The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN r ~ ~ 1/-5-10 ;;; . ,_ -... LARRY HOOKER ¡ C@&c;:ié '!CVH3 ~ 12~ lÞ3 HOOKER BROS. VALLEY AUTO AIR 4321 Stine Rd. Bakersfield, CA 93313 (805) 834-9892 -1-, ;§:§! ,sa 6Ll 3,,1<;,<;£00 N I \.\'~' .,.....~' " r·'··',· I l{1 I ~ -' ~ ~~'¡) cS ~ C}''''<-'''- ,t/ ~ ~ S (j'~~ ~DIJIj ~ §§ ~ ITJ[] \ - ----s:; 3 f-LeÜ. ~ ~ t\¡-)r¿ \5 ':.' 'v·... .' ():, ï ¡\I"'\l.j .#»/æ-Z 6.L¿>s. ~;;~ /V<:::~ 5333 wA7'-<'::-- ¿N., #' /27 J77?-~ f ~ I~ I § d _L- ' I .... ,1f>t7 ()~2 j --;:~ ~", . . ^ - .... ~. . r .i"~ . .. í· 'I>~'~ .b ~f\'\ <0(\\.\ 'þø6i'1i,.. '1" i ;, ;~ ~(\ ~J ~ II I ~/ , ' I "- , . _' ~ ~;: .;.; . r' , eH~II\IP PLL>\~ l\;l.\.P SITE DIAGRAM 0 FACILITY DIAGRAM 0 3"-s::>m "ame )/ostR-r ß/'1J5 t/a/tr f/tfl-n. ¡:¡¡.r /\ ,. \ ,I , A=~a ~aç ~ 0: -- -- Nc~~~ ~ame 0: Ar~a: \~ I¿ I ~ l(t ~ r' \4.fJ a.4\ ~f ~I G ~ " ~ -T,'~ "" .,. t'. ~ .:J AS, I A5 5'1 ¿.s p/o{) r/ FRtDIJ :..;--- /", L..~~ :~15 t sio~ \. ~ q > it) ~ .¿ ~ r A5 A.s Fill (J/t~f¿ /,., tit íVt~ 1tøfPWÞ W b c- ,If .. o,,~ ";' L ( I ( ....--'" - ~~ e H~I~IP SIT E OtAGRAM 0 p L4~ l\1-~P FACiliTY DIAGRAM ~\ 3'..:.s:..::.~sS ~{ame: /-h,ð¡¿Et2 (?¡:u,1'. 1/4//'1 t:J..d", F:\.:t:e /1\ ./ 'o.. - - Nc:--:::' ~rame 0: ';'.r~a: A=~a ~aç ~ 0: -~....y-- -- - -..---- - --- - - , (. (. v> > r' rJ C'\ -' ~~ ~ ~:]: 1'\ Þ "/'" "" '" .r:> -+ ¡ ;3"t ~ 3 't: ~ ~-1 .3' '/ () " ~ 1 <:::J .. ~ -- - --- fþ/oya·f ¿ CUd/f ~ (" ~ c/) ~ ~ t!"r- ~-r { ( < <. r r '!» \ ,- ..--- """'-- - - -- J:'P!":'<'J- _.~ <4 -~-_. ~ ~ ~~~~ ~ ?? /~ ~ ~ A :"(? '\ r""'<:J cJ ""'f - -- «) «, -". , 5r~ ~,- ~. ~ /':) ct1:> So \:J~ tT'> 1- .' ~\::; ~~ -.fç; Ì' - -- ,- o '13 1: ;7..1 nI\;n II (1 > .f(' ri' -...- :r -( \, r r0 \~ ,T ~ -<: ~ .::p ~ " "-' ~ ..J' N l.I\ ~ ~ ('1 7J 7 '. STATEMENT OF ACCOUNT .__' CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA 93301-0000 TO: HOOKER BROS ( 80~H ,326":':3979 / i, { ~ t" ~ :",,~,~~,":(:/>-,: / .' DATE: 1/01/97 ~ , y~'\-\~ ,:,"\,<::."\\. CUSTOMER NO: CUS:T,OMERTYPE: ESI 3696 _________________...:....;;.....:........_,,;;......~~--------~'-~'-.:.--'O.....--------___.:::\~;.,'2;.--~~~~____-___------.- , ' , .' ' 'hv.. -"-""'':-, CHARGE DATE DESCRIPTION ,n ','¡REt_.....NUMBER f:>ÙEoDÄTE T[fTAL. AMOUNT ------ 7</-ï-:Q-sJ- -,~,:,' :,,~':::''::~,',/-,; --:f;~':'. .,...-:-,'~.';:..,.~, ";;~~~;-~f-:: ,,¡,! ,~l:;f-7-,i ;;-," '.~, ',',- :.'....:-..:-....'7-'~ -------------- "0' " '> "':; L. "/.- ~ . / '~ ,,), f",i ,',:.-'/ "",,-^,',--,; //) 12/01/96 BEGINNING BALÄNé~È~'~! \" ![,';",;,£:',j';"1, 2. 23-- ,- - -, -' j.. , , ...- "'ý " . -'-'//#¿' "~"" ~ FOR GUESTIONS:OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. -------------- -------------- -------------~- -------------- CURRENT OVER 30 OVER 60 OVER 90 -------------- -------------- -------------- ------------.-- DUE DATE: 1/01/97 PAYMENT DUE: TOTÂL DUE: 2. 23-- $2. 23-- ,y.... , j -- -- 1-1/11420 PO I ACCOUNT NUMBER CASH MANAGEMENT ADJUSTMENTS TO ACCOUNTS RECEIVABLE DATE .s- / I ~ 9 J () NEW ACCOUNT ( ) DELETE Þð $ ADJUSTMENT ( ) SERVICE CHANGE ( ) ADDRESS CHANGE PARCEL # SITE ADDRESS 432/ '5r,lA/G ~ù ROUTE # PROPERTY OWNER ACCOUNT NAME ).J 00 I<.~-d., ~ Il..O ~. /1w r-oP70 r- ,IV€, RECEIVED ,MAY J 7 J995 HAZ. MAT. DIV. MAILING ADDRESS CITY. STATE, ZIP LAST BILL AMT CORRECTED BILLING AMOUNT ADJ TO NEXT BILU+ OR - ; EFFECTIVE DATE <2..2-3» , APPROVED~~ REMARKS C/-l;e1pr61L· 7 --;a.4A/I<xt//)/(!...Y PI¿6-ß "I-¡I./-CfJ. /Î7).:n/sr C!-;-.r.4ItÞé?<¡ ,ê; 7J....~-FL(;-c.T ~ 4 J-"::¡ iI t!...¿ v:; / "'-n?