The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN Per '," "-. "-', ·.-t·· ':-~¡O,,··· :,'::··..-..'·..IP"·:·' ,....:,~,·t':,'·.. ,,' 'Ia;: ..',,/ ~:; : ..::;..'..;,..' -.:=;' , .... ',_ ~_ ';_. ~ .:..:, , , ....; . '.'_.', /.,:,. ,;.:..'<" .....\~: . 0,,--:". '" ..', ~ . " " ,<' ' . : . '. - ~ ~. Hazardous MateriªlstHaz'8:·rd'ous Waste Unified Permit . .,. ~. ," . ~, ~' " '. CONDITIONS O:F 'PERMIT~ONREVERSE SIDE Permit ID #:: 015-000-000594 PAGE MEDICAL INC LOCATION: 3101 N SILLECT AVE 112 Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: '. ~ .. <'::.' ..' - I~. " " . ,.... ,-'" ':" Issue Date June 30, 2003 -------...-- ~ - .--.-.--- PerDlit to Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ':~f~ardous Materials Plan , !~$lround Storage of Hazardous Materials agement Program Waste 3101 N SILLECT PERMIT ID# 015-021.000594 PAGE MEDICAL INC 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 *~ ph Huey. ffice of ental Servi as June 30, 2000 Approved by: Expiration Date: .-:~~~~ - ;; N;~- .1:;"". ~ ~t:.. H'MlIp PLAN- MAP SITE DIAGRAM 1'><1 FACILITY DIAGRAM Business Name: ?1\G¡f tv\FD' CAL -:s:..~c..... Business Address: First In Station: Inspection Station: ,~([c,Jt} '1 I7g Ú~IO~ Air- oçç ~.p 4f- ',Qt. "',?AA~'" E£ 1> £. 'E.. 3\. S,"",oQA~é: '1/ \\Þù..A \~ (\Ç{,C-£. d oçç\c.£:~ 1.- 1-1 O{Ç atç'Ct. ci o f'~£. uJ ~ ""E:Dlc.A1.. [t o S~I2..-J\c..(. 1)t.~"~"". 0 5\~ C. ç'. - OI'-\G.~~ I J.SIo \:.., ç - .:i\Tnac-..t .;¡.SIo c...\',- c.o",,~. ~\Q... For Office Use Only Area Map # of NORTH{r / "¥À.~~ ",,~'¡)\~L ::s:.~<:.. ~ w~(.~ ""~\~ OHcc o~o<;l\::' :,A.\~ V \"A L A \ R. E: ~AQk.l~~ Lö"T ,..."',o t.~(,c.-w..\<:A'- 'SI-\I,)T o'fi;: LìQ,lJ\J) ÄìQ.. \.oJ 7 <! "'Z.. o -- -:z ":) M()~R£.'1 -' .~ FOR DATE (J1t; ~LèfY Q J TIME A.M. P.M. FROM FIRM PHONE AREA CODE NUMBER EXTENSION M~ t~ ß~ ðQ~J SIGNED TOPS' FORM 4007 ( ............,..,. .',.. ··,·.,·E··· .,..,.,I·,·,\,'.·,.S·,·""",··,,··A· '. \."~, c.···,·E I·:~.:\:I' -'-"- -, ""'-":i ".; ,.,.-. :.- ) -:: It e PAGE MEDICAL INC SiteID: 015-021-000594 (661) 326-8073 CommHaz : Moderate FacUnits: 1 AOV: Manager : Location: 3101 N SILLECT City BAKERSFIELD CommCode: COUNTY STATION 66 EPA Numb: SIC Code:5047 DunnBrad:62-213-4054 Emergency Contact / Title Emergency Contact / Title COSTA PAGE / PRESIDENT ALEX PAGE / GENERAL MANAGER Business Phone: ( 661) 326-8073x Business Phone: (661) 326-8073x 24-Hour Phone : (661) 871-5537x 24-Hour Phone : (661) 872-9645x Pager Phone : (661) 635-6943x Pager Phone : (661) 635-6883x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 326-8073x MailAddr: 3101 N SILLECT AVE 112 State: CA City : BAKERSFIELD Zip : 93308-6348 Owner COSTA PAGE Phone: (661) 326-8073x Address : 3101 N SILLECT AVE 112 State: CA City : BAKERSFIELD Zip : 93308-6348 