HomeMy WebLinkAboutBUSINESS PLANFOODS CO #773
Manager :
Location: 8200 ROSEDALE HWY
City : BAKERSFIELD
CommCode: COUNTY STATION 65
EPA Numb:
SiteID: 015-021-002232
BusPhone: (661) 587-6265
Map : 102 CommHaz : Moderate
Grid: 29B FacUnits: 1 AOV:
SIC Code:5411
DunnBrad:78-617-6628
Emergency Contact / Title
DICK NEWTON / DIRECTOR
Business Phone: (661) 587-6265x
24-Hour Phone : (310) 900-3700x
Pager Phone : ( ) - x
EmergenCy Contact / Title
ALARM CENTER / RALPHS SECURITY
Business Phone: (310) 900-3700x
24-Hour Phone : (310) 900-3700x
Pager Phone : ( ) -~- x
Hazmat Hazards:
Fire Press ImmHlth
Contact : CARROL CHEN
MailAddr: 2201 S WILMINGTON AVE
City : COMPTON
Phone: (310) 884-4288x
State: CA
Zip : 90220
Owner RALPH GROCERY COMPANY
Address : 2201 S WILMINGTON AVE
City : COMPTON
Phone: (310) 884-9000x
State: CA
Zip : 90220
Period :
Preparer:
Certif'd:
ParcelNo:
to
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Emergency Directives:
~ Hazmat Inventory
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EPA Hazards
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One Unified List
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07/18/2003
UNIFIED PROGRAM I PECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
Bakersfield Fire Dept.
Enironmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
FACILITY NAME
[INSPECTION DATE INSPECTION T ME
........................................................ / t I Ur~ ~/J / J
ADDRESS .......................... ~ ................ ~6~'-~ .............. [~;- ~F~-~T~;~ ...... J
FACILITYCONTACT ............................................. ~ .... I ............... ~ .......... [ ......... J -- I
J / I~siness ID Numar -' ............ J
' ~ / 15-021-
Section 1: Business Plan and Inventory Program
[] Routine [~J'Combined [] Joint Agency I~ Multi-Agency I~ Complaint ~ Re-inspection
f. C V (vC:vCi~ir~tPi~annce) OPERATION COMMENTS
~[] APPROPRIATE PERMIT ON HAND .
f//~[] VERIFICATION OF
INVENTORY
MATERIALS
~ VERIFICATION OF QUANTITIES . - .........................................................................................
ION OF HAT MAT TRAINING
OF ABATEMENT SUPPLIES AND PROCEDURE~
..................................................................... ~ ...............................................................................
~ FIRE PROTECTION
ANY HAZARDOUS WASTE ON SITE?: ~ YES ~ No
EXPLAIN:
QUESTION/~REGARDI,~IG THIS INSPECTION? PLEASE CALL US AT (661) 326-39 .
Inspector Badge No.. {~......./~Siness,,~R~ Responsible Party
White - Environmental Services Yellow. ~ation CoDy Pink - Business Copy
UNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
BUSINESS ACTIVITIES
Page i of
I. FACILITY IDENTIFICATION
FACILITY ID #(Agency Use Only) ~ I~[~:::~ J [ [ I 1. EPAID# (Hazardous Waste Only) 2.
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3.
Foods Co - Store #773
" II. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
please submit the Business Owner/Operator Identification page (OCS Form 2730).
Does your facility... If Yes, please complete these pages of the UPCF...
A. HAZARDOUS MATERIALS
Have on site (for any purpose) hazardous materials at or above 55 gallons
for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases
(include liquids in ASTs and USTs); or the applicable Federal threshold [] YES [] NO 4. HAZARDOUS MATERIALS INVENTORY
quantity for an extremely hazardous substance specified in 40 CFR Part -CHEMICAL DESCRIPTION (OCS 2731)
355, Appendix A or B; or handle radiological materials in quantities for
which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or
70?
B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A)
1. Own or operate underground storage tanks? [] YES [] NO 5. UST TANK (one page per tank) (Formerly Form B)
2. Intend to upgrade existing or install new USTs? [] YES [] NO 6. UST FACILITY
UST TANK (one per tank)
UST INSTALLATION - CERTIFICATE OF
COMPLIANCE (one page per tank) (Formerly Form
C)
3. Need to report closing a UST? [] YES [] NO 7. UST TANK (closure portion- one pageper tank)
C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs)
Own or operate ASTs above these thresholds:
---any tank capacity is greater than 660 gallons, or [] YES [] NO 8. NO FORM REQUIRED TO CUPAs
---the total capacity for the facility is greater than 1,320 gallons?
D. HAZARDOUS WASTE
1. Generate hazardous waste? [] YES [] NO 9. EPA ID NUMBER - provide at the top of
this page
2. Recycle more than 100 kg/month of excluded or exempted recyclable
RECYCLABLE MATERIALS REPORT (one
materials (per H&SC §25143.2)? [] YES [] NO 10. per re, cycler)
3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE
[] YES [] NO i1. TREATMENT - FACILITY (Formerly DTSC
Forms 177:2)
ONSITE HAZARDOUS WASTE
TREATMENT - UNIT (one page per unit)
(Formerly DTSC Forms 1772 A,B,C,D and L)
4. Treatment subject to financial assurance requirements (for Permit by [] YES [] NO 12. CERTIFICATION OF FINANCIAL
Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232)
5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION
[] YES [] NO 13. SITE ANNUAL NOTIFICATION (Formerly
DTSC Form 1196)
6. Need to report the closure/removal of a tank that was classified as HAZARDOUS WASTE TANK CLOSURE
hazardous waste and cleaned onsite? [] YES [] NO 14. CERTIFICATION (Formerly DTSC Form 1249)
E. LOCAL REQUIREMENTS 15.
(You may also be required to provide additional information by your CUPA or local agency.)
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
CONSOLIDATED
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
Page
of
FACILITY ID #
(Agency Use Only)
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
Foods Co - Store #773
BUSINESS SITE ADDRESS
8200 Rosedale Highway
CITY
Bakersfield
I. IDENTIHCATION
3. BUSINESS PHONE
(661) 587-6265
DUN & BRADSTREET
78-617-6628
104.
101.
102.
103.
CA
106.
ZIP CODE 1o5.
93301
SIC CODE (4 digit #) 1o7.
5411
COUNTY
Kern County
BUSINESS OPERATOR NAME
Ralphs Grocery Company
108.
OWNER NAME
Ralphs Grocery Company
OWNER MAILING ADDRESS
2201 South Wilmington Avenue
109. BUSINESS OPERATOR PHONE 11o.
310-884-9000
H. BUSINESS OWNER
111.
OWNER PHONE
310-884-9000
112.