/ é? ð F ,c I L/AJk;. F.ottM 88~ 6/90 B9C-71A U. S. BANKRUPTCY COURT 2656 U.s. COURTHOUSE 1130 0 STREET FRESNO, CA 93721 e United States .4Ii.kruptcy Court P90001927 28 EASTERN DISTRICT OF CKLIYO~I NOTICE OF COMMENCEMENT OF CASE UNDER CHAPTER 7 OF THE AKA/DBA. BANKRUPTCY CODE, . MEETING OF CREDITORS, AND FIXING OF DATES (Individual or Joint Debtor Asset Case) CASE NUMBER: FILED: 93-12005-A-ï-K 4/14/93 IN RE (NAME OF DEBTOR) LARRY C. HOOKER BERNETTA SUE HOOKER LARRY CHARLES HOOKER, SUE HOOKER, MEETING OF CREDITORS DATE: MAY 26, 1993 HOUR: 3.30 P.M. AT: U.S. BANKRUPTCY COURT ROOM #204 FEDERAL BUILDING 800 TRUXTUN AVENUE BAKERSFIELD, CA SOC. SEC./TAX ID NOS. 553-58-8621 429-84-9939 ADDRESS OF DEBTOR 4001 ADIDAS AVENUE BAKERSFIELD, CA 93313 FILING CLAIMS --- DEADLINE TO FILE A PROOF OF CLAIM - AUGUST 24, 1993 DEBTOR'S ATTORNEY RAY T. MULLEN ATTORNEY AT LAW 1405 COMMERCIAL WAY, STE. 130 BAKERSFIELD, CA 93309 TELEPHONE: 805-397-4495 TRUSTEE RANDELL PARKER PO BOX 221 ARVIN, CA 93203 TELEPHONE: 805-854-1503 DEADLINE TO FILE A COMPLAINT OBJECTING TO DISCHARGE OF THE DEBTOR OR TO DETERMINE DISCHARGEABILITY OF CERTAIN TYPES OF DEBTS: JULY 16, 1993 ~ - '..-:;. COMMENCEMENT OF CASE. A petition for liquidation under chapter 7 of the Bankruptcy Code has been filed in this' court by or against the person or persons named above as the debtor, and an order for relief has been entered. You will not'receive notice of all documents filed in this case. All documents filed with the court, including lists of the debtor's property; debts; and'property claimed as exempt are available for inspection at the office of the clerk of the bankruptcy court. .','.' ''f:-' ' ,:çc",~_, ,j~'" ' CREDITORS MAY NOT TAKE CERTAIN ~CTIONS. A creditor is anyone to whom the debtor owes money or property. Under the Bankruptcy Code. the debtor is granted certain protection against creditors. Common examples of prohibited actionsl byi creditors are contacting the debtor to demand repayment, taking action against the debtor to collect money owed, to creditors or to take property of the debtor, and starting or continuing foreclosure actions, repossessions, or wage deductions...1f unauthorized actions are taken by a creditor against a debtor, the court may penalize that creditor. A creditor who is considering taking action. against the debtor or the property of the debtor should review section 362 of the Bankruptcy Code and may wish to seek legal advice. The staff of the clerk of the bankruptcy court is not permitted to give legal advice. ' MEETING OF (:REDITORS. The debtor (both husband and wife in a joint easel is required to appear at the meeting of creditors on the date and at the place set forth above for the purpose of being examined under oath. Attendance by creditors at the meeting is welcomed, but not required. At the meeting, the creditors may elect a trustee other than the one named above, elect a committee of creditors, examine the debtor, and transact such other business as may properly come before the meeting. The'meeting may be continued or adjourned from time to time by notice at the meeting, without further written notice to creditors. LIQUIDATION OF THE DEBTOR'S PROPERTY. The trustee will collect the debtor's property and turn any that is not exempt into money. If the trustee can collect enough money and property from the debtor, creditors may be paid some or all of the debts owed to them. EXEMPT PROPERTY. Under state and federal law, the debtor is permitted to keep certain money or property as exempt; If a creditor believes that an exemption of money or property is not authorized by law, the creditor may file an objection. An objection must be filed not later than 30 days after the conclusion of the meeting of creditors. DISCHARGE OF DEBTS. The debtor is seeking a discharge of debts. A discharge means that certain debts are made unenforceable against the debtor personally. Creditors whose claims against the debtor are discharged may never take action against the debtor to collect the discharged debts. If a creditor believes that the debtor should not receive any discharge of debts under section 727 of ,the Bankruptcy Code or that a debt owed to the creditor is not dischargeable under section 523(a)(21, (4), ,or (6) of the Bankruptcy Code, timely action must be taken In the bankruptcy court by the deadline set forth above labeled '''Discharge of Debts." Creditors considering taking such action may wish to seek legal advice. PROOF OF CLAIM. Except as otherwise provided by law, in order to share in any payment from the estate, a creditor must file a proof of claim by the date set forth