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì f= Hazmat Inventory p== Alphabetical Order Hazmat Common Name... SpecHaz EPA Hazards \ \ COMPRESSED AIR t1 NITROGEN (., OXYGEN PROPANE P IH G F P IH G F IH DH G E F P IH G I, ~~ Do hereby certify that I have reviewed the attached hazardous materials manage- ment plan for tÂc:.r MQ> ~CAI ~nd that it along with (Name of BUSlIless) any corrections constitute a complete and correct man- agement plan for my facility. ~ Signature . . 3Æ~, / ate DailyMax MCP 400.00 660.00 660.00 1820.00 Min Min Low Hi FT3 FT3 FT3 FT3 03/08/2001 ~ e e SiteID: 015-021-000594 ì Fast Format ì Overall Site ì 03/06/2000 F PAGE MEDICAL INC I p= Notif./Evacuation/Medical Agency Notification IN CASE OF EMERGENCY ALL EMPLOYEES HAVE BEEN INSTRUCTED TO NOTIFY THE FIRE DEPT BY CALLING 911. IMMEDIATELY FOLLOWING THIS CALL THEY ARE TO CONTACT COSTA PAGE BY PHONE, BEEPER, OR MOBILE PHONE. Employee Notif./Evacuation 03/06/2000 IN CASE OF EMERGENCY ALL EMPLOYEES ARE VERBALLY NOTIFIED AND HAVE BEEN INSTRUCTED TO MEET IN THE PARKING LOT AND IMMEDIATELY ACCOUNT FOR EVERYONE IN THE BLDG. Public Notif./Evacuation 03/06/2000 ALTHOUGH OUR BUSINESS IS NOT CONDUCIVE TO WALKIN BUSINESS, IF ANYONE IS IN THE BLDG AT THE TIME OF AN EMERGENCY THEY ARE VERBALLY NOTIFIED AND PROMPTLY ESCORTED TO THE NEAREST EXIT. Emergency Medical Plan 03/06/2000 IF THERE IS A MEDICAL EMERGENCY EMPLOYEES HAVE BEEN INSTRUCTED TO RENDER FIRST AID IF POSSIBLE. IF THE INJURY REQUIRES HOSPITALIZATION OR HOSPITAL EMERGENCY SERVICES, THE INJURED PERSON IS TO BE TAKEN TO KERN MEDICAL CENTER OR BAKERSFIELD MEMORIAL HOSPITAL. -2- 03/08/2001 Þ' ,. e e F PAGE MEDICAL INC I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-000594 ì Fast Format ì Overall Site ì 06/15/1992 OUR HIGH PRESSURE CYLINDERS ARE CHAINED AGAINST THE WALL FOR SAFETY. EMPLOYEES HAVE BEEN INSTRUCTED ON THE SAFE HANDLING OF HIGH PRESSURE Release Containment 06/15/1992 WE HAVE CHOSEN TO MINIMIZE THE RISK BY NOT HAVING EXTRA FULL CYLINDERS IN OUR FACILITY. Clean Up 03/06/2000 ] I N/A. Other Resource Activation -3- 03/08/2001 ~. ~ ~ e e SiteID: 015-021-000594 ì Fast Format ìì I Overall Site I F PAGE MEDICAL INC I p= Site Emergency Factors ~ Special Hazards Utility Shut-Offs 03/06/2000 A) GAS -OUTSIDE NE CORNER OF BLDG B) ELECTRICAL - INSIDE E WALL NEXT TO SLIDING DOOR C) WATER - OUTSIDE UNDER METAL COVER 10-15 FT E OF GAS SHUT OFF D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 03/06/2000 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND ALARM SYSTEM. NEAREST FIRE HYDRANT - ACROSS THE ST ABOUT 100 YDS W OF BLDG. Building Occupancy Level -4- 03/08/2001 '¿:\ ..... ...... .... e e F PAGE MEDICAL INC I F Training Employee Training SiteID: 015-021-000594 ì Fast Format ì Overall Site ì 03/06/2000 WE HAVE 