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Home My WebLink AboutBUSINESS PLAN S~I TE/FACI LI TY D FORM 5 R~ NORTH SCALE: BUSINESS NAME-:~-.. ' DATE: ~// /F~FACIL~TY N~E: UNiT :: (CHECK ONE) SITE DIAGR:kY / FACILI~ DrAGR.%~ i( Inspector's Comments) -OFFICIAL USE ONLY- - 5A - JOE HOBBS AUTO REPAIR SiteID: 215-000-000783 Manager : Location: 1100 SACRAMENTO ST City : BAKERSFIELD BusPhone: Map : 103 Grid: 29A (805) 322-7933 CommHaz : Moderate FacUnits: 1AOV: CommCode: BAKERSFIELD STATION 02 EPA Numb: SIC Code:7538 DunnBrad:95-3268753 Emergency Contact / .Title JOE HOBBS / OWNER Business Phone: (805) 322-7933x 24-Hour Phone : (805) 366-3708x Pager Phone : ( ) - x Emergency Contact / Title JIM DOSER / Business Phone: (805) 322-7933x 24-Hour Phone : (805) 324-0745x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Agency-Defined Topic Title ~ Hazmat Inventory --- MCP+DailyMax Order. OLVENT - MINERAL SPIRI F DH L F DH L One Unified List Ail Materials at Site I Unit MCP Daily~ax ~150 G~ Low ~-~-~ , · 1 06/10/1997 BAKERSFIELD September 13, 1994 Joe Hobb's Auto Repair 1100 Sacramento Street Bakersfield, California 93305 Dear Owner: Our office has notified you on several occasions that your hazardous materials account is seriously past due. You have failed to make payment or to make and keep any payment arrangements. The City of Bakersfield hereby demands payment in full on account HM425801 in the amount of $263.41. Payment must be received in my office within ten (10) working days of your receipt of this demand. Failure~ to make payment within the ten working days will force the City of Bakersfield to commence legal action against you. If a judgement is granted you will be held liable for the amount of the suit plus court costs plus interest at 10% until such time as the judgement is satisfied. Respect ull~ .× Drew Sharpies Financial Investigator City of Bakersfield · Treasury Division · P.O. Box 2057 · Bakersfield · California - 93303 04/21/92 JOE HOBBS AUTO REPAIR 215-000-0( Page ~-~AY 18 1992 Overall Site with 1 Fac. Unit General Information 1 Location: 1100 SACRAMENTO ST Community: BAKERSFIELD STATION 02 Map: 103 Hazard: Moderate Grid: 29A F/U: 1AOV: 0.0 JOE HOBBS OWNER (805) 322-7933 x (805) 366-3708/ JIM BO~..- D~C~ (805) 322-7933 x (805) 324-0745/ Administrative Data Mail Addrs: 1100 SACRAMENTO ST D&B Number: 95-3268753 City: BAKERSFIELD State: CA Zip: 93305- Comm Code: 215-002 BAKERSFIELD STATION 02 SIC Code: 7538 Owner: JOE HOBBS Phone: (805) 322-7933 Address: 3507 JEAN ST State: CA City: BAKERSFIELD Zip: 93306- Summary ."-'~,~, .f'- ~c,~o/~ Do hereby carllfy that I have I, (T~ Or ~r~n~me) ' reviewed 'the attached hazardous materials manage- ment plan for_~ H4~ ~ L,'~o ~,3~d~at it along with (Name of Business) : any corrections constitute a complete and correct man- agement plan for my facility. 