113.
CITY i14. STATE 115. ZIP CODE 116.
Compton CA 90220
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117. CONTACT PHONE 118.
Carrol Chen 310-884-4288
CONTACT MAILING ADDRESS
2201 South Wilmington Avenue
119.
CITY 120. STATE 121. ZIP CODE
Compton CA 90220
122.
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME 123. NAME 128.
Dick Newton Alarm Center
TITLE 124. TITLE 129.
Store Director Ralphs Security
BUSINESS PHONE 125. BUSINESS PHONE 130.
(661) 587-6265 310-900-3700
24-HOUR PHONE* 126. 24-HOUR PHONE* 131.
310-900-3700 310-900-3700
PAGER # I27. PAGER # 132.
ADDITIONAL LOCALLY COLLECTED INFORMATION:
Property Owner: Ralphs Grocery Company Phone No.: 310-884-9000 133.
Billing Address: 2201 South Wilmington Avenue, Compton, CA 90220
Number of employees: 045
Administering Agency: City of Bakersfield
Certification: 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 and believe the information is true, accurate, and complete.
DATE 134. I NAME OF DOCUMENT PREPARER 135.
h[%[ o[I Cynthia Cardenas
136. 137.
iSIG~W~REPRESENTATIVE
NAME O~SIGNE~ (print)
Carrol Chen ~/
TITLE OF SlGNER
Manager, Environmental Affairs
* See Instructions on next page.
Ralphs Grocery Company / Food 4 Less Business Plan
Rev. 03/01
Emergency Response Plan
Page __ of__
All facilities that handle hazardous materials in specified quantities must have a written emergency response
plan. This site-specific Emergency Response Plan is the facility s plan for dealing with emergencies.and'shall
be implemented ~mmediately whenever there is a fire, explosion, or release of hazardous materials that could
[hreaten hu. man health and/or the enviro, msn~ ent. At leas.t one copy.of the plan shall be maintained at the facility
for use in the event of an emergency and for inspection I~y the local agency.
1. Evacuation Plan:
a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply):
[~ Bells; ~] Horns/Sirens; ~] Verbal (i.e. shouting); ~] Other (specify)
b. ~] Evacuation map is prominently di'splayed throughout the facility.
Note.'A properly, completed Site Plan satisfies contingency plan map requirements. This drawin£ (or any other
d?aMng that shows p. rimary and alternate evacuation routes, emergency exits, and primar~. ~tnd alternate
staging areas) must be prominently posted throughout the facility tn locations where it will be visible to
employees and visitors.
. ao
b°
Emergency Contacts*:
Fire/Police/Ambulance
State Office of Emergency Services
Post-Incident Contacts*:
Fire Department Hazardous Materials Program
Department of Toxic Substances Control
911
(800) 852-7550 or (916) 262-1621
(661) 326-3979
(510) 540-3739
* These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may
be required to be notified.
c. Emergency Resources:
Poison Control Center
Nearest Hospital:
Name:
Address:
City:
Phone No.:
(800) 876-4766
Industrial Medical Group of Bakersfield
2501 G Street
Bakersfield, CA 93301
(661) 327-2225
3. Arrangements With Emergency Responders:
If you have made special (i.e. contractual) arrangements with any p. olice department, fire department, hospital,
contractor, or State or local emergency response team to coordinate emergency services, describe t~ose
arrangements below:
Designated Cleanup Contractor: Advanced Cleanup Technologies Inc. (ACTI)
20928 Lamberton Avenue, Carson CA 90810
800-334-2284; 310-763-1423
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
Emergency Response Plan
Page __of__
4. Emergency Procedures:
Prevention
All employees are trained in Hazard Communication that includes safe handling procedures of hazardous
materials. In some cases Employees do not come into direct contact with the hazardous material due to self-
contained units or closed-loop systems.
Mitigation
Small spill - employees are trained to stop and contain the leak.
Large spill - employees are to notify the store director or person-in-charge as well as the local fire department
to respond. When safe to do so, employees will attempt to isolate the leak.
Fire - employees are to call the fire department. Trained employees are to use the fire extinguisher to control
the fire when safe to do so. When necessary, the employees will be notified to evacuate the store safely.
Abatement
When safe to do so, employees will don personal protective equipment to stop the release, cordon off the area
from further traffic, and contain the release with absorbent. The waste is then placed in a labeled waste drum
for proper disposal. The fire department and/or a cleanup contractor will be contacted to control and abate large
spills.
Notification & Evacuation
Upon hearing the evacuation alarm or PA announcement, employees will evacuate and report to designated
meeting areas. The store director or person-in-charge is responsible for making the announcements and to
ensure that all employees exit safely.
5. Post-Incident Reporting/Recording:
The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be
noted in the facility's operating record. Within 15 days of any hazardous materials emergency incident, a
written Emergency Incident Report must be submitted to the California Environmental Protection Agency's
Department of Toxic Substances Control and the local fire department's hazardous materials program. The
report shall include:
a) Name, address, and telephone number of the facility's owner/operator;
b) Name, address, and telephone number of the facility;
c) Date, time, and type of incident (e.g. fire, explosion, etc.);
d) Name and quantity of material(s) involved;
e) The extent of injuries, if any;
f) An assessment of actual or potential hazards to human health or the environment, where this is applicable;
g) Estimated quantity and disposition of recovered material that resulted from the incident;
h) Cause(es) of the incident;
i) Actions taken in response to the incident;
j) Administrative or engineering controls designed to prevent such incidents in the future.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
Emergency Response Plan
6. Emergency Equipment:
22 CCR §66265.52(e) requires that emergency equipment at the facility be listed.
following Emergency Equipment Inventory Table meets this requirement.
Page __of__
Completion of the
EMERGENCY EQUIPMENT INVENTORY TABLE
1. 2. 3. 4.