above labeled "Filing Claims." The place to file the proof of claim, either in person or by mail, is the office of the clerk ,of the bankruptcy court. Proof of claim forms are available in the clerk's office of any bankruptcy court. , IN ORDER TO RECEIVE A CONFORMED COPY, YOU MUST FILE AN ORIGINAL PLUS ONE COpy OF YOUR CLAIM ALONG WITH A STAMPED, SELF-ADDRESSED ENVELOPE. REQUESTS FOR INFORMATION SHOULD BE ADDRESSED TO: u.S. BANKRUPTCY COURT, 1130 0 STREET, FRESNO, CA 93721, AND MUST BE ACCOMPANIED BY A $15 SEARCH FEE AND A STAMPED, SELF-ADDRESSED ENVELOPE FOR EVERY FILE SEARCHED. COPIES ARE $.50 PER PAGE. WE CANNOT ACCEPT PERSONAL CHECKS. FOR THE COURT, R.G. HELTZEL, CLERK 1130 0 STREET, FRESNO, CA 93721 DATED APR. 30, 1993 FORM REV. 8/1/91 FORM B10 6/90 93303 9312005 HOOKER, LARRY C. 4001 ADIDAS AVENUE BAKERSFIELD, CA 93313 e United States SAaruptcy Court P9000H:f27' 2ã EASTERN DISTRICT OF CALIFORNIA IN RE LARRY C. HOOKER BERNETTA SUE HOOKER PROOF OF CLAIM CASE NUMBER 93-12005-A-7-K CHAPTER Q7 NOTE: This form should not be used to make a claim for en administrative .xpense arising after the comm.ncament of the cue. A "r.quest" of payment of an administrative .xpense may b. filed pursuant . to 11 U.S.C section 503. o Check box If you.,. aware that anyone .... has filed a proof of claim relating to your claim. Attach copy of statement giving particular$. o Check box If you have never 0 Check box If the address differs received any notices from the from the addresa on the .nvelope banknlptcy court in this case. sent to 'you !:IY the court. INDICATE CHANGE OF ADDRESS BELOW: . YOUR CREDITOR NO. IS: 0000016 CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD, CA 93303-2057 11,1""11",11,11,1,"11,"1,111111,111,11111,1,1,1,,,1111,1I 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 9312005R0000016 THIS SPACE IS FOR COUR1 USE ONI. Y ACCOUNT OR OTHeR NUMBeR BV WHICH CReOITOR IOeNTI~JeS O.BTOR, I Check here if this cl.lm o replaces e previously fi.d claim, dated:' SG292402 and HM420801 o amends 1. BASIS FOR CLAIM o Money , oanacs o WAoes ~ $a¡ ,." '8S. and _ ConIIplansat: ions 1~111 out ...,....1 o Caods s01d o ~.,.s~na1 tnJury/wrong'u1 åNth Your soci.' SftCur ity ".,...,. ~ Services p.r,o,.mea o of 8.8. o Otner (Describe Þr>fef'v) Unpaid CDIIIp.nHt ions for s.rYices perfornMtd o Retir... b..neftts ..s defined in 11 U.S.C. section 111.fa) from to I ¡CI,ne) (date) 2. ~t'" ,DEBT WA,INCrt:¡ED ! 3. IF COU:¡T JUDGEMENT, DATE OBTAINED: 10 1 92 - 3 31 93 4. CLASSfFICATlON OF CLAIM. Under the Banknlptcy Code all claims ere c/a$sified as one or more of the fellowin,: (1) Unaacured nonpriority, (2) Unsecured Priority, (3) Secured. It Is possible for part of e claim to be in one catagory and pert In another. CHECK THE APPROPRIATE BOX OR BOXES that best deaorlbe your cleim and STATE THE AMOUNT OF THE CLAIM. D SECU:¡ED CLAIM $ o UNSECURED PRIO:¡ITV CLAIM $ Attach evidence of perfec:tlon of security interest Specify the priority of the claim. BrI.f Description of Collateral: o Othar (Describe briefly) o Wages, salar/e$. or commiaalons (up to $2000), earned not more than [¡ Real Eatate 0 Motor Vehicle 90 deys before filing of the benknlptcy petition or ceaationof tha debtor's buain.... whichaver Is urtw) - 11 U.S.C. IIØC. 507(a)(3) Amount of arrearage and other chargn Included In secured claim above. D Contrlbutlona to an employee benefit plan - U.S.C. uc. 507(a)(4) i ihny$ 0 559.01 Up to $900 of deposita to_d purchase, ..... or rental of property or }OJ: UNSECU:¡ED NONPRIO:¡ITY CLAIM $ services for personal, family, or hou..hold uu-11 U.S.C. uc. 507(a)(6) A claim is unsecured If there Is no collateral or lien on property of the 0 debtor aecurlng tha claim or to the extent that the value of such Taxea or penalties of go_mantal unlta - 11 U.S.C. IIØC. 507(a)(7) property ia .... than the amount of the claim. 0 Other - 11 U.S.C. sections 507(.)