HomeMy WebLinkAboutBUSINESS PLAN ITE, DIAGRAM
Business Name:
~usiness AC=tess:
FACILITY DIAGRAM
For Office Use Only
First In
JnsoectJon Stction:
Area M¢~ # cf
NORTH
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE
NEWACCOUNT ;
ADDRESS CHANGE
CLOSEACCT j
'FINANCE CHARGE I .,/I
OTHER ADJ j
,/ -
CUSTOMER NAME
MAILING ADDRESS
CITY
ZIP CODE
SITE ADDRESS
PARCEL NUMBER
(IF APPUCABLE)
ADJUSTMENT
I OHG DATE I
CHARGE CODE J
I
ADJUSTMENT AMOUNT
REMARKS: '~'--~ ~
/
APPROVED
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF ~PERMIT ON REVERSE SIDE
PERMIT ID# 015-021 ~)01519
PACIFIC TRANSPORT
LOCATION 182
Issuedby:
This permit is issued for the following:
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:
~flph Huey,~._~~_.~
Office of lt~.~enml Sen'ides
Expiration Date:
June 30. 2000
· OFFICE OF ENVIRONMENTAL SERVICES
~ 1715 CHESTER AVENUE, 3RD FLOOR
BAKERSFIELDi. CA 93301
INSTRUCTIONS:
To avoia turmer action, return mis form within 30 days of receic;t. -
'2. ~PE/P9INT ANSWERS IN ENGUSH.
3. Answer The cuesTions beJow tot the business cs a whole.
3e brier cna contuse cs po~ibie.
SECTION I' BUSINESS IDENTIFICATION DATA
I
.SECTION 2: EMERGENCY NOTIFICATION:
~,...,*~ TA CT
2.
T~TLE
BUS. PHONE
2.4 HR. PHONE
sEcTION 3: TRAINING:
NUMBER OF EMPLOYEES:
MATERIAL SAFELY DATA SHEETS ON FILE;
BRIEF SUMMARY OF TRAINING PROGRAM: /..)O,,~--.
SECTION 4: EXEMPTION REQUEST:
i CEF, TiFY UNDeR c=,',~^ OF - ,~A~ MY BUSINESS IS EXEMPT FROM THE
, ~-, , _~'~,-,LT"{ ."ER JURY"'" -'
,-. -.RTING ~'--'. '- ,..,r--Cv~APT.~.~ ' -
.... 6.?,~ OF ,Hr- "'CALIFORNIA HEALTH &
"' ''-- D'"' lin,z, ~-~.wWING REASONS
b,;..k:_ x: V, ma',,
'--'~ : FCR -"* :,'-" "~ ,
",'VE DO NCT H,Z,N~ -
~.L: HAZ-',ROC'US MATERIALS.
',YE O,C HANDLE '-' '"~'" hr-,.--,
,¢,,-,l~.x BUT ,n~_ QUANTITIES AT NO
-r '=z',.,,-'-* ,mE MINIMUM REFORTiNG GUANTITIE.~.
~- ....(,~?E''''zv
SECTION 5' CERTIFICATION:
!, CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNOERSTAN0 THAT THiS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE "'CALIFORNIA HEALTH AND SAFETY C-ODE"
'ON HAZARDOUS MATERIALS (D(V. cO CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES ~-~.RJURY.
SIGNATURE TITLE DATE . ....
. ,OHazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCF. DURES:
AGENCY NOTIFICATION PROCEDURES'
B. E!,4PLCYEE NCTIFiCATICN AND :VACUATICN:
--ME";GF-:",IC'r' ME-" "
., - :_,,,C,-...,,L ?LAN:
Bnkersfield. FL~e Dept. ~
Hazardous Mate~ats Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7' MITIGATION, PREVENTION AND ABATEMENT PLAN:
A. RELEASE PREVENTION STEPS:
No,O ~
B. RELEASE. CONTAINMENT AND/OR MINIMIZATION'
CLEAN-U?