5 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TAUGHT THE SAFE HANDLING OF HIGH PRESSURE CYLINDERS AT THE TIME OF HIRE. WE SHOW THEM THE LOCATION OF ALL EXTINGUISHERS AND DISCUSS NOTIFICATION AND EVACUATION PROCEDURES. ADDITIONAL DISCUSSIONS TAKE PLACE DURING OUR MONTHLY SAFETY Page 2 [ I I Held for Future Use Held for Future Use ,,---... -5- 03/08/2001 e - CITY OF BAKERSFIEI.lD FIRE DEPARTMENT OFFICE OF ENVIRONMENT AI... SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd .'Ioor, Bakersfield, CA 93301 FACILITY NAME Pð.,l ADDRESS ~f 0 I N. FACILITY CONTACT INSPECTION TIME f1it Nt t (d ( LI"l'. -$ I He l.-+ AVL It 2.. INSPECTION DATEJ~ 8 -01 PHONE NO. '3;)(, - f!:oì.3 BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES é) 0 Section 1: Business Plan and Inventory Program D Routine ~ombined o Joint Agency D Multi-Agency D Complaint D Re-inspection OPERA TION C V COMMENTS Appropriate penn it on hand V Business plan contact infonnation accurate V Visible address V" Correct occupancy V Verification of inventory materials V Verification of quantities V Verification of location V' Proper segregation of material V Verification of MSDS availability V Ned l-n f" cl- Verification of Haz Mat training V Veri fication of abatement supplies and procedures V Emergency procedures adequate V Containers properly labeled V Housekeeping 1/ Fire Protection ,[/ t)l'fV((C H., r: Ut.cQ. Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes DNo Questions regarding this inspection? Please call us at (661) 326-3979 White - Env, Svcs, Yellow· Station Copy Pink, Business Copy Inspector: - -- .::; - PAGE MEDICAL INC fé~.&j~lq Manager : Location: 3101 N SILLECT AVE City BAKERSFIELD ,. ~CEIVED 12 MAR '2 2000 BY: ) CommCode: COUNTY STATION 66 EPA Numb: Emergency Contact COSTA PAGE Business Phone: 24-Hour Phone : Pager Phone : / Title / PRESIDENT (80S) 326-8073x (80S) 871-5537x ( c..,,') 'is"" - f,<¡~3 x Hazmat Hazards: Contact : MailAddr: 3101 N SILLECT AVE 112 City : BAKERSFIELD Owner Address City COSTA PAGE : 3101 N SILLECT AVE 112 : BAKERSFIELD Period : Preparer: Certif'd: to Emergency Directives: SiteID: 215-000-000594 (80S) 326-8073 CommHaz : Low FacUnits: 1 AOV: SIC Code:5047 DunnBrad:62-213-4054 Em~~~~n~~~ontact STEVE MCWILLIAMO Business Phone: 24-Hour Phone : Pager Phone : Fire Press / Ti tIe ~(j:IE:íZ.A'- / OER~ICE MANAGER (80S) 326-8073x (80S) 872 7JOlxR7Z'-<\fA ((,CoI ) <0 ~S - Cc.R'8 3 x ImmHlth DelHlth Phone: ( ) ~ State: CA Zip : 933086348 Phone: (80S) 326-8073x State: CA Zip : 933086348 x TotalASTs: = TotalUSTs: = RSs: No I, C Qfll+ PAqt: Do hereby certify that I have (Type or print name) reviewed the attached hazardous materials manage- ment plan for 'PACE'" tv1 {~/CA(":Z:~ that it along with 1J'I8111& of 8\JSIfI8S8) any corrections constitute a complete and correct man- agement plan for rAY facility. a¿ -1- lÄ~~ / te Gal Gal 02/29/2000 ,. e e SiteID: 215-000-000594 ì By Facility Unit ì Fixed Containers on Site ì specHazEPA Hazards Frm 1 DailyMax UnitMCP F PAGE MEDICAL INC f= Hazmat Inventory p== Alphabetical Order Hazmat Common Name... COMPRESSED AIR P IH G 400.00 FT3 Min NITROGEN F P IH G 660.00 FT3 Min OXYGEN ~D~~ . 