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Home My WebLink AboutBUSINESS PLAN -~.., ~ 7G 'i' . . .. . j' <r.<\~ 1. -; .. PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 Manager : MIKE DEVANEY Location: 5201 STOCKDALE HWY City BAKERSFIELD BusPhone: Map : 123 Grid: 03B (661) 834-9115 CommHaz : Low FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code:5541 DunnBrad: Owner Address City DFL AUTO SPA LLC 5201 STOCKDALE HWY D BAKERSFIELD / Title / OWNER/MG MEMBER (661) 834 - 9115x (954) 232-0498x () x Emergency Contact MBJ'.'l'IIER 'fA'-~ L01.Z siness Phone: 24-Hour Phone Pager Phone / Title / MANAGER (-6-tH) .30:31 õ'764x () x () x Emergency Contact MIKE DEVANEY Business Phone: 24-Hour Phone : Pager Phone Hazmat Hazards: DelHlth Contact : MIKE DEVANEY MailAddr: 5201 STOCKDALE HWY City BAKERSFIELD Phone: (661) 834-9115x State: CA Zip 93309 Phone: (661) 834 - 9115x State: CA Zip 93309 Period Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Dire (661) r, A-C-k" Æ . (TYPf¡orprintnarne ~O h61'GkJÿ cr.;r"(d,,¡ fh.:-'i' : ...~ reViewed th .. ""'" : IQve - e attached hazaidøus material' , ment plan for.8?~Itc. ~ I ~/? ' s man::Ì,~~e- (~..£ ðVf-O at'riff/¡ ...t . an . -'ft. of ,'1IJ¡;ir.ass¡- ''"', - ~'11:¡ It along with y correctIons cOnstitute a comp'· t ¡ IS e and correct agement plan for my fac'/'t man- 1/ y. ),J L~ - $/- 7-() V D.at8 -1- 04/06/2004 .~- '. ,/, .;;> .. .,..... " e e '1"; F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 9 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: PRESTIGE AUTO SPA/EXPRESS LUBE Cross Street : Business Type: GAS STATION Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : HEATHER TAYLOR Phone: (661) 331-6784x Address: City : State: Zip: Type : CORPORATION TANK OWNER INFORMATION Name : HEATHER TAYLOR Phone: (661) 331-6784x Address: City : State: Zip: Type : CORPORATION BOE UST Fee# : UNKNOWN Financ'l Resp: STATE FUND Legal Notif : Tank Owner Mailing Address Date:01/24/2001 Phone: (661) 834-9115x Name:MIKE DEVANEY Ttl:OWNER State UST # : 1998 Upg Cert#: 00868 -2- 04/06/2004 .- ~ e e .j' ... .~ ~ F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 9 f= Hazmat Inventory By Facility Unit 9 f== MCP+DailyMax Order Fixed Containers at Site 9 Hazmat Cornman Name. . . specHazEPA Hazards Frm I DailyMax IUnitlMCP UNLEADED GASOLINE L 10000.00 GAL Mod PREMIUM UNLEADED L 10000.00 GAL Mod MIDGRADE UNLEADED GASOLINE L 10000.00 GAL Mod CLEANER DH L 55.00 GAL Mod WASTE OIL F DH L 550.00 GAL Low OIL L 400.00 GAL Min LUBE GREASE F DH L 60.00 GAL Min POLISH DH L 160.00 GAL UnR SOAP L 55.00 GAL UnR \ -3- 04/06/2004 , ;l ...,,~ 'F . e '" F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME UNLEADED GASOLINE SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 10000.00 GAL %Wt. RS CAS# 100.00 Gasoline No 8006619 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod HAZARD ASSESSMENTS Ag.Definedl: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -4- 04/06/2004 , , "" ..","~ '..i' -, e " F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 ì f= Inventory Item 0002 Facility Unit: Fixed Containers at Site ì STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UST TANK DESCRIPTION Tank ID#: 1 Mfr: Modern Weld Installed: 9/1997 Capacity: 10000 Gals Additional Info: Compart Tank: N No. Of Comparts: Tank Use: MOTOR VEHICLE FUEL MatI Name:UNLEADED GASOLINE TANK CONTENTS Petrol Type: Cas #: 8006-61-9 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED Spill Cnt : 1997 Drop Tube : 1997 Striker Plate: 1997 Sgl Wall: PLASTIC Alarm : Ball Float : Fill Tube S/O: 1997 TANK LEAK DETECTION Dbl Wall: INTERSTITIAL MONITORING Installed: Installed: 1997 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -5- 04/06/2004 " .' < .-I e ....,": '$' " e F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 9 f= Inventory Item 0002 Facility Unit: Fixed Containers at Site 9 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 UNKNOWN FIBERGLASS FIBERGLASS AboveGround Piping PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 11/20/1996 Date: 01/24/2001 Name:MIKE DEVANEY Prmt Number: 1843 TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:11/04/2003 DISPENSER CONTAINMENT Type: FLOAT MECH. SHUTS OFF SHEAR VAL. OWNER/OPERATOR SIGNATURE Ttl:OWNER Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED -6- 04/06/2004 .' ~, "i"'~ ~' e e F PRESTIGE AUTO SPA/EXPRESS LUBE p= Inventory Item 0003 == COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 10000.00 GAL %wt. I 100.00 Gasol~ne HAZARDOUS COMPONENTS ~ CAS# I B006619. TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / 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.DefinelO: '- Ag. Define11 -7- 04/06/2004 " '. . ...,-,- s' e F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 , f= Inventory Item 0003 Facility Unit: Fixed Containers at Site, STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UST TANK DESCRIPTION Tank ID#: 2 Mfr: Modern Weld Installed: 9/1997 Capacity: 10000 Gals Additional Info: Compart Tank: N No. Of Comparts: Tank Use: MOTOR VEHICLE FUEL MatI Name:PREMIUM UNLEADED TANK CONTENTS Petrol Type: Cas #: 8006-61-9 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): FIBERGLASS Material(s) : Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED Spill Cnt : 1997 Drop Tube : Striker Plate: Sgl Wall: PLASTIC Alarm : Ball Float : Fill Tube S/O: 1997 TANK LEAK DETECTION Dbl Wall: AUTOMATIC Installed: Installed: Exempt: No TANK GAUGING INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -8- 04/06/2004 ¡: fi"1' " e e F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 ì f= Inventory Item 0003 Facility Unit: Fixed Containers at Site ì STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : Const: Mfgr : Mtl : & : Corr : Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping INTERSTITIAL MONITORING Installed: 11/20/1996 Date: 01/24/2001 Name:MIKE DEVANEY Prmt Number: 1843 DISPENSER CONTAINMENT Type: FLOAT MECH. SHUTS OFF SHEAR VAL. OWNER/OPERATOR SIGNATURE Ttl:OWNER Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:11/04/2003 -9- 04/06/2004 ,.' . ~'.'~ .' e e F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0004 == COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 10000.00 GAL %Wt. RS CAS# 100.00 Gasoline No 8006619 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined8: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined5: I- Ag.Define11 -10- 04/06/2004 .~ .t' e e ¡ F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 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: UST TANK DESCRIPTION Tank ID#: 3 Mfr: Modern Weld Installed: 9/1997 Capacity: 10000 Gals Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: MatI Name:MIDGRADE UNLEADED GASOLINE TANK CONSTRUCTION Compart Tank: N No. Of Comparts: Cas #: 8006-61-9 Type : DOUBLE WALL Material(p): FIBE~GLASS Material(s): FIBERGLASS Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED Spill Cnt : 1997 Drop Tube : 1997 Striker Plate: 1997 Sgl Wall: PLASTIC Alarm : Ball Float : Fill Tube S/O: 1997 TANK LEAK DETECTION Dbl Wall: INTERSTITIAL MONITORING Installed: Installed: 1997 Exempt: No Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -11- 04/06/2004 e e F PRESTIGE AUTO SPA/EXPRESS LUBE SiteID: 015-021-001843 ì f= Inventory Item 0004 Facility Unit: Fixed Containers at Site ì 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 UNKNOWN FIBERGLASS FIBERGLASS AboveGround Piping PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS Installed: 11/20/1996 Date: 01/24/2001 Name:MIKE DEVANEY Prmt Number: 1843 TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:11/04/2003 DISPENSER CONTAINMENT Type: FLOAT MECH. SHUTS OFF SHEAR VAL. OWNER/OPERATOR SIGNATURE Ttl:OWNER Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED -12- 04/06/2004 " ~í'~ e e F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0005 == COMMON NAME / CHEMICAL NAME CLEANER WHEEL CLEANER Location within this Facility Unit STORAGE ROOM SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Map: Grid: CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container 55.00 GAL ,AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. RS CAS# 100.00 Cleaning Solvent No 8030306 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined8: I- Ag .Define11 -13- 04/06/2004 , ,. ~,. e e F PRESTIGE AUTO SPA/EXPRESS LUBE p= Inventory Item 0009 F= COMMON NAME / CHEMI CAL NAME WASTE OIL SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 ' Location within this Facility Unit EXPRESS LUBE BUILDING Map: Grid: CAS # 221 STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 550.