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HomeMy WebLinkAboutBUSINESS PLAN 1/10/2000 Per it to Operöte Permit ID #:: 015-000-000782 HOLIDAY CLEANERS LOCATION: 4200 STINE RD E Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX,(661) 326-0576 Expiration Date: This permit Is Issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment Issue Date .,.. Issued by: June 3..0, 2003 ------ ----.--.---.------.....---- - Per... it to Operil.te Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 01S-021.Q00782 HOLIDAY CLEANERS LOCATION Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 4200 STINE This permit is issued for the following: zardous Materials Plan "',~9round Storage of Hazardous Materials ""'agement Program , Waste Approved by: ~. ph Huey, ffice of ental Servi es June 30, 2000 Expiration Date: V:~J '-:...o::-~ A~ ,1IIt.,.-;;-A. -e 41, ¡-, ~1 SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUSINESS NAME: Hol i OA'I c.' eC\1'\ e.1I" .$_ FLOOR: \ OF , ./ Î DATE: ß /~o/gJFACILITY NAi'lE: UNIT #: OF (CHECK ONE) SITE DIAGRA)I FACILITY DIAGR.~'I ~ W }or!. \E L",\ ~N r- ~ W ~ r~ V1 S)' rq.; #' \' r\- 'y;.- ~ ,,~<t(' c)\' .ct;., c...' 0 ",\V ~~~'to.'"\ WO s"^ v ~\ j \,; ~t!( ~ , 1\(.,'<, ,/' .,. ~l ,~( (, 4- "7 v.' . &Q~ ~rv ~\" 'l,-q\ o-ì tl'~' ~ ft,tÇ . v.fU f;Jµ.f' v~'I æ (Inspector's Comments): -OFFICIAL USE CNLY- Æ~b~ Ck/?'/lA:!T/GS ~O/") ~vC #~ h .:?/è- ..s;rP'9ø /' - 5A - b. Masonry construction e 9. Lock (key) 80x 10. NSDS Stora~e Box 11- Ra11road Track. 12. Fence or Barrier a. W1re b. Masonry c. Wood d. Gates 13. Powerlines 14. Guard Station 15. Stora~e Tanks: Identify the capacity in ¡ai. a. Above ¡round b. Underaround 16. Dikine or Sere 17. Evacuation Route ,--J.~ .of," · o-.;::.;;;f1:~. .... S[TE DIAGRAM (ReqUi~te.S) 1. Address: Identity the principle buildings by the Street nuebers. ~. .' '. 2. Street(.I. Alleys, Driveways. and Parkin~ Areas adjacent to the property. Include the street na.es. 3. Store Drains. Culverts. Yard Drains 4. Drnina¡e Canals. Ditches. Creeks. 5. 8uildings a. Fra.e construction c. Metal construction d. Access Door 6. Utility Contrel: a. Gas b. Electricity c. Water 18. Evacuation Area: Identity the location "here eeployees will ..et. 7. Fire Suppression Systecs: a. Fire Hydrants b. Fire Sprinkler COMectlona 19. Outside Hazardous Waste Stora¡e c. Pire Standpipe Connections 20. Outside Hazardous Material Stora¡e d. Water Control Valves tor protection syetee. 21. Outside Hazardou. Mater ial Un/Handlinr e. Pire Pup 22. Type ot Hazardous Materid/Wuta Stored or Used (See Below) 8. Fire Depart.ent Access TYPE OF HAZARDOUS MATERIAL F · FI_able B · bploaJve L . Liquid R · Rad1010¡iclil C · Corrosive 0 ,. Oxidher G " Galli P · Pobon W · Water Reactive T · Taxi c S . SolId H · Cryo¡enic D · Waste S · Et1olo¡ical Exa.ple: Pla..able L1quid . I'L h fACILITY DIAGRAM (Required Iteaa in addition to the IIGove) 1. Rben tor SprInklers 8. Pire Escapes 2. PartItions W. Air CondItlonIn, Unit. 3. Steirweys: Indicate the 10. WIndow. levels aerved tro. hiehast to loweat. 11. Inside Hazardous Welte Storalrs 4. Escalator: IndIcate the levels served tro. ta. Inside Hazardous hichest to lowest. Naterla1s Storsce S. Elevator 13. Inside Hazardous Materials Use/Handline 6. Attic Acees. 