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Home My WebLink AboutBUSINESS PLAN 9/22/2004 ""~ .". tI - T' RALPHS #653 SiteID: 015-021-002185 Manager : Location: 5200 STOCKDALE HWY City BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: BusPhone: Map : 123 Grid: 03B (661) 859-1668 CommHaz : Minimal FacUnits: 1 AOV: SIC Code:5411 DunnBrad:78-617-6628 Emergency Contact ROCKY RAY Business Phone: 24-Hour Phone : Pager Phone : / Title / STORE DIRECTOR (661) 859-1668x (310) 900-3700x ( ) - x Emergency Contact / Title ALARM CENTER / RALPHS SECURITY Business Phone: (310) 900-3700x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Period : Preparer: Certif'd: ParcelNo: to Phone: (310) 884-4085x State: CA Zip : 90220 Phone: (310) 884-4085x State: CA Zip : 90220 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : GAYLANN DENHAM MailAddr: 2201 WILMINGTON AVE City : COMPTON Owner Address : City RALPHS GROCERY COMPANY 2201 WILMINGTON AVE : COMPTON Emergency Directives,: . that \ have l\\\\W \\~~ ~ DO hereby certliy Sø \, _~ (fypeOfpc'\ntname) douS materia\s manag attached hazar . h ra,Vi9wed \\19 __E>'\¡6~ _and \ha\ 1\ along WI\ men\ plan for (e of BlI&iMss) and correct man- . n$\\tu\e a complete any correctIons co . . 'an for my 1acI\\ty . agemen\ P . ,gKi~ O\,i~'ok_ ()at8 - -~ , -1- 09/22/2004 e e , F RALPHS #653 SiteID: 015-021-002185 9 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: RALPHS #653 Cross Street : Business Type: Org Type: Total Tanks : 2 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : ALARM CENTER Phone: (310) 900-3700x Address: City : State: Zip: Type : TANK OWNER INFORMATION Name : ALARM CENTER Phone: (310) 900-3700x Address: City : State: Zip: Type : BOE UST Fee# : Financ'l Resp: Legal Notif : Property Owner Mailing Address Date:01/10/2002 Phone: (310) 884-9000x Name:DAVE PUGUSI Ttl:SAFETY MGR. State UST # : 1998 Upg Cert#: 28506 -2- 09/22/2004 e F RALPHS #653 f= Hazmat Inventory ~ MCP+DailyMax Order e SiteID: 015-021-002185 By Facility Unit Fixed Containers at Site L L G G 9 9 9 DailyMax unitlMCP 20000.00 GAL Mod 8000.00 GAL Mod 8437.61 FT3 Low 488.00 FT3 Min Hazmat Common Name... REGULAR UNLEADED PREMIUM UNLEADED GASOLINE FREON 22 HELIUM specHazEPA HazardS Frm I F IH DH F IH DH F P R IH F P IH -3- 09/22/2004 e e F RALPHS #653 f= Inventory Item 0003 === COMMON NAME / CHEMICAL NAME REGULAR UNLEADED SiteID: 015-021-002185 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Location within this Facility Unit Map: Grid: THIS IS A SPLIT TANK CAS# 8006-61-9 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 20000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 20000.00 GAL Daily Average 20000.00 GAL %wt. I 100.00 GasolJ.ne HAZARDOUS COMPONENTS ~ CAS# I 8006619 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defin~d8: Ag.Defined9: Ag.Define10: I- Ag. Define11 -4- 09/22/2004 e e " F RALPHS #653 SiteID: 015-021-002185 9 f= Inventory Item 0003 Facility Unit: Fixed Containers at Site 9 STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: ' Location In Site: Tank ID#: 1 Installed: 12/01 Additional Info: TANK DESCRIPTION Mfr: XERXES Capacity: 28000 Gals SPLIT TANK Compart Tank: Y No. Of Comparts: 2 Tank Use: MOTOR VEHICLE FUEL MatI Name:REGULAR UNLEADED TANK CONTENTS Petrol Type: REGULAR UNLEADED Cas #: 8006-61-9 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED Spill Cnt : 2001 Drop Tube : 2001 Striker Plate: 2001 Sgl Wall: PLASTIC Alarm : Ball Float : Fill Tube S/O: 2001 TANK LEAK DETECTION Dbl Wall: INTERSTITIAL MONITORING Installed: Installed: 2001 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -5- 09/22/2004 e e F RALPHS #653 SiteID: 015-021-002185 9 p= Inventory Item 0003 Facility Unit: Fixed Containers at Site 9 STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION Piping Type : Canst: Mfgr : Mtl : & : Corr : Prot : UnderGround PRESSURE DOUBLE WALL ENVIRON "FLEX" AboveGround Piping "FLEX" PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 12/01/2001 Date: 12/10/2002 Name:DAVE PUGULSI Prmt Number: 2185 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:SAFETY MGR. Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:12/09/2003 -6- 09/22/2004 .,' e e 9 F RALPHS #653 f= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE SiteID: 015-021-002185 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Mixture PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 8000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8000.00 GAL Daily Average 8000.00 GAL HAZARDOUS COMPONENTS ~ CAS # I 8006619 %wt. I 100.00 Gasoline TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -7- 09/22/2004 e e F RALPHS #653 SiteID: 015-021-002185 9 f= Inventory Item 0004 Facility Unit: Fixed Containers at Site 9 STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: TANK DESCRIPTION Tank ID#: 2 Mfr: XERXES Installed: 12/2001 Capacity: 8000 Gals Additional Info: SPLIT TANK Compart Tank: Y No. Of Comparts: 2 Tank Use: MOTOR VEHICLE FUEL MatI Name:PREMIUM UNLEADED 'GASOLINE TANK CONSTRUCTION TANK CONTENTS Petrol Type: PREMIUM UNLEADED Cas #: 8006-61-9 Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED Spill Cnt : 2001 Drop Tube : 2001 Striker Plate: 2001 Sgl Wall: PLASTIC Alarm : Ball Float : Fill Tube S/O: 2001 LEAK DETECTION Dbl Wall: INTERSTITIAL MONITORING Installed: Installed: 2001 Exempt: No TANK Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -8- 09/22/2004 ~ e e F RALPHS #653 SiteID: 015-021-002185 ; f= Inventory Item 0004 Facility Unit: Fixed Containers at Site; STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION Piping Type : Const: Mfgr : Mtl : & : Corr : Prot : UnderGround PRESSURE DOUBLE WALL ENVIRON. "FLEX" AboveGround Piping "FLEX" PIPING LEAK DETECTION UnderGround Piping AboveGround Piping INTERSTITIAL MONITORING Installed: 12/01/2001 Date: 12/10/2002 Name:DAVE PUGULSI Prmt Number: 2185 DISPENSER CONTAINMENT Type: DISP. PAN SENSOR W/ POS. SHUTOFF OWNER/OPERATOR SIGNATURE Ttl:SAFETY MGR. Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:12/09/2003 -9- 09/22/2004 " e e SiteID: 015-021-002185 ì Facility Unit: Fixed Containers at Site ì F RALPHS #653 p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME FREON 22 CHLORODIFLUOROMETHANE Location within this Facility Unit MACHINE ROOM Days On Site 365 Map: Grid: CAS # 75-45-6 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 8437.61 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 8437.61 FT3 Daily Average 8437.61 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Chlorodifluoromethane No 75456 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Cúries F P R IH / / / Low Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -10- 09/22/2004 .r e e F RALPHS #653 f= Inventory Item = COMMON NAME / HELIUM 0001 CHEMICAL NAME SiteID: 015-021-002185 , Facility Unit: Fixed Containers at Site, Days On Site 365 Location within this Facility Unit FLORIST COUNTER FRONT OF STORE & INSIDE STOCKROOM NEXT TO BOX CRUSHER Map: Grid: CAS# STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 244.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 488.00 FT3 Daily Average 488.00 FT3 %Wt. I 100.00 Helium HAZARDOUS COMPONENTS .~ CAS # I 7440597 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min Ag.Defined1: Ag.Defined5: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -11- 09/22/2004 ./' ~. - /..,'--'" ~-' , . ", RALPHS #653 . SiteID: 015-021-002185 / --. Manager : Location: 5200 STOCKDALE HWY City BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: ~ \'\)~~ Ç;)<V '\ BusPhone: Map : 123 Grid: 03B (661) 859-1668 CommHaz : Minimal FacUnits: 1 AOV: SIC Code:5411 DunnBrad:78-617-6628 Emergency Conta~ \_L Title ·BILL ARIkL OO~ 'üOd~~TORE DIRECTOR Business Phone: (661) 859-1668x 24-Hour Phone : (310) 900-3700x Pager Phone : ( ) - x Emergency Contact / Title ALARM CENTER / RALPHS SECURITY Business Phone: (310) 900-3700x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact : CAROL CHEN ~~ ~ MailAddr: 2201 WILMINGTON AVE City : COMPTON Period : Preparer: Certif'd: ParcelNo: to Phone: (310) 884 4268£ State: CA L\O<i?S Zip : 90220 Phone: (310) 884~~oöx State: CA 4o~S. Zip : 90220 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Owner Address : City RALPHS GROCERY COMPANY 2201 WILMINGTON AVE : COMPTON Emergency Directives: I ~ I , ~.... \..¿ f'-......ln'M 1""\- ....~...~h,' ,-.aP-}if,.' 1h~t I have 1 _l"~""'\...I' \..J,...{J, " !,....!...,.! i t~ \ l. ' .;: ......... _"..." ... .f. , - (Type or print name) - reviewed the attached hazardous materials manage.. ment pian forJ~Þ~$ -:f,{o'S~ and tha.t it along with (N, me of BljSll1ess) . any correcÜons constitute a complete and correct man- agement plan for my ¡aciliiy. J~~/ I¡J(¡/o ) [)Q&a -1- 09/26/2003 " ¡ ... -- . o c:==,~===.:: :::::'~==:~~~~N=~~~~'~"--~-'~~~~'^"------'~-"--'-'-------~"-.-.-'--~_=~_~=~ GROCERY COMPANY GENERAL OFFICES P.O. BOX 54143 . LOS ANGELES, CALIFORNIA 90054 Telephone (310) 884,9000 January 30, 2003 City of Bakersfield Office of Environmental Services 1 715 Chester Avenue Bakersfield, CA 93301 To: Ron Fraze Here is a an updated business plan for our store # 653, I included the gasoline inventory sheets and a site map. If you have any questions you can call me at 310-884-4085. Thank you. Gayeann Denham Environmental Affairs Department Ralphs Grocery Company Cc: file store RALPHS. FOOD 4 LESS. BELL MARKETS. CALA FOODS. FOODS CO UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA, Doing Business As) Ralphs Grocery Company - Store #653 Page 1 of _ EPA ID # (Hazardous Waste Only) 2, 3. Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) 1. Own or operate underground storage tanks? 2. Intend to upgrade existing or install new USTs? 3. Need to report closing a UST? C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? Treat hazardous waste on site? 3. 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5. 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? E. LOCAL REOUlREMENTS 1:81 YES 0 NO 4, DYES 1:81 NO 5, DYES 1:81 NO 6, DYES 1:81 NO 7, DYES 1:81 NO 8, DYES 1:81 NO 9. DYES 1:81 NO 10, DYES 1:81 NO 11. DYES 1:81 NO 12- DYES 1:81 NO 13, DYES 1:81 NO 14, HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Formerly SWRCB Form A) UST TANK (one page per tank) (Formerly Form B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) UST TANK (closure portion - one page per tank) NO FORM REQUIRED TO CUPAs EP A ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Forms 1772 A.B.C.D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249) (You may also be required to provide additional information by your CUP A or local agency.) IS, Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 IFIED PROGRAM CONSOLIDATED FO FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY ID H (Agency U.fe Ollly) BUSINESS NAME (S.me us FACILITY NAME or DnA - Doing Business As) Ralphs Grocery Company - Store #653 BUSINESS SITE ADDRESS 5200 StocMale Highway CITY .Bal<ersfield DUN & BRADSTREET 78-6] 7-6628 COUNTY Kern County BUSINESS OPERA TOR NAME Ralphs Grocery Company 104. II. BUSINESS OWNER OWNER NAME Ralphs Grocery Company OWNER MAILING ADDRESS 2201 South Wilmington Avenue CITY Compton 114, STATE CA m. ENVmONMENTAL CONTACT 117. CONTACT NAME Carrol Chen CONTACT MAILING ADDRESS 2201 South Wilmington Avenue CITY Compton 120. STATE CA IV. EMERGENCY CONTACTS -PRIMARY - NAME Bill Arial TITLE Store Director BUSINESS PHONE (661) 859-1668 24-HOUR PHONE'" 310-900-3700 PAGER II 123. NAME Ala¡m Center 124, TITLE Ralphs Security 125. BUSINESS PHONE 310-900-3700 126. 24-HOUR PHONE* 310-900-3700 127, PAGER # ADDITIONAL LOCALLY COLLECTED INFORMATION: Property Owner: Ralphs Grocery Company Billing Address: 2201 South WilmingtonAvenue, Compton, CA 90220 Number of employees: 73 Administering Agency: City of Bakersfield 3. CA ZIP CODE 93309 SIC CODE (4 digit H) 5411 Page of 101. 102, Hl3. 105. 107, lO8. 110. 112. 113, 116, liB, 119. 122* 11M, 129. 130. 131. 132, 133. Certification: 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 Witll ¡he infoT111ation submitted and believe the information is true, accurate, and complete. D REPRESENTATIVE 136. · See Instruclions on next page, Ralphs Grocery Comp:my I FOOll4 Less Business Plan 106. 109. BUSINESS OPERATOR PHONE 310-884-9000 III. OWNER PHONE 310-884-9000 115. ZIP CODE 90220 CONTACT PHONE 310-884-4288 121. ZIP CODE 90220 -SECONDARY- Phone No.: 310-884-9000 NAME OF DOCUMENT PREPARER Gayeann Denham 135. 