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HomeMy WebLinkAboutBUSINESS PLAN 5/4/2001 ~ .J "It (tþ \, HMMP PLAN MAP :,,; SITE DIAGRAM FACIUTY DIAGRAM Business Name: Sundale Country Club / Buslness.Address: 6218 Sundale Avenue :5 f7'ê (. D. * He¡ 7 For Office Use Only , Iì\ { ~ Fht in Station: Inspection Station: Area Map# Of NORTH Fertilizer Gypsum Urea Oil 000 Grass Seed Storage ¡Junk Room .- j Gas Diesel Office File Storage f<-lÆ:.£:¡-r- ILl£... ,.-y .$~Ù'\ .:=o~ L..J Welder Office Equipment Shed Shop Time Storage #2 Storage #1 Clock Lunch Room Shwr. 8ath Parts l CÎA~ M~e::,~\ \ ti 6~J'1 ~\ .J~~\ 'V / Sencor Ttrf Herbicide Oi Quat Herbicide -. Maxiplex Soli Amendment Rubigan Fungicide Aquagro L Vitamin B 1 Trlmlc Plus Herbicide Apsa 80 Spray Rennaissance Nutrient Compound Ferromec AC Liquid Iron Tesan 1991 Herbicide Surf/an Herbicide Roundup Oacthal W-75 Herbicide Potassium Nitrate 13.5-0-45 Champion Potassium Nitrate 3336 WO Fungicide 6-2- 12 Chemical Fertll/zer r Kiso Spray Cleaner Elanco Balan ' Best Greenskote 18-3-18 Fertilizer U~a18-4-10F~Unz~ Fast Green 16-4- 8 Pellets Scotts Pro Turf 19-0-17 Fertilizer !Jumper Harvest Gypsum DlIsban 2 GrBnuals Par Ex 14-19-19 Best Triple 12-12-12 Omega Medil/st Grass Seed Pencross Bent Seed Scotts Pro Turf Insecticide Preemergent Weed Control - " " ~' e $u-~á~1~ /~"A~C~,^h.- b~(J- >~/'^- àh- iIv~. / F,~ }fy (::) flAw r \..~-~-_// '. / ¿ !-t- - - ¡ ~ - Séûuúk '. 6218 SUNDALE AYENUE·. BAKEFlSFIELD,'CALiFORN'ÎÄ 93309 " PROSHOP(661)831~5224 e. BUSINESS OFFICE (661) 83i~4200 Cauntry,Club . ' , , , , , , r;.s~Þ~~ ',." " ø~'-v-1ç ~V~I'~.JòJ\5?yv'~ .,', '[),~h~. j)~0_r~~. / / e ~/OI /' n J ¿ ____ c. ^ 0 >/'- ::. 5> ~ /:-r N 1L-r(ff~4~ /I~~ r lA+~~1 s~~';j-1/!; .. ê---Y . (f-w-r~7 w~~· /h.,~ ' ~ - - , '- ,< - , .. :k 1~1 ~J..o L$r~' ì 5~~)~:/ . / /' / ' ·1~J-~~ Per it Operil.te to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the following: IØ Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment Permit ID #:: 015-000-001197 SUNDALECOUNTRYCLUB LOCATION: 6218 SUNDALE AVE Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: Issue Date June 30, 2003 -'f. HMMP PLAN MAP SITE DIAGRAM FACIUTY DIAGRAM Business Name: Sundale Country Club Business Address: 6218 Sundale Avenue For Office Use Only First in Station: Area Map# Of Ins ection Station: NORTH Fertilizer Gypsum Ur ea Oil 000 Junk Grass Seed Storage Room Gas Diesel Office File Stora ge Equipment Shed Welder Lunch Room Shop Time Clock Storage #2 Storage #1 Office Shwr. Bath Parts f'- Sencor Turf Herbicide Di Quat Herbicide Maxiplex 5011 Amendment Rubigan Fungicide Aquagro L Vitamin 81 Trlmlc Plus Herbicide Apsa 80 Spray Rennaissance Nutrient Compound Ferromec AC Liquid Iron Tesan 1991 Herbicide Surf/an Herbicide Roundup Dacthal W-75 Herbicide Potassium Nitrate 13.5-0-45 Champion Potassium Nitrate 3336 WD Fungicide 6-2-12 Chemical Fert1Ïizer Kiso Spray Cleaner Elanco Balan Best Greenskote 18-3-18 Fertilizer Ultra 18-4-10 Fertilizer FastGreen 16-4-8 Pellets Scoffs Pro TLI119-0-17 Fertilizer Bumper Harvest Gypsum Dursban 2 Granuals Par Ex 14-19-19 Best Triple 12-12-12 Omega Medilist Grass Seed Pencross Bent Seed Scotts Pro Turf Insecticide Preemergent Weed Control - <, ... MICHAEL A. GREER Course Superintendent 6218 Sundale Ave. Bakersfield, CA 93309 ~ 1/ PRIVATE 805/831-4170 Res: 805/833·6933 . " i r' 'Ç - - u ~;"'.J47è-'- - - - _Taver'-ly The Green ___!c.uM.:;CIU..! - -- -: ..~-: _ - _ -w '831~5225 NlVan- __ - -- -- ~ ~ YOUNGK.OHR . President 6218:Sundale Avenue Bakersfield, CA 93309 805/831·4200 Fax 805/831·2045 - . . ø CITY OF BAKERSFIEl.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Hoor, Bakersfield, CA 93301 FACILITY NAME ~/V/7/1/E'" ~Z- doð INSPECTION D1\ TE øY¿;l..5 ADDRESS ~"""'/~...b/V¿J/J/¿:- A PHONE NO. t?"".J/~.Þ~ FACILITY CONTACT.ÞV~ o#~ BUSINESS ID NO. 15-210- 00//..9';/ , INSPECTION TIME - /...:7.4"P /PÆS. NUMBER OF EMPLOYEES // . Section 1: Busin.ess Plan and Inventory Program ~outine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS 0 Appropriate pennit on hand ¿, ,/ Business plan contact infonnation accurate ¿.. ,;' Visible address ~ .... Correct occupancy L- Verification of inventory materials i- ,,;' Verification of quantities ~ - Verification of location ¿. Proper segregation of material ,t;-"" Verification of MSDS availability L- ...- Veri fication of Haz Mat training L.- - Verification of abatement supplies and procedures L- Emergency procedures adequate t- .- Containers properly labeled ¿.- Housekeeping '- - Fire Protection j ....,- Ÿ'Jt- 0!rJ ovr ~4'<"- C&;;-~ / -J ~' Site Diagram Adequate & On Hand t- - p::.A¡dYA,-":;vJ~ ./ C=Compliance V=Violation Any hazardous waste on site?: ,/ ffies 0 No Explain: h/~¿;:;:-- 0/<..-:- White - Env. Svcs. Yellow· Station Copy Pink· Business Copy y,/kt>L-./ Business Site Responsible ~ Inspector: C~ P/ /~ -' Questions regarding this inspection? Please call us at (661) 326-3979 lid /I1J¡ ,) //4 \ }~ "".i ,IÞ _ ~ 0l.J-'ouJ ____of I V'5~f . . ~ ,JZ:f{' ~ 'to. r¿øJL-Î (d' A) CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 I ~ I FACILITY NAME ~a;;:1t&6 INSPECTlONDÛE ¡:Z//1f /9$ ADDRESS <1'dl,Ø ~ PHONE NO. ~# ~~'!-Af/7-6 FACILITY CONTACT 3rr-, (YkJ1'tt- e.5 BUSINESS ID NO., 15-210- / d/S-¿;cC)-ðéJ I/t¡ ¡- INSPECTION TIME /Ifhz- NUMBER OF EMPLOYEES / / Þ/ ;=r?JP Ø-ye e-:s Section 1: ~outirie Business Plan and Inventory Program o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand I/x Business plan contact infonnation accurate 1/\ tit tId-~¿',(/ Ænz~/:-- Visible address ~ Correct occupancy JI Verification of inventory materials D< tl..t,./Jit/d~þ rëlZ.¿í/?~/!?;iVð ~ if t:HhIL:. r"%ídt?¿¡ /....:;,y Þ< r , Verification of quantities Verification of location K Proper segregation of material t\ Verification of MSDS availability p( Verification ofHaz Mat training IX J/f:~tt'7 M¿. /Yl4 rf Æne'7~ é~ Verification of abatement supplies and procedures t\ / Emergency procedures adequate Containers properly labeled ~ Housekeeping !)( Fire Protection I'X Site Diagram Adequate & On Hand ~ C=Compliance V=Violation ðlOlJ~" :CftP(/J15ð~' Z5 ~/'/v'2 ¿7(? ~.-.;'"L. rnke<.. {f'-:; 5q/Jer{Jp¿-/Þ~- <33/-~/r-ð ONo , r n ~\ ~ Questions reg~dingthis inspection? Please call us at ( White ->Env.'Svcs. ~' Yellow - Station Copy Pink - Business' Copy Inspector: Per...Ît to Operü.te Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: "t.ilµrdous Materials Plan round Storage of Hazardous Materials "",agement Program "', Waste 6218 PERMIT ID# 015-o21~01197 SUNDALE COUNTRY CLUB & ' LOCATION Issued by: I ~-"~, k-'" SUNDALE Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rdFloor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 *~ ph Huey, ffice of ental Servi es ' June 30, 2000 . Approved by: Expiration Date: -~:......, ''''"::=-=.' ~ .-~#' ~,,¿il"'- Sf. ~ \ HMARDOUS MATERIALS INVEN~RY Btß:nessNM1e/~¡f/¡jA-¿'£ ~~Y6.v8 Addrcssb'Z/B .sU~If¿E" Att - (/ CHEMICAL DESCRIf110N 1) INVENTORY STATUS: New ( ) Addition (..-(ReYision ( ) Deletion ( ), Check ifchemica1 is a N<?N Trade Secret evfTrade Secret e ) 2) Common Name: WIf1JT€O"L' 3) DOT II (optional) Page L of± Chemical Name: AJiM [ ) CAS II 4) Physical & Health PHYSICAL HEAL m Hazard Categories Fire [VÍ Reactive [ ) Sudden Release ofPressuæ [ J rmm~ia~ Health (Acute) [ J Delayed Health (Chronic) ( J 5) WASTE CLASSIFICATION -Z "2 I (3~git code âom DHS Form 8022) . USE CODE 6) PHYSICAL STATE Solid [ J Liquid [vi' Gas ( J Pure [ Mixture [ J Waste [v(' RadiOlldive ( J 7) AMOUNT AND TIME AT FACIUIY Maximum Daily Amoum / / D Avenge Daily Amouat ?-O Annual Amount Largest Size Container '!J"5" II Days on Site ~ -S- UNITS OF MEASURE Lbs[ ]Gal{ Jft3[ ] Curies [ ] 8) STORAGE CODES a) Container: O(D b) Pressure: 1 c) T~.&ue '-f ~J, F. M, A, M, J, J. A. S, O. N. D CASt# % wr AHM [ ] [ ] [ ] Circle Which Months: 9) MIXTURE: List the three most hazardous chemical componéDts or , any AHM compoacnts COMPONENT I) fAI.t\~ T~ C> (c..... 2) 3) 1 O)LOCA TION EA 5T tEN 1J 1<.1 G HT SIc) ¡;- 1) INVENTORY STATus: New { ] Addition [v('Rcvision [ ] Deletion [ ] Checkifc:JJemical is a NON Trade Secret (rlTradeSec:n:t [ ] 2) Common Name: USeD Of(. p/t-Tt3¡2... S 3) DOT t# (optional) Chemical Name: AHM [ J CAS II 4) Physical & Health PHYSICAL HEALm Hazard Categories Fire { vfÍeactive [ ] Sudda1 Relase of Pressure [ J rmmflJlfi.tl! Health (Acute) [ J Delayed Health (Cbrœic) ( ] 5) WASTE CLASSIFICATION (Uigit code âom DHS Form 8022) 6) PHYSICAL STATE Solid [v( Liquid [ Gas ( ] Pure [ 7) AMOUNT AND TIME AT FACIUIY Maximum Daily Amount II 0 Average Daily Amount. "Zf) ¡/ Annual Amount Largest Size Container 5"-S- II Days on Site 36~ UNITS OF MEAS)JRE Lbs [ ] Gal [ v1 ft3 [ ] Curies [ J USE CODE Mixture [ ] Waste C¿RadiOlldive ( ] 8) STORAGE CODES a) Container: ð(é, b)~: ( c) Temperature 'f ~. J. F, M, A, M, J, J, A, S, 0, N. D Circle Which Months: 9) MIXTURE: Lin the three most hazardous chemical components or any AHM components I) 2) 3) COMPO)ŒNT l/S€b OIl..- FI'-I~I2-S CASII %wr AHM [ ] [ ] [ ] IO)LOCATION ÇA-.5T C;?"¡V~ ~G~ ~IDt ~~5:::~:~~:::;dM_~ud~_;;~ RINT Name & Tide of AIUborizod C_llepraenlalive . i..._ ~ nar+ - " ,<t .;:,,- . t ~ ":~. ..'? ~OUS~~RlALS ~~NT()~ Address Pâse í of .-:.::... ',~ ;, Business Name \ CHEMICAL DISCRIPTIØN I) INVENTORY ST A JUS: New [ ) Addition [ ) Revision [ ) Deletion [ ) Check if chemical is a NON Trade ,~, [' ) Trade Secret [ ) 2) Common Name: 3) DOT II (optional) Chemical Name: AHM [ ) CAS II , 4) Physical & Health PHYSICAL HEAL1H Hazard Categories Fire [ ] Reactive [ ] Sudda1 Release of Pressure [ ] Immediate Health (Acute)[ ] Delayed Health (Chroniç) [ ] . ..n ¡,., 5) WASTE CLASSIFICATION (3~git code &om DHS Form 8022) 6) PHYSICAL STATE Ou[ ] Pure [ Liquid [ Solid [ 7) AMOUNT AND TIME AT FACJUIY Maximuin Daily Amount Average Daily Amouat ADDual Amouat Largest Size ContaiDcr II Days on Site UNITS OF MEASURE Lbs[ ]Ga1[ ]ft3[ ] ,Curies [ ] ciié1e Which Mcmtbs: 9) MIXTURE: Ust the three most hazardous 1) chemi,cal c:ompona1ts or 2) any AHM compoacnts 3) COMPONENT , USE CODE· Mixture [ J Waste [ J Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: ,ç)T~ All Year, I, F. M. A. M. I, I, A. S, 0, N. D ' ." 'CAStI, .;,,' %wr AHM [ ] [ ] [ ] IO)LOCATION ., " " - J) INVENTORY STA1US: New [ ] Addition [ ] Revision [ ] Deletion I r chcèk ifchemical is a,NoN Trade Sc~creq ] T~ Secret [ ] ,2) Common Name: Chemical Name: 3) DOT tI (optional) AHM [ ] CAS II 4) Physical & Health PHYSICAL HEAL1H Hazard Categories Fire [ ] Reactive [ ] Sudden ReI_ of Pressure [ ] rmmNli_tl!Hea1th (Ac:ute)[ ] Delayed Health (Chroniç)[ ] S) WASTE CLASSIFICATION (J.di¡it code fiom DHS Form 8022) 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ 7) AMOUNT AND TIME AT FACJUIY Maximum Daily Amount Average Daily,Amount' Annual Amount Largest Size Container II Days on Site UNITS OF MEAS~ Lbs[ ]Gal[ ]ft3[ J Curies [ ] Circle Which Months: 9) MIX11JRE: List the three most baurdous 1 ) chemical components or 2) any AHM components 3) IO)LOCATION COMPONENT USE CODE Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE~CODES a) Container: ' b) Pressure: ç) Temperature All Year. I. F. M. A. M. I. I. A. s, 0, N, D ,\ ',', :. "CASfI ,:'::, % wr AI;fM [ ] [ J [ ] , . I certtlY under penalty oClaw, that I have persona1Jy __mined and am familiar with the intòrmation on this anda11 attachcc1 doc:umats. I believe the sUbmitted information is crue, accurate and ~J.ete. , 1 - . .' " Signature Date PRINT Namè & Title o( Authorized Company Representative I~ ,-IÃ, ", i,. '.' ""i e - SUNDALE COUNTRY CLUB & TAVERN SiteID: 215-000-001197 IF?i!Er'' .... . '~i::'fVÞ.:DBusPhone: (661) 831-4200 (¡fO!!" Map: 123 CommHaz : Moderate , . 2;} 1999 Grid: 03C FacUnits: 1 AOV: f:::,u¡, "'8 IJ 'i!zryf"¡, ^ 11 · ',.!'f.¡.f0"""r:¡ SIC Code' 7997 "" ,"t::, V¡C.€:'"@unnBrad ~ Manager Location: 6218 SUNDALE AVE City BAKERSFIELD, CommCode: BAKERSFIELD STATION EPA Numb: Emergency Contact YOUNG OHR Business Phone: 24-Hour Phone Pager Phone / Title / OWNER (661) 831-4200x (661) 663-0878x () x Emergency Contact / Title ÐA~v~E. BOLM ÑE"/(.. -p,¡£6.~ ~i f/~~:'lk l!o\J~~ - BUSlness Phone: () ,xWW~ ~ 24-Hour Phone (~) ~81 8~~4~ Pager Phone (l:k/ ) 329 -21/4 x Period Preparer: Certif'd: to Fire Press ImmHlth DelHlth Phone: (661) 831-4200x State: CA Zip 93309 Phone: (805) 831-4200x State: CA Zip 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Hazmat Hazards: Contact : MailAddr: 6218 SUNDALE AVE City BAKERSFIELD Owner Address , City SUNDALE COUNTRY CLUB 6218 SUNDALE AVE BAKERSFIELD Emergency Directives: I, J"'l- Yr<W'~ (Typa or print namo) reviewed 1he attached hazam1@us mM~rials manage- <.. A _ J í(L'I C-t...- ù '3 ment pian for ~lI~bALt l,;.O tv and thaî it along with (NsIma of Businoœ) any corrections constitute a complete and coiTed man- [)@ hemby c~rti~ t"'~ ~ &1avs agement plan fo&" my facility. -1- 11/03/1999 .iâ.~ '~ fþ e f SUNDALE COUNTRY CLUB & TAVERN p= Hazmat Inventory p== MCP+DailyMax Order e SiteID: 215-000-001197 ì By Facility Unit ì Fixed Containers on Site ì Hazmat Common Name... SpecHaz EPA Hazards GASOLINE DIESEL CARBON DIOXIDE F F F P -2- IH DH IH DH IH L L G DailyMax MCP 245.00 GAL Mod 245.00 GAL Mod 344.00 FT3 Low 11/03/1999 ..1\....