Equipment Equipment
Category Type Locations * Description**
Personal [] Cartridge Respirators
Protective [] Chemical Monitoring Equipment (describe)
Equipment, [] Chemical Protective Aprons/Coats
Safety [] Chemical Protective Boots
Equipment, ['3 Chemical Protective Gloves
and [] Chemical Protective Suits (describe)
First Aid [] Face Shields
Equipment [] First Aid Kits/Stations (describe) Throughout Bandages, aspirin, antiseptic
[] Hard Hats
[] Plumbed Eye Wash Stations
[] Portable Eye Wash Kits (i.e. bottle type)
[] Respirator Cartridges (describe)
[] Safety Glasses/Splash Goggles
[--] Safety Showers
[] Self-Contained Breathing Apparatuses (SCBA)
[] Other (describe)
Fire [] Automatic Fire Sprinkler Systems Throughout
Extinguishing [] Fire Alarm Boxes/Stations
Systems [] Fire Extinguisher Systems (describe) Throughout
[] Other (describe)
Spill [] Absorbents (describe) Throughout Spill Magic stations; kitty litter in pet food aisle
Control [] Berms/Dikes (describe)
Equipment [] Decontamination Equipment (describe)
and [] Emergency Tanks (describe)
Decontamination [] Exhaust Hoods Service Deli Used for hot food preparation
Equipment [] Gas Cylinder Leak Repair Kits (describe)
[] Neutralizers (describe)
[20verpack Drums
[] Sumps (describe) Back Dock
[] Other (describe)
Communications [] Chemical Alarms (describe)
and [] Intercoms/PA Systems Throughout
Alarm [] Portable Radios
Systems [] Telephones Office Also located at front end of store
[] Underground Tank Leak Detection Monitors
[] Other (describe)
Additional []
Equipment []
(Use Additional []
Pages if Needed.) []
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
Employee Training Plan
Personnel are trained in the following procedures:
Page __of__
[] Internal alarm/notification
[] Evacuation/re-entry procedures & assembly point locations
[] Emergency incident reporting
[] External emergency response organization notification
[] Location(s) and contents of Emergency Response Plan
[] Facility evacuation drills, that are conducted at least (specify)
(e.g. "Quarterly", etc.)
Ralphs Grocery Company, Food 4 Less, Foods Co, Bell Markets and Cala Foods employees are trained in
Hazard Communication upon hiring. Employees are instructed in safe handling procedures of hazardous
materials, emergency response procedures and evacuation and notification procedures. A chemical safety video
and handbooks are used in the training program. Refresher training is provided annually.
Ralphs Grocery Company, Food 4 Less, Foods Co, Bell Markets and Cala Foods stores do not have on-site
emergency response teams. The stores rely on the local fire departments and hazardous materials services for
assistance in a chemical release or other incident.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
(one pa~e D .... terial per building or area1
[] ADD [] DELETE [] REVISE 2°°-I Page of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3.
Foods Co - Store #773
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 2o2.
Machine Room EPCRA
[] YES [] NO
FACILITY ID # (Agency Use On ly,~ ~[~[¢~{~ gI1 MAP# 203. GRID# 204.
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET [] Yes [] No 206.
Chl0rodifluoromethane if Subject to EPCRA. refer to instructiom
COMMON NAME 207. 208.
Freon 22 EHS* [] Yes [] No
CAS# 209.
75-45-6 *If EHS is "Yes," all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210.
HAZARDOUS MATERIAL I 213.
TYPE (Check one item only) 15~ a. PURE [] b. MIXTURE [] c. WASTE 211. RADIOACTIVE [] Yes [] No 212. CURIES
I
PHYSICAL STATE 215.
214. LARGEST CONTAINER
(Check one item only) [] a. SOLID [] b. LIQUID [] c. GAS
FED HAZARD CATEGORIES 216.
(Check all that apply) [] a. FIRE [] b. REACTIVE [] c. PRESSURE RELEASE [] d. ACUTE HEALTH [] e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. ] MAXIMUM DALLY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
22204.23I 22204.23
221. DAYS ON SITE 222.
UNITS* [] a. GALLONS [] b. CUBIC FEET [] c. POUNDS [] d. TONS 365
(Check one item only) * If EHS, amount must be in pounds.
STORAGE
CONTAINER [] a. ABOVEGROUND TANK [] e. PLASTIC/NONMETALLIC DRUM [] i. FIBER DRUM [] m. GLASS BOTTLE [] q. RAIL CAR
[-I b. UNDERGROUND TANK [] f. CAN [] j. BAG [--I 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 223.
STORAGE PRESSURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT 224.
STORAGE TEMPERATURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] d. CRYOGENIC 225.
% WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
1. 100 226. Chlordifluoromethane 227. [] Yes [] No 228. 75-45-6 229.
2. 230. 231. [] Yes [] No 232. 233.
3. 234. 235. [] Yes [] No 236. 237.
4. 238. 239. [] Yes [] No 240. 241.
5. 242. 243. [] Yes [] No 244. 245.
If more hazardous components are present at greater than 1% by weight if non-careinogenie, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
If EPCRA, Please Sign Here.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
tone pa~e per material per buildinlg or area)
[] ADD [] DELETE [] REVISE 200. I Page __of
I. FACII,ITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3.
Foods Co - Store #773
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202.
Floral Department EPCRA
[] YES [~] NO
FACILITY ID # 1. MAP # 203. GRID # 204.
H. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET [] Yes [] No 206.
Helium
If Subject to EPCRA, refer to instructions
COMMON NAME 207. 208.
EHS* [] Yes [] No
CAS# 209.
7440-59-7 *If EHS is "Yes," all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (complete if required by local agency) 210.
HAZARDOUS MATERIAL 213.
TYPE (Check one item only) [] a. PURE [] b. MIXTURE [] c. WASTE 211. RADIOACTIVE [] Yes [] No 212. CURIES
PHYSICAL STATE 215.
(Check one item only) [] a. SOLID [] b. LIQUID [] c. GAS 214. LARGEST CONTAINER 244 cubic feet
FED HAZARD CATEGORIES 216.
(Check all that apply) [-I a. FIRE [] b. REACTIVE [] c. PRESSURE RELEASE [] d. ACUTE HEALTH [] e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
244 244
221. DAYS ON SITE 222.
UNITS* ['-I a. GALLONS [] b. CUBIC FEET [] c. POUNDS [] d. TONS
(Check one item only) * If EHS, amount must be in pounds. 365
STORAGE
CONTAINER [] a. ABOVEGROUND TANK [] e. PLASTIC/NONMETALLIC DRUM [] i. FIBER DRUM [] m. GLASS BOTTLE [] q. RAIL CAR
[] b. UNDERGROUND TANK [] f. CAN [] j. BAG [] n. PLASTIC BOTTLE [] r. OTHER
[] c. TANK INSIDE BUILDING i-'] g. CARBOY [] k. BOX [] o. TOTE BIN
[] d. STEEL DRUM [] h. SILO [] I. CYLINDER [] p. TANK WAGON 223.
STORAGE PRESSURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT 224.
STORAGE TEMPERATURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] d. CRYOGENIC 225.
% WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
1. I00 226. Helium 227. [] Yes [] No 228. 7440-59-7 229.
2. 230. 231. [] Yes [--I No 232. 233.
3. 234. 235. [] Yes [] No 236. 237.
4. 238. 239. [] Yes [] No 240. 241.
5. 242. 243. [] Yes [] No 244. 245.