2/20 1/; 0 F IH DH G 660.00 FT3 Low ~Y'C po.~"'" 7;;¿~ \ ~ d.-Ù 3b,-\ -2- 02/29/2000 ,.' e e SiteID: 215-000-000594 ì Facility Unit: Fixed Containers on Site ì F PAGE MEDICAL INC p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME COMPRESSED AIR Days On Site 365 Location within this Facility Unit BEHIND SERVICE DEPT Map: Grid: CAS # o STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 400.00 FT3 Daily Average 200.00 FT3 HAZARDOUS COMPONENTS ~ CAS # 01 I %Wt. I 100.00 Air HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min p= Inventory Item 0002 F== COMMON NAME / CHEMICAL NAME NITROGEN Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit BEHIND SERVICE DEPT Map: Grid: CAS # 7727-37-9 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 660.00 FT3 Daily Average 300.00 FT3 Z U %Wt. RS CAS # 100.00 Nitrogen No 7727379 HA ARDO S COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -3- 02/29/2000 e e SiteID: 215-000-000594 1 Facility Unit: Fixed Containers on Site ì F PAGE MEDICAL INC p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME OXYGEN Days On Site 365 Location within this Facility Unit BEHIND SERVICE DEPT Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 660.00 FT3 Daily Average 300.00 FT3 HAZARD US COMP N %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 o 0 ENTS HAZARD A E TS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low SS SSMEN -4- 02/29/2000 e e F PAGE MEDICAL INC I p= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-000594 ì Fast Format ì Overall Site ì 06/15/1992 IN CASE OF EMERGENCY ALL EMPLOYEES HAVE BEEN INSTRUCTED TO NOTIFY THE FIRE DEPARTMENT BY CALLING 9-1-1. IMMEDIATELY FOLLOWING THIS CALL THEY ARE TO CONTACT COSTA PAGE BY PHONE, BEEPER, OR MOBILE PHONE. Employee Notif./Evacuation 06/15/1992 IN CASE OF EMERGENCY ALL EMPLOYEES ARE VERBALLY NOTIFIED AND HAVE BEEN INSTRUCTED TO MEET IN THE PARKING LOT AND IMMEDIATELY ACCOUNT FOR EVERYONE IN THE BUILDING. Public Notif./Evacuation 06/15/1992 ALTHOUGH OUR BUSINESS IS NOT CONDUCIVE TO WALK-IN BUSINESS, IF ANYONE IS IN THE BUILDING AT THE TIME OF AN EMERGENCY THEY ARE VERBALLY NOTIFIED AND PROMPTLY ESCORTED TO THE NEAREST EXIT. Emergency Medical Plan 06/15/1992 IF THERE IS A MEDICAL EMERGENCY EMPLOYEES HAVE BEEN INSTRUCTED TO RENDER FIRST AID IF POSSIBLE. IF THE INJURY REQUIRES HOSPITALIZATIONOR HOSPITAL EMERGENCY SERVICES, THE INJURED PERSON