(2), (a)(5)- (Ducrtbebrlefly) ¡ 5. TOTAL AMOUNT OF CLAIM AT TIME CASE FILED: $ 559.01 (Unaecunld) $ (Secured) $ (Priority) 1$559.01 (Total) o Check thia box If cleim includeapr.petltlon ch..,.. in addition to the principal amount of the claim. Attach ItemiZlld atatementof all addftlonalchar 6. CREDITS AND SETOFFS: The amount of all payments on this claim has been cTedlted and deducted for the purpoae of making thla proof of claim. In filing this claim, claimant has deducted all amounts that claimant ow.. to debtor. THIS SPACE IS FOR COURT USE ONLY 7. SUPPORTING DOCUMENTS: Attach copies of supporting documents. such as promiasory not.., purchase orders. Invoices. itemized statements of running accounts, contrects, court judgem.nts. or avidence of security Interest. If the documents are not aYeIl.ble, explain. If the documents are voluminous. ettach a summery. 8. TIME-STAMPED COPY: To receive an acknowledgement of the filing of your claim, enclo18 a stamped, self-addressed envelope and copy of this proof of claim. 5-12-93 Drew Shar les - Financial lnvesti ator Dete Penalty for presenting fraudulent claim: Fine of up to S500,OOO,or imprisonment for up to 5 years, or both. 18 U.S.C. sections 152 end 3571. FORM S9A ti790" '" B9A-7IN U. S. BANKRUPTCY COURT 2656 U.s. COURTHOUSE 1130 0 STREET FRESNO, CA 93721 - ) United States Ankruptcy Court P90001926 28 EASTERN DISTRICT OF CALIFOJlfA ' NOTICE OF COMMENCEMENT OF CASE UNDER CHAPTER 7 OF THE BANKRUPTCY CODE, MEETING OF CREDITORS, AND FIXING OF DATES (Individual or Joint Debtor No Asset Case) CASE NUMBER: FILED: 93-12012-A-7-K 4/14/93 MEETING OF CREDITORS DATE: MAY 26, 1993 HOUR: 3.00 P.M. AT: U.S. BANKRUPTCY COURT ROOM #204 FEDERAL BUILDING 800 TRUXTUN AVENUE BAKERSFIELD, CA IN RE (NAME OF DEBTOR) JIMMY RAY HOOKER PAULA JOY HOOKER SOC. SEC./TAX ID NOS. 553-64-1625 561-90-8936 ADDRESS OF DEBTOR 7600 BRANDING IRON COURT BAKERSFIELD, CA 93309 DEBTOR'S ATTORNEY , RAY T. MULLEN ATTORNEY AT LAW 1405 COMMERCIAL WAY, STE. 130 BAKERSFIELD, CA 93309 TELEPHONE: 805-397-4495 TRUSTEE RANDELL PARKER PO BOX 221 ARVIN, CA 93203 TELEPHONE: 805-854-1503 DEADLINE TO FILE A COMPLAINT OBJECTING TO DISCHARGE OF THE DEBTOR OR TO DETERMINE DISCHARGEABILITY OF CERTAIN TYPES OF DEBTS: JULY 16, 1993 AT THIS TIME THERE APPEAR TO BE NO ASSETS AVAILABLE FROM WHICH PAYMENT MAY BE MADE TO UNSÈCURED CREDITORS. DO NOT FILE A PROOF OF CLAIM UNTIL YOU RECEIVE NOTICE TO DO SO. COMMENCEMENT OF CASE. A petition for liquidation under chapter 7 of the Bankruptcy Code has been filed in this court by or against the person or persons named above as the debtor, and an order for relief has been entered. You will not receive notice of all documents filed in this case. All documents filed with this court, including lists of the debtor's property, debts, and property claimed as exempt are available for inspection at the office of the clerk of the bankruptcy court. ' CREDITORS MAY NOT TAKE CERTAIN ACTIONS. A creditor is anyone to whom the debtor owes money or property. Under the Bankruptcy Code, the debtor is granted certain protection against creditors. Common examples of prohibited actions by creditors are contacting the debtor to demand repayment, taking action against the debtor to collect money owed to creditors or to take property of the debtor, and starting or continuing foreclosure actions, repossessions, or wage deductions. If unauthorized actions are taken by a creditor against a debtor, the court may penalize that creditor. A creditor who is considering taking action against the debtor or the property of the debtor should review section 362 of the Bankruptcy Code and may wish to seek legal advice. The staff of the clerk of the bankruptcy court is not permitted to give legal advice. MEETING OF CREDITORS. The debtor (both husband and wife in a joint easel is required to appear at the meeting of creditors on the date and at the place set forth above for the purpose of being examined under oath. Attendance by creditors at the meeting is welcomed, but not required. At the meeting, the creditors may elect a trustee other than the one named above, elect a committee of creditors, examine the debtor, and transact such other business as may properly come before the meeting. The