If more hazardous components are present at greater than 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
If EPCRA, Please Sign Here.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
[] ADD [] DELETE [] REVISE 2oo.I Page of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3.
Foods Co - Store #773
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202.
Porter's Room EPCRA
[] YES [] NO
FACILITY ID # :~
(Agency Use Only)
II. CHEMICAL INFORMATION
CHEMICAL NAME 20s. TRADE SECRET [] Yes [] No 206.
Propane If Subject to EPCRA, refer to instructions
COMMON NAME 207. 208.
Propane EHS* [] Yes [] No
CAS# 209.
74-98-6 *If EHS is "Yes," all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210.
213.
HAZARDOUS MATERIAL [] a. PURE [] b. MIXTURE [] c. WASTE 211. RADIOACTIVE [] Yes [] No 212. CURIES
TYPE (Check one item only)
215.
PHYSICAL STATE 214. LARGEST CONTAINER
(Check one item only) [-[ a. SOLID [] b. LIQUID [] c. GAS
FED HAZARD CATEGORIES 216.
(Check all that apply) [] a. FIRE I'-] b. REACTIVE [] c. PRESSURE RELEASE [] d. ACUTE HEALTH [] ¢. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. I MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
182I 182
221. DAYS ON SITE 222.
UNITS* [] a. GALLONS [] b. CUBIC FEET [] c. POUNDS I'"] d. TONS 365
(Check one item only) * If EHS, amount must be in pounds.
STORAGE
CONTAINER [] a. ABOVEGROUND TANK I'--1 e. PLASTIC/NONMETALLIC DRUM [] i. FIBER DRUM [] m. GLASS BOTTLE [] q. RAIL CAR
[] b. UNDERGROUND TANK [] f. CAN [] j. BAG [] n. PLASTIC BOTTLE [] r. OTHER
[] c. TANK INSIDE BUILDING .l'-] g. CARBOY [] k. BOX [] o. TOTE BIN
[] d. STEEL DRUM [] h. SILO ['"1 1. CYLINDER [] p. TANK WAGON 223.
STORAGE PRESSURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT 224.
STORAGE TEMPERATURE [] a. AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] d. CRYOGENIC 225.
% WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
1. 100 226. Propane 227. [] Yes [] No 228. 74-98-6 229.
2. 230. 231. [] Yes [] No 232. 233.
3. 234. 235. [] Yes [] No 236. 237.
~-. 238. 239. [] Yes [] No 240. 241.
5. 242. 2t,3. [] Yes [] No 244. 245.
If more hazardous components are present at greater than 1% by weight if non-earcinogeuie, or 0.1% by weight if earcinogeuic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCADLY COLLECTED INFORMATION 246.
DOT Hazard Class:
If EPCRA, Please Sign Here.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
'/HAZARDOUS SITE PLAN
MATERIAL
~CLOSURE
Chemical Inventory & Business Emergency Plan
"1 A B I C I D I E I F la H I I..ll~J_ I~ K I L I MI N I
3 u3 v~ 3
4 0 ~ , 4
7 7
11 ~a~ ~ ~ -- ~11
14 , I
i, 14
BUSINESS "AME (Circle ~ ~~ IDATE
Ralphs Food 4 Less ~ Cala Bell · Store ~ ~-- ~-O/
ADDRESS CI~ ZIP
FACILITY NAME
ADDRESS
FACILITY CONTACT
INSPECTION TIME
Section 1:
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301
INSPECTION DATE ~'l
PHONE NO. ~(. ~-~5~
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES
Business Plan and Inventory Program
qz5
,j~--Rautine [~ Combined I~ Joint Agency [~ Multi-Agency ~,] Complaint ~ Re-inspection
OPERATION C V COMMENTS
Appropriate permit on hand
Business plan contact reformation accurate
Visible address
Correct occupancy
Verification of inventory materials ~'"5'T~,~C-O ~ t~
Verification of quantities
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate'
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand ~,~;,,ar_~ ~ t,~t<;
C=Compliance V=Violation
Any hazardous waste on site?: [~ Yes [~o
Explain:
Questions regarding this inspection? Please call us at (66 I) 326-3979
White - Env. Svcs. Yellow - Station Copy Pink - Business Copy
CITY OF BAKERSFIE~
(~ICE OF ENVIRONMENTALnJ'ERVICES
1715 Chester Ave., CA 93301 1661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
NEW [-1 ADO I"1 DELETE r"] REVISE
2OO
INFORMATION
(one fon~ per mate#al per buildim3 or ama)
Page __ of
3
2011 CHEMICAL LOCATION [] Yes [] No 202
CONFIDENTIAL (EPCRA)
203 GRID # (optional) 204
· ~"" · . - ' II. CHEMICAL INFORMATION
,'~..,/.~¥~.... · .. :. · .,, ~ ,.
COMMON NAME
CAS#
TRAOE SEC, RET [] Yes E] NO 206 1
If Su0ject to EPCRA. refer to instructions
207
EHS° []Yes [] No 208
209 } *'If EHSIi~.,e~_ ,'~"':~:~'"'~':::'~"~'"~:~*'~;;:~';&¢'"~':"';i~:'::';;: ~~:bem ~.'.':.
FIRE CODE HAZARD CLASSES (Com#e~e if r~quested by local fire c~iet)
210
[] w WASTE 2:: *' RAOIOACTIVE [] Yes [] NO 212 i CURIES 213
TYPE [] p PURE [] m MIXTURE
PHYSICAL STATE ' [] $ SOLID ~-'ll LIQUID [] g GAS 214 i LARGEST CONTAINER t ~. ,~0 215
FED HAZARD CATEGORIES I--I1 FIRE []2 REACTIVE []3 PRESS:JRE RELEASE ~""14 ACUTE HEALTH 1--15 CHRONIC HEALTH 216
(C, hec~ all that apply)
ANNUAL WASTE 217 MAXIMUM /~.,-~ 218 i AVERAGE 219 I STATE WASTE CODE 220
AMOUNT ~_ DALLY AMOUNT I DAILY AMOUNT t
UNITS* ~ GAL [] cf CU FT ' [] lb lBS [] tn TONS 221 } DAYS ON SITE 222
· ff EHS, amount must be in [b~.
STORAGE TEMPERATURE
STORAGE CONTAINER [] a ABOVEGROUND TANK [] · PLASTICJNONMETALLIC DRUM [] i FIBER DRUM [] rn GLASS BOTTLE [] q RAIL CAR 223
(Check all ~at apply)
[] b UNDERGROUND TANK [] f CAN ~ j BAG ~ 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 SELOWAMBIENT 224
[] ba SELOWAMBIENT [] c CRYOGENIC 225.
