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Home My WebLink AboutBUSINESS PLAN :oC[ /,'Y/ R][ SITE/FACILITY D I AG RAM iNORTH SCALE: FLOOR: / OF / · (CHECK ONE) SITE DIAORA~ UNIT FACILITY DIAGRAM Comments): -OFFICIAb USg ONLY- Pat Jamieson Manager (~397-4984 LIFECOM-SAFETY SERVICE & SUPPLY CO. "Service is our Middle Name" 6000 "B" Schirra Court Bakersfield, California 93309 Fax: (805) 397-7527 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ Lg O t ~CL ADDRESS ~ ~!~.,~e~v ~c'- FACILITY CONTACT. I,\4<,e_. C~v-o~oe.q INSPECTION TIME qO ,,~,,,. INSPECTION DATE PHONE NO. ~'~ ? - BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES .,, ~5-('~ Section 1: Business Plan and Inventory Program ffRoutine [~l Combined I~ Joint Agency [~ Multi-Agency [~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address v Correct occupancy Verification of inventory materials v Verification of quantities Verification of location / . Proper segregation of material Verification of MSDS availability v/ Verification of Haz Mat training v Verification of abatement supplies and procedures v Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Questions regarding this inspection? White - Env. Svcs. Yes [~o Please call us at (661) 326-3979 Yellow - Station Copy Pink - Business Copy Fire Department M.R. Kelly Acting Fire Chief of BAKER SFIEL. "WE CARE" March 11, 1994 1715 Chester Ave., Ste. #300 Bakersfield, CA 93301 (805) 326-,3979 Ufecom 6110 Valley View St Buena Park, CA 90620 RE: Hazardous Materials Bill HM448301 Dear Sirs: We received your note on your returned bill stating that you are no longer doing business in the City of Bakersfield. We have removed you from the computer and there will be no future billing. However, since you were still in business for part of the billing period and the City of Bakersfield does not prorate, the bill is still due. Thank you for your prompt attention to this matter, your bill is enclosed. Sincerely, Esther Duran Hazardous Materials Division /ed Utilities General Account Maintenance 03/04/94 PUTLS80! Acct Nbr: 448301 Bill Stat: FB Cyc Stat: CL Acct Cyc Stat: CL Transfer-from: Transfer-to: Page 1 of 6 Due: 137.77 2. 4. Service Address: 6000 SCHIRRA CT - STE B 5. Service City: BAKERSFIELD 6. State: CA Customer Name: LIFECOM SAFETY SERVICE & SUPPLY Social Sec Nbr: 3. Telephone: 800-824-5178 20. Water Svc Class: 8. Parcel ID: 9. Bill Cycle: 5 10. Route Nbr: 11. Comments : 12. Prev Acct: HM01069 23. 13. Service Date: 14. Fund no: 15. Billto Adl:6110 VALLEY VIEW ST 16. Billto Ad2: 17. Bill-to City: BUENA PARK 7. Zip: 93309 Misc Services: 23.1 F99 NOT IN BUSINESS 23.2 F99 NOT IN BUSINESS 23.3 23.4 24. Closing Date: 02/09/94 18. State: CA 19. Zip: 90620 Enter Save(S), Cancel(XX), Next. Page(/), or Field # to Change 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Page Overall Site with 1 Fac. Unit A j~ General Information ~ Location: 6000 SCHIRRA CT B 'Map: 123 Hazard: Minimal Community: BAKERSFIELD STATION 09 Grid:'15C F/U: 1 AOV: 0.0 Contact Name PAT JAMIESON MEL TRUBEY Title