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Home My WebLink AboutBUSINESS PLAN 10/17/2007~,,,1 ~ (~ `~ ~I ~ [ Leslies Swimmi~a Pool Su 1ies~ I, ~ i g P P i 74-6 .~'' Per it Operil.te ~. t, to Hazardous Materials/Hazardous Waste Unified Permit ~ CONDITIONS OF"PERMIT ON REVERSE SID~ .j.... , , . " 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 Permit ID #:: 015-000-001746 Issued by: ,'.{ ." -: . ':: . . . ~" ":;'; ":~~\:;::"'~ (:.r':..: .;..,. Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 ., Approved by: , Issue Dale .' I. ; Expirati~n Date: ' ',J:une 30, 2003 -.., . . .".;. ." f;.... -:;. .;'. ". .-,.:.... -,..-......... . ." .,,',' Per Ït to Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE LESLIES SWIMMING POOL 5 This permit is issued for the following: ;::Hazardous Materials Plan round Storage of-Hazardous Materials qagement Program H',', Waste / PERMIT ID# 015-021.Q01746 LOCATION 8200 \ . ~.1 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 Approved by: Expiration Date: June 30, 2000 -; ..Li .L T.L J.'.L ~. .. SITE OrAGRA·M -. '. .L .1..J...C"':1,J" ~ , ~ ..I...A. Business Nome: v~ l--t3s. L ( E '~ ~ FACIUTY DIAGRAM PGöL s..UPPL(£S·, ~þ; i~'" ;f,' . Business Address: <g 2-00 ~ íVCKDAŒ H-w Y ò - s For Office Use Only FirST !n Sterion: Area Mea ;; of Inspecrion Ste!ion: NORïH 0 ./,v~ ~C;'" '-;, r. QoR~ . l;? ~,:,--' ~ o ~ .............-- ¡!1 UNOc..AL. S \f)...'Ífo-rJ ~\<tC' r1 ( 'jf i \b ~4. ~ ~~ .¿¡~~Q.> ~oti e C '- II') ~.3 ~ ('- J ~' ~ª' <1. '{ ~ ¿ ''- 11\ ).. ).) ~lt ",^ l~ \u 0 l~ ~ Q f\ÎI ~,.J ð c \~ ~ I ~ ,j Q..' ð ClJtJ,v-rn-Y .J -~ 4 \.t), .-J '::> ~ 'D fl- \\) ~ '.A \A. ~' \.l1J J.. ') 3 -...jB \fI \J CL c: ~ . "" . ~ ~~ ~~ ()2V) : ~ = LESLIES POOL SUPPLIES-STOCKDALE Manager DENNIS WHEELER Location: 8200 STOCKDALE HWY D-3 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: ~Z~tCi SiteID: 015-021-001746 BusPhone: (661) 396-9738 Map 102 CommHaz High Grid: 32D FacUnits: 1 AOV: SIC Code:5091 DunnBrad: Emergency ContGac~ / Title ~ _-~~idY..~1~E~''L-~''~~~~~~It,Q/ M$xPd~G~R(~s~`~~-f' ~' Em~P.,r~~~encyT Congas t -~R~G GPrPdE~i~" / ~j,~ ~T~~t]tes ~~. / ~i~3'P~''R~~S'OR Business Phone: ( 3-9 x Business Phone: (89fl) ~~~"~x~95o 24-Hour Phone (. 3 B 24-Hour Phone l.v~z- 3~stc _ ~4'K ( ) 0, - y ~S Pager Phone (sue ) x Pager Phone ~ (~~~ l ~z-? ~yNgx Hazmat Hazards: Fire React ImmHlth DelHlth Contact MIKE JENNINGS Phone: (602) 366-3999xsg~LP MailAddr: 3925 E BROADWAY RD 100 State: AZ City PHOENIX Zip 85040 Owner LESLIES POOLMART Phone: (602) 366-3999x Address 3925 E BROADWAY RD 100 State: AZ City PHOENIX Zip 85040 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~N~'Q~ ~~~ ~ ~ . ~'~07 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. -~ Z ~y~o ? e Date -1- 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP POOL ACID E R IH .~ L 150.00 GAL Hi LIQUID CHLORINE ~ R IH L ~~J-x--00 GAL Hi TRICHLORO-S-TRIAZINERTRIONE IH DH S 7000.00 LBS Mod SODIUM DICHLORO-S-TRIAZINETRION S 6000.00 LBS Mod CALCIUM HYPOCHLORITE/POOL SHOCK F R IH S 3940.00 LBS Mod POTASSIUM SULFATE DH S 1000.00 LBS Min -2- 02/02/2007 -3- 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME POOL ACID Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM & STORAGE AREA CAS# ~SolidE TMixture ~ Ambient~E ~ AmbientT~E ~STICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 150.00 GAL 100.00 GAL IlEiGHKLVU~7 LV1~lYV1VL"1V1J %Wt. RS CAS# 100.00 Muriatic Acid Yes 7647010 IIHGHCCL H. 7.7L' .7~J1~11".i1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME LIQUID CHLORINE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM & STORAGE AREA CAS# Liquid TMixtur~ Ambient~E ~ AmbientT~E DRUM/BARRELENONMETAL~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1. 0 0 GAL 1 r,.~ ~-8--6 0 _ GAL ( ~~~ _]~5.0-. 0 0 GAL rac~uruu~vvo ~.v1.1rv1v~ly t ~ %Wt• RS CAS# Sodium Hypochlorite No 7681529 11tiL~riRL 1'iJ JP~.7 ~J1"1L'1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi -4- 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME TRICHLORO-S-TRIAZINERTRIONE Days On Site • 365 Location within this Facility Unit Map: Grid: , CTR SHOWROOM FLR & WALL CAS# 87901 ~SolidE I Mixture~T~ PRESSURE ~T TEMPERATURE CONTAINER TYPE I Ambient I Ambient DRUM/BARREL-NONMETA~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 LBS 7000.00 LBS 6000.00 LBS nt~~Kt<,l~uu5 cuinrulv~iv 15 %Wt. RS CAS# 100.00 Trichloro-s-triazinetrione No 87901 r1.y~tittL raa ~~a~l~ir~1.V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mod ~ Inventory Item 0005 Facility Unit:. Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM DICHLORO-S-TRIAZINETRIONE Days On Site DIHYDRATE 365 Location within this Facility Unit Map: Grid: SHOWROOM & STORAGE AREA CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid Mixture 1 Ambient ~ Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 40.00 LBS 6000.00 LBS 5000.00 LBS ntiGtiCUJV U J l.uP7YU1V L~1V 1 J %Wt. RS CAS# 100.00 Sodium Dichloro-s-triazinetrione No 2893789 I1L-1GtiKL tiJ JL~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- ~~ 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME CALCIUM HYPOCHLORITE/POOL SHOCK Location within this Facility Unit SHOWROOM & STORAGE AREA SiteID: 015-021-001746 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# ~SolidE TMixture ~Ambient~E ~ AmbientT~E -~STOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 100.00 LBS 3940.00 LBS 2000.00 LBS t1AGL~CLVU~ lrV1~lYV1VI;1V1.7 %Wt. RS CAS# Calcium Hypochlorite No 7778543 ri1~GKKJJ AaaJ;a~1~1J/1V'1'J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME POTASSIUM SULFATE Days On Site POTASSIUM MONOPERSULFATE 365 Location within this Facility Unit Map: Grid: SHOWROOM & STORAGE AREA CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid TMixture~Ambient ~ Ambient BAG AMOUNTS AT THIS LOCATION Largest Con40100rLBS Dailyl000100m LBS I Daily A50r00e LBS t1L~GE3ttLV U.7 1.V1~lYV1V~1V 1 A °sWt. RS CAS# 100.00 Potassium Sulfate No 7778805 I1HGtiKL .[~J .7~.7Jl~li',1V-1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Min -6- 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/24/2000. TELEPHONES AVAILABLE IN OFFICE AND AT EACH SALES COUNTER TO DIAL 911. Employee Notif./Evacuation 12/18/1998 VERBAL. Public Notif./Evacuation OUT OF BUILDING THROUGH EAST ENTRANCE DOORS. 