-. .. e e f SUNDALE COUNTRY CLUB & TAVERN p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME GASOLINE SiteID: 215-000-001197 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit EAST END RIGHT SIDE Map: Grid: CAS # 8006619 STATE - TYPE Liquid Pure PRESSURE Below Ambient TEMPERATURE Below Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 245.00 GAL Daily Average 35.00 GAL HAZARDOUS COMPONENTS ~ CAS#a006619 I %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 p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME DIESEL Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit EAST END RIGHT SIDE Map: Grid: CAS # 68476302 STATE - TYPE Liquid Pure PRESSURE ---- TEMPERATURE Below Ambient Below Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 245.00 GAL Daily Average 20.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Diesel oil No 68476302 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -3- 11/03/1999 J!~ Ja. e :¡. e F SUNDALE COUNTRY CLUB & TAVERN p= Inventory Item 0003 F= COMMON NAME / CHEMI CAL NAME CARBON DIOXIDE SiteID: 215-000-001197 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SE CORNER SNACK BAR , Map: Grid: CAS # 124389 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 344.00 FT3 Daily Average 170.00 FT3 U %Wt. RS CAS # 100.00 Carbon Dioxide No 124389 HAZARDO S COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -4- 11/03/1999 }--.::::,?\ . e e F SUNDALE COUNTRY CLUB & TAVERN I p= Notif./Evacuation/Medical ~' Agency Notification CALL 911 SiteID: 215-000-001197 l Fast Format l Overall Site l 01/02/1991 1 01/02/1991 Employee Notif./Evacuation USE VERBAL AND PUBLIC ADDRESS SYSTEM AND CALL 911. Public Notif./Evacuation 01/02/1991 ;Alff¥ IJ1'~ß2',.!RºOTT~ a¡:gM-reJ\L :~m ôR 8UßS'IT'í'N'CEß U;:)J:!íL) Ul'Ìj P}{,¡:œLlOE£, 'fUEl F\fflbK WILL -;J:/J¡J;;dJ ;;;;;;;;;;~4J;it~;U1Æ #¡/¡;J'r;1f/;A}æ fJt/Ø¡¡1! /~ ;tIJ1 ßXf~. ' I Emergency Medical Plan 01/02/1991 LOCAL AND CLOSE HOSPITAL FACILITY. CALL 911 FOR HELP. -5- 11/03/1999 ·:i:'v:~),.~ (~ . e í SUNDALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë Sit~ID: 215-000-001197 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Mitigation/Prevent/Abatemt ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Release Prevention ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/02/1991 ¡ o 0 o CO-2 IN PRESSURIZED CONTAINERS PROPERLY STORED. o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Release Containment ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/19/1999 ¡ o 0 o ALL MATERIALS ARE STORED IN PROPERLY LABELED CONTAINERS LOCKED IN A SEPERATE 0 o STORAGE BLDG. 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Clean Up ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/02/1991 ¡ o 0 o ALL CLEAN-UP PROCEDURES ARE IN ACCORDANCE WITH THE INSTRUCTIONS GIVEN BY o CHEMICAL MANUFACTURERS AND IN ACCORDANCE WITH HAZARDOUS CHEMICALS LAWS OF o THE STATE OF CALIFORNIA. o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Other Resource Activation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj J----:.:;;-~\-.. <!1' '. e e -6- 11/03/1999 ,.M~¡.· E~. '..... . e í SUNDALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-001197 ¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format ¡ íë Sîte Emergency Factors ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site ¡ íëë Special Hazards ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ ~. 0 ·0 o / åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Utility Shut-Offs ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/19/1999 ¡ o 0 o A) GAS - FRONT YARD IN FRONT OF SW CORNER OF MAIN BLDG o B) ELECTRICAL - PG&E NW CORNER OF BLDG TWO PATIO DECK o C) WATER - LOCATED S CENTER OF BLDG ONE o D) SPEACIAL - NONE o E) LOCK BOX - NO o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Fire Protec./Avail. Water ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/19/1999 ¡ o 0 o PRIVATE FIRE PROTECTION - SECOND FLOOR OF SUNDALE COUNTRY CLUB. WE HAVE A o BUILT IN SPRINKLER SYSTEM. KITCHEN ALSO HAS SPECIAL BUILT IN SYSTEM FOR o GREASE AND COOKING FIRES PLUS HAND HELD EQUIPMENT. CONCRETE STORAGE BARN o FULLY SPRINKLERED. o o o o o o o o o o o FIRE HYDRANT - S CENTER OF DOWNSTAIRS OUTSIDE OF BLDG IN FRONT OF BACK DOOR o ENTRANCE. o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Building Occupancy Level ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj -7- 11/03/1999 " '~~:ð~.: ~, ;;... ," -' e . í SUNpALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-900-001197 íëëë€ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëê Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/19/1999 ¡ 0/ 0 ~ WE HAVE 68 EMPLOYEES IN THE GOLF CLUB AND RESTAURANT COMBINED. 0 o 0 o WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. 0 o 0 o BRIEF SUMMARY OF TRAINING: A HEALTH AND SAFETY ORIENTATIQN MEETING IS HELD 0 o WITH EACH NEW EMPLOYEE AND AT REGULAR INTERVALS THROUGHOUT HIS/HER 0 o EMPLOYMENT AT SUNDALE COUNTY CLUB. THESE WILL PROVIDE INFORMATION ON THE 0 o FOLLOWING: 0 o 0 o AN OVERVIEW OF REQUIREMENTS CONTAINED IN THE HAZARD COMMUNICATION REGULATION 0 o INCLUDING EMPLOYEE RIGHTS, SHOW WHERE HAZARDOUS CHEMICALS ARE STORED AND 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Page 2 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëë~ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj -8- 11/03/1999 , -~ !~ 7. ~ t: Þ "i. . . . ., i CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUSMATEmALS~NTORY FACILITY DESCRIPTION ~ECEŸVE:D ~---7"" éE3~· ¿. -V-"''''I',~-, l;~~~,,·¡: r~t~'j'\. ;.::;~,..~\j'~'~.2"~~) CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME ' Sundale Country Club .~~... FACILITY NAME Sundale Country Club SITE ADDRESS n?lR ~l1nr'l;:¡lp Zl.VP CITY Bakersfield STATE CA ZIP 93309 NATURE OF BUSINESS Golf Course/Restaurant SIC CODE DUN & BRADSTREET NUMBER OWNER/OPERATOR Young K. Ohr PHONE (805) 831-4200 MAILING ADDRESS 6218 Sundale Ave. CITY Bakersfield STATE CA ZIP ' 9 3 3 0 9 EMERGENCY CONTACTS Young K. Ohr TITLE Owner NAME, BUSINESS PHONE 831-4200 24 HOUR PHONE 6(;'7 --eJ7r NAME TITLE BUSINESS PHONE 24 HOUR PHONE ·1 ;,,- ~OUS MATERIALS INVENT. .. ~ ~ ~ l: . .~ !J~ Business Name Address Page~of~ :' 5" . ¡' CBENDCALDESCRDnnON 1) INVENTORY ST A ruS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret ( ] Trade Secret ( 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # PHYSICAL HEAL1H Fire [ ] Reactive [ ] Sudden Release of Pressure ( ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 4) Physical & Health Hazard Categories 5) WASTE CLASSIFICATION (3-digit code ftom DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solid [ , Liquid [ Gas [ ] ~[ Mixture [ ] Waste [ ] Radioactive ( 8) STORAGE CODES a) Container: b) Pressure: c) Temperature- All Year, J, F, M, A. M, J, J, A. S, 0, N, D 7) AMOUNT AND TIME AT FACILITY MaxiDium Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [ Curies [ ] Circle Which Months: 9)~: List the three most hazardous I) chemical components or 2) any AHM componeIits 3) COMPONENT CAS# %Wf AHM [ ] [ ] [. ] lO)LOCATION I) INVENTORY STAruS: New [ ] Addition [] Revision [ ] Deletion [ 1 Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # PHYSICAL HEAL1H Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute)[ ] Delayed Health (Chronic)[ 4) Physical & Health Hazard Categories 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ Liquid [ Gas [ ] Pure [ Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container , # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [ Curies [ ] Circle Which Months: All Year, J, F, M, A. M, J, J, A. S, 0, N, D 9)~: Li~ the three most hazardous I) chemical components or 2) any AHM components 3) COMPONENT CAS# %Wf AHM [ ] [ ] [ ] lO)LOCATION I certify under penalty of law, that I have personally examined and am familiar with the information' on this and all attached documents. I believe the submined information is trµe, accurate and complete. . Signature Date PRINT Name & Title of Authorizeq. Company Representative - ..",.. ~,~ Ii', . e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979, HAZARDOUSMATEmALS~NTORY INSTRUCTIONS FACILITY DESCRIPTION: Check if your business is a farm. Enter the full legal name and site address of your business. Do not use post office box numbers. Give a brief description of the nature your of your business activities. Enter the Standard Industrial Classification (SIC) number for you business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on page,4. Other SIC codes may be obtained trom your worker's compensation insurance fomis, the State of California Employment Development Department by giving them you employer number, trom the U.S. Labor Department or fÌ'om the Standard Industrial Classification Manual. Enter the Dun & Bradstreet or fed~I"~ tax identification number for your business. Enterthe name of the owner, their mailing address and phone number. EMERGENCY CONTACTS: List two persons who have full access to the facility, including locked areas, and that are knowledgeable about your materials and process. CHEMICAL DESCRIPTION: Make as many copies of the chemical description fonn as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of a gas.' Enter the full legal name and site location of your business at the top of the fonn. Enter the page number in the right hand comer. ' Each of the instructions below correspond to the entry field with the same number on the chemical description fonn. e - HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS { 1. ' Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Check non-trade secret unless the chemical composition meets the criteria for trade secret status per Section 6254.7 of the California Government Code and Section 1060 of the California Code of Evidence. Copy tradè secret pages onto yellow paper before submitting your inventory so that they will be easily identified. , 2. Enter the common name or the manufacture's product name. Enter the standard chen1ical name. If a pure material is an acutely hazardous. material (AHM), check the box labeled AHM. Report the components of mixtures under item 9 below. 3. Enter the Dept. of Transportation (DOT) identification number and the Chemical Abstract Service (C~S) number for this chemical. CAS numbers are commonly found on Material Safety Data Sheets. 4. Check the box(es) which describe the physical and health hazards associated with the chemical. 5. If the material is a waste, enter the appropriate three-digit California waste code. California's non restricted waste codes are listed on page 4 of these instructions. Questions regarding the waste classification codes and requests for hazardous waste manifest form #8022 may be addressed to the Department of Health Services, Toxic Substances Control Program at (916) 322-3670. 6. Enter the appropriate use code from the following list. USE CODES 01. Additive 02. Adhesive 03. Aerosol 04.' Anesthetic 05. Bactericide 06. Blasting 07. Catalyst 08. Cleaning 09. Coolant 10. Cooling 11. Drilling 12. Drying 13. Emulsifier/ demulsifier 14. Etching 15. Experimental 16. Fabrication 17. Fertilization 18. Formulation 19. Fuel 20. Fungicide ·21. Grinding 22. Heating 23. Herbicide' 24. Insecticide 25. Instructional 26. Lubricant 27. Medical aid/process 28. Neutralizer 29. Painting 30. Pesticide 31. Plating 32. Preservative 33. Refining 34. Sealèr 35. Spraying 36. Sterilizer 37. Storage 38. Stripper 2 39. Washing 40. Waste 41. Water Treatment 42. Welding/soldering , 43. Well injection 44. Oil Treatment 45. Resale 46. Aircraft systems 47. Battery electrolyte 48. Breathing air 49. Drafting aid 50. Finished product 51. Fire protection 52. Hydraulic equipment 53. Road/hwy maintenance 54. Testing 55. Wholesale chemicals 99. Other - specify .' . -. - e j~ 1; 7.~ Check the boxes which describe the physical state of the chemical. Pure materials are 100% of the chemical listed in item #2. Chemicals that have been diluted with water or combinations of two or more chemicals should be reported as mixtures and the components listed in under item #9. 8. Enter the maximum daily amount, the average daily amount and the total annual amount o( material in storage or use at your facility. Enter the largest container size and the number of days/year that the matérial is on site. Circle the months that the material is on site. Enter the units of measure. Report solids in pounds, liquids in gallons, gases in cubic feet and radioactive materials in curies. 9. Select the appropriate storage codes ITom the lists below a) CONTAINER CODES 01. Underground Tank 02. Aboveground Tank 03. Fixed Pressurized Tank 04. Portable Pressurized Cylinders 05. Insulated Tank (Includes cryogenics) 06. Drums or barrels - metallic 07. Drums or barrels - non-metallic 08. Carboy(s) 09. Glass container( s) 10. Plastic container(s) 11. Box(es) 12. Bag(s) 13. Metal Containers ( not drums) 14. In Machinery or Processing equipment 15. Bin(s) 99. Other - specify b) PRESSURE CODES 1 - The material is stored at ambient (nonnal atmospheric) pressure. 