04/21/92 JOE HOBBS AUTO REPAIR 215-000-000783 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 WASTE MOTOR OIL · Fire, Delay Hlth Liquid 150 Low GAL CAS #: 221 Form: LiqUid Daily Max GAL 150 Storage DRUM/BARREL-METALLIC Type: Waste -- Conci Components 100.0% IWaste Oil, Petroleum Based Trade Secret: No Days: 36~ Use: WASTE Daily Average GAL I Annual Amount GAL -- I 55.00 150.00 Press T Temp ' Location AmbientlAmbientlW OF BOUNDRY LINE MCP --~List 02-002 CLEANING SOLVENT - MINERAL SPIRITS · Fire, Delay Hlth Liquid 55 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Pure .Days: 365 Use: CLEANING Daily Max GAL I Daily Average GAL 30.00 Annual Amount GAL . 55.00 Storage DRUM/BARREL-METALLIC Press T Temp Location IAmbientlAmbientlSW CORNER INSIDE -- Conc 100.0% IMineral Spirits Components MCP ...[List Moderate~ 04/21/92 JOE HOBBS AUTO REPAIR 215-000-000783 00 - Overall Site <D> Notif./Evacuation/Medical Page <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL NOTIFICATION <3> Public Notif./Evacuation NONE LISTED <4> Emergency Medical Plan' NEAREST HOSPITAL 04/21/92 JOE HOBBS AUTO REPAIR 215-000-000783 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page <1> Release Prevention STORE IN BARRELS <2> Release Containment WE WOULD CONTAIN BY USING ABSORBANT MATERIAL <3> Clean Up WASTE OIL - DRY ABSORBANT MATERIAL SOLVENT - MOP WITH MOP & BUCKET, PUT IN ANOTHER CONTAINER <4> Other Resource Activation 04/21/92 JOE HOBBS AUTO REPAIR 215-000-000783 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - NORTHWEST CORNER OF BUILDING C) WATER - NORTHWEST CORNER OF ALLEY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Pr°tec./Avail. Water PRIVATE FIRE PROTECTION - 5 FIRE EXTINGUISHERS FIRE HYDRANT -OUTSIDE FRONT DOOR <4> Building Occupancy .Level 04/21/92 JOE HOBBS AUTO REPAIR 215-000-000783 00 - Overall Site <G> Training Page <1> Page 1 WE HAVE NO EMPLOYEES ONLY MYSELF AND MY WIFE WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE <2>.Page 2 as needed <3> Held for Future Use <4> Held for Future Use Io~717/'~} JOE HO~S AUTO REPAIR 215-000-000~83 Overmll Site with I Fmc. Units Page Ger, eral Ir, format ion Location: 1100 SACRAMENTO ST Map: 103 Moderate Ider, t Number: 215-000-000783 Grid: 29A Area of Vul: 0.0 Cor, tact Name Title I Busir, ess Phone ~ 24 Hour P~c,r~e] JOE HOBBS I (805) 388-7933 x I(805) 366-~708I Admir, istrative Data IlO0 ~~~ ~'~ D&B Nurnber: State: ~ Zip: SIC Code: Mail Addrs: City: ~-'~~E GeoSubDiv: 2 RSFIELD STATION (:)2 Owner: JOE HOBBS Phor~e: (~0~) Address: 35(:)7 JEAN ST State: CA City: BAKERSFIELD Zip: 93306- Summary RECEIVED 2 3 1990 HAZ. MAT, JOE H~S AUTO REPAIR 215-000-00~3 Haz~nat Ir, ventory List ir, Referer, ce Number Order 02 - Fixed Containers on Site Page 2 02-001 WASTE MOTOR OIL ? 