04/14/2006 Emergency Medical Plan 08/13/1996 FIRST AID KIT IN OFFICE. -7- 02/02/2007 F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/13/1996 ~ INCOMPATIBLES SEPARATED. PALLETS KEPT IN SHRINK WRAP. Release Containment 07/19/2006 WATER-TYPE FIRE EXTINGUISHERS AVAILABLE IN BACK ROOM FOR USE ON CHLORINE FIRES. NEUTRALIZERS AVAILABLE ON SHOWROOM SHELVES. Clean Up 08/13/1996 NEUTRALIZATION RETENTION OF SAMPLE AND DISPOSAL OF NEUTRALIZED LIQUIDS PER WASTE WATER STANDARDS. ~,_ _ v~.,iici ncavui~.c ral.l.lVQl.1V11 -8- 02/02/2007 ~, F LESLIES POOL SUPPLIES-STOCKDALE SitelD: 015-021-001746 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aYc~:ia..L na~ctiu5 Utility Shut-Offs A) GAS/PROPANE - OUTSIDE W WALL B) ELECTRICAL - INSIDE BACK RM NW & SW CRNRS C) WATER - PLANTER ACROSS FROM STORE FRONT D) SPECIAL - NONE E) LOCK BOX - NO ~J4/14/2006 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLERS. NEAREST FIRE HYDRANT - REAR ALLEY W OF BLDG. 12/14/2006 Building Occupancy Level 12/27/2006 5 EMPLOYEES -9- 02/02/2007 Y ~', G F LESLIES POOL SUPPLIES-STOCKDALE SiteID: 015-021-001746 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/19/2006 ~ MSDS SHEETS ON FILE IN THE OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING HANDBOOK AND SAFETY MEETING MATERIALS LOCATED IN OFFICE. EMPLOYEES UNDERGO VIDEO TRAINING COURSES. VIDEOS ALSO LOCATED IN OFFICE. rays c. I1Clu 1VS. 1' ul.uLC USC a1c1u tV1 t'ul. U1C Vu7-C -10- 02/02/2007 UNIFIED PROGRAM INSPECTION CHECKLIST i€'Ee*5~: :: m''.;ii£>-a":F'S~.Y_.1'.~~*e,..:m,.._..z9.:i^_.,,_.d'-. ,tkr_.~,...r.,.~uS..r_._ ~.n,. .,.. ,:Y - ..~.a_r- ,K-... ..u~, _. t__.;~r." SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT s Prevention Services /SRS 900 Trtuctun Ave., Suite 210 ~wrM ~ Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS HONE NO. O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- p0! 7 ~/~ Section 1: Business Plan and Inventory Program ~ ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERAT{ON V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIII2SS PLAN CONTACT INFORMATION ACCURATE - Q'1 ~ ~ ~ ~0 6 ~~i ^ VISIBLE ADDRESS [.Y ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROC RES EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: .56~ ~'~'faGl~ ['YES ~ NO QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) ~ Fire Prevention / 1s' In /Shift of SitelStation N ®ei~n<S (.ti~i Be lQr White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2048 (Rev. 02!05) tt" ~ . + LESLIES POOL SUPPLIES _______________________________ SiteID: 015-021-001746 + Manager SEAN COPE BusPhone: (661) 396-9738 Location: 8200 STOCKDALE HWY D-3 Map 102 CommHaz High City BAKERSFIELD Grid: 32D FacUnits: 1 AOV: CommCode: BFD STA 11 SIC Code:5091 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title SEAN COPE / MANAGER .STEVE NESS / SUPERVISOR Business Phone: (661) 396-9738x Business Phone: (559) 433-9097x 24-Hour Phone (661) 66.3-3938x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone (559) 994-6382x Hazmat Hazards: Fire React ImmHlth DelHlth Contact DENNIS WHEELER Phone: (661) 396-9738x MailAddr: 8200 STOCKDALE HWY D-3 State: CA City BAKERSFIELD Zip 93311 Owner LESLIES POOL MART Phone: (602) 366-3999x Address 3925 E BROADWAY RD State: AZ City PHOENIX Zip 85040 Period to TotalASTs: _ Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'D APR 14 2006 Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that f have personally examined and am familiar with the information submitted and believe the information is 4rue, accurate, and complete. Signature Date -1- 03/13/2006 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 933//0~1 FACILITY NAME - ~ _ ItNSPECTION DATE INSPECTION TIME . - ~es I t ~ S S~ ~ n~ h^ I N __ __ _rJ_c~_ (_ _ _s_~~ - ~ ! ~s -- ---- ------- ---- ~~- 3~-" ~ (~j ~ vv ADDRESS ~ PHONE No. No. of Employees FACILITYCONTACT Business ID Number ~v+h e~S w L,,e ~e /`r- 15 -021- t~O t°7 ~ ~ Section 1: Business Plan and Inventory Program ~~ Routine ^ Combined O Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection ~~~~ C ~ \V~Viofatlonnce~ OPERATION APPROPRIATE PERMIT ON HAND COMMENTS ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ~^ CORRECT OCCUPANCY 1 l~~^ VERIFICATION OF INVENTORY MATERIALS ~^ VERIFICATION OF QUANTITIES ~^ VERIFICATION OF LOCATION li,d' ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF FIAT MAT TRAINING ~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES L~' ^ EMERGENCY PROCEDURES ADEQUATE ~^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING -- --- - - FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8c ON HAND ANY HAZARDOUS WASTE ON SITE?: ^ YES ~NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~66'I~ 326-3979 Inspector Badge No,. White -Environmental Services Yellow - Sletbn Copy Business Site Responsible Pa Pink -Business Copy " e UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield. CA 93301 Tel: (661)326-3979 ADDRESS <l INSPECTION DATE .:::Jí:f?J " PHONE No, '7 {, ..c¡ 7..M Business 10 Number 15-021-00 1"/ INSPECTION TIME 070 .........;__ :~~:~I:~_~:_~ , Section 1 : Businèss Planánd Inventory Program ~:' . -. 'Ø Routine D Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection C V ( C=Compliance ) V=Violation OPERATION COMMENTS rJ.. ~ Ap~RO~RI~TE PE~~~ ON HA~.?____,__,_,________ ..,_'_.____,_'."'..'___,_'_______'..'',,__,__...,'_____,__,__"",_._ ~ D BUSINESS PLAN CONTACT INFORMATION ACCURATE 'P' D VISIBLE ADDRESS '~ D CORRECT OCCUPANCY ~ D VERIFICATION OF INVENTORY MATERIALS ~ D VERIFICATION OF QUANTITIES --------~-----------_._._---------_.--- --------------..---------------------.- -,------..-------..---...--.---..--.-..------- '~ D VERIFICATION OF LOCATION )..f D PROPER SEGREGATION OF MATERIAL ~ D VERIFICATION OF MSDS AVAILABllITYE ----- _____._.___..__________.___ __ .._ _.__________...._____..._____.d..._.. ø____ __..___.______ .._.._.___.....______... h_*.._______ ----"+,--------.--------..---. .--- -..-.---.--------.-.----------.----.--.-.--.---..---.-..-..--.-.--.----....-.-----. --- -----...--------.----....--.------..-.-----.------.----.----.----..- ......-.-----. ----.-.----------.---.----- ------.. -..-.-------.----.----.--.--------------.--------------.,...----.--.--.-.-.-- --------------------.-- -~---_.__._---_._.._-_._------_._._-_._----_._----_._. ---------------.