14:' Sewer Drain Inleta T. Skyl1¡hts · - ... R~Ç;ElVED - / ,JAN 1 0 2000 / ' /,BY:_ e HOLIDAY CLEANERS SiteID: 215-000-000782 = Manager Location: 4200 STINE RD E City BAKERSFIELD - BusPhone: Map : 123 Grid: 14C (805) 397-5635 CommHaz : Moderate FacUnits:1 AOV: CommCode: BAKERSFIELD STATION 13 EPA Numb: SIC Code: DunnBrad:77-01161160 - 1\ Emergency Contact / Title lC~ I ''iY ,,_ IT.'...... / Title F~'@''I''-... Em r e cy Contact KHANDU D. PATEL / OWNERS ~--- tf'f ø. -.- /~ß Business Phone: (805) 397-5635x Business Phone: (805) ~P':' [La Ex 3~.2~ 24-Hour Phone : (805) 323-2937x 24-Hour Phone : (805) 3J? IHJ3 9x 6 ().J Pager Phone : ((b J ).3-'Œ -:3g1t x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : Phone: ( ) - x MailAddr: 4200 STINE RD E State: CA City : BAKERSFIELD Zip : 93313 Owner KHANDU PATEL Phone: (805) 397-5635x Address : 4200 STINE RD E State: CA City : BAKERSFIELD Zip : 93313 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List 9 All Materials at Site 9 p= Hazmat Inventory f== MCP+DailyMax Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP PERCHLOROETHYLENE F DH L ))Ù . 1). fA-'\f5L-· I, \< H~t--\ !Do tøsrsby csrtüfy that ~ hav(8 (Yv~ or print n:;)mo) re~i~w~d ~i1~ t§lfct!a©h~(QÌ ~~l3lro1©us materials mana.ge- '\1 \ . . e. R.5 m~iî~ ~~~U1 ~©)r_ pO (~~ ~~ )'¡ ~OO tha~, it along ·~'.f¡th any oorú"OO\tñ(Q)~~ OOü1S~8RI)J~a ® oom¡\»ltS~s and com~ct man- agemeiîl pl$1n fl¡f my I&1d61y.. ~ ~c,\I\~ .f>' 90.00 GAL Low , r , b ---aD -1- 12/21/1999 .. e e SiteID: 215-000-000782 ì Facility Unit: Fixed Containers on Site 9 F HOLIDAY CLEANERS F Inventory Item 0001 = COMMON NAME / CHEMICAL NAME PERCHLOROETHYLENE Days On Site 365 Location within this Facility Unit IN DRY CLEANING MACHINE Map: Grid: CAS # 127184 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE IN MACHINE/EQUIP Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 90.00 GAL Daily Average 90.00 GAL %Wt. RS CAS # 100.00 Perchloroethylene No 127184 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low HAZARD ASSESSMENTS -2- 12/21/1999 · e e SiteID: 215-000-000782 ì Fast Format ì Overall Site ì 07/25/1991 F HOLIDAY CLEANERS I p= Notif./Evacuation/Medical Agency Notification CALL 9-1-1 FIRE DEPT. LOCK THE DOOR, PUT NOTE CLOSED FOR EMERGENCY. Employee Notif./Evacuation 07/25/1991 TELL ALL EMPLOYEES AND PERSONNEL TO IMMEDIATELY GO TO THE NEAREST EXIT AND CALL 911. Public Notif./Evacuation 07/25/1991 TELL ALL CUSTOMERS TO GO OUT AND LOCK THE MAIN ENTRANCE DOOR, PUT NOTE CLOSED FOR EMERGENCY AND CALL 9-1-1. Emergency Medical Plan 07/25/1991 MEDI CENTER - 820 34TH ST - 325-6334 -3- 12/21/1999 e e SiteID: 215-000-000782 ì Fast Format ì Overall Site ì 09/11/1992 F HOLIDAY CLEANERS I p= Mitigation/Prevent/Abatemt Release Prevention KEEP ALL HAZARDOUS MATERIALS IN CAPPED BOTTLES AND IN HOLDING TANKS. TURN ON OUR EXHAUST FANS TO GET FUMES OUT AND CLEAN UP ANY LIQUID ON FLOORS. PERCHLORETHANE IN A SEALED PROCESSING MACHINE. Release Containment 09/11/1992 WE HAVE A PAD BEHIND THE MACHINE IF CHEMICALS LEAK ONTO THE PAD WE WILL TELL ALL CUSTOMERS TO LEAVE. THEN ALL EMPLOYEES WILL LEAVE AND LOCK THE MAIN ENTRANCE AND CALL 911. Clean Up 09/11/1992 PUT SAND ON IT OR CALL 9-1-1 