137. Rev. 03/01 - UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one naae ner material Der buiIdina or area) o ADD o DELETE IZI REVISE 200, Page _ of - I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3, Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 20L CHEMICAL LOCATION CONFIDENTIAL 202, Machine Room EPCRA DYES IZI NO FACILITY ID # I I I I I I I I I I I MAP # 203, I GRID # 204, (Agency Use Only) ll. CHEMICAL INFORMATION CHEMICAL NAME 205. TRADE SECRET DYes IZI No 206, Chlorodifluoromethane If Subject to EPCRA. refer to instructions COMMON NAME 207, 208, Freon 22 EHS* DYes IZI No CASH 209, 75-45-6 *If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212, I 213, TYPE (Check one item only) ~ a. PURE o b, MIXTURE DC, WASTE 21L RADIOACTIVE DYes ~No CURIES PHYSICAL STATE 215, (Check one item only) o a, SOLID o b, LIQUID ~ c, GAS 214. LARGEST CONTAINER FED HAZARD CATEGORIES 216, (Check all that apply) o a, FIRE o b, REACTIVE ~ c, PRESSURE RELEASE ~ d, ACUTE HEALTH De, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217'1 MAXIMUM DAILY AMOUNT 218, ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220. 8437.61 8437.61 22L DAYS ON SITE 222, UNITS' o a. GALLONS ~ b. CUBIC FEET o c, POUNDS o d. TONS 365 (Check one item only) · If EHS, amount must be in pounds. STORAGE CONTAINER Oa, ABOVEGROUND TANK De, PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om. GLASS BOTTLE Oq. RAIL CAR Db. UNDERGROUND TANK Of. CAN OJ, BAG On. PLASTIC BOTTLE Dr. OTHER ~c, TANK INSIDE BUILDING Og, CARBOY o k. BOX DO, TOTE BIN Od. STEEL DRUM Oh. SILO o I. CYLINDER Op. TANK WAGON 223, STORAGE PRESSURE Oa. AMBIENT ~b. ABOVE AMBIENT o c, BELOW AMBIENT 224, STORAGE TEMPERATURE ~a, AMBIENT Db. ABOVE AMBIENT o c, BELOW AMBIENT o d. CRYOGENIC 225, %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 100 226, Chlordifluoromethane 227, DYes IZI No 228. 75-45-6 229, 2. 230, 23L DYes 0 No 232, 233, 3. 234. 235, DYes 0 No 236, 237, 4, 238, 239, DYes 0 No 240, 24L 5. 242, 243, DYes 0 No 244, 245, If more hazardous components are present at greater than 1 % by weight if non-carcinogenicJ or O. t % by weight if carcinogenic, attach additional sheets of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246, DOT Hazard Class: - If EPCRA, Please Sign Here. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 - UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (0"" page per material per building or area) D ADD D DELETE ~ REVISE 200, Page _ of - I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3, Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202, Floral Department EPCRA DYES ~ NO FACILITY ID # I I I I I I I I I 11.1 MAP # 203, I GRID # 204, (Agency Use Only) ll. CHENßCALThœORMATION CHEMICAL NAME 205, TRADE SECRET D Yes ~ No 206, Helium If Subject to EPCRA, refer to instructions COMMON NAME 207. 208, EHS* D Yes ~ No CASU 209, 7440-59-7 *If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212. I 213, TYPE (Check one item only) 181 a, PURE o b, MIXTURE DC, WASTE 21L RADIOACTIVE DYes 181 No CURIES PHYSICAL STATE 2\5, (Check one item only) o a, SOLID o b, LIQUID 181 c, GAS 214, LARGEST CONTAINER 244 cubic feet FED HAZARD CATEGORIES 216, (Check all that apply) o a, FIRE o b, REACTIVE 181 c, PRESSURE RELEASE 181 d, ACUTE HEALTH o e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217'1 MAXIMUM DAILY AMOUNT 218, ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220, 488 488 221. DAYS ON SITE 222- UNITS' o a. GALLONS 181 b, CUBIC FEET o c, POUNDS o d, TONS 365 (Check one item only) · If EHS, amount must be in oounds, STORAGE CONTAINER oa. ABOVEGROUND TANK De, PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om, GLASS BOTTLE oq, RAIL CAR Db. UNDERGROUND TANK Of. CAN OJ, BAG On, PLASTIC BOTTLE Or. OTHER DC, TANK INSIDE BUILDING og. CARBOY D k, BOX 00. TOTE BIN Od. STEEL DRUM Oh, SILO 1811. CYLINDER Dp, TANK WAGON 223, STORAGE PRESSURE o a, AMBIENT 181 b. ABOVE AMBIENT o c, BELOW AMBIENT 224, STORAGE TEMPERATURE 181 a, AMBIENT Db, ABOVE AMBIENT o c. BELOW AMBIENT o d, CRYOGENIC 225. %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CASU 1. 100 226, Helium 227, DYes ~ No 228, 7440-59-7 229, 2. 230, 231- DYes D No 232, 233, 3. 234, 235. DYes D No 236, 237, 4, 238. 239, DYes D No 240. 24L S. 242, 243. DYes D No 244, 245, If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246, DOT Hazard Class: - If EPCRA, Please Sign Here. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03101 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one DaI!e Dee marerial Dcr buildinI! or area) o ADD o DELETE 181 REVISE 200, Page _ of - I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3, Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202, Underground Storage Tank (2 compartment tank - 20,000 gal. / 8,000 gal.) EPCRA DYES ~ NO FACILITY ID # I I I I I I I I I I I MAP # 203, I GRID # 204, (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 205, TRADE SECRET DYes 181 No 206, Gasoline, Regular Unleaded If Subject to EPCRA, refer to instructions COMMON NAME 207, 208, Gasoline, Regular Unleaded EHS* DYes 181 No CASH 209, 8006-61-9 *If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212, I 213, TYPE (Check one item only) o a, PURE 181 b. MIXTURE DC, WASTE 211. RADIOACTIVE DYes 181 No CURIES PHYSICAL STATE 215, (Check one item only) o a, SOLID 181 b. LIQUID o c. GAS 214, LARGEST CONTAINER FED HAZARD CATEGORIES 216, (Check all that apply) 181 a, FIRE o b, REACTIVE D c. PRESSURE RELEASE 181 d. ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217, MAXIMUM DAILY AMOUNT 218, ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220, 20,000 20,000 0 221. DAYS ON SITE 222. UNITS' 181 a, GALLONS o b, CUBIC FEET o c, POUNDS D d, TONS 365 (Check one item only) · If EHS, amount must be in pounds. STORAGE CONTAINER oa, ABOVEGROUND TANK De. PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om, GLASS BOTTLE oq, RAIL CAR 181 b, UNDERGROUND TANK D f, CAN OJ, BAG On. PLASTIC BOTTLE Or. OTHER Dc. TANK INSIDE BUILDING Og, CARBOY D k. BOX 00, TOTE BIN od, STEEL DRUM Oh, SILO D 1. CYLINDER op. TANK WAGON 223, STORAGE PRESSURE 181 a. AMBIENT Db, ABOVE AMBIENT o c. BELOW AMBIENT 224, STORAGE TEMPERATURE 181 a, AMBIENT Db, ABOVE AMBIENT o c. BELOW AMBIENT o d, CRYOGENIC 225, %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 100 226, Gasoline 227, DYes 181 No 228, 8006-61-9 229, 2. 230, 231. DYes D No 232, 233, 3, 234. 235, DYes D No 236, 237, 4. 238, 239, DYes D No 240, 241. 5. 242, 243. DYes 0 No 244, 245, If more hazardous components are present at greater than 1 % by weight if non-carCÎnogenk, or 0.1 % by weight if carcinogenic, attach additional sh~ts of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246, DOT Hazard Class: - If EPCRA. Please Sign Here. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one page per material per building or area) D ADD D DELETE IZI REVISE 200. Page _of_ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3. Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202. Underground Storage Tank (2 compartment tank - 20,000 gal. / 8,000 gal.) EPCRA DYES IZI NO FACILITY ID # I I I I I I I I I 11.1 MAP# 203, I GRID # 204, (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 205. TRADE SECRET DYes IZI No 206, Gasoline, Premium Unleaded Jf Subject to EPCRA, refer to instructions COMMON NAME 207. 208, Gasoline, Premium Unleaded EHS* DYes IZI No CASH 209, 8006-61-9 *If EHS is "Yes," all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212, I CURIES 213, TYPE (Check one item onJy) o a, PURE 18] b. MIXTURE DC. WASTE 211. RADIOACTIVE DYes 18] No PHYSICAL STATE 215, (Check one item only) o a, SOLID 18] b. LIQUID o c, GAS 214, LARGEST CONTAINER FED HAZARD CATEGORIES 216, (Check aJ! that apply) 18] a. FIRE o b, REACTIVE o c. PRESSURE RELEASE 18] d, ACUTE HEALTH 18] e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217'1 MAXIMUM DAILY AMOUNT 218, ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. 8,000 8,000 0 221. DAYS ON SITE 222. UNITS' 18] a, GALLONS o b. CUBIC FEET o c, POUNDS o d, TONS 365 (Check one item only) · If EHS, amount must be in Dounds. STORAGE CONTAINER oa, ABOVEGROUND TANK De. PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om, GLASS BOTTLE oq, RAIL CAR 18] b, UNDERGROUND TANK Of. CAN OJ. BAG On. PLASTIC BOTILE Or. OTHER DC, TANK INSIDE BUILDING og. CARBOY o k. BOX 00. TOTE BIN od. STEEL DRUM oh. SILO o 1. CYLINDER op. TANK WAGON 223, STORAGE PRESSURE 18] a. AMBIENT o b, ABOVE AMBIENT o c. BELOW AMBIENT 224, STORAGE TEMPERATURE 18] a. AMBIENT o b, ABOVE AMBIENT o c. BELOW AMBIENT o d, CRYOGENIC 225, %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 100 226. Gasoline 227, DYes IZI No 228, 8006-61-9 229, 2. 230, 231. DYes D No 232, 233, 3. 234, 235, DYes D No 236, 237, 4. 238, 239, DYes D No 240, 241. 5. 242, 243. DYes 0 No 244, 245. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246, DOT Hazard Class: - If EPCRA, Please Sign Here, Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 e Emergency Response Plan e Page _of_ All facilities that handle hazardous materials in specified quantities must have a written emergency response plan. This site-specific Emergency Response Plan is the facility's plan for dealing with emergencies and shall be implemented Immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): [g Bells; 0 Horns/Sirens; [g Verbal (i.e. shouting); D Other (specifY) b. [g Evacuation map is prominently displayed throughout the facility. Note:A properl)! comyleted Site Plan satisfies contingency plan map requirements. This drawing (or any other drawmg that shows p'rimary and alternate evacuatIOn routes emergency exits, and primary and alternate staging areas) must be prominently posted throughout the ftcility m locations where it will be visible to employees and visitors. 2. a. Emergency Contacts*: FirelPolice/ Ambulance State Office of Emergency Services b. Post-Incident Contacts*: Fire Department Hazardous Materials Program Department of Toxic Substances Control 911 (800) 852-7550 or (916) 262-1621 (661) 326-3979 (510) 540-3739 * These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may be required to be notified c. Emergency Resources: Poison Control Center (800) 876-4766 Nearest Hospital: Name: Industrial Medical Group of Bakersfield Address: City: Phone No.: 2501 G Street Bakersfield, CA 93301 (661) 327-2225 3. Arrangements With Emergency Responders: If you have made special (i.e. contractual) arrangements with any P9lice department, fire qepartment,- hospital, contractor, or State or local emergency response team to coordmate emergency services, descrIbe those arrangements below: Designated Cleanup Contractor: Advanced Cleanup Technologies Inc. (ACTI) 20928 Lamberton Avenue, Carson CA 90810 800-334-2284; 310-763-1423 Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 Emergency Response Plan e e Page _of_ 4. Emergency Procedures: Prevention All employees are trained in Hazard Communication that includes safe handling procedures of hazardous materials. In some cases Employees do not come into direct contact with the hazardous material due to self- contained units or closed-loop systems. Mitigation Small spill - employees are trained to stop and contain the leak. Large spill- employees are to notify the store director or person-in-charge as well as the local fire department to respond. When safe to do so, employees will attempt to isolate the leak. Fire - employees are to call the fire department. Trained employees are to use the fire extinguisher to control the fire when safe to do so. When necessary, the employees will be notified to evacuate the store safely. Abatement When safe to do so, employees will don personal protective equipment to stop the release, cordon off the area from further traffic, and contain the release with absorbant. The waste is then placed in a labeled waste drum for proper disposal. The fire department and/or a cleanup contractor will be contacted to control and abate large spills. Notification & Evacuation Upon hearing the evacuation alarm or P A announcement, employees will evacuate and report to designated meeting areas. The store director or person-in-charge is responsible for making the announcements and to ensure that all employees exit safely. 5. Post-Incident ReportinglRecording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility's operating record. Within 15 days of any hazardous materials emergency incident, a written Emergency Incident Report must be submitted to the California Environmental Protection Agency's Department of Toxic Substances Control and the local fire department's hazardous materials program. The report shall include: a) Name, address, and telephone number of the facility's owner/operator; b) Name, address, and telephone number of the facility; c) Date, time, and type of incident (e.g. fire, explosion, etc.); d) Name and quantity ofmaterial(s) involved; e) The extent of injuries, if any; f) An assessment of actual or potential hazards to human health or the environment, where this is applicable; g) Estimated quantity and disposition of recovered material that resulted from the incident; h) Cause(es) of the incident; i) Actions taken in response to the incident; j) Administrative or engineering controls designed to prevent such incidents in the future. Ralphs Grocery Company I Food 4 Less Business Plan Rev. 03/01 · Emergency Response Plan 6. Emergency Equipment: 22 CCR §66265.52(e) requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. e e Page _of_ EMERGENCY EQUIPMENT INVENTORY TABLE 1. 