IS TO BE TAKEN TO KERN MEDICAL CENTER OR BAKERSFIELD MEMORIAL HOSPITAL. -5- 02/29/2000 e e SiteID: 215-000-000594 ì Fast Format =¡ Overall Site ì 06/15/1992 F PAGE MEDICAL INC I p= Mitigation/Prevent/Abatemt Release Prevention OUR HIGH PRESSURE CYLINDERS ARE CHAINED AGAINST THE WALL FOR SAFETY. EMPLOYEES HAVE BEEN INSTRUCTED ON THE SAFE HANDLING OF HIGH PRESSURE Release Containment 06/15/1992 WE HAVE CHOSEN TO MINIMIZE THE RISK BY NOT HAVING EXTRA FULL CYLINDERS IN OUR FACILITY. Clean Up 06/15/19921 I N/A Other Resource Activation -6- 02/29/2000 .). ~ .. e e SiteID: 215-000-000594 ì Fast Format ì Overall Site ì I F PAGE MEDICAL INC I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs A) GAS - OUTSIDE NE CORNER OF BLDG B) ELECTRICAL - INSIDE E WALL NEXT TO SLIDING C) WATER - OUTSIDE UNDER METAL COVER 10-15 FT D) SPECIAL - NONE E) LOCK BOX - NO 06/15/1992 DOOR EAST OF GAS SHUT OFF Fire Protec./Avail. Water 06/15/1992 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND ALARM SYSTEM. NEAREST FIRE HYDRANT - ACROSS THE STREET ABOUT 100 YARDS WEST OF BLDG. Building Occupancy Level -7- 02/29/2000 .; ",I I'¡.'" e e SiteID: 215-000-000594 ì Fast Format ì Overall Site =¡ 06/15/1992 F PAGE MEDICAL INC I F Training Employee Training WE HAVE 5 EMPLOYEES AT THIS FACILITY. MATERIAL SAFETY DATA SHEETS ON FILE??????? YES OR NO BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TAUGHT THE SAFE HANDLING OF ,HIGH PRESSURE CYLINDERS AT THE TIME OF HIRE. WE SHOW THEM THE LOCATION OF ALL EXTINGUISHERS AND DISCUSS NOTIFICATION AND EVACUATION PROCEDURES. ADDITIONAL DISCUSSIONS TAKE PLACE DURING OUR MONTHLY SAFETY Page 2 [ I I Held for Future Use Held for Future Use -8- 02/29/2000 e e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FAClLITYNAMEof1L ~t'i ADDRESS ~ I If. { l FACILITY CONTACT mlÞ. PlJ.1C INSPECTION TIME .1:w tI: (I L INSPECTION DATE 3 ~ "'00 PHONE NO. ~GJ,""~07) BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES II() Section 1: Business Plan and Inventory Program o Routine ¡ytombined 0 Joint Agency 0 Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand V Business plan contact infonnation accurate V Visible address V Correct occupancy 1/ Verification of inventory materials V Verification of quantities J AAÁ(1 tOr-nD" I\t ./ v I Verification of location Proper segregation of material / Verification of MSDS availability V Verification of Haz Mat training V Verification of abatement supplies and procedures t/ Emergency procedures adequate !V Containers properly labeled v' Housekeeping iV Fire Protection IJ Site Diagram Adequate & On Hand IV C=Compliance V=Violation White - Env. Svcs. Ye\low - Station Copy Pink - Business Copy ¿?d Business S~Responsible Party InBPector:~ ¡,~ Any hazardous waste on site?: Explain: o Yes CfJ-No Questions regarding this inspection? Please call us at (805) 326-3979 ...