HomeMy WebLinkAboutBUSINESS PLAN
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4kITÉ/FACILITY D~GRAM
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BUSINESS NAME:
DATEl')/ / ð7FACILITY NAME:
SITE DIAGRA)f
FACILITY DIAGRAM
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REFERRAL TO FINANCE DEPARTMENT FOR COLLECTION
1/-1-90
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Referring Depart nt/Section
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Person Making Referral ~
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Account Number
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Name ( siness Name of Commercial Account)
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Site Address
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Mailing Address
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Telephone Number
ð19-97~
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THIS BILLING HAS BE&N VERIFIED AS ACCURATE AND VALID
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Authorized Signature
(O~iginal to Cash Management, copy to Accounts Receivable)
NM 6/8/90
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March 6, 1990
TO: Nina Mayer, Accounts Receivable
FROM: Ralph Huey, Hazardous Materials Coordinator
SUBJECT: Vaughns Wheel & Brake
Nina, account #431101 is no longer in business. There is an
outstanding balance o£ $75.00 that should be turned over £or
collection. There is a £orwarding address on the invoice,
however I have no way o£ veri£ying that Vaughn acutally is there.
An inspection was done on this business last year and the person
there at that time told the inspector that Vaughn was in jail. I
have no other in£ormation.
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¡,~~O~_~~.-,.. .s'''))~'\),~/!fJ rõ, CITY of BAKERSFIELD q\ð1 ~i~:~:'l'U If,/~-~
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(tYDe or pr'lnt. name ì
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RECEIVED
fEB 02 1989
Doh ere bye e :- t i f y t hat I h a '\ - ere vie h" e d the
Ans' d............
attached Hazardous Mat.è~ials busines~ plan
for
c7~~~r
(name 'of busi ess)
and that it along with the attached additions
or corrections constitute a complete and correct
Business Plan for my facility.
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liE RGEHCY CCIITACTS 11 Jþ!?L-£-./¿4~-f-Jf..L-m---- ~ffL.JJ-£.J:=------------- ?r-~!P:t.l-~ 12 .l:,j ~~.Jti<Jj.6L.~---------- nnf tt!d e..t=-________ ¡,t-~-7 ¿,~-
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Certific,tion (Read ~nd sign lifter co.pip-ting IIll sections) , I
I certHy under IIMlty of 1.. that I have uersonelly e.,.ined end e. f.ilier with the infor~tion subllitted in this end en ettechld __t., end that based on ., inquiry of tho.. individuel. ....I!III.ibl.
for c¡bt,;nin9 the inf_tion. I bl!1ieve that the subllitted inforution is true. accurete, end C~P' t . ~ l
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CITY of BAKERSFIELD
~~
HAZARDOUS MATERIALS INVENTORY
NON-TRADE SECRETS
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OWNER NAME: (),11
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RUIØf ro IlISrRucrIOIIS roll ""OPIIIl CODIlS
NAME OF Tft1Š ~~Ç~L~TY:
STANDARD IND. CLASS CODE
DUN AND BRADSTREET NUMBER
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BAKERSFIELD CITY FIRE DEPAR~
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
RECEIVED
103-~Ob JUl 23 1987
"" Ans',d............
\(J ...LtJ~p ~
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OFFICIAL USE ONLY
ID#
INSTRUCTIONS:
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HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
1. To avoid further action, return this form by
2. TYPE/PRINT ANSWERS IN ENGLISH,
3. Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NAME:
B. LOCATION / STREET ADDRESS:
CITY: ZIP:
( 905T.
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
NAME AND TITLE
A. 7'/)/.17 t.-- ð 1.í',1 011;'
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B . "'- j (2.- ~';' Pi:{ 1f"{ "'1
EMERGENCY:
DURING BUS. HRS.
Ph# 3~J;J~.7
Ph# .3~)' /01-)
AFTER BUS. HRS.
Ph# .3 9 9,-9 ?(,y
Ph# J> 9..9 9 ) t Y
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
IF YES, LOCATION:
.,."
YES, DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
\
MSDSS? YES / NO
KEYS? YES / NO
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
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11!II!lu/fL- 'Fõ¿ ¿me~j1 r/t:.sr #/0
;í!o 0/1 é /:5 E (/13 ¡f fJ/(J ,<: t:'1 ;1;;¡G J4 to M S
é/11é£t;E./1cy !Ý05. fð sf~-
,¿ SECT(ION ~: :-.:O~~/EM~~~~Y ~~~I~A~_ASSISTANCE FOR VOUR BUSINESS AS A WHOLE Ú!e.{( ,+0 fly' .tK.
