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HomeMy WebLinkAboutBUSINESS PLAN 7/14/1987 NORTH t. ATE/FACILITY DI~RA.M RECEIVED FORM õ JUl1 it 1987 Ans'd, -.......... FLOOR: OF FI> 1¡"PI!~ \ o ~A7e- SCALE:..L" / BUSINESS~\{E: = 5 . 1/ 'II.¿,ts: DAT~:~III ~ FACILITY N~\{E: (CHECK ONE) SITE DIAG~~ w. G A-Tt!. F."',e.. f:) F'f,'/C ~ Y A Roy \ __n·..._... ,SrOI.t!A'e,.. /5SQ UNIT #: OF .. FACILITY DIAGRk~ v ~ þftJo,A,Þ fl.()o "1 ~ ß,.VJ.IM'Y ()¡:'¡J: ( ~ ' Plitt '(~ ... A~ G SSð",li~ 1 1"'- ~ ~"t Ø/ll/" po~ ß ~Hð¡Þ (Inspector's Comment~): -OFFICIAL USE ONLY- - SA - , , ,-' 0'. . ., .,\t.', . fr: *,". , .. ; ¡ . .. oÞ., '. ~ " NORTH ... SCALE :¿": IOf BUSINESS NAJ E: ¥ . J,.L£ DATE:? /(1 /f7 FACILITY NAi\fE: -Ø(JI' 7"'5 . .2 / ¡ ? Ú/l! tð/lJ DI~RAM # 639 lYIJ-s FLOOR: OF I , ! 'ITE/FACILITY FORM 5 , \ UNIT #: OF (CHECK ONE) SITE DIAGRA\f V' . . FACILITY DIAGRA\f UNIOl't Ave; . -- rl,((. rH C;"YI! 8 1I.fH N tt " ~ . DeNíl~" r-- AAÄ"""N" ?"a.{I~.lw 'ttI{. I.ANi I I " .~ ßI<IE.A Þ ~Ø-N I.ED ?Aru('ri~ ,\¡J ~ TOR~ YAftO i ~ (WI Jut ) Q Q FL ----... v \It ~ ? Art. ("I t. - "ß ..J ; I Cítß B , PA t'" nil. I il~å~ ~, I;, II!. I, MH"I . MYPIt"ð ~ ALLI!Y ) . . . R.: s, /)£1" G.. R E.~ IInr N' Ii:. (Inspector's Comments): -OFFICIAL USE ONLY- - 5A - ..I TE/FACI LI TY .. FORM 5 ,) / rèf' - {//¿l!C)/¿;' DW-GRAM -,# . 639 IYlJ5 . Of NORTH .. SCALE :¿. "; 10 ( BUS I NESS NA: E: 'if . J..LJ: DATE:? /11 /,7 FACILITY NA¡'~Œ: ..L3o A .1''5 . \ UNIT~: OF (CHECK ONE) SITE DIAGRA~ v" FACILITY DIAGRA~ UNIOJŸ AVE ...... rlD4. fH PA~KiN6 ..- -) ....... ..., -.-..-- --. .-......- -Xi 5 ¡I ¡:¡:i(F ~=: JI . ", .. , '. ~ ~ f ,E.. t.. E.. L1" " ';' li:(,;,~t'Þ..4 C-rD(.l.. ß()<¡i/I'/ 9$i," ,':- ' De /'J '¡.,j .,. , ~..-. - ¡- ~ i c;l 'J ~ :i'~ Q .~ I' i~ ~ I ~ ~ I 1 , I I t (;AToE ".- \- ~ ...... --<...-. ...- VALLG,V ßO/n'~ VA LL E'I SrDl'. S ¡: I1..N ,,¡; D YAR..i') (WI R.£.) ?~rz."r4" ~G) ~~ YAft,Kl Ñ t. ~ ~ J. F L ---- PAe.~"'4 l~"iÐ~ ( rtoo.... ...~.. -J B F" " It. Hypjt~ ALL!!)' î ".' R.: S I /)f!,U Iã.. · f: · . · f{ ESIJ)trIV' t:. (Inspector's Comments); -OFFICIAL USE ONLY- - 5A - (C(f))rPJV /\./ , ' , ! . SITE/FA.CILITY e FORM :s DIAGRAM e /5SC¡ NORTH þ.ø SCALE :...L " / BUS I NESS ~\{E: = 5 . VAJ,.~~ DAT~:~/II ~ FACILITV N~\{E: (CHECK ONE) SITEDIAG~~ FACILITY DIAGRk~ ,~././? (J ., . ~f¡/ f; -;; (/ (J/lI/{J/[J /(j(!~ , / n J.S __ / ~ j SFT. ~HOIN ROo "1 ~ .L ,,' ..'" " on,,¿, YA Q,D PII (l. r~ \j-o A~ G SSo~I';~ j , . ~ '$,-, P, "''' Po~ Go ~ 1, ,', \ F ) i'-,PIl'- \ o ~A7é. ~HDi1 ,s TO« II" ~ RECEIVED JUl 1 4 1987 Ans'd, .................... .. FLOOR: OF UNIT #: OF V' I3AJ..AOAI'Y ()P.¡:,<: p!. ' ": '-~ . ...... . .':'.~ .... , ". J; . .. ~ j. t' (Inipector's Comment~): -OFFICIAL USE ONLY- t(Q)~)f - SA - (i" a H~I~lP SITE OTAGRAM 0 P L~~~ .lYI~-\P F A.I LLTY 01 AGRAM ~, :'..:s:::ess :lame: '.' I II IH/>.[ i 5 PI') '¥ )/ó¡}E- (i)IÝ of tI,,^¡.i'.ý..lJø~ I /'\ - - ~¡c="::: ~lame :: -: Ar'.!a: Ar'.!a ~a~ ~ 0: " ' s,. () ,,\ IC)""¡ AJê "-... <S: -~ 1"/~ ~ '... .' . . ~ $ )~ . o FFl(:L @ ,~ @) ,"OJ" r..a.. ¡~ ¡) J!f 1-.1.. E -¡ ;5 pit.,..... .-$ {Ù tJ f:. ~ ,. ,... ê ~ "< ~ . Do~~ 1 (;A-TE. 51 , / r' _ ~. F J.. 0 <P '"lK- /~ T CC©(p)1f - .. - HM413801 Account Number. ACCOUNTS RECENABLE ADJUSTMENT January 13. 1995 Date Esther Duran From x Fire Department- Hazardous Materials Division Department/Division VALLEY BOATS Billing Name 3118 UNION AVE Billing Address Site Address Parcel # (If Applicable) landlord Name & Address (If Applicable) ADJUSTMENT last Billed Correct Billing Adjustment to Effective Date of Billing Change 0 <14.73> 1-11-95 Remarks: THESE ARE FINANCE CHARGES THAT HAVE ACCRUED SINCE THE 93-94 BIWNG. THIS BUSINESS MOVED OUT IN OCTOBER OF 1993, r\'!:'""-' :t¿ ../" -- Bakersfield Fire D~t. Hazardous Materials Division 2130 "G" Street . . Bakersfield, CA. 93301 RECEIVED FEB 1 9 1991 Ans'd............ -- . HAZARDOUS ,MATERIALS MANAGEMENT-PIÄ-~-~'---'-------'- INSTRUCTIONS: 1, To avoid further action, return this form within 30 daYs of receipt." 2, TYPE/PRINT ANSWERS IN ENGLISH, 3, Answer the' questions below for the' businëss as a whole, 4. Be brief and concise as possible, . ~ECT10N 1: BUSINESS IDENTIFICATION DATA ¡/ ~. BUSINESS NAME: tJ A I.. k ~ 'ý 130" 7 S LOCATION: jll~ UNION AvE MAILING ADDRESS: 51t tv7 ;r CITY:, 014 K ß¿.sÞ//!!J..p STATE:~ ZIP: 7"3JðÆ PHONE: :3'2.3 '33 '('I 'ÇJ'¿ T~'f :Z:.D.::::'- ¿¡f1-"~1 '9'1'i'c{ DUN &: BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: ~ ~ ~ ~ ~ ~ J.,.{b. OWNER:-l~ ~ \ K~ 4,..........)~ MAILING ADDRESS: ~ .; ~CTJON 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS, PHONE. 1. rl!.A-Nt<' lvN".¡eø M(é,R' 3~1:~.:s3Vý 2,' . FRo S-D 'ßð "''''l!~ ðwtJ£L 1(' oC> 1. 24 HR. PHONE ':3~,:'Z. ~ .3 if"1/ <¡ J ~ I ~'3 ,-¿,ob FOI' -- Bakersfield Fire Dept. _ Hazardous Materials Division '~~:" .·HAZARDOUS MATERIALS MANAGeMENT PLAN ~ ,'10 .. ~i:CT1ON 3: TRAINING: NUMBER OF EMPLOYESS: 8 - ,.__'.._u_,_,._ ---- <- -~ - -- -- - - ------- ~ ~ ~ -, ------" ~- - _, - _.._ ._ ._ ~ __ - n_ _ .---..----.--.., p-- MATERIAL SAFETY DATA SHEETS ON FILE: ~ BRIEF SUMMARY OF TRAINING PROGRAM: ~~.~' ~~~b to ~. ~ " ""0" SECTION 4: EXEMPTION REQUEST: I èERTIFY UNDER PENALTY OF PERJÙRY THAT MY BUSINESS IS'EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6:95 OF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS, WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTlTJES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES, OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: ¿ I, CERTIFYTHATTHEABOVEINFOR- MATlON,IS ACCU~ATE,IUNDERSTAND TI;iAT THIS INF9RMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFÓRNIA HEALTH AND SAFETY CODE" //ON ·HAZA,RDOUS MATERIALS (DIV. 49 CHAPTER ,6.9~ SEC: 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ' . . Lf'..ui2~ 9~. . ?-!I,/(cr/ SIGNATURE TITLE DATE co 2. FD1S e Bakersfield Fire Dept. _ Hazardous Materials Divisll ~---r; ~ I , . . HAZARDOUS MATERIALS MANAGEMENT PLAN -' SECTION 7:-- MITIGATION, PREVENTION'AND ABATEME~n PLAN: ·A.'..·..· RELEASE PREVENTION STEPS:' C,u,u éJ~'~ __._~._____:. ^~.__..=~_____~ _u._ __ ,- '-~'.._---- <i 1 'lit." B. RELEASE CON.TAINMENT ANOìoR M'INIMIZATJON: o C, ¡' ,.cLEAN~UP P.