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 550.00 GAL Daily Average 40.00 GAL ZA 0 C ON %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 HA RD US OMP ENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / 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 -14- 04/06/2004 ,P e e ;.....,~. F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0009 SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 WASTE DATA Treated On Site CA Code US Code GAL Generated/Mo. GAL Generated/Yr. No Treatment UnitID: I Unit Type: Agency-Defined Text Label -15- 04/06/2004 " '" ",-,I, e e F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0010 === COMMON NAME / CHEMICAL NAME OIL SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit EXPRESS LUBE BUILDING Map: Grid: CAS# STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 400.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 400.00 GAL Daily Average 400.00 GAL %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined8: - Ag.Define11 -16- 04/06/2004 r ~~ e e F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0008 == COMMON NAME / CHEMICAL NAME LUBE GREASE SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit EXPRESS LUBE BUILDING Map: Grid: CAS# 8020835 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 60.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 60.00 GAL %Wt. RS CAS # 100.00 Heavy Machine Oil No 8020835 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min 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.DefinelO: ,.- Ag. Define11 -17- 04/06/2004 ;...' ¡;- e e ~-. F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0006 ¡== COMMON NAME / CHEMICAL NAME POLISH POLISH WAX Location within this Facility Unit STORAGE ROOM SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 160.00 GAL Daily Average 160.00 GAL %Wt. I HAZARDOUS COMPONENTS I~I CAS# TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / UnR HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined?: Ag.Defined9: Ag.Define10: Ag.Defined8: - Ag.Define11 -18- 04/06/2004 ;, f- e e if'" ~ F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0007 F== COMMON NAME / CHEMICAL NAME SOAP CAR WASH SOAP Location within this Facility Unit WHERE IS IT LOCATED?????????? SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. I HAZARDOUS COMPONENTS G CAS# TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag.Defined5: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag .Define11 -19- 04/06/2004 ,\ ~.~ e e ¿-\. , F PRESTIGE AUTO SPA/EXPRESS LUBE ¡=S p= Notif./Evacuation/Medical r=: Agency Notification ~LM AUTO STICK 2. SiteID: 015-021-001843 9 Fast Format 9 Overall Site 9 01/25/2001 1 01/25/2001 Employee Notif./Evacuation IN THE EVENT OF INJURY, WILL BE TAKEN TO THE NEAREST HOSPITAL/MEDICAL Public Notif./Evacuation 01/25/2001 MAINTAIN PROPER ABSORBENT ON SITE. HAVE CLM SUTO STICK 2. NOTIFY FIRE DEPT OFFICE OF ENVIRONMENTAL SERVICES OR 911. Emergency Medical Plan 01/25/2001 ALL EMPLOYEES GO TO THE NEAREST HOSPITAL. -20- 04/06/2004 . . Prestige Auto SpalExpress Lube 5201 Stockdale Hwy. Bakersfield, CA 93309 Customer #: 34457 To: Jack Date: November 25,2003 (è ((); ~ 'ìr Subject: Past Due Account FAX: 834-9129 From: Karen Crawford, Bakersfield Fire Department, Environmental Services Telephone: 326-3642 Account Status: January 1. 2003 Haz Mat Handling Fee: ............................$229 Haz Mat Annual Inspection Fee: .............$53 Small Quantity Haz Waste Generator......$53 CA State Surcharge..................................$17 UST State Surcharge............................... .$30 Underground Tank Annual Fee: ..............$225 Januarv 15.2002 Haz Mat Handling Fee: ............................$229 Haz Mat Annual Inspection Fee: .............$53 Small Quantity Haz Waste Generator......$53 CA State Surcharge..................................$17 UST State Surcharge................................$30 Underground Tank Annual Fee: ..............$225 .June 31. 2001 Haz Mat Handling Fee: ............................$229 Haz Mat Annual Inspection Fee: .............$53 Small Quantity Haz Waste Generator......$53 CA State Surcharge ..................................$10 UST State Surcharge ...... ........ ......... .........$24 Underground Tank Annual Fee: ..............$225 To tal: ..........................................................$1 ,808 ----- ~. ø , L ---- -' " SPA/EXP.S ...,-j, PRESTIGE AUTO LUBE , Manager : MIKE DEVANEY Location: 5201 STOCKDALE HWY City BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: . ¿-,': ( SiteID: 015-021-001843 BusPhone: ~) Map : 123 ~l? '2,i~ 'l.ij Grid: 03B (661) 834-9115 CommHaz : Low FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title MIKE DEVANEY / OWNER/MG MEMBER HEATHER TAYLOR / MANAGER Business Phone: (661) 834-9115x Business Phone: (661) 331-6784x 24-Hour Phone (954) 232-0498x 24-Hour Phone ( ) x Pager Phone ( ) x Pager Phone ( ) x Hazmat Hazards: Fire DelHlth Period Preparer .: Certif'd: ParcelNo: to Phone: (661) 834-9115x State: CA Zip 93309 Phone: (661) 834-9115x State: CA Zip 93309 / TotalASTs: Gal TotalUSTs: Gal RSs: No Contact : MIKE DEVANEY MailAddr: 5201 STOCKDALE HWY City BAKERSFIELD Owner Address City DFL AUTO SPA LLC 5201 STOCKDALE HWY D BAKERSFIELD Emergency Directives: JACK TUTTLE (661) 303-9780 i ¡. ~ I ¡¡llf' ¿J'f:. Iþ,£,/- Do hereby certify t.hat I have · ' '(TYpe or þl'i:am9) reviewed the attached hazardous materials manage- ment plan for 1m-Ai' ItID ÝJ4 and that it along with (Naf'M of Su&lnesa) any corrections constitute a complete and correct man- ¡!41 \1&\\\ -1- 07/02/2003 ~>PRESTIGE AUTO SPA/EXPØltS LUBE STO CONTAINER D SiteID: 015-021-001843 l ( ST FORM A) . RAGE ATA U Last Action Type: FACILITY/SITE INFORMATTON Business Name: PRESTIGE AUTO SPA/EXPRESS LUBE Cross Street : Business Type: GAS STATION Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : HI3A'PIIEft IA y .G"öR Phone: (661) ~~x Address: /II¡Ir{ ¿1c~(' ï f7ý -If //') City : State: Zip: Type : CORPORATION TANK OWNER INFORMATION Name : ·IIEATHER 'fAYLO~,k ("" I:JrMw~ Phone: (661) 3-31- 67 82f'x Address: try-q((!>- City : State: Zip: Typ'e : CORPORATION BOE UST Fee# : UNKNOWN Financ'l Resp: STATE FUND Legal Notif : Tank Owner Mailing Address Date:01/24/2001 Phone: (661) 834-9115x Name:MIKE DEVANEY Ttl:OWNER State UST # : 1998 Upg Cert#: 00868 , , , ,.' 1 -2- 07/02/2003 '"' ¡-." . . f PRESTIGE AUTO SPA/EXPRESS LUBE p= Inventory Item 0005 F= COMMON NAME / CHEMICAL NAME CLEANER WHEEL CLEANER Location within this Facility WHERE IS IT LocnTRn????????2??? SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Unit Map: Grid: /ut'l£-.( ?~C ~ CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximúm 55.00 GAL Daily Average 55.00 GAL %Wt. RS CAS# 100.00 Cleaning Solvent No 8030306 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod Ag.Defined5: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined1: Ag.Defined8: - Ag.Define11 0\ -13- 07/02/2003 " . . F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0009 = COMMON NAME / CHEMICAL NAME WASTE OIL SiteID: 015-021-001843 l Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility,Unit . WHERE IS IT. LOCATED - ~7fP¡¿«·ctvh:. 'íYfAïdr"-r Map: Grid: CAS# 221 STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 550.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 550.00 GAL Dåily Average 40.00 GAL ZA D U M NENT %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 HA R 0 S CO PO S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined8: - Ag.Define11 I- -14- 07/02/2Ò03 " '" _.I< i , . . F PRESTIGE AUTO SPA/EXPRESS LUBE f= Inventory Item 0010 COMMON NAME / CHEMICAL NAME OIL SiteID: 015-021-001843 l Facility Unit: Fixed Containers at Site ì ! . Days On Site 365 Location within this Facility Unit WHERE IS IT LOCATED???????????? 7"1\': <55" Lv6c ~·/dt Map: Grid: CAS# STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 400.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 400.00 GAL Daily Average 400.00 GAL %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined8: - Ag.Definell ~ -16- 07/02/2003 -< ~. ~ . . F PRESTIGE AUTO SPA/EXPRESS LUBE p= Inventory Item 0008 F== COMMON NAME / CHEMICAL NAME LUBE GREASE SiteID: 015-021-001843 l Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit WHERE IS IT LOCATED t:. '(ltU)~ LJx g;., Jd~ Map: Grid: CAS# 8020835 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 60.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 60.00 GAL %Wt. RS CAS# 100.00 Heavy Machine Oil No 8020835 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min 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: I-- Ag .Define11 & -17- 07/02/2003 ::""~ . . . F PRESTIGE AUTO SPA/EXPRESS LUBE ~ Inventory Item 0006 == COMMON NAME / CHEMICAL NAME POLISH POLISH WAX Location within this Facility Unit WHERE IS IT LOCATED????~.?????? ~f1,¿,.l, . ì C ~ SiteID: 015-021-001843 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Dáily Maximum 160.00 GAL Daily Average 160.00 GAL HAZARDOUS COMPONENTS G CAS# I %Wt. HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / UnR 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 \ ;. ~ -18- 07/02/2003 '" _i' . - f);f.