2. 3. 4. Equipment Equipment Catel!ory Type Locations * Description ** Personal - n Cartridge Respirators Protective ;:::: Chemical Monitoring Equipment (describe) Equipment, ;::: Chemical Protective Aprons/Coats Safety ~ Chemical Protective Boots Equipment, ~ Chemical Protective Gloves and T Chemical Protective Suits (describe) First Aid Face Shields Equipment X First Aid Kits/Stations (describe) Throughout Bandages, aspirin, antiseptic Hard Hats Plumbed Eye Wash Stations í Portable Eye Wash Kits (i.e. bottle type) ~ Respirator Cartridges (describe) ;:::: Safety Glasses/Splash Goggles Safety Showers Self-Contained Breathing Apparatuses (SCBA) Other (describe) Fire rx Automatic Fire Sprinkler Systems Throughout Extinguishing Fire Alarm Boxes/Stations Systems rx Fire Extinguisher Systems (describe) Throughout Other (describe) Spill ~ Absorbents (describe) Throughout Spill Magic stations; kíttV litter in pet food aisle Control n Berms/Dikes (describe) Equipment ;:::: Decontamination Equipment (describe) and ;::: Emergency Tanks (describe) Decontamination IX Exhaust Hoods Service Deli Used for hot food preparation Equipment ~ Gas Cvlinder Leak Repair Kits (describe) n Neutralizers (describe) Overpack Drums '5< Sumps (describe) Back Dock Other (describe) Communications Chemical Alarms (describe) and -IX] Intercoms/ P A Systems Throughout Alarm n Portable Radios Systems i5<J. Telephones Office Also located at front end of store n Underground Tank Leak Detection Monitors ;:::: Other (describe) Additional c- Equipment c- (Use Additional c- Pages if Needed.) C- ~ ~ Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 ~ e Employee Training Plan e Page _of_ Personnel are trained in the following procedures: oint locations (e.g. "Quarterly", etc.) Ralphs Grocery Company and Food 4 Less employees are trained in Hazard Communication upon hiring. Employees are instructed in safe handling procedures of hazardous materials, emergency response procedures and evacuation and notification procedures. A chemical safety video and handbooks are used in the training program. Refresher training is provided annually. Ralphs Grocery Company and Food 4 Less stores do not have on-site emergency response teams. The stores rely on the local fire departments and hazardous materials services for assistance in a chemical release or other incident. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 U.1',a'u~ ~--- --- --..- .- ," .-r"'. I ....., 'it · "-- . --;---- e ,- ..-e-- .-. .-- --.. ~ -"':- HAZARDOUS MATERIAL D-"::LOSURE Chemical Inventory & ~usiness Emergency Plan ,-' SITE PLAN , . , :1 2 L J 4 (:AI.JFOf¿NIA AVE. 4 5 ~ r 5 _.~ œa.=. W\I:..c, CA'W 6 6 7 PARK¡ H~ tDt PAIit~ ¡..if£:¡ LOt: 7 B VY, B l' G(¡)·8 ~ '" 9 "" 9 IEJ - ~ ~ r!æ ~ .~ 0000 f 10 '~ . 10 ~~ ~ ~ ¡ërþ.~s i~ I ~~ 0' ~ 11 " ~I~~ -Ji~ ~ 11 ~~~ Q¡ 12 ~ 12 - V\ 13 V ~ 13 g 14 ~N't LÞt 14 15 § 15 BuRqI!JL. ~- '" 16 dLtICé 16 17 V~ L0t- H Ralphs Grocery Com n - Store # "63 ADDRESS CITY 5Wo ~.(W E ~\M.i ~E.t2SR 6l.D FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 oW Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAJ( (661) 395-1349 SUPPRESSION SERVICES 2101 'W Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES' ENVIROHIlEHTAl. SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3979 FAJ( (661) 326-0576 PUBLIC EDUCATION 1715 Chester Avè. Bakersfield, CA 93301 VOICE (661) 326·3696 FAJ( (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAJ( (661) 326-0576 TRAINING DIVISION 5642 VIctor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAJ( (661) 399-5763 - . November 25, 2002 Ralph's Retail Maintenance P.O. Box 54143 Los Angeles, CA 90054 RE: Repairs to Ralph's Fueling Center 5200 Stockdale Hwy Bakersfield, CA Dear Mr. Taylor: Please be advised that repairs were witnessed by Howard Wines of the Bakersfield Fire Department under pennit #BI-0258 on November 22, 2002. Should you have additional questions or concerns, please feel free to contact me at 661-326-3190. I I Sincerely, :Jz~ Steve Underwood Pire InspectorÆnvironmental Code Enforcement Officer Office of Environmental Services SBU/dc ~~7~ de W~.¥eve ~0P6 y~ J6 W~" '.-" _ .,....1 / // /UNlFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES /.. / FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) Ralphs Grocery Company - Store #653 '~.h " 2, 3, Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) 1. Own or operate underground storage tanks? 2. Intend to upgrade existing or install new USTs? 3. Need to report closing a UST? C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? Treat hazardous waste on site? 3. 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5. 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? E. LOCAL REQUIREMENTS ~ YES D NO 4, D YES ~ NO 5, D YES ~ NO 6, D YES ~ NO 7. D YES ~ NO 8. DYES ~ NO 9, DYES ~ NO 10, DYES ~ NO 11. DYES ~ NO 12, DYES ~ NO 13, DYES ~ NO 14. HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Formerly SWRCB Form A) UST TANK (one page per tank) (Formerly Form B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) UST TANK (closure portion - one page per tank) NO FORM REQUIRED TO CUPAs EP A ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Forms 1772) ON SITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B.C.D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) REMOTE WASTE 1 CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249) (You may also be required to provide additional information by your CUPA or local agency,) 15, Ralphs Grocery Company 1 Food 4 Less Business Plan Rev. 03101 ...3 U IFIED PROGRAM CONSOLIDATED FOR FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITYlD # (Agency Use Only) 100, ENDING DATE 12/31/01 3, BUSINESS PHONE (661) 859-1668 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Ralphs Grocery Company - Store #653 BUSINESS SITE ADDRESS 5200 Stockdale Highway CITY Bakersfield DUN & BRADSTREET 78-617-6628 COUNTY Kern County BUSINESS OPERATOR NAME Ralphs Grocery Company 104. II. BUSINESS OWNER OWNER NAME Ralphs Grocery Company OWNER MAILING ADDRESS 2201 South Wilmington A venue CITY Compton 114. STATE CA ill. ENVIRONMENTAL CONTACT 117, CONTACT NAME Carrol Chen CONTACT MAILING ADDRESS 2201 South Wilmington A venue CITY Compton 120, STATE CA IV. EMERGENCY CONTACTS -PRIMARY - NAME Bill Arial TITLE Store Director BUSINESS PHONE (661) 859-1668 24-HOUR PHONE* 310-900-3700 PAGER # 123, NAME Alann Center 124, TITLE Ralphs Security 125, BUSINESS PHONE 310-900-3700 126. 