-- ~ - , , \ '., ' CUST-'E&NO. f]5- ~1 MISCELLANEOUS RECEIVABLES ADJUSTMENT '~ - ;. DA!E3-/~ -~ NEW ACCOUNT ! ADDRESS CHANGE CLose ACCT I : FINANce CHARGE . OTHER ADJ I CUSTOMEANAME p~Jf'- m~',c~.J ~C ~ MAILING ADDRESS 3{O, ~~\\eG+- ~e, S+e~l~ CllY ßo1.U"'J~-¡L-'.cl STATE 0A I ZIPCODE~r-:S0,'ð' SITE ADDRESS PARCEL NUMBER (lFAPPUCASLE) ADJUSTMENT A~S:b~: ~Ó :"'~rc.hQC'j~ doJ\J-\(~ APPROVED BY -<;t &ç ':¿f- "" '~~ ~ '; :'3 J" ~ ~ ~ ~~ ~~c( ~ ID i-1 ~'~ ~ lì1 ~ ~ ~ § ~ ~ Q) <:t. ð.~.~ ~ e e r<) i:~ ~ ~ - CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD, CALIFORNIA 93303-2Q57 . _", .~~ /\:'1'::1 .·~(1. i ,..:,~1. 'i5~'~::~:¿ '.- .~' _ í{'O " ..8.i)i)8, ,., '\ ...·JL~, .\ .::;:...¡ i::l }r.·,:;d)t-:"~Ir ~'....<:;: e. '--,:.... ....'- .~. ..; .w \ .~...... '_.\..... ....tl. i:.·::.,';)...·..:.·.\ \'....,~µ\þ -,..\.j\::. -'.ø,::,' '..;¡~;1\·1~,·t ~.\E.~~l.'.~I:':c.~ t~"':l30ð~ , .... '. ,..T'; , ....j..' \...i-._ ", ....;;a · p p. .,.... \ .~. ,y ü 'h·. ' :;l-O:b\}·~f'i~-:;:-e.fJ.Ú~f'. \\ ,\\\1\\ B(:;N'·.~·:~\\ 1\..l .. ,\\\\1\\ \' , fi.~1v . \\1'\\\'\'\\ . \\ \\\..\\\\' .. \\\\ \1 \\\.\1\\,\\1' ADDRESS CORRECTION REQUESTED DO NOT FORWARD ~) ¿. _-;:1/-''' -.'," '" '.' t ---.-.-.........-'-) \'7'''' ", h..~-';,.'.._· . """'''':J ... ,H~Ç "ÅKl,;~~r,~ ELP f,;A ,::.:s::'i~I.t~·c::~~~~~(¡~¿;Ui}:S~-Õ~0~~l· : *" <' \;":. ,J;::i ., ,P 1'\..[: . "(, r," \' \~~r_;:. :C í' , (f\ .JAN,,\ 9J 0,.:· ;'" :'.',' '. _;~ , . ·~_º,A,.,/··::~:J}/',:~~,:j..::,:..~...::=..~~_~'t -- PAGEMI:.DICAl INC. 121 ESPEE 51 BAKERSFIELO, (A 93301 hM737601 11,1".ill.I.I'III,..,I,IIIII.""II",IIII""II,,1 . , ~-.... .... ~..~.-.~...~, ,~ ". " e e of- Bakersfield Fire Dept. . Hazardous Materials' Division 2130 "G" Street Bakersfie ., qA\~3301 1i?q~ \ HAZARDOUS MATE LS MANAGEMENT PLAN 1?J"\\Qb\ /()~;;t~ ~~ S-. RECEiVED, JUN 0 2 1992 HAl. MAT. DfV. INSTRUCTIONS: l. 2. 3. 4. To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. ,,(piP Answer the questions below for the business as a whole. , ! (f\ Be brief and concise as possible. ·r SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~:PA6£ ~1.~\c.A\.. I~c.. LOCATION: \.). \ ~ S-\>E.t. ~ MAILING ADDRESS: ~.(). ~~.~ ,¡g<oS CITY: ~'w_(.q->~\~c:> STATE: ~ ZIP:ct~() \ PHONE: (i ~ f¡ 1;;t / ß(j6-C¡OJ;s ë}" ~JD,fJ) , ¡I : ~io\ -10~ \ DUN & BRADSTREET NUMBER: l.ø~ - ;t\~ - 4os4 SIC CODE: PRIMARY ACTIVITY: \l\~'3:)\c.A'- E.~\.)\~N\~k -- ~ ~~\...€.. 'S.Þ.\....t. OWNER: c..os.-\Þ. ~E: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT 1 . c.~5s\A ?~ç.£. TITLE BUS. PHONE 24 HR, PHONE 'P\2.{'s'~'i..~ ~Cc \ - ì~ù.q . ~ 'l1\·ÇS~1 2. ..5-n:'\I€. ~c.~\,-,-\~~ ~\~ ""clL ~(n'-lo:?:>\ ~ 1;l.- ., ~~ \ . I 1 , ^ / FD15~ r--- e Bakersfield Fire Dept. e Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN 01- 'I. " < \' :.j ..'