2 - The material is stored at greater than ambient pressure. 3 - The. material is' stored at less than ambient pressure. c) TEMPERATURE CODES 4 - The material is stored at ambient (surrounding) temperature. S - The material is stored at greater than ambient temperature. 6 - The material is stored at less than ambient temperature, 7 - The material is stored under cryogenic conditions. 10. Enter the maximum % concentration by weight of the three MOST hazardous components in the material. Round up to the nearest whole number percentage. Enter the CAS number for each component of the mixture. If the component is an acutely hazardous materials, check the box labeledAHM. 1 I . Briefly describe the location of the material within the building/facility using compass directions and obvious landmarks. 3 .. ,. COMMON LARD INDUSTRIAL CLASSIFICATION & CODËS \ o I I I Wheat pròduction o I 15 Com production 0131 Cotton production 0139 Field crops, except cash grains o 161 Vegetables & melons 0172 Grapes . 0173 Tree nuts 0174 Citrus ftuits 0175 Deciduous tree ftuits 0179 Other tree ftuits & nuts 0192 General farms, primarily crop 0241 Dairy farms 0252 Chicken eggs 0253 Turkey eggs 2851 Paint manufacture 0291 General farm, primarily livestock & animal specialtieS Code DescriDtion 0724 Cotton ginning 0541 Grocery store 1541 Dry cleaners 2911 Oil refineries 3441 Welding/fabrication - structural 3443W~dinglfumcation-ooiler 3569 Machine shop 4222 Cold Storage' 4925 Compressed gas supplier 5093 Automobile salvage 5169 Chemical supply 5511 Motor vehicle dealers (new & used) 5521 Motor vehicle (used only) 5531 Auto & home supply stores 5541 Gasoline service stations NONRESTRICTED WASTE CODES Inonzanics III Acid solution 2 < pH < 7 with metals (antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium. silver, thallium, vanadium and zinc) 112 Acid solution without metals 113 Unspecified acid solution 121 Alkaline solution pH >12.5 with metals (see Ill) 122 Alkaline solution without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12.5) containing reactive anoins (azide, bromate, chlorate, cyanide, fluoride, hypochloritc::, nitrite, perchlorate and sulfide anions) 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues 10% or more 134 Aqueous solution with total organi~ residues less than 10% 135 Unspecified aqueouS solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 161 FCC Waste 162 Other spent catalyst' 171 Metal sludge (see 111) 172 Metal dust and machining waste (see 1.1) 181 Other inorganic solid waste Or2aniCS 211 Halogenated solvents (methylene chloride, chlorofol1D, TCE, TCA) 212 Oxygenated solvents (acetone, butanol, MEK) 213 Hydrocarbon solvents (stoddard solvent, xylene) 214 Unspecified solvent mixtW'e 221 Waste oil and mixed oil 222 Oil/water separation sludge 223 Unspecified oil - containing waste 231 Pesticide rinse water 232 Pesticide and other waste associated with pesticide production 241 Tank bottom waste 251 252 261 271 272 281 291 311 321 322 331 341 343 351 ~ 411 421 431 441 451 461 471 481 491 Code . i , ~ 5821 Eating places 5813 Drinking places (Alcohol service) 5983 Fuel oil dealers 5984 LPG dealers 7342 Pest control 7532 AutQ top, body, upholstery repair Auto paint shops 7533 Auto exhaust repair 7536 Auto glass replBC""tlent 7537 Auto trRn!ll11ission repaiÌ- 7538 General auto repair 7542 Car washes 8071 Chemical1aboratory DescriDtion Still oottoIns with halogenated organics Other still bottom waste PCB's and material cnntaining PCB's Organic monomer waste (includes uureacted resins) Polymeric resin waste Adhesives Latex waste Pharmaceutical waste Sewage sludge Biological waste other than sewage sludge Off-spec, aged or surplus organics Organic liquids (nonsolvents) with halogens Unspecified organic liquid mixture Organic solids with halogens Alum and gypsum sludge Lime sludge Phosphate sludge Sulfur sludge Degreasing sludge Paint sludge Paper sludge/pulp Tetraethyllead sludge Unspecified sludge waste Miscellaneous 511 Empty pesticide containers 30 gal or more 512 Other empty container 30 gal or more 513 Empty containers less ,than 30 gal 521 Drilling mud 531 Chemical toilet waste 541 Photo chemical/photo processing waste 551 Laboratory waste chemicals 561 Detergent and soap 571 Fly ash, bottom ash, and retort ash 581 Gas scrubber waste 591 Baghouse waste . 611 Contaminated soil ftom site clean-ups 612 Household wastes (Restricted waste codes are listed on the back ofform #8022) 4 ·J ,.... -(". ~ 'r: '¡', ~ous MATERIALS INVENTe.V BusinessN~e SÙV'\ð. ~~ (. C . Addressß\ ~ Sv",~~\i. __ ..,."' .;::0. M~e_of- CHE~CALDESC~ON I) INVENTORY STAl1lS: New ( ] Addition [ ] Revision ( ] Deletion [ '2) Common Name: ~'lL\ c~<k. ~ ~"'-J G Check if chemical is a NON ;rrade Secret [ ] Trade Secret ( ] 3) DO~ 1#'(optiònÁ1): I ':, Chemical Name: AHM [ ] CAS 1# 4) Physical & Health PHYSICAL HEAL TII Hazard Categories Fire [ ] R~ve ( ] Sudden Release of Pressure ( ] Immediate Health (Acute) O(] Delayed Health (Chronic) f)<J 5) WASTE CLASSIFICATION (3-digit code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [)(] Liquid ( Gas ( ] PW'e ( MixtUre [ ] Waste ( ] Radioactive ( 8) STORAGE CODES a)CoritaiJÌèr. b) Pressure: ' c) Temperature 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount \0 Average Daily Amount Annual Amount Largest Size Container 1# Days on Site UNITS OF M£Þ...SURE Lbs lXJ Gal [ ] ft3 [ Curies [ ] Circle Which Months: All Year, J, F, M. A. M. J, J, A. S, 0, N, D ..,;. -t 9)~: Lim the three most hazardous ,c.hemical components or any AHM components COMPONENT CASI# %wr , AHM [ ] [ ] [ ] . "/ " ',- ;, e:t'.A ~~J \ 0<:>- Ÿ3 c.¡ 10)LOCATION··. ", ;'" 'I "h~ ._~) ',,: <.' \-'~. '.... ('¡. -\-. ,'. ' ,'.'."'-..'~,. :"','" " , '1,'Q I%~h\L '~Q:O"'\ ,~CnW:~'Ca.~: ~,~~ô..~ ~~'~ I) INVENTORY STA1US: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade ~ [ ] Trade Secret [ 2)COmmonName:_"'RE:~~~ 3)DOTI#(optio~r··· ; .:... , 1) 2) 3) Chemical Name: AHM [ ] CAS 1# 4) Physical & Health PHYSICAL HEALTII Ba.~rd Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) fA] Delayed Health (Chronic) [X] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid ~] Gas [ ] Pw-e [ Mixture t ] Waste [ ] Radioactive [ 8) STORAGE CODES a) ContaiIÍer:" : b) Pressure: c) Temperature 7) AMOUNT AND TIME AT F ACn.rn; ... ",Q Maximum Daily Amount ~ Average Daily Amount ' Annual Amount Largest Size Container 1# Days on Site UNITS OF MEASURE Lbs [ ] Gal1X] ft3 [ Curies ( ] Circle Which Months: All Year, J, F, M, A. M, J, J, A. S, 0, N, D 9) MIX11JRE: List the three most hazardous chemical components or any AHM components COMPONENT CASI# %wr AHM [ ] [ ] [ ] .,. : . €-PA' * '0 l'i2. - '3 ~ ~ 10)LOCATION ..., a . \~"_ 1'1 . ' /1, r\:.w..,~ 0 " r certitÿ under penalty of law, that r have personally examined d am familiar with the information on this an all attached documents. I believe the SUb'1tte? inf~nnation is true, accura~ and complete,' ,": . . .~' _ lJ. J\~ Mo~~~' Ç'u . ~ " ~ '." .' --.-:-~_~ :,r,11_'4T:'-9 ~,,- PRINT Name & Title of Authorized Com y Representative Signature Date 1) 2) 3) " - Busmess Name ~OUS MATERIALS INVENTO. ;: Address ~ . ~ ,. ~ Page ~'of _ .. \.....1 .,.......r ,"'\. ......i ~,.. .. r CHEMICAL DESCRIPTION I) INVENTOR Y STATUS: New [ J Addition [ J Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ 2) Common Name: Su R. -+.\ AN Chemical Name: 3) pOT 1# (9P.tio~)· ,';' ~ ~'. . < ..~ ..... . ARM [ J CAS 1# 4) Physical & Health PHYSICAL ' HEAL rn Hazard Categories Fire [ J R~ve [ J Sudden Release of Pressure [ ] Immediate Health (Acute) ~ Delayed Health (ChrOnic)~ 5) WASTE CLASSIF1CATION (3-digit cOOe from DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solid [ Liq~d ["'I- Gas [ ] Pure [ 7) AMOUNT AND TIME AT F ACn..ITY UNITS OF MEASURE Maximum Daily AmOlDlt ~,\' î ~ Lbs [ ] Gal [')(] ft3 [ .J, Average Daily AmOlDlt Curies [ J' Annual Amount Largest Size Container f# Days on Site Circle Which Months: Mixture [ ] Waste [ l Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature ' All Year, J, F, M, A. M, J, J, A. S, 0, N, D 9)~: Li~ the three most hazardous 1 ) chemical components or 2) any ARM components 3) , " ':" ,E.t>Þ,," ~'~7..í-ÇA -at lO)LOCATION "( 1'\ ,r..c,~o~~, ~~/. ·C~~'cJ1.· srCQ..~ ~C>~ . ~ ' c.' '/. .', " " I " .' '. ' , ,.", " " 'i " .' ..: ~, " , 1) INVENTOR Y STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ], Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: t="' \J S ,Ya.. ~ .!J COMPONENT CASI# %Wf ARM [ ] [ ] [ ] 3) DOT 1# (optio~) . . ..,: Chemical Name: ARM [ ] CAS 1# 4) Physical & Health PHYSICAL HEAL rn ~ Categories Fire [ ] Reac~ve [ ] Suddeµ Release of Pressure [ ] Immediate Health (Acute) 1><..1 Delayed Health (Cbronic)W 5) WASTE CLASSIF1CATION (3-digit cOOe from DHS Form 8022) USE CODE 6) PHYSICAL STA1E Solid [ ] Liquid ~] Gas [ ] Pure [ Mixture (] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: ./' . I b) PréSsqre: . c) Temperature 7) AMOUNT AND TIME AT F ACn.rrY Maximum Daily AmOlDlt _) 4 bl A verage Daily AmOlDlt Annual AmOlDlt Largest Size Container 1# Days on Site UNITS OF MEASURE Lbs [ ] Gal rx.J tµ [ Curies [ . ,.] Circle Which Months: All Year, J, F, M, A. M, J, J, A. S, 0, N, D 9)~: Li~ the three most hazardous 1 ) chemical components or 2) any ARM components 3) COMPONENT CASI# %Wf ARM [ ] [ ] [ ] IO)LOCATION '-2~-St 3:. .' . "D~ ., ... . . ,,- 'ate'· . '......' t. ;; j " , , . ~ous MATERIALS INVEN-.Y S'\.Md ~~ C ,( . Address . .' Page~of_ " :. Business Näme , CHEMICAL DESCRIPTION' I) INVENTORY ST A 111S: New [J Addition [ J Revision f J Deletion [ ] Check if chemical is Ìl NON Trade Secret [ ] Trade Secret [ 2) Common Name:..S-:."" r ~ '- Î S- 3) DOT # (optional) Chemical Name: AHM [ ] CAS # , 4) Physical & Health ' PHYSICAL ' HEAL rn ' Hazard Categories Fire [ ] Reactive [ J Sudden Release of Pressure [ ] Immediate Health (AcutC~laYed Health (Chronic~ 5) WASTE CLASSIFICATION (3~git code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE ' Soffi11(] Liquid [ 7) AMOUNT AND TIME·AT FACILITY~ Maximum Daily Amount I) " Average Daily Amount Annual Amount Largest Size Container . # Days on Site Gas [ ] Pure [ J' Mixture [,] Waste [ ] Radioactive [ UNITS OF MEASuRE Lbs rv1 Gal (, ,~] ft3 c- ] L~ Curies [ J Circle Which Months: 9) MIX11JRE: List the three most hazardous I) chemicalcomponeÌ1ts or 2) any AHM ~ponents 3) , COMPONENT , 8) STORAGE CODES a) Container: b) Pressure: c) Temperature All Year, J, F, M. A. M. J, J, A. S, 0, N, D , .. CAS# %wr AHM [ ] [ ] [ ] . ;. ',' ~" / l;(Þ.~, ŠI'2.ç--s~ ~ ,Ýbe<l ck I GhJtrn,~" ~Þa.l? './::1)J¿a. ,- I' , , ' ] Revision [ ] Deletion [ ] ,Check ifchemical is a NON Trade Secret [ J Trade Secret [ 1 O)LOCA TION 'Î (q' -P~\:L.~ 1) INVENTORY STA 1US: New [ J Addition [ . 2) Common Name: _::n2..\ M..Q... c.. Chemical Name: 3) DOT # (optional)' , ':, , AHM [ J CAS # 4) Physical & Health \. PHYSICAL fÎEALrn ' Hazard Categories Fire [ J Reactive [ J Sudden Release of Pressure [ J' Immediate Health (Acute)~ Delayed Health (Chronic~ 5) WASTE CLASSIFICATION (3-digit code Û'ODl DHS Form 8022) USE CODE ~('A ~-=Z?-\l- c :" I certitÿ under penalty of law, that I have persoiIally examined and tàmiliar with the intòrmatiòn on tlùs an I beliève the submitted infonnati~ is true, ac:cur:te and complete. ' ( \\\"\01'\ 1V\r-l!..L. . S\J~ .....+~ð~1- PRINT Name & Title of Authorized Com y R~tative 6) PHYSICAL STATE Solid [ J Liquid ~J Gas [ J Pure [ 7) AMOUNT AND TIME AT F ACILiT¥ ('\, MaximUm Daily Amount _IDíø.. A verage Daily Amount ' Annual Amount Largest Size Container # Days on Site ' . UNITS OF MFASUR,E LOO [ ] Gal þ(] ttf[ ] Cunes [ J Circle Which Months: I 9) MIXTURE: List the three most hazardous chemical components or, any AHM components COMPONENT 1) 2) 3) I O)LOCA TI~N( J " Mixture·[ J Waste [ J Radioactive [ 8) STORAGE CODES a) Container: ~ , " b) Pressure: c ) Temperature All Year, J, F, M. A. M. J, J, A. S, 0, N, D CAS# . % wr AHM [ J [ J [ J ~J , . Signature J -1..<:--"\\ " , Date .;: . , ] ] , Business Name ~OUS MATERIALS ThfVENTO. Add.ress Page~of_ CHEN.UCALDESC~ON I) INVENTORY STATUS: New ( ] Addiúon ( ] R.evision ( ] Deleúon ( ] Check: if chemical is a NON Trade Secret [ ] Trade Secret [ . ~ "- 2) Common Name: . V\ 't'I\..s2.>r\!... '0,,", 3) DOT # (opúonaI) , Chemical Name: AHM ( ] CAS # 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire ( ] Reactive [ ] Sudden Release ofPressurc [ . ] Immediate Health (ACU~1aYed Health (Chronic)~ 5) WASTE CLASSIFICATION (3~git code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid ( Liquid ~ Gas [ ] Pure [ Mixture [ ] Waste [ ] Radioactive ( ]' 8) STORAGE CODES a) Container: b) Pressure: c) Temperature Ail Year, J, F, M, A. M, 1,1, A. S, 0, N, D , . 7) AMOUNf AND TIME AT FACILITY", &.. Maximum Daily Amount -" ç '\ ' Average Daily Amount Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs ( ] Gaf~.J ft3 ( . ] Curies [ ] Circle Which Months: 9) MIX1URE: List COMPONENT CAS# % Wf AHM the three most hazardous 1) [ ] chemical ,components or 2) [ ] any AHM components 3) [ ] . ./~ ~01 ~tr IO)LOCATIO~)9 ~~ ~~~/( ,,~·:Q~Þ.