BRANCH MANAGER Business Phone----F 24-Hour Phone- (805) 397-4984 x ~(805) 765-5309 (805) 397-4984 x/(805) 872-2042 · Administrative Data Mail Addrs: 6000 SCHIRRA CT B City: BAKERSFIELD Comm Code: 215-009 BAKERSFIELD STATION 09 D&B Number: 02-888-7693 State: CA Zip: 93313- SIC Code: Owner: A. L. BARNETT CO. Phone: (805) 397-4984 Address: 1801 OAK ST State: CA City: BAKERSFIELD Zip: 93303- Summary 02/01/94 Pln-Ref LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Name/Hazards Form Max Qty Page MCP 02-002 OXYGEN · Fire, Pressure, Immed Hlth Gas 50 Low FT3 02-001 BREATHING AIR · Fire, Pressure, Immed Hlth Gas 57600 Minimal FT3 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-002 OXYGEN · Fire, Pressure, Immed Hlth Gas 50 Low FT3 CAS #: 7782-44-7 Form: Gas Type: Pure Daily Max FT3 50 I Trade Secret: No Days: 365 Use: MEDICAL AID OR PROCESS Daily Average FT3 [ Annual Amount FT3 -- 25.00I 50.00 Storage Press T Temp Location PORT. PRESS. CYLINDER IAbove ~AmbientlNORTH END OF WAREHOUSE -- Conc 100.0% IOxygen, Compressed Components MCP ~Guide ILow ! 14 02-001 BREATHING AIR · Fire, Pressure, Immed Hlth Gas 57600 Minimal FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 57,600 Daily Average FT3 57,600.00 Annual Amount FT3 57,600.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Above ~AmbientlNORTHEAsT CORNER OF SHOP -- Conc 100.0% lAir Components MCP ---TGuide Minimal I 12 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Page 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IF AN EMERGENCY ARISES (MYSELF) WOULD EVACUATE THE EMPLOYEES FOR THE SHOP BY INTERCOM. WE WOULD ALSO NOTIFY THE NEIGHBORING BUSINESSES THE EVENT TO EVACUATE. I WOULD ALSO CALL THE FIRE DEPT 911 IN THIS EVENT AND POLICE. WE HAVE EMERGENCY #'S POSTED. NO ONE IS.IN THE BUILDINGS IN THE EVENINGS. <3> Public Notif./Evacuation WE WOULD NOTIFY THE NEIGHBORING BUSINESSES THE EVENT TO EVACUATE <'4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371. 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Page O0 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALL OUR EQUIPMENT, MEANING AIR PAKS AND AIR CYLINDER ARE ALL HYDRO TESTED PER STATE REQUIREMENTS. EVERYTHING IS STORED IN A SECURE CASE IN ONE AREA. ALL OUR CYLINDERS ARE KEPT IN A SELF CONTAINED SACK OR ARE CHAINED TO THE WALL WITH ADEQUATE AVAILIBILITy TO THEM FROM TWO DIRECTIONS. ALL OUR AIR IS MONITORED AND CHECKED PERIODICALLY FOR IMPUTITIES. ALL OUR TEST GAS IS KEPT IN A SELF CONTAINED BOTTLE IN ONE CABINET. <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 00 - Overall Site <F> Site Emergency Factors Page 6 <1> Special Hazards <2> Utility Shut-Offs A) GAS - SOUTHEAST CORNER OF BUILDING B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - EAST WALL OF BUILDING D) SPECIAL.- NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON PREMISES. FIRE HYDRANT - IN FRONT OF.THE OFFICE IN PARKING LOT <4> Building Occupancy Level 02/01/94 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Page O0 - Overall Site <G> Training <1> Page 1 WE HAVE 3 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: WE HAVE 1 PERSON TRAINED TO EMT LEVEL. WE HAVE 2 PEOPLE FIRST AID/CPR TRAINED. OUR PERSONNEL ARE ALSO TRAINED IN RESPIRATORY EQUIPMENT AND RESCUE. OUR EMT IS ALSO A RESERVE FIREMAN. ONE OF OUR OTHER INDIVIDUALS IS 40 HOUR TRAINED TO 1910.12 OSHA REG. ALSO WILL HAVE A DEGREE IN HAZAROUS MATERIAL TECH. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 02/01/94, LIFECOM SAFETY SERVICE & SUPPLY 00 - Overall Site <H> RMPP DATA 215-000-001069 Page 8 <1> Release Containment <2> Offsite Consequences <3> In House Capabilities <4> Plant Shutdown Instruction 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 Overall Site with 1 Fac. Unit General Information Page Location: 6000 SCHIRRA CT B Community: BAKERSFIELD STATION 09 Map: 123 Hazard: Minimal Grid: 15C F/U: 1 AOV/ 0.0 / Contact Name DOUGLAS Mail Addrs: 6000 SCHIRRA CT SUB City: BAKERSFIELD Comm Code: 215-009 BAKERSFIELD STATION 09 Title Business Phone ~A~,c~ 1(805) 397-4984 x [ (805) 397-4984 X Administrative Data D&B Number: State: CA Zip: SIC Code: (24-H~r P~Lon~ 02-888-769/ Owner: A. L. BARNETT CO. Phone: (805) 397-4984 Address: 1801 OAK ST State: CA City: BAKERSFIELD Zip: 93303- Summary RECEIVED ,SEP 0 § HA.X_. MAT. DIV, I, _/~ EL, 77E'ue~y Do hereby certify that 1 have (Time er ~m nan.- reviewed the attached hazardous materials manage- ment plan for. ,Z,, ~,~-c, or~ and that it along with (Name or Business) any corrections constitute a complete and correct man- agement plan for my facility. 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 02 - Fixed Containers on Site Hazmat Inventory Detail .in. Reference Number Order Page 02-001 BREATHING AIR · Fire, Pressure, Immed Hlth Gas 57600 Minimal FT3 CAS #: Form: Gas Type: Pure Daily Max FT3 57,600 I Trade Secret: No Days: 365 Use: MEDICAL AID OR PROCESS Daily Average FT3 Annual Amount FT3 57,600.00 I 57,600.00 Storage Press T Temp . Location PORT. PRESS. CYLINDER Above I AmbientlNORTHEAST CORNER OF SHOP -- Conc Components 100.0% lAir MCP iList Minimal 02-002 OXYGEN · Fire, Pressure, Immed Hlth Gas 50 Low FT3 CAS #: 7782-44~7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily'Max FT3 Daily Average FT3 Annual Amount FT3 50.00 Storage I Press T Temp Location PORT. PRESS. CYLINDER IAbove ~AmbientlNORTH END OF WAREHOUSE -- Conc 100.0% IOxygen, Compressed Components i LowMCP i List 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 00 - Overall Site <D> Notif./Evacuation/Medical Page 3 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IF AN EMERGENCY ARISES (MYSELF) WOULD EVACUATE THE EMPLOYEES FOR THE SHOP BY INTERCOM. WE WOULD ALSO NOTIFY THE NEIGHBORING BUSINESSES THE EVENT TO EVACUATE. I WOULD ALSO CALL THE FIRE DEPT 911 IN THIS EVENT AND POLICE. WE HAVE EMERGENCY #'S POSTED. NO ONE IS IN THE BUILDINGS IN THE EVENINGS. <3> Public Notif./Evacuation WE WOULD NOTIFY THE NEIGHBORING BUSINESSES THE EVENT TO EVACUATE <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371. 