24-HOUR PHONE* 310-900-3700 127. PAGER # ADDITIONAL LOCALLY COLLECTED INFORMATION: Property Owner: Ralphs Grocery Company Billing Address: 2201 South Wilmington Avenue, Compton, CA 90220 Number of employees: 73 Administering Agency: City of Bakersfield CA ZIP CODE 93309 SIC CODE (4 digit #) 5411 Pa e of 101. 102, 103, 105, 107, 108, 110, 112, 113, 116, 118. 119. 122, 128, 129. 130. 131. 132, 133. Certification: 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. 106, 109. BUSINESS OPERATOR PHONE 310-884-9000 111. OWNER PHONE 310-884-9000 115. ZIP CODE 90220 CONTACT PHONE 310-884-4288 121. ZIP CODE 90220 -SECONDARY - Phone No.: 310-884-9000 NAME OF I Carrol Chen * See Instructions on next page, Ralphs Grocery Company / Food 4 Less Business Plan 136. NAME OF DOCUMENT PREPARER Cynthia Cardenas 135, 137, Rev. 03/01 · .... " UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one na.e per material ner buildin. or area) o ADD o DELETE IZI REVISE 200, Page _ of - I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3, Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202. Machine Room EPCRA DYES IZI NO FACILITY ID # I I I I I I I I I I I MAP# 203. I GRID # 204. (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 205, TRADE SECRET DYes IZI No 206, Chlorodifluoromethane If Subject to EPCRA, refer to instructions COMMON NAME 207. 208. Freon 22 EHS* DYes IZI No CASH 209. 75-45-6 *If EHS is "Yes," all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212. I 213, TYPE (Check one item only) 181 a. PURE o b. MIXTURE DC. WASTE 211. RADIOACTIVE DYes 181 No CURIES PHYSICAL STATE 215, (Check one item only) o a. SOLID o b. LIQUID 181 c. GAS 214, LARGEST CONTAINER FED HAZARD CATEGORIES 216, (Check all that apply) o a. FIRE o b, REACTIVE 181 c, PRESSURE RELEASE 181 d. ACUTE HEALTH o e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217'1 MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220. 8437.61 8437.61 221. DAYS ON SITE 222. UNITS' o a, GALLONS 181 b. CUBIC FEET o c, POUNDS o d. TONS 365 (Check one item only) · If EHS, amount must be in Dounds. STORAGE CONTAINER oa. ABOVEGROUND TANK De. PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om. GLASS BOTTLE oq. RAIL CAR Db. UNDERGROUND TANK Or, CAN OJ. BAG On. PLASTIC BOTTLE Or. OTHER 181 c, TANK INSIDE BUILDING og, CARBOY o k. BOX 00. TOTE BIN od. STEEL DRUM oh, SILO o I. CYLINDER op. TANK WAGON 223, STORAGE PRESSURE oa. AMBIENT 181 b, ABOVE AMBIENT o c. BELOW AMBIENT 224, STORAGE TEMPERATURE 181 a. AMBIENT Db, ABOVE AMBIENT o c. BELOW AMBIENT o d. CRYOGENIC 225. %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 100 226. Chlordifluoromethane 227. DYes IZI No 228. 75-45-6 229. 2. 230, 231. DYes 0 No 232. 233, 3. 234, 235, DYes 0 No 236, 237. 4. 238. 239. DYes 0 No 240. 241. 5. 242, 243. DYes 0 No 244, 245. If more hazardous components are present at greater than 1% by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246, DOT Hazard Class: - If EPCRA, Please Sign Here. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 ~. . UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one pa~e per material per buildin~ or area) D ADD D DELETE 1:81 REVISE 200, Page _ of - I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3. , Ralphs Grocery Company - Store #653 CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL 202, Floral Department EPCRA DYES 1:81 NO FACILITY ID # I I I I I I I I I 11.1 MAP# 203. I GRID # 204. (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 205. TRADE SECRET DYes 1:81 No 206, Helium If Subject to EPCRA, refer to instructions COMMON NAME 207. 208. EHS* DYes 1:81 No CASH 209, 7440-59-7 *If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210, HAZARDOUS MATERIAL 212, I 213, TYPE (Check one item only) 181 a, PURE o b. MIXTURE DC. WASTE 211. RADIOACTIVE DYes 181 No CURIES PHYSICAL STATE 215. (Check one item only) o a. SOLID o b. LIQUID 18 c, GAS 214. LARGEST CONTAINER 244 cubic feet FED HAZARD CATEGORIES 216, (Check all that apply) o a, FIRE o b, REACTIVE 181 c. PRESSURE RELEASE 18 d. ACUTE HEALTH o e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217,/ MAXIMUM DAILY AMOUNT 218, ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220, 488 488 221. DAYS ON SITE 222, UNITS' o a. GALLONS 18 b. CUBIC FEET o c. POUNDS o d. TONS 365 (Check one item only) · If EHS, amount must be in pounds, STORAGE CONTAINER oa. ABOVEGROUND TANK De, PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om. GLASS BOTILE oq. RAIL CAR Db. UNDERGROUND TANK Of. CAN OJ. BAG On. PLASTIC BOTILE Or. OTHER DC. TANK INSIDE BUILDING og. CARBOY o k, BOX 00. TOTE BIN od. STEEL DRUM oh. SILO 1811. CYLINDER op. TANK WAGON 223, STORAGE PRESSURE oa. AMBIENT 181 b, ABOVE AMBIENT o c. BELOW AMBIENT 224, STORAGE TEMPERATURE 181 a. AMBIENT Db. ABOVE AMBIENT o c. BELOW AMBIENT o d, CRYOGENIC 225. %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 100 226, Helium 227, DYes 1:81 No 228, 7440-59-7 229. 2. 230, 231. DYes 0 No 232, 233, 3. 234, 235. DYes D No 236, 237, 4. 238, 239, DYes D No 240. 241. 5. 242. 243, DYes D No 244, 245. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246. DOT Hazard Class: - If EPCRA, Please Sign Here. Ralphs Grocery Company 1 Food 4 Less Business Plan Rev. 03101 " "-\ :"-";1 e Emergency Response Plan e Page _of_ All facilities that handle hazardous materials in specified quantities must have a written emergency response plan. This site-specific Emergency Response Plan is the facility's plan for dealing with emergencies and shall be implemented Immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ~ Bells; 0 Horns/Sirens; ~ Verbal (i.e. shouting); 0 Other (specify) b. ~ Evacuation map is prominently displayed throughout the facility. Note:A properl)! completed Site Plan satisfies contingency plan map requirements. This drawing (or any other drawmg that snows p'rimary and alternate evacuatIOn routes emergency exits, and primary and alternate staging areas) must be prominently posted throughout the ft¡cility m locations where it will be visible to employees and visitors. 