PRINT NAME
i2 I
238
242
[] a AMBIENT
[] aa ABOVE AMBIENT
~?,;:~,~.,,...'...:...,:'~;~:'?~ ". '.~-.'.~" -,..., .,:*.'~.~:.~,~ ',,'. '-": ,i~ ....... +.'~' :,.,. "~ ".-'~ .... '.":'::.: ":'
227
231
235
[] Yes [] No 232 233
[] Yes [] No 23~ 237
;OMPANY REPRESENTATIVE
241
239 [] Yes [] No 240
243 [] Yes [] No 244 245
-- -- !!::ii] ~'"'"'~?i' i": :']'""' '~'~ :~' ~'~~ii ~ ~:'" '~' ~' ~"<~*~:"~'~"~· ' ~'~'':~
SIGNATURE DA~ 248
UPCF (7199)
S:\CUPAFORMS\OES2731.'rV4.wpd
~~'~(;.i,.' ':'" . "- UNIFIED PROGRAM CONSOLrDAT~D FORM .
.... , BUS.SS ACTI T S
.$':~?~i~';;;:-::'. · . Page 1 of
BUS~S N~E (Sine as Facfli~ Nme or DBA - Do~ Bus,ess As) ~..:
,-5'?;
Foods Co - Store ~73 · ',
. ?" '/.:' "V.' '
H. AC~S DECL~ON ; ~:'
NOTE: If you check ~S to ~y p~ of t~ ~t, : --
pl~e sub~t ~e Bm~s O~er/Operator Identffimfion page (OES Fora 2730).
Does your facili~... If Yes, please mmplete ~ese pag~ of ~e UPCF...
A. ~OUS MATE~ .~ . I :.'
, ' 'F'
Have on site (for ~y pu~ose) h~ardous materials at or above 55 g~lo~
for liquid, 5~ ponds for solids, or 200 cubic feet for compressed gases
(include liquids ~ ASTs and USTs); or ~e applicable Federal ~re~old ~ YES ~ NO 4. ~OUS ~TE~ ~EN~RY.
q~ti~ for ~ ex~emely h~ardous subsmce specified in 40 CFR Pa~ .. -CHEMIC~ D~C~ON (O~ 2731)/
355, Appendix .A or B; or 'h~dle radiological materials in quantities for
which ~ emergency plan is required purser to 10 C~ Parts' 30, ~ or
70~
B. ~ERGRO~D STOOGE TA~S ~STs) UST FAC~
1. Own or operate underground storage ~s? ~ ~S ~ NO . ~. UST T~K (o~ p~e ~ ~) (Fo~eriy For~ B) ·
2. Intend to upgrade existing or install new USTs? ~ Y~ ~ NO 6. UST FAC~
UST TANK (o~ ~ ~)
: . U~ ~A~A~ON - CER~CATE OF
[ ~ '. COMPL~CE (o~ p~ ~ ~) (Fomr~y ~o~
. Need to report closing a US~ ~ ~ ~ NO 7. · UST.T~K(vI~
C. ~OVE GROUND PETROLE~ STOOGE TA~S {ASTs) . . :.
Own or operate ASTs above ~ese ~resholds:. ::
---~y m~ mpaci~ is grmter ~ 6~ g~]ons, or' .. ~ ~'. ~ NO · s. NO F0~ ~Q~D TO'C~As
--~e to~ mpaciW for ~e faciliF is greater ~an 1,320 gallom? ~.
D. HAZA~OUS'WASTE ", :.' . .''
' ' ' EPA ~ N~ER - provide at
1. Generate h~rdous waste? " ' ~ ~S ~ NO
~' ' ~s page
2. Recycle more ~an I00 kg/mon~ of excluded or exempted r~y~lable ~: ' ' ' . . . ~CYC~LE
materials ~er H&SC 125143.2)? ~ ~ ~ NO' lo. '~r~lcr)
· ' ONS~E ~Z~OUS
3.. . Trot h~rdous waste on site? ~ ~ ~ NO' · ~ L . T~A~ENT -
ONS~E HAZ~OUS WA~
' (Formcrl~ B~C For~ 1~ &B,C,D ~ L)
CER~CATION OF ~C~
4. Trea~ent subject to fi~ncial assur~ce rcquiremen~ (for Permit by ~ Y~ ~ NO ~.
Rul~ ~d Conditioml Authori~tion)? ' ASS~CE
5. Co~olidate h~ardous waste generated at a remote site? ~OTE WA~ / CONSOL~A~ON ' '
D~C Form 11~)
6. Need to rcpo~ ~c closure/removal of a ~ ~at was classified as ~ ~ ~ NO ~4. ~A~OUS ~A~ T~K CLOS~ '
' :'h~rdo~s waste and cleaned onsite? " CERT~CATION (Form~rl~
E. LOCAL ~QUI~MENTS ~'
~ou ~ also bc rcquff~ m providc Mdifio~l infomfion b~ your CUPA or I~l agcncT.) ·
Ralphs Grocery Company / Food 4 Less Business Plan
i:' :: FACILITY INFORMATION .
'" · BUSINESS OWNER/OPERATORIDENTIFICATION -
Page of ',
" .~ I. IDENTIFICATION
~¢!!~! BEGINNING DATE ENDING DATE
~:~: 01/01/01 12/31/01
(Agency Use Only) ~ ~ ?
BUSINESS NAME (Same a~ FACILITY NAME or DBA - Doing Bozinez$ A~) 3. [ BUSINESS PHONE 102.'%
~ Foods Co- Store #773 (661) 587-6265 '
" BUSINESS SITE ADDRESS .,, l~..
8200 Rosedale Highway
Bakersfield CA 93301 · ~:
I
DUN & BRAI)STREET lO~. SIC CODE (4 digit/0 lo?..'
COUNTY ,, lOS.
BUSINESS OPERATOR NAIVIE Io9. I BUSINESS OPERATOR PHONE
I
Ralphs Grocery Company 310-884-9000
H. BUSINESS OWNER · -,
OWNER NAME Ill. I OWNER PHONE ...Il2
Ralphs Grocery Company] 310-884-9000 .: '~
OWNER MAILING ADDRESS I
2201 South Wilmington Avenue
CITY Il4. [ STATE az. ZIP CODE ,n6.
Compton. CA 90220
m. ENVIRONMENTAL CONTACT
CONTACT NAME ~l?. CONTACT PHONE lla.:,'-'.
'arrol Chen 310-8~-4288 :..
.n"'CONTACT MA/LING ADDRESS
2201 South Wilmington Avenue : '
CITY 120. STATE 121. I. ZIP CODE . ~22.