(f(,;C. BA~\.U~\.7,u.J:DD AUTO SPA/EXPRESS LUBE .~ SiteID: 015-021-001843 Manager MIKE DEVANEY Location: 5201 STOCKDALE HWY City BAKERSFIELD BusPhone: Map : 123 Grid: 03B (661) 834-9115 CommHaz : Low FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title MIKE DEVANEY / OWNER/MG MEMBER HEATHER TAYLOR / MANAGER Business Phone: (661) 834-9115x Business Phone: (661) 331-6784x 24-Hour Phone : (954) 232-0498x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire J µk rvlfk. (G61)"Jo'J.,17!O DelHlth Contact : MIKE DEVANEY Phone: (661) 834-9115x MailAddr: 5201 STOCKDALE HWY State: CA City : BAKERSFIELD Zip : 93309 Owner DFL AUTO SPA LLC phone: (661) 834-9115x Address : 5201 STOCKDALE HWY D State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: I, A~~ Or:v.If..1~ Do hsrsbv certi4u ~hSlt a hov.o. ype orpnnt na :¥ I Y Q 'Q' reviewed the attached hazardous materials manage- ment plan fortJ¡::¿ Adift. t.LL and that it along with (Name of Irf8SS) , any corrections constitute omplets and correct man- 0W . "9 ¡7 Ii.. -1- 07/15/2002 F BAKERSFIELD AUTO . SPA/EXPRESS LUBE STORAGE CONTAINER . SiteID: DATA (UST FORM ) 015-021-001843 ì A Last Action Type: FACILITY/SITE INFORMATION Business Name: BAKERSFIELD AUTO SPA/EXPRESS LUBE Cross Street : Business Type: GAS STATION Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : HEATHER TAYLOR Phone: (661) 331-6784x Address: City : State: Zip: Type : CORPORATION TANK OWNER INFORMATION Name : HEATHER TAYLOR Phone: (661) 331-6784x Address: ~ City : State: Zip: Type : CORPORATION BOE UST Fee# : UNKNOWN Financ'I Resp: STATE FUND Legal Notif : Tank Owner Mailing Address Date:01/24/2001 Phone: (661) 834-9115x Name:MIKE DEVANEY Ttl:OWNER State UST # : 1998 Upg Cert#: 00868 f= Hazmat Inventory One Unified List 9 f== Alphabetical Order All Materials at Site 9 Hazmat Common Name. . . SpecHaz EPA Hazards DailyMax MCP CLEANER DH L 55.00 GAL Mod LUBE GREASE F DH L 60.00 GAL Min MIDGRADE UNLEADED GASOLINE L 10000.00 GAL Mod OIL L 400.00 GAL Min POLISH DH L 160.00 GAL UnR PREMIUM UNLEADED L 10000.00 GAL Mod SOAP L 55.00 GAL UnR UNLEADED GASOLINE L 10000.00 GAL Mod WASTE OIL F DH L 550.00 GAL Low -2- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE p= Inventory Item 0005 = COMMON NAME / CHEMI CAL NAME CLEANER WHEEL CLEANER Location within this Facility Unit WHERE IS IT LOCATED???????????? . SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. RS CAS # 100.00 Cleaning Solvent No 8030306 " HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0008 = COMMON NAME / CHEMICAL NAME LUBE GREASE Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit WHERE IS IT LOCATED Map: Grid: CAS# 8020835 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 60.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 60.00 GAL %Wt. RS CAS# 100.00 Heavy Machine Oil No 8020835 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min HAZARD ASSESSMENTS -3- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE f= Inventory Item 0004 === COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE . SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 10000.00 GAL %Wt. RS CAS# 100.00 Gasoline No 8006619 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod f= Inventory Item 0010 === COMMON NAME / CHEMICAL NAME OIL Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit WHERE IS IT LOCATED???????????? Map: Grid: CAS# STATE - TYPE Liquid Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 400.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 400.00 GAL Daily Average 400.00 GAL HA T %Wt. RS CAS # 100.00 Motor Oil, Petroleum Based No 8020835 ZARDOUS COMPONEN S E TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min HAZARD ASS SSMENTS -4- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE f= Inventory Item 0006 F== COMMON NAME / CHEMICAL NAME POLISH POLISH WAX Location within this Facility Unit WHERE IS IT LOCATED???????????? . SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 160.0Q GAL Daily Average 160.00 GAL %Wt. I HAZARDOUS COMPONENTS ~ CAS # HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No! Curies DH / / / UnR f= Inventory Item 0003 F== COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Facility Unit: Fixed 'Containers at Site 9 Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 10000.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Gasoline No 8006619 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE f= Inventory Item 0007 F= COMMON NAME / CHEMI CAL NAME SOAP CAR WASH SOAP Location within this Facility Unit WHERE IS IT LOCATED?????????? . SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. I HAZARDOUS COMPONENTS G CAS# TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARD ASSESSMENTS f= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ~ P~ESSURE ---r TEM~ERATURE ~ CONTAINER TYPE ==L1qU1d __pure ~mb1ent ---1 Amb1ent ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL %wt. I 100.00 Gasoline HAZARDOUS COMPONENTS ~ CAS # I 8006619 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod HAZARD ASSESSMENTS -6- i I 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE f= Inventory Item 0009 = COMMON NAME / CHEMICAL NAME WASTE OIL . SiteID: 015-021-001843 9 Facility Unit: Fixed Containers at Site, 9 Days On Site 365 Location within this Facility Unit WHERE IS IT LOCATED Map: Grid: CAS # 221 STATE - TYPE Liquid Waste PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 550.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 550.00 GAL Daily Average 40.00 GAL %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low HAZARD ASSESSMENTS -7- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE I f= Notif./Evacuation/Medical ~ Agency Notif.ication ~LM AUTO STICK 2. . SiteID: 015-021-001843 ì Fast Format ì Overall Site ì 01/25/2001 ] 01/25/2001 Employee Notif./Evacuation IN THE EVENT OF INJURY, WILL BE TAKEN TO THE NEAREST HOSPITAL/MEDICAL Public Notif./Evacuation 01/25/2001 MAINTAIN PROPER ABSORBENT ON SITE. HAVE CLM SUTO STICK 2. NOTIFY FIRE DEPT OFFICE OF ENVIRONMENTAL SERVICES OR 911. Emergency Medical Plan 01/25/2001 ALL EMPLOYEES GO TO THE NEAREST HOSPITAL. -8- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE I f= Mitigation/Prevent/Abatemt Release Prevention . SiteID: 015-021-001843 9 Fast Format 9 Overall Site 9 01/25/2001 STICK TANKS DAILY. HAVE CONTINUOUS TANK AND LINE LEAK MONITORING. HAVE ABSORBENT MATERIALS FOR NOZZLE AND SMALL QUANTITY RELEASES. Release Containment 01/25/2001 SHUTOFF PUMPS, CALL 911, EVACUATE PREMISES, SHUTOFF POWER. Clean Up 01/25/2001 HAVE ABSORBENT MATERIAL KEPT ON SITE AT ALL TIMES TO CLEANUP SMALL QUANTITY RELEASES. MAINTAIN 5 GAL WASTE DRUM FOR USED ABSORBENT COLLECTION. Other Resource Activation -9- 07/15/2002 . F BAKERSFIELD AUTO SPA/EXPRESS LUBE I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs . SiteID: 015-021-001843 9 Fast Format 9 Overall Site 9 I 11/30/1998 A) GAS - ROOM 9 B) ELECTRICAL - ROOM 9 C) WATER - D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 11/30/1998 PRIVATE FIRE PROTECTION - ????????? FIRE EXTINGUISHERS, SPRINKLER SYSTEM NEAREST FIRE HYDRANT - NEXT DOOR IN FRONT OF BANK. Building Occupancy Level -10- 07/15/2002 Or '. . F BAKERSFIELD AUTO SPA/EXPRESS LUBE I F Training Employee Training . SiteID: 015-021-001843 9 Fast Format 9 Overall Site 9 01/25/2001 WE HAVE APPROXIMATELY 25 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MONTHLY SAFETY MEETINGS AND WILL LOG INTO LOG BOOK. Page 2 [ I I Held for Future Use Held for Future Use ) -11- 07/15/2002 I ( CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., "Bakersfield, CA (661) 326-3979 // , ~ / \ /2--~.D HAZARDOUSMATEmALS~AGEMENTPLAN qt~ H- ,€" ~ (P4 rv~ ~">?- INSTRUCTIONS: 3~ ç 7 .y( ~« 1. To avoid further action, return this fonn within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. you may also attach Business Owner / Operator Fonn and Chemical Description Fonn(s) to the front of this plan instead of completing SECTION 1. below for initial submission. - - '1' SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: 1fí,/rUS' Itø 1!v4 fa JFr¥j'{Ç k6c ( LOCATION:)Zð I ~¡'tI'~ //wy MAILING ADDRESS: ~/hI1f CITy:-g:;.Ir~4'¡;¿tÞ STATE: CJA ZIP: 'fffðt:¡ PHONE: UI/:1</-1/1) PRIMARY ACTIVITY: ~ h,.r~ ~¡J~$!.f /J(" 6#r <~ I, I OWNER: f)r2 Ah ~/J I LLe. PHONE: ¿1/11tj"'¿¡¡j) , MAILING ADDRESS: $Ít9/ -Çþ¿d".k Ihvr I ~¿:;qh(:lct; c/I ¿¡ro 1 EMERGENCY NOTIFICA nON CONTACT I. /1l;kr 1411h1(y 2. TITLE BUS. PHONE 24 HR. PHONE tJ~ (leI) frc/~fltŠ ffly) 'JYz- ..../¥If' . c 1 ) c ( ( - -- - ,..' HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. I : DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: ~LI11 U SlicK 2- B. EMPLOYEE AND AGENCY NOTIFICATION: :¡;; /f¡(' i'vJ ç/ 1JW'f / ~ ~ M~ ¿ rk tI~d ~/vß¡jJ/MC~ ,Lhl"t;. C. ENVIRONMENTAL RESPONSE MANAGEMENT: /) 1Jtir».