(~,~ ~Ç?;JJo.. 1) INVENTORY STATUS: New [ ] Addiúon [ ] Revision [ ] DeleÚon [ ] ,Check: if chemical is a NON Trade Secret [ 1 Trade Secret ( 2) Common Name: q..C2- ~,'\oì UVV'\ 3) DOT # (opÚonal). ChCIÌ1ical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL 'HEAI;.,~ r .... /. Hazard'Categories Fire [ ] Reacúvel ] Sudden Release ofPressurc [ ] Immediate Health (Aw~~1ayed Hèa1th (Chronic) D<J.; 5) WASTE CLASSIFICATION (3~git code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ]. Liquid 04 Gas [ ] Pure [ Mixture [>] Waste [ ] Radioactive [ 7) AMOUNf AND TIME AT F ÂCILITY Maximum DailyAmount" .~ Average Daily AmoUnt Annual Amount Largest Size Container # Days on Site UNITS O~URE Lbs( ] ft3[ ] uries [ ] 8) STORAGE CODES a) Container: . b) Pressure: c ) Temperature Circle Which Months: All Year, J, F, M, A. M, 1,1, A. S, q, N, D 9)~:· Lért the three most hazardous 1) chemical components or 2) any AHM components 3) . COMPONENT CAS# %Wf AHM [ ] [ ] [ ] IO)LOCATION l' ~ ¡ certify UDder penalty ofIaw, that I have personally examined and am låmiliar with th¿'in1ònnaúon on beJi""" rb< mbmincd inf_ is _, """"".. aDd complete. ~ G\\~~~" ",. r, ,', ~ PRINT Name & Title of Authorized Company RepresentaÚve Signature .' '. ts. I l-èz-qL , . Date o í3 'h , ' , ~OUSMATERlALSIN~N"Y ~~à~ C. C. AddIess' . Page _of_ Business Name CHE~CALDESC~ON I) INVENTORY STATIlS: New [ ] Addition[' ] Revision [ ] Deletion [ ] Check ifchemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: \}..)E~ ~Q6 3) DOT II (optionål) .. .,.. .~. Chemical Name: AHM [ ] CAS II 4) Physical & Health PHYSICAL HEAL ill, . Hazàrd Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) £\¡ Delayed Health (Chronic ~ 5) WASTE CLASSIFICATION (3-<iigit code ûom DIjS Form 8022) ,USE CODE 6) PHYSICAL STATE " Solid r Ljqui~ Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT F ACILlTY UNITS OF MEASURE . 8) STORAGE CODES " Maximum Daily Amount " , Lbs ( ] Gal (.~ ft3 ( ] a) Container. , A veiage Daily Amount Curies ( , ] b) Pressure: Annual Amount c) Temperat1U'e Largest Size Container II Days on Site Circle Which Months: All Year,l, F, M, A.M, 1,1, A. S, 0, N, D , , 9) MIXTIJRE: List the three most hazardous 1) chemical ,components or 2) any AHM componei1ts 3) :' "&' ,·t:'A: S-O~&t ~ - )7rL. ~ IO)LOCA TION " " ,'", . ï/q ~~R..Q,d\,¡ / ; hJ¿,C,J( ~çf=I>1",,~i1~~ 1) INVENTORYSTATIJS: New [ ] Addition [ ] Revision [ ] Deletion [ ] 'Checkifchemical is a NON Trade Secret ( J Trade Secret ( 2) Common Name: ~V~ Vf ~~ 3) DOT II (optional) . Chemical Name: AHM [ ] CAS# COMPONENT CAS# %wr AHM [ ] ( ] ( ] 4) Physical & Health PHYSICAL HEAL 111 Hazm1'Categories Fire ( J Reactive [ ] Sudden Release of Pressure ( J Immediate HCalth (Acute~1ayed Health (Chronic~] , 5) WASTE CLASSIFICATION (3-<iigit code ûom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid ( ] ,Liquid ~ Gas ( J Pure [ Mixture ( J Waste rJRadioactive ( 8) STORAGE CODES a) Container., b) Pressure: c) T emperat1Jre 7) AMOUNT AND TIME AT FACILITY n Maximum Daily Amount 2 .~~~ Average Daily AmoUnt·' , Annual Amount Largest Size Container # Days on Site ' ; , UNITS OF MEASURE Lbs [] GalIXJ ft3 ( ,,] , Curies [ ] Circle Which Months: . All Year,l, F, M, A. M, 1,1, A. S, 0, N, D 9) MIXTIJRE: ' List the three most hazardous chemical components or , any AHM components COMPONENT CAS# %wr AHM ( ] ( ] ( ] Q.;t. -Ò;. , S2. '1- 't"] Ç7. 'A' _ " . ~~"" [ ceTtifyundcr penalty of law, that I have pefsoßaIly . ed and am tiùniliar with the intònnation on believe the subnúttcc{ infonnation is trUe, accurate and comple~ ~\_ M~lo... ç,£0A.~QL..\' PRINT Name &Tit1e of Authoiized Com y RepreSentativc ..' 1) 2) 3) lO)LOCA TION II . s and all attached doc:1:mu:nts. I ~~. ~ , Date ~ ,'; Business Name' , ~OUS ~TERIÁLS INVENTO. Address Page~of_ CHEMICAL DESCRIPTION I) INVENTORY STA 111S: New ( ] Addition ( ] ~evision ( ] Deletion (] Check if chCmical is a NON Trade Scc:ret ( ] Trade Secret ( 2) Common Name: b;a..~\oA........ :PC? t2> 3) DOT 1# (optionå1) Chemical Name: ARM [ ] CAS 1# 4) Physical & Health PHYSIÇAL . HEALTII Hazard Categories Fife ( ] Rêactive [ J Sudden Release of Pressure ( ] Immediate Health (Acute)1)qpelayed Health (Chronic»(J 5) WASTE CLASSŒ1CATION (3-digit code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE . Solid [ Liquid ~ µas [ J, Pure [ Mlxtur¢ ( J waste [ J Radioactive [ , 8) STORAGE CODES a) Container. b) Pressure: c) Temperature 7) AMOUNT AND TIME AT FAC¡y;ry Maximwn Daily Amount -I Average Daily Amount Annual Amount Laigest Size Container 1# Days on Site UNITS OF MEASURE Lbs( ]~ft3[ J Curies [ ] Circle Which Months: All Year, J, F, M. A. M.I,I, A. S, 0, N, D . 1) INVENTORY STA rus: New [ ] Addition [ 2) Common Name: h )<2...S~~ ' 2 9) MIXlURE: List the three most hazardous 1 ) chemical components Or 2) any AHM components 3) .', ,"j" er~ b~lr~- 6b IO)LOCATION ()q1'~\d:k.~~/..('J~~:,r~'" çfnO:A~O~ J RevisiOÌl [ J DeÌetion [ J Check if chemical is a NON Trade Secret r Co~ c.QÅ\\~\~ 3) DOT 1# (optional) 1 COMPONENT CASI# %wr , AHM [ J f ] [ J ] Trade Secret [ ] Chemical Name: AHM [ 'J CAS 1# 4) Physical & Health PHYSICAL HEALTII Hazard·Categories Fire [ J R~,tive [ 1 SuddeD Release of Pressure [ J Immediate Health (Acute) ~ Delayed Health (Chronic~ 5) WASTE CLÀSSŒ1CATION (3-digit code ftom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid~ Liquid [ 'J 'GaS [ J Pure [ 'J Mixture [ J Waste [ Radioactive [J 7) AMOUNT AND TIME AT FACILITY :::tt Maximum Daily Amount . ~ 0 Average Daily Amount Annual Amount Largest Size Container 1# Days on Site UNITS OF MEASURE Lbs 1\11 Gal [ J tÙ [, J' ~'curies [ ], 8) STORAGE CODES a) Contajoer: < b) Pressure: c ) Temperature Circle Which MoDths: All Year, J, F, M. A. M.I,I, A, S, 0, N, D 9) MIX11JRE: List the three most hazardous I) chemical components or 2) any AHM components 3) COMPONENT CASI# %wr AHM [ J [ J [ J I O)LOCA TION." e in1òrmation ,on this and all attached doc:umci1ts. I ' \' r PRINT Name & Title of Authorized Company Represèntative Signature Date . ¿. r.~ ,. · r. _ . _~OUSMATERlALSINVEN.Y C, \ \'\ C,... 'L ful, n Page~of_ BusmessName~'t'~~\(". .\.. Addressj;"2..,\~ .suY'\a<\\\L ' ~~ CHEN.UCALDES~ON I) INVENTORY STATIIS: New ( ] Addition ( ] Revision ( ] Deletion [ ] CIiecIc ifchemÍcaJ is a NON Trade Secret ( ] Trade SCcrct ( ) 2) Common Name: SA c;:: 30 3) DOT # (optional) Chemical Name: , AHM [ ] CAS # 4) Physical & Health PHYSICAL , , HEAL 1H , Hazard Categories Fire [ ] Reactive [ ] Sudden ReleaSe of Pressure [ ] Immediate Heà1th (Acute)[ , ] Delayed Health (Chronic)[ 5) WASTE CLASSIFICATION (3~git code fi'om DHS Form 8022) USE CODE L .o ~ - '\/. L . 6) PHYSICAL STATE Solid [ Liquid~ Gas [ ] PW"e [ , Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY' ~ Maximum Daily Amount I bS î' A vcrage Daily Amount, " Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] G8l1X1 ft3 [ ] Curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature , Circle Which Months: All Year, J, F, M. A. M. J, J, A. s, 0, N. D . 9) MIX11JRE: List the three most hazardous ,1 ) chemicaJ,COIÌ1poneDts or 2) any AHM components. 3) COMPONENT CAS# %Wf , ARM [ ] [ ] [ ] , I ¡ : IO)LOCATION ÎI"1 -1'c,~ ~d" I '5toRAðoj¡J-tl~. C"",t-~-D: I) INVENTORY STA1US: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check ifchemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ J CAS # 4) Physical & Health PHYSICAL HEAL1H \ Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [- ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3~git code fi'om DHS Fotin 8022) USE CODE 6) PHYSICAL ~TATE Solid [ ] Liquid [ ] Gas [ ] PW"e [ ] Mixture [] Waste [ I Radioactive [ ], 7) AMOUNT AND TIME AT F ACIÜIY Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Site - UNITS OF MEAsuRE Lbs[ ]Gal[-]ft3[ 1. Curies l ) 8) STORAGE CODES a) Container: b) Pressure: c) Temperatw'e Circle Which Months: All Year,J, F, M. A. M. J, J, A. S, 0, N, D - ' 9) MIXTURE: List the three most hazardous 1 ) chemical components or 2) any AHM components 3) COMPONENT CAS# %Wf ARM [ ] [ ) [ ] I O)LOCA TION I certify Wider pè:nalty of law, that I have personaUyexamined and am tàmiliaèwith .the intònnation on this and all attached documents. I believe the ...bmitted infmmaûon is -, """"'te.aad """plctA:. ~ 0.9:: .\ -' 2.:t _,\ ~ i PRINT Name & Title of Authorized Company RepreSeritative ~ture ' Date I ,~.. -¡, ~ - -. Business Name ~OUS MATERIALS INVENTO. ,~ ' I. ,., _ Address " . Page ~c of _ , " J. CHEMIÇAL pESCRJPTION I) INVENTORY STA ruS: New ( .J Addition [ J Revision [ ] Deletion [ ] Check if chemical is a NON TradC Secret [ ] Trade Secret [ ] 2) Common Name: Chemical Name: 3) DOT # (optionål) AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire [ J Reactive [ ] SuddeÓ RClease of Pressure [ ] ImmediattiHealth (Acute)[ ]Delayed Health (Chronic)[ 5 ) WASTE CI..f\Sß.ÌFICA TION -J-: (3-digit code ftom DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solid [ '] LiqWd [ Gas [ ] Pure [ Mixture [ ] Waste [ ,] Radioactive [ J: 8) STORAGE CODES a) Container. \ b) PresSure: c ) Temperature 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual A1:i1ount Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gà1 [ '. ] ft3 [ Curies [ ] Circle Which Months: All Year, I, F, M. A. M.l, I, A. S, 0, N, D . 9) MIXTIJRE: List the three most hazardous I) chemicalcomponei1ts or 2) any AHM components 3) COMPONENT CAS# %wr , AHM [ ] [ ] [ ] IO)LOCATION I) INVENTORY STAruS: New [ ] Addition [ ] RevisiOÌ1 [ ")DeÌetion [ Check ifchemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire [ ] Reactive [ í Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION , (3-digit code ftom DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pw"e [ Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [ ] Curies ( ] Circle Which Months: All Year,l, F, M. A, M.l,I, A. S, 0, N, D 9)~: List the three most hazardous I) chemica! components or 2) any AHM components 3) COMPONENT CAS# %wr AHM [ ] [ ] [ ] lO)LOCA TION [ certify under penalty of law, that I have personally examined and am tàmiliar with the intòrmation on this and all attached documents. I believe the submitted infonnatiOJi is true, accurate and complete. ' ¡ . !' PRINT Name & Title of Authorized Company Representative ' Signature Date ~- f:;!>"~';::f;!ii;:::",,:~: RU,'1.:IV[lIG El, ..e:....."'Ti '''_'__'-r'-f~.P. _. _L (LEV',... MI! I·i1-m. EDJIP'J_ ::_~:. ,-- ----.- :" ',.~} / '"-. ."1 ", ,<.../ [...I.J - e -.... -, . .,-.. .._.~ ..__..~ ~ , ~ - - R I A I---r------, GALLE ,- ---r ________-1 ·L___ BAG -LIUB ROOM STORAGE _ '0' ~HOP L PR _, 1--______.____, T -...... --=1- []FF' I C E~ --..-.....-[' "'J- , ~...= ""-i 1 _..__ ~ .....- --- -'-'-frmR .1 . F~O OD"~ ~I"-'-'- S E ~ \/ I C E~_~_[__ :......-... [--'-'--J -... '. - .. _1-' L r'~ DIE :S:··' L 0 L.lt',J GE _ ¡ 11' :-., ¡;:;;: , i~~ . ;.<~ .,- '. ... - :t.;= , _. .nITII1U1JJII.. -, ~~ ::~~. 'Olo'f.'N'i: lO::U'R E'n:::H -T~I~_ ::: I J.~ r-rj Wl~H, '.', , .. t ,~'> A U I'J ¡r;- ~-t-,-- - H----L_-'--__L_ i I-ì_. d·, _..~ ~ ],£\,'ATI:I:: t:1. .-.....-......-... -----{) 111 ~ s: T 1-\ I R: ',,\,' f-\ Y u';:. ....,- :~. T Å IF:::: ,,\,' 0'-\ Y r~:- I ,R, :«:: 'T' . . . '-'0' r:..' [..'.'J [-J f~:~ ". .._~ -. . " . FOY,ER STORAGE STORAG =-r c t5L :Ö-.l , STORAGE O~F~~-EJ RECEI\lING --- o i . KITC~tEN' ELEV A TO *2 .-._~, J' DLf\Jlt'JG ROOM ~ SERVICE PANTRY VlOMEN MEN . SfAIR'W"AY #:1 ,.,- G! /--...... , \ i "'_..~~" . " ., . i e '~' , . FO·...·ER '-I :) ~. LEVA TOR *1 rMEN OMEN '. i SECOND FLOOR e ! . ,~ . , .:..... I ' I' / '\ ( : \ ; I I ., \ / \, , e (~) -L,' ,\ I . _, .-- . IOFFILl I #'1 T I IC ! >/ Dt~I'l:E ./~ I I ___ ! ' I I #1 I , -L I I I O[1 ~J 1'] j\ L E \ \l/H . ~} _/ . . '1°1 C.0L" OF r . LL / I ' e STORE , ROOM ~ OFFICE #3 i I I : . I \J Df\1EN I ' I , I I I ~¡1 E r'~ I ~ . J.CDFFEE I OFFICE #4 , i ; I ¡ , ' I i I· I I I I I I I ; I I ! Î ! i I ¡ I I I I i I , I ~ . ,~ ( ) " / . ~ ('-'\ " I ~ ( ) e s:tJr\~DALE CC ,-.. f1 ¡--... ~ J '~~I i '.~'! I ". ! ST AIRS I e BL.JILDIN(~ ':""-'-"IR'" .:' I t-; ..) i I CART DECK ' PATIO S[CDÎ~D FLOOR rDRIVEWA1'! . SHOP I· y I I I I I I I I i j j I I 1 I. · ì STORAGE I ROCt~ ! ! I I r .. '" ... . ................. .. ............ ... . qç.¡ E\ i" V 1'11,-'.... '~ f-\ I . . . . . . . . . . . . . . i , i I I I I I I I I . ! i ...~ rART ~TnD~~~ tRE~ ~ .'. .~ -:1·...Ml.J_ . H", H , ~Y·1T "- I '. .... ......................... ............. '" ... ..... ....... FIRST FLOOR "T I -"" ... ..; "¡;Î í.. ,- .-.. -\ STORAGE -. ,- -\' (---... , í ; \ CHANGE BREAK Rom1 GROUNDS MAINT, qrFIcE T SUNDALE COUNTRY CLUB MAINTENANCE & OPERATIONS YARD /' ( " SHOP BUILDING TIt·1E CLOCK RODt~ T -+--_..- -. 'Lo,cked . Chemic 1 Room' MAINTENANCE BAYS ( '- - TOOLS AND FERTILIZER STORAGE AREA . I >N COVERED STORAGE AREA OIL DRUt·1S , FUEL 0 TANK ,'.