200 Low GAL 02-002 CLEANING SOLVENT - MINERAL SPIRITS ? 55 GAL Moderate JOE H~ AUTO REPAIR 215-000-00~3 O0 - OYerall Site <D> Not i f. /Evacuat ior,/Medical Page <1> Ager, cy Notificatior, CALL 911 <2> Employee Notif./Evacuation VERBAL NOTIFICATION <3> Public Notif. /Evacuatior, NONE LISTED <4> Emergency Medical Plat, NEAREST HOSPITAL O~/i7 JOE HO~S AUTO'REPAIR 2_15-000-00~)~Z83 00 - Overall Site Page 2 <E> Mit i gat ic, r~/Prevent/Abatemt <1> Release Prevention <2> Release ContairJmerlt <3> ClearJ Up <4> Other Resource Activation 1 '7/~0 JOE HOWS AUT° REPAIR 215-000-00~ O0 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Ut ii ity Shut-Offs A) GAS - NONE B) ELECTRICAL - NORTHWEST CORNER OF BUILDING C) WATER - NORTHWEST CORNER OF ALLEY D> SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water pRIvm-E FIRE PROTECTIO~ - ?????????????? FIRE HYDRANT - ?????? ~)~/-~$~ ~p~ ~)~ <4> Held fc, r Future use JOE H~S AUTO REPAIR 215-000-000~83 O0 - Overall Site <G> Trair~ing Page <1> Page'l WE HAVE NO EMPLOYEES ONLY MYSELF AND MY WIFE WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY of BAKERSFIELD Far- and aqriculture ~ Standard eus,..s ~-~ I-IAZARI:)OUS NON--'ITRADE SECRETS ' Page BUSINESS NAME: ~, OWNER NAME: '~.J~"~' NAME OF T~ FACILITY: LOCATION: J/~,/),.'~',~7('~,~7,71/~/,/..~/-C~ ..~ ' ~S~7 ~Oq STANDARD IND. CLASS CODE CITY, ZZV:.~ff~(~/~/~- ff~, ~ ~ ~ CITY, zze:~ff&ff~/~/~ C~, P~ DUN AND BRADSTREET NUMBER PHONE l: ~/ ~,g~ PHONE l: _~ ~ ~ f~~fO~ ~ ~O~ ~O~ C~e C~e ~t ~t ~ Est ~n*ts m Site I~ ~s Tm ~ .. St~ Iff F~tllty~- ~ I~t~tt~ ............... (C~k ~11 t~t a~ly) ~,. r-~ ~-~ r- r-~ ~t ~lth of P~ ~lth ~ ~t 13 (C~, ," tat lOp'y) :. With Of ~m Ml~h P~lcal ~ Mlth ~za~ C.A.S. ~ ~t (C~k ell t~t apply) ~ Flee HizaPd [ ~ n~ct*vtty ~--d hle~ [ ~ ~ Relme[ ~ I~tite Hfllth of P~suq ~lth P~Jcal ~ H~lth ~zl~ C.A.S. ~ ~t II (C~k all t~t a~ly) - r--~ ~--~ r-- ~ r--~ Cat ~ ~ Ftee Hezaed ~--J ~tJv~ty ~la~ L_a ~dd~ Reline ~_a I~tete H~lth of Pr~sure Health . ....... .............. ~[1~ .............. ~I'~F'~ ........ Certtfication (Read and sJKn after coepJetJn£ aJJ sections) I c,r't~fy~ under ammlty of la, t~t I ~ve ~vs~ellyexamJn~ ~d am f~ilJir vtth t~ tnfor~t~ su~Jtt~ ;tn this ~ II1 IttK~ ~ts. ~ t~t ~s~ ~ ~ ~ ':'/'~"~ ~'~': MATERIAL SAF DATA· SHEET : · Dear Customer, ' ,. .... You are probably aware of recent developments'regarding worker "Right-to-Know" laws and the 'OSHA Hazard Communication Standard.' While these laws and the OSHA . ~ 'Standard have numerous r~qui[~ments, the development of a Material Safety Data .