~ I~ "'¿('d~ at ~ìJ 2) ¡IN t LJ4 4tt {'/$k 2 5J #ø/it¡ 1iÍt~~{)Ik< uI £:rUt;'·.. ¡v.i/ ~~ N-- 11f. D. EMERGENCY MEDICAL PLAN: Jf1{i ~(,Cf r Ii tit" Æh~ ;",it-/, \ 2 e e c~.r" ~ HAZARDOUS MATERIALS MANAGEMENT PLAN / , SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: ì) .çh-ck ~¡) ~i¡ 2) ~úxllH~hk~J,,? Icd-~~~ " ?? !IJtr< M54flJ 1ú*';ß ~ /J;z~k ~ sN4f'¡Jf 4ck£J' ~ B. RELEASE CONTAINMENT AND/OR MITIGATION: , ¿-/!J dl¡CMfJ5' ¿ud' t:¡f/ I 2f//fCwfc t&itltr("~ . shJ {f/ fJlW{L., C. CLEAN-UP AND RECOVERY PROCEDURES: ;} ~( ~aJ~ ~ /(,1 ~q ~ ,.,¡f ¡'~1'r $ ¿:/ÚnfJ ( S/1tø/l ~r?ç/t:4r6. 7) !/!m1l,Þcit Ç)1~ MlSk ck~ ~ ucJ ¿~a¿bJ- dI~ r UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) NATURAL GAS/PRQP ANE: ¡/,( ks ~'hIft.1 ELECTRICAL: ' PbC I WATER: úHi~tif /AJ~ SPECIAL: LOCK BOX: YESINO IF YES, LOCATION: PRIV A TE FIRE PROTECTIONIW A TER AVAILABILITY I ( A. PRIVATE FIRE PROTECTION: AI lit B. WATER AVAILABILITY (FIRE HYDRANI): 11 In 3 y^"~ e e .. HAZARDOUSMATEIDALSMANAGEMENTPLAN ( SECTION III: TRAINING NUMBER OF EMPLOYEES: Z S- MATERIAL SAFETY DATA SHEETS ON FILE: k)' BRIEF SUMMARY OF TRAINING PROGRAM: ~~Iy ?~ fJt1:ChfltF - L" ~ 4r ð~/¡-\ ( CERTIFICATION I, /I/-e--/¡f£! ßI/Jfvr{"c-/ CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTtwD THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON ARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INA C TE INFORMATION CONSTITUTES PERJURY. ~u< SIGNATURE ( HAZ MAT MNGMNT PLAN & INSTRUC 4 , , e CITY OF BAKERSFIELDe OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION : .~N~~_" __~A..cE___ __~ ~~~~!5__._ 0 ~~~~__ 200 (one fonn per material per buitdlng or area) Page of __.____________________.__ ____···_w__ ! I. FACILITY INFORMATION :-BUSI~sJNAME~e...as?fI~'tM~BA-~BuslnessAs) J / /J../1 / t' / ' ~ _ ~_FA1(W!¡i,l4" INle -r"J ?~!'~ ~(' A.c/ £Æ m:/~ a~ ¡ CHEMICAL LOCATION ~ I 5k1c~ cFÃëlLITY ID # ~ I , L-__ CHEMiCAl NAME , I ! ! COMMON NAME CAS # II. CHEMICAL INFORMATION ~~r- FIRE CODE HAZARD CLASSES (Complete If requested by Ioi:aI fire chief) i i I I , i 3 203 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID # (optionaf) o Yes ~ No 202 204 ' 205 TRADE SECRET 0 Yes ~ No 206 If Subject 10 EPCRA. refer 10 instructions 207 EHS· o Yes 0 No 208 209 oJ( EHS is·Yes. . alllDIOUDIS below mull be in 1bs. '! I 210 o P PURE 213 TYPE IJ/C m MIXTURE o w WASTE 211 RADIOACTIVE DYes CURIES PHYSiCAl STATE o S SOLID 216 FED HAZARD CATEGORIES , Cr''>Ck aU that apply) (( AL WASTE I A".vUNT I 01 FIRE STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE 8UILDING o d STEEL DRUM I I I ~ORAGE PRESSURE STORAGE TEMPERATURE ;#) a AMBIENT W a AMBIENT %Wf , , 226 i 2 230 1-",--' - I~ 234 4 238 5 242 .ßt I LIQUID 214 lARGEST CONTAINER OgGAS o 2 REACTIVE 514 ACUTE HEALTH o 3 PRESSURE RElEASE 217 218 AVERAGE DAILY AMOUNT o In TONS );4 UNITS· ga GAL 0 d CUFT 0 Ib LBS . If EHS, amount must be In Ibs. «e PLASTletNoNMETAllIC DRUM Of CAN 09 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYliNDER o 5 CHRONIC HEALTH # o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o P TANK WAGON o aa ABOVE AMBIENT o ba BELOW AMBIENT , o ba 8ELOW AMBIENT o aa ABOVE AMBIENT ."...' -, 'HÄZARDOUS' COMPONENT_ :~, - i ' pO'''IT NAME~ ~E.,o?U~IZED ,MPANY REPRESENTATIVE 1\ /nlC~ _ 'f"~ !.,------------.--:-----? UPCF (7/99) . EHS . "'," 227 o Yes 0 No 228 231 o Yes 0 No 232 235 DYes 0 No 238 239 DYes 0 No 240 o Yes 0 No 244 215 i 219 STATE WASTE CODE 220 221 DAYS ON SITE _ I I 222 ¡ i i ¡ 223 i I I I I I I I 224 I o q RAIL CAR Dr OTHER o c CRYOGENIC 225 ..." CAS # 229 I 233 : I --1 I 237 i I J 241 ¡ 245 ~ / S:\CUPAFORMS\OES2731.TV4.wpd e CITY OF BAKERSFIEL. OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION 200 (one form per material per buDding or area) Page of ,!(N-'5,~__.. __~~D~._._ __~ ~~~!!-'5___._ 0 R~~~~___ I. FACILITY INFORMATION ; BU?:ir~t:t:;fU~~-~;;Uc J& k/~ ak : CHEMICAL LOCATION ~ I 5k1c~ _______________.._.'·M_.____ _._ _.___...___ 3 FACILITY ID # 203 ~T CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID # (optional) - o Yes ~ No 202, 204 : ¡ r-- --' CHEMICAL NAME II. CHEMICAL INFORMATION 205 TRADE SECRET 0 Yes ~ No 206 If Subject to EPCRA, refer to instructions o Yes 0 No 208 COMMON NAME CAS # J-r- ~ ~¡ ÓI1;¡ , EHS' 209 ·If EHS ¡.oY's.· alllI1lCW1Þ below mu~ be in n... FIRE CODE HAZARD CLASSES (Complete If requested by loCal fire chief) CURIES 213 210 I TYPE OpPURE DYes PHYSICAL STATE o s SOLID 216 ¡ , I (FED HAZARD CATEGORIES ~ ''''~''Ck aD that apply) t( Al WASTE ¡ A..oJUNT 01 FIRE /JQ m MIXTURE o w WASTE 211 RADIOACTIVE 215 ! ,., I LIQUID 214 lARGEST CONTAINER ogGAS o 2 REACTIVE ¡ij' 4 ACUTE HEALTH o 5 CHRONIC HEALTH o 3 PRESSURE RELEASE 217 MAXIMUM DAILY AMOUNT UNITS· . IlJ ga GAl 0 d CU FT . If EHS, amount must be In Ibs. STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK Db UNDERGROUND TANK Dc TANK INSIDE BUILDING o d STEEL DRUM AVERAGE DAILY AMOUNT 219 STATE WASTE CODE 220 ¡ 222: ¡ 1 DAYS ON SITE, o Ib LBS o In TONS 221 fí( e PlASTIC/NoNMETAlLIC DRUM ofGAN o 9 CARBOY o h SILO o i FIBER DRUM OBAG o k BOX o I CYliNDER o m GLASS BOTn.E o n PlASTIC BOTTLE 00 TOTE BIN o P TANK WAGON o q RAIL CAR o r OTHER 223 ¡ j 224 ; STORAGE PRESSURE a AMBIENT o sa ABOVE AM81ENT o ba BELOW AMBIENT " STORAGE TEMPERATURE ~ a AMBIENT %wr .... . . ," - ¡ .' , , n ~ ! 226 i 2 i 230 , i_..,._, - 1..3 r 234 238 UPCF (7/99) o sa ABOVE AMBIENT o ba BELOW AMBIENT o C CRYOGENIC 225 ".;-. .,' . 'tiÄžARDOUS C()MPONEN'( .~' CAS # 227 o Yes 0 No 228 231 o Yes 0 No 232 235 o Yes 0 No 236 239 o Yes 0 No 240 243 Dyes 0 No 244 229 233 : r --.J i 237 ¡ ; ..1 r 241 i 245 I III. SIGNATURE SIGNATURE 246 S:\CUPAFORMS\OES2731.TV4.wpd e CITY OF BAKERSFIELDe OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION .... ~.' , _~N.§~__" __~A...D!:J__,_...J:!. ~~~E!!:..___,,_~_~~~~~~__. 200 (one form per material per buDding or area) Page 01 -----------~_._._- ---_._-- ----.. 3 . I. FACILITY INFORMATION " BUSI~SJ NAME ~eJS FjflLJl'f ty.M~BA - ~ Business As) J / ð.../1 / ~ / ,¿ _ ~I1!f..~1ji-t.cr NVú ~ I ?~~S' ~~ ~ I:Æ m:/~ a~ ; CHEMICAL LOCATION ~ I 5k1c~ c"FÃCILlTY /0 II i r-- l 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID 1/ (optionaf) 203 o Yes ~ No 202. 204 ' --' 205 TRADE SECRET 0 Yes ~, If Subjecllo EPCRA. refer 10 instructions II. CHEMICAL INFORMATION CHEMICAl NAME , ¡ COMMON NAME I i i CASI/ , EHS· o Yes 0 No 208 207 M(c./ t!I~v< FIRE CODE HAZARD CLASSES (Complete If requested by loCal fire clliel) 209 '·If EHS ¡,oYes, . alIamounIS below mull be ÍD Ibs. .! 210 : TYPE ~ m MIXTURE 213 o w WASTE 211 RADIOACTIVE 0 Yes ~ No 09 GAS 214 lARGEST CONTAINER « o P PURE PHYSiCAl STATE o s SOLID IiIl LIQUID ¡ FED HAZARD CATEGORIES : ¡r""Ck all that apply) 'r( AL WASTE ¡ A>...JUNT I ¡ i 1til2 REACTIVE ø' 4 ACUTE HEALTH o 1 FIRE o 3 PRESSURE RELEASE ~ 5 CHRONIC HEALTH ) 218 AVERAGE DAILY AMOUNT .« 217 MAXIMUM CAlLY AMOUNT , UNITS· . ~ga GAL 0 cI CUFT 0 Ib LBS D In TONS . It EHS. amount must be In Ibs. 223 STORAGE CONTAINER (Check aI/that apply) it e PLASTICJNoNMETALLIC DRUM OrGAN o 9 CARBOY o h SILO o m GlASS BOTTLE o n PLASTIC BOTTLE DO TOTE BIN D P TANK WAGON D a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING D d STEEL DRUM o i FIBER DRUM 01 BAG Ok BOX o I CYLINDER I i J STORAGE PRESSURE ~ I STORAGE TEMPERATURE ~ a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT . Ql a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC CAS # .; .j', ':. . ~ ',"', ". . . '.-., ';'HAžARDO~S'c6MPONENT " %WT . .....;..:.;-.. ,., 226 227 Dyes ONo 228 231 o Yes D No 232 235 o Yes D No 238 239 DYes 0 No 240 Dyes DNo 244 ¡ 2 230 I , i-_...._ -,-- i 3 234 1- 4 238 5 242 ----- t'"'2::;;70~ ~;;;_"_Ame UPCF (7/99) CURIES 215 ! 219 218 ¡ I 220: ¡ 222: STATE WASTE CODE 221 DAYS ON SITE_ o q RAIL CAR o r OrnER í 224 ' I 225 I I 229 ! 233 i -----1 I 237 i 241 ! J 245 i S:\CUPAFORMS\OES2731.TV4.wpd tit CITY OF BAKERSFIELntt OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,,~N,~""'__n _,_~i\..D!?,_._ _~ ~~~!:!'~__,.,__e_~~~~~__. 200 (one form per meterial per building or area) Page of --~---------~._._._--_._----- ----"..-.-.+ 3 I. FACILITY INFORMATION ; 8USI~S~ NAME ~~e~as F)fILJY ~~BA - ~ Business As) J / /1.A / t' / ,¿ _ ~f/11(úrh'~l4" ñVú , ?~/'> ~{" A-vr i'Æ ~/~ a~ i CHEMICAL LOCATION ~I 5k1c~ . FACILITY ID # ~~ CHEMICAL LOCATION J CONFIDENTIAL (EPCRA) GRID # (optiona" o Yes ~ No 202 204 ' , , r I ; L----- .---_._--- CHEMICAL NAME COMMON NAME /1;)<s~ ~ CAS # 203 II. CHEMICAL INFORMATION 205 TRADE SECRET 207 EHS· o Yes No 206 If Subject to EPCRA. refer to instructions o Yes 0 No 208 FIRE CODE HAZARD CLASSES (Complete If requested by loCal fire chief) 209 I ·If EHS ¡s'Ves,' aU IIIIIOWIIS below must be in Ibs. 'i I 210 , TYPE o p PURE 212 CURIES 213 PHYSiCAl STATE o s SOLID 216 ! I FED HAZARD CATEGORIES ! ¡r~'>Ck aU that apply) r( AL WASTE ¡ A.....¡UNT I o 1 FIRE ¡ð m MIXTURE RADIOACTNE 0 Yes {llLNO lARGEST CONTAINER çs: /I//ðv1 215 219 STATE WASTE CODE 22O! ¡ 222 ¡ o w WASTE 211 221 DAYS ON SITE, [i?J I LIQUID ogGA5 214 STORAGE CONTAINER (CheCk all that apply) 223 o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING Cd STEEL DRUM STORAGE PRESSURE I(j a AM81ENT ¡g a AMBIENT STORAGE TEMPERATURE %Wf 8= I ' 1-..,-' I~ 226 230 234 4 238 5 242 o 2 REACTNE o 3 PRESSURE RELEASE ð 4 ACUTE HEALTH o 5 CHRONIC HEALTH 217 AVERAGE DAILY AMOUNT IbtJ f# MAXIMUM / / DAILY AMOUNT, / pO ·~gaGAL odCUFT , . If EHS. amount must be in Ibs. o Ib LBS o In TONS UNITS· 'þr e PlASTICJNoNMETAlLIC DRUM 01 CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYliNDER o m GLASS BOTTlE o n PlASTIC BOTTlE 00 TOTE BIN o P TANK WAGON o as ABOVE AM81ENT o ba BELOW AMBIENT , o sa ABOVE AMBIENT o ba BELOW AMBIENT "HAZARDOUS cOMPONÊNT· EHS 227 o Yes 0 No 228 231 o Yes 0 No 232 235 o Yes 0 No 238 239 o Yes 0 No 240 243 Dyes oNo 244 D COMPANY REPRESENTATNE . , UPCF (7/99) o q RAIL CAR Or OTHER o c CRYOGENIC i , , i I 224 I 2251 :CAS# 2291 I I 233 : I ------1 i 237 i I .J 241 ! J 245 I 246 I I .J S:\CUPAFORMS\OES2731.TV4.wpd tit CITY OF BAKERSFIELne OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,,~N,~\\I_. __~~?!'__ __~ [)~~~5-___e~ev~~!.___ 200 (one form per meterial per lJuildlng or area) Page of --._------ -----,.--.---.-.- ._~-_._._--_. 3 I. FACILITY INFORMATION .-B~?:ir;;lí,"telf~~~-~~;U<: J rYe ht-;/~ Cbk ! CHEMICAL LOCATION "fie I 5k1c~ FACiliTY 10# 203 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID # (optional) o Yes 11;1 No 202, 204 ' i ¡--- i L-__ CHEMICAL NAME II. CHEMICAL INFORMATION 205 TRADE SECRET 0 Yes 0{NO 206 If Subject 10 EPCRA, refer to instructions DYes 0 No 208 207 5m-,o -bh: d41Á I COMMON NAME i ¡ I CAStI t I ¡ FIRE CODE HAZARD CLASSES (Complete If requested by loCal fire chief) i t t TYPE ì I i PHYSICAL STATE o P PURE o s SOLID ; i FED HAZARD CATEGORIES : (r~..c!< aU \hat apply) r( At WASTE ¡ A..oVUNT t i o 1 FIRE UNITS· STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING ~ d STEEL DRUM I I i STORAGE PRESSURE ~ ¡ STORAGE TEMPERATURE We AMBIENT o c CRYOGENIC EHS· 209 i , . of( 5HS is"Y..." al18111OW11S below must be in Ibs. '" , I I ø m MIXTURE 211 I 214 j I o w WASTE RADIOACTIVE DYes 0 No 210 , 212 CURIES 213 lARGEST CONTAINER 5) f~r' 215 ! IQ I LIQUID OgGAS o 2 REACTIVE ' Jia" 4 ACUTE HEALTH o 3 PRESSURE RElEASE o 5 CHRONIC HEALTH 217 ç~ :r-ç MAXIMUM DAILY AMOUNT , ·Œ[gaGAl OdCUFT . If EHS. amount must be In Ibs. 218 AVERAGE DAILY AMOUNT o Ib lBS o In TONS o e PLASTICINoNMETALLlC DRUM Or CAN o 9 CARBOY o h SilO o I FIBER DRUM OJ BAG Ok BOX o I CYliNDER o m GLASS BOTTlE o n PLASTIC BOTTLE 00 TOTE BIN o P TANK WAGON o aa ABOVE AMBIENT o ba BELOW AMBIENT o ba BELOW AMBIENT -'.'.;, "~. ~- " ~ a AMBIENT 0 aa ABOVE AMBIENT , ',:, 'HÂZARDÔiJs'êôMP6N~NTh'~ %wr . ;" .:.' .~_ ;':'.1 .' I 1 ~ ¡ 2 ¡,--" - I.~ 226 230 234 4 238 5 242 227 o Yes 0 No 228 231 o Yes 0 No 232 235 OYesONo 236 239 o Yes 0 No 240 243 '. , ! ,P"'~T NAM)&J'r::e¡F AU;o/0,",D COMPANY REPRESENTATNE 1\ /f'þ&fIncI" U.z:;t#1VfC¡ I.·,:..-----·--'-----T'-' UPCF (7/99) ; I 216 i 219 STATE WASTE CODE 220 221 DAYS ON SITE, I 222 ; I 1 o q RAil CAR Or OTHER 223 224 :CAS# I 229 i i I 233 : I _--1 . i 237 i I J 241 i j 245 h Z~ATE 246 S:\CUPAFORMS\OES2731. TV4.wpd tit CITY OF BAKERSFIEL4 OFFICE OF ENVIRONMENTAL SE'RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION .,!(N~~_,___~~D~__,_ __9. ~~~~__.___~~5~~~~___ 200 ì , !....----. II. CHEMICAL INFORMATION : CHEMICAL NAME ì ¡ COMMON NAME I i i I CAS# I I i FIRE CODE HAZARD CLASSES (Complete if requested by loCal fire chief) ¡ I t.tiJ( Øt-~ c (one form per malerial per building or area) Page of - -.-.-----------.---.----. --.- ..._._..._~--. 3 o Yes ~ No 202 204 ' 205 TRADE SECRET 0 ' I '-'Yes ~ If Subject to EPCRA. refer to instructions 207 EHS· o Yes 0 No 208 209 '·If EHS is,"yes." all amounb below must be in Ibs. , 210 TYPE 2!1PPURE 212 CURIES 213 I I. FACILITY INFORMATION ~~'?.J;;;r;z,?J'u;:;-~";;'¿¡<' J &: J,;/'t a~_____ - ! CHEMICAL LOCATION ~ _( // /_ J /. 201 CHEMICALLOCATION ; ) W -;) (r:XÄI(.~ CONFIDENTIAL (EPCRA) ¡ FACILITY 10 # 203 GRID # (oplionaf) I o m MIXTURE o w WASTE 211 RADIOACTIVE 215 i PHYSICAL STATE o Ii SOLID 214 , I FED HAZARD CATEGORIES : (f" '>Ck aU that apply) r( AL WASTE I A..",UNT I I I Jðt 1 FIRE ß(I LIQUID LARGEST CONTAINER OgGA5 IIsJ 2 REACTIVE Ø. 4 ACUTE HEALTH o 3 PRESSURE RElEASE 217 MAXIMUM / DAILY AMOUNT, pO UNITS· . ff ga GAL 0 d CU FT , . If EHS, amount must be In Ibs. AVERAGE DAILY AMOUNT o In TONS I i ¡ STORAGE CONTAINER (Check all /hat apply) ~a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM I I : STORAGE PRESSURE f- ,STORAGE TEMPERATURE ø a AMBIENT De PLASTICI/IÌONMETALLlC DRUM Of CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER Dyes ~NO 6ð f4~ . 11'{ 5 CHRONIC HEALTH 6tJ ,4/ o m GlASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN o P TANK WAGON o sa ABOVE AMBIENT o ba BELOW AMBIENT I 216 I 219 STATE WASTE CODE 220 221 DAYS ON SITE, 2221 I I ! o q RAIL CAR o r OTHER 223 224 ¡¡a a AMBIENT 225 o/~wr '. " . -.:- ;~.:.:: ¡ ." - ; ~ 226 i 2 i 1-,--- I I 3 1-- 230 234 4 238 5 242 o ba BELOW AMBIENT o sa ABOVE AMBIENT .:. . " ~. . .' . ,. .:. I J , Hf\ZARDOUsc6MPONENT,' I ,po''''T NAME & TI~E 0j!Ur;JfI"ŒD COMPANY REPRESENTATIVE i~, ;#¿(/~ L/£r.ßL,-, 1,..-----.-..---.-----+--, UPCF (7/99) .'. . 227 DYes 0 No 228 231 o Yes 0 No 232 235 o Yes 0 No 238 239 o Yes 0 No 240 o Yes 0 No 244 o c CRYOGENIC CAS # 229 233 , I -~ I 237 ¡ I .J I 241 ! J 245 i I 246 I I S:\CUPAFORMS\OES2731.TV4.wpd tit CITY OF BAKERSFIELoe OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,,~N~""'_" __~~~_,,_,_9. ~~~!!.~__~~~~~~____ 200 ------------...-.-...--.----.-.- -_.-..._- 3 , I. FACILITY INFORMATION .-~~?4r:;r;;ZlfU~~-¥;;'¿jc J& k/~ ak ! CHEMICAL LOCATION ~ I 5k1c~ (one form per material per buDding or area) Page at ¡ FACILI'TY 10 II l j CHEMICAL LOCA nON CONFIOENTIAL (EPCRA) GRID /I (optionaf) DYes ~No 202 204 . 203 , r- II. CHEMICAL INFORMATION 205 I TRADE SECRET 0 Yes Œ;No 206 If Subject 10 EPCRA. refer to instructions ! L--__ CHEMICAL NAME EHS' o Yes 0 No 208 ; COMMON NAME WMh: tJt! 207 I I CAS# I , I 209 ·U EHS is'Yes," oJllIDOUIIIS below must be inlbs. . I . . I I FIRE CODE HAZARD CLASSeS (CQmpl9le if requested by loCal fire cNef) 210 , TYPE $1 m MIXTURE o Yes ¡('NO 212 CURIES 213 o w WASTE opPURE 211 RADIOACTIVE PHYSICAL STATE LARGEST CONTAINER ~~& f~ 215 : ogGAS ~ I LIQUID o s SOLID 214 , j FED HAZARD CATEGORIES ! (r~'OCk aU that apply) (( AL WASTE -,r""/'rl) : A.,oVUNT I è) (/ CI I f I ¡ Z{1 FIRE' - ßI. 2 REACTIVE o 3 PRESSURE RELEASE 1M' 4 ACUTE HEALTH 29,5 CHRONIC HEALTH 218 AVERAGE DAILY AMOUNT qo MAXIMUM DAILY AMOUNT LjO '~gaGAL odCUFT . If EHS, amount musl be in Ibs. o Ib LBS o In TONS UNITS· STORAGE CONTAINER (Check alt that apply) J;[a ABOVEGROUND TANK Db UNDERGROUND TANK o c TANK INSIDE BUILDING o d STEEL DRUM De PLASTICINoNMETALLIC DRUM Of CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN o p TANK WAGON I i J STORAGE PRESSURE I ' ~ ,STORAGE TEMPERATURE bI e AMBIENT o sa ABOVE AMBIENT o ba BELOW AMBIENT , 219 STATE WASTE CODE 216 j í 220 I I I 222 ; ¡ 221 DAYS ON SITE. o q RAIL CAR o r OTHER 223 224 o aa ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC 225' tia a AMBIENT o/~ wf ";'1".':'. -;0 ~.__ , ' . . ,- ~ -.', .... . -. '. ¡:, ,",. v' -,' .", ".., -.... . -, HAZARDOUS COMPONENT.··'· ." ~',-.1 . ~. ;.., . 226 227 o Yes 0 No 228 231 DYes 0 No 232 235 OYesONo 238 239 o Yes 0 No 240 i 2 , 1--,+-, 3 230 234 4 238 5 242 CAS # 229 ¡ I 233 , r ---~ ì 237 ¡ J 241 ¡ ~ 245 I I : ,PO'f\lT NAME ~7~OF AUTHORIZEj1'MPANY REPRE ENTATIVE :\. /17/~( Uf.'tA1( L_____,__. - ~ DATE 246 I , I Z~&I ! .__ I UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd " . e CITY OF BAKERSFIELrAt OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,~N~,:,__,__~~.D~,_._ ,-.!:! ~~!:..~______~~~~~~____ 200 (one form per materiat per buDding or af'fla) Page at _________~_>_.~__.__._'._ _ h4__"."__ 3 , I. FACILITY INFORMATION c eUS¡:ir;;;l;zlfUr;:A.~e;;L6~ J ¿)¿ #;/~ a~_ ; CHEMICAL LOCATION -4 a I ./1 /- J /.. 201 CHEMICAL LOCATION , ) W ;J ;-r::r:;« ~ CONFIDENTIAL (EPCRA) c-¡:ÃCILITY 10 iii 203 GRID iii (optional) ¡ r--- L--_. CHEMICAL NAME COMMON NAME iJ¡/ CAS iii II. CHEMICAL INFORMATION o Yes ~ No 202 204 205 TRADE SECRET 0 Yes ~Ne 206 If Subject to EPCRA. refer 10 instructions 207 EHS· o Yes 0 No 208 209 ·If EHS is"Yes." all aIIIOWIIS below must be in Ibs.' ! I FIRE CODE HAZARD CLASSES (Complete If requested by loCal fire chief) .... TYPE ~ p PURE PHYSICAL STATE o s SOLID i FED HAZARD CATEGORIES : ¡"''ICk an thaI apply) r( AL WASTE ¡ Am'-"UNT J:a 1 FIRE UNITS' STORAGE CONTAINER (Check aU that apply) fZJ a ABOVEGROUND TANK Db UNDERGROUND TANK o c: TANK INSIDE BUILDING o d STEEL DRUM I i ¡ STORAGE PRESSURE ~ j STORAGE TEMPERATURE B2Ø a AMBIENT 210 : ø m MIXTURE RADIOACTIVE 0 Yes 0 No LARGEST CONTAINER Z..