2. a. Emergency Contacts*: FirelPolice/ Ambulance State Office of Emergency Services b. Post-Incident Contacts*: 911 (800) 852-7550 òr (916) 262-1621 Fire Department Hazardous Materials Program (661) 326-3979 Department of Toxic Substances Control (510) 540-3739 * These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may be required to be notified. c. Emergency Resources: Poison Control Center Nearest Hospital: Name: (800) 876-4766 Industrial Medical Group of Bakersfield Address: City: Phone No.: 2501 G Street Bakersfield, CA 93301 (661) 327-2225 3. Arrangements With Emergency Responders: If you have made special (i.e. contractual) arrangements with any P9lice department, fire q.epartment,. hospital, contractor, or State or local emergency response team to coordmate emergency servIces, descnbe those arrangements below: Designated Cleanup Contractor: Advanced Cleanup Technologies Inc. (ACTI) 20928 Lamberton Avenue, Carson CA 90810 800-334-2284; 310-763-1423 Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 9'Jt.1 e e Page _of_ .. Emergency Response Plan 4. Emergency Procedures: Prevention All employees are trained in Hazard Communication that includes safe handling procedures of hazardous materials. In some cases Employees do not come into direct contact with the hazardous material due to self- contained units or closed-loop systems. Mitigation Small spill - employees are trained to stop and contain the leak. Large spill - employees are to notify the store director or person-in-charge as well as the local fire department to respond. When safe to do so, employees will attempt to isolate the leak. Fire - employees are to call the fire department. Trained employees are to use the fire extinguisher to control the fire when safe to do so. When necessary, the employees will be notified to evacuate the store safely. Abatement When safe to do so, employees will don personal protective equipment to stop the release, cordon off the area from further traffic, and contain the release with absorbant. The waste is then placed in a labeled waste drum for proper disposal. The fire department and/or a cleanup contractor will be contacted to control and abate large spills. Notification & Evacuation Upon hearing the evacuation alarm or P A announcement, employees will evacuate and report to designated meeting areas. The store director or person-in-charge is responsible for making the announcements and to ensure that all employees exit safely. 5. Post-Incident Reporting/Recording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility's operating record. Within 15 days of any hazardous materials emergency incident, a written Emergency Incident Report must be submitted to the California Environmental Protection Agency's Department of Toxic Substances Control and the local fire department's hazardous materials program. The report shall include: a) Name, address, and telephone number ofthe facility's owner/operator; b) Name, address, and telephone number of the facility; c) Date, time, and type of incident (e.g. fire, explosion, etc.); d) Name and quantity ofmaterial(s) involved; e) The extent of injuries, if any; f) An assessment of actual or potential hazards to human health or the environment, where this is applicable; g) Estimated quantity and disposition of recovered material that resulted from the incident; h) Cause(es) of the incident; i) Actions taken in response to the incident; j} Administrative or engineering controls designed to prevent such incidents in the future. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 c; ~ ~v e e Page _of_ Emergency Response Plan 6. Emergency Equipment: 22 CCR §66265.52(e) requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. 2. 3. 4. Equipment I Equipment I Categorv Type Locations * DescriDtion** Personal Cartridfle Respirators Protective Chemical Monitoring Equipment (describe) Equipment, Chemical Protective Aprons/Coats Safety Chemical Protective Boots Equipment, n Chemical Protective Gloves and n Chemical Protective Suits (describe) First Aid n Face Shields Equipment I5a First Aid Kits/Stations (describe) Throughout Bandages, aspirin, antiseptic ;::: Hard Hats ;::: Plumbed Eye Wash Stations ~ Portable Eye Wash Kits (i.e. bottle tvve) ~ Respirator Cartridges (describe) r Safety Glasses/Splash Goggles Safety Showers Self-Contained Breathing Apparatuses (SCBA) Other (describe) Fire 'X Automatic Fire Sprinkler Systems Throughout Extinguishing Fire Alarm Boxes/Stations Systems '5< Fire Extinguisher Svstems (describe) Throughout Other (describe) Spill '5< Absorbents (describe) Throughout Spill Magic stations; kitty litter in pet food aisle Control Berms/Dikes (describe) Equipment n Decontamination Equipment (describe) and n Ernerflency Tanks (describe) Decontamination & Exhaust Hoods Service Deli Used for hot food oreoaration Equipment ,..... Gas Cvlinder Leak Repair Kits (describe) ,..... Neutralizers (describe) ~ Overpack Drums 1'5< Sumps (describe) Back Dock ~ Other (describe) Communications ~ Chemical Alarms (describe) and IS< Intercoms/ P A Systerns Throughout Alarm í Portable Radios Systems XI Telephones Office Also located at front end of store :::¡ Underflround Tank Leak Detection Monitors Other (describe) Additional Equipment (Use Additional Pages if Needed.) n Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 '. '" 5>1;,., e Employee Training Plan e Page _of_ Personnel are trained in the following procedures: oint locations (e.g. "Quarterly", etc.) Ralphs Grocery Company and Food 4 Less employees are trained in Hazard Communication upon hiring. Employees are instructed in safe handling procedures of hazardous materials, emergency response procedures and evacuation and notification procedures. A chemical safety video and handbooks are used in the training program. Refresher training is provided annually. Ralphs Grocery Company and Food 4 Less stores do not have on-site emergency response teams. The stores rely on the local fire departments ånd hazardous materials services for assistance in a chemical release or other incident. Ralphs Grocery Company / Food 4 Less Business Plan Rev. 03/01 -- ~~ - FAX ,fansmittal Cover Sheet ~ .e BAKERSFIELD CALIFORNIA Bakersfield Fire Dept. Office of Environmental Services 1715 Chester Ave. · Bakersfield, CA 93301 FAX No. (;66~.) 326-0576 · Bus No. (:66l) 326-3979 Today's Date ~ Time [0',31 No. of Pages I / TO: 11 f()¿i . . ....... . .-.. . ... . H' ............... .... ................ ............ .... .... ... ............ ...............'.. 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Bak~~~; Dept. .~~~Of EnVirOrim.;t...1a,.:,...~,!,~;fces .;::;::::::;.:........ :':::::-. .... .. .. .... COMME1ii~b~~í:;IP·~!¥t~1~i;~IV :)~~·~:::,::::;(,~:i¡!:!:::;¡i:!:::!::':::',!¡:::~:¡::!!¡,:'::;::~'J;;:;:":.