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I ; RETURN PAYMENTS TO:.. .. ) . · . _I PLEASE MAKE CHECKS PAYABLE TO:
I'~, BOX20~~SF" ' " D¡vtSIO~ CITY OF BAKERSFIELD
BAKERSFIELD~ CA 93303-2057 RETURN THIS COpy WITH PAYMENT
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(' BAKERSFIELD, CA 93303-2057 ACCOUNT ~?: _---I 1;"~' :;2?? í)2.
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Pl~A~E MAKE CHECKS PAY ABLE TO:
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~SI~SS NAME HIGHLAi::-R OASIS AIR COND CO
LOCATION 1000 E TRUXTUN AV
db
. NUMBER 215-000-000048
HIGH HAZARD RATING 1
1. OVERVIEW
LAST CHANGE 09/13/88 BY ESTER
JURIS CODE 215-002 JURIS BAKERSFIELD STATION 02
MAP PAGE 103 GRID 29D FACILITY UNITS 1 HAZARD RATING 1
RESPONSE SUMMARY
2A SEC 4) MARTY J WEST, BEN J COMINQUEZ, DALE W CARLSON AND JOEL DOOLEY.
EMERGENCY CONTACTS 2A SEC 2)
MARTY J WEST - 322-9601
BEN J DOMINQUEZ - 322-2665 OR 397-4564
UTILITY SHUTOFFS 2A SEC 3)
A) GAS - W END OF BLDG B) ELECTRICAL - E END OF BLDG C) WATER - SW CORNER
OF SIDEWALK D) SPECIAL - NONE E) LOCK BOX - NO
4. LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 09/13/88 BY ESTER
2A SEC 5) 911
~
/Ju~ f AÞ
PAGE :L
09/13/88 08:21
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
BUSINESS NAME HIGHLAND AIR OASIS AIR COND CO
LOCATION 1000 E TRUXTUN AV
FACILITY UNIT 01
ID NUMBER 215-000-000048
HIGH HAZARD RATING 1
A. OVERALL HAZARDOUS MATERIALS INVENTORY,
LAST CHANGE 09/13/88 BY ESTER
ID TYPE NAME MAX AMT UNIT HAZARD
LOCATION CONTAINMENT USE
1 PURE FREON 22 10200 FT3 MODERATE
NE CORNER BAY 5 REAR PORTABLE PRESS. CYL. COOLANT
ID PERCENT COMPONENTS HAZARD LIST,
1104.00 100.0 CHLORODIFLUOROMETHANE MODERATE
B. FIRE PROTECTION / WATER SUPPLIES
LAST CHANGE 09/13/88 BY ESTER
3A SEC 4) FIRE EXTINGUISHERS (5) ARE LOCATED THROUGHOUT THE BAYS FOR FIRE
PROTECTION.
PAGE. 2
09/13/88 08:21
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
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HIGHLAJlÞAIR OASIS
1000 E TRUXTUN AV
01
AIR COND CO
tlÞNUMBER 215-000-000048
HIGH HAZARD RATING 1
BUSINESS NAME
LOCATION
FACILITY UNIT
D. EMPLOYEE NOTIFICATION / EVACUATION
LAST CHANGE 09/13/88 BY ESTER
3A SEC 2) THERE ARE 11 ESCAPE ROUTES SHOULD A PROBLEM ARISE. DURING WORKING
HOURS THERE ARE NO EMPLOYEES IN THE VACINITY OF THE BOTTLES OF
FREON 22 UNLESS THE EMPLOYEE IS GETTING ADDITIONAL BOTTLES TO USE
IN HIS WORK, IN THE CITY AT LARGE. OFFICE EMPLOYEES ARE 100 FEET
AWAY FROM THE BOTTLES.
E. MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 3
09/13/88 08:21
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
¡:. ,i
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
~
¡03-:<CfD
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/I! 61/tJYI/):J
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USINESS NAME
1j11.2 COA/tJ CCJ
Co t1../,(J
OF~ICIAL USE ONLY
ID#
dD \ 5 L\
OCC048
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
INSTRUCTIONS:
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:/jltf#?-Þ1tfV/J IJ(/ol / C 8-<)/5 /f-II< rO/1/ (].. CO ~
B. LOCATION / STREET ADDRESS: If) () () }ç-ðc¡/ ~U )2 { <..J V\. fJ- ~
CITY: 8ti-~"?C(.../IcL- ZIP: "',lCr BUS.PHONE: (~r) 1))-~60/
'J ~) =J)-). ;}!/Ç š-
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
A. MJ/-I<T y ~ wß)¡
B. B.,o11 d. Do--;,-n/n9~-¡
DURING BUS. HRS.
Ph#~)- ¿Zúø
Ph# 1) )- r;}-úó r
AFTER BUS, HRS.
Ph# 1d -;--'l t;ú/
Ph# 317 'Ir~'f
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
~: ~m~~~~~j~A~f!f/:?:~fçJ~l{l! f; J
D. SPECIAL: ~~
E. LOCK BOX: YE~ /(7 IF YES, LOCATION:
IF YES. DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO
FLOOR PLANS? YES / NO KEYS? YES I NO
- 2A -
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. ,"' ........
SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
I/;t êy-t,¡ .J LJ~)' T.
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<'Ð'''15;~ cû Ca.,A;V'v\-
dc--e / Doc!'" r
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
q/!