~ GAS 0 PUt~P!' '~ ' I I , I I I ~. . , r. t 0'8 11'6/94' SUNDALE COUNTRY CLUB & TAVERN 215-000~001197 Overall Site with 1 Fac. Unit Page 1 General Information , Location: 6218 SUNDALE AV Map:123 Haz:3 Type: 3 City . Grid: 03C FlU: 1 AOV: 0.0 . - Contact Name Title - Contact Name Title BEN NOLAN I GENERAL MANAGER JIM KIGER I GOLF PRO Business Phone: (805) 831-4200x Business Phone: (805) 831-5224x 24-Hour Phone · (805) 833-6888x 24-Hour Phone · (805) 834-5829x · · Pager Phone · ( ) - x Pager Phone · ( , ) - x · · , Administrative Data Mail Addrs: 6218 SUNDALE AV D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-011 BAKERSFIELD STATION 11 SIC Code: 7997 Owner: SUNDALE COUNTRY CLUB Phone: (805) 831-4200 Address: 6218 SUNDALE AV State: CA City: BAKERSFIELD Zip: 93309- Summary , ø . IOoŒöe~' OOfi1i4.· ttlat f; have UJ (T~OrPrl"tMme) Q'CJI\JI.}7 uy ~eviewed; the attached hamrdws matenat$ maroage-- ~nt plan ~r_(Nañ;ëØf~ mdthat 'ßt¡ along wùtth My œ~fiomoonsmute Sl oompi~~aOOoorred.~ .~pøaiA!'~ My fatåIMtv.,· ~ ìf)01 - e 08/16/94' SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 Hazmat Inventory List in MCP Order Page 2 02 ~ Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-002 GASOLINE Liquid 245 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-003 DIESEL Liquid 245 Low '~ Fire, Immed Hlth, Delay Hlth GAL 02-001 CARBON DIOXIDE Gas 344 Minimal ~ Fire, Pressure, I~ed Hlth FT3 ' e . 08/3.6/94' SUNDALE COUNTRY CLUB & TAVERN, 215-000-001197 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-002 GASOLINE , ~ Fire, Immed Hlth, Delay Hlth Liquid 245 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days; 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 245, I 35.00 12,000.00 Storage ABOVE GROUND TANK 'r Press T Temp l Location Below Below EAST END RIGHT SIDE - Conc l 100.0% Gasoline Components r; MCP -:--rGuide Moderate 27 - Notes HAD AN UNDERGROUND TANK - TANK REMOVED 02-003 DIESEL ~ Fire, Immed Hlth, Delay Hlth Liquid 245 Low GAL CAS #: 68334-30-5 Trade Secret: No Form: Liquid Type: Þure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 245 I 20.00 I 6,000.00 Storage ABOVE GROUND TANK r pr,ess T Temp l' Location Below Below EAST END RIGHT SIDE - Conc l 100.0% Diesel Fuel No.2 Components r; MCP ~uide Moderate 27 02-001 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 344 Minimal FT3 CAS #: 128-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 344 I, 170.00 860.00 Storage r Press T Temp ~I Location METAL CONTAINR-NONDRUM Above Ambient SE CORNER SNACK BAR - Conc -, 100.0% Carbon Dioxide Components , MCP --¡Guide ~ow I 21 e . 08/·16/94 SUNDALE COUNTRY CLUB &, TAVERN 215-000-001197 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation USE VERBAL AND PUBLIC ADDRESS SYSTEM AND CALL 911. <3> Public Notif./Evacuation ANY HAZARDOUS CHEMICAL AND OR SUBSTANCES USED ON PREMISES, THE PUBLIC WILL BE GIVEN 3" DAY~ NOTICE OF INTENT TO USE SUCH. <4> Emergency Medical Plan LOCAL AND CLOSE HOSPITAL FACILITY. CALL 911 FOR HELP. . . 08/~6/94 SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention CO-2 IN PRESSURIZED CONTAINERS PROPERLY STORED. <2> Release Containment ALL MATERIALS ARE STORED IN PROPERLY LABELED CONTAINERS LOCKED IN A SEPERATE STORAGE BUILDING I <3> Clean Up ALL CLEAN-UP PROCEDURES ARE IN ACCORDANCE WITH THE INSTRUCTIONS GIVEN BY CHEMICAL MANUFACTURERS AND IN ACCORDANCE WITH HAZARDOUS CHEMICALS LAWS OF THE STATE OF CALIFORNIA. <4> Other Resource Activation . . 08/·16/94 SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 00 - Overall Site Page 6 <F>Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - FRONT YARD IN FRONT OF SOUTHWEST CORNER OF MAIN BUILDING B) ELECTRICAL - P.G.&E. NORTHWEST CORNER OF BUILDING TWO PATIO DECK C) WATER - LOCATED SOUTH CENTER OF BUIDING ONE D) SPEACIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SECOND FLOOR OF SUNDALE COUNTRY CLUB. WE HAVE A BUILT IN SPRINKLER SYSTEM. KITCHEN ALSO HAS SPECIAL BUILT IN SYSTEM FOR GREASE AND COOKING FIRES PLUS HAND HELD EQUIPMENT. CONCRETE STORAGE BARN FULLY SPRINKLERED. FIRE HYDRANT - SOUTH CENTER OF DOWNSTAIRS OUT SIDE OF BUILDING IN FRONT OF BACK DOOR ENTRANCE. <4> Building Occupancy Level - - 08/,16/94 SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 68 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: A HEALTH AND SAFETY ORIENTATION MEETING IS HELD WITH EACH NEW EMPLOYEE AND AT REGULAR INTERVALS THROUGHOUT HIS/HER EMPLOYMENT AT SUNDALE COUNTY CLUB. THESE WILL PROVIDE INFORMATION ON THE FOLLOWING: AN OVERVIEW OF REQUIREMENTS CONTAINED IN THE HAZARD COMMUNICATION REGULATION INCLUDING EMPLOYEE RIGHTS, SHOW WHERE HAZARDOUS CHEMICALS ARE STORED AND USED IF ANY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use - It 08"16/97.! SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 00 - Overall Site Page 8 <H> RMPP DATA , <1> Release Containment <2> Offsite Consequences <3> In House Capabilities <4> Plant Shutdown Instruction . . 08'<16/9~ SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 00 - Overall Site Page 9 <I> Underground storage Tanks <1> Leak ~onitoring Methods <2> Leak/Spill Response Plans <3> Financial Responsibility <4> Tank Test/Service Company ~ ~/- \ . , ' cusT,l.e & NO. es- 33~ MISCELLANEOUS RECEIVABLES ADJUSTMENT '. DATE3-/~ -Ð NEW ACCOUNT ¡ ADDRESS CHANGB CLOS ACCT I : FINANCE CHARGE . OTHER ADJ I CUSTOMER NAME ...C),LLQc1L\ e: (' r.)()crtry C¡ <J b f-~CW P f " Sùrx:loJ ~ Jlv L (-A- ' ZIP CODEq~~(jCf. MAILING ADDRESS (o~ l ~ . CITY ß-J::ers~; eJçÀ STATE SITE ADDRESS PAACELNUMBEA (IF APPUCABlE) ADJUSTMENT I R~\;S:b~: ~Ó :">L)CGkCtJ~ stojJ'V~ APPROVED BY ~~ -:¿( ------- --------;------- , '" A .. c;~~==-' 1 .. - ""./7 ,0/ -- SUNDALE COUNTRY CLUB & TAVERN SiteID: 215-000-001197 Manager 'Location: 6218 SUNDALE AVE City BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: BusPhone: Map : 123 Grid: 03C (805) 831-4200 CommHaz : Moderate FacUnits: 1 AOV: SIC Code:7997 DunnBrad: I: ) Emergency Contact / Title 15Emergency Contact / Title :ai:N I~ò.1.ú-U\lfYoung Ohr j / GENERAL MANAGER JH1 KIGER \~Dave BolarY GOLF PRO Business Phone: (805) 831-4200x Business Phone: (805) 831-5224x 24-Hour Phone : (805~.ß.33 COB8x__ 24-Hour Phone : (805) .ß.31 S829x '" Pager Phone : ( 6b7-~7Jx Pager Phone : ( ) ~? J11~ Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 6218 SUNDALE AVE State: CA City : BAKERSFIELD Zip : 93309 Owner SUNDALE COUNTRY CLUB Phone: (805) 831-4200x Address : 6218 SUNDALE AVE State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì f= Hazmat Inventory ~ As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax GASOLINE DIESEL CARBON DIOXIDE I, 'I0lJrJCq- k, Of-rf( (Typa or print 11QmS i's'fiewed the attached hazardous materials manage- ment plan for Sl\/V" á. ~~ Q.x ~ L ,and that. it along with (Nama or BuaiM8a any œrradions consìiiute a complete Bind correct man- F IH DH L F IH DH L F P IH G Do hereby certify that I have 245 GAL 245 GAL 344 FT3 Mod Mod Low agemsnt plan for my facility. -1- 12/23/1998 ~ " .~ v e e .. F SUNDALE COUNTRY CLUB & TAVERN p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME GASOLINE SiteID: 215-000-001197 ì Facility Unit: ,Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit EAST END RIGHT SIDE Map: Grid: CAS # 8006619 STATE Liquid TYPE Pure PRESSURE Below Ambient TEMPERATURE Below Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 245.00 GAL Daily Average 35.00 GAL HAZARDOUS COMPONENTS ~ CAS#S006619I I l~~~öoIGaSOline TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0002 = COMMON NAME / CHEMI CAL NAME DIESEL Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit EAST END RIGHT SIDE Map: Grid: CAS # 68476302 STATE :....-- TYPE Liquid Pure PRESSURE ---- TEMPERATURE Below Ambient Below Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container GAL AMOUNTS AT'THIS LOCATION Daily Maximum 245.00 GAL Daily Average 20.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Diesel Oil No 68476302 HAZ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ARD ASSESSMENTS -2- 12/23/1998 " .. e e .. F SUNDALE COUNTRY CLUB & TAVERN p= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME CARBON DIOXIDE SiteID: 215-000-001197 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SE CORNER SNACK BAR Map: Grid: CAS # 124389 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 344.00 FT3 Daily Average 170.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Carbon Dioxide No 124389 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -3- 12/23/1998 e e F SUNDALE COUNTRY CLUB & TAVERN I p= Notif./Evacuation/Medical r=: Agency Notification LL 911 SiteID: 215-000-001197 ì Fast Format ì Overall Site ì 01/02/1991 ] 01/02/1991 Employee Notif./Evacuation USE VERBAL AND PUBLIC ADDRESS SYSTEM AND CALL 911. Public Notif./Evacuation 01/02/1991 ANY HAZARDOUS CHEMICAL AND OR SUBSTANCES USED ON PREMISES, THE PUBLIC WILL BE GIVEN 3 DAYS NOTICE OF INTENT TO USE SUCH. Emergency Medical Plan 01/02/1991 LOCAL AND CLOSE HOSPITAL FACILITY. CALL 911 FOR HELP. -4- 12/23/1998 e e í SUNDALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-001197 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Mitigation/Prevent/Abatemt ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Release Prevention ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/02/1991 ¡ o 0 ~ o o CO-2 IN PRESSURIZED CONTAINERS PROPERLY STORED. o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Release Containment ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/02/1991 ¡ o 0 o ALL MATERIALS ARE STORED IN PROPERLY LABELED CONTAINERS LOCKED IN A SEPERATE 0 o STORAGE BUILDING 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Clean Up ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/02/1991 ¡ o 0 o ALL CLEAN-UP PROCEDURES ARE IN ACCORDANCE WITH THE INSTRUCTIONS GIVEN BY o CHEMICAL MANUFACTURERS AND IN ACCORDANCE WITH HAZARDOUS CHEMICALS LAWS OF o THE STATE OF CALIFORNIA. o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Other Resource Activation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf . I ,; ~ e e -5- 12/23/1998 " ~ '! '" e e í SUNDALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-001197 i íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format ¡ íë Site Emergency Factors ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site ¡ íëë Special Hazards ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0' 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Utility Shut-Offs ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/11/1992 ¡ o 0 o A) GAS - FRONT YARD IN FRONT OF SOUTHWEST CORNER OF MAIN BUILDING o B) ELECTRICAL - P.G.&E. NORTHWEST CORNER OF BUILDING TWO PATIO DECK o C) WATER - LOCATED SOUTH CENTER OF BUIDING ONE o D) SPEACIAL - NONE o E) LOCK BOX - NO o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Fire Protec./Avail. Water ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 02/11/1992 ¡ o 0 o o o o o o o PRIVATE FIRE PROTECTION - SECOND FLOOR OF SUNDALE COUNTRY CLUB. WE HAVE A o BUILT IN SPRINKLER SYSTEM. KITCHEN ALSO HAS SPECIAL BUILT IN SYSTEM FOR o GREASE AND COOKING FIRES PLUS HAND HELD EQUIPMENT. CONCRETE STORAGE BARN o FULLY SPRINKLER ED. o o o o o FIRE HYDRANT - SOUTH CENTER OF DOWNSTAIRS OUT SIDE OF BUILDING IN FRONT OF o BACK DOOR ENTRANCE. o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Building Occupancy Level ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -6- 12/23/1998 ~ , '",,; ~ ~-:; .. - .- e e :; í SUNDALE COUNTRY CLUB & TAVERN ëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-001197 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Employee Training ëëëëëëëëëëëëëëëëëëë..··.. eee..·· ëëëëëëëëëëëëëëëëë 02/11/1992 ¡ o '\ 0 o WE HAVE~ES AT THIS FACILITY o WE HAVE MATERIAL SAFETY-DATA-SHEE~S-eN-FI á0~Ct~K' 0 - ,Jv< \",-"..-1 0 (2...J--c" \Í l ~ 0 o o o BRIEF SUMMARY OF TRAINING: A HEALTH AND SAFETY ORIENTATION MEETING IS HELD 0 o WITH EACH NEW EMPLOYEE AND AT REGULAR INTERVALS THROUGHOUT HIS/HER 0 o EMPLOYMENT AT SUNDALE COUNTY CLUB. THESE WILL PROVIDE INFORMATION ON THE 0 o FOLLOWING: 0 o 0 o AN OVERVIEW OF REQUIREMENTS CONTAINED IN THE HAZARD COMMUNICATION REGULATION 0 o INCLUDING EMPLOYEE RIGHTS, SHOW WHERE HAZARDOUS CHEMICALS ARE STORED AND 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Page 2 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -7- 12/23/1998 'c. ~ - e -.~:... FIRE DEPARTMENT S, 0, JOHNSON FIRE CHIEF CITY of BAKERSFIELD "WE CARE" ~JJM-uf ~ 81¡IQqð-- 2101 H STREET BAKERSFIELD, 93301 326·3911 August 3, 1992 Mr. Young K. Ohr Sundale Coùntry Club 6218 Sundale Ave. Bakersfield, Ca. 9.3309 Dear Mr. Ohr¡ NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE - - - - - _0_- ______ _ _ _ _ _ ___ ------- --- - - ---- - - -- _......:. - -- ----------------------------------------------- In the inspection of your business Sundale Country Club, located at 6218 Sundale Ave.~ Bakersfiel~,Ca.93309 on August 3, the following Hazardous Materials regulation violations were identified: 11 The Sundale Country Club Business Plan is incorrect and needs to be updated. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25505 (b) In addition to the ~equirements of Section 25510, whenever a substantial change in the handler's operations occurs which requires a modification of its business plan, the handler shall submit a copy of the plan revisio~ to the administering agency within 30 days of the operational change. ' (c) The handler shall, in any case, review the ,business plant submitted pursuant to subdivisions, (a) and (b), on or before January 1, 1988, and at least once every two years thereafter, to determine if a revision is needed and shall certify to the administering agency that the review was made and that any necessary changes were made to the plan, A copy of these changes shall be submitted to the administering agåncy as part of this certification. (d) Unless exempted from the business plan I, I , , ~ -. e ~-~- requirements under this chapter, ðny business which handles a hazardous material shall annually submit a completed inventory form to the administering agency of the county or city in which the business is located. Notwithstanding ~ny other provisions of the law, an inventory form shall be filed on or before January 1, 1988, for the 1988 calendar year, and annually thereafter. This inventory shall be filed annually, notwithstanding the review requirements of subdivision (c) . 2) Several Hazardous Materials were on hand that were not included in your hazardous materials. inventory. VIOLATION OF CH. 6.96 CALIFORNIA HEALTH, & SAFETY CODE 25509(a)(1-4) (a)The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (1) A listing of the chemical name and common names of every hazardous substance or chemical product handled by the busines~. (2) The category of waste, including the general chemical and mineral composition of the waste listed by probable maximum and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing a hazardous material handled by the business which is not otherwise listed pursuant to paragraph -(1) or (2). (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at anyone time by the business over the course of the year. 3) Waste oil drum and cleaning solution drum were not properly labeled. VIOLATION OF OSHA 1910.1200 - e cl- ...., --"""l-- (1) The chemical manufacturer¡ importer¡ or distributor shall ensure that each container of hazardous chemicals leaving the workplace is labeled¡ tagged or marked with the following information: (i) Identity of the hazardous chemical(s). (ii)Appropriate hazard warnings; and (iii)Name and address of the chemical manúfacturer ¡ importer ¡ or other ,responsible party. (4) Except as provided in paragraphs (3) and (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled¡ tagged¡ or marked with the following information: (i) Identity of the hazardous chemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) The employer may use signs, placards, process sheets¡ batch tickets¡ operating procedures, or other such written materials in lieu of affixing labels to individual stationary process containers, as long as the alternative method identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readily accessible to the employees in their work area throughout each work shift. " (7) The employer shall not remove of deface existing labels on incoming containers of hazardous chemicals, unless the container is iIÍunediately marked with the requ~red inf6rmation. (8) The employer shall ensure that labels or other forms of warnings are legible, in English, and prominently displayed on the container, or readily available in the work area throughout each work shift. Employers having employees who speak other languages may add the information in their language ,to the material presented, as long as the information is presented in English as well. 4) Hazardous ~aterials spilled onto the ground adjacent to ',~ ~, ., ....::. - _..~- drum dispensing area. VIOLATION OF UFC 80.104 e (b) Release of Hazardous Materials. Hazardous materials shall not be released' into a sewer, storm drain, ditch, drainage canal, lake, river or tidal waterway, or upon the ground, sidewalk, street, highway or into the atmosphere. The above violations must be corrected by~ugust 31st, 1992. The department will schedule a re-inspection of your facility tO'verify compliance. If you have any questions regarding this notice, þlease contact Ralph Huey at 326-3979. I have included a set of-Business Plans and instructions for your convenience. Sincerely, Ralph E.Huey Hazardous Materials Coordinator y , ! ! - - MEMORANDUM "WE CARE" I March 24, 1992 TO: Valerie Pendergrass FROM: Joe A. Dunwoody SUBJECT: Billing for remedial action oversight of the Sundale Country Club Project The remedial action at the Sundale Country Club is now complete. A total of 2.25 hours, at a rate of $45.00 per hour, were spent on this project. The total amount is listed below. Please enter the amount on the computer, note the date on the memo and file when completed. 2.25 hrs. * $45.00/hr. = $101.25 cc: Ralph E. Huey tV \~ yqv 0;1) e .~~. Bakersfield Fire Dept.e HAZARDOUS MATERIALS DIVISION Date Completed ¡ Business Name: Ç;UA.)DfJlk C£;fJJJ78¡ C/W/Þ ~ 11flC'k.-tJ Location: (ß ~1 g' SuJOItL£ tWG. Business Identification No. 215-000 ~ (fop of Business Plan) Station No. t \ Shift ft Inspector '~ Adequate ~ g: ~ cJl Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: ./ ö 2'" 2(£-1 2, RECEIVED FEB ¿ ì 1992 HAZ. MAr. D1v. Inadequate D D D D D Verification of MSDS Availablity Number of Employees Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Comments: ~ ~ ø'/ D D Emergency Procedures Posted Containers Properly Labeled Comments: ~ D D D Verification of Facility Diagram Special Hazards Associated with this Facility: ~ If- I"ARIJI? .Am#IÁI!'Í ð.P Ftf:e.77ÚZæ.- /? ~ ðÆJ ~!6-ff r(l/rtlfl1d/dU:> 77~ o-r 77j(Ç V6j1ê.):J:¡ I;, AJ()f ó,¡Q we & I1plPræ PÆ/"'¡¡::C7 u"T. ~(igIBtieQS: AI CJ ~ c.v?"r ::::;'("'J 1 ocrA/---r- '(1A-Q,c, \ 1/\..1 (,r ^ ICúV Q 4- z. q,. () Q M t a.AJ --r A-,^AQ... \ t "-.J ~ 0.... Z ~u ÆJ!;; ~ U~O'F Tð2-IHùsYYH!:6\OJ...) PI UtI:? } S KepT (].A) S ~(y¡--t{, All Items O.K. Correction Needed ~ FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink·Business Copy ~.. ,~ .-,-:- - e CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT S, D JOHNSON , FIRE CHIEF 2101 H STREET BAKERSFIELD, 93301 326·3911 August 3, 1992 Mr. Young K. Ohr Sundale Country Club 6218 Sundale Ave. Bakersfield, Ca. 93309 Dear Mr. Ohr; NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE ----------------------------------------------- ----------------------------------------------- In the inspection of your business Sundale ,Country Club, located at 6218 Sundale Ave., Bakersfield, Ca.93309 on August 3, the following Hazardous Materials regulation violations were identified: 1) The Sundale Country Club Business Plan is incorrect and needs to be updated. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25505 (b) In addition to the requirements of Section 25510, whenever a substantial change in the handler's operat~ons occurs which requires a modification of its business plan, the handler shall submit å copy of the plan revision to the administering agency within 30 days of the operational change. (c) The handler shall, in any case, review the business plan, submitted pursuant to subdivisions (a) and (b), on or before January 1, 1988, and at least once every two years thereafter, to determine if a revision is needed and shall certify to the administering agency that the review was made and that any necessary changes were made to the plan, A copy of these changes shall be submitted to the administering agency as part of this certification. (d) Unless exempted from the business plan \.. ;;-. . - ,~ - e' --"""'- requirements under this chapter, any business which handles a hazardous material shall annually submit a completed inventory form to the administering agency of the county or city in which the business is located. Notwithstanding any other provisions of the law, an inventory form shall be filed on or before January 1, 1988, for the 1988 calendar year, and annually thereafter. This inventory shall be filed annually, notwithstanding the review requirements of subdivision (c) . 2) Several Hazardous Materials were on hand that were not included in your hazardous materials inventory. VIOLATION OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(a)(1-4) (a) The annual inventory form shall include, but shall not be limited to, information on all of the, following which are handled in quantities equal to or greater than the quantities specified in subdivision (á) of Section 2p503.5: (1) A listing of the chemical name and common names of ~very hazardous substance 6r chemicaì product handled by the business. (2) The category of waste, including the general chemical and mineral composition of the waste listed by probable maximum and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name ,and common names of every other hazardous material or mixture containing a hazardous m~terial handled by the business which is not otherwise listed pursuant to paragraph (1). or (2)., ( 4 ) The maximum amount of each hazardous material \ or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at anyone time by the business over the course of the year. / 3) Waste oil drum and cleaning solution drum were not properly labeled. VIOLATION OF OSHA 1910.1200 I ~..- .. ~ - It, .-~- (1) The chemical manufacturer, importer': or d~stributor shall ensure that each container of hazardous chemicals leaving the workplace is labeled, tagged or marked with the following information: (i) Identity of the hazardous chemical(s). (ii)Appropriate hazard warnings; and , ) (iii)Name and address of the chemical manufacturer, importer, or other responsible" party. (4) Except as provided in paragraphs (3) and (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged, or marked with the following information: (i) Identity of the ha¿ardouschemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) The employer may use signs, placards, process sheets, batch tick~ts, operating procedures, or other such written materials in 1i~u of affixing labels to individual stationary process containers, as long as the alternative method identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readily accessible to the employees in their work area throughout each work shift. (7) The employer shall not remove of deface, existing labels on incoming containers of hazardous chemicals, unless the container is immediately marked with the required information. " (8) The employer shall ensure that labels or other forms of warnings are legible, in English, and . prominently displayed on the container, or readily, available in the work area throughout each work shift. Employers having employees who speak other languages may add the information in their language to the" material presented, as long as theinformatiòn is presented in English as well. 4) Hazardous materials spilled onto the ground adjacent to I,", ~ ...~ - e ,- , ~- ,,- drum dispensing area. VIOLATION OF UFC 80.104 (b} Release of Hazardous Materials. Hazardous materials shall not be released into a sewer, storm drain, ditch, drainage canal, lake, river or tidal waterway, or upon the ground, sidewalk, street, highway or into the atmosphere. , The above violations must be corrected by August 31st, 1992. The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. I have included a set of Business Plans and instructions for your convenience. Sincerely, Ralph E.Huey Hazardous Materials Coordinator ì - ~.' T:;"-~---'-""'------'-_:~C- -"". -·.·e,·.-.~._.. -..~-----..-------_.. ---- ..--- f" --JI ¡ ·e ¡ , ." ·1, ..~ -tflO¡ BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREVENTION . - - - Ì)L¿p6'- c¿¿ ~ ~ ... ~ x.- 327 ~~01 I ! i APPLICATION Application No. In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made t~ ì0p Con /;)tn¡ c-c-klYì V O. ~¡C, '0 IA__ V ì ~JJ~ · Name of Company I Address l C 3Z71 to display, store, install, use, operate, sell or handle mat ials or processes involving or creat;ng con- G itions deemed h frdous to life or opertv os folio s: ¡!.. j +1fJvv -0 ,/ Lf 'cf -' ~" I ~' " LæJ)L¿_:!-t;¿L~[:£~~~tM i , " c,-Û-' AJ"thorlzed Representative rr0~ L¿ J ¡ Pe, . issued moo. ...<!f..2::;..U:.!...... ¿p.......~....Fi;;..;¡;;;;¡;;ïTtìæT........... - -. :;[.:~~\ ~ 'i' SUNDALE~OUNTRY CLUB & TAVERN 215~0-001197 Overall Site with 1 Fac. Unit Page 1 12/10/91 0: RECEIVED General Information 1 BEC 1 7 1991 ' © Location: 6218 SUNDALE AV Community: BAKERSFIELD STATION 11 - Map: ~ MJlM'.zIðM: Moderate Grid: 03C FlU: 1 AOV: 0.0 Contact Name BEN NOLAN JIM KIGER Title GENERAL MANAGER GOLF PRO Business Phone (805) 831-4200 x (805) 831 ,5224 x 24-Hour Phone (805) 833-6888 (805) Owner: SUNDALE COUNTRY CLUB , Address: 6218 SUNDALE AV City: BAKERSFIELD // Administrative Data Mail Addrs: 6218 SUNDALE AV City: BAKERSFIELD Comm Code: 215-011 BAKERSFIELD STATION 11 D&B Number: ate: CA Zip: 93309- SIC Code: Phone: (805) 831-4200 State: CA Zip: 93309- Su~ary E ¥ BUN A/ðhJ;i'/. . it .1.:-:" ~ ~ {,,,..'~ 1 (!/;"? Do hereby certify that ~ have y~ or print name) reviewed the attached ha.z¿¡T~i(¡;.:s materials manage- o ment plan forjj.wlJa/i!_~ó1¿¡'-l..tþS;d Hlat it along with (Nøroø (¡f [;u,,:r.r,¡¡¡, any corrections cons.titute a complete and correct man- agsment plan for my facility. 1~-/3-C¡ ( Dtlte !...~ 12/10/91 , r.. SUNDALE~OUNTRY CLUB & TAVERN 215~0-001197 . 