Compton CA 90220 · ~.:;
-Pm VoatY- · ye. , maa cY CoNTaCts -S CO rVA Y-
NAME ~ l~. NAME
Dick Newton ' Alarm Center
TITLE 124. TITLE 129.
Store Director Ralphs Security .
BUSINESS PHONE 12.s. BUSINESS PHONE .;" .
(661) 587-6265 310-900-3700 '
24-HOUR PHONE* 126. 24-HOUR PHONE*
310-900-3700 310-900-3700 '
PAGER # 127. PAGER #
ADDITIONAL LOCALLY COLLECTED INFORMATION:
Property Owner: Ralphs Grocery Company Phone No.: 310-884-9000 ' n3.
Billing Address: 2201 South Wilmington Avenue, Compton, CA 90220
Number of employees: 045
Administering Agency~ City of Bakersfield
Certification: 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 and believe the information is true, accurate, and complete. - -
~~ 134. I NAME OF DOCUMENT PREPARER ~35.
}w ~^TO~ OR VESI~N^'rE~ m~PRm~^T,V~ V^T;[ ~! 0 ~ ~_~nthia Cardenas
IIAME OF SIGNE (print) 136. TITLE OF SIGNER 137.
Carrol Chen ~, Manager, Environmental Affairs
* See Instructions on next page.
Ralphs Grocery Company/Food 4 Less Business Plan
Rev. 03/01
.... ~?ili2: ~ ,.Emergency ResPonse Plan
Page 'of
_ ~ ~' that handle hazardous materials in specified quantities must haVe a wri~en emergency
..This site-specific. Emergency Response Plan is the facility's plan for dealing with emergencies
~lemen Ied munediately ~vhenever there is a f?e, explosion, or release of haT. ardous maIeri.'als that could
in hum xn health and/or the environment. At leas.t one copy pf the plan shall be maintained at the facility.
': fo.r use~ .'.m the event of an emergency and for inspection by the local agency.
· 1. Evacuation Plan:
a. ~The following alarm signal(s) will be Used to begin evacuation of the facility (check all that apply):
[~] Bells; [---] Horns/Sirens; [~ Verbal (i.e. shouting); [-] Other (specify)
b. [~ Evacuation. map is prominently displayed throughout the facility.
Note:A prot~erly, coml~leted Site Plan satisfies'C ontingenc, y plan map requirements. This drawing (or
dt:awlng, ihat st~ows Rrimary and alternate evacuation routes, emer~en.cy exits,
staging areas), must be prominently posted throughout the facility 'in locations be visible
, employees anct visitors. '
e no
Emergency Contacts*:
Fire/Police/Ambulance
State Office of Emergency Services
Post-Incident Contacts*:
911
(800) 852-7550 or (916) 262-1621
Ce
Fire Department Hazardous Materials Program (661) 326-3979 '
Department of Toxic Substances Control (510) 540-3739.
* Thesd telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may
be required to be notified.
Emergency Resources:
Poison Control. Center
Nearest Hospital: 'Name:
Address:
City:
Phone No.:
(800) 876-4766
Industrial Medical Group of Bakersfield
2501 G Street
Bakersfield, CA 93301
(661) 327-2225
3. Arrangements With Emergency Responders:
If you have mad_e special (i.e.. contractual) arrangements with any p. olice department, fire d. epartment
contractor, or ~tate or local emergency response team to coordinate emergency services,
arrangements below:
Designated Cleanup Contractor: Advanced Cleanup Technologies Inc. (ACTI)
20928 Lamberton Avenue, Carson CA 90810
800-334-2284; 310-763-1423
Ralphs Grocery Company / Food 4 Less Business Plan
Rev. 03/01 '~'
I
,~': ',;-:Emergency Response Plan Page.
II17:" ::.~:-:-:::~.4~:,,c::?,.. ?.
?5 ;~' 4;?[~EmergencyProcedures:
I~~
"~.~-' ~.. ~:~llempl~ees ~e ~ned in H~ad Co~ication ~at hcludes s~e h~dlhg procedures of h~adous'
? matefi~s, In some cases Employees do not come into direct contact M~ ~e h~dous material due to
.:'cOntained units or closed-loop systems.
Mitigation
Small spill - emp~0yees are trained to stop and contain the leak.
Fire - employees are to call the fire'department. Trained employees are to use the fire extinguisher to conffol::
tl{e fire when safe to do so. When necessary, the employees will be notified to evacuate the store safely.
i) Actions taken in response to the incident;
j.l Administrative or engineering controls designed to prevent such incidents in the future.
Ralphs Grocery Company / Food 4 Less Business Plan
Abatement
When safe to do so, employees will don personal protective equipment to stop the release, cordon off the area
from further traffic, and contain the release with absorbent. The waste is then placed in a labeled waste dram,.
for proper disposal. The fire department and/or a cleanup contractor will be contacted to control and abate
spills.
. Notification & Evacuation "'.
nen UpOn hearing the evacuation alarm or PA announcement, employees will evacuate and report to designated '?
eeting arbas. The store director or person-in-charge is responsible, for making the announcements and to
sure that all employees exit safely. . '
· -. , . ..,.
5. Post-incident Reporting/Recording: - ' ' .
The time, date, and details of any hazardous materials incident that requires implementation of this plan shall
noted in the facility,s operating record. Within 15 days of any hazardous materials emergency incident,
written Emergency Incident Report must be submitted to the California Environmental Protection AgencY's
Department of Toxic Substances Control and the local fire department's hazardous materials program. The
report shall include: .,...-~ -
a) Name, address, and telephone number of the facility's owner/operator; :
b) Name, address, and telephone number of the facility;
· c) Date, time,'and type of incident (e.g. fire, explosion,.etc.);
d) Nam6 and quantity of material(s) involved;
e) Theextent of injuries, if any; .." ..
f) An assessment of actual or potentiai hazards to human health or the environment, where this is applicable;
g) Estimated quantity and disposition of recovered material that resulted from the incident;
h) Cause(es) of the incident;
Large spill - employees are to notify the store director or person-in-charge as well as'th~ local fire department
to respond. When safe to do so, employees Will attempt to isolate the leak. '"
lll~}~:.:c~E~iiEin~i'~ency Response Plan
~ . :~. ~.,. ~.. ?i..~.~::~ , ~. , ... , '
/i-~i::' '" '''~6.~ Em'ei~gencYEquipment:
.~'~i'' '~i22:'-'~CRT§66265.52(e) requires that emergency equipment at the facility be 'listed.
clii::;. ~0'll0',~ing EmergenCy Equipment Inventory Table meets this requiremefit.
EMERGENCY EQUIPMENT INVENTORY TABLE
Page __of__
Completion of the
1. 2. 3. 4.
Equipment Equipment ,,'.,..