. . SECTION 3: TRAINING: y,n¡ b"íi ~'¡, '-t NUMBER OF EMPLOYEES: S MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: AI-'- ~M~\....~ £.E:..s. P\'Q.E:. -rt\ù'\""" '"T'r\L. sÞ.,Ç'E,. ~þ,~\-\~c; 0,," ~\G¡~ ~~s.s.ù~£. ~~I~(.It$ þ¡" ~t. 'T\~..1 6f'i ~\~t.. ~~ .s\.-\c>~ ~(."" -n\~ '-'CA'T IC~ o~ þ.,\..J.., t't-\ \~{:\IJ\S'.~t.í2..$. p..¡:¡¡D 1>\Sc.Ù>S> ~\)'J'~'CA,\\O~ A"Yþ t..\fH:.."Þo",\O~ ~(t()~\)~(..$. ~ A 1>'3>'-n~~o.,- "þ \ s.~ ~~'\t).ls. ~Æ'-~\..ÞIIC:,t.--:Þ"'(\.\,.)~-o\Ya... ' 't-J\à"'~'-l $~ E.~ Mi~ \S~s.. SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6,95 OF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. ~- - -- OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, CO-X7J 11<;£ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC, 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. f1d~ SIGNA TURE 'J? Q.\.<>'lDf£..~ TITLE s) ~Á;¡ ! DATE 2. FD1590 ·, . "1i e Bakersfield Fire Dept. e Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit' Name: ~^<:i£ ME.'1>\C4\- :I:..~c... SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: :t...:I c.~s.Ç,. oç ~t-o\~Q.."t...~~ Þr'-'- U'\\>\-()'1t..'(..s \-\~\lE: "'òE.t.~ :L~9>\~~~(.'t)'"1t>~O\\~ï \'~€. f"i!.('"Dt.~""(l.""'Çt-'\'ë..~ 1~'1 C.M...\..\c"I~ '=\\\. -:r:. '""''"'''t.~\!o''E..\..l .ç-Qw..o~tÑ~ 1'\\\5- ~..'-\,. ""~'1 ~Q..£. ""1"0 ~o'ð'TP\c...~ C.OSTA '?~~E:. '&'1 P~6~E..) ~u;.\>£.'\2-) OCl.. t-\1)\h\'-E:. F,"~~~. B, EMPLOYEE NOTIFICATION AND EVACUATION: ::ï:~ c-þ.st. oç €.~~~~£..:>~ A\...\.. ~t-\ ()L.()'1(..t...$. ~\l.~ "(;~\ÞI>.\..\...\ 1.?€..t.~ ::1:.~'S.-rQ..\,)~e::tI -ro "-'.'£..€:"Ç' \.:> -n.\€,. ~~R."'-\~G,¡ \-ò'T A:.>-p A c..c:..oo~ !f-E)Q. E:"'£'~\o~C \~ ~t.. ~~\\.!I) \r-'~ . "=>0\ \ç.\~ ~ ~~of. ''"'' \'o\.E,. 'b \Þ.o-"\~\...1 C. PUBLIC EVACUATION: A\"""'Ç~otJ~" ÐUR. 'ßU$ \~t.$.s. \'::...so--r- ~"""b~c::.\-l~ -q) \¡JA\..~-\~ ~US\~U~ :J:.Ç' Ao)'1~~E:,. \ß \~ ~€.. ~U\~'~G. A, ~{.,. ~,~ ð~ Þr~ ~""£.~~~.:>c..1 ,",,,,,,,,' 1\0..£. --lE.R..Iò~\...\"'\ oIIC!I..... \ç:\~ Þ¡cVÞ ~~t-\~,I..\ E..~~(lTh'I) '\1) ~t. ~€.~9.t.~\ E.'JL\\'. D, EMERGENCY MEDICAL PLAN: :t:.~ -'\\.\t.Q..~ \~ þ.. t-J\\.."D\cA\.. -(Mt.Q.G¡t~C>1 e.M\>\..()\~~S \-\Pr-J(. ~t.E.~ ~~~~ Ïò Q.f..~t.u.. ç, ~~, þo..Y'þ I ç: ~b$S\<2>\-£. l :r ~ ...~€. \~-:rû~ \2.t..~0'í.l..t.c;.. "OS.\>\-çþ,\,..''2Å''"'Ç$)~ oíL ~()..$~,~þ,'- €.""E..~~~c..1 S£"{l..4\~LS; -ç;.\(. ~:>o,,"E:D t(.."O!>~ \'::. -m ~E. ,",¡\\L.E.~ -m '\L~~ ",,~,c;...\... c.~ ()~ ~A\lt.<¡.~Ç\~\:J> ~(.MOQ.\"",- ~~5.~\,,","þ.'-. 3. R: ' e Bakersfield Fire Dept. e Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: OIJR "\~'" Ç>¡u..c:;.s\JlU.. ~\\...I~E:(\...~ M..E.. c...'Aþ.\~'~ þçr:..A\~~ ~€. \,.1Þ1IÄ... ~~ s.ÞI"Ç:\.."ì. E..",P\...Q It.~> 'AÞ.."{.. (!;'~E.~ \~ ~c."