FOR THE FIRE DEPT. SHUT OFF GAS UTILITY AND GET READY WITH FIRE EXTINGUISHER. Other Resource Activation -4- 12/21/1999 '. e e SiteID: 215-000-000782 1 Fast Format =¡ Overall Site 1 07/25/1991 1 07/25/1991 F HOLIDAY CLEANERS I p= Site Emergency Factors r=: Special Hazards I PERCHLOROETHYLENE Utility Shut~Offs A) GAS - BEHIND OUR BUILDING B) ELECTRICIAL - BEHIND OUR BUILDING C) WATER - BEHIND OUR BUILDING D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/25/1991 PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS AND SPRINKLER SYSTEMS FIRE HYDRANT - ON THE CORNER OF STINE. Building Occupancy Level -5- 12/21/1999 .. e e SiteID: 215-000-000782 ì Fast Format ì Overall Site ì 06/19/1991 F HOLIDAY CLEANERS I F Training Employee Training WE HAVE 3 EMPLOYESS AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: Page 2 r I I Held for Future Use Held for Future Use -6- 12/21/1999 ~ Y.hiNL . /' . Bakersfield Fire Dept. II HAZARDOUS MATERIALS DIVISION Business Name: It/I 4 L..~4 ~? Location: q 2. ß tJ )" II k ~ X'J , .:tI= ¡Ç Business Identification No. 215-000 ()t9t9 -¡r g Z (Top of Business Plan) Station No. ) > Shift A Inspector f? .#Jt,t "~J. ".. ..... . ~ Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: Date Completed Adequate ~ ~ ~ ~ t" ,L Oz/ ;I '..o,#T, L _ /' RECEIVED NOV 19 1992! HAZ. MAT. DIV. Inadequate D D D D Verification of MSDS Availablity Number of Employees '1 Verification of Haz Mat Training Comments: D D ~ ~. o Verification of Abatement Supplies & Procedures Comments: ~ Emergency Procedures Posted Containers Properly Labeled Comments: o ~ t2K o Verification of Facility Diagram Special Hazards Associated with this Facility: D tØ Violations: /111-- ~~Je--'¡' ~ JI~, /Ud-; h?5 ~G-J...() II ~ '12- ;' M~~r 7fJ-ut Á--- "-" t::: J~~e:lt'~7:./'~~: 7:tÚ[:'~Þ All Items O.K. Correction Needed D "\ \ Business Owner/Manager FD 1652 (Rev. 1·90) White-Haz Mat Div. Yellow·Station Copy Pink-Business Copy I' ' 'BUSINESS NAME: ;::I/dq~' cle:;;. e tRJ- LOCATION: -4o? S'T" /ý ~ J;J...'E.. CITY, ZIP: 13ß-K'e¡:l.JJ::..i"eicl..¡ ~ Y3.?J3 PHONE I: RIJ ~~ r;,ae¡'J - S03S- ,~ page_:~ NAME OF THIS FACILITY, Þ í1'f cI e.~ ?:>~1 STANDARD IND. CLASS CODE:' DUN AND BRADSTREET NUMBER/FEDERAL ID # ii-õlJ6 pï bë- o Farm and Agriculture 0 Standard Business CITY OF BAKERSFIELD HAZARDOUS MATERIALS INVENTORY NON - TRADE SECRET ADDRESS: CITY, ZIP: PHONE,I: , , 13 , by wt 14 Names of Mixture/Components See Instructions fe~~~cyOYO~ ~~ Physical and Health Hazard (Check all that apply) ~ C.A.S. Number ~~~'It ,~ Component It 1 Name & C.A.S. Number o Fire Hazard c:J Sudden R~lease of Pressure o Reactivity 0 Inunediate 0 Delayed Health Health 2 Name & C.A.S. NUmber Component It 3 Name & C.A.S. Number ¡' Physical and Health Hazard '<j (Check all that apply) C.A.S. Number Component It 1 Name & C.A.S. Number ·'·f ,; D Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 DeiaYed of Pressure Health Health 'Component It 2 Name & C.A.S. Number Component It 3 Name & C.A.S. Number Physical and Health Hazard (Check all that apply) D Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 Delayed of Pressure Health Health C.A.S. Number Component It 1 Name & C.A.S. Number Component It 2 Name & C.A.S. Number Component 1/ J Name & C.A.S. Number , , " . ~ .