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
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS:.................................... . .. Y~ NO YES~O
B. PROCEDURES FOR COORDINATING ACTIVITIES v'
WITH RESPONSE AGENCIES:.......................... ~ NO YES~~O
C. PROPER USE OF SAFETY EQUIPMENT:.................. y~ NO YES~NO
D. EMERGENCY EVACUATION PROCEDURES: . . , . . . . . . . . . . . . .. y~ NO YES NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:...., .. Y~ ~ YES' NO
¡()(l r 1 -vvd (~ 'f d '--'0 /.
- O¡y-(/</(J Þt~-tnï r
INITIAL
REFRESHER
SECTION 7:
HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~F A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: . . , . .. ~ NO
I. D~~ fA) (q-y-/s~ . 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
&J
DATE )-lr-)7
- 2B -
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 lOG" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
I/I(jH~¡¡-N/:) H¡f{ eONO.. rL1D#
BUSINESS N~ME: O/f-c:::; /5 fJ / R CO/fAO Ct:J,
------
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoid fuither 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 »ossible.
FACILITY UNIT#
FACILITY UNIT NAME:
SECTION 1: MITIGATION. PREVENTION, ABATEME~ì PROCEDURES
¡f//IJ-
§ECTION 2: NOTIFICATION AND EVACUATION PROCEDú~ES AT THIS ù~IT ONLY
I~ èYv-f JI "'¿'5C Q~ Y'Ov-r4.S 5ÅC/v/c:L cl
f n- h /'-I?-rr\ d V (~) -e,.. Du V /'ÞL7 W 0 Y /é { ~L j ÁD U r 'S .
-r A-e y e- ¿vy-<" '1-\. c> --e]/V\... f I 0 I"\.IU-S I I'L T 0- (/ ë C / 11 t 1,7-
ð,f -¡-k bofl¿s cJ~ r~;;-J-- . vV'\.. (--eS-S -¡-/uL
~ ¡/Io 'f -e ~ (5' 1'" 1/ r ~ ') d cLJ t f ICM d / bc:ill¿ 5'
-þ (/ <)--e (1'1 .A L S ~ k, 111. fl.. ~- Cl-ly ð-(
1ð'V}-J2, 0 <J-5ÿU-€' ~¡?Io /"''5" ~ . 100 rr- {
d.vv d Y I Yl cJ ~ ,f' ~ (-< d--y- 'é' éL '(..,V t * d I yv:; C r
o€<"hd~ ~d 7 -f~ -t-~ kl!¿s,
- 3A -
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f, .... ~
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this Facility Unit contain Hazardous Materials?.. ... BNO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES~
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
f /r-e... -e,¡{ -f r ~J ~ ¿.:oA...cJ rf C') ~
-¡-~ r hdL(5..
(OC~¿d 11 ýC/v ¡.tout
^'3
S TION 6: LOCATION OF
A, NAT. GAS/PROPANE:
(JU+5(~¿ T ÁJ
-+- /ï -I- J Iou t (d/~J ...
c./\)-.e S ( L.u ò.- I, o,..ç J f.J
B. ELEC7RICAL:
o C/l 7L& -r/..-R
-€d'5T wðl( ~ 1b
f
JVl (/~J
C. W;~~R:~ 7 ( d.e tA./d/k O"ŸL ~
D;f- --/i.r; h u (r ( cI I' U-j
7~ IY\Á.P 5 -¡- C 07 /J ...øv-
0, SPECIAL:
¡(j ¡If
E. LOCK BOX: YES ~ YES, LOCATION:
IF YES, SITE PLANS? YES / NO MSOSs? YES I NO
FLOOR PLANS? YES I NO KEYS? YES / I :';0
- 3B -
BAKERSFIELD CITY FIRE DEPARTMENT -L" "..'
LD. # FORM 4A-l Page of 0-
NON-TRADE SECRETS
HAZAR'DOUS MATERIALS INVENTORY ~
~ ..
BUSINESS NAME: ~/~j!t/Lf I}/f< ((J'/U/) Q.JtNER NAM.E:~<; ~/'i'~ C-c;;/U/J " FACILITY UNIT #:
ADDRESS: (O()()' q - - Y (J v 'I <..J V'- ADDRES.S: (o¡' G'd, 7 y......K .f--B.ACILITY UNIT NAME:
CITY, ZIP: e p£.,O f?-3é1 5" CITY,ZIP: ~P?'-? 4 5~/5 ç-
PHONE #: 3d d er~/ PHONE #: 'Çrj ~ "3 J-.J.- :J.. ~ (d ~ IOFFICIAL USE CFIRS CODE
~ ONLY
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT, WT. CHEMICAL OR COMMON NAME CODE GUIDE
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NAME: T)£ (f¿ U) L ð-v 5ývo- TIT L E: ~}J...o':::; S IG~lTURE: l' ~~,."., ¿ DATE: 7-/S- rl?
EMERGENCY CONTACT: AA ~I.; Ii /-p 'nL TITLE: tV /' r"¡:; r-e r P'lfO~~ BUS HOURS: 1;).}- ?(;(}(
I . A ER BUS HRS: ?)- J- 9MI
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EMERGENCY C.ONTACT: ~/\ DO)¿¡/Î'l-1-f/-.R1!- TITLE: IIIC£' PI<E5
PRINCIPAL BUSINESS ACTIVITY: /J-I R éa/VI1/T/ð/t/ éÒ f>
- 4A-l -
PHONE # BUS HOURS: ¿;} J..-;)fÞú r
AFTER BUS. HRS: "2;1/7 YJ(;. r