--.------ --------------..--------. -- .-.-_.._-------------- ----..---.------.---....-..-. ...--- -------.-----.. <-.------ ---.----.-------.- -----.---.-----.----.----------.-----.--- D VERIFICATION OF HAT MAT TRAINING --------.-.--.-.--.- .-------.----.--.----------.-----.-..-.-.---- --.--------.---.--..- Já D !A D VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ------.-.--.-------..-.--- --.-----.-----..-..---.--.---...--------...---.-.-..-----.------.-- EMERGENCY PROCEDURES ADEQUATE ~_~ C~NTAINE~~ P~OPERLY _ LABELE~~==~=~~=~~:=~- -:=~==~'~~~=:==~~~,'~~_~=====-_~~.=~~:-=~~_-~= ~ D HOUSEKEEPING }'( D FIRE PROTECTION ..--..---.---.------ ----------------.---------------.--.--------- ----- .----.---------.------ -------------..-----.------.-----.----.---.---.--------. ~ D SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: DYES ~No ~, ~ ~ EXPLAIN: White . Environmental Services Yellow - Station Copy Pink· Business Copy \\0 ------- Badge No, e e FACILITY NAME ADDRESS z.e-" FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd f·'loor, Bakersfield. CA 93301 , f l,d1JISPECTlON DATE \ Z - ~ - D'Z.. PHONE NO. ~~{n -~ 1-.'l~ BUSINESS tD NO. ~- OJ~"" - O~ I - {Jú /1- '1 Cn. NUMBER OF EMPLOYEES .?; Section I: ~ Routine Business Plan and Inventory Program o Combined D Joint Agency D Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS App~opriate permit on hand .~ r/ f\ Business plan contact information accurate I~ ! NpA-v tt{...... uo. ð ~ - ~-e ~ 0Jtr-.J-t·Jd , I/V \ , Visible address Correct occupancy / Veri fication of inventory materials / Verification of quantities 1/ Verification of location 1/ Proper segregation of material I Verification of MSDS availability .¡ Verification of Haz Mat training ./ Verification of abatement supplies and procedures r/ Emergency procedures adequate .¡ ~ Containers properly labeled :/ Housekeeping / Fire Protection y'/ . Site Diagram Adequate & On Hand V ,/ C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes DNo White - Env, Svcs. Yellow - Station Copy Pink - Business Copy Questions regarding this inspecüon? Please call us at (661) 326-3979 e e ~. ~ :¡, " Hazardous Material Additions Store 249 S.W. Bakersfield Hazmat Common Name Sodium Dichloro-s-Triazinetrione, Dih drate Potassium Mono ersulfate Location in Facili Showroom & stora e area Showroom & stora e area ! - ¡ e e LESLIES SWIMMING POOL SUPPLIES Manager SEAN COPE Location: 8200 STOCKDALE D-3 City BAKERSFIELD CommCode: BAKERSFIELD STATION EPA Numb: --.'$- Code: 50 91 DunnBrad: 015-021-001746 (661) 396-9738 CommHaz : Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title SEAN COPE / MANAGER STEVE NESS d~) sm~g}~~~ Business Phone: (661) 396-9738x Business Phone: 24-Hour Phone : (661) -3-9-=1- 3 9 3 8 x 24-Hour Phone : ( ) - x Pager Phone : ( ) (þ3_ x Pager Phone : (m) 87~ 9~¿lx C¡Cf'f - u3fJZ. Hazmat Hazards: Fire React ImmHlth DelHlth Contact : Phone: (661) 396-9738x MailAddr: 8200 STOCKDALE D-3 HWY State: CA City : BAKERSFIELD Zip : 93311 LESLIES POOL MART,..1"Vlc. J Phone: ~_ ""l. ~ ú>c" - '~C¡~ ~ Owner (818) 9~ ~212)( Address : 20630 I'Lur~mR C'I' '5'12>" E. ðroo.rJ~o.'f {: . #/00 State: -eJIr. AZ City : CIIl'~'I'£WORTH Pt-..oev1;~ Zip : 91311 '05""0'-10 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: p= Hazmat Inventory p== Alphabetical Order Hazmat Common Name... SpecHaz EPA Hazards CALCIUM HYPOCHLORITE/POOL SHOCK F R IH S LIQUID CHLORINE R IH L POOL ACID E R IH S TRICHLORO-S-TRIAZINEtTRIONE IH DH S ><oJ~/ÂV\Á c)'.~kll1(,o - $'- ír~o.:"l...:vt~ .¡...."ovt~1 O,·kyJro...-I-e... p o+Ck 55; v.. "'^ ¡JOv1.0f&-ô'S1Å (-fev-(-~ I, M:/£(T!. ',)~",,^,.'VlrS Do hereby certify that f have ype or pnnt name) .' reviewed the attached hazardous materials mar:age- ment plan 10rLed:,.'ç ~.I >t.\ff~ná that it along W·th (NalTlS oI-àuSIOGS8) any corrections constitute a complete and correct man- agement plan for my facility. -" d~l- fA .' c( I' Ignature..... .>=-/7- 0 / Date One Unified List ì All Materials at Site ì DailyMax MCP 3940.00 z..u. o~. 00 I s-ro -+G-. 0 0 7000.00 {.,oottJ. 0 ¡() /°00.00 LBS GAL GAL LBS (..,~S ~¡'$5 Mod Hi Hi Mod 05/04/2001 e e F LESLIES SWIMMING POOL SUPPLIES p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME CALCIUM HYPOCHLORITE/POOL SHOCK SiteID: 015-021-001746 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit SHOWROOM AND STOCK (STORAGE) AREA Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container ,100.00 LBS AMOUNTS AT THIS LOCATION Daily Maximum 3940.00 LBS Daily Average 2000.00 LBS %Wt. RS CAS # Calcium Hypochlorite No 7778543 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0003 F= COMMON NAME / CHEMI CAL NAME LIQUID CHLORINE Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit s:kDtÑ('<Do,^^ J- s:kk. L >-\-orafe.) AurA. Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container I GAL AMOUNTS AT THIS LOCATION Daily Maximum z- r-(O;oQ g¡t. 00 GAL Daily Average / $"O,ooGAL %Wt. RS CAS # Sodium Hypochlorite No 7681529 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi HAZARD ASSESSMENTS -2- 05/04/2001 e e F LESLIES SWIMMING POOL SUPPLIES f= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME POOL ACID SiteID: 015-021-001746 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit .s;lAolI"roovv\ J- 5~k C s-kro..ge) o-reO\ Map: Grid: CAS # STATE - TYPE Solid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container I GAL AMOUNTS AT THIS LOCATION Daily Maximum ;9/.0070.00 GAL Daily Average /00.00 GAL %Wt. RS CAS # 100.00 Muriatic Acid Yes 7647010 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi HAZARD ASSESSMENTS f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME TRICHLORO-S-TRIAZINERTRIONE Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit CENTER OF SHOWROOM FLOOR AND WALL Map: Grid: CAS # 87901 STATE Solid TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container 50.00 LBS AMOUNTS AT THIS LOCATION Daily Maximum 7000.00 LBS Daily Average 6000.00 LBS %Wt. RS CAS # 100.00 Trichloro-s-triazinetrione No 87901 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mod HAZARD ASSESSMENTS -3- 05/04/2001 e e F LESLIES SWIMMING POOL SUPPLIES I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-001746 ì Fast Format ì Overall Site ì 03/24/2000 TELEPHONES AVAILABLE IN OFFICE AND AT EACH SALES COUNTER TO DIAL 911. r=:: Employee Notif./Evacuation CRBAL. I Public Notif./Evacuation OUT OF BLDG THROUGH E ENTRANCE DOORS. I Emergency Medical Plan FIRST AID KIT IN OFFICE. 