( Physical and Health Hazard C.A.S. Number (Check all that apply) o Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 Delayed of Pressure Health Health Component , 1 Name & C.A.S. Number Component' 2 Name & C.A.S. Number ...1 Component' 3 Name & C.A.S. Number EMERGENCY CONTACTS u t1W'h~ Title 3.:o~.:t :) 24 Hr Phon I ·1 ì Certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I haver personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those ,~ndividuals responsible for obtaining the information. I be~ieve that the submitted information is true~ac urate, and complete. ¡ k~?) rlu... 7J.. ß-l-d, (0 WNGR..) , _b. ~1 ~.9 t1Id 8- o?1f- 92-1 lfJIMEAND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED REPRESENTATIVE 'GNATURE DATE SIGNED f:18/~::;' i./'3'~i' '.. ~.,..~. ¡..IIDAY CLEANERS 21~¡-000-00.2 verall Site with i Fac. Un~ PaRe 1 General Information ..---------....-....-....--.....------..----.. ---------- Location: 4200 STINE RD E Community: BAKERSFIELD STATION 13 ._I'r1~p~--- 1~~ '-;'ia-;:~~: I'r1c:d~'~0 Grid: l~C FlU: 1 AOV: u:OI ..J ..------......... ê COY'lt act Name KHANDU D. PATEL PRSHANT N. PATEL -- Title ---]I; BusiY'.ess PhOY'.e~ 24-Hou.,.'" PhcmÐ OWNERS (805) 397-5635 x (805) 323-2937 OWNERS (805) 397-5635 x (805) 323-2937 ----..-- ------ - -----....-........--- Ma i 1 Add.,."'s: City: CCfmm Cc.de: ----------- AdmiY'.ist","'ative Data 4200 STINE RD #E BAKERSFIELD 215-013 BAKERSFIELD STATION 13 D&B Nw.lbe.,."': State: CA Zip: SIC Code: 93313,- ----..------..-- ..-....------ ___00_- Owner: KHANDU PATEL Address: 4200 STINE RD #E City: BAKERSFIELD Phone: (805) 397-5635 State: CA Zip: 93313- -....-....--..........-....---..--..--------- Summa.,."'y ------ ------..---..--- -......--..- RECEIV'ED SfP 1 0 1992 HA~. M&\T. £'IV. ..---....-..------..- '--- 1.ÌJ-tAI\.I ou· .D. ~A-ŒLDO hereby certify that I have (Type or print name reviewed the attached hazardous materials manage. ment plan for.h9Jì~4"1æ c Ie'}» t-1(nd that it along with (Frame' éuslness) .. any corrections constitute a complete and CO"Qct man. agement pJan for my facility. * ~!dYl ~ - Pi ßiJ. QnaIU1'e g. oli/- o¡~ . Dete ------'" 08/21/92 HOLIDAY CLEANERS 215-000-000782 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Quantity MCP 02-001 PERCHLOROETHYLENE Fire, Delay Hlth Liquid 90 Low GAL 00__- e - Ø8/ê:l/'38 . HAIDAY CLEANERS 215-000-00~2 '(!III!!!' - Fix ed COY'lt a i Y'let~s CIY'I S i _ Page 3 Hazmat Inventory Detail in MCP Order 02-001 PERCHLOROETHYLENE FÌ1'~e, Delay Hlth Liquid '30 LCM GAL CAS #: 127184 Tt~ade Sect~et: No FClnt' : Liquid Type: Pure Days: 365 Use: CLEANING - Dai ly Max GAL --¡- Dai ly Avet~age GAL \- AY'IY'Il\al AmclLmt GAL - '30 I '30.00 I 1,000.00 Stclt~age IN MACHINE/EQUIP r Pt-'ess T Temp :l LCleat iCIY'1 Ambient Ambient I IN DRY CLEANING MACHINE - CCIY'IC -\ . 100.0~ Perchloroethylene CompC'Y'leY'lt s r.- MCP -TList I Lc,¡,, I 08/21/92 HOLIDAY CLEANERS 215-000-000782 00 - Overall Site Page 4 (D) Notif./Evacuation/Medical (1) Agency Notification CALL 9-1-1 FIRE DEPT. LOCK THE DOOR, PUT NOTE CLOSED FOR EMERGENCY. (2) Employee Notif./Evacuation TELL ALL EMPLOYEES AND PERSONNEL TO IMMEDIATELY GO TO THE NERREST EXIT AND CALL 911. (3) Public Notif./Evacuation TELL ALL CUSTOMERS TO GO OUT RND LOCK THE MAIN ENTRANCE DOOR, PUT NOTE CLOSED FOR EMERGENCY AND CALL 9~1-1. (4) Emergency Medical Plan ---- MEDI CENTER - 820 34TH ST - 325-6334 e e Ø8/21,1'3é: Ha[DAY CLEANERS 215-000-0(H_2 ~ 00 - Overall Site ~ ------.. (E> Mitigation/Prevent/Abatemt (1) Release Prevention Page ~5 ....----..------ KEEP ALL HAZARDOUS MATERIALS IN CAPPED BOTTLES AND IN HOLDING TANKS. TURN ON OUR EXHAUST FANS TO GET FUMES OUT AND CLEAN UP ANY LIQUID ON FLOORS. PERCHLORETHANE IN A SEALED PROCESSING MACHINE. (2) Release Containment c:..v Ë A ~ "e t11 Pd . L-e.(2)~ f~Q"fJ í-f O)o¡ d cvlJ· 6- m p I ð'je e..J j) 0 ð f7- (c-AJ Fí~~ <3) Cl€~a""l Up J3 e.t, i /) d '1@/1 Clio 0 £Jf -!H- 6111 iF <}Y ar....e h lJvte. CfAJTð~ L Q (" k. -1 <---f.... rm PI II) q._\r)~ 'TD c h e''W\}~ (¡'\ 0 0 i.Jt ;,; /)" """'-f!- t1 t4 (.. tz:."J Q'l-td t:JY/d 7 c. P, \I PUT SAND ON IT OR CALL '3-1-1 FOR THE FIRE DEPT. SHUT OFF GAS UTILITY AND GET READY WITH FIRE EXTINGUISHER. <4) Other Resource Activation 08/21/'32 HOLIDAY CLEANERS 215-000-000782 00 - Overall Site <F} Site Emergency Factors ---... ......------.. (1} Special Hazards PERCHLOROETHYLENE (2} Utility Shut-Offs A) GAS - BEHIND OUR BUILDING B) ELECTRICIAL - BEHIND OUR BUILDING C) WATER - BEHIND OUR BUILDING D) SPECIAL - NONE E) LOCK BOX - NO (3} Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS AND SPRINKLER SYSTEMS FIRE HYDRANT - ON THE CORNER OF STINE. (4} Building Occupancy Level e e Page 6 ----- ("8/~ 1 /93 '. (1) Page 1 H~. DAY CLEANERS 215-000--00(_2 ~ 00 - Overall Site ~ (G} Tt"'a irsi 1'"19 --..---------..------..- ....----....- WE HAVE 3 EMPLOYESS AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: (2} Page 2 as needed (3} Held for Future Use (4} Held for Future Use Page 7 ~c~. -()~ - ,.,.-- .. ~. ~y- e e BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 )d3- \Lt ~ @ . ~ç>( OFFICIAL USE ONLY BUSINESS NAME ID# _Il (J·13 HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A r:b'" ~ ~ 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. RECEIVED AU G 28 1987 Ans'd........ .... SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME :---1-\ 0 \ \í) ~'I c.\e..C\'Y'\e:«~ B. LOCATION / STREET ADDRESS: l\òtOO' ~T\"'E RD- .::: :t.£. 00 CITY: ßA'Ke..Rsf\e...\.D.. ZIP: ~~~"3 BUS.PHONE: (80S) 391- S"6:5S 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 ~~D TITLE DURING BUS. HRS. A. lll-'ANOU~ D· fA\FL Ph# 397"'Sb~ B. rf<S\-'A~\\' f\..LP~'TÞL Ph# '3,~1-st3S- Ph# AFTER BUS. HRS. 3~ó - òL~ßl. 3~~ - ø1..<\37 Ph# SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: -- Bel, iMa ,OM /Ju/c:/t"¥J- B. ELECTRICAL: ß.p.J,;¡f-JP\ ()~ I1i.MJtrry-- C. WATER: -- Oe.A¡?10 1JUr/ t1l..L.ilcJr^~ D. SPECIAL: ---- E. LOCK BOX: ~ / NO Iof' ';[is, LßCA'PION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - e - -,,-~, , ,'""- " " fa, -4 "·-...t -- . , '" ", '", SET¡OÑ2:-°NSE TEAM FOR BUSINESS AS A WHOLE ...--" SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE . , ., .