASTE. 3/15/04 CA STATE SURCHARGE 58. O0 24. O0 ANNUAL HAZ-MAT BiLLiNg FOR FISCAL YEAR 7/01/03 THROUGH 6/30/04-IF RECEIVED IN ERROR CALL 326-3658 CURRENT DUE DATE: 4/14/04 OVER 30 OVER 60 OVER 90 PAYMENT DUE' TOTAL. DUE' 82.00 $82.00 DATE:' 3/15/04' CUSTOMER NO' 46~24/56434 REMIT AND MAKE CHECK PAYABLE TO: CiTY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD CA 93303-2057 (661) 3~-3~58 TOTAL DUE: $82.00 ~ CITY OF BAKERSFIELI~ ' . ' !" OFI"I'CE OF ENVIRONMENTAL S~tVICES ' "~iill !/"~-~'~L 1715 Chester Ave., CA 93301 (661)'326-3979 · .... -- _ ~~'~6~FACILI~INFORMaTION ' · ~BUSINESS NA~ (Same as FACILI~ N~E or DBA- Doing Business ~) -- -- 3 BUSINESS PHONE ~02 SITE ADDRES~ B~DSTREET " COUN~ . '~o8 OPE~TOR NAME ~ ~ OPE~TOR PHONE ~o ~6~f~,~:[~:~-~.~:::.~',''~ L: :2~7. ,~ ,~z~ :,~4~;~;~' '5~-~-~f~'~,"'r~c~;~:.~';~<~'~ ~-~:~'~ ,~;~:~-,,~ .... -~.~,,. ~'~, ~,~ . .~-~. ~ OWNER ~ILING CONTACT ~ILING 119 129 : 130 [ 131 132 133 i Certificalion: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. TITLE OF. OWNER/OPERATOR NAMES OF OWNER/OPERATOR (print) 136 137 UPCF (7/99) : '. S:\CUPAFORMS\OES2730.Tv4.wpd CITY OF BAKERSFIELI~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~' ~ HAZARDOus MATERIALS MANAGEMENT~PLAN Section I1.1 - DISCOVERY AND NOTIFICATIONS .... ,- * ~* ,':~>~:~:'~-:.~}~:~:,~?;:~ 1. FACILITY BUSINESS ~E (~me as FACIL~ NAME or D~ - ~ ~ ~) ADDRESS (For local use only) 476. FAclLFF~'I~'~,, 'A.' LEAK'DETECTION AND MONITORING PROCEDURES: EMERGENCY AND AGENCY NOTIFICATION PROCEDURES: C. SPECIFIC RESPONSIBILITIES OF EMPLOYEES: CLOSEST LOCAL MEDICAL FACILITY: 0.. L./M/c: S:'~PROC~:OURE MANuAL~Iew HMMp form.wp~ UPCF (7/99) .: . ' · Section 11.2 - RELEASE RESPONSE PLAN B. RELEASE coNTAINMENT AND MITIGATION: ~--~(__~ C-~/~J'~'"~ O (~/~ ~//~ Z -- C. CLEAN-UP AND RECOVERY PROCEDURES: UPCF (7/~i .S:~PROCEDURE MANUAL~New HUMP foml.v4xI HAZARDOUS MATERIALS MANAGEMENT PLAN Sectionlll.1 - FACILITY AND LOCALITY INFORMATION LOCATION OF SHUT-OFFs AT YOUR FACILITY: WATER: SPECIAL: LOCK BOX: YES ·~)· IF YES, LOCATION: ko Bo A. NUMBEROF EMPLOYEES: CERTIFICATION · Based on my inquiry of tho~e individuals resp~b~e f~ obtaining the info~matioa, I cerafy ur~der penalty of law Ihat I have pemonnaly examined .and am familiar vath Ihe Infom~)n ~tted and IN~ieve the Informatioa Is true, accurate, and co~te. 478· 479. NAME OF SIGNER TITLE OF SIGNER uPc~ CITY OF BAKERSFIELI~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester. Ave., CA 93301 (6'61) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material per building or areal [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ BUSINESS ~ME (same as FACILI~ ~ME ~ DBA - ~ng Busin~ ~) 3 . CHEMICAL NAME MAP tt (optional) 203 ] GRID # (optional) 202 204 TRADE SECRET [] Yes [] No 206 If Subject to EPCRA, refer to instructions 207 ' FIRE CODE H~RD C~SSES (~plete ~ ~u~ by I~1 fire ~i~ 2~0 ~PE D p PURE ~ m ~RE ~ w WASTE 211 i ~DIOA~IVE ~Y~ ~No 212 ~ CURIES- 213 PHYSICAL STATE OS SOLID i'~l LIQUID 214 1~'~I';ARGEST-CONTAINER j ,~ ~ & ~ 2'15 FEDH"~ZARD CATE~RIES [] 1 FIRE []2 REACTIVE [:]3 PRESSURE RELEASE ~--]4 ACUTE HEALTH [--15 CHRONIC HE. ALTH 216 (Check ail that apply) UNITS* [] ga GAL [] cf CU FT [] lb LBS E] in TONS,{ · If EHS, amount must be in lbs. 221 DAYS ON SITE 222 STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTrLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BO"CI'LE [] r OTHER [] C TANK INSIDE BUILDING [--[ g CARBOY [] k BOX' [] o TOTE BIN [] d STEEL DRUM [] h' SILO [] I CYLINDER [] p TANK WA~N STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE E] a AMBIENT [] aa ABOVE AMBIENT [] be BELOW AMBIENT [] ¢ CRYOGENIC 225 '. ~ !!: . .~' -'-'~i~'~,~, .- 1 226 227 [] Yes [] No 228 229 2 230 231 [] Yes' [] NO 232 233 3 234 235 E~ Yes [] No 236 237 4 238 239 [] Yes [] No 240 241 5 242 · 243 [] Yes'[] No 244 ~ 245 Iii, SIGNATURE PRINT NAME & TITLE OF' AUTHORIZED COMPANY REPRESENTATIVE SIGNATUR~ . DATE 246 UPCF (7/99) - · S:\CUPAFORMS\OES2731 .TV4.wpd CITY OF BAKERSFIELI~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 9330,1 (661) 326-3979 ~HAZARDOUS MATERIALS INVENTORY· CHEMICAL DESCRIPTION -. (one form per material per bu#riing or area) [] NEW [] ADD [] DELETE [] REVISE '200 Page __ of __ . BUSINESS ~ME (Same as FACILI~ ~ME or DBA - ~n~ Busin~ ~) 3 f CONFIDENTIAL (EPC~) FACILI~ ID ~ :. i ~:t~], ,'~ ,J [~":[%~}~ i Ji I I ~P 8 (opt~naO 203 j GRID ~ (op:t~naO ":'7:' >-:-~;'>':~:~' ',~:~,~'- .'?';, ::: ~' '~:.: "II. CHEMICAL INFORMA~N,B~: ',: 4-': '. t ', CHEMICAL NAME 205 ! TRADE SECRET [] Yes [] No 206 If Subject to EPCRA. ret'er Io instructions COMMON NAME [] Yes [] No 208 207 [ I EHS* CAS Cf FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE r-] p PURE [] m MIX-PJRE [] w WASTE 211 i RADIOACTIVE r-]Yes ['~No 212 i CURIES 213 [] s SOLID r-Il LIQUID [] g GAS 214 i LARGEST CONTAINER 215 PHYSICAL STATE FED HAZARD CATEGORIES I--J1 FIRE r-'J2 REACTIVE J-13 PRESSURE RELEASE r-J4 ACUTE HEALTH F-15 CHRONIC HEALTH 216 (Chect( all that apply) DAYS ON SITE 222 UNITS' [] ga GAL [] cf CU FT [] lb Las [] tn TONS 221 · If EHS. amount must be in lbs. STORAGE CONTAINER [] i FIBER DRUM [] m GLASS BOTTLE [] q 'RAIL CAR 223 (Check all that apply) [] a AI~3VEGROUND TANK [] · PLASTIC/NONMETALLIC DRUM [] b UNDERGROUND TANK [] f GAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOvE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT ' ' [] ba BELOW AMBIENT [] c CRYOGENIC 225 · . : ... ......... .,..,.,...,...~.,.~:;,,.~ .,, ,.~.,~,>:,.,~.; ~..? ...... ..~.~,?,: ....... ~>~:~?~!;~,~., ~:.~.,.~.:,.. ,~:~....:,::.....~,. .......;~ ~:. i?.~:~ ~'. %VVT ,, .-. ,? ~ '::,~,' :',¢4":-"':~:~:?::;¥,. HAZARDOUS COMPONENT .,."%:,-,:-:' ,:-~.., . ',-./,.:..? .. ~,~.'" EHS 1 226 227 [] Yes [] No 228 229 2 230 231 [] Yes [] NO 232 233 3 234 235 [] Yes [] No 236 237 4 : 238 239 []Yes []No 240 I 241 5 242 243 [] Yes [] NO 244 I: 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .Tv4.wpd OFFICE OF ENVIRONMENTAL SERVICES · . ~ FII~£ ~ ~ J~rm,~rr 1715 Chester Ave., CA. 93301 (661) 326-3979 .,z,%o'us ' CHEMICAL ~:e~o~"~'~' ' , , ' (one fo~ perma~dalperbuilding ora~a) ~ NEW D ADD ~ DELETE ~ R~ISE 200 Page BUSINESS'NAME (Same as FACILI~ ~ME or DBA - ~ng Busin~ ~) . ' 3 FACILI~.ID # [~j ~ ;:' J ~P¢(op~naO 203 GRIDS(opine0 ' 205 T~DE sECRET B Y~ D NO 206 ?M'-c¢'L?ME ,44 O'T'C:' i COMI~ION NAME Oit 207 CAS # 209 If Subject to EPCRA. refer to instructions EHS* [] Yes [] No 208 · .IfEHS ts~ye~, .,~11 a~ounts below must be:m,lbs,,;.~ [ FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 ! RADIOACTIVE DYes •No 212 t CURIES 213 PHYSICAL STATE [] S SOLID ~ ' LIQUID r-1 g GAS 214 ":"RGEST CONTA,NE. FED HAZARD CATEGORIES [] I FIRE (Check all that apply) ANNUAL WASTE?:. "-~ ~'~ 21 ,,.o,,.,-.- u UNITS* [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4' ACUTE HEALTH [] 5 CHRONIC HEALTH 218 DALLY AMOUNT ' DAYS ON SITE ga GAL cf CU FT lb LBS tn TONS 221 ° If EHS. amount must be in lbs. 222 STORAGE CONTAINER (Check all that apply) r-~a ABOVEGROUND TANK I-'lb UNDERGROUNDTANK []c TANKINSIDE BUILDING r']d STEEL DRUM [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 [] f CAN [] j BAG / [] n PLASTIC BOTTLE [] r OTHER '[-'1 g CARBOY [] k BOX [] o ToTE BIN [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba SELOWAMBIENT [] c CRYOGENIC 225 1 226 227 [] Yes [] No 228 229 2 230 231 [] Yes [] No 232 233 3 234 235 [] Yes [] No 236 237 4 238. 239 [] Yes [] No 240 24'1 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE ' -- DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.Wpd