- . Sheet and ~ts d~ssemmat on to [he purchaser of the chemical-product are among .the :~" , principal,means of achieving an effective hazard communication program and of satisf- · "' ':~.' ~:"ying the Right-to,Know need. For the MSDS to. serve its purpose as an effective means ' ='" 'of hazard cSmmuni~'~tion, the information contained therein must be passed along to "" "all. those wh'b haqdJe or use the product and/or are involved with the design, implemen- ' '"~a.t[~9~ofme~t'~o[~of..~p~e~tJLO~'s~.~.v~l~g thelprod~t. ~.~ogly~u,ge you to forward . the 'MS D~.t~ell~ R~ie~ W. hO~h~ye~a~Beed~.fo~th~ i~fo~m:~o~,~contained, thereto. ..,:~ EMPTY ' CONTAI N EB~..WARN I NG "~"~mPty'' containers,retain residu'e (liquid and/q~ vapor) an~ c~n ~ ~apg~rous. DO NOT "~' ':?~EssURi~E,, CUT',.,:WELD, ~ BRAZE, SOLDE~"~R"I~E, ~'~Ri~'~dR~' 'EXPOSE SUCH =. ~:~:~:,~AINERS~ TO. HEA~f FLAME., sPARKS OR OTHER SOURCES OF IGNITION; ~.-~..'THEY.MAY~E. XP~ODE A. ND CAUSEI.NJURY OR DEATH. Ali precautions detailed on ~. ?~?:~(h~'.:contain~r la~ei a'ppl'i'~s . '[.~:.~:~J:~'n~s'nce residu~" S,diffic~ t to re'~ "~t~"' dru:ms's~'ul~ ~ ~ompietely drained 3 ~:,~, ~D:pe[~closed~ and ro~htly returRed to a' drum re~ond t Drier to be .commerc al y · :,,,~..~ . .. . :.P .~.... , ,.. ,. · . . . '.'~'~,." cleaned .A . other cos~iner~ shou d be disposed.of n an environmentally ~afe manner and in accord~'6:~g¢~n.~en~:¢E~,gul&~r~Dr work on tanks refer to Occupa- '"~ tal and industrial feferences,p~.daj~iog ;t~¢~¢~q~g~,;(ep3ir,iqg;,w¢l,~i,sg;,or 9thef.,.® :templa~ed operations. '"When a Lu~n'¢ :~'i~t'f~b :Cb~¢any:~product is resold in the original container with an oHgin'atT~l~el~]h'6~[~s~l[err'ha~?'res¢oH~ibili~y:fbred¢flring .that the proper Material Safety' Data Sheet is provided to its purchaser. ?. ;Although:the,~information and.recommendations set forth herein (hereinafter "lnforma- .Presented id good'faith and believed to be correct as of the date hereof, Lubricating Specialties;Gbmpany makes no re.Pres~ntat~ons as to the completeness or accuracy thereof. Information is supplied upon the condition that the persons receiving ~'~same~d .~ake the~rowndeterm~nat~onas to ~ts..saf~ty~and suitability for their purposes :...~ ?pr~or;~*'use. In no event wdl Lubrmahng Spec~alt~esl:Company be responsible for ;.;~'~,;~,~',~.da~age~ 0fa~y"na~u~h~ats0ever resultingfrom the use or reliance upon information. NO ,REPRESENTATIONS ORWARRANTIES, .EITHER EXPRESSED OR IMPLIED, OF ~ MERCHANTABILITY, ~E[~NESS FOR APARTiGUEAR PURPOS.E OR~'GP~ANY OTHER '~::. '.:.;.. NA~UREARE..MADE~.HEREUNDER WI.TH RESPECT TO INFORMATION OR THE .,~ '-;~' PRODUCT'TO'WHIC~ (This M.SpS co~p[i,es ~,tb, 29CFR 1910.1200) .. [ub~caling Sp~iallles Company . CHEMTREC 24 ~R. EMER~H~{~NO. T:800~24:93~'~ :, " .MATI ilAL SAFETY DATA SleET (Essentially similar to Form OSHA-20) ~Complies with 29CFR 191'0.1200~ CODE NUMBER: H83~ DATE TRADE NAME: flZNERRL SPIRITS SUPERCEDES CHEMICAL FAMILY: ~ C.A.S. NO.: '~[~' TSCA INFORMATION: ~ ~ COMPONENTS C.A.S. TLV/PEL PERCENT BY NOS.: PPM mg/m~ WEIGHT~OLUME · IS ~T ~I~ ~ ~~ D ~T ~ ST~I · ~. DI~_~ ~ HAZARD.OUSTHERMAL DECOMPOSITION ' 'FLAMMABLE LEL-- UEL EXTiNGuisHiNG =, ., F~SH POINT: ~ ~) MEDIA: ~ Ol~l~ ~ ~I~ ~0 o C (10~° ,:~:~,_.~ ~ DOT INFORMATION: ~.~ ~rl~ U~I~, ,.0.S. UNUSUAL' FIRE AND EXPLOSION~HA~RDS: ~~.. ~ ~ ~~ ~ ~IF ~'T0 ~ ~ I~ITIM. SPECIAL'FIRE FIGHTINGPROCEDURES: ~ ~ ~ ~ ~ ~ BOILING.RANGE: [~Se ~ SOLUBILITY: ~ PH: VAPOR PRESSURE: ~ ~ APPEARANCE AND ODOR: ~ ~I~ 2~ °c SPECIFIC WEIGHT % VOLATILE VAPOR DENSITY EVAPORATION RATE GRAVITY PER GALLON BY VOLUME . ~IB THAN AIR ~ 'THAN ETHER' 0.~ 6.~ INCOMPATIBILITY ~MATERIALS TO AVOIDS: ~T~ O~l~lZl~ ~ STABILITY: CONDITIONS TO AVOID: HAZARDOUS DECOMPOSITION PRODUCTS: HAZARDOUS POEYM~RI~TION ~, / ~UPRTZONRL EXPOSURE L[H~ ADVERSE FIRST AID EFFECTS: PROCEDURES: NFPA ..... ~ISIMIIIIM. I~IIL ~ 00 '~! IIeIICE J~01III'IIIG J COI~LT PHYSICIItll N G I DIZZIIES$: RESPIIMTOiW ddD ~ ~.A. APPLY ~RTIFICI~ N CONSULT PHVSIClM E C OF gRIBt. IF INtlIR~I~I ¥ 0 ~ Q]II$~? I~$1CI~II EN A S C IM C~9S~ ~I# IRRIT~TI~. tLqSR #ITH $O~P ~ND I~l~lt. c K 0 CONSt~! PHYSIClM IF~ · U I N IRRITItTIM OR TN E IILI~L~S. 0 N gin I~ITATI~ ~ I~ ~T ~ICI~.':,IF~* N MTIM. ~ ~I~ I~IT~TI~ M I~I~ J ~ISTI~ ~IN DI~ ~S. STEP$ TO BE TAKEN IN CASE MATERIAL 15 RELEASED OR $PlLLED: Sf~ ~B ~ ~ ~ ~ ~l ~ IBIfl~. IN ~IR~ ~RI~ ~Y ~ ~S ~ I~ITI~ ~ 0I~. WASTE DISPOSAL METHOD: IN ~ ~I~ L~ STR~ ~ ~ ~TI~ ~I~ ~ ~I~ TRANSPORTATION INFORMATION: ~.~I~ LIef0 ~ 4~ ~ ~.~ ~ T0 ~1~ III ~ ~IS ~ F~ ~Itl~ ~TI~ ~I~ ~lg. RESPIRATORY PROTECTION: ~ ~y ~l~ IF ~ IS ~T ;. PROTECTIVE GLOVES: ~~ EYE PROTECTION: OTHER PROTECTIVE EQUIPMENT: ~]~Y ~IST~T ~ ~ ~ ~~. VENTILATION: ;l;l~ 10 ~I;RI~ R~ ~ ~0 LI~IT PRECAUTIONS TO BE TAKEN ~HEN HANDLIN6 OR STORING: ~I0 S~E ~ ~ ~ ~ ~ ~S ~ l~ITl~. ~I~ ~ISYI~ ~Y ~ ~I~ ~. ~ ~ ~I~. OTHER P~HCAUTION$: ~ ~T~ ~ IF~,.~ ~_~. ~ OIL- APPROVED BY: ~XCHR~ J. [8[~H~DT DATE: Ill LgBORRTO~¥ flRhAG£~ T (t,vDe or prin% name) Do herebi certify that I have revie~,-ed the attached Hazardous Haterials business plan for (name of business) RECEIV;D HAE. MAT. and that it alon~ with the attached additions or corrections consti~ ~ ~u~e a complete and correct Business Plan for my facilit.v. sl,~na%ure mane '~'-BUSINESS NAME JOE H AUTO REPAIR LOCATION t1(~ SACRAMENTO ST ID NUMBER 21S-000-~783 HIGH HAZARD RATING 1. OVERVIEW JURIS COOE MAP PAGE 103 LAST CHANGE tl/04/88 BY VAL Z1S-OOZ JURIS BAKERSFIELD STATION 02 GRID 29A FACILITY UNITS 1 HAZARD RATING 3 RESPONSE SUMMARY ZA SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC JOE