~::::::,,:,?,:\,,)::::::;,.,/:::::,:,,:,::::::.:,:?:::)}:,,:::{r:::"·~m·:":::'::"':'::::':'.:"':'i:¡:::¡,,¡¡::!::"ii::;:::!:i¡,:::~..:..:.'...:..':'.:. . '.""":':'::::::,::.::,:,:,:: ::'::" ':/Iltt::'t(.j(;,:,·(;;s· H, ). . II: -1:: :::,:,: -::.:::,""f):, .::::':, ':':::':.. ,:,:,:,::::::':':.',...,.. "",:,::::·,,····:·:'··:·;::,,;::·::'::::;;¡1,::·:::·....::~;':::. ;~:¡r-¡¡:i:¡; :¡¡i~:ii~':"';:¡:~~:·;:,··~j':·~ ..;::::::::::: .:;:;:;: :::::;: ;:;:;:; ~:~;~; :;~;::: ';;:;:;. :;:;:;:; ::;:;:f" ,'.; "". ;;;:;;. :::;;;:.::::;::;.:.;;;;;:::::::::;: ..".,."".................. ....,.............. 04120/01 10:41 '8661 326 0576 BFD HAZ MAT DIV \4]001 e e *************************** *** ACTIVITY REPORT *** *************************** TRANSMISSION OK TX/RX NO. 9649 CONNECTION TEL 8591775 CONNECTION ID START TIME 04/20 10:36 USAGE TIME 04'43 PAGES 11 RESULT OK )-\ t,"::- ,,/ l.?- '7--03.& OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ---.. d ~'3CÞ \~ N j;#{ -::::¡;ç- FACILITY NAME ~J.{S ~ç3. ADDRESS ~ S1beJ'¿·C~.:C;: ~ FACILITY CONTACT fI/l,u<.<:..5( 11V7JW1<AÄ INSPECTION TIME INSPECTION DATE (2 ~'i;/~ PHONE NO. (f/vtJ !79-ll/tpg BUSINESS ID NO. 15-210- M:w<.J ~.,... NUMBER OF EMPLOYEES qO Section 1: Business Plan and Inventory Program ~utine D Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection OPERA nON C v COMMENTS Appropriate pennit on hand Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials rlC'"1...t v4 Verification of quantities 21( C(:: X ~ Verification of location ~:s.'í Cå.MÍ~ t A1 ~ C(Z..usl/8L Proper segregation of material Verification of MSDS availability Verification ofHaz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes ~o Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow· Station Copy Pink - Business Copy Inspector: LA.) i rJ"GS r c; tp e .¡("Ie "''/~''" l I ;J-Li).?Æ..ll· .¡-rt2?Ch \ 1 C OF BAKERSFIELD! FIRE pEf ~~TMENT t) f OFFICE OF ENVIRQNM~NT AL SERV~CE$ f 7 UNIFIED' PROGRAM INSPECT.JON--CH}:GKLIST (/> ~ 1715 Chester Ave.,·3rd FlõOO::-Bakersfield, S~\19~301 jÇ . ~ FACILITY NAME ~PþtS ~S-""3> ADDRESS ~ S'~~C;, ~ FACILITY CONTACT ¡\It, ,,<&'1 IlVJ41uRA.· INSPECTION TIME INSPECTION DATE I Z I <& I~ PHONE NO. (t/V() fJ$1--((ø(,g BUSINESS ID NO. IŠ-21O- Nt:"-<.J ~I.r NUMBER OF EMPLOYEES '¥') Section 1: Business Plan and Inventory Program ~utine D Combined DJoint Agency DMulti-Agepcy' 0 Complaint D Re-inspection OPERA nON C v COMMENTS . Appropriate penn it on hand Business plan contact infonnation accurate Visible address < Correct occupancy .. , . Verification of inventory materials rl€-Lt v4 . .. Verification of quantities 2'; cr:= X- l " , Verification of location Y'icNl.1 :1''í ("òJN\1I2.. Ai ßc>)l c(2.vsl.ÝéQ... Proper segregation of material . Verification of MSDS availability Verification of Haz Martraining V erificationof abatement sùpplies and procedures Emergency procedures adequate . Containers properly labeled . Housekeeping Fire Protectiòn .' Site Diagram Adequate & On Hand C=Compliance V=Violatjon Any hazardous waste on site?: Explain: DYes ~ Questions regarding this inspection? Please call us at (660326-3979 White ..EflV. Svcs. Yellow - Station Copy ,Pink· Business Copy Inspector: W, rJ"G-S I CITY OF BAKERSFIELia OF CE OF ENVIRONMENTAL sMtVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION, NEW DADO 200 D DELETE (one fonn per material per building or area) Page 01 ,~: ' ,~:_,., r;~.:~~}~.~~~;iI;~~~i:;,,<~:~~;. . " ~~;4' ;~~~;t~;~;~f/\~Wi.~~,;;;;;:+·,~,;~,;!~~~·t:JM-'t )~i:)ii.I~'f7A.CIIi.tr'(:!NfØR"'A " 3 " ,,'" . B CHEMICAL LOCATION 2011 CHEMICAL NAME tf. c::LlJ P7 ., , . Dyes D No 202 204 D Yes D No 206 If Subject to EPCRA, refer to ins1ructions 207 Dves DNo COMMON NAME CAS II 209 FIRE CODE HAZARD ClASSES (Complete if requested by local fire chief) 210 , TYPE )'L., PURE D m M/Xl1JRE D w WASTE 211 RADIOACTIVE Dves DNo 212 ! CURIES 213 i , ! I PHYSICAL STATE LARGEST CONTAINER 2(7 215 ! I D s SOLID D I LIQUID iL GAS 214 ¡ ! FED HAZARD CATEGORIES 01 FIRE o 2 REACTIVE .R6 PRESSURE RELEASE o 4 ACl1TE HEALTH o 5 CHRONIC HEAlTH 216 ! (Check all that apply) ANNUAL WASTE 217 I MAXIMUM '<-I) 218 AVERAGE 219 STATE WASTE CODE 220 ¡ AMOUNT DAIL V AMOUNT DAIL V AMOUNT UNITS· o .g& GAL ~CUFT o Ib LBS o In TONS 221 DA VS ON SITE 222 If EHS. amount must be In Ibs. 223 STORAGE CONTAINER (Check alrthat apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM De PLASTlClNONMETALLIC DRUM Of CAN o 9 CARBOY o h SILO OJ FIBER DRUM OJ BAG Ok BOX C!l4-cvLlNDER o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON STORAGE PRESSURE ~,ABOVE AMBIENT o ba BELOW AMBIENT o a AMBIENT èf.a AMBIENT STORAGE TEMPERATURE o as ABOVE AMBIENT o ba BELOW AMBIENT o c CRVOGENIC 225 o q RAIL CAR o r OTHER 224 226 2 230 3 234 4 238 5 242 227 oVes DNo 228 231 D Ves 0 No 232 235 D Ves D No 236 239 Dves DNo 240 243 oVes oNo 244 229 233 237 241 245 UPCF (7/99) S:\CUPAFORMS\OES2131.TV4.wpd -""1!T I, CITY OF BAKERSFIELia OF CE OF ENVIRONMENTAL S~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION o DELETE 200 (OM form per material per building or BffJa) Page or j.:--~~~.::~~~f¿~UiG';'V;~~';,;,-~;;:;;~~" ;::1l;,~:~~!.~'!~;j~}}~~Ç;; "~>i:'i~I:FAÇltO'¥I~r::ØRMATION, ., 3 2011 D Yes D No 202 204 -. , . CHEMICAL NAME +{c-u~ D Yes 0 No 206 If Subject to EPCRA. refer to instructions 207 Dyes DNa 208 COMMON NAME CAS # 209 FIRE CODE HAZARD ClASSES (Complete il requested by local ftre chief) 210 I TYPE ~PURE D m MIXTURE D w WASTE Dyes DNo CURIES 213 , 211 RADIOACTIVE 212 , I PHYSICAL STATE D s SOLID D I UQUID ~GAS LARGEST CONTAINER -¿ '7 215 : ! 214 ¡ FED HAZARD CATEGORIES 0, FIRE o 2 REACTIVE .3å PRESSURE RELEASE o 4 ACUTE HEALTH D 5 CHRONIC HEALTH 216 : (Ched< all that apply) ANNUAL WASTE 217 I MAXIt.«JM 4")4- 218 AVERAGE 219 STATE WASTE CODE 220i AMOUNT DAILY AMOUNT DAILY AMOUNT I UNITS· D ga GAL ~,CUFT o Ib LBS o In TONS 221 DAYS ON SITE 2221 . If EHS, amount must be in Ibs. I ¡ STORAGE CONTAINER o a ABOVEGROUND TANK De PLASTICINONMETALLlC DRUM o i FIBER DRUM o m GLASS BOTTLE o q RAIL CAR 223 (Check all that apply) o b UNDERGROUND TANK Or CAN OJ BAG o n PLASTIC BOTTLE o r OTHER o c TANK INSIDE BUILDING o d STEel DRUM 09 CARBOY o h SILO Ok BOX JE:u:YLlNDER o 0 TOTE BIN o P TANK WAGON STORAGE PRESSURE o a AMBIENT ~.ABOVE AMBIENT o ba BELOW AMBIENT 224 STORAGE TEMPERATURE o e AMBIENT ß.- ABOVE AMBIENT o be BELOW AMBIENT o c CRYOGENIC 225 226 227 o Yes 0 No 228 229 2 230 231 Dyes 0 No 232 233 3 234 235 Dyes D No 236 237 4 23S 239 Dyes D No 240 241 5 242 243 Dyes 0 No 244 245 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd