HomeMy WebLinkAboutBUSINESS PLAN 7/13/1987
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BAKERSFIELD CITY FIRE DEPARTMENT R E r. E, \I E 0
2130 "G" STREET
BAKERSFIELD, CA 93301 J U L 1 3 1987
(805) 326-3979 A
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OFFICIAL USE ONLY
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0008.18
USINESS ~A¡'O(E
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
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.
SECTION 1: BUSINESS IDENTIPICATION DATA
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A. BUSINESS NAME: ",7~';"Elev:en 0 Foo'd' Store 11212'5-16288.
B. LOCATION / STREET ADDRESS: 5301 Stockdale Hwv.
CITY: Bakersfield
ZIP:
93309
BUS.PHONE: (805) 832-4455
SECTION 2: EMERGENCY NOTIPICATIONS
In case of an e.ereency involvin¡ the release or threatened release of a
hazardous .aterial, 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 OP EMERGENCY:
NAME AND TITLE
A. Larrv & Patti Frost. Franchisee
DURING BUS. HRS.
Ph_ (805)832-4455
AFTER BCS. HRS.
Ph_ (80S)812-44SS
B. Kathy Meiia. District Manager 2125 Ph_ (805)814-2711
Ph. (RO'))R14-?711
SECTION 3: LOCATION 0' UTILITY SBUT-oPPS POR BUSIRBSS AS A WROLE
A. NAT. GAS/PROPANE: None
B. ELECTRICAL: Back Room
C. WATER: Outside - rear
D. SPECIAL:
E. LOCK 'BOX: ~S / NO IF YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PL~~S? YES / ~O
MSDSS? 'YES ! NO
KEYS? YES / NO
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
Emergency Coordinator (pre-determined) shall notify all agencies and inter-
~~ R :~é~~p~ÞY persons in the event of incident. Emergency Coordinator shall implement
..'" , à1Y necessary measures in regard to employee/environmental safety as instructed
by training received.
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
Police/Fire Department: 911
Nearest E.R. to location is to be used in the event of injury.
SECTION 8: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROG~~ WHICH PROVIDES EMPLOYEES WITH I~ITIAL A~D
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR ~O I~ITIAL REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
~TERIALS:...................................... . YES ~O YES ~O
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES:....... ................... YES ~O YES ~O
C. PROPER USE OF SAFETY EQUIPMENT:......... ......... YES NO YES NO
D. EMERGENCY EVACUATION PROCEDURES:.............. ... YES ~O YES NO
E. DO ,YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.. ..... YES NO YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS RANDLE HAZARDOUS MATERIAL I~ QUANTITIES LESS THAN 500 POCNDS OF A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: . . , . .. YES ~o
I, Larry Frost , certify that the above intormation is accurate.
I understand that this intor.ation will be used to fulfill my firm's obligations under
the new Calitornia Health and Safety code on Hazardous Materials (Div. 20 Chapter 6,95
Sec. 25500 Et AI.) and that inaccurate information constitutes perjury.
TITLE Franchisee
DATE 7- (p -%7
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BAKERSFIELD CITY· FIRE DEPARTMEXT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFiCIAL GSE ONLY
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BUSINESS NA~Œ:
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 . ,- --- -'-.-. --..
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FACILITY UNIT#
FACILITY UNIT N~~:
SECTION 1: MITIGATION. PREVENTION I ABATEMENT PROCEDURES " ..,.
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SECTION 2: NOTIFICATION .~\~ EVACGATIO~ PROCEDLKES AT THIS ú~IT ONLY
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BAKERSFIELD CITY FIRE DEPARTMENT
FORM 4A-1
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
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BUSINESS NAME: 7-Eleven Food Store 112125-16288
ADDRESS: 5301 Stockdale Hwv.
OWNER NAME: The Southland Corporation FACILITY UNIT #: 100
ADDRESS: 1240 S. State College Bl\RIACILITY UNIT NAME:
CITY, ZIP: Bakersfield 93309 CITY,ZIP: Anaheim 92806
PHONE t: (805) 832-4455 PHONE #: (71?f) 635-7711 IOFFICIAL USE CFIRS CODE
ONLY
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAJ, CONT USE LOCATION IN THIS % BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE
¡') M ~)iJ5 ~..9"Cõ /ø1S/
:::::s:= ~ Ft3 04 99 Near Sales Counter 100 C02jCarbon Dioxide NFLG 1013
/ /
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NAME: Kathy Meiia
EMERGENCY CONTACT: Larry Fro~t
EMERGENCY CONTACT: Kathy Mejia
PRINCIPAL BUSINESS ACTIVITY:
TITLE: District Manager SIGNATURE:
TITI.E: Franchi~ee
TITLE: Di~trirt M~n~geT
Convenience store
PHONE # BUS HOURS:
AFTER BUS HRS:
PHONE # BUS HOURS:
AFTER BUS HRS:
DATE:
(805)832-4455
(805)832-4455
(805)834-2711
(805) 834-2711
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