\.1 ~. ... "" ~~~ ~~'-d-"'\'Y\W' ceaL . C~",~~ -- --- -- --- - - -'-""------- -- ~----- 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 A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:..........,............... C. PROPER USE OF SAFETY EQUIPMENT: . . . . . . . . . . . . . . . . . . D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . . . E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:..... .. INITIAL REFRESHER ~NO YES NO ~ NO ~ NO ii5 NO ~NO YES NO YES NO YES NO YES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A COMPRESSED GAS: . . . ... YES NO I, 1</,", ffN 0 U' 1J Pf:(ÎÈL. , 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 AI.) and that inaccurate information constitutes perjury. SIGNATUREj( ~ ~ cl.u.: CJ, O.l.£. TITLE o'W 'h-€.Jý . DATE b' ao~,.. - 2B - ~, ./~ -;: .- ( ,~ ~ .. e - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# _ L J_ ~ '-3__ BUSINESS NAME: BUSINESS PLAN SINGLE FACILITY 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 below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NA~: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES .;4C¡J M¿ ;/f¡r-II-.R t5t>u $' trMíêtl f1t S IIv t!11:f,.J~ 5 ¡þV ð IN !f~t-b(N6 Ifuv(5 {t.(tlv ðN (fUll. E,Kf/lttlS,T /-,4IV 5 TCJ 6eí Fu /Yl E5 t) C-( 7 Yeecklo~tkNe Iffl/b {!/Eft¡V up öe-~ ~N~ .?lQU. ( ¡) , .' . . - . P&~f~, o µ J-¿¿J¿)¡<' S' . tw.>:-1IAf ~... 1 /oJ It..... SECTION 2: NOTIFICATION AND EVACUATION PROCEDu~ES AT THIS UNIT' ONLY --- /ç¿t /f¿¿ Ell? flo t' ~.5 MJJ f)¡<!¡{ <;'" Ne/ hI;"'" ed,4 e" 7 7D N~eS''T é~/í. AMQ) <:'A~~. _,~. . 4 60 - 3A - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials?..... YES ê) If YES, see B. If NO, continue with SECTION 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-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade - '--~---sec!'-et, ,fo7.'m. List only the, tJ'ad~..§ecr?,ts on form 4A-2. - ~ ------...- ---- -- SECTION 4: PRIVATE FIRE PROTECTION ~,. (fflr $f/lllll/d-e/'" ðy,fre¡ns &- 7'-·L rvrJ 'Shfl.( S' ¡:rrvh SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~~ERS Of'J Ï7f~ (!D~Ne.1( ð F ~/NE< SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. ~AT. GAS/PROPANE: Ï3r!:hOJj) bu I I J IIv 1- ()U~ B. ELECTRICAL: I( C. WATER: I ( D. SPECIAL: E. LOCK BOX, YESB IF YES, [,OCATION, IF YES, SITE PLANS? FLOOR PLANS? YES / NO YES / NO YES / :\0 YES / \'0 MSDSs? KEYS? - 3B - :- " '1 "'--"f ~;- ... " .. . B/\KL {:)l'lI:.J.u \.,1/1 1'lhL !J , l\i\ll'IIJUJ FORM 4A:-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUS I N E S S N AM E: H {j It, 14-1 -0 c. O¡ "1 <.,"1& OWN ERN A ME: k 1-1 A J'..l ø LJ. ¡J I} n: L FA C I LIT Y UN I T #: ADDRESS: 4~oo rjt,¡..l~ ,(.,. :;þ-£. ADDRESS: S...~ FACILITY UNIT NAME: CITY, ZIP: 1J-4-~f.J.-:jØdL .I(.A---113J3- CITY,ZIP: ""- PIIONE 1t: /!ó:;- ~ J~ PIIONE #: ~'')-r(.J.r I . D. #: I) OJ J...---. J TYPE CODE 3 ANNUAL AMOUNT 2 MAX AMOUNT 456 CO NT USE UNIT CODE CODE '10./... .. r:.,..... "'1 ~ 1.....' r"'" YOrÞ<- ~ :~ 1'-'- ~ , 1-1 I ^ ... ~..l ~ , (T -,- u q;.. ;ìo~ too'~ ~ tY, 7 LOCATION IN THIS FACILITY UNIT ~ .... vr . 8 % BY WT. ~\,.[ t Ut.. Ð ø. L ß~ I( ~A(L !)b~e... 8 ~'~ ~'L '{ o . S-O~ wctù- C-ou--. \1\> \J . NAME: no'ìq)~V Gle.G\\\.ð;t..--:t-- TITLE: EMERGENèV CONn~r;T: KC90.. ()~ EM ERr, ENe Y CON T ^ C T : r1 'N 1:/ ~1ì;L PRINCIPAL ßUSINESS ACTIVITY: ~ 6l.oJe.,~ TITLE: SIGNATURE: IOFFICIAL I ONLY 9 GIIEMICAL OR COMMON NAME rot' \. \ ..JA' -. f.. / -^-', A~;..J -- Page of TITLE: - J. ." ... -~t' ô USE CFIRS CODE 10 HAZARD O.O.T CODE GUIDE ,-' /' . #<.. "t:. ~ (') I ~~~o /U)~<O~, ~---""rL L9. r95W,Q;2 \ /\ ... {, ~~""~. 