(."D ()~ ~t. s Þ,Ç'€ \-\A~\...H~<\ ~ ~I~~ ~Q.t.$$.o~ ~\\....\~t.(\..~. B, RELEASE CONTAINMENT AND/OR MINIMIZATION: ~E. "ME. ~~os.t.~ \0 r-\1~''''''2...E. -~È. -Q..~'<. '~""I'~t\.,.. \-\þ-..j,,.)(Õo¡ ~'¡(.~<2.À fuu- c.\\-,~t.1l~ \ ~ !)" 0.. ç Þ>c..\ 1-.\ -,; 1- I C, CLEAN-UP PROCEDURES: r-JjA. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: OLn'S.Iì>E.... Ñ!)Q,.\\~~ þ,~ ln~t'\\.. ei ~$\\..l>\~G¡ ELECTRICAL: --r,..:)s.\"D~ - t.-o.'S;;\" WÞ\lÄ.. ~~..,.:'""; -"I"() S\-\"D\~c. ~OI\'\2.. WATER: O~~I~£. - "~ESI.. t'\\'-,-P.\... c.o"~'Q.. 16-\<; k (.~ of- G.¡:\-'- So'o\O'", o~ - _. -- SPECIAL: LOCK BOX: YES@ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABILlTY: A. PRIVATE FIRE PROTECTION: f\~L ()(""'I'\~C\l)\S~:z.t A~ Þ\\..AP-M, s"'{s'__E.,,",- B, WATER AVAILABILITY (FIRE HYDRANT): r,(tL \-\1'D~ p\c..~~s. ~'- S\'9-t-~ ~U\ \.....'1::>\~G¡ . ~(:)\YT \~C) 'iA0ø5 ~tc..-\ oç. 4, " FDI590 .. [] Farm and Agriculture~ standard Business CITY OF BAKERSFIELD HAZARDOUS MATERIALS INVENTORY ~~ :,6'.." page_of NON - TRADE SECRET BUSINESS NAME: "Ç>~c,£. ~E..'1>'CAL -:s::. ~(L. LOCATION: \').\ '-~f'E..(. S-r CITY, Z;tP: 'Bc.w.(.~'l."'" CA. C\2>'?x-, \ PHONE t: ~~~. ~(,,\.~,(.~, OWNER NAME: (" ..b"'r"':"'Þo. Ç>~&€. ADDRESS: 511.). i-/¡D::DF,.) \/M...L..cì CITY, ZIP: 'F,.f.¡~rzs.~II!tz> cA. PHONE , t : ~'Ç. ~lo\ -'110 ']. \ REFER TO 7 8 /I Days Cont Site av.. . !. tt~c..: NAME OF THIS"'FACILITY: STANDARD IND. CLASS CODE: DUN AND BRADSTREET NUMBER/FEDERAL ID # ~~-~i.:}'-':Lº-£IJ.. 6 14 Names of Mixture/Components See Instructions ,~ Physical and Health Hazard (Check all that apply) ~Hazard ~~lease '0 of Pressure " C.A.S. Number Component /I 1 Name , C.A.S. Number Reactivity 0 Innne~:I1ate 0 Delayed Health Health , Component /I 2 Name , C.A.S. Number Component # 3 Name ., C.A.S. Number Physical and Health Hazard (Check all that apply) AI Fire Hazard ~n Release . of Pressure C.A.S. Number Component # 1 Name & C.A.S. Number o Reactivity 0 Innnediate 0 Delayed Health Health component # 2 Name , C.A.S. Number Component # Physical and Health Hazard (Check all that apply) o Fire Hazard ~dden Release of Pressure C,.A.S. Number Component # 1 Name & C.A.S. Number o Reactivity 0 I~ediate 0 Delayed Health Health Component # 2 Name , C.A.S. Number component /I 3 Name , C.A.S. Number Name 'ÿ~.:;"~,,,-~ Title '9T1-S.Ç3'7 #2 ~¡(" 't-'\t'..W\I...L.'o.--s, 24 Hr. Phone Name 'S.tct>l \c£. M.C:; \\. Title EMERGENCY CONTACTS #1 " Certification (READ AND SIGN AFTER COMP~ETING 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 i!1d., 1.1<_18 ~_1bl. ,~ _lei.. t>e 1.'_11=. ,"""... thet .... """"tied 1.'_11.. 10 1<0., ==.,"~~comPl te., Cð:5-n Aç~- P17ESOX.:>-r C~_q, :s/t9hz NJIHE AND OFFICIAL TITLE OF amER/OPERATOR OR OWNBR/OPERATOR I S AUTHORIZED REPRESENTATIVE SIGNATURE ."- ' DATE SIGNED