~OCE~JU~~,"~:' '.' /J ';:; ;::;;:J! ~ ~x: ~. b SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: CJA. ~ t . ~ ' ELECTRICAL: Ir WATER: (( SPECIAL: ~ LOCK BOX: YE~ IF YES. LOCATION: . ,.;¡. :-', . ~ ' , . ) '''-'' SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAilABILITY (FIRE HYDRANT): ~ ~ 4. FDI5' _~_-::õ::- ::;-r¡" ~ ~ --..--- -- Bakersfield Fire Dept. e Hazardous Materials Division . . HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: I/~ ~-r rJ~ .~ -¥-- - - -.... - ..-.- -.-. , __ .,m _. ~_ ~_...~~_..., __e ,-,-_. -.. ..-. ------ --- . ___ _._ __~_______' ~__ __._____~ __n_.. _ <__._ ~ ~_ _ SECTION 6: NOTIF1CAT10N ANDEV ACUAT10N PROCEDURES: -\ '.. 7'.·.A. \ B, . c. ::r ~ h .."-.'-'.- -' . .. ~ .- - '-"-'''~~ --,-- ---, - AGENCY NOTlF¡CATION PROCEDURES: ~ C(ll tf'L ~.~ -3 ~ary EMPp~E~N~,~~ .~ PUBLIC EV ACUA TIO N: ~ o-L- 15 ~ D. EMERGENCY MEDICAL PLAN: j¿f1~, _ . _ _ , . _ _." (/ ~_?'(I O'L ~ ~ If~ ~~3~~ _ ~. ..,' r ~ ,; ~...,- ~ ti "': ~ '.. ;. to .... .~ 3. R); I 0 ~-;xJ è..- ® dJlJSPC¡ t ij f ¡ , . \ I " I I. OFFICIAL USE ONLY ID# /5SQQ HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A ,. INSTRUCTIONS: 000639 I ' r- ' t ¡ i i 1. To avoid further action, return this form by ~. 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: U~ ~ . B. LOCATION / STREET ADDRESS: ..31l1 ~ ~ CITY: 4~_ ZIP: r"3:3t2.5 BUS.PHONE: (qÞ~) "'f...~ :3,;1r~Y EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE A. DURING BUS, HRS. ~FTER BUS. HRS, Ph# 'Ph# , I , , I. I, I: . I \ : ,I ;.{ ìi Ii' !I 'I I' ,I· Ii' ¡: ,I 111 I' ¡: ¡I f ¡ . II' ¡ i I ¡: 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 QY law. , '. B. ' Ph# Ph# , SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT, GAS/PROPANE: B, ELECTRICAL: C. WATER: D, SPECIAL: E.' LOCK BOX: 'YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PL~~S? YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - -- .' e tit :BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BM<ERSFIELD, CA 93301 OFFICIAL USE O~LY ID# BUSINESS NAME: ------ 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:h}"l~ '(. L3ó". /5 ,SECTION 1: MITIGATION, PREVENTION. ABATEMENT PROCEDURES 55 CAL. /?lê.vI'1 WITI-/ OV/~~rJ...ðw ',FI X7v£¿ n 7 ''115 GI9 ..., ~£I/r:I.... é)vGrt,:=I....(:)W IN'(ð e.ðN7',I).IN/~,i? ID ACT vS Y(NOu.) IVNEI'I F¡)~~. Itr 7"/'Ihí 7'''''é ¡µ £ a. A-J. to- . C? 12~116:. ¿,U ~ rl!!. & I J- SECTION 2: NOTIFICATION fu~ EVACUATION PROCEDL~ES AT THIS L~IT ONLY fß~5""¡ A " c ~ rl'T Act Î () «. J '" rël-(! 0 ^1'() ..sJ¡-c. f2 (Cøf(þ 9/( - 3A - ,. ---"~t ' ( , I " i 1 ! 'j. ~¡ ',! , . " \1 :i :, i II: 'I' r .. 'I ¡¡, /1 :[, I, . II ., !i !! :: " il Ii 1¡ I' 1 " :1' ,.:.: . 1"'1 1 ~.". Ii.. 'I : t·,.~· il-- , 'I, I . ;1. i, '., \! ~'- CITY of BAKERSFIELD J 1 ? . . HAZARDOUS MATERIALS INVENTORY Farm and Agtlculture [] Standard BusIness Dö ' I NON-TRADE SECRETS Page __ of _ BUSINESS, NAME: ~L~ !"'" /tß*T'S + SWtI.rS OWNER NAME: ~~"H"t:1<.. NAME OF THIS FACILITYÒ' ';*LÁ~-IZDIlfT,,-f(}Å-J.HrÝ I ~~~~~]1'3~~: ~§:T¡gv-: AVe ~~~~~S~jp~:~?!