0- , PHONE # BUS HOURS: AFTER BUS fiRS: PHONE' BUS HOURS: AFTER BUS, fiRS: - ,41\-1 - - " DATE: n j. '{~~~1~'.JS I .3<3 -~J') >~')~1S- ~ ~ 4~ ~ / e Bakersfield Fire Dept. e HAZARDOUS MATERIALS DIVISION . Date Completed ~.- I - c¡ I Business Name: flðLi d IA Y C} € 'Lt'\ tV -e (C S Location: Li '""20 D 5 ¡; «':- Business Identification No. 215-000 ()()l) 77/-"L (Top of Business Plan) Station No. \ ~ Shift P Inspector }-/(') U6L~ Li rr ~ Verification of Inventory Materials Verification of Quantities ~- ~omments: ~ Number of Employees ~ Comments: Verification of Abatement Supplies & Procedures Verification of Location Proper Segregation of Material Adequate IJY' ŒV Q/ ~ RECEIVED J U N 1 ~ 1991 Ans'd.. ........... Inadequate D D D D Verification of MSDS Availablity 3 Verification of Haz Mat Training ~ D ~ D Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: rtV D -'-~~"0 /- \ .{j rn,/ , (D Ü¡/~ ~ '.... ~/ '-....~ ---- D ~ Violations: ~cJ0 hsiness Ownér/Manager FD 1652 (Rev. 1·90) All Items O.K. D Correction Needed 0 White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 04ì05/91 /0\.\ 0,ið e e HOLIDAY CLEANERS 215-000-000782 Overall Site with 1 Fac. Unit l .. RECEIVED J U l 2 ~ -1991 An.s:d.... h ...... Page 1 General Information Location: 4200 STINE RD E Ident Number: 215-000-000782 Map: 123 Hazard: Moderate Grid: 14C Area of Vul: 0.0 COr-It act Name KHANDU D. PATEL SHA T N. PATEL Mail Addrs: , City: Cc,mm Code: I Business Phone I (80~) 397-5635 x .. (805) 397-5635 x - Admir'iÍstrative Data "yS-¡qq 4200 STINE RD #E D&B Number: BAKERSFIELD State: CA Zip: 215-013 BAKERSFIELD STATION 13 SIC Code: - Title 24 HClut~ Ph':'Ylel (805) 323-2937 (805) 323-29371 C OWG µß{J..J;J 9331 :3- --- Owner: KHANDU PATEL Address: 4200 STINE RD ,E City: BAKERSFIELD Ph,:.y,e: (1{ 6) 3q 7 State: CA Zip: r~3313- -sD~ ~ r SUMMary L I ~ o ? ~ ~ \J~ /S=. ì 04/05/'31 HOLIDAY CLEANERS 215-000-000782 HazMat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site Plr,-Ref NaMe/Hazat~ds FClt~M Quarlt it Y 'r1CP 02-001 PERCHLOROETHYLENE ? '30 LClw I GAL , I, e e .. e e HOLIDAY CLEANERS 215-000-000782 00 - Overall Site Page 3 04/05/'31 (D) Notif./Evacuation/Medical (1) Agency Notification / LOG", Tk J>uo I'- ~v.J;: c...tì- \ , C\ , , fÎ (L £.. ~~'\:. NulQ. FuGL £.'""1"1"1 ~"I"'3<-~c."I <:.. \0 S e-d. (2) Employee Notif./Evacuati~~ , r, TELL ALL EMPLOYEES AND PERSONNEL TO IMMEDIATELY GO TO THE NEAREST EXIT AND CALL '311. (3) Public Notif./Evacuation ?, l'e.J\ cJJ ~v ~. o..",d LCJctK C.U0Th~ 'TO E I'-C'\X-f<- ~ CL 3)OI..)~ f~'\ ì'-\.ÔTe.. 'FCi (L.. c \0 ~~t2\ c... A\ \ ~\\ \'-~ ""-\ N ~ E'ì"Y\~e.~\ (4) Emergency Medical Plan MEDI CENTER - 820 34TH ST - 325-6334 04/05/91 HOLIDAY CLEANERS 215-000-000782 00 - Overall Site Page 4 <E> Mitigation/Prevent/Abatemt <1> Release Prevention KEEP ALL HAZARDOUS MATERIALS IN CAPPED BOTTLES AND IN HOLDING TANKS. TURN ON OUR EXHAUST FANS 'TO GET FUMES OUT AND CLEAN UP ANY LIQUID ON FLOORS. PERCHLORETHANE IN A SEALED PROCESSING MACHINE. <2> Release Containment /' <3> Clearl Up )< C--fr' \ , Ç,C(f\- \- r lA--\ q \ \ .