02 - Fixed Containers on Site Page 2 Hazmat Inventory Detail in MCP Order 02-002 GASOLINE Fire, ~mmed Hlth, Delay Hlth Liquid 500 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL L- Daily Max.GAL ~ Daily Average GAL_--r-- Annual Amount GAL -- ~rS I ~~ð.uu . I 12,000.00 ,/ \ ' ~r ~14-t. ' . Storage r Press T Temp 1 Location' GROUND TANK Below, Below . EAST END RIGHT SIDE ABOVE - Cone l 100.0%. Gasoline Components f; MCP -:-¡List . Moderate - Notes HAD AN UNDERGROUND TANK - TANK REMOVED ~f~ 02-004 SOLVENT' Fir¡e, Immed Hlth CAS #: 64742-54-2 [)'f-. I ß· 1'- -,Cone 100.0 Moderate Liquid Trade Secret: No For : Liquid Type: Pure Use: Daily Max GAL -S-5- Average ~AL ~ Annual Amount GAL -- ..§.§. 60, I 16S.. as Storage DRUM/BARREL-ME T Temp _I Location Below EAST END RIGHT SIDE Component,s MCP -:-¡List f;oderate I Liquid î-r:{J ~ Low GAL 02-003 DIESEL Fire, Immed Hlth, Delay Hlth CAS #: 68334-30-5 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL ABOVE Daily Max GAL ~' Daily Average GAL --r-- Annual Amount GAL -- 5ø1J ~.1. ~()OT I 6,000.00 1--" c ')..L) tØR'I Storage ,,- r Press T Temp 1 l Location GROUND TANK Below Below EAST END RIGHT SIDE - Cone l 100.0% Diesel Fuel No.2 r=- MCP --rList ¡Low I Components ''''. !~ ,. 12/10/91 ¡. " . ~ SUNDALEtlbUNTRY CLUB & TAVERN 215-~0-001197 02 ~ Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 CARBON DIOXIDE Fire, Pressure, Immed H1th . b(L Gas 344 Minimal FT3 CAS #: 128-38-9 Trade Secret: No Form: Gas Days: 365 Use: OTHER Type: Pure Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 344 170.00 I' 860.00 Storage r Press T Temp ~ ,Location METAL CONTAINR-NONDRUM Above Ambient SE CORNER SNACK BAR - Conc l 100.0% Carbon Dioxide Components r; MCP -=--rList Minimal I ,. SUNDALE~OUNTRY CLUB & TAVERN 215~0-001197 00 - Ovèrall Site Page 4 .'r::- ~ 12/10/91 =' <D> Notif./Evacuation/Medical <1> Agency NotificationÐl CALL 911 <2> Employee Notif./Evacuation~~ USE VERBAL AND PUBLIC ADDRESS SYSTEM AND CALL 911. <3> Public Notif./Evacuation~v ANY HAZARDOUS CHEMIC~L AND OR SUBSTANCES USED ON PREMISES, THE PUBLIC WILL BE GIVEN 3 DAYS NOTICE ,OF INTENT TO USE SUCH. <4> Emergency Medical Plan ()U- LOCAL AND CLOSE HOSPITAL FACILITY. CALL 911 ,FOR HELP. 12/10/91 ;" SUNDALE~OUNTRY CLUB & TAVERN 215~0-001197 00 - Overall Site I Page 5 ,;:ç. ~ '" ç- <E> Mitigation/Prevent/Abatemt <1> Release prevention'~ CO-2 IN PRESSURIZED CONTAINERS PROPERLY STORED. <2> Release Containment ~ ALL MATERIALS ARE STORED IN PROPERLY LABELED CONTAINERS LOCKED IN A SEPERATE STORAGE BUILDING <3> Clean Up \\.... ALL CLEAN-UP PROCEDURES ARE IN ACCORDANCE WITH THE INSTRUCTIONS GIVEN BY CHEMICAL MANUFACTURERS AND IN ACCORDANCE WITH HAZARDOUS CHEMICALS LAWS OF THE STATE, OF CALIFORNIA. \ <4> Other Resource Activation ·r, I ~--ç" . -,' . e SUNDALE~UNTRY CLUB & TAVERN 215-000-001197 00 - Overall Site Page 6 12/10/91 (oi ," <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - FRONT YARD IN FRONT OF SOUTHWEST CORNER OF MAIN BUILDING B) ELECTRICAL - P.G.&E. NORTHWEST CORNER OF BUILDING TWO PATIO DECK C) WATER - LOCATED SOUTH CENTER OF BUIDING ONE ,D) SPEACIAL - NONE ,E) LOCK BOX - NO <3> Fire Protec./Avail. Water / I / PRIVATE FIRE PROTECTION ~, SECOND FLOO,R OF SUNDALE COUN7RY C UB. ~E HAVE A BUILT IN SPRINKLER SYSTEM. KITCHEN ALSO HAS SPECIAL BUILT N SYSTEM FOR GREASE AND COOKING FIRES PLUS HAND HELD EQUIPMENT. CJ1n-.,...~ SnDo.,o..t.n S....7&J</ FUllY !.P~ t: t:.'1r~9 ,- ( ,7.'~ r/,iV ¿;;~/ r/hü'.~o!J""'o' /'d~Þ7ý FIRE HYDRANT - SOUTH CENTER OF DOWNSTAIRS OUT SIDE OF BUILDING IN FRONT OF BACK DOOR ENTRANCE. <4> 'Building Occupancy Level I ' - ..........~? ~~ -:"I}"~ ~-;~:< ~ SUNDk£E~UNTRY CLUB & TAVERN 215~0-001197 00 - Overall Site Page 7 ··12/10/91 ¡~. " <G> Training <1> Page 1 n fp'fJ I WE HAVE ~ EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: A HEALTH AND SAFETY ORIENTATION MEETING IS HELD WITH EACH NEW EMPLOYEE AND AT REGULAR INTERVALS THROUGHOUT HIS/HER EMPLOYMENT AT SUNDALE COUNTY CLUB. THESE WILL PROVIDE INFORMATION ON THE FOLLOWING: AN OVERVIEW OF REQUIREMENTS CONTAINED IN THE HAZARD COMMUNICATION REGULATION INCLUDING EMPLOYEE RIGHTS, SHOW WHERE HAZARDOUS CHEMICALS ARE STORED AND USED IF ANY. ' . l <2> Page 2 as needed <3> Held for Futurè Use <4> Held for Future Use 1!'~r r .~. '~ '.~ It .,.-..,.... _ __ ~,.l,:: 10/23/90 / SUNDALE .UNTRY CLUB & TAVERN 215-a)-OOI19ftECEIVED Overall Site with 1 Fac. Unit Page 1 ,OfC 1 0 1990 General Information Hazat~d: Mc.det~ate ~ Area of Vul: 0.0/ / ~ 24 Hour Phone, I \ (805) 833-6888\ (~oS') ~...~ I I Location: 6218 SUNDALE AV Ident Number: 215-000-001197 Map: 123 Gt~id: 03C r--- Contact Name ¡BEN NOLAN JIM KIGER f:>Alhr ¡..}e:Wh-4.,.,! Mail Addrs: 6218 SUN DALE City: BAKERSFIELD Comm Code: 215-011 BAKERSFIELD STATION 11 I Tit Ie 1-::- Busirless Phc.rle I ¡Çéf7v /7ç~ I (805) 831-4200 x .stgj/£;t'~o¡r4/ '/ (805) 831-5224 x Administrative Data AV D&B Numbet~: State: CA Zip: 93309- SIC C.:.de: Owrlet~ : Addt~èss : City: ..5UA/L?¡!ÇJl[:~ ('tJVA/T/Z,Y CLL/~ 6:2..19 .5{/NO&W'¡l)¡I~ 13~¡.ç1:7;SA ¡::ZL7 J é'61¿/.c Ph.:.rle: (&Jf) tf~ - ~2/)(/ State: Zip: 9'.Y3Cf - r Summary I I ~I It PAV ~ p Id/Ey.( MIP) Do hereby certify that I naviS (Type or print name) reviewed the attached hazardous materials manage- ment plan for SutV~B:-.~~ G~.t__and that it along with , (" Sl1l0 ':1 ¡::,~)f,;!f".) any corrections G'Or~3 jtute a complete and correct mana agement plan for my faCUiIL^. 00 o. °0 ¿~ ( /- ;; g'~'j.() Signature Date \ 10/23/90 SUNDALE COUNTRY CLUB & TAVERN 215-000-001197 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards FClrm Quantity MCP 02-001 CARBON DIOXIDE Fire, Pressure, Immed HIth Gas 344 M i rli ma I FT3 .. ,~f' ¡ ~:~' - -- '!, 10/23/90 "6 SUNDALE ~UNTRY CLUB & TAVERN 215-_)-001197 00 - Overall Site Page .:, <D} Notif./Evacuation/Medical <1} Agency Notification CALL 911 <2} E~ployee Notif./Evacuation USE VERBAL AND PUBLIC ADDRESS SYSTEM AND CALL 911. (3) Public Notif./Evacuation At\J1j Hw)Z./l-R...D 0 '-<.. s ch .e ~, I C-q 1S.?JV't> (> v ~ jJ'~ -fa- Vl.-o....e.-s -tJ.4..R..- .p tt k ¡1:-e.. Vv/ ¡'II b~ G I V é:. V\ ~ <:L-a...y <;, N/Q- ~l (..-e u.. S E- S-u...e-¡;¡-, ¿¿SEt:> c> ""- PRt;;þ1tS1Æ-S ~ f -X:vt "ì -e..:Vt. r 1õ <4) Emergency Medical Plan LOCAL AND CLOSE HOSPITAL FACILITY. CALL 911 FOR HELP. 10/23/'30 SUNDALE COUNTRY CLUB &(TAVERN 215-000-001197 00 - Overall Site Page 4 (E} Mitigation/Prevent/Abatemt (1} Release Prevention CO-2 IN PRESSURIZED CONTAINERS PROPERLY STORED. (¡ (2} Release Containment It/ I ,þtd~rtC(15 ct Ir (... S. h Y'-e ct 11'1 \ . J . f'rïY V ~ Y" ,L ce 13{3 ¡: E.1J .J'Q. \ot..dd V\ -r~ e. \ v- <3 ~ {7 C< y- Ct -re.... ~ -rv y cur -E:- g l J...J- ......, ~ c ~+ a. i '" (.. '-5 1-, ).. CH!:- K; .e- \) I VI úL (3} Clear! Up -~ LL C/..- ~Q. V\..::J! \? ~ :;:r::: \^- S-t-J-L.L0+' ~ ()l--l...-(L t-/r.ct. z. CL, ~ J O'tA.-ç p r--o-G -e-e. J (Á )"eS a. v <- I.....~ Á-,CJ:;A:J y fa- ó'f-c.,~ ~,\¡~~ .b y Ch eVY>-l~c('_ (I 1j..{2!"-s <Z~ ~~. ~ III e "'^ t-c.-. ct., {c.S. L' ~9- CSL? ~ ~ f"-: ~ / L/fl W1.~ A-c-c--c> v- d q )LC- ~ (4} Other Resourc~ Activation 1!- e - ~ ,. SUNDALE .UNTRY CLUB & TAVERN 215-_)-001197. 00 - Overall Site Page t::' >oJ . 10/23/90 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - FRONT YARD IN FRONT OF SOUTHWEST CORNER OF MAIN BUILDING B) ELECTRICAL - P.G.&E. NORTHWEST CORNER OF, ~UILDING TWO PATIO DECK C) WATER - LOCATED SOUTH CENTER OF BUIDING ONE D) SPEACIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SECOND, FLOOR OF SUNDALE COUNTRY CLUB. WE HAVE A BUILT IN SPRINKLER SYSTEM. KITCHEN ALSO HAS SPECIAL BUILT IN SYSTEM FOR GREASE AND COOKING FIRES PLUS HAND HELD EQUIPMENT. FIRE HYDRANT - SOUTH CENTER OF DOWNSTAIRS OUT SIDE OF BUILDING IN FRONT OF BACK DOOR ENTRANCE. <4} Held for Future use ',.~ . " ~,> : 10/23/'30 SUN DALE COUNTRY CLUB & TAVERN 215-000-0011'37 00 ~ Overall Site Page 6 (G) Tt~ai r-.i rig (1) Page 1 IJ.. WE HAVE?? EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? YE:5 /' BRIEF SUMMARY, OF TRAINING: A 1+<tJt 71.. cr' Sa.+~Ty C> 'r/-€V\.i-<>c.iï 0'1'\. m~-efn1_' I S 'J¡ ¿ / cI WI :::,{ eAZ&h ,11/ e.-w is rl fJ J tHj E 1£ a...-V'\- cl ~ I r ~J L(. I Q y- .:::r- V\+ <- '(' v cds ~?~-tL9h-<>u í ¡..(..¡$ /'~-r , ~ JßM-P /oy.,~~· 12' Su. Vi Ja /.e C1ou. i4-frY C Lt.d!' 1# '-~ISS.~ WI I ~Þtjl//'¡ -G ,.::r;.tÞl':I't'lcA..17u-.A- ð--n --fl.e:... -Pc-tlcYw;/A. w~ I... (þV\/., ó'.v'e.¡-VI-eW &-.¡.. ~e-<ø-u(/re W\.~~~..". ~'f-ll 11.-t'" r ,'::\.: -rf,..e.. .fll4-"ZafJ C!øW1f11ü/}'IJC-rr.fJdYfS /{,If!-.9tl a..-1?trn :::r:;>1.c-/ud11A.j' J8., /v)p/ðJ,/<-e I?I...9'hT~ S fïD-U.J ~c.-"'-'l. t+llzt:t.-clo-t.<..s-e.... C/~ ¿vV2.-1 c...a../!3> Cl. ~-5;flÞ+<é:I ClA/tc::l ll&<.c£ -¡.--f' a,v! y _ (2) Page 2 as ~eeded (3) Held for Future Use (4) Held for Future Use <1,';. :ï. ,,~ . It ~(~- '>--., , '.- ". :s._~~ .... ;!:., ~ _, 'j (1:-: ~/'~' . ·....·'v e e BAKERSFIELD CITY FIRE DEPAR~~ 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 US I~ESS ~A.'fE RECEIVED JAN ,? 1988 Ane'L......... . 1/£/7 , -0 HAZARDOUS MATERIALS ~ BUSINESS PLAN AS A WHOLE U FORM 2A ~Gt ~ OFFICIAL USE ONLY ID# INSTRUCTIONS: ... -- ~ - .-. 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IX ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 'I SECTION 1: BUSINESS IDENTIFICATION DATA SUNDALE COUNTRY CLUB AND TAVERN BY THE GREEN A. BUSINESS NAME: B. LOCATION / STREET ADDRESS:- 6218 SUNDALE AVE CITY: BAKERSFIELD ZIP: 93309 BUS. PHONE: (805) 831-4200 SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. A. BEN NOLAN MGR Ph#' 831-4200 Ph#' AFTER Bt;S. HRS. 833-6888 B. JIM KIGER HEAD PRO Ph# 831-5224 Ph:/: SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE NAT GAS SO CAL FRONT YARD IN FRONT OF s/w CORNER OF MAIN BUILDING A. NAT. GAS/PROPANE: , B. ELECTRICAL: \1Gtt- P.G.& E. N/W CORNER OF BUILDING TWO PAllU UéGX. C. WATER: r.ill w m I ()CATFD S/CENTER OF BUILDING ONE. D. SPECIAL: E. LOCK BOX: YES ! ® IF YES, LOCATION: IF YES. DOES IT CO~TAI~ SITE PLANS? YES / ~o FLOOR PLANS? YES / ~O MSDSS? YES I NO KEYS? YES / NO - 2A - - e _U~~~U 'f:i- '~, ;. ~.\-(, ~~:~. "-~ \ "<,' \ \ \ " SECTION 4: PRIVATE RESPONSE TEA." FOR BUSI~ESS AS A WHOLE NONE \ \ , " . '\ \ \ SECTION 5: LOCAL EMERGE~CY ~EDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE LOCAL AND CLOSE HOSPITI}.L FACILITY CALL 911 FOR HELP: SECTION 6: EMPLOYEE TRAINING E:-IPI.O¥E-R-S-AR-E-R-EQB-I-R-E-D-"'"'10~~HAVE-A~PReGRAM~~iH-leH~"PROVI-ÐES-'EMPT:;eYE-ES-~I-TH~I-)1-I-TI-AD -:4~D REFRESHER TRAIXING IN THE FOLLOWING AREAS. CIRCLE YES OR NO IXITIAL A. ~ETHODS FOR SAFE HANDLING OF HAZARDOUS ~TERIALS:....................................... @ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH~RESPONSE AGENCIES:.............. ............ ~ XO C. PROPER USE OF SAFETY EQUIP~EXT:.................. ~NO D. EMERGENCY EVACUATION PROCEDCRES:................. . YES ~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:....... ~,~9 REFRESHER YES :'/0 YES XO YES NO YES ßO YES C~O SECTION 7: HAZARDOUS MATERIAL CIRCLE YES - NO - NONE DOES YOCR BCSINESS HANDLE HAZARDOUS ~~TERIAL I~ QUA.~TITIES LESS THAX 500 POUXDS OF A SOLID. 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A COMPRESSED GAS:...... YES NO I. BEN NOLAN . certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et AI.) and that inaccurate information constitutes perjury. SIGNATURE ~~ TITLE" GEN MGR DATE '1/15/88 ¡ , . ...-5jC< ,',' / .y-- .~ , .- .", ¡, .,'- 11_ _'" e e 0: BAKERSFIELD CITY FIRE DEPART~ŒXT 2130 "G" STREET BAKERSFIELD. CA 93301 CF?:CTA~ rSE OXLY ID# ------ BUS IXESS X.-\:'-Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIO~S 1. To avoid further action. this form must be returned hy: 2. TYPE/PRIXT YOGR AXSWERS I~ ENGLISH. 3. An~wer the questions b~lo~ fer THE FACILITY UXIT LISTED BELOW, 4. Be as BRIEf and C8~CISE as pos~ible.· FACILITY UNIT:: FACILITY u~IT NA~: SECTION 1: ~ITIGATIO~. PREVE~iION, ABATEME~ï PROCEDu~ES ~~.~ IN,~~ES$S~/ZED CONTA.INERS PROPERLY ~~ORED.' . .' . '. J "'..r' ~ ---- ~~----;-...~. -...- ~-----.,.- - ~. __,_ 0' SECTION 2: NOTIFICATION AXD EVACGATIO~ PROCEDl~ES AT THIS t~IT OXLY USE VERBAL AND PUBLIC AQDRES$ 'SYSTEM, AND CALL..9tt .' 1 ,r--.J"', ..t'O ,.'" 0" ~>/~. / ;~"-' . - 3A - .. (-~--~-- . \ ' ? 7·--:-·" )"~ ¡ ! :;;;¡ ,r v', ',' ,i TAVERN BY THE G_N BUILàlNG 6218 SUNDALE AVE _09 , ..... '. SECTIO~ 3: HAZARDOUS ~ATERIALS FOR THIS L~IT OXLY A. Does this Facility Unit contain 9aznrdous ~aterials?. . . . . ( »i¡ , XO If YES, see B. If NO, continue with SECTIO~ 4. B. Are any of the hazardous materials a bona fide Trade Secret YES a.~') If No, complete a separate hazardous materials inventory form marked: ~O~-TRADE SECRETS OXLY (white form =4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS OXLY (yellow form :4A-2) in addition to the non-trade secret form. List o~ly the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTIOX SECOND FLOOR OF SUNDALE COUNTRY CLUB. .wE HAVE A BUILT IN SPRINKLER SYSTEM KITCHEN ALSO HAS SPECIAL BUILT IN SYSTEM FOR GREASE AND COOKING FIRES PLUS HAND HELD EQJJIPMENT. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS LOCATED SOUTH CENTER OF DIWNSTAIRS OUT SIDE OF BUILDING IN FRONT OF BACK DCXJR ENTRANCE SECTIO~ 6: LOCATIOX OF UTILITY SHLi-OFFS AT THISUXIT OXLY. ~ \"' T r-,\t" :P"'O?' ~..: . . ...... . v, .