%"{}4~ ~MN2~~DB~gŠT~~HsN8Mg~--- ~,J~ ~Â3 ';) ~ II t REFER TO-rN trdNS rU~ I-'ROPER CODES. ~ß.. g.3g. (;) 3.,::1 ~ 1 I 2 3 ( 1, 8 9 10 11 12 13 It Tr~ns . TYQe Max Average , Dys Cont Cont Cont Usa loc~tion Where \ by Narles of Mixture{Ccllconents Code . Code Allt Amt on SIte Type Press Temp Code Stored In FaCIlIty Wt See lnstrue 10ns U 'P I' ~186': OfD '-I 2ft> OtJ1S1 - t øt= ðJ. " I.... (J 'ð e.. ([) I PhY~ieJ.I and Health Halard Component'l Name & C.A.S. Number (~heeK all that apply, \j( Fil¡re Hazard [] Reactivity 0 Delayed [] Sudden Release 'fI . Hea Ith of Pressure t/ I I PhY~icØ.I aDd Health Hafard (~heck all that apply J¡¡f Ft Hazard [] Reactivit~ 0 Delayed 0 SUddfn Release ~ I . Health 0 Pressure O . Component'2 Name & C.A.S. Number ImmedIate Hea Ith . Component'3 Name & C.A.S. Number C.A.S. Humber "'1 ¡.//é-r¡t . 5 tiED I'" Component.1 Name & C.A.S. Number O Component.2 Name & C.A.S. Number Immediate Health Component.3 Name & C.A.S. Number 11.. '$ Phïsieil and Health Hatard (CheeR all that apply, o Fil¡re Hazard 0 Reactivity 0 Delayed '6l Suddfn Release Health ~ 0 Pressure U P (;'0 Physical and Health Hafard (CheeR all that apply I 0 ,Component'2 Name & C.A.S. Nu~ber ril' Fi¡r. e Hazard 0 Reactivity 0 Delayed œ-SUddf" Release ImmedIate ~ Health ~ 0 Pressure Health Component'3 Name L C.A.S. Number EMER1ENCY CONTACTS #1RfffhN¡(, ;/yNIWe,· mfe1C;;¿~~;7~( #2 ame Certifiç1ation (Reed and $ign BfJf3r cÇJmpleting, ç¡ll, sections] , , . I certIfy under penaltï 0 la~ th~t I have persona Iy examlnaQ ond om famIlIae Ylth the informatIon $ubmltte~ In thIs ond all attaçhed dQcu~entsl anQ t at based on my Inquiry Q those IndIvIduals responsIble for obtaIning the InformatIon. I belIeve that the submltte~ Infor~atlon I true, ac rate, and complete. . ~ ~,~ ~ I " _ ~ ¿;--y~~(~ /!fie "I ". e "" op "or "" r op or s" or I e represen' IV õïgñatu re '----- O . Component'2 Name & C.A.S. Number Immediate Health Component 13 Name & C.A.S. Number ~\ >' Ti ~~91..3-b 2fl{f11ñ~ z~~1/ UAthh(ú-U-' 01/07/91 ( tLLEY Overal.l. ct ~10 oJ ..7 BOATS 215-000-0006QIÞ Site with ?-Fac. Unit Page 1 General. Inxormation Location: 311B UNION AV Ident Number: 215-000-000639 Map: 103 Grid: 20C Hazard: Low I Area ox Vul.: 0.0 ~ 24 Hour Phone~ I I(B05) 328-97361 I , I ( ), - I II~ Contact Name ¡DAVID BONNER I Titl.e Business Phone 1:805: 323-3344 = v ?~ Administrative Data 'II Mail. Addrs: 3118 UNION AV City: BAKERSFIELD Comm Code: 215-004 BAKERSFIELD STATION 04 Owner: VALLEY BOAT CORPORATION Address: 3118 UNION AV City: BAKERSFIELD D&B Number,: II State: CA Zip: 93305- I I SIC Code: I I Phone: (f()$) J!?> -;}.,t(~ ) ) State: CA II Zip: 93305- J Summary 01/07/91 VALLEY BOATS 215-QQQ-QQQR~€ f!Ãff~ ? Hazmat Inventory List in MC? O~Q~~ 02 - Fixed Containers on Site PIn-Ref' Name/Hazards P'ttrm gu~t1tity fltt1þ 02-001 LUBE OIL Liquid 160 Minimal Fire, Delay Hlth GAL ..e <. 01/07/91 ~LLEY BOATS 215-000-0006~JIÞ 00 - Overall Site Page 3 <D> Noti£./Evacuation/Medical <1> Agency Noti£ication <2> Employee Noti£./Evacuation PERSONAL CONTACT OR INTERCOM USAGE AND CALL 911. <3> Public Noti£./Evacuation 64ft'1e A-~ ~ ,4ðotJ/f <4> Emergency Medical Plan NEAREST HOSPITAL. 81tz:.. e A" ~ q ( ( 01/07/91 VALLEY BOATS 215-000-000639 00 - Overall Site Page 4 <E> Mitigation/Prevent/Abatemt <1> Release Prevention 55 GAL DRUM WITH OVERFLOW FIXTURE AT 45 GAL LEVEL. OVERFLOW INTO CONTAINER TO LET US KNOW WHEN FULL. AT THAT TIME WE CALL CRANE WASTE OIL. <2> Release Containment <3> Clean Up <4> Other Resource Activation e ~ 01/07/91 ~LLEY BOATS 215-000-0006ÇIlÞ 00 - Overall Site Page 5 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-O££s A) GAS - ????????? c:: ~ cJJ. JJ2..IJ.....L B) ELECTRICAL - ??????????~ -V ~- ~. , C) WATER - ????????? ___ a4'~ D) SPECIAL - ???????? E) LOCK BOX - ??????????? <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ???????????? -?..ù4 ~~ FIRE HYDRANT - ????????????? - ~, g a* ~ '6 /HAA. o.RA.., .'I- ~ ~ <4> Held for Future use 01/07/91 VALLEY BOATS 215-000-000639 00 - Overall Site Page 6 <G> Training <1> Page 1 WE HAVE 9 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held £or Future Use <4> Held £or Future Use e >~. / ð1-; / (~. . ()IIIIII" ~AKERSFIELD CITY FIRE DEPARTMENT ~~M 2130 "G" STREET ~ ~~ BAKERSFIELD, CA 93301 ~C (805) 326-3979 '- IOb-;X;t..., ® -:JJùSp c¡ OFFICIAL USE ONLY ID# 155'~rq BUSINESS NAME . HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 000639 1. To avoid further action, return this form by 2, TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business 4. Be as brief and concise as possible. as a whole, SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME, U~ ~ , B. LOCATION / STREET ADDRESS: ..3 Ii <6 ~ ~ CITY: 4~_ ZIP: f("33fl.!5 BUS.PHONE: (qÞ~) "~~~~~ý' 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. AFTER BUS. HRS. A. PhI PhI B. PhI PhI . " SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES. DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSS? YES! NO KEYS? YES I NO - 2A - i ~ SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE ,No¡J~ e SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE ,~~ ":~ ~..t. ~,7- ~ -~ ~~.:~ N(2aR-es-t· #CSf SECTION 6: EMPLOYEE TRAINING ,":-. ~\ -'~"~ .' ,J'..t" ?;?~,- . _ !'- ~ Ì' ....!4i .'" \ 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:., ,.,..,.".........................,... B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:....,..,..,..., ,........., C. PROPER USE OF SAFETY EQUIPMENT:."... ... ,...,... . D. EMERGENCY EVACUATION PROCEDURES: , . , , . . . . . . . . , . , . . E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:,.,. .. . SECTION 7: HAZARDOUS MATERIAL INITIAL REFRESHER CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: , , . . " ~ NO I, 'c.~¿L) ~#N~ , 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. ~5500 Et Al and that inaccurate information constitutes perjury. TITLE ~ JìeóS.,.. DATE b/IJ1/¡-¡ . . - 2B - YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO .... ~ .~....... It: {ì' .¡ ,i ~t~,"" ~"'\; ~; 0<, ;-;-.: 7 / "I'" / / / e., t. -BAKERSFIELD CITY FIRE DEPART:\iENT 2130 "6" STREET BAKERSFIELD, CA 93301 OFFLCIAL USE ONLY ID# ------ BUSINESS NA~lE: 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:hl--tlS." L3ón r5 SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES 65 ÇAL. p(¿ V 1'1 W ITI-I OV/~~rJ....ðW F='¡ X7veJ~ It- 7 t( t5 G ~ ... , ~£ V IË J... 0 v E~'::I...(:) ().) IN '{¿:;' e.d If r-,I}.I N I~,e ID AEï tI~ v(NO/AJ /VtfE;./ t:='v ..l..... Ifr -r'l'Ihí TllY?é ().J t:. a. A- ~ ..... . (! 12 ~ It r.; vJ ~ r f!.. ¿f)) J-. SECTION 2: NOTIFICATION AND EVACUATION PROCEDL~ES AT THIS UNIT ONLY fe,£5b,.tAk Cðrl'TAC!.í ()f{" }/'Ir.E~<:!ø^1 u,SJ¡-(..E. !eøJ2þ C(/( - 3A - ~ e .. SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials?.... . YES NO If YES. see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO 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 addiiion to the non-trade secret form. List only the trade secrets on form 4A-2. - - -- -.-- -~~ -- - , - ... <'--- ~-~-- SECTION 4: PRIVATE FIRE PROTECTION SECTION ,5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS . 1,-' , , SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A, NAT. GAS/PROPANE: B. ELECTRICAL: - . - .---- ......".:r-~ -_-- - --.- C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSs? KEYS? YES / NO YES / ~O - 38 - ò: :~ ,:' '~-J f'" :~; ~ ~~~'.. ! 'I l.D. . . BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A""1 NON-TRADE SECRETS iIA~;~H~Z~:DOUS OW::::~I;ðLL:ð~::::TORY P8g;"~ ¿f" ~ ~~ ~ -t· FACILITY UNIT .. ""'I ¡. , I BUSINESS NAME' . , , . ,. J ADDRESS: ~í1. "U ~E. ADDRESS: / , FACILITY UNIT NAME: I' C I TV J ZIP: 15:l,. CITY,ZIP: J If I(í s./l.!!Þ'- IJMð~ ., PHONE .: ~'2..;~"~'~~ ' PHONE . : 10FFICIAL USE CFIRS CODE I . ONLY 1 2 3 4 5 6 7 8 9 10 . TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY . . HAZARD 0,0.'1' CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHÈMICAL OR COMMON NAME CODE GUIDE 'ÌP- I ~fJ&,A£ ~:~ "'-Þ lit:.. [)J It u... ~O'lf·O d- ,(í. 1 ' (!. KI LC{ I 1{,o~R "" l~ t.IIße.. 1!? I 1...., ¡.?ß/,¡ltt£, J I " 1\-... I ,~' -----, ' -- ~ . '\ \ , , I I , . NAME:I FIl£D ßðNNEL TIT L E : '1'7 /è è S ' SÀGNATUREÇ '.... ..A.. 1/ ~ .. - DATE: -,/~/ . EHERG ENCY CONTACT: 'DAJ//J") " ððh'NISJ? TITLE: V 'r¿¡¿ ~ plIONE . BUS HOURS: ~ 2...3 3:1 .., c¡ . rYHi,y ¡:. TITLE: ""¿,I!. ", AFTER BUS HRS: ;J "1..1f '7 :;!;" EM ERG ENCY CONTACT: F ¡¿fI.,,¡K PHONE . BUS HOURS: 3 'Z.. =" ~ ~ ., "I 'PRINC ¡PAL BUS ¡,NESS ACTIVITY: ;ßIJIFf',;!J A¡"~ ~ .6'&¿g¡ e-Æ. AFTER BUS HRS: '3~'L7S'i> .. ", .. ~ .'. ..... (.~.:.. . - 4A-l - . .. < ~ --.. .u .. 0,. . ~ .-.. - - -.".- ._-~ - -'.-- ,. .. ,- - ~ C?~ '; Bakersfield Fire nIt. Hazardous Materials Inspection Date Completed ì>~G [3, L c¡ 1 D I i'V' ~A· e / Business Name: VALLe¡ 'ß~15 31l~ l/AJIfM. Avt.. Location: Plan ID # 215-000 ooo{¡;;31 (Top right comer Business Plan) Station No, --±- Shift f-) Inspector (;. M..o 0 (L.f-.- RECEIVEO DEl; 1 4 1990 Ans'd............ Adequate Inadequate Verification of Inventory Materials D D ci d Verification of Quantities Verification of Location Proper Segregation of Material r Comments: INV€1\íO~ ~ QIAAWflOe5 /J6rè.