03/24/2000 12/18/19981 1 08/13/19961 -4- 05/04/2001 e e F LESLIES SWIMMING POOL SUPPLIES I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-001746 ì Fast Format ì Overall Site ì 08/13/1996 INCOMPATIBLES SEPARATED. PALLETS KEPT IN SHRINK WRAP. Release Containment 08/13/1996 WATER TYPE FIRE EXTINGUISHERS AVAILABLE IN BACK ROOM FOR USE ON CHLORINE FIRES. NEUTRALIZERS AVAILABLE ON SHOWROOM SHELVES. Clean Up 08/13/1996 NEUTRALIZATION RETENTION OF SAMPLE AND DISPOSAL OF NEUTRALIZED LIQUIDS PER WASTE WATER STANDARDS. Other Resource Activation -5- 05/04/2001 e e F LESLIES SWIMMING POOL SUPPLIES I f= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 015-021-001746 ì Fast Format 1 Overall Site 1 I 03/24/2000 A) GAS/PROPANE - OUTSIDE OF W WALL B) ELECTRICAL - INSIDE BACK RM NW AND SW CORNERS C) WATER - IN PLANTER ACROSS FROM STORE FRONT D) SPECIAL - NONE E) LOCK BOX - NO Fire protec./Avail. Water 03/24/2000 PRIVATE FIRE PROTECTION - SPRINKLERED BLDG. NEAREST FIRE HYDRANT - REAR ALLEY W OF STORE BLDG. Building Occupancy Level -6- 05/04/2001 ,¡. ( 1 .. e e F LESLIES SWIMMING POOL SUPPLIES I F Training Employee Training SiteID: 015-021-001746 ì Fast Format ì Overall Site ì 12/18/1998 WE HAVE 4 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN THE OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING HANDBOOK AND SAFETY MEETING MATERIALS LOCATED IN OFFICE. EMPLOYEES UNDERGO VIDEO TRAINING COURSES. VIDEOS ALSO LOCATED IN OFFICE. Page 2 r I I Held for Future Use Held for Future Use -7- 05/04/2001 04/30/01 10:04 "\ '5'661 326 0576 BFD HAZ MAT DIV ~001 *************************** *** ACTIVITY REPORT *** *************************** TRANSMISSION OK TX/RX NO. CONNECTION TEL CONNECTION ID START TIME USAGE TIME PAGES . RESULT 9771 16023663921 04/30 09:58 06'23 8 OK 4 BAKERSFIELD FIRE DEPARTMENT ENVIRONMENTAL SERVICES 1715 Chester Ave. · Bakersfield CA 93301 Business Phone (661) 326-3979 · FAX (661) 326-0576 FAX Transmittal . TO: ,1Y!J:.z- J~ ~ ~ COMPANY:' ~~ FROM: ¿~ ~O-- (c::'D~) , FAX No. 3b6'~ 3~ d.. \ COMMENTS: ¡;1;)Lë I . tI~ Ùv~ ('~Jx ~~J ~e~ i 4 h~áAd~ ff1ti!J:u¡~ ¡d~ Jð7 R. I ~~ d g;x)() ~Jk, Ahð -»7cJw~ w-- q ~; ~ ~ -tAJ-Uh AUld e wk zLJ ~&-U-o r&·~ rHãT~;.J~ ¿U1 tA1-ôlP.~ I ù- -M,wJ;;fi1 ¡YIkJ~, &LRÞJ. Mol /MJ¡~ (lð1ÆiëJ(huY ~ ~~ cl-1101 ~d,y¡!Ìð. . ~ ~J.( ~d ~~ t7!- /J1tUÝ '6azL'f;¡,! ~ &idÆLM-~¿jOL ðwLkM1~ ~ I ~ ~ ::1. ý yle.r Harf/~ \1 -4 fA L -- Ix> ~ --~---k, '-- - · -,--- FKI- 0J2~ ~ ~ 1997 -- ~ --u.- '?~ ( LESLIES SWIMMING POOL SUPPLIES SiteID: 015-021-001746 Manager SEAN COPE Location: 8200 STOCKDALE D-3 HWY City BAKERSFIELD BusPhone: Map : 102 Grid: 32D (661) 396-9738 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code:5091 DunnBrad: Emergency Contact I Title Emergency Contact / Title SEAN COPE / MANAGER STEVE NESS / SUPERVISOR Business Phone: (661) 396-9738x Business Phone: (209) 433-9097x 24-Hour Phone : (661) 397-3938x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : (888) 876-9321x Hazmat Hazards: Fire React ImmHlth DelHlth Contact : Phone: (661) 396-9738x MailAddr: 8200 STOCKDALE D-3 HWY State: CA City : BAKERSFIELD Zip : 93311 Owner LESLIES POOL MART Phone: (818) 993-4212x Address : 20630 PLUMMER ST State: CA City : CHATSWORTH Zip : 91311 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List l All Materials at Site l p= Hazmat Inventory p== Alphabetical Order Hazmat Common Name. . . SpecHaz EPA Hazards DailyMax MCP CALCIUM HYPOCHLORITE/POOL SHOCK TRICHLORO-S-TRIAZINERTRIONE I, F R IH IH DH S S 2000.00 LBS 6000.00 LBS Mod Mod (TYJIê or print name) Do hereby certify that I have reviewed the attached hazardous materials manage- ment plan for (Name ot Businoss) and that it along with any corrections constitute a complete and correct man- agement plan for my facility. -1- 04/30/2001 F LESLIES SWIMMING POOL SUPPLIES p= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME CALCIUM HYPOCHLORITE/POOL SHOCK SiteID: 015-021-001746 l Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit SHOWROOM AND STOCK (STORAGE) AREA Map: Grid: CAS # STÀTE - TYPE Solid Mixture PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 100.00 LBS AMOUNTS AT THIS LOCATION Daily Maximum 2000.00 LBS Daily Average 2000.00 LBS %Wt. RS CAS # Calcium Hypochlorite No 7778543 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME TRICHLORO-S-TRIAZINERTRIONE Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit CENTER OF SHOWROOM FLOOR AND WALL Map: Grid: CAS# 87901 STATE - TYPE Solid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container 50.00 LBS AMOUNTS AT THIS LOCATION Daily Maximum 6000.00 LBS Daily Average 6000.00 LBS %Wt. RS CAS # 100.00 Trichloro-s-triazinetrione No 87901 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mod HAZARD ASSESSMENTS -2- 04/30/2001 F LESLIES SWIMMING POOL SUPPLIES I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-001746 ì Fast Format ì Overall Site ì 03/24/2000 TELEPHONES AVAILABLE IN OFFICE AND AT EACH SALES COUNTER TO DIAL 911. r=:: Employee Notif./Evacuation L:RBAL. I Public Notif./Evacuation OUT OF BLDG THROUGH E ENTRANCE DOORS. I Emergency Medical Plan FIRST AID KIT IN OFFICE. 03/24/2000 12/18/1998 ] 1 08/13/1996 ] -3- 04/30/2001 F LESLIES SWIMMING POOL SUPPLIES I F Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-001746 1 Fast Format ì Overall Site 1 , 08/13/1996 INCOMPATIBLES SEPARATED. PALLETS KEPT IN SHRINK WRAP. Release Containment 08/13/1996 WATER TYPE FIRE EXTINGUISHERS AVAILABLE IN BACK ROOM FOR USE ON CHLORINE FIRES. NEUTRALIZERS AVAILABLE ON SHOWROOM SHELVES. Clean Up 08/13/1996 NEUTRALIZATION RETENTION OF SAMPLE AND DISPOSAL OF NEUTRALIZED LIQUIDS PER WASTE WATER STANDARDS. Other Resource Activation -4- 04/30/2001 F LESLIES SWIMMING POOL SUPPLIES I f= Site Emergency Factors r== Special Hazards Utility Shut-Offs A) GAS/PROPANE - OUTSIDE OF W WALL B) ELECTRICAL - INSIDE BACK RM NW AND SW CORNERS 'C) WATER - IN PLANTER ACROSS FROM STORE FRONT D) SPECIAL - NONE E) LOCK BOX - NO SiteID: 015-021-001746 1 Fast Format 1 Overall Site 1 I 03/24/2000 Fire protec./Avail. Water 03/24/2000 PRIVATE FIRE PROTECTION - SPRINKLERED BLDG. NEAREST FIRE HYDRANT - REAR ALLEY W OF