Locations * ~' :t:: ,Description~__ * *
Category
Type
Personal [] Cartridge Respirators ~
Protective [] Chemical Monitoring Equipment (describe)
Equipment, [] Chemical Protective Aprons/Coats '
Safety [] Chemical Protective Boots
Equipment, [] Chemical Protective Gloves
and [] Chemical Protective Suits (describe) ":'~'
Fffrst Aid [] Face Shields
Equipment [] First Aid Kits/Stations (describe) Throu[~hout Banda§es~ aspirin~ antiseptic
[] Hard Hats ,
[] Plumbed Eye Wash Stations
[] Portable Eye Wash Kits (i.e. bottle ~vpe)
[] Respirator Cartridges (describe)
[] Safety Glasses/Splash Goggles
[] Safety Showers
[] Self-Contained Breathing Apparatuses (SCBA)
[] Other (describe)
Fire [] Automatic Fire Sprinkler Systems Throughout
xtinguishing [] Fire Alarm Boxes/Stations
ystems [] Fire Extinguisher Systems (describe) Throughout
[] Other (describe)
Spill [] Absorbents (describe) Throughout Spill Ma~ic stations; kitt~ litter in pet food aisle
Control [] Berms/Dikes (describe)
Equipment [] Decontamination Equipment (describe)
and [] Emergency Tanks (describe)
Decontamination [] Exhaust Hoods Service Deli Used for hot food preparation
Equipment [] Gas Cylinder Leak Repair Kits (describe)
[] Neutralizers (describe)
[] Overpack Drums
[] Sumps (describe) Back Dock
[] Other (describe) '
Communications [] Chemical Alarms (describe)
and [] Intercoms/PA Systems Throughout
Alarm [] Portable Radios
Systems [] Telephones Office Also located at front end of store
[] Underground Tank Leak Detection Monitors
[] Other (describe)
Additional . []
Equipment [-']
(Use Additional []
Pages if Needed.) []
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
Employee Training
Page
Evacuation/re-entry procedures & assembly point locations
Emergency incident reporting
External emergency response organization notification'
Location(s) and contents of Emergency Response Plan
Facility evacuation drills, that are conducted at least (specify)
Ralphs Grocery Company / Food 4 Less Business Plan
Ralphs Grocery Company, Food 4 Less, Foods Co, Bell Markets and' Call Fo0d~ employees are trained
Hazard Communication upon hiring. EmplOyees are instructed in safe handling.procedures of hazardous
materials, emergency response procedures and evacuation and notification procedures. A chemical safety video
and handbooks are used in the training program. Refresher training is provided annually, i :~
Ralphs Grocery Company, Food 4 Less, Foods Co; Bell Markets 'and Call Foods stores do not have on-site::
emergency response teams. The stores rely on ~e local fire departments and hazardous materials services f6~!
assistance in a. chemical' release or other incident. '" ";'
(e.g. "Quarterly'; etc.).
UNIFIED PROGRAM CONSOLIDATED FORM
-: '- " HAZARDOUS MATERIALS -
,'. . HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION .i.
,I- 1--1 ADD [] DELETE [] REVISE Page of '
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
Foods Co - Store #773
CHEMICAL LOCATION 2ol. CHEMICAL LOCATION CONFIDENTIAL ,
Machine Room ,. EPCRA ,:
[] YES [gl.N0::.
H. CHEMICAL INFORMATION ..
CHEMICAL NAME 2o~. TRADE SECRET [] Yes [] No 2o6:,.
Chlorodifluoromethane If Subject to EPCRA, refer to inzttucfion~
COMMON NAME~ 2O7.
EHS* [] Yes [] No ".'
F~eon 22
CAS// 2o9. .. ¥
75-45-6 *If EHS is 'Yes," ali mounts below must b~ in lbs. · ·
FIRE CODE HAZARD CLASSES (Complm if required by local agency) 210''
213.
HAZARDOUS MATERIAL [~ a. PURE . rn b. MIXTURE [-I c. WASTE 211. RADIOACTIVE I-'l Yes [] No 212. CURIES
TYPE (Check one item only) ' ~
PHYSICAL STATE' .
(Ch~onei~only). rna. SOLID []b. LIQUlV []c. GAS 2~4' LARG~SrCONTAINER
FED HAZARD CATEGORIES .' 216.
(Check all that apply) . [] a. FIRE [] b. REACTIVE [] c. PRESSURE RELEASE [] d. ACUTE HEALTH I-'l e. CHRONIC HEALTH .:~ ......
- 221. DAYS ON SITE .222.
UNITS* [] a GALLONS, [] b. CUBIC FEE'r [] ¢. POUNDS [] d. TONS 365. ·
(Check one item onl¥~ ' * If EHS) a~nount must be in pounds.
STORAGE
CONTAINER ['-I a. ABOVEGROUND TANK I~1 e. PLASTIClNONMETALLIC DRUM [] i. FIBER DRUM [] m. GLASS BOTTLE 1-] q. RAIL CAR '
[]b. UNDERGROUND TANK []f. CAN []j.'BAG []n. PLASTiCBOTrLE []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 [~ b. ABOVE AMBIENT [] ¢. BELOW AMBIENT ' 224.
STORAGE TEMPERATURE [] a. AMBIENT. [] b. ABOVE AMBIENT [-I'¢. BELOW AMBIENT 'I-I.d. CRYOGENIC 22~.
% WT HAZARDOUS' COMPONENT (For mixture or waste only) EHS . CAS #
1. 100 22~. Chlordifluoromethane 22z [] Yes [] No 228. 75-45-6 22~.
2. l~0. 221. [] Yes [] No z):l.
3. 2~. 22~. [] Yes [] No 23e. ~?.
4. 238. z)¢. [] Yes [] No 24o.
lt' more hamardom eompoaenm are present at greater than 1~ by we~ht If no~.earelnosenle) or 0.1~ by ~elght ff eaechmg~fie) altaeh additional ~hec~ of paper c~pturla~ the requital hfformation..
ADDITIONAL LOCALLY COLLECTED INFORMATION
DOT Hazard Class:
I) If EPCRA, Please Sign Here:
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
''r~.:~} :. ,': .. UNIFIED PROGRAM CONSOLIDATED FORM
'"';.' ; HAZARDOUS MATERIAI~
& ' '": HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIFFION
.t [] ADD [] DELETE [] REVISE Page __of~
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITy NAME or DBA - Doing Business As)
Foods Co - Store #773
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL . 202.
Floral Department EPCRA
[] []. NO.
IT. CHEMICAL INFORMATION
CHEMICAL NAME 2os. TRADE SECRET [] Yes [] No 206.