ì> U PT7þrL- Verification ofMSDS Availability ø cz( D D D Number of Employees ~ Verification of Haz Mat Training D [JI' ~ Comments: tJúd> ~Ufrl Ttul-lIJ1Al6ì (JY\ tM-m6fmj r-'c.G1)-v~ II'lm EŸ>¡ ~1 e-t95 N œp MÇ D5 1J.JJ P ~t'>5'5 ,... / Verification of Abatement Supplies & Procedures U2r D Comments: Emergency Procedures Posted D ~ Containers Properly Labeled Comments: ~/ D Verification of Facility Diagram D u:Ý Special Hazards Associated with this Facility: !kGíYLeNe WGt..,!)e1¿ Nf1U)S 7ð Be- ~ TO ~D 1N1/f1t flIð ' Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business-@#iee. ~ ~ -' AzARDOUS MATERIALS' &'fAGEMENT PL\.N INVENTORY INSTRUCTIONS GENERAL INFORMATION: Important: If you reqUire more inventory-forms than the one provided, you should make photocopies of the forms prior to entering any information on them. T~e additional copies must be on the same color paper as the original. Information must be typed/printed in English. Make a copy for your records. Complete business name and address information. Iftheybave been required, the number of separate facility units will be determined by the Bakersfield City Fire Department. Give each facility unit a common name, and a one or two digit number. NOTH: An inventory form must be made for each separate facility unit. The top of the form must be completed for each facility - s how i n g Business name and location as well as owner name and mailing address. Also include "SIC" Standard Industrial Classification Code and if available Dun ~nd Bradstreet Number. Non-Trade Secrets (White Form). Non-Trade Secret Materials in one facility unit. Trade Secrets (Yellow Form). Trade Secret Materials in one facility unit. I' I 1. TRANSACTION CODE: .. Is this inventory ,sheet new, an addition, deletion or update to your hazardous materials business plan. A - Addition D = Deletion U = Update N = New 2. TYPE/CODE: For the purpose of this entry, there are three types of hazardous materials: P = Pure M = Mixtures of pure substances W = Wastes. (Also add appropriate waste code) 3. MAXIMUM AMOUNT: This should represent the maximum number of units of this material present at anyone time. (Refer to the "UNIT" section of these instructions) 4. A VBRAGB AMOUNT: This should represent the average amo~nt, usually on hand at any one time. HAZ~US MATERIALS MAJ.~A.MENT PL~~ ~ .~ INVENTQRY INSTRUCTIONS 5 . ANNUAL AMOUNT: This should represent the anticipated annual (thru put) number of units of the material, 6. MEASURE UNITS: . LB~ = Pounds, for ma~erials stored as solids GAL = Gallons, for materials stored as liquids FT3 = Cubic Feet at S.T.P" for materials stored as gases CUR = Curies, for radioactive materials 7. DAYS ON SITE: Days anticipated that this material will be at this site, for the calendar year reporting. 8. CONTAINER TYPE: (Use appropriate code) 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. Corboy(s} 9. CONTAINER PRESSURE (Use appropriate code) 1 = Ambient Pressure (I-Atmosphere) 2 = Greater than'Ambient Pressure 3 = Less than Ambient Pressure 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 10. CONTAINER TEMPERATURE (Use appropriate code) 4 = Ambient Temperature 5 = Greater than Ambient Temperature 6 = Less than Ambient Temperature 7 = Cryogenic Conditions 11. USE CODES: (Use appropriate code) 01. Additive 02. Adhesive 03. Aerosol 04. Anesthetic 05. Bactericide 06. Blasting 07. Catalyst 08. Cleaning 09. Coolant 10. Cooling II. 12. 13. 14. 15. 16. 17. '18. 19. 20. 