(¡. !þ o w WASTE 211 213 216 ¡ I 219 STATE WASTE CODE 220 (Ø I LIQUID ogGAS 214 221 DAYS ON SITE. ¡ 222 ' j ¡ 82 REACTIVE 1&4 ACUTE HEAlTH !g 5 CHRONIC HEAlTH o q RAIL CAR Or OTHER 223 o 3 PRESSURE RELEASE 217 ¿ o c CRYOGENIC i i 224 ; I 225' ø a AMBIENT -....... " . ." " . %WT .; . .;.' ;:.. ~.,';1.. ~, .' ,;-.:.¡ ~ .. 226 : 2 I , !--,., - i 3 1- 230 234 4 236 5 242 AVERAGE / J DAILY AMOUNT . -it?z' o Ib LBS 0 In TONS 'I ð» .Ill 9a GAL 0 d CU FT . If EHS, amount musl be In Ibs. De PLASTICINoNMETALLIC DRUM DlCAN 09 CARBOY o h SILO o i FIBER DRUM o/BAG Ok BOX D f CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN D P TANK WAGON o aa ABOVE AMBIENT D ba BELOW AMBIENT . D aa ABOVE AMBIENT o be BELOW AMBIENT ,-,'- . .... :-" .; - ,.... -.. - . -,. ~J' .. ". . .r,.,,". . .'.. HAZARDOl,JS COMPONENT' . 227 Dyes ONe 226 231 D Yes 0 No 232 235 DYes D No 236 239 Dyes oNo 240 Dyes ONe 244 iC~~~1;:- UPCF (7/99) CAS # I 229 : I I 233 , I --.J I 237 j J 241 ¡ J 245 I ¢V;0E 246 I I I S:\CUPAFORMS\OES2731.TV4.wpd ~. e CITY OF BAKERSFIELne OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION . ,~!'I,~\'I__,__~~~__ _~ ~~~!!!'____9.~~~~~_ 200 (one fonn per material per builc1lng or area) Page of - -------- -----~ -~~+---_._._~._,- - -.- _.."-- 3 I. FACILITY INFORMATION ¡ BUSI~S'NAME~~eias~l~ftM~BA-~BuslnessAs) / I /J../1 / f / ,¿ _ f_pIf1fWfii-l.ef/ NVú ~ I ?~)~ ~(" Ad t/C ~/~ a~ ¡ CHEMICAL LOCATION ~ I 5'klcM ¡'-FÂCILlTY ID # i r---- L___ 203 1 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID # (oplionaf¡ CHEMICAL NAME o Yes ~ No 202 204 . 205 TRADE SECRET 0 I 'Yes~' If Subject to EPCRA, refer 10 instructions II. CHEMICAL INFORMATION COMMON NAME ;%d ~ ?d~ EHS' CAS # ¡Ç( 207 o Yes 0 No 208 . FIRE CODE HAZARD ClASSES (Complete If requested by loCal fire chief) 209 ·If EHS is"Yes,' alllI1IICWIIS below must be in Ibs. 210 ' TYPE OpPURE 212 CURIES 213 PHYSICAL STATE a s SOLID , I FED HAZARD CATEGORIES i (r""Ck atl that apply) r{ Al WASTE : A...JUNT I ItiJ 1 FIRE UNITS· IXf m MIXTURE 18:(1 LIQUID a w WASTE 211 I RADIOACTIVE 0 Yes .IQ No 214 I LARGEST CONTAINER I 215 : 216 i 219 STATE WASTE CODE 220 ogGA5 221 DAYS ON SITE, i 222¡ ~2 REACTIVE III 4 ACUTE HEALTH ~5 CHRONIC HEAlTH 223 . ! STORAGE CONTAINER (Check alt that apply) a a ABOVEGROUND TANK 1ii{ b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM I i i STORAGE PRESSURE ~ I ,STORAGE TEMPERATURE bõ' a AMBIENT 1M- a AMBIENT %Wf ,',.of" ",',: ,.' ''';.,' .. 226 i 2 230 I._-..L-, I-~ 234 4 238 5 242 ~3 PRESSURE RELEASE 217 MAXIMUM f) /../' CAlLY AMOUNT , Iv" . M,ga GAl 0 á CUFT . If EHS. amount must be In Ibs. a Ib LBS a In TONS 218 AVERAGE DAILY AMOUNT ¡ok a e PlAST1CJNoNMET AlLlC DRUM Of CAN 09 CARBOY a h SILO o i FIBER DRUM OjMG Ok BOX a I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN o p TANK WAGON o aa ABOVE AMBIENT a ba BELOW AMBIENT , a ea ABOVE AMBIENT o be 8ELOW AM81ENT . - ". ".:. , ' 'HAŽARDOÙS'coMPoNEN'r " EHS ' 227 DYes oNo 228 231 a Yes a No 232 235 a Yes a No 236 239 ayes oNO 240 I :, pO/lilT NAME & TITLE OF AU~IZED COMPANY REPRESENTATIVE :~, 4Ir~Ifc,II/~£y -- ~ 1,.,-----.;.--,--- _-¡-____ UPCF (7/99) o q RAIL CAR Or OTHER o c CRYOGeNIC i ! i 224 I 225 ':CAS#: I 229 : I I 233 , I I i 237 j I J 241 ! J 245 I DATE 246 I I J S:\CUPAFORMS\OES2731.TV4.wpd e CITY OF BAKERSFIEL4 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,,~~\'J__,.__~~D~_._....E. [)~~~!~_.__._~_~~~~~__. 200 -_.-.--------'-_.~_.._.._---_.~-- -----..--------. 3 I. FACILITY INFORMATION BUSI~SJ NAME ~e"as FJflLJlY ~~BA. ~ Business As) J /11 A / f / ,¿ _ ~. ff"41(úJ?!¡~u.r ~ 7"", ?'fU..!,f' ~<" ~ I'.K ~/~ a~_ t, CHEMICAL LOCATION ..t::; _I .//, /_"J ~ 201 CHEMICAL LOCATION ) ?o -;) ~ 'l'f.Æ£ CONFIDENTIAL (EPCRA) r-FÃëiLfry ID t# -r 203 GRID # (Optional) i r- .----- II. CHEMICAL INFORMATION (one form per material per buDding or atlla) Page 01 o Yes ~ No 202, 204 ' h£M(~ t#b/J 20~RADESECRET 0 m1 'Yes q No 206 ' If Subject to EPCRA. relet to instructions ! CHEMICAL NAME f---- i COMMON NAME ! o Yes 0 No 208 : 207 EHS· CAS # FIRE CODE HAZARD CLASSES (Compl8lelf requested by loCal Ore chief) 209 ·ff EHS is"Yes,' all amOWllS below muSl be in Jbs. 210 TYPE o p PURE 212 CURIES 213 øø m MIXTURE RADIOACTIVE DYes Œ(NO o w WASTE 211 PHYSICAL STATE o s SOLID ; 216 j ; i FED HAZARD CATEGORIES : ¡"'''Ck aD Ihelapply) r( AL WASTE ¡ A....,UNT tÇ 1 FIRE UNITS' 0(1 LIQUID I[)k 215 ; 219 STATE WASTE CODE 22O! ¡ 222 ! OgGAS 214 LARGEST CONTAINER 221 DAYS ON SITE, fþl2 REACTIVE Œ:4 ACUTE HEALTH I2i( 5 CHRONIC HEALTH 223 STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK O!I b UNDERGROUND TANK o ç TANK INSIDE BUILDING o d STEEL DRUM ¡ I J STORAGE PRESSURE i- STORAGE TEMPERATURE ¡þ( e AMBIENT æ e AM81ENT " %Wf , - 226 i 2 230 1--,,--1 I 3 234 4 236 5 242 1]æ3 PRESSURE RELEASE 217 MAXIMUM OAIL Y AMOUNT , 218 AVERAGE DAILY AMOUNT , /ok /OA" . 0t1 ga GAL 0 á CUFT 0 ib Las 0 In TONS . If EHS. amount must be In Ibs. De PLASTIC/NoNMETAlLIC DRUM Of CAN 09 CARBOY o h SILO o I FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN op TANK WAGON o aa ABOVE AMBIENT o be BELOW AMBIENT o /Ie ABOVE AMBIENT ";-liAžÄR6ôûs'êóMPONENT o be BELOW AM81ENT o q RAIL CAR Or OTHER I 224 ¡ I 225 I 'EHS .. o ç CRYOGENIC <CAS # ' 227 0 Yes 0 No 228 231 0 Yes 0 No 232 . . - ", ~ 235 OYesoNo 238 239 o Yes 0 No 240 243 o Yes 0 No 244 '..' , , ! (ØI~TNA;;¿wORIZ ~COMPANYR~&::: L_______.__, ~ UPCF (7/99) 229 233 i _----1 i 237 ¡ J 241 ¡ J 245 i I . , ~ ,TE ,__,_.~_._i~ ~/~ I 246 I I .J S:\CUPAFORMS\OES2731.TV4.wpd ,~ e e ,--~--------'-'----- -.------------------------------- I. FACILITY IDENTIFICATION CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 32,6-3979 FACILlTV INFORMATION Business Activities ì----.--~--- i ------- II. ACTIVITIES DECLARATION i i I L I' A. 1. ---. ;, '1";"""""," Page of -------.--------..--.------.--- I ! FACILITY IÕïi(For office usêoñ¡y=p¡ease leavêï;iã'rik)- 1 'LA 10 i/--- -- ----'--" ----, ï D~:~i;j/u- Þ/~/¡tt:~ t~ J ¿f~/nf c;:;r-'- --------'------'----'---------3-' , 2. ! l ; B. ì I i ! C. (,1. ì'~- : I ~ÑK:ClOSURE/REMOVAl I 1. Need to report closing a UST that held hazardous i materials or waste? I ì 2. Need to report the closure/ removal of a tank that was ! classified as hazardous waste and cleaned onsite? I E. ABOVE GROUND PETROLEUM STORAGETANKS (ASTs) I 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. F. HAZARDOUS WASTE: 1. Generate hazardous waste? I I 2. Recycle more than 100 kg/mD of recyclable materials at I the same location it was generated? I 3. Recycle more than 100 kg/mo of recyclable materials at ¡ an offsite location different from the point of generation? i 4. Treat Hazardous Waste on site? I -----.. OVES ONO 5 OVES .NO 6~ .... I .... I .... I I 7 .... .... 8 .... .... .... 9 ¡ .... I OVES eNO 10 I .... TANK CLOSURE FORM ~ 1____, r .VES ~O~ .... CONSOLIDATED COMPLIANCE PLAN / . Incorporating Federal Spill Prevention Control and Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112 EPA ID number-provide on this page To obtain EPA ID#, please phone (916) 324-1781 RECVCLlNG FORM 15 I¡.... TP FACILlTV FORM (DTSC Form 1772) .... TP UNIT FORM (one per unit) .VES ONO 16.... CERTIFICATION OF FINANCIAL ASSURANCE (fVES ONO ~: I ~ REMOTE WASTE / CONSOLIDATION SITE ~ NOTIFICATION FORM OYES .NO 18 II ;/-- CONSOllDATED-ëOMPLlANCE PLAN . Incorporating all other environmental I permit requirements per 27 CCR 10410 Does Your Facility... HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55,gallon5 for liquids, 500 pounds for solids, or 200 cu ft for compressed gases (include liquids in ASTs and USTs)? Have any amount of an explosive material (other than ammunition) on site? , .VES ONO 4 .... 12 13 .... 2 .... .... If Yes, Please Complete... OES FORM 2731 (Chemical Description Form) CONSOLIDATED COMPLIANCE PLAN Minimum required planninQ elements: · Emergency Response Plan · Maps · Training · Prevention · Certifications REGULATED SUBSTANCES (RS) Have onsite RS at greater than the threshold planning quantities established by the California Accidental Release Prevention program (CaIARP)? UNDERGROUND STORAGE TANKS (USTs) Own or operate Underground Storage Tanks? Intend to upgrade existing or install new USTs? .VES ONO OVES ONO 14 .... OES FORM 2731 (Chemical Description Form) RISK MANAGEMENT PLAN (RMP Submit to USEPA) CONSOLIDATED COMPLIANCE PLAN · Incorporating CalARP Program Elements UST FACILITY FORM UST TANK FORM (one per tank) UST FACILITY FORM UST TANK FORM UST INSTALLATION FORM (one per tank) ---- UST TANK FORM (dosure section-one per tank) RECVCLlNG FORM i i I I I I i I I \ I OVES ONO .VES ONO OVES eNO OVES .NO OVES if NO 5. Subject to Financial Assurance requirements? 