STORE BLDG. Building Occupancy Level -5- 04/30/2001 f LESLIES SWIMMING POOL SUPPLIES I F Training Employee Training SiteID: 015-021-001746 ì Fast Format ì Overall Site ì 12/18/1998 WE HAVE 4 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN THE OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING HANDBOOK AND SAFETY MEETING MATERIALS LOCATED IN OFFICE. EMPLOYEES UNDERGO VIDEO TRAINING COURSES. VIDEOS ALSO LOCATED IN OFFICE. Page 2 r I I Held for Future Use Held for Future Use -6- 04/30/2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAJ( (805) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAJ( (805) 395-1349 PREVENnONSERVlCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3951 FAJ( (805) 326-0576 -------- . ---- ''''.. ~VlRONMENTAL SERVlCÈS / 1715 Chester Ave. r Bakersfield. CA 93301 VOICE (805) 326-3979 \ FAJ( (805) 326-0576 TRAINING DMSION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 , FAJ( (805) 399-5763 ¥ 30, -'::¿OO Dear Business Owner: This notice is meant to act as a reminder that the California Health and Safety Code, Chapter 6.95, requires any handler of hazardous materials to revise their hazardous materials business plan within 30 days of anyone of the following events: (1) A ,100 per cent or more increase in the quantity of a previously-disclosed material. (2) Any handling of a previously-undisclosed hazardous material, subject to the inventory requirements of Chapter 6.95. (3) Change in business ownership. (4) Change in business address. (5) Change of business name. Any questions regarding these required revisions, please call the Hazardous Materials Division at (805) 326-3979. , Sincerely yours, ""7~ de W~ ~.AORÞ.r~ A W~" · e CITY OF BAKERSFIEI..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd I'loor, Bakersfield, CA 93301 FACILITY NAMEL~leG f&.o( §v#fr ADDRESS ?i;)oo SfcokD.tfe.- #t.dt: FACILITY CONTACT \:S&~ c.¿;p INSPECTION TIME 'is /IIl("'~ I INSPECTION DATE 1/ - ;;l ,£'- (9 ( PHONE NO. 37~- rJ.3~ BUSINESS ID NO. 15-210- (')()! 'Jif~ NUMBER OF EMPLOYEES g' e7,1.cr'oye.e.5 Section 1: Business Plan and Inventory Program ~Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V ' COMMENTS Appropriate permit on hand K Business plan contact information accurate )( Visible address K Correct occupancy )( Verification of inventory materials X (p Ii' GA-(. t.. Hi CI\.( oV' í A) e- Verification of quantities 'i 1000 €..ßS oueV" OI.J 7~IC.Nov:, - s- ~,;¡;wewT, If'lo t. 0.0::. ;JlJe,r ð Ù / tit¡.l~ Iw c.- Verification of location )( 70 &1¡f (. Pool AC(¿)L Proper segregation of material i-. Verification of MSDS availability )( Veri fication of Haz Mat training Y... Verification of abatement supplies and procedures 'I... Emergency procedures adequate K Containers properly labeled \( Housekeeping "- Fire Protection X. Site Diagram Adequate & On Hand y... 1Þrf..e- C=Compliance V=Violation White· Env. Svcs, Yellow - Station Copy Pink - Business Copy Any hazardous waste on site?: Explain: DYes )QNo Questions regarding this inspection? Please call us at (661) 326-3979 ...... ". - e .' LESLIES SWIMMING POOL MAR 2 -4 2000 Bu Phone: ~/ \ Ma 102 /BY:..,' d: 32D '. ./ \ ./ SiteID: 215-000-001746 ~~l (e-e-5) 396-9738 CommHaz : Moderate FacUnits: 1 AOV: Manager "'5~ {' ~ Location: 8200 STOCKDALE D-3 City BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code:5091 DunnBrad: Emergency Contact / Title SEAN COPE ~t/ MANAGER Business Phone: (&&5) 396-9738x 24-Hour Phone (&65) 397-3938x Pager Phone (G:,b¡ ) x Emergency Contact STEVE NESS Business Phone: 24-Hour Phone Pager Phone / Title / SUPERVISOR (209) 433-9097x () x (~7) c:g=¡6 - q3~1 x Hazmat Hazards: Fire React ImmHlth DelHlth Owner Address City LESLIE'S POOL MART 20222 PLUMMER 31' ~?o "'R~u-'St. CHATSWORTH Phone: ( State: CA Zip 93311 Phone: (818) 993-4212x State: CA Zip 91311 x Contact : MailAddr: 8200 STOCKDALE D-3 HWY City BAKERSFIELD Period Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: \, ~+(. AJer$Of\.· Do hereby œrîiiy that! hsv® (Typ3 or print Mme) reviewed the attached hazardous materials mar;ags- ment plan for é..e>1;o(..'~ t&d~c:.;t and that it along with (Nama of BusinØll8) any com~ctions constitute a completiS and oorrsd man- agemen~ plan for my i8cility. "5 )~Ò)DÖ I Date -1- 02/29/2000 · - It e f LESLIES SWIMMING POOL SUPPLIES p= Hazmat Inventory p== Alphabetical Order SiteID: 215-000-001746 By Facility Unit Fixed Containers at Site ì ì ì DailyMax UnitMCP 2000.00 LBS Mod 6000.00 LBS Mod Hazmat Common Name... specHazEPA HazardS Frm I CALCIUM HYPOCHLORITE/POOL SHOCK TRICHLORO-S-TRIAZINERTRIONE F R IH IH DH S S -2- 02/29/2000 ¡ . .. - e F LESLIES SWIMMING POOL SUPPLIES p= Inventory Item 0002 = COMMON NAME / CHEMI CAL NAME CALCIUM HYPOCHLORITE/POOL SHOCK SiteID: 215-000-001746 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit ~rOl>~~ ~ ~C".Jz..l ~co.'j~ Io-.r-eo- Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER tDO AMOUNTS AT THIS LOCATION Daily Maximum 2000.00 LBS Largest Container LBS Daily Average 2000.00 LBS %Wt. RS CAS # Calcium Hypochlorite No 7778543 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME TRICHLORO-S-TRIAZINERTRIONE Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit CENTER OF SHOWROOM FLOOR AND WALL. Map: Grid:, CAS # 87901 STATE - TYPE Solid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container So LBS AMOUNTS AT THIS LOCATION Daily Maximum 6000.00 LBS Daily Average 6000.00 LBS %Wt. RS CAS # 100.00 Trichloro-s-triazinetrione No 87901 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mod HAZARD ASSESSMENTS -3- 02/29/2000 ^. - e F LESLIES SWIMMING POOL SUPPLIES I p= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-001746 ì Fast Format l Overall Site l 08/13/1996 TELEPHONES AVAILABLE IN OFFICE AND AT EACH SALES COUNTER TO DIAL 9-1-1. r=:: Employee Notif./Evacuation CRBAL. I Public Notif./Evacuation : OUT OF BUILDING THROUGH E ENTRANCE DOORS. I Emergency Medical Plan FIRST AID KIT IN OFFICE. 