2 Drilling Drying Emulsifier/Demulsifier Etching Experimental Fabrication Fertilizer Formulation' Fuel Fungicide - ... HAZ~OUS MATERIALS MAL~.MENT PL~~ " INVENTORY INSTRUCTIONS 11. USE CODES: (Continued) 21. Grinding 22, Heating 23, Herbicide . 24, Insecticide 25. Instructional 26. Lubricant 27, Medical Aid or Process 28. Neutralizer 29. Painting 30. Pesticide 31. Plating 32. Preservative 33. Refining 34, Sealer 35, Spraying 36, Sterilizer 37. Stor~ge 38, Stripping 39, Washing 40. Waste 41. Water Treatment 42. Welding Soldering 43. Well Injection 44. Oil Treatment 99. Other - Specify' 12. LOCATION WHERE STORED IN THIS FACILITY Briefly indicate the location of the material wi thin the building/facility unit using compass points and obvious landmarks. 13. PERCENT BY WEIGHT Indicate the 'concentration of each pure substance as a percentage of total weight. In the case of mixtures and wastes enter the maximum expected concentration of the three most Hazardous Components. Rounà off %. 14. NAMBS OF MIXTURE/COMPONENTS BMBRGENCY CONTACTS: Enter the name, title and phone numbers of two persons who are knowledgeable about this facili~r. PLEASE BE CERTAIN THAT FORMS ARE. PROPERLY SIGNED AND DATED AT THE BOTTOM 3 · CITY of BAKERSFIELD f' OHAZARDOUS MATERIALS INVENTORY NON-TRADE SECRETS Page ____ of '-_ ~~~~~s~~ME: . ~~~RD~~oT~~B, F¿EUPt6oE:-·--'· ,-----,--- JJpMh ~)~~NsTRucnoNs-roR--PROPER D~~::; BRA~S~R~E~ ~U~B~R~-~ -=--=--- "__m___'~__ ~ 8 9 10 11 12 13 u 'ys Cant Cant Cant Use Loc~t ion IIhere 'by lIallesof lIixture{COI'Donènts on Ite Type Press Temp Code Stored In FacIlity Wt See Instruc Ions Farm and Agticulture [] Standard Business BUSINESS NAME: L9CATION¡, ~HM~I ~I .: -----------.. 1 I 2 3 4 5 Tr~ns TYQe Max Average Annual Code Code Allt Allt Est I PhYs¡c~1 and Health Ha~ard IChe,k all that apply, o Fire Hazard 0 Reactivity 0 Delayed 0 Sudden Release I Health of Pressure I PhYSic~1 aod Health Halard ICheck all that apply, I o Fire Hazard 0 React ivi ty 0 D~el:r£~ 0 sUdgf"pf:J:~¡: I I Physidal and Health Ha~ard ICheok all that apply, o flire Hazard 0 Reactivity 0 Delayed 0 SUddfn Release I Health 0 Pressure I physidal and Health Ha~ard (Check all that apply, I ·0 .' d' Component f2 Nalle' C.A.S. Number . 0 f ire Hazard 0 Reactivity 0 Delayed 0 Suddi!n Release IlIme late Health of Pressure Health Component '3 Nalle' C.A,S. NUllber EMER1¡GENCY CONTACTS "1 t tt2 Rue T,tle 241Ir phone me Certifi~atioo (Reed Bnd $ign Bfjf3r cÇJmpleting, till, ~ectionS)' , . I certIfy under penaltï 0 la_ th4t I have persona Iy examlneQ OOd 011 famllla( WIt the Info(matlpn $ubaltte~ In this ond all . attaçhe~ dQcu~ents, ano t at based on my Inquiry 0 those IndIvIduals responsIble or obtaIning the Inforaatlon. I belIeve that the submItted Inforllatlon IS true, accurate, and coiplete. . I, ' ~jje ~ralõfîfTil title of Ownerlooerator UR owner/operator's authorized representative STQgñãture I . C,A.S, NUØlber Component.1 Name' C.A.S. Number O ,Collponent f2 Nue I C.A.S, NUllber IlImedlate ' Health COllponent '3 Nalle' C.A.S. Number I ·1 C.A.S. Number COllponent.1 Name' C.A.S, NUllber O Component.2 Naae I C.A.S. Number IlIlIediate Health Component.3 Naae I