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 4 <1> Release Prevention ALL OUR EQUIPMENT, MEANING AIR PAKS AND AIR CYLINDER ARE ALL HYDRO TESTED PER STATE REQUIREMENTS. EVERYTHING IS STORED IN A SECURE CASE IN ONE AREA. ALL OUR CYLINDERS ARE KEPT IN A SELF CONTAINED SACK OR ARE CHAINED TO THE WALL WITH ADEQUATE AVAILIBILITY TO THEM FROM TWO DIRECTIONS. ALL OUR AIR IS MONITORED AND CHECKED PERIODICALLY FOR IMPUTITIES, ALL OUR TEST GAS IS KEPT IN A SELF CONTAINED BOTTLE IN ONE CABINET. <2> Release Containment <3> Clean Up <4> Other Resource Activation 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 215-000-001069 00 - Overall Site <F> Site Emergency Factors Page <1> special Hazards <2> Utility Shut-Offs A) GAS - SOUTHEAST CORNER OF BUILDING B) ELECTRICAL - SOUTHEAST CORNER OF BUILDING C) WATER - EAST WALL OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON PREMISES. FIRE HYDRANT - IN FRONT OF THE OFFICE IN PARKING LOT <4> Building Occupancy Level 07/29/92 LIFECOM SAFETY SERVICE & SUPPLY 00 - Overall Site <G> Training 215-000-001069 Page 6 <1> Page 1 WE HAVE-4~ EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: L~)~ /~/~Vf / <2> Page 2 'as needed '~d~ ~ <3> Held for Future Use <4> Held for Future Use Do hereby oert ~ ~" _~,, that I ha-ce reviewe~ the attached for Hazardous Materials name of business business Dian and that it along with the attached additions or. corrections constitute a complete and correct Business Plan for my facility. CITY of BAKERSFIELD CITY, ZIP: ~ ~1~ ~z ~ ~'Z~ CITY, ZIP: .~ff)~ ~d~ q~(.~ DUN AND BRADSTREET frans I~ ~x i~ ~1 ~su~ I ~ Cat ~t ~t ~ L~tt~ ~ ~ ~ [~ C~e ~t ~t Est Units m Site I~ ~s T~ ~ St~ I~ [~tlity~- ~ I~t~ti~ IC~k all t~ ~ly) ~lth of P~ ~lth ~t 13 ~&C.A.S. ~ ..... k l .... ............ l .............. 1 I L.-_._L,_L_LJ_ ..... I P~ical ~ ~lth ~aza~ C,A.S. ~ ~t II ~ i C.A.i. i (C~k all t~t apply) ~lth of ~ ~l~h ~t 13 h&C.A.S. ~ P~ical ~ ~lth ~z4~ C.l.S. ~ ~t II h i C.l.S. ~ (C~k ~11 t~t ~p~ly) ~t 12 lmiC.i.S. ~ ..~__t .......... [ ..... : ...... l .......... J ~ __t--_J_ ! __[ .... l .. _ P~icml ~ H~lth ~tm~ C.A.S. ~ ~t I1 h & C.A.S. ~ (C~k all t~t ~ly) Hfllth of Prfllure Health ........... ~tl] ~ i C.A.5. ~ .......... ..... ......... m~, -~ ........... ~--- ,- - - ., ~ Cmrttficatiofl (Reed and sign after compJet:~ng all sections/ I certtfi~?~nder p~n~lty of law that I have. Dersonmll!f examined end am fHiliir vtth t~ tnforNtim subitt~ tfl t~ ~ Ill lttKi ~ts, ~~m t~tvi~ls m~sJble for obtaining t~ iflf~tim, I ~)ieve tMt t~ sumJtt~ infg~tim isJ~, I~urate, and cmp~ NIGH HRZARO RATING I I. OVERVIEW LRST CHANGE 09/19/88 BY ESTER JURIS CODE ZJS-~X~9 JURIS BAKERSFIELD STRTION OB HAP PAGE 123 GRID IGC FACILITY UNITS I HRZARD RATING 1 n~SPON~E SUMMARY ZA ~EC 4) NO PRIVRTE RESPONSE TEAM. OOUGLAS. UE~TRU~ - ~?-4~84 UTILITY SHUTOFFS ZR SEC 3) R) GRS- SE COF~ER OF BL[~ ~) ELECTRICAL - SE CORNER 0F C) WATER - E WALL OF 8L~ D) SPECIAL - NONE E) LOCK BOX - NO rLJBL,~ EVRCURTION NOTIFICATION / o -~. LRgT CHRNGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PRGE I fZ/IBZB8'09'~SS" MATERIAL SAFETY DRTR SYSTEMS. INC. (8~S) 648-G888 BUSINESS NAME LIFECOM ~ ~' ~FE,~ SERVICE & SUPPLY LOCATION GOQO-B SCNIRRA COURT ID NUMBER WIGH HBZARD RATING ~. HAZ MAT TRAINING SUMMARY !,RST CHANGE / / BY < NO INFORMATION RECORDED FOR TNIS SECTION EMERGENCY MEDICAL ASSIoTA,~CE LAST CHANGE 09/19t88 8Y ESTER 2A ~EC §) MERCY HOSPITAL- ZZIS TRUXTUN AVE - ~L,-~?I.