12/18/1998 12/18/19981 1 08/13/19961 -4- 02/29/2000 ~ '" - e F LESLIES SWIMMING POOL SUPPLIES I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-001746 ì Fast Format ì Overall Site ì 08/13/1996 INCOMPATIBLES SEPARATED. PALLETS KEPT IN SHRINK WRAP. Release Containment 08/13/1996 WATER TYPE FIRE EXTINGUISHERS AVAILABLE IN BACK ROOM FOR USE ON CHLORINE FIRES. NEUTRALIZERS AVAILABLE ON SHOWROOM SHELVES. Clean Up 08/13/1996 NEUTRALIZATION RETENTION OF SAMPLE AND DISPOSAL OF NEUTRALIZED LIQUIDS PER WASTE WATER STANDARDS. Other Resource Activation -5- 02/29/2000 ~ Ii, " ".. - e f LESLIES SWIMMING POOL SUPPLIES I p= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 215-000-001746 ì Fast Format ì Overall Site ì I 12/18/1998 A) GAS/PROPANE - OUTSIDE OF W WALL B) ELECTRICAL - INSIDE BACK ROOM NW AND C) WATER - IN PLANTER ACROSS FROM STORE D) SPECIAL - NONE E) LOCK BOX - NO SW CORNERS FRONT Fire Protec./Avail. Water 08/13/1996 PRIVATE FIRE PROTECTION: SPRINKLERED BUILDING. WATER AVAILABILITY FIRE HYDRANT: REAR ALLEY WEST OF STORE BUILDING. Building Occupancy Level -6- 02/29/2000 ::; .,~' õ .' ,..... - e F LESLIES SWIMMING POOL SUPPLIES I F Training Employee Training SiteID: 215-000-001746 ì Fast Format ì Overall Site ì 12/18/1998 WE HAVE 4 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN THE OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING HANDBOOK AND SAFETY MEETING MATERIALS LOCATED IN OFFICE. EMPLOYEES UNDERGO VIDEO TRAINING COURSES. VIDEOS ALSO LOCATED IN OFFICE. Page 2 r I I Held for Future Use Held for Future Use -7- 02/29/2000 \ .. ..'" ,.-: - f-----.. LESLIES SWIMMING POOL SUPPLIE¡r-,' ~~G' ~~~99ã Manager Location: 8200 STOCKDALE D-3 City BAKERSFIELD Y: e SiteID: 215-000-001746 Phone: 102 id: 32D (80S) 396-9738 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code:S091 DunnBrad: Emergency Contact / Title Emergency Contact / Title SEAN COPE / MANAGER STEVE NESS / SUPERVISOR Business Phone: (80S) 396-9738x Business Phone: (209) 433-9097x 24-Hour Phone : (80S) 397-3938x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire React ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 8200 STOCKDALE D-3 HWY State: CA City : BAKERSFIELD Zip : 93311 Owner LESLIE'S POOL MART Phone: (818) 993-4212x Address : 20222 PLUMMER ST State: CA City : CHATSWORTH Zip : 91311 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List l All Materials at Site l p= Hazmat Inventory p== As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP TRICHLORO-S-TRIAZINERTRIONE CALCIUM HYPOCHLORITE/POOL SHO~ " ~p0~ ~P£ w<' Of ~n& nMI:Þ) U'®\ý~®w~©1 ~~® ~ij~hed hazar@ous mª~®fÙ2Is manage- msn~ p~ai"O ~©r¡4:sj~.5 ~(e~~rdJ ~l>'Bta~ g~ ~i©K'Q@ with ~of ) any cOfr¡edd©ln~ ooi1$~itlJJ~s a compl~te and oornr®d man- IH DH S F R IH S Do hereby eertiiy tha~ i have 6000 LBS Mod 2000 LBS Mod agsmsi"O~ ~~~1i1 ~©f mv ~a~å~. /?-/tf--7ð -1- 12/07/1998 e e F LESLIES SWIMMING POOL SUPPLIES p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME TRICHLORO-S-TRIAZINERTRIONE SiteID: 215-000-001746 1 Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit CENTER OF SHOWROOM FLOOR AND WALL. Map: Grid: CAS # 87901 STATE - TYPE Solid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-NONMETAL Largest Container LBS AMOUNTS AT THIS LOCATION Daily Maximum 6000.00 LBS Daily Average 6000.00 LBS HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Trichloro-s-triazinetrione No 87901 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME CALCIUM HYPOCHLORITE/POOL SHOCK Facility Unit: Fixed Containers at Site 1 Days On Site 365 Location within this Facility Unit Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container LBS AMOUNTS AT THIS LOCATION Daily Maximum 2000.00 LBS Daily Average 2000.00 LBS %Wt. RS CAS # Calcium Hypochlorite No 7778543 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod HAZARD ASSESSMENTS -2- '12/07/1998 .;, e e F LESLIES SWIMMING POOL SUPPLIES I p= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-001746 ~ Fast Format l Overall Site l 08/13/1996 TELEPHONES AVAILABLE IN OFFICE AND AT EACH SALES COUNTER TO DIAL 9-1-1. r Employee Notif./Evacuation 08/13/1996 ] VERBAL Public Notif./Evacuation 08/13/1996 OUT OF BUILDING THROUGH EAST ENTRANCE DOORS. Emergency Medical Plan 08/13/19961 FIRST AID KIT IN OFFICE. -3- 12/07/1998 e e F LESLIES SWIMMING POOL SUPPLIES I p= Mitigation/prevent/Abatemt Release Prevention SiteID: 215-000-001746 1 Fast Format 1 Overall Site 1 08/13/1996 INCOMPATIBLES SEPARATED. PALLETS KEPT IN SHRINK WRAP. Release Containment 08/13/1996 WATER TYPE FIRE EXTINGUISHERS AVAILABLE IN BACK ROOM FOR USE ON CHLORINE FIRES. NEUTRALIZERS AVAILABLE ON SHOWROOM SHELVES. Clean Up 08/13/1996 NEUTRALIZATION RETENTION OF SAMPLE AND DISPOSAL OF NEUTRALIZED LIQUIDS PER WASTE WATER STANDARDS. Other Resource Activation -4- 12/07/1998 J ~ ':.' 'Q e e F LESLIES SWIMMING POOL SUPPLIES I p= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 215-000-001746 l Fast Format l Overall Site l I 08/13/1996 NATURAL GAS/PROPANE: OUTSIDE OF WEST WALL. ELECTRICAL: INSIDE BACK ROOM NORTHWEST AND SOUTHWEST CORNERS. WATER: IN PLANTER ACROSS FROM STORE FRONT. Fire Protec./Avail. Water 08/13/1996 PRIVATE FIRE PROTECTION: SPRINKLERED BUILDING. WATER AVAILABILITY FIRE HYDRANT: REAR ALLEY WEST OF STORE BUILDING. Building Occupancy Level -5- 12/07/1998 ~ ., ......, . -;;." e e f LESLIES SWIMMING POOL SUPPLIES I F Training Employee Training SiteID: 215-000-001746 9 Fast Format 9 Overall Site 9 08/13/1996 NUMBER OF EMPLOYEES: 4 MATERIAL SAFETY DATA SHEETS: YES IN OFFICE BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING HANDBOOK AND SAFETY MEETING MATERIALS LOCATED IN OFFICE. EMPLOYEES UNDERGO VIDEO TRAINING COURSES. VIDEOS ALSO LOCATED IN OFFICE. Page 2 [ I I Held for Future Use Held for Future Use -6- 12/07/1998 ~~~~ ~ SEAN SMITH STORE MANAGER (80S) 396-9738 I. 8200 STOCKDALE Hwy" STE, 0-3. BAKERSFIELD. CA 9331 1 ~' ,~ BAKE~FIELD CITY FIRE D~ARTMENT 4J~ ...---- L.. ' HAZARDOUS MATERIALS DIVISION 1715 'CHESTER',AV.£~ Ä \.Q BAKERSFIELD, CA. 93301 \ (\., HAZARDOUS MATERIALS MANAGEMENT PLAN 4. JOJ dfl, Z _ . ¿.. e..)~ - To avoid further action. return this form within 30 days of receipt. ~.12J2-- TYPE/PRINT ANSWERS IN ENGLISH. a Answer the questions below for the business as a whole. /D-fo-Q7 .¡o FØ ( Be bnet and conc~e cs possible. tr~ INSTRUCTIONS: l. 2. 3. SECTION 1: BUSINESS IDENTIFICATION DATA 3USINESS NAME: L-és.. L (E 'S .$W"""1I1 ;,..)6 poc.><.... ~uPPLrEs. LOCATION: ~'?.ØO çTz)<><¡~A<'E HwY ò - 3. MAILING ADDRESS: ~ CiTY: C¡3->;. f \ STATE: _ ZIP: PHONE: 3<1'<0 -9733 DUN & 8RADSTRE=T NUMBER: SIC CODE: ?RIMARY,A,CTIV1TY: flê\A/1..