3d ,;.~~O;.n~Ofi!;:.*, caLC {Ò,(. r:F~:<L( O-sS~~t;:-:c'ej (;1( ,'l(/-:j ef tf41/
cifd ,./!J ?'~ ~W.Y/:ifVìd.~; a.,n'c}'Þa-Y )¡~II /7eÆd~
¿{.,4V-l t-l a4-::J I ~ ~c. e Qj"'/, I l/ e-S'. . _
(IJ&lJ1oR¡flL /Ýo5jl~·+c¿.1 .s/J)(.~* ~
/llflCV ¡Ið~I/1el/ /I1£/J/ Ceð7€¿
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL
A. ~~~~~~~L~~~.~~~~.~~~~~~~~.~~.~~~~~~~~~........... ~ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES I
WITH RESPONSE AGENCIES:.. . . . . . . . . . . . . . . . . . . . . . . .. ,ES \ NO
C. PROPER USE OF SAFETY EQUIPMENT:..... . .. ........ . . NO
D. EMERGENCY EVACUATION PROCE~URES:................. E'~
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:...., .. YES ~
REFRESHER
YES
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YES
YES
YES
YES
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~ A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ..... , ~NO
I, , certify that the above information is accurate.
I mation will be used to fulfill my firm's obligations under
the new California Heal h and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec. 25500 Et AI.) and that inaccurate information constitut~s perjury.
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'SIGNATUR~~' ~TITLE ~-v.
DATE 7·-:/...p.7
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
3 )..(p - 39"77
OFFICIAL USE ONLY
BUSINESS NAME, \J ~IJC<" 4ci:é'
ID# j;ç¡ K tf-/7 fI /
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS "
1. To avoid further action, this form must be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT#
FACILITY UNIT NAME:
SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES (
II ¿{ Con fa!l1eRC; SEll-LEO
L () _/--1. ý',o/? /J ¿} L {lce /c!t::?/lt/' ~S'/l, -¿~.
c57õ /2é.-¡J O~T tJ-r- ?-/;e I e-u:¿r; ¡ r
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SECTION 2: NOTIFICATION AND EVACUATION PROCEDL~ES AT THIS v~IT ONLY
~ qt¡ o.-nct kwc QL( eVh~ (oyec:.s
Vct.c..Q..,1c +he- premiSeS
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Ooeß this Facility Unit contain Hazardous Materials?,., .~NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YE~
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials inveatory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the traqe secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
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SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~ERS
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SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT. GAS/PROPANF:=¿ílST ð ç /r1CCoy' 0 rFf(£ 0/1 11If:-~r ~Kiç¡(/¿¡(I(/t:t CY
o -f -f; Re Wa4:E (Yð C<-S'~ "
B ELECTRIr,AL$!JI. 4()är(E~ ,~f 5 h ov3^'-i ~5 -1-, ,~~: ~ trl- W~
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C. WATER:
7
,
D. SPECIAL:
,
E. LOCK BOX:, YES ~ IF YES, LOCATION:
IF YES, SITE PLANS?
FLOOR PLANS?
YES / NO
YES / NO
MSOSs?
KEYS?
YES / NO
YES / ~o
- 38 -
I. D. #
~^KERSFIELD CITY FIRE DgÞARTMENT
, FORM 4A-l
NON-TRADE SECRETS
HAZARDOUS MATERI ALS' INVENTORY
~~~::S:~~~~~i{~TY U:~~I~¡:~, UNIT t:
CITY, ZIP '. _'no _ __ 0 _ _ ' , I
PHONE # :r-' ", ?c¡>CJ :.;c;'7(;;;C.7------ 10FF I C I At USE¡CF I RS CODE
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BUSINESS NAME: \J^tJ('!-!~I'r,:- tMHCI::L l BRA~{E
ADDRESS: I . ,. -.... ....) .. ....- ,. ,
:~3C ,~.~:..~ S:r:~:ET 325 9127
C I TV, Z I PI:: P. O. 80:'( 3a~47
PHONE #: ' 8^VERSFIELD Cð 93385
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TYPE MAX 'f\-1. ANNUAJJ CONT USE LOCATION IN THIS % BY H~ZJŒD D.O.T
CODE AMOU!NT ~ AMOUNT HNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR .COMMON NAME .,CODE GUIDE
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NAME: F -¡J1/ì I/Iì//?Jhl/ì TITLE: n(l)VIPP SIGNATURE~: "'-.P/#~~ .-/' þ-;;b~.? //~ .......:::_ '/..../DATE:
, v T .E: \.:;7 PHONE # BUS7JlOURS: _ ~ ::::J. ' a
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AFTER BUS HRS: ,~/J. yf :(: ~ J
PHONE # BUS HOURS: I
AFTER BUS HRS: j
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