~"'= ~ 12/t~/88 Q~:SS MATERIAL SAFETY DATA SYSTEMS, IN(:, <80S) G48-..G8~ ~F3UQINESS NRME LIFEC RFETY S~r~'rlCE 2, :uPPL: LOCRTION G~'-8 SCHIRRR COURT FACILITY U,.I, ID NUMBER Hl~n H~Z~RO RATING A.'0VERRLL HAZARDOUS MRTERI~LS INVENTORY LAST ~ ~ ~HRN~ 0~I~9/~8 BY ESTER ID TYPE NRME MAX RMT UNIT' &~RZARD LOCRTION CONTRINMENT USE X PURE BRERTNING RIR NORTH ~0 OF WRREHOUSE ID r~RC=N~ COMPONENTS 3313.~ 1OO.~ AIR PORTABLE PRESS. CYL. PURE OXYGEN NORTH ENO OF WAREHOUSE I0 PERCENT COMPONENTS ~~YC~,-COMPRESSEO PORTRBL. E PRESS, CYL. GTGf~ FT3 UN~NOW,~ MEDICAL RID OR PROCESS HRZRRD LIST ~NKNOwN ~ FT3 HIGH MEOICRL RID OR PROCESS · HAZRRO LIST HIGH FiRE PROTECTION / WATER SUPPLIES L. RST CHRNGE ~8/19/B8 BY ESTER SEC 4)r~Inc'=~ EXTINGUISHERS ON PREMISES. SEC G) FIRE HYDRRNT IN FRONT OF THE OFFICE IN'PA~KING LOT. PRGE 3 MA'FERtRL SAFETY DRT/~ SYSTEMS, INC, (8OB) G48-G880 BUSINESS NAME LIFECOM "~Arr-,Y~r'r ~'oERVi~.E' '" ~," SUPPLY LOCATION ~J~O-B SCH!RRA COURT ID NUMBER HIGH HAZARD RATING D, EMPLOYEE NOTIFICATION / EVA~UATION LAST CHANGE ~9/19/88 8Y ESTER 3R SEC 2) IF AN EMERGENCY ARISES (MYSELF) WOULD EVACUATE THE EMPLOYEES FOR THE SHOP BY INTERCOM, WE WOULD ALSO NOTIPY THE NEIGHBORING BUSINESSES THE EVENT TO EVACUATE~ I WOULO ALSO CALL TH~ FIRE DEPT 911 tN THIS~V=NT~'~ ~ND POLICE, WE HAVE EMERGENCY ~'~ POSTED, NO ONE IS IN THE 8L. DG IN THE EVENINGS.- -. E, MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 89/1B/88 BY ESTER SEC ~) ALL OUR EQUIPMENT, MEANING AIR PAKS AND AIR CYLINDER ARE ALl, HYDRO TE~TED PER STATE ~ ' ~ ' . nEQUIR~MENIS, EVERYTHING IS STORED IN~ ~URE CASE IN ONE AREA. ALL OUR CYLINDERS ARE KEPT IN A SELF CONTRINEO S~CK OR ARE CHAINED TO THE WALL. WITH ADEQUATE RVAILIBIL. iTY TO THEM FROM TWO OIRECTIONS, ~LL OUR AIR IS MONITORED AND CHECKED PERIODICALLY FOR IMPUTITIES, ALL OUR TEST GAS IS KEPT IN A SELF CONTAINED 80TTLE tN ~E CABINET, lZ/19788 QB:SS HATERIAL SAFETY DATA SYSTEMS~ INC, (80S) Business Name: Location: Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed RECEIVED Plan ID # 215-000Oq~O0~ (Top right comer Business Plan) Station No. c~ Shift .~ Inspector ~ JUN 9 2 1989 H~-7__. MAT. DIV. Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material ~- Comments: Verification of MSDS Availability Number of Employees Verification of Haz Mat Training ~( [--] Comments: Verification of Abatement Supplies & Procedures Comlnents: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: bloo~ FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office BAKERSFIELD CITY FIRE DEPARTMENT 2130 "O" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# RECEIVED OCT 19 1987 A,,'d ............ 001069 HAZARDOUS MATERIALS 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 IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: ~000 ~ol,~ ~~ ~ C~TY: *~Sm~;~L~ z~: ~33o~ ~US.