- pc>",- $.c;PPLfE s OWNER: L E S LiE. 's P 00 L y¡.., 13.('. T ~'~I 77 ~ - 4'LCL. MAILING AD DRESS: 202 '2.. ~ PLuVV\ (\'\E(L">T C(lA. TS<.....b,e11~ CA c:¡ ('3li SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. 56A,v .5:M /'n-4' IVt "II~ 3.96-973<6 GG;,'3- ~(ÓÓS- ~ '1 ((;~/72C¡ - 64<g( 2. ~Oì-f~ /VI e ,.J6EL~ ~ PI! - µÓ1tA.t: oJ=Cf<'C 1 jj akersfield Fire Dept. .rdous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN .. .. 'r, þ ~ ·f SECTION 3: TRAINING: \ NUMBER OF EMPLOYEES: 4- MATERIAL SAFETY DATA SHEETS ON FIL~: c.rES ,,J 0-+[:, CE, BRIEF SUMMARY OF TRAINING PROGRAM: ,(LÞ.. ,,J ì.J 6- ¡-I·()..,..J9ßOo¡L ~ '!::::j'>d~G-íY M£:.6'Í I~ /I1A-rJu.4c:...s r ~.;. _ P ~ - . ~ rf\6æL::D V d) CD C«A. II\)¡~ L oc...A:re.. () I rJ o·{t- ¡ c..f. ~ c.:/'""I- 1Þ T cé$ U' - .... eo, 0-(7. st:s. J' OE-o s A LSD LDC. Po íC -0 ; ,.j o? Çï c...c ~ 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 CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAffiROOUS MATERIALS. WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO ïiME=XCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPEC¡FY REASON) SECTION 5: CERTIFICATION: I, ,¿;,~ _>--,'11. MArION ¡S ACCURATE. \ UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY F!RM'S 08UGA TlONS UNDER THE "CALIFORNIA HEALTH AND SAFEïY CODE" ON HAZARDOUS MATERIALS (D(V. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. CERTIFY THAT THE ABOVE INFoR- ,.., " 1 ...~ i1:.~. ,I' " .' ..- ~;. Dë::US:.ersa.~la. .r rre .uept. e Hazaràous Materials Divisioe HAZARDOUS. MATERIALS MANAGEMENT PLAN Facility Unit Name: L-Gs,-,e is PCU1- S..JPPu..;' SECTrON 6: NOTfFfCATfON AND EV ACUATrON PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: ,E-LEP¿JøfJéS AvA ¡ L./j ß LCS ,,.J o{:-ç, cE d <::I( .A..,¡ C.A.c+f ~·u::.s Ci.)JNTC.J2... 'TO DiAL q - / - I a. EMPLOYE~ NOTIFICATION AND EVACUATION: \.J C../l.. ß/).L C. PUBLIC EV ACUA nON: CN\\" ~ ß L()G,... ~ E: CN'rRJ1NcE {;::>èc)(ê ~ D. ~!'v1ERGENC,( MEDICAL PLAN: çJts rr A ¡(J K ! " IN c..>f"-J:. cE. fV\ c--a.. (. '<' '.s:>~ t.J EC; 1""' 1. ;:Ol~ e Bakersfield Fire Dept. e Hazardous Materials Division ',' I, '~1 ., ...... ~. ./.:j ,f ", HAZARDO'U5 MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: (I\JCONlPATI ßlCS S<P!Jf2AT"~P.. ?^ t 'E . (..;" '.....-./ . . -~~ T.$ KEP. IN s«'{\AJK. wf!4p " 8. RELEASE· CONTAINMENT AND/OR MINIMIZATION: (y..)A'-rf:;!?-"T4Jf'6 FI Q(. "6XTI~G-J154L~ hJ/1 ic4ßLé /,~ ßAeK 12-001'1\ Rxz- us6 cx0 (!..j..J.·w.'Z,.JE ç, æes", N~tæ~ AVA..it..AP;.i.....£ o!\J S~JV'\ SHELVéS4 ,... '--' . CLEAN-UP PROCEDURES: . I~ULA--r(cJrJ) e£--,s.rJ·n (),.) A"- ¿ AJOA. P' ~ d_ ,,~' D. tV ,( , , , U"'f- -;:) ,"'....<>;;. .;. r" (.:>or Ös..AL. I o.r= N6.rrf?...AI..I"c,-o L1Q. ud)'S. ?8Z-~'TE!.AJA'Tc::!L 'STA-7Jo~Q.I)..s SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACIUTY): NATURAL GAS/PROPANE: .;J:þ.. OUT<;'()é uJ ¿..JAì.L ~LECTR!C,;L: ,('.is/DE ~-~ r20DN\ ,.Jc.ù -t S;W Cft.NfèS ìN fl^"í~jJ \NAïE~: P.N 0'- ACI1oS$ r~ S"t"OQ.G- ç::/2.Ø'rJ¡- S?::C:AL: lOC:< BOX: YES/NO iF YES. ~OC.; nON: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTrON: Spe..~K<-L~-o ß.LOGs.. B. WATER AVAILABILlTY (FIRE HYDRANT): ~-C~ Äl.LGY fA} DF SV(t..G ßL.D~ ~ BAKERiflELD CITY FIRE DEijARTMENT H~RDOUS MATERIALS INVEm-ORY . . Page 1. of 3 ~.. r. /, If Business Name LEsu r='s ~~L SJPPt/6S Address ~?é)O 5~Kf)A.<-€ D-~ r CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ) Addition [ ) Revision ( ) Deletion ( ) Check if chemical is a NON TRADE SECRET ( ), TRADE SECRET ( ) 2) commonName:~l~ I - C +\ Lo(l... -r A ISlG-r .s 3) DOT # (optional) Chemical Name: AHM ( ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ( ] Reactive ( ] Sudden Release of Pressure I ] Immediate Health (Acute) I ] Delayed Health (Chronic) ( ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid ø Uquid ( ) Gas ( ) Pure ~ Mixture ( ] Waste ( ] Radioactive ( ) OlEa< AU. THAT APPLY 7) AMOUNT AND TIME AT FACIUTY ÕØOO UNITS OF MEASURE 8) STORAGE CODES f\.AS·1r'- Maximum Daily Amount: Ibs i' gal ( ] ft3 ( ) a) Container: ~T5 Average Daily Amount: t;,ooO curies [ ] b) Pressure: , Annual Amount: <rbáõ~ c) Temperature: Q Largest Size 'Container: # Days On Site ~b~ Circle Which Months: All Year, J. F, M, A, M, J, J, A, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) 1~1<:f-\lOP..O - S -,t'{IAZ/Né-r¡'2.fONE" ic;,C¡ ( ] chemical components or any AHM components 2) [ ] 3) ( ) 10) Location ~ C-v.J'(C-I?.. oÇ" S:-/b..cJ,~""" r:- U:X::J f1- €t vJAL<- CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ( ) Addition ( ) Revision [ ] Deletion ( ] Check if chemical is a NON TRADE SECRET ( ) TRADE SECRET ( ] 2) Common Name: C!.A<..C.IU ttI'I ¿J'¡JfflC{-tLoR. (íG fh-ùoGe- 3) DOT # (optional) Chemical Name: AHM ( ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ( ] Reactive ( ) Sudden Release of Pressure ( ) Immediate Health (Acute) ( ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid fíiJI Liquid [ ] Gas ( ] Pure ( ] Mixture $ Waste ( ) Radioactive [ ) CHEat. AU THAT APPt.Y 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: '2..Cbð Ibs ~ gal ( ] ft3 { ] a) Container: PLJ).c.;·í,~ Ki(<:-r Average Daily Amount: '2.000 curies ( ] b) Pressure: Annual Amount: ( rJDc:JO c) Temperature: Largest Size Container: '~~ # Days On Site 'J0~ Circle Which Months: All Year, J. F, M, A. M, J, J, A, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS# %WT AHM the three most hazardous 1 ) C!A ~C(U;V'l I-( V f'OC4-{ t() Q I T éG. ~ [ ] chemical components or any AHM components 2) ( ] ." 3) ( ) 1 0) Location certify under penalty of law, that I have personallyexammed and am famtliar with the mfomation submItted on this and all attached documents. I Þetteve the submitted information is true, a ('"' ¿i. ?;? . ané5 ~¡;6 Da SCIf..m.3n Ian AECJIOIV lEPC8TMDMDFæU BAKERSFI5äD CITY FIRE DEPARtþ1ENT HAZARc-ðUS MATERIALS INVENTORY ~ 3usiness Name Address Page_ot..!;; 2/ 3> .\~ . CHEMICAL DESCRIPTION , I ! 1) INVENTORY STATUS: New ( 1 Addition [ 1 Revision [ 1 Deletion [ 1 Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ 1 I CHlOR- 'JJ.