6. Consolidate Hazardous Waste generated at a remote site? ( :>TE: . . ·1 " If yo, ohed<ed YES to aoy part of Seoti"'" 11A-IIG above, th.... In addlllon to the Ionn. '"",ested above, plea.. S,"mlt aES Fonn 2730. G. PERMIT CONSOLIDATION ZONE: Intend to consolidate other CallEPA agency permits? (If yes, please complete Section III and attach) UPCF (7/99) S:ICUPAFORMSIACTIVITY,wpd "" e e " CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORMATION Business Activities Addendum Page of I ! FACILITY 10 # (For office use only - please leave blank) i I I I. FACILITY IDENTIFICATION ~EPAID# ___.L___________ 2 I DBA/FACILITY NAME ,/J ; ~/r6tS~èltr,¢;6~/' G¡JlKff 1..6L",dJ lÎ~þ,~ L~ I 3 Is your Facility Compliance Plan subject to review by... I H. DEPARTMENT OF TOXIC SUBSTANCES CONTROL OYES eNO I I ¡ I 1 ¡ I. SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION i CONTROL DISTRICT, L J. STATE WATER RESOURCES CONTROL BOARD l III. CONSOLIDATED PERMIT ACTIVITIES for satisfying the conditions of these permits? STANDARDIZED PERMIT . All Modifications t/ OYES .NO t/ It/ Non-RCRA HAZARDOUS WASTE FACILITY OYES ONO RCRA HAZARDOUS WASTE FACILITY eYES ONO t/ AUTHORITY TO CONSTRUCT eYES ONO t/ PERMIT TO OPERATE .YES ONO It/ WASTE DISCHARGE REQUIREMENT (WDR) ':NTRAL VALLEY REGIONAL WATER QUALITY CONTROL eYES ONO t/ GENERAL PERMITS I dOARD ¡_YES ONO I t/ SPECIFIC PERMITS ì I I ; i t/ NATIONAL POLLUTION DISCHARGE I i .YES ONO ELIMINATION SYSTEM (NPDES) I I K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES ONO t/ REGISTRATION PERMIT ! i I i I L. KERN COUNTY RESOURCE MANAGEMENT AGENCY ENVIRONMENTAL HEALTH SERVICES PERMITS I OYES .NO t/ Domestic Water Well Permit I ! I OYES _NO t/ Haz Mat Monitoring Well Permit I OYES ~NO t/ Septic System Permit i I I OYES _NO t/ Public Swimming Pool Permit ! I I OYES _NO I t/ Food Facility Construction Permit ¡ i OYES .NO\ t/ Solid Waste Local Enforcement Agency ! (LEA) Related Permits ! OYES eNO t/ Medical Waste Related Permits ¡ i i M. CITY OF BAKERSFIELD WASTE WATER DIVISION fl'YES ONO t/ INDUSTRIAL WASTE WATER DISCHARGE ¡ PERMIT i NOTE: I ! I t/ If you checked YES to any part of Sections III-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan. I ( S:ICUPAFORMSlAclMty adondum,wpd July 1, 1998 .. e CITY OF BAKERSFIEL. OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION Page _ Of I. FACILITY IDENTIFICATION ¡ FACILITY ID # : " ~¡ I I 1 Year Beginning 100 I Year Ending 101 ! BUSINESS NFM~ J.5a!J1~S FACILl~ NAME or DBA· Doi29Busin~s j5).L 'I . /1~ L A 3 I BUSINESS PHONE 102 L_,M~s.-'i!-'!!:,,~S¡!~LE!t«f'(' LJX ~!!é~~"!...r~~_,____L,..~ / ð'1f.'=9/1['___,_,________, i SITE ADDRESS ,,/ /,. J1; / / y- 103 i )U I .;: /'PCIf crH1 (' /'TW f CITY 'ffÁ/rUJ !f£/cIJ 104 I CA I ZIP e¡TJð 1 I DUN & 106 I,' SIC CODE I BRADSTREET ,. (4 Digit #) ~UNTY k~ I OPERATOR NAME I I ¡ OWNER NAME i I ! OWNER MAILING ¡ ADDRESS L-, I . L( 1"5fð1 116 1 'I . , ' " .., , 1 ¡::;'\'}'III/ENVIRONMENTAL CONT~(:T " I : CONTACT NAME /I1i&hltt:/ i)~Î,"if'Jl(~ 117/ CONTACT PHONE It/ !ltf-4/11 ~,~ ~ONTACTMAILlNG -C ~/ /.,j ¿1 f ~¿ 119 I ADDRESS :> ZtJI ::> ~CK'q'lf-t:e /~ i CITY 1Š~ ~4/ . 120 I STATE ðf 121 I·" ,. . I -PRIMARY- .'.,. , IV. EMERGENCY CONTACTS" .... I NAME 1If~1 ¡Æt-#vr1''f '" I NAME ~ r;¡yIM.. I_TITlE ~/4f"""f''''-f /ff~ '" ! TITLE It(ffXdr~ BUSINESS PHONE ttl nt/ ql/)" 126 I BUSINESS PHONE ~( 1_":"-OUR PHONE qJ.¡ "7?2 ~i? 'I r¡1' ~HOUR PHONE 661 1'1/ ~/.'/_""_ I PAGER # 128 1 PAGER # . ¡ . . V. CERTIFICATION, ' I I 105 : i 107 I I I I ... .. .. . .' p. ,. ..., 109 ~RATOR PHONE : ·IL OWNERINFORMATIOt:J'-': 108 I i 110 ¡ I I 111 ¡ OWNER PHONE I "r ð''lt/-9/I5"'' j 112 i , 113 ' ZIP err!'µ¡- . ;..... ;.sECONDARY· 122 129 . I 130 ! 131 ! , 132 : ! n m inquiry of those individuals responsible for obtaining the information, I certify under penalty of Jaw that I have personally examined the' formation submitted in this inventory and believe the information is, true, accurate, and complete. SIGNATURE, OW RIOPERATOR DATE / 1341 NAME OF DOCUMENT PREPARER I. 7/fln ,__,_,_.__ ,L,______, ,NAM~ qyvNE~,l%TOR (priot) '" TI LE OF O~PERATOR l~__!# . ~/___u__ __~ ~iL!"~£v( I 133 i i I I I I i I I 135 I I I I I 137 I I I ! UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd " Isiness Owner/Operator Identificlon -: Please submit the Business Activities page. the Business Owner/Operator Identification page (OES Fonn 2730). and Hazardous Materials - Chemical Description pages (OES Fonn 2731) for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual. "Iote: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used Jr electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY 10 NUMBER - This number is assigned by the CUPA or M. This is the unique number which identifies your facility. 3. BUSINESS NAME - Enter the full legal name of the business. 100. BEGINNING DATE - Enter the beginning year and date of the report. (VYYYMMDD) 101. ENDING DATE - Enter the ending year and date of the report. (VYYYMMDD) 102. BUSINESS PHONE - Enter the phone number. area code first, and any extension. 103. BUSINESS SITE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This infonnalion must provide a means to geographically locate the facility. 104. CITY - Enter the city or unincorporated area in which business site is located. 105. ZIP CODE - Enter the zip code of business site. The extra 4 digit zip may also be added. 106. DUN & BRADSTREET - Enter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling (610) 882-7748 or by Internet. 107. SIC CODE - Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more than 4 digits. report only the first four. 108. COUNTY - Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business operator. 110. BUSINESS OPERATOR PHONE - Enterbusinèss operator phone number, if different from business phone. area code first. and any extension. 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER PHONE - Enter the business owner's phone number if different from business phone. area code first. and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's mailing address if different from business site address. 114. OWNER CITY - Enter the name of the city for the owner's mailing address. 115. OWNER STATE - Enter.the 2 character state abbreviation for the owner's mailing address. 116. OWNER ZIP CODE - Enter the zip code for the owner=s address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACT NAME - Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE - Enter the phone number, if different from Owner or Operator. at which the environmental contact can be contacted. area code first. and any extension. 119. CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent. if different from the ( site address. .20. CITY - Enter the name of the city for the environmental contact=S mailing address. 121. STATE - Enter the 2 character state abbreviation for the environmental contact=s mailing address. 122. ZIP CODE - Enter the zip code for the environmental contact=S mailing address. The extra 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency invoMng hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 124. TITLE - Enter the title of the primary emergency contact. 125. BUSINESS PHONE - Enter the business number for the primary emergency contact, area code first. and any extensions. 126. 24-HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 127. PAGER NUMBER - Enter the pager number for the primary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access. site familiarity, and authority to make decisions for the business regarding incident mitigation. 129. TITLE - Enter the title of the secondary emergency contact. ' 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extension. 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24 hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number. then the service answering the phone must be able to immediately contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUPAs or AAs to collect any additional infonnatlon necessary to meet the requirements of their indMduaJ programs. Contact your local agency for guidance. 134. DATE - Enter the date that the document was signed. (YVYYMMDD) . 135. NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal infonnation. 136. NAME OF SIGNER - En~ the full printed name of the person signing the page. The signer certifies to a familiarity with the Infonnatlon submitted and that based on the signer=s inquiry of those individuals responsible for obtaining the infonnation, all the Information submitted is true. accurate and complete. SIGNATURE OF OWNER! OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall ~gn in the space provided. This signature certifies that the signer is familiar with the infonnatlon submitted and that based on the signer=s inquiry of those Individuals responsible for obtaining the infonnatlon It Is the signer=s belJef that the submitted information is true, accurate and complete. 