~HONE: (Fo~) 3?V~W?C~ 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 1-916-427-4341. 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. 'I)o~ ~L~ tde_~z~u~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS.FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B, ELECTRICAL: [~f'~-~/o,~- /' " " " C, WATER: D, SPECIAL: E. LOCK BOX: YES / NO~F YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TE,a3~ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...- .................................... ~Y~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. N~ D. EMERGENCY EVACUATION PROCEDURES: ................. E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... REFRESHER YES NO YES NO YES NO YES NO YES NO SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANT~O POUNf~F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF ~COMPRESSED GAS:._~%... YE~ NO I, ~N/~J ~/'dOd/'K'-k3 , certify that the above information is a'ccurate. 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. S I GNATURE T I TLE / BAKERSFIELD CITY FIRE OEPART}.iEXT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: USE ONLY ID= BUSINESS PLAN SINGLE FACILIT~~ 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 betow-fo~-{HE--FACILI.~.-UNIT--LISTED BELOW 4. Be as BRIEF and CONCISE as .possible. FACILITY UNIT~ . ~ FACILITY ~IT NAME: k ;~ ~ ~ ~z~ SECTION I: MITIGATION, PREVENTION, ABATEM~'r PROCEDURES SECTION 2: ~OT!F!CATION AS~ EVACUATION PROCEDL~ES AT TI{IS ~'iT 05U~Y $~CT!ON 3: IIAZARDOIiS 5taTERIAES FOR A. Does this Facility [init conra'n Hazardous ?[aterf;.~l?? ...... If YES, see B. If ~0, continue ~ith S~CT~O~ 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: .NON-TRAOE SECRETS ONLY (whi~e form If Yes, complete a hazardous materials inventory fo~m marked: TRADE SECRETS ONLY (¥ello~ form ¢4A-2) in addition to the non-trade secr,~t form. List only the trade secrets on form 4A-2. 'SECTION 4: pRIvAT~ F!~-PROTE_cTioM ...... ' SECTIOM ~: LOCATION OF WATER SUPPLY FOR USE 8Y EMERG~I~ RESPONDERS SECTION ~: lOCATION OF UTILI?f Sh'UT-OFFS AT THIS b~IT ONLY. A. .MAT.5~~ ~GAS/PROPANE] B. ELECTRICAL: O. SPECIAL: LOCK BnX. LOC. ',TzO'' FI.00R BAKERSFIEIoU CITY FIRE UEt'ARTMENT I.D. ~t FORM 4A-1 Page NON-- TRAD]E: S lei C RENTS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAHE:~;~¢C. onq S~Ce)L~ ~e~0;¢e~-~o,~?~ O~NER NA~E: ADDRESS: 6o'o'~ ~¢H;o~A C~ ~ ADDRESS: l~ CITY, ZIP: fl~lcencC;~.12 ~ q33ofl CITY,ZIP:~~,'~){/ ~ q32~ . I 0~rv 1 2 3 4 5 6 7 8 9 10 rY.~ .Ax ANNUAL CO~T USE LOCATIO" IN T.IS ,~ BY .AZARD o.O.T CODE AHOUNT At4OUNT UNIT CODE CODE FACILITY UNIT tiT. CHENICAL OR CO"HO" "A"E CODE GUIDE EMERGENCY CONTACT: ~ ~V~gO~ TITLE: ~ -bHONE ~ BUS HOURS: 3o~-377-q~Pq .;' ~ ~ ' ~ AFTER BUS HRS: Ro~- ~,~- ~o'~ EHURGENCY CONTACT: ~e~R~ ~CZI,~ TITLE: O~;Ce ~C~ PHONE ~ BUS HOURS: ~o~-~97-qgP~ PRINCIPAL BUSINESS 'ACTI~ITY:~~ ZAI~ .9~Ce~ ~;2~ AFTER BUS HRS: '~o~-- ~- J~] - 4A-I - FACILITY UNIT #:, /~ FACILITY UNIT NAME: F" . 0 'i-