meeting may be continued or adjourned from time to time by notice at the meeting, without further written notice to creditors. LIQUIDATION OF THE DEBTOR'S PROPERTY. The trustee will collect the debtor's property and turn any that is not exempt into money. At this time, however, it appears from the schedules of the debtor that there are no assets from which any distribution can be paid to creditors. If at a later date it appears that there are assets from which a distribution may be paid, the creditors will be notified and given an opportunity to file claims. EXEMPT PROPERTY. Under state and federal law, the debtor is permitted to keep certain money or property as exempt. If a creditor believes that an exemption of money or property is not authorized by law, the creditor may file an objection. An objection must be filed not later than 30 days after the conclusion of the meeting of creditors. DISCHARGE OF DEBTS. The debtor is seeking a discharge of debts. A discharge means that certain debts are made unenforceable against the debtor personally. Creditors whose claims against the debtor are discharged may never take action against the debtor to collect the discharged debts. If a creditor believes that the debtor should not receive any discharge of debts under section 727 of the Bankruptcy Code or that a debt owed to the creditor is not dischargeable under se,ction 523(a1(21, (41, or (61 of the Bankruptcy Code, timely action must be taken in the bankruptcy court by the deadline set forth above labeled "Discharge of Debts." Creditors considering taking such action may wish to seek legal advice. DO NOT FILE A PROOF OF CLAIM UNLESS YOU RECEIVE A COURT NOTICE TO DO SO REQUESTS FOR INFORMATION SHOULD BE ADDRESSED TO: u.S. BANKRUPTCY COURT, 1130 0 STREET, FRESNO, CA 93721, AND MUST BE ACCOMPANIED BY A $15 SEARCH FEE AND A STAMPED, SELF-ADDRESSED ENVELOPE FOR EVERY FILE SEARCHED. COPIES ARE $.50 PER PAGE. WE CANNOT ACCEPT PERSONAL CHECKS. FOR THE COURT, R.G. HELTZEL, CLERK 1130 0 STREET, FRESNO, CA 93721 DATED APR. 30, 1993 FORM REV.a/l/91 e e Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 ~,,; " .,." ({}~[r ' . µ HAZARDOUS MATERIALS MA'NAGEMENT PL~c INSTRUCTIONS: . ~; (}I 6 1. To avoid further action, return this form within 30 days of receipt. \J ...Ii: 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. RECEIVED NOV 2 7 1990 Ans'd.. .......... .tQ.\ ~ SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ¡.Jot!¿/ärr B/orJ-tPr~ tlQL/-tý 1J~+" 91'£ LOCATION: l./3;1 , Sf; Wi',' ~tJ MAILING ADDRESS: ~¿(fm." 1'1'7 IIbtJ~ CITY: l$ð~. STATE:~ZIP: 1'$3/3 PHONE: -rðS- ff3lJ..~¡çZ- -ç ¿ T~'f I.!).:tt-- DUN & BRADSTREET NUMBER:Î7/)01~ SIC CODE: PRIMARY ACTIVITY: R,{+n rn,ä+ttl;(.. Sfll",~ ~ £~IIt/I; L OWNER: L'A('( 'I ~ J;"" Ht)~¡¿~r t Ji('t/~ ð~~ I MAILING ADDRESS: t,f.JT61 ' ¡;:¡/, íI~ ( , 1/ tH!- SECTION 2: EMERGENCY NOTIFICATION: CONTACT 1. J,...J~ {'Ill Hook" t/ ~ I Ii 2. J . V\-'\ f1 (){) It..t ¿r TITLE BUS. PHONE 24 HR. PHONE o ~ f1L/,q~l- 'ð:3 t¡~ µ¡ 1- gj/pol'l!'7 «32..~L1r () uM. ,/ 1. FD15Q, I '~ \, _ Bakersfield Fire Dept. e Hazardous Materials Division ",~_Cè <Of'_':':. ~ ¡ " HAZARDOUS MATERIALS MANAGEMENT PLAN :. ~ ,,";: TV ; ../ J. ~ ~:' ~., .., ). t . , . .: : ~ . V',. ,", SECTION 3: TRAINING: .-1 .- NUMBER OF EMPLOYESS: ~ MATERIAL SAFETY DATA SHEETS ON FilE: yé> BRIEF SUMMARY OF TRAINING PROGRAM: (IV,1fIAd--rJ Ut~ ð'{ F{~ @ ~ú ~ ð wf-sr:1--G J)I ¿ II 9/1 SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY COD .. OR THE FOllOWING REASONS: W DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TlMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) CERTIFY THAT THE ABOVE INFOR- CUR TE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFill MY RM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET Al.) AND THAT INACCUR NFORM ION CONSTITUTES PERJURY. Q TITLE DATE 2, FD1590 " ,.,.. ....'~ ;¡;.'.....,... e Bakersfield Fire Dept. e Hazardous Materials Division ~. \ HAZARDOUS MATERIALS,MANAGEMENT PLAN í Facility Unit Name: #~ 1:"« r >.. ~ ~ ' ~'-. ..~. 