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PERMIT ID # 015-021-002050
MAACO
LOCATION 4321
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Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SERVICES'
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 326-0576
This Dermit 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
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Approved by:
Issue Date
Issued by:
Expiration Date:
. June 30, 2003
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SITE DIAGRAM r ì< 1
Business Name: m N+CD
Business Address: Ÿ3~,
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Adel Shafik
Manager
4321 Stine Rood· Bokersfield, CA 93312
tel 805.B33,1253 . fox B05,833.1428
poger 805.335,3144
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfie 61) 326-3979
HAZARDOUS MATE
EMENT PLAN
INSTRUCTIONS:
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To avoid further action, return this form within 30 days of receipt. I 1-1'2>::'~Û
TYPE/PRINT ANSWERS IN ENGLISH. FJ
Answer the questions below for the business as a whole.
Be as brief and concise as possible.
You may also attach Business Owner / Opërator Form and Chemical Description Form(s)
to the front of this plan instead of completing SECTION 1. below for initial submission.
1.
2.
3.
4.
5.
SECTION I: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: /7)/9IJCD /}J,7é) ,/kJPA.J:J
LOCATION: 'IJ~/ .//)ef.l} .q}1.if' RD.
MAILING ADDRESS: 5A11Jb,
CITy:13ÆherS-fJeúJ STAT~: CIJ- ZIP:9'ß'/.3 PHONE: '633-/;;..;;3
PRIMARY ACTIVITY': f1tjM tý/ 80* 'S40¡J
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OWNER: [)e¡()¡/j¿/¿ ~ gEckv ðSß:,vVl/-f
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MAILING ADDRESS: lOW 3 /'l1tJc)LEV ÐIl/Vi:
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PHONE: (br;5- c?-b8" Y'
EMERGENCY NOTIFICATION
CONTACT
TITLE
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2. DeN I/'f/" G5/¿KJ£¡{}-f
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BUS. PHONE 24 HR. PHONE I
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HAZARDOUS MATERIALS MANAGEMENT PLAN
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SECTION II. 1 : DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
f d~c/o !k/;-fT /ltX/#t Every PfCJY
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B.
EMPLOYEE AND Àt1EN'CY NOTIFICATION:-," - '",'-'
/ F /J ¡z;y ¡(.deASe C¡;Q¿¿ 9'//
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C. 'ENVIRONMENTAL RESPONSE MANAGEMENT:
£¡J/¡ZYez:~s
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D. EMERGENCY MEDICAL PLAN:
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HAZARDOUSMATEIDALSMANAGEMENTPLAN
SECTION II.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
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B. RELEASE CONTAINMENT AND/OR MITIGATION:
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CLEAN-UP AND RECOVERY PROCEDURES:
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C.
UTILITY SHUT -OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROPANE: AJJ}-To, k¿
ELECTRICAL: jl?, G· IE
WATER:"'r:U·· :.
SPECIAL: s!iJfj < .. .
LOCK BOX: YE IF YES, LOCATION:
PRIVATE FIRE PROTECTIONIW A TER AVAILABILITY
A.
PRIVATE FIRE PROTECTION:
Ç}}/pr
B. WATER AVAILABILITY (FIRE HYDRANT): /3A/(Pr~etJ} CI if
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HAZARDOUSMATE~S~AGEMENTPLAN
SECTION III: TRAINING
NUMBER OF EMPLOYEES: /:.J-
MATERIAL SAFETY DATA SHEETS ON FILE: ýe$
BRIEF SUMMARY OF TRAINING PROGRAM:
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/HfJ1/ .$M/iLý 7?A/~ ~//)1/$.
CERTIFICATION
I, tJeAlt/V O;5(3!¥W-e CERTIFY THAT THE ABOVE INFORMATION
IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY
CODE" ON ARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND
THA'IJ INA CURATE_INFORMATION CONSTITUTES PERJURY.
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TITLE
¿:Z·30 -Q?
DATE
4
CITY OF BAKERSFIELD
OF.E OF ENVIRONMENTAL S.VICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER I OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page
Of
:t~~ªlt~J~~~~!!~¡É,ÀJjº~'~~~;:;,~t~\:~;2}:;"~,::;¡A?"î:;;~~~~~;:i¡'(¡,
1 Year Beginning 100 Year Ending
101
BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As)
/17.A-/fGÔ /tcJTo '/J/M/µO¡
3 BUSINESS PHONE
J>33 --/,;2.5
102
/(IJ,
103
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104 CA ZIP r ~3/ .?
106 ,SIC CODE
(~ ~igit #)
105
CITY
DUN&
BRADSTREET
107
108
OWNER MAILING
ADDRESS
113 ¡
,
I CONTACT MAILING
¡ADDRESS
CITY
119
TITLE 125 TITLE 130 :
126 BUSINESS PHONE 131
127 24-HOUR PHONE 132
134
135
0.58tJLAJfè
P'30 -ez;
136 TITLE OF OWNER/OPERATOR
Q:fV/JE/2.
SEXF
137
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. CITY OF BAKERSFIEL"
OFFrtE OF ENVIRONMENTAL SIMVICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
D REVISE
200
(one form per materiat per building or area)
Page of
COMMON NAME
CAS #
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
213
TYPE
o P PURE
PHYSICAL STATE
o s SOLID
FED HAZARD CATEGORIES
(Check all that apply)
ANNUAl WASTE
AMOUNT
. É. 1 FIRE
UNITS'
210
m MIXTURE
o w WASTE 211 RADIOACTIVE
CURIES
DYes
1!9 1 LIQUID
~ 9 GAS
214
5 <:;AL .
LARGEST CONTAINER
215
É 2 REACTIVE
Jg(3 PRESSURE RELEASE
x)5 CHRONIC HEAlTH
216
o 4 ACUTE HEALTH
217 MAXIMUM
DAILY AMOUNT
218 AVERAGE
DAILY AMOUNT
o Ib LBS 0 tn TONS
221 DAYS ON SITE 222
CII~iiD /J1OO7It I..
219 STATE WASTE CODE 220
OgaGAL OdCUFT
. If EHS. amount must be in Ibs,
STORAGE CONTAINER o a ABOVEGROUND TANK o e PLASTIC/NONMETALLIC DRUM o i FIBER DRUM o m GLASS BOTTLE o q RAIL CAR 223
(Check all that apply) o b UNDERGROUND TANK ¢fCAN OJ BAG o n PLASTIC BOTTLE o r OTHER
DC TANK INSIDE BUILDING o 9 CARBOY Ok BOX o 0 TOTE BIN
o d STEEL DRUM o h SILO o I CYLINDER Op TANK WAGON
STORAGE PRESSURE ~ a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT 224
STORAGE TEMPERATURE ~ a AMBIEKJ: o aa ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC 225
2 230 231 DYes 0 No 232 233
3 234 235 DYes 0 No 236 237
4 238 239 DYes 0 No 240 241
5 242 245
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