Helium If Sub}m ~o BI'CRA, r~f:r to
COMMON NAME 2o7. 2o8.
EH$* [] Yes [] No
CAS#, 2o9.
7440-59-7 : *If EHS is "Yes," all amounts below must be in lbs. '-. '" ,~
FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210.
HAZARDOUS MATERIAL I~ a. 'PURE [-] b. MIXTURE I-1 ¢. WASTE 211. RADIOACTIVE I-I Yes [] No 212. CURIES · '
TYPE (ChecIr one item only)
PHYSICAL STATE' 214. LARGF-,3T CONTAINER 244 cubic feet
(Check on~ item only) I--I a. SOLID I-1 b. LIQUID [] ¢. GAS ,',
FED HAZARD CATEGORIES ll6.
(Check all that apply) I'-I a. FIRE I-I ti. REACTIVE [] ¢. PRF. SSURE RELEASE [] d. ACUTE HEALTH I-I ¢. CHRONIC HEALTH
AVERAGE DALLY AMOUNT 217. MAXIMUM DALLY AMOUNT 218. / ANNUAL WASTE AMOUNT 210. STATE WASTE CODE 220:.
44 244
- 221. DAYS ON SITE 222.
UNITS* [--[ a. GALLONS, [~ b. CUBIC FEET [] c. POUNDS [] d. TONS 365 '
(Check one item only} * if EHST ~mount must be in pounds.
STORAGE
CONTAINER [] a. ABOVEGROUND TANK [] e. PLASTIC/NONMETALLIC DRUM [-] i. FIBER DRUM [-] m. GLASS BOTTLE [] q.' RAIL; CAR
[] b. UNDERGROUND TANK [] f. CAN [] i.'BAG [] n. PLASTIC BOTTLE I-I r. OT~ER
~ [] c.. TANK INSIDE BUILDING 1-] g. CARBOY [-I k. BOX [] o. TOTE BIN
[] d. STEEL DRUM [] h. SILO [] I. CYLINDER [] p. TANK WAGON 223.'
STORAGE PRESSURE [] a. AMBIENT [~1 b. ABOVE AMBIENT [] c. BELOW AMBIENT ' 224.
STORAGE TEMPERATURE [] a. AMBIENT. [] b. ABOVE AMBIENT l-lc. BELOW AMBIENT '"[~'d' .CRYOGENIC
225.
% WT HAZARDOUS COMPONENT (For mixture or waste only). EHS - CAS #
1. 100 22~. Helium 22?. [] Yes [] No 22s. 7440-59-7
2. 2~o. 231. [] Yes [] No 232.
3. 2~. 235. [] Yes [] No 13~.
4. us. 2~. [] Yes [] No 2~0.
5. m. ~3. []Yes [] No 144.
If mor~ hazm'dous compoue~ts m-~ prtseut at ~.ater than 1% by wet~ht if nou-carclnosenlc, or 0.1~ by wel~ ff cllrchlogeJdc, sttach additional shee~ of paper e.~pim'ln~ tl~ r~qulred Information.
ADDITIONAL LOCALLY COLLECTED INFORMATION ~6.
DOT Hazard Class:
)' If EPCRA, Please Sign Here.
I ~:!: ~'' Raiphs Grocery Company / Food 4 Less Business Plan
Rev. 03/01
.. ' ',?,'~ .... ,' ' UNIFIED PROGRAM CONSOLIDATED FORM" ' ,'
" HAZARDOUS MATERIALS
' HAZARDOUS MATERIALS INVENTORY - CI-IE CAL DESCRIPTION
.] lone ~nje per material ~er buildin~ or area)
[] ADD [] DELETE [~ REVISE 200.[ Page __of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA = Doing Business As) $...
Foods Co - Store/~773
CHEMICAL LOCATION. 201. CHEMICAL LOCATION CONI-'LUENTIAL 2o2.
Porter's Room [] YES I~, NO":'
H. CHEMICAL INFORMATION
CHEMICAL NAME 2os. TRADE SECRET [-'l Yes [] No 206...
Proparle if Subject to EPCRA, refer to imffuctiom ' .
C~)MMON NAME 20~. 298..
Propane
*If EHS is 'Yes," all amounts below must be in lbs.
74-98-6
FIRE CODE HAZARD CLASSES (Complet~ if re~uired by Io~d ~cncy) 2~0.
HAZARDOUS MATERIAL [] a. PURE [] b. MIXTURE [] ¢. WASTE 211. RADIOACTIVE [] ¥~ [] No 212. CURIES
TYPE (Ch~k one item only)
P. SacAL rrATE LARGer CONTAINER
(Check on~ item only) [] a. SOLID [] b. LIQUID [] ¢. GAS
FED HAZARD CATEGORIES 216.
(Check all that apply) I~ a. FIRE [-I b. REACTIVE [] ¢. PRF~SURE RELEASE [] d. ACUTE HEALTH [] ¢. CHRONIC HEALTH
~ 221. DAYS ON SITE 222.
UNITS* [] a. GALLONS 1~ b. CUBI~ FEET [] c. POUNDS [] d. TONS 365 · -
(Check one item only) * If EHS~ amount must be in pounds.
STORAGE '
CONTAINER ~~K f"l e. PLASTIC/NONMETALLIC DRUM [] i.. FIBER DRUM [] m. GLASS BOTTLE [='] q. RAIL CAR
[] b.. UNDERGROUND TANK [] f. CAN [] j. BAG [] n. PLASTIC BOTI'LE [] r. OTHER
[] c. TANK INSIDE BUILDING [] g. CARBOY ~ [] o. TOTEBIN
[] d. STEEL DRUM [] h. SILO [] p. TANK WAGON 223.
STORAGE PRESSURE [] a. AMBIENT [] b. ABOVE AMBIENT [].c. BELOW AMBIENT
STORAGE TEMPERATURE [] a. AMBIENT f=] b. ABOVE AMBIENT [] c. BELOW AMBIENT .'~l d. ~RYOGENIC 225.
% WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS.#
L loo ~2~. Propane ~?. [] Yes [] No 228. 74-9g-6 229."
2. 230. 231. [='] Yes [] No 232. 233.
3. 234. 225. [] Yes [] No 236. '~37.
4. ' ' 238. 239.. [] Yes [] No 240. 241.
If mor~ lmz~rdous components are present nt gr~nter than 1% by weight if non-cnrcinogenk~ or 0.1% by weight if cnrdnogeni¢, attach additional sheets of paper rmpturing the required htfornmtion.
ADDITIONAL LOCAI~LY COLLECTED INFORMATION 246.
If EPCRA, Please Sign Here.
Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01
.~., SITE PLAN
Chemical Inventory &'BuSiness Emergency Plan
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