8¡rð5", 14· /~ 1I!It,ÍiJ /J(;; SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: Cq II q 1/ B. EMPLOYEE NOTIFICATION AND EVACUATION: f-uJ 0 PJl+s,je DI~J OJ II C. PUBLIC EV ACUA TlON: ¡:'~O rvt, J;)ðo Y Út~;¡. O¡ II D D. EMERGENCY MEDICAL PLAN: ¡JÐ fI-J,f- lUeû.res1- ~osp,'fct ( 3. FDl5'> ~ . -.... . i~ -~- ~ __ Bakersfield Fire Dept. e Hazardous Materials Division ""- S' ,~ "":'..:..;, -" ~ .. "~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMHH PLAN: A. RElEASE PREVENTION STEPS: ¡VI) ,t,~ Fre.DC' - -L1\ smú\\ IYo""L c.Of\-\Q\ (\e..r~ B. RELEASE CONTAINMENT AND/OR MINIMIZATION: IVOvv~. C. CLEAN-UP PROCEDURES: ¡VðW~ !Jì SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ()(/~/¡}"¿ µ Ir' {()irdÞlv ELECTRICAL: /It/5/Le- Bad:: Dt- iJ rA ìI JlNj WATER: Frð¡Jf- ð+ 'i3LlI~lcI N...Ç Ú>/A/.er o SPECIAL: LOCK BOX: YE6> IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: f;re... t:X+¡?Juí'&),e.r~ WATER AVAILABILITY (FIRE HYDRANT): pI -petrIe.. l<ßr V rr (ð/~ V 4. FDI59C' I B. OHAZARDOUS MATERIALS INVENTORY NON-TRADE SECRETS Page of ~~~~~S~~ME:~~ ~!:~f~~O~~.~¿< ~~M~Ð~~ÐT~~B.Fèfl~~Tl¿~a~'- ~/'ð~ ~óTY ¡!P: =~~=:~=- DU~ AND BRADSTREET NUMBER--"-----' RÊP~~ to-r ~- rIrls~~Utt PROPER CODES - - - - 7 8 9 10 11 12 13 U . Dys Cont Cont Cont Us~ loc~tion Where 'by Na~es of ~ixture{ço~ponents on SIte Type Press Temp Code Stored In FacIlIty Wt See Instrut 10ns 36..)' ·0 N-W.c.on1P/ Q Component.1 Name & C.A.S. Number 6 Mea$ure Units o.L C.-A.S. Number ~. [] Sudden Release Health of Pressure ,~ Farm and Agticulture [] Standard Business BUSINESS NAME: LOCATION: " CITY/- ZIP: PHONt: II: 1 Tr~ns Code 2 Type Code 3 4 Max .L Average Alltb'""" Allt Physical and Health Ha~ard (Check all that apply ~azard [] Reactivity e . o?¿.J 5 ' CITY of BAKERSFIELD ~~:: [] ,Component'2 Name & e.A.S. Number Immediate Health Component.3 Name & C.A.S. Number C.A.S. Number ø4e Hazard [] Reactivity. ~Iayed [] Sudd~n Release Health of Pressure -\-1:, Component.1 Name & C.A.S. Number [] Component.2 Name & C.A.S. Number Immediate Health Component.3 Name & C.A.S. Number C.A.S. Number Reactivity ~yed 0 SUddfn Release ';::r- Hea Ith {Î, 0 Pressure Zc;t:)é) 31 cO::> ~ ~ / t) Physical aod Health Ha~ard (Check all that apply C.A.S. NUllber r¡y1ire Hazard' [] Reactivity IJ"6la{ed [] Sudd~n Re 1 ease Hea th of Pressure EMERGENCY CONTACTS #1 LA/V'l r/)dJl..A.¥ k;?J-IZ~"7 #2 R! rUe 1t1fr 'Phonê Wi Certifjcatio fReed and $ign afìør cÇJmp7eting, (111, sec~ions) , . " 1 certIfy un r penaltï 0 la~ that I haVe persona Iy exam,nâQ ond am famIlIar wIth the InformatIon çub~ltte~ In thIs ond all °al~açhed d ~ents, aOQ t at based on my Inquiry 0 those In lVlduals responsible f~r obtaIning the Infor~atl0n. I belIeve that the su~mrtte n or~atl0n IS true, accurate, and co~plete. ' Name' etA.S. Number [] Component.2 Name & C.A.S. Number Immediate Health Component.3 Hame' e.A.S. Nu~ber Component" Hame & C.A.S. NUfber [] Component.2 Name & C.A.S. Number Immediate Health Component.3 Nalle & e.A.S. NUllber ~ toU IV.R V Tlt e 83:2- 02- 7c/ 2nffrñõ;W-- oflClal tItle Ot owner/operator UR owner/operator's authorIzed represen 8 v FIRE DEPARTMENT D S NEEDHAM FIRE CHIEF e e CITY of BAKERSFIELD "WE CARE" 2101 H STREET BAKERSFIELD. 93301 326,3911 October 1, 199Ø Mr. Larry Hooker Hooker Brothers Valley Auto Air 4321 Stine Road Bakersfield, CA 93313 Dear Mr. Hooker, Following ~y inspection of your facility on SepteMber 28, 1990, I converted the aMount of cOMpressed freon that you store into the cubic feet of gas that it will yield at standard teMperature and pressure. The calculation shown below indicates that this aMount exceeds the hazardous ~aterials reporting requireMents established by California law. You are required to cOMplete the attached forMs, a Hazardous Materials Manage~ent Plan, and to return theM to this office by NoveMber 5, 1990. If you have not eliMinated the waste oil storage by this date, report it on the inventory forMs along with the freon. Please call me at 326-3979 if you have any Questions or need assistance filling out the management plan. If the waste oil file on NoveMber 5 , year to verify that premises. Thank you is not included on the inventory which you I will reinspect your facility later this this waste oil has been removed froM the for your cooperation. Sincerely, ~\YÞ-\O-.