~. 1\ .~,!:. . SO CAL GAS CO. SHUT OFF VALVE LOCATED IN FRONT LAWN SOUTH SIDE OF MAIN BUILDING JUST OF SIDE WAL ON SUNDALE AVE. B. SLECTRICAL: LOCATED NORTH vlEST CORNER PATIO DECK LOCATED SECOND STRUCTURE WEST ~ID£. C. WATER: REFER TO SECTION F IV£. O. SPECIAL: E. LOCK BOX: YES . ýtr!J '~YES, LOCATIOX: IF YES, SITE PLAXS? YES / ~~ FLOOR P~AXS? YES / ~ ;'ISOS$? YES '1fJ ~EYS? YES! ~ - 3B - ';''''7/~ n<.· / ¡" ,/ V· ." :- 1"'- ." ..';; {. ..~'~ .. , . - e t BAKERSFIElD CITY FLRE DEPART~!EXT 2130 "G" STREET BAKERSFIELD, CA 93301 CFF:CTA~ rSE OXLY ID# ------ BUS IXESS X"\~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action. this form must be r~turned hy: 2. TYPE:'PR IXT YOI.;R AXS\ŒRS I~ ENGL ISH. 3. An~wer the questions b~lo~ for THE FACILITY UXIT LISTED BELOW 4. Be as BRIEf and C8~CISE as ~os~tble.· -- - - - - FACILITY U~IT~ FACILITY ù~IT NA~: SECTION 1: ~ITIGATIO~, PREVE~LION, ABATEME~l PROCEDù~ES [": Ç()':;;~ IN: PBESSURIZED CON:TAINERSPROPERLY' . STORED ' .,- .' .- .r . ----.,.~----_. ---,.,.,.-.-:; --- - --- ~ SECTION 2: NOTIFICATION AXD EVACt"ATIO:'i PROCEDt"RES AT THIS t:iIT O~LY tY:Sr VER,B~L lND PUB~lC ADD,RES$-$YSTEt(!AND CALL'7Jl1 , - 3A - I I .. (-' ", \ I 5 7-·,~-..¿' ! /'. · SUNDALE COUNTRY CLUB CLUB, ROOM 6218 SUNDALE AVE 93309 FIRST FLOOR SECTIO~ 3: HAZARDO¡;S ~ATERIALS FOR THIS ú~IT OXLV A. Does this Facility Unit contain Hazaråous :-1aterials?...,. :1/ffiIf:iI: ':\'0 If YES, see B. If NO. continue with SECTIOX 4. ....--.... '"" B. Are any of the hazardous materials a bona fide Trade Secret YES~ ~O \ '---...... If No, complete a separate hazardous materials inventory form marked: :s'O~-TRADE SECRETS OXLY (white form =4A-l) If Yes. complete a hazardous materials inventory form marked: TRADE SECRETS OXLY (yellow form :4A-2) in addition to the non-trade secret form. List only the trade secrets on form4A-2. SECTION 4: PRIVATE FIRE PROTECTIOX WE HAVE A BUILT IN OVER HEAD SPRINKLER SYSTEM IN BOTH FLOORS IN EACH ROOM. THE KITCHENS ALSO HAVE SPECIAL FIRE PROTECTION FOR GREASE AND COOKING FIRES. PLUS HAND OPERATED EQUIPMENT, SERVICED ON A REGULAR BASIS. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E~RGENCY RESPONDERS LOCATED SOUTH CENTER QF DOWN STAIRS OUTSIDE OF BUILDING IN FRONT OF BACK DOOR ENTRANCE. SECTIO~ 6: lOCATIOX OF L~ILITY SHL~-OFFS AT THIS UXIT OXlY. A. YAT. G~S¡PRO?~XE~ GAS CO SHUT OFF VALVE LOCATED IN FRONT LAWN SOUTH SIDE OF MAIN BUILDING JUST OFF SIDE WALK. NAME SO. CAL GAS CO ON IT. B. SLECTRICAL: LOCATED NORTH WEST CORNER FO PATIO DECK LOCATED SECOND STRUCTURE WEST SIDE. C. WATER: CAL WATER CO. LOCA TED REFER TO SECTION FIVE. D. SPSCI~L: E. LOCK BOX: Y!::S.'#!IJi '~YES. LOCATIO~;: IF YES. S"'~'" PLAXS? YES /;xJ. )!SDSs? .....,.. :)(Ó l i Co of!:...') FLOOR PLAXS? YES /)m ;{EYS? YES I ~ e - 38 - e I" {tU~I"ltl.U Gal\' I'IUI~ 1JI:.I'AlUIH.UJ FORM 4A-1 NON-TRADE SECRETS IIAZARDOtJS MATERI ALS' I NVENTOHV I CLUB RCXJM '1\1'; I Ilrss UMIE: SUNDALE COUNTRY CLUB OtfNRn "AHEI " I II 1111: ~; S : 621 E5 SUNDALE A VE Mill It E S S 1 I Y, 7. II' : ~£2 C I TV. ZIP I I II IF, . : 805 831-4200 PIIO"E · I II . ¡/ ... \..- r [ IP! (I ( '. I -, F^CII.ITY UNIT': F^CII.ITY UNIT tI^HE:_.----. , ..;. - ~ , ' I ....... -- o % nv -HL- ~!!~H.Hi~L OfU!QMtIQtl_tlM!E CO-2 METAL CONTAINERS J OS- / o In F FIr. I ^ I. II S E r. FIn s ON I. y I 0 1I^7.^11I1 ~!! l! ~--- rllllr -----" ;s.3....~.- --= -Y9.l~~ o " IISß l.nC^TIO" I" TII18 CIJº~ __f ^ÇlklIL.!W I T 99) S/ECORNER SNACK BAR- II II l:iJIIIL ..---- :1 .. Ii MItIII ^ I. f: nrn _Mm~!!L _!!tl!I ~!HHt .. _ "',l.. _ 4~L. --"--- 13 --e .-------. ---.- - .. . -.---_& ----- ----- ------ ---- --..' - --- -_.-- --.----- r -.----- -.'." - ----.- .----. - --,--- .-- -_.- -- -- ..- -_.- -- .---.. e --- ...----- -----. -. - -'-' ..--.---- -.-.--.---- .--. . ----- ---- ---- ------- -----. --. .. I ,\ II r· -- TED -FERGUSON '\lIII,f.ïi\:Ÿ-(:"ÎIT^,~T: JOHN PRESLIK I I 'I. T I TI.E I DEFT NGR TITI,EI 810H^TUnEI 'HEAD CHEF Or?'77~~~/ nÄTf.: l~i~Jt¡ _ PlíóHÉ . nus IInuns :R31 5225 ----- - AFTEn "US liftS: PIIOHE , nus nnURS: 8'jJ-p-yaJ------· ^FTER nilS, IIRS: ~"?~-ctftY __.~~ ~ I ,-- :11 II I. c: II n'nlflT M: T : ð¿- /'! //1& 1-:22L II 1111 I ^ I.. 1111 S 1111: ~ s ^ C T I V I TV: ~r;;;,;? TITI,BI ~eW //~ f!Ød~V - ..,,,, - I^t<tU~I;ltl.1J GII~ I'IUI~ IJI:.I'I\II 11-11.11 1 FORM 4A-1 NON-TRADE SECRETS IIAZARnOtJS MATBRI ALS' I NVENTOHV l"II(;II~r.~S II^~H":~. . ~~~~Þ'if<i't/ OHNBn HAHBI ,·."/1111."" :- _ _ C-- _ ~ AIIIIIIE99 I . I I Y. 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'" ~'IIn I:IIIITAr.T: dJ1Þ7J ~¿~ , TITLB'é ¿":;:?~ II I ;;;:~^ .. /IllS IIIEfì!1 ACT I V I TV: ,no£J e.. ~dtØ(? r9ßl.//;7~ "SIONATIIIIBI ~~/~ )1ÃiE~ - . TIT..Ea ÆXtt' C#.é;7= ~ /~PÚO"E . nus nnURS: X?Ï- -¡'/2fYL AFTER nus IIRS: ß3~ðtfD ..-+ ----.--+ PIIONE , nlls IIOURS: AFTER nlls. IIRS: -----.-- - ..,,,, - IIJ\KI;n:H'1 ~I.U t II~' I' IIII~ Uhl'A ( HI&." FORM 4A-1 NON-TRADE SECRETS IIAZARDOtJS MATERI ALS' I NVENTOHY I ""(; /lUìS IIMIE: '-M/fi!¡( /3''/ ~6~~ OHNRn NAMEI ,',/I/I E~;S: 6 2../! .s[),A/þI~ AIJUnESS I I I ~', Z I I' : 2..3? ý C I T Y ZIP I I 1111 II F ': l""":' ~'.'" PaIP'! ,,( . ( " II . _. . F ^ C II. I T Y II NIT ,: FA C II. I T Y II NIT N MI E : -----.... . g-D.$~ %'.3 J . t? r:Kf- PIIONB . I , n F Fie I ^ I. USE CflRS Cl1l1r ONI. Y I .....i" -- ----- :) " fi ß 1 0 0 I n ^,'tllI^l. corn "Sf. I. ()(~ ^ T ION IN TII18 % nv "^7.^ I ) II I MltI II IH UN 11 CUIIE ~!! º ~ __F ^Çlk!~Ët~T -HI.:..- ~!!~HJJì~L OR cºmlºtl_~M!E .-f!! ~! ~--- I ~ ~! ! 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IIRS: - -1/1' - U^Kt (~I:I~I.U tll\' I'IUI~ IH.I'AUIIH.UI FORM 4A-1 NON-TRADE SECRETS I IIAZARIJOtJS MArrERIALS' INVENTOHY L~ ,.. (!ßM-//'I frA/Ø'YCF Y¿? õ" it ';'/I/:fìS "M'f.:""'¿~~;~p.. ~c..LvL7 01lHHR HANH. ,^cntTY IIIIII I, '. "" Ii r. '" , _ _b/...j 1"- __ _~ - __ __ A II II A E S S . FA c II. I TY 11111 T II AIlE , - -- - - , I y, Z II': ~ C I TV. ZIP' I IIII/ ~ ': _.~~Ð..!~ - ~ ~./_ L//70 - fllONE '1 USE CF IRS I:lllIr ----- "IF' ,..-J.1T1.E:· 810NATURE, '1ÃiE: - -- ',.1 1\ ",,; f. i i ¡; ¡; -I: ¡¡ ilT AI: T : lrl/1Ø/71l t? FZ- T ¡;Æ¡'9-/JI. TIT r. E 1 ¿tl ""'" h9i'Y...v Æ90e?""""]" II 0 liE. II II S II n II II S : 2i;j;:"'~ _.n _ A:~ /~ L AFTER nlls IIRS: ;37:Y-~JI :I'lil.""'\, t:ll1I TAr. T ,~/V ¿r ~ ~ T ITLþ~ /7t5f . PIIIIIIH · AII9 IlIIIIA9: ~? /~'7 . :=:·1 " "'" ^ I,. Ii II " II II os " Ar. T 1 V 1 T Y: ~__IL--.- . /. '0a ß'p. - . Aft E II A II 9. II A 9 : k't'i-£ J:E:< ----- I , I J I I II I~<::~> ( '-, ....{.~".. - _. __._6 __ ,..~. I;' t! :J -t fi ß 7 "II /I^X MItIII^J. C:IINT "Sf. 1.()(~^TI0" I" TII18 'IIIL ^"I!II~!L _MH!~H!L _!!!!!.I ~!HH~_ Ç!Œ~ __fAfl!J.1Y-Yt!JT ~ r~ - - --~(;(j)-~- ~f;L- ø (XL JlIE Cb~N&Z-ý¡f£O 11 - %J)~ .f¡¡:Jf;it '~L (; ¡., /1 tMTW&12- (#fi/ . I ¿¥:,J7tJr&£-þ¡f{ oC_"¿" ß/PP/l8l ~#M 'P /(Plf:1t.-:_ ßr~#'I_ ~I1L, oC (:)f ¡J!U:9Vfl;?! FP7Vi:e:-- ~...'. .fJf/j(.: . ~t4L; 6,;[ Db ~ ,(II/' Æ£ N/[P . I p !~__ -~ ,6ßl b & ~ /'IItC ~n>Jf ~1Iø. - ; tx .1:£(;;4;- . tfJ>(i)l- tilt- d~ I ~ /v/¿£' Rat! ;:ðIP . ~. iff¿-L. øotM-t- ~ðt b& .I.JD .LI/r 'i;íõL f;/£O --' - - -- ----- --- ...------ - ---- . .- ~- ---.-- --' . --.-- -- --.---- --- - -1,,' Pa !p. _ II r __,_ !' o 9 ,n % n V II ^ 7. ^ 1111 II II I JL..... ~!!gMHì~L OR cmwºt!.-!JM!E ~!!PL_ !~!! P!: <?;~9?k~~ ;¿n ;)/ ~Lf9b ----' Þðl:-FViL f/7q) 0 J ~I§,>_-- ~7ïJL .1}/ L - - -d~D~- - p't./4 ____u PI - t;5p'~ ~ pt, $ l,/y ;;?j¡liOZI¿ Þi/~ c9-<lO~-~ ~r;_ GE;?JÆ ¿¿;¿ >~ //.0. ,a~_ J;I=?(O~ÐÝÞ- HðL / I Î?f .q/J Fl6~__ -'" 1Jj1~~(t.:('(j'NT~'/~ð" _ : ¡-=tÇ-ß _ _____ --.- ------ -e ------- - -- --- .-. -----. . ---.- -. o Farm and Agriculture [tr'standard Business CITY OF HAZARDOUS BAKER.SFIELD MATERIALS INVENTORY '. NON -TRADE SECRET I ~ page_of-L' ~i ,." "'" BUSINESS NAME: (;h1/0n/Þ ¿;""AITn.y ¿Iv¿ LOCATION: ø -:). /tf J'tJ.lVo;4-/c dŸd CITY, ZIP: .¡þA-~ "~~"'9 PHONE #: f;. 3;' ~2.ð£~ OWNER NAME: ADDRESS: CITY, ZIP: PHONE J: V¿'~.AI# T . 5~q;'W/1t' t!Jd;:z. NAME OF -THIS 'FACILITY: ~¿'PNT.t2>, ¿/u,ÿ STANDARD IND. CLASS CODE: DUN AND BRADSTREET NUMBER/FEDERAL ID * - - -- Physical and Health Hazard (Check all that apply) o Fire ~azard 6 REFER TO 7 8 /I Days Cont on Site INSTRUCTIONS FOR PROPER CODES 11 12 Use Location Where Code Stored in Faci1it 13 'Is by wt 14 Names of Mixture/Components See Instructions ~Ço¡t/ð I 1 Trans Code tJ S~,iV$Z>I/ , Component /I 1 Name' C.A.S. Number 0 Component /I 2 Name " C.A.S. NUmber Delayed Health Component , 3 lIIame , C.A.S. Number Physical and Health Hazard C.A.S. Number Component II ll11ame', C.A.S. lIIumber (Check all that apply) 0 O' Reactivity 0 0 component , 2 lIIame , C.A.S. Number 0 Fire Hazard Sudden Release Immediate Delayed of Pressure Health Health Component /I 3 Name " C.A.S. Number Physical and Health Hazard C.A.S. Number component II 1 Name' C.A.S. Number (Check all that apply) i 0 0 0 0 Component II 2 Name', C.A'.S. Number [J Fire Hazard Sudden Release Reactivity Immediate Delayed of Pressure Health Health Component /I 3 Name , C.A.S. Number Name Title Component /I 1 Name , C.A.S. Number Component II 2 Name , C.A.S. Number Component II 3 Name , C.A.S. Number #2 24 Hr. Phone Name Title 24 Hr Phone Physical and Health Hazard (Check all that apply) o Fire Hazard D Sudden Release of Pressure C.A.S. Number o Reactivity 0 Immediate 0 Delayed Health Health EMERGENCY CONTACTS #1 Certification -(READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I haver personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those individuals-responsible for obtaining the information. I believe that the submitted information is true, accurate, and complete. . /:2. ·/3-f I :;...-¡e:....:.. R/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED REPRESENTATIVE DATE SIGNED -, e e December 10, 1991 Mr. Be!n Nolan Sundale Country Club 6218 Sundale Ave. Bakersfield, Ca. 93309 Dear Mr. Nolan: Per our phone conversation of , December 9, 1991, enclosed you will find a copy of your Hazardous Materials Management Plan. It looks real good except for the inventory information. Please take a look at the inventory section of this plan and revise it to reflect the removal of your underground storage tank. Also if you find any other corrections that need to be made please take this opportunity to change them. G If we can be of any assistance please don't hesitate to call 326-3979. Please return these forms to 2130 G Street, Bakersfield, Ca. 93301 by December 30, 1991. Thank You, Valerie Pendergrass, Hazardous Materials Divïsion ENCLOSURES . I CITY of BAKERSFIELD O OHAZARDOUS MATERIALS IN,VENTORY Farn' and Agticutture Standard Business - _ NON-TRADE ,SECRETS Paqe __ of ~gsI~ÍðS Nt.~E: 51~/'£1/~ Jf.L·''ij. Vµ.~ '~WNER NAME: 6~~... ',-NAM~ ~~ THIS FAcniTYò,öf-'ll2Æ.!J: t'1M'Ylr8:.!~, {tk.i> BÀb~è ¡~~:l¡!~:~!~~_~~1 ó'..~~?Oy ~~~~~S~~p,f;:t.:.f,. "~ ~JY~:'i/,¢·~~Y)~_,5Ù~ ~NDDB~~BsT~~~~SN8MB~Å-'-----"-_--!~--- '0 - -- REFER To=i'ifiS<tm TION~PROPCR CODES - - - - - - - - - - . 1 2 3 4 7 8 9 10 II 12 13 U Trans TYDe "ax Average . Dys Cont Cont Cont Use location Where . by Nalles of lIi.ture{COIIDonents Code Code Ant Ant on SIte type Press telllP Code Stored In Facility wt See Instruc Ions U-l 5IJ, 0 I l1í '.' PhYSicøl Ind Health Ha¡ard _ "JOOf.:, -·",l..if' , ICheck all that apply 1 [1 Fire Hazard '3 o Reactivity 0 De!ared 0 Sudden Release o . ..2.. Hea th of Pressure o Fire Hazard n Reactivity o De !ared o SUddfn Release z.. () :L Hea th o Pressure LA- 5--;- 12 Ph~sical ,nd ~ealth Ha~ard I heck a I t at apply o Fire Hazard o Reactivity o Delared o SUddf" Re 1 ease tJ p~ ;;. Hea th 9....1.{ 0 Pressure It· / O d' COllponent.2 N&II8' C.A.S. NUllber IlIlIIe late Hea I th ~ Conponent .3 / e O Conponent.2 Nane' C.A.S. Nunber IlImediate Health Component '3' Nalle "C.A.S. NUllber O . COllponent.2 Nalle' C.A.S. NUllber IlImedlate Hea I th )j-¡ COllponent.3 Nalle' C.A.S. NUllber Physical 'nd Health Ha¡ard ICheck a I that applYI C.A.S. Nunber COllponent.1 Nalle' C.A.S. NUllber o Fire Hazard -~ o Reactivity pæ: o De 1ayed 0 Suddßn Re 1 ease ~Health ~ of Pressure O . Component 12 Nalle' C.A.S. NUllber IlImedlate- Health Component.3 Naie,' C.A.S. NUllber EMERGENCY CONTACTS ., M2 Ifhe Tttle lflfr pnone NUle TItle ÍertifiCHio~ (Reed and $i9n aflør c9mpl(lting li71. sections) . certIfy un1er pena11t 0 la~ that I have pe(sona I~l e.all,näo O"d In familla( Yltb the info(lIatlon $ubll¡tte~ In this ond all , - , ,a"ttached docUllents, anQ t at based on IIY InquirY 0 hose I"n IVlduals resP,on,Slble foroblalnlng the Inf,orllatlon~ I belIeVe th~t th , ' ,- , - - . -S,U~"'ltted Infor~lIatlon IS true, accurate, and.,coIIPlete., ,- _ ". / _ /), '\'\.', , " ',' . . ' fl#4~~ ~ IIDê ~r,fyflctal t!tle of ()\ln~r¡ooerator UII o\fnerl.oøemor's authorized reDresentatlve ',_ ' &t~r , '_. - I '0' ' n ~rtM I DAU)r4r.!~,-1 -I - - - -- -'J--;,JO_~~r~-v...____........-v-_-_-___~_ol'rJ"r_"""'~'~__~_ _, _ _ _ ~v __~ _ _~, ~ ~~'-'._~____ _~... _ ___---------:~.............. _.............. _____......... ___ __.. __ .........._...-..... 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