- ft ~~ d ì ~ LU-< o 'Yì. . rl. 09-- s t\ "^' d ,.- ~ c-~I\ _ 0,",,'" "ì r F-\ R~ ~~~" '5 ~ O\=-F- £.1'1 ) j'-\ (t~) \,~\ C£~S ~R~ y <4> Other Resource Activation ~-- I I I \ !; e e .. ,I' ,,. e e HOLIDAY CLEANERS 215-000-000782 00 - Overall Site Page 5 04ì05/91 (F> Site Emergency Factors (1) Special Hazards f~p-c .. (2) Utility Shut-Offs A) GAS - BEHIND OUR BUILDING B) ELECTRICIAL - BEHIND OUR BUILDING C) WATER ~ BEHIND OUR BUILDING D) SPECIAL - NONE E) LOCK BOX - NO (3) Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS AND SPRINKLER SYSTEMS FIRE HYDRANT - ON THE CORNER OF STINE. (4) Held for Future use ---T~-- - -- -- .-- 04/05/91 HOLIDAY CLEANERS 215-000-000782 00 - Overall Si~e Page 6 <G> Tra i rlÍ rig (1) Page 1 /' WE HAVE ?? EMPLOYESS AT THIS FACILITY 'i IZ$, DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? 'i ~3· BRIEF SUMMARY OF TRAINING: 'i 0-5 , <2> Page 2 as needed <3> Held for Future Use " <4> Held for Future Use '~, ',~/ - . CITY of BAKERSFIELD . ~.HAZARDOUS MATERIALS INVENTORY Farm and Agticulture [] Standard 8uslness NON-TRADE SECRETS Page ~_,_ of BUSINESS NAM~:ItO/¡dq~ C/eqn~ OWNER NAME: kJlANJ)\)' D' f~íSL. NAME OF THIS FACILITYÒ' f) ¡(Y" c..{e.q'>1t'">i.j. LOC¢TION' __"\Q.JL l..rl_l= /4).~£. ADDRESS' ~D~~ ~ STANDARD IND. CLASS C DE: -" cn È ZIP: A k ~ r=¡.i:!, Cð-- "163) 3 CITY ~ zìp: I!IJK ~FrtJ.J , ~~ "(.3)3 DUN AND BRADSTREET NUMBER--'--------------- PHON $I: PHONt: $I: [))'- J REFER TO-rNSTRU~·,1VN5 rUt< fJRUPER CODES - - - - 1 3' 5 1 8 9 10 11 ,12 U Tr4ns Max Average Annual . Dys Cont Cont Cont Usa loc4tlon Where Nalles of ~ixture(çoIlPonents Code Amt Amt Est on SIte Type Press Temp COde Stored In FaCIlity See Instruc Ions I IN ])f, /O/èe)IIl-t;Æ o Reactivity O Component.2 Name I C.A.S. Number Immediate Health Component 13 Name I C.A.S. Number Phïsical GOd Health Halard ¡çheck all that apply) C.A.S. Number Component 11 Name! C.A.S. Number o Fire Hazard o Reactivity o De Jared 0 Sudden Re I ease Hea th of Pressure Component.2 Name I C.A.S. Number o Immediate Health Component.3 Name & C.A.S. Number Physical 'nd Health Halard (Check a I that applYI C.A.S. Number Component.1 Name & C.A.S. Number o Reactivity o De I ared 0 Sudden Re I ease Hea th Of Pressure Component.2 Name & C,A.S. Number o Immediate Health Component 13 Name & C.A,S. Number Phïsical GOd Health Hafard (çheck all that apply C.A,S. Number Component 11 Name I C.A.S. Number O ,Component'2 Nallle & C.A.S. NUlllber Immediate Health Component.3 Name I C.A.S. Number , EMERGENCY CONTACTS #1 Ef'-J pø- j L O(µ-eYl~ rg3l ~)}8Y ø-R:L. ~íN~ t Name 24 Hr I'none Tit Ie Certificatioq (Reed and $ign afjer c9mp7~ting ç¡77 sections) . I ~ertlfy under penaltï 0 la~ that I have persona Iy examlnaQ aqd am familIar with the informatlon $ubmltted in this and all lttaç~~d dQcu~ents, ano t at Dased on my InQuiry Q those IndlVlduals responsible for obtaIning the lnformatlon. I belIeve that the submItted Infor~at on IS true, accurate, and complete. f) , , I ,[ . _ ~, 6).. e.X .w \I\Jl.. 'Y) J.£-L. S). (?:A..q ~Na~~ 0 IC 8 e wner ooera or owner opera or s au ortze represen a Ive ~~ ?~ ~,~ . o Fire Hazard o Reactivity o Delayed 0 Sudden Release Health of Pressure 3~~~3~ Zf1fr I'nOff¡ ï~)~~1 Dãt:eïjiqill -., I . I