~(' Barbara Brenner Hazardous Materials Planning Technician * 14 cases freon :.; 12 cans )( .12 0: x L1Jl x 3.175 Pt3 case freon can 16 0: Ib of R-12 4ØØ.05 cubic feet R-12 freon e e Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 RECEIVED ,llJl 2 6 1990 HA?:. MAT. OiV. HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action. return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions be.l0w for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: .-BðÐt;E:.<2- ~RO~E.~Ç ÚAI-L.E1 A,,-tc) A~ LOCATION: 1.13'2- I Sp:::fo.J IS M. ß..... oLð ILS rp- f[.. L. 0/ C' Ä _ '"} .3:J;'";--- MAILING ADDRESS: <:::Amt" CITY: ßAI<eR.ÇFrGC:(~ STATE: ('4. ZIP: Cl1?¡J PHONE: R'1'1- Cf&>qL DUN & BRADSTREET NUMBER: ..e-- SIC CODE: PRIMARY ACTIVITY: lIui-€> RÆ~,4.xæ J#ð¿o OWNER: 7G~ r LA,¿ß.'t }-\oð,,\.LEIZ¡ -r- ,. Iv eRR '1 D IN ÞI<1o¡ MAILING ADDRESS: ,f"..'1P7G- ~)' flß ð J/ E.. SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. JxM. ~'"" 'ilZe..R... 2. L~ì lkk~tL DWNU- J Pt)(Z..fAJu..... Ei -? (/4 f'q 2- . I á~oJe(L J¡:J4;JzJ1ú~ A fÇ7~'7ð9"2- ( .- ,/\-A-J'YtÇ ,~ 1 , FD1590 e e 4 ~ ~. ~". -"-'""'" Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALlFORNIA HEALTH & SAFETY CODP FOR THE FOLLOWING REASONS: ><J " ,/ WE DO NOT HANDLE HAZARDOUS MATERIALS. ---<---,-,- - 'WE-SO HANDLE HAZARDOUS MATERIALS, BUT-"FHE-QldANT-ITJES-AT-NQ-- - - TlMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, ~ \:\'ðQ:>Y--<2JL CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. 2. FD1590 r~ .....~ "'~':\!,i, ~".:.,."'~ e Bakersfield Fire Dept. It Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: 3. FDl&JO It Bakersfield Fire Dept. e Hazardous Materials Division r~·'...".,. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (lOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ELECTRICAL: l?t:.4"l.. ""~ ,(1£-l:icJJ;z, ¡Ge..~r f--v ¡2Dd {.,l.p Pð¡.j/L J~rIJ,(J,,< WÃTE'R: .~' óf- ?Jwæ P"o,'tll ~r r aÞAJv-- -~.' -' , ' SPECIAL: LOCK BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 4. FD1590 " . " ~~ e Bakersfield Fire Dept. Hazardous Materials Inspection e Business Name: HookVL gyt05. 53:?? wktt¡ Date Completed Cf(J tú. L¡v, ~o /1,-30-3/ Location: Plan ID # 215-000 721 (Top right corner Business Plan) Station No. 7 Pr Inspector f}Nso rJ Shift RÉ.celVEO OEC 0 6:'~.'~1 HC<?, MAT, OIV. Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: [!Y' Œr Œf [fJ/ o o o o Verification ofMSDS Availability Number of Employees tJ 0 tv é:..- Verification of Haz Mat Training Comments: ~ ~ o o Verification of Abatement Supplies & Procedures Comments: Œr o Emergency Procedures Posted Containers Properly Labeled Comments: 0-' [Ø'" o o Verification of Facility Diagram Spe~ial Hazards Associated with this Facility: Q1/ o Violations: FD 1652 (Rev. 3-89) ,/ White-Haz Mat Div. Yellow-Station Copy Pink-Business Office " \. --'", ~: ·,·....w..· '.:-:'"C " -0.' ,_ '- ~,' '>iI-"-,"_ ,... -- . . . . . --:. ..."" t"" ~~'''' - -', J~~ '" R I,,! ;'1 If. -'" --L """., .a~ ,'- ....... :;"~;: ,~ (' 'llll ~f .~ ....... c! . V ¡ (! . T.1 f\..i t;- 1\ 1..,/ .r: ,,;;, tit e ~~ Jza» , , vYJWrÆ~ to C¡3~1 ßJ~ úftth ~ IflÞ»J pnrtW ~ ðJ g 3if...93Cl;)- - O\~ c.o. -\{C>C~ ~ Â-ù+o \5 , (\Ow 00-\ ~ 't)ùs-il'teSS · Ñe.w (0, +-tOO K.u' Ú<b~. ~ Jt.r ~~ Qo~ e L'3;l\ S,:~ Gþ) ,)-17-'ìo !"'''~'~.-:;-~-_'~:~'T~~-:!r:--~~.- -- ~'.', -~........,-..: ..::':-.,1"···. ........ ---~ ---;;.~- . , Q~- ~ e e 1 23-¡6'- I) cÐRECEIVED 3DsP 9 JUl 9 1987 Aßs'd.... ........ I i( 't- l~ ~ ~tr .:7t~j..~ ~, KERN COUNTY FIRE DEPARTMENT 5642 VICTOR STREET BAKERSFIE~D, CA 9~308 (805) 861-2761 OFFICIAL USE ONLY ID# \ ~g <6 1.