~ - 2) Common Name: ßf! (T<=: 3) DOT # (optional) , . Chemical Name: AHM [ 1 CAS # i ' - " ¡ 4) PHYSICAL & HEALTH PHYSICAL HEALTH I HAZARD CATEGORIES Fire ['I Reactive ~ Sudden Release of Pressure [ 1 Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 1 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE "3>6 6) PHYSICAL STATE Solid ~ Liquid [ 1 Gas [ 1 Pure [ 1 Mixture [ 1 Waste [ 1 Radioactive [ ]. CHEC1CAU. THAT APPtr 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES {'6 Maximum Daily Amount: 1 SQ-..) Ibs[]gal[1 ft3 [ ] a) Container: Pt..As"nc %I.ICI~"" Average Daily Amount: I5'O~ curies [ ] b) Pressure: I Annual Amount: 14Z c) Temperatùre: 4- Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M. A. M, J. J. A. S, 0, N. D 9) MIXTURE: List COMPONENT CAS # %WT AHM the three most hazardous 1 ) 500 n.J VV"\ f)iC.I-ILD(l()- $- '-rt2..íALIAlETl<IOrJ . () H..{ YI) RAí6 '7~ [ ] chemical components or , any AHM components 2) [ 1 3) [ 1 1 0) Location e..C --r.J reV'<... ~ S~ (:UJ()t"L ( VJ('..:>.. <-C... CHEMICAL DESCRIPTION , 1) INVENTORY STATUS: New [ 1 Addition [ 1 Revision [ 1 Deletion [ 1 Check if chemical is a NON TRADE SECRET [ 1 TRADE SECRET [ 1 I 2) Common Name: 1'\11 V(L1 ATlc.... ACi':> 3) DOT # (optional) I Chemical Name: AHM [ ] CAS # i 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ 1 Reactive [ ] Sudden Release of Pressure [ 1 Immediate Health (Acute) [ 1 Delayed Health (Chronic) [ 1 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE >.b 6) PHYSICAL STATE Solid [ ] Liquid [~ Gas [ ] Pure [ ] Mixture IiiIt Waste [ ] ,Radioactive [ ] CI-IECKALl. THAT APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES 10 Maximum Daily Amount: ·z.ill Ibs [ ] gal [~ ft3 [ ] a) Container: Average Daily Amount: ì S'b curies [ ] b) Pressure: I Annual Amount: 3.300 c) Temperature: 4 Largest Size Container: 1 # Days On Site Circle Which Months: All Year. J, F, M. A. M. J. J. A. S, O. N. D 9) MIXTURE: List +-t.Y í)C2ò 6-&J COMPONENT CAS # %WT AHM the three most hazardous 1) Cf-kolt'DE 31 [ ) chemical components or any AHM components 2) ,. [ ) "" 3) ( 1 .- 10) Location (2 C-r¡/',TC-P.... c:Ç ßac-< ~ .J.. r.-.." 1= W~ W\J:>.l.L.. certHy under penalty of law, that I have personally exammed and am familiar WIth the mtomation submItted on mls and all attBcned aocuments. I believe the submitted information is true, accurate, and complete. Signature Date PRINT Name & Title of Authorized Company Representative 'J«IIMItW3Ø, 1i1a AEGIOIY I..EPC8TNG#IAOFCAM BAKERSfiELD CITY FIRE DEP..ARTMENT HA1IKRDous MATERIALS,INVE~ORY Page~of ..3 Business Name L C-S(lé > Póð'L SJP-fL.qs:..> Address ß~ SïO£.l<OALe ~ D-"'3> . CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ) Addition [ ) Revision [ I Deletion [ I Check if chemical is a NON TRADE SECRET [ ) TRADE SECRET [ ) 2) Common Name: c..r+LO~INAT/,vb- L...l QIJ 10 3) DOT # (optional) Chemical Name: AHM [ ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire II Reactive rtf' Sudden Release of Pressure [ I Immediate Health (Acute) [ ) Delayed Health (Chronic) [ ) ' 5) WASTE CLASSIFICATlON (3-digit code from DHS Form 8022) USE CODE 3(, 6) PHYSICAL STATE Solid [ I Liquid ~ Gas [ ) Pure [ ) Mixture ~ Waste [ ) Radioactive [ ) . OIEQ(AU THAT APPlY 7) AMOUNT AND TlME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: ¡ÇQ Ibs [ ) gal ~ 1t3 [ I a) Container: Average Daily Amount: I <LŠ- curies [ I b) Pressure: Annual Amount: I~ c) Temperature: Largest Size 'Container: # Days On Site 30S' Circle Which Months: All Year, J, F, M. A, M. J. J. A. S, 0, N, D 9) MIXTURE: List $C>D, ù ¡V\ COMPONENT CAS # %WT AHM the three most hazardous 1) .µ.y Pac ~ LOf1.. 1TC to [ ) chemical components or any AHM components 2) [ ) 3) [ J 10) Location ¡N'$Ið)r= ~I( <;""tr..)/l f:ft4:J,,^ £:: WiA LL CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ) Addition [ ) Revision [ ) Deletion [ I Check if chemical is a NON TRADE SECRET [ ) TRADE SECRET [ J 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ J CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ) Reactive [ ) Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ) 5) WASTE CLASSIFICATlON (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ) Mixture [ I Waste [ ) Radioactive [ ) CHECI<AU. THAT APPlY 7) AMOUNT AND TlME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] 1t3 [ ) a) Container: Average Daily Amount: curies [ ) b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J, F, M. A, M, J, J, A, S. 0, N, D 9) MIXTURE: List COMPONENT CAS # %WT AHM the ,three most hazardous 1 ) [ ) chemical components or ··r- any AHM components 2) [ ] 3) [ ) 10) Location certify under penalty of law, that I nave personally examined and am familiar Wltn tne mfomation submitted on tnlS and all attacnea aocuments. I belIeve the Company Representative ~ c/;)e- / Date ~~tan AE~Y l£PCSTANQMO~U BAKERSFIFäD CITY FIRE DEPARIIt1ENT HAZARIMUS MATERIALS INVENTOìTÝ Page_of_~, 3usiness Name Address . CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is aNON TRADE SECRET [ ). TRADE SECRET ( ) 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # , 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive ( ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE ; , 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas ( ] Pure [ ] Mixture ( ] Waste' ( ) Radioactive ( ) CHECKALL THAT APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: 100 ( ] gal ( ] 113 ( ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1 ) ( ] chemical components or any AHM components 2) [ ] 3) [ } I 10) Location I CHEMICAL DESCRIPTION I 1) INVENTORY STATUS: New ( ] Addition [ ] Revision ( ] Deletion [ ] Check if chemical is a NON TRADE SECRET ( ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) , \ Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ } Reactive ¡ ] Sudden Release of Pressure ¡ ) Immediate Health (Acute) ¡ 1 Delayed Health (Chronic) ¡ } ! 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE \ 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive ( ] i OlEO( AU. THAT APPlY I I 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: 100 [ ] gal [ ] 113 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) ( ] I chemical components or any AHM components 2) ,. [ ] 3) [ ) 10) Location certify unaer penalty of law, that I have personallyexamtned and am familiar with the tnfomation submitted on this and all attached Qocuments. I oelteve the submitted informs.tion is true, s.ccurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date ~..MttW3Ci ,. AE'GICN V LÐC IITANQW) FCAM