......... ~'a F";F ~'HUT-OFFS AT YOUR FACiLtTY):
SECTION $' UTILITY SHUT-OFFS ::.L,_~.,-,t,,,...,~, ~
_.~ C',< ,.E C.X:
SECTION 9' PRIVATE FiRE PROTECTION/WATER AVAILABILITY:
A.
PRIVATE FiRE PROTECTION:
WATER AVAILABILITY (FIRE HYQRANT}'
BAKERSFIELD CITY FiRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES ._
1715 CHESTER AVENUE, 3RD FLOOR
BAKERSFIELD, CA 93301
(805) 326-3979
HAZARDOUS MATERIALS INVENTORY
FACILITY DESCRIPTION
CHECK 1F BUSINESS IS A FARM
SiTE ADDRESS
SiC CODE
DUN & 8PADSTREET NUMBER
ZIP
I
OWNE.:,/CFEFATCR
PHONE
MAIL!,NG ADDRESS
C ;T'¢ STATE
ZIP
=MEF. GENCY CONTACTS
BUSINESS FHONE {o°O&~) ~- ~-~0~'''~
BAKERSF[[.LD CITY ,FIRE DEPA![-TMENT
HAZARDOUS MATERIALS INVEN'I IIRy '
CHEMICAL DESCRIPTION
',r } INvENToRY STATUS; New ! ! ] Rev~e~ [ ] Deletion
Name:
AHM [ ] CAS ~
PHYSICAL & HEALTH
HAZARD CATEGORIES
PHYSICAL
Fire [ ] Reac~ve[ ] Sudden Release of Pressure [ ]
HEAL,TH
Immediate Heath (Acute) [ ] Delayed HeIJUI (Chronic) [ ]
~) WASTE CLASSIFICATION ,{3-cligit cocle from OHS Form 8022) USE CODE
PHYSICAL sTATE Solid [ ] LiClUid [~ Gas [ ] Pure [~Mixture [ ] Waste ( ] ~ [ ]
,AMOUNT AND T~ME AT FACiUTY
MaxJrnum DaN Amount:
Average OwN Amount:
Annual Amount:
LaJ'gest Size'Contmnec.
~ Dave On Site
? 9) MIXTURE: List
· ,~e t~tree most na~a~(3ous
· c~emlca~ comDonefl[s or
; :~'~y~-AHM com~nen~
COMPONENT . CAS~' % WT NlM
· '. O) Locaz~on
CHEMICAL DESCRIPTION
INVENTORY STATUS: New .~aition ( ] ~eWSion'{ ] Deletion ! ] ChecX if chemical is · NON TRADE SECRET [ ] TRADE SECRET
!) Common Name:. 1~--/'2- A~
Chemtcal Name: AHM [ ] CAS #
*PHYSICAL & HEALTH
HAZARO CATEGORIES
PHYSICAL
Fire ] .=,eac~we { ] Sudden Reteaseof Pressure
HEALTH
Immedi~e Healt~ {Acutel [ ] ~:h~layed Healt~ (ChroniC) [ ]
S) WAST~. CLASSIFICATION ,3-clicj~t co~3e from OHS Form 80223 USE CODE
$) rpHY~ICAL STATE Solid [ I~auld [ ] Ga~ [/~'~ Pure ~'"~ure [ ] Waste [ ] Rm3ioecttve [ ]
AMOUNT AND T~ME AT FAC:LJTY
Maximum 0a~i¥ Amount:
Average Omhf Amount:
~nnuaJ Amount:
L.m'gest Size ContaJne~
~* Oa~ On Site
UNITS CF' MEASURE 8) STORAGE CODES
!be ~ [ ] ft3 [ ] a) Container: ~"~
· - ;unes [ ] b) Pressure:
c) TemDera~um:
?=/o~ C~r~e~icnMonms: ~lYe~. J, F. M. A, M, J. J, A. S,,O. N. O
>~) MIXTURE: t Jet
:he three most hazamous
cnem~ca~ coml~onents or
a~y AJ-tM components
COMPONENT CAS ,~ % WT NlM
[ l
o~