·' BUSINESS ~AME o¡O '(0/ HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A {Ul¿' <fªW' E-. INSTRUCTIONS: 49\Y 000'121 1. To avoid further action, return this form by JUl 2 9 1987 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. jfbq~ ~~ SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: II 00«",/ 13 r ð ~ . II fA- 1-0 ht t!J -I ~rl .8'"~ 33 CA/4 lÌ--e fA/ ZIP: 9"3 ~ l~' BUS. PHONE: at (~5) [3 3-ý/f1 B. LOCATION / STREET ADDRESS: CITY:~ CAJ 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 INCASE OF EMERGENCY: NAME AND TITL~ ~ ~ DURING !JUS HRS. A, L.t)J·"'Y . tJ¡t.¡y. O,W v.l V, n;' Ph# ¡-:J-g -4'11- 7 B. P í /I ·)./ð 0 l~ / (J r}/µ(¡y ! tip Ph# ð3 '3 {// f7 , I ' AFTER BUS. HRS. Ph# f"7/-1£'5"'7 Ph# fJ2.-)"3 f-f.o . .' SECTION 3: LOCATION OF UTILITY SHUT-OFFSFOR BUSINESS AS A WHOLE A. NAT. GAS/PROP~E: t1JOA/¿ B. ELECTRICAL: ~ M~~_ - ;.P.Á~~ Û-~ Ill;; C. WATER: _ ._ _ ' Nð-~ LlJ~ _ ¿'6>_ Ð ¡s::- ~/2'~ D. SPECIAL: E. LOCK BOX:~I NO' IF YES, LOCATION: p.e,.. rl-lZ.- IF YES, DOES IT CONTAIN SITE~~NS? YES FLOOR PLANS? YES /~ KEYS? / 1N'b\ MSDSS? YES / NO ~/~ -Over- , HMCU-4 It. " , I ( V :\ e e -";lrr,·J: ,,' . -~. ------.,.... \ SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE GA-Je.... ",,qfvE'J e>Ñ trle 0..;4.... ÜNc..J F~JL on :Þ~.) ~ ~t,,- f"'-......"'. " ~tJ cl\-Se....' oF- c;;r/c....K-tV SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE w" ¡ ~~- (,..~6........0\.~.!).;:¡:z;:o~c_,<<:'t!!o/11:;~~-,:-",~---~-,-, -~~"~--- - - "-~--"----'~'~"~--~-'-- -~-=-=----~'- -- [i~;; ';~~~~~~;~;J 3~) 2~ p~~ m ~1Lc.., t+é> 'r f ~ ~/) , ~~. .~{~-"t-.. ~ .:. .....-- --- ------ -~ SECTION 6, EMPLOYEE TRAINING NO /!in f' ~~ e¡5 'l ~ /J-w f . EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH P~I~S EMPLOYEESv~~INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. " -;, ,CIRCLE" YES,OR--NO' , __, __" -< ->. 0_' ,-- ~~"-~---""""'-=---INITTAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ŒY NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:.......................... IES NO C. PROPER USE OF SAFETY EQUIPMENT:. ................. ES NO D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . ..' NO E. DO YO MAINTAIN EMPLOYEE TRAINING RECORDS:....... NO '\ '- ~REFRE'SHER- .. ,- YES NO YES NO YES NO YES NO YES NO . 'riertifythritthe above informationis'accurate__ this information will be used to fulfill my firm's obligations under California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Et AI.) and that'inaccurate information constitutes perjury. D~n~. Wtf;7:~,-, - ~~ ---.--- ~- TIT-~E'~_, - -.- HMCU-4 ..... ~ t~~ ~~ .~ e e BAKERSFIELD CITY FIRE OE?ARTXEXT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL CSE ONLY ID# - - -" - - - BUS INESS NA.'1E: 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 NA.'Œ: f~·tJf6.tv 8/iJs. ·¡ftth~r~ t I FACILITY UNIT# .' '"'-.-. ......, . . .. - , .. u. . .' -.-. - "-. .--...---------..-.--- .", _ .." 4__~ SEC;: 2, ;:::d:: ::ATI06 PROC;f::T ~~ t£ ßd4 ctMif c&J 9//, \:: :)4 - ~ e ql ç~:I 41 '7fl r0 ?-oo; ( ~LI ;:: "f7Á ~o GJ/O'e --) 1,C;~<S.. vðJJdÇTJ <,:I-CI ~ e -,~ - Cc,- ;e--; - -,--,' g C¡e IJ-c ~/( '---;e? )( ~ -~Je/ ;( hi - . ""f v ?YJ '2-9 e / ". f {Jt~ -~ ~-- --- ------- - - .' .. fi)Ð() 1.2 7 - , , R^KERSFIEJ.D CITY FIRE DEPARTMENT .. ' .,/ ~~ I .D. # FORM 4A-t Page _ofL 11:-__,. NON-TRADE SECRETS - ê HAZARDOUS MATERIALS INVENTORY V- i.. OWNER NAME: 5t:Z4AA .# FACILITY UNIT #: BUSINESS NAME, - - t>f11 Æ~- ,ADDRESS: S"-35 CAJ ' ADDRESS: FACILITY UNIT NAME: I CITY, ZIP: fJ Q ~ v ft ../'c -e ( ¡J rØ' CITY,ZIP: PHONE #: ÝlJ \'- ~"37 - fif f'? PHONE # : 10FFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE EACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE .---.. AI ---- / ff=" A' IV [JJ ~ 1'1.fl..f'1 e- ~ ~ IPVf.. ~J{\.¿. ~L ~ J / :;::::: p - L ::::::.-- X ./ ...--.v ...., "'^ ~' , ~ s-s-~ p ~O ÇJ ~, ø:J ~- wI . -1~ .A/1A.¡/Jh (¡/~O-I. 1 , ()O~ II/-&AJ IJA'/ .J,Ÿ(")ct CmLQ e $~ J~~( ~tlJ1 c9~ Cf/? c;}¡; G;-t:/lf~:lrI:ø IODt¿ Ilkl"'Þ /JÁ~ \ SC\ OJ C'" L t)2 ...., r - .., e // , / / \ -/ /// p ~ /~ NAME(:- y-..."..,." ~ /--~ " TITLE: ¡1'"I///1ð/A ./ SIGNATURE: /" / ~~ DATE:O -/. 1?:7'/ 1 , EMERGENCY~ON~ACT: TITLE: " (/ ~HO~E # BUS HOURS: AFTER BUS HRS: I EMERGENCY CONTACT: ..,.~, TITLE: PHONE , BUS HOURS: I PRINCIPAL 8USINESS ACTIVITY: AFTER BUS HRS: I , . . I