137. TITLE OF SIGNER - Enter the title of the person signing the page. , e CITY OF BAKERSFIEL' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,,~~~~,___,_~~D~,_,~D!~~____~EVIS~____ ! l : BUSINESS NAME €Ja"'.e~as F)fILJlY ry-ME i ~drWhi,~ /Me r CHEMICAL LOCATION I i I FACILITY 10 # L__, [ CHEMICAL NAME tilt l~aI tÎK Iflt,,'r I COMMON NAME I CAS# 200 (one form per material per building or area) Page of ----------------------.."-- 3 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) 2õ3fGRID # (optionaf) II. CHEMICAL INFORMATION 2Ò5 TRADE SECRET 207 EHS· o Yes ~ No 202 204 DYes FIRE CODE HAZARD CLASSES (Complete if requested by loCal fire chief) 209 ·If EHS isM Yes. . all amounts below must be in Ibs. o Yes 0 No 208 L I TYPE I I PHYSICAL STATE ! 210 o p PURE )(1 m MIXTURE o w WASTE 211 RADIOACTIVE DYes ~NO 212 t CURIES 213 I o s SOLID ~ I LIQUID o 9 GAS 214 LARGEST CONTAINER lOIn-!) f"'(ke 215 ~1 FIRE W 2 REACTIVE Jll3 PRESSURE RELEASE þl4 ACUTE HEALTH ø 5 CHRONIC HEALTH 216 217 MAXIMUM ¡Ok 218 AVERAGE ¡OK 219 STATE WASTE CODE 220 DAILY AMOUNT DAILY AMOUNT UNITS· ~ ga GAL o d CUFT o Ib LBS o tn TONS 221 DAYS ON SITE 222 . If EHS. amount must be in Ibs. FED HAZARD CATEGORIES ¡(I"'<>ek all that apply) r( AL WASTE i A,....JUNT I I I : STORAGE CONTAINER i (Check all that apply) I I I I STORAGE PRESSURE f-'-- STORAGE TEMPERATURE o a ABOVEGROUND TANK ~ b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM De PLASTIC/NONMETALLIC DRUM Of CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o P TANK WAGON o q RAIL CAR o r OTHER 223 'ó(I' a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT , 224 o aa ABOVE AMBIENT o ba 8ELOW AMBIENT 225 o c CRYOGENIC 227 DYes 0 No 228 229 231 o Yes 0 No 232 233 j ~ I 235 o Yes 0 No 236 237 I I ---- J I 239 DYes 0 No 241 I 240 DYes 0 No 244 245 ~ a AMBIENT , . ~ - . '.' - .'.1 . ". ',·'..1 ' , HAZARDOUS COMPONENT . ',·'Ofo wr . 226 i 2 230 L.L-,-, 13 234 4 238 5 242 pOll'IT NAME & TITLE OF AUTHORIZ~ COMPANY REPRESENTATIVE I ( tØwW Ot"tA-f~ -iW71ûl L_______,___,_I- CAS # 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd '. e - ,j' Hazardous Materials Inventory· Chemical Description You must complete a separate Hazardous Materials Inventory - Chemical Description page tor each hazardous material (hazardous substances and hazardous waste) that you handle at your taclllty In aggregate, quantities equal to or greater than 500 pounds. 55 gallons, 200 cubic teet of gas (calculated at standard temperature and pressure) or the tederalthreshold plannong quantIty tor Extremely Hazardous Substances. whichever is less, Also complete a pege for each radioactive material handled over quantities tor wt1ich, an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantltfes of hazardous matenals at your faCIlity, reported separately tor each building or outside adjacent area. with separate pages tor unique occurrences of physical state. storage temperature and storage pressure, (Note: the numbering of the instructions tollows the data element numbers that are on the UPCF pages. These data element numbers are used tor electronic submission and are the same as the numberin9 used in 27 CCR. Appendix C, the Business Section of the Unified Program Data Dictionary,) Please number all pages of your submittal, This helps your CUPA or M identify whether the submittal is complete and if any pages are separated. 1. FACILITY 10 NUMBER - This number is assigned by the CUPA or M. This is the unique number which identifies your facility, 3, BUSINESS NAME - Enter the full legal name of the business. 200. ADD/DELETEI REVISE - indicate if the material is being added to the inventory. deleted from the inventory, or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201, CHEMICAL LOCATION· Enter the building or outside! adjacent area where the hazardous material is handled, A chemical that is stored at the same pressure and , temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is nol subject to public disclosure pursuant to HSC §25506. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA· All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check "Yes" to keep chemical location information confidential, If the business does not wish to keep chemical location information confidential check "No'. 203, MAP NUMBER· If a map is included. enter the number of the map on which the location of the hazardous material is shown. 204. GRID NUMBER· If grid coordinates are used. enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable. multiple grid coordinates can be listed. 205. CHEMICAL NAME· Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not complete this field; complete the 'COMMON NAME" field instead. 206. TRADE SECRET· Check "Yes' if the information in this section is declared a trade secret, or "No" if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by HSC §25511. Federal requirement: If yes, and business is ~ubject to EPCRA, disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a 'Substantiation to Accompany Claims of Trede Secrecy" form (40 CFR 350.27) to USEPA. 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS . Check "Yes" if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209. CAS # . Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or M to collect it. A list of the hazard classes and instructions on how to determine which class a material fails under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class, include all. Contact CUPA or M for guidance. 211. HAZARDOUS MATERIAL TYPE - Check the one box that best describes the type of hazardous material: pure, mixture or wasle. If wasle material, check only that box. If mixture or waste, complete hazardous components section. 212. RADIOACTIVE - Check ·Yes" if the hazardous material is radioactive or "No' if it is not. 213. CURIES· If the hazardous material is radioactive, use this area to report the actMty in curies. You may use up to nine di9its with a floating decimal point to report activity in curies. 214. PHYSICAL STATE· Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total capacity oflhe largest container in which the material is stored. ( 216. FEDERAL HAZARD CATEGORIES - Check all cateaories that describe the chvsical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Liauids and Solids, Combustible Liauids, Pvrochorics. Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives. Reactive: Unstable Reactive. O-manic Peroxides, Water Reactive, Radioactive other hazardous chemicals with an adverse effect with short term eXOO5ure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with lono term exnasure . . 217. AVERAGE DAILY AMOUNT - Calculate the average dally amount of the hazardous material or mixture containing a hazardous matenal, In each building or ad¡acent/ outside area. Calculations shall be based on the previous years inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location. the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218. MAXIMUM DAILY AMOUNT· Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at anyone time over the course of the year. This amount must contain at a minimum last years inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT - If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE ·If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221. UNITS· Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that , the material is stored in (gallons, pounds, cubic feet, or tons). 222. DAYS ON SITE - List the total number of days during the year that the'material is on site. 223. STORAGE CONTAINER· Check all boxes that describe the type of storage containers in which the hazardous material is stored, NOTE: if appropriate, you may choose more than one. 224. STORAGE PRESSURE· Check the one box that best describes the pressure at which the hazardous material is stored, 225, STORAGE TEMPERATURE· Check the one box thai besl describes the temperature at which the hazardous material is stored. 226. HAZARDOUS COMPONENTS 1·5 (% BY WEIGHT) - Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227. HAZARDOUS COMPONENTS 1·5 NAME· When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in Ihe mixture present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231. 235, 239, and 243,) 228. HAZARDOUS COMPONENTS 1·5 EHS . Check 'Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or 'No· i'it is nol. (Report for components 2 throu9h 5 in 232, 238, 240, and 244,) 229. HAZARDOUS COMPONENTS 1-5 CAS· List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2,5.) 246, LOCALLY COLLECTED INFORMATION - This space may be used by the CUPA or M to collect any additional information necessary to meet the requirements of their individual programs. Contact the CUPA or M for guidance. ( UPCF (1/99) 7 OES Fonn 2731