HOBBS '- 322-7933 OR 366-3708 UTILITY SHUTOFFS ZR SEC R) GAS - NONE B> ELECTRICRL- NW CORNER OF BLDG O) SPECERL - NONE E> LOCK BOX - NO C) WATER - NW CORNER OF ALLEY CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE I 12/28/88 t2:29 MATERIAL SAFETY DATA SYSTEMS, INC. (805) G48-G800 BUSINESS NAME JOE HOBBS AUTO REPAIR LOCATION 11OO SACRAMENT0 ST 3. HAZ MAT TRRININO SUMMARY ID NUMBER Z 15~0~-00~785 HIGH HAZARD RATING LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > LOCAL EMERGENCY MEDICAL ASSISTANCE LAST Ct"IRNGE 11/04./88 BY VAl. SEC S) NONE PAGE Z 1Z/Z8tA8 IZ:ZB MATERIAL SAFETY DATA SYSTEMS. INC. <80S) 648-6800 · BUSINESS NAME JOE AUTO REPAIR LOCATION 11~ SACRAMENTO ST FACILITY UNIT O! ID NU~R HIGH HAZARD RATING R. OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 11/04/88 BY VRL IO TYPE NAME MAX RMT UNIT HAZARD LOCATION CONTAINMENT USE WASTE WASTE MOTOR OIL W OF NW CORNER ID PERCENT COMPONENTS 15~8.~(~.1(z~,0 WASTE OIL 2~ SRL DRUMS OR BARRELS MET.. WRSI'E UNKNOWN HAZARD LIST UNKNOWN PURE CLEANING SOLVENT - MINERAL SPIRITS SS GAL S SIDE INSIDE BLDG DRUMS OR BARRELS MET.. CLEANING ID PERCENT COMPONENTS ~ZO3.O? 1~.0 MINERAL SPIRITS EXTREME HAZARD LIST EXTREME B. FIRE PROTECTION / WATER SUPPLIES 3A SEC 4) NONE 3R SEC 5) NONE LAST CHANGE 11/04/88 BY VRL 1Z/Z8/G8 1Z:Z9 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NRME JOE HOBBS RUTO REPAIR LOCRTION 11~) SRCR~MENTO ST D. EMPLOYEE NOTIFICATION / EV~CUSTION ID NUMBER 215-0~-000783 HIGH H~ZRRD RATING LRST'CHANGE 1t/0~/B8 BY VRL 3R SEC Z) NONE E. MITtGRTION / PREVENTION / RBRTEMENT LRST CHRNGE 1t/04/8B BY VRL SEC 1) NONE PRGE 4 IZ/ZB/88 1Z:Z9 MRTERIRL SRFETY ORTR SYSTEMS, INC. <80S'> B48-G800 CITY of BAKERSFIELD "~4'£ C.4 RE" FIRE DEP~RTMENT = ,,-' ~ ~,T-3EET O S NE-ZDH~M ._=,~KEFSFiE~.C 93,301 F!RE ,S'~EF 32~-39', ~ Dear Business Owner: Enclosed Dlease find a copy of your response to the Hazardous Material Management Plan (HMMP) request. We have found it necessary to reject your plan for the following reason(s) as checked below. ~--~ Illegible Management PLan (please print or type information) . Section(s) ~~ ~~J of HMMP incomplete. Inventory Missing or ~--~ Incomplete. Diagram ~--~ Missing or Incomplete. This is to be corrected and resubmitted within 30 days to: City of Bakersfield, Fire Department Hazardous Materials Division 2130 G Street Bakersfield, CA 93301 If additional coDies of any forms are needed they can be picked up from the Hazardous Materials Division at 2130 G Street in person. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 BUSINESS N~ME OFFICIAL USE ONLY ID~ HAZARDOUS lVLIkT E R I ALS BUSINESS PLAN 2Al A WHOLE FORM 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 IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: //Od~ ZIP: F~(~_~' BUS.PHONE: 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 1-91B-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: NAME AND TITLE A. Ph# DURING BUS. HRS. AFTER BUS. HRS. Ph~ Ph~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE B. ELECTRICAL: /~"a~MA -- fL?~{~5'7~ ~_~-~F'~ 0 ~ ~:~/~]/Z~'~ D. SPECIAL: E. LOCK BOX: YES ,("~0~ IF YES, LOCATION: IF YES, DOEs IT CONTAIN SITE PLANS? YES / NO MSDSS? FLOOR PLANS? YES / ~0 KEYS? YES ,/ NO YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHIUM ~o9'ioES EM?LGYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. · CIRCLE YES OR NO A. METHODS FOR SAFE HANDLING OF HAZARDOUS .MATERIALS:.... .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU ,MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO INITIAL REFRESHER SECTION 7: HAZARDOUS I~ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS ,MATERIAL IN QUANTITIES LESS THAN 500 POUN_,~F A SOLID,~..-5 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... { YESj NO I, ~/;3_~ I.~-- , 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. - 2B - BAKERSFIELD CITY FIRE DEPARTMENT "'~' I.D. # FORM 4A-1 Page / NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY ADDRESS:_ //(p~ ,5/r'~..),'~'~gmd,~?~O ._~7~.' ADDRESS: ~d~ ~.~ Y~ FACILITY UNIT NAME: PHONE ~:_ ~-df.~ PHONE ~: ~-~6~ OFFICIAL USE CFIRS CODE { ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD ~D.0.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT, CHEMICAL OR COMMON NAME CODE GUIDE ! I NAME: TITLE: <:~_~C/~ SIGNATURE: DATE: EMERGENCY CONTACT: ~,t~: ~PHO{E # BUS HOURS: AFTER BUS HRS: EMERGENCY CONTACT: TITLE: [. ~ PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: zz~'/~ .,,~)~ AFTER BUS HRS: 4A-1 - CITY of BAKERSFIELD RRE DEPARTMENT [~ .--'-~ ~I'.~ 2101 H STREET O. S. NEEDHAM ~ BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Dear Business Owner: Enclosed please find a copy of your response to the Hazardous Material Business Plan request. We have found it necessary to reject your plan for the following reason(s) as checked below. Illegible Business Plan (please print or type information in English). Form 2A ~ Missing or F--l Incomplete Form 3A ~sing or~ Incomplete '~.¢p~- Form 4A ~ Missing or.Incomplete -M~' Form 5A O~ I~C~/eNe - ~l~e~ Site Diagram ~ Missing or ~ Incomplete Facilities Diagram ~-i Missing or[---[ Incomplete This is to be corrected and resubmitted within 30 days to: Bakersfield City Fire Department Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 If additional copies of any forms are needed they can be picked up from the Hazardous Materials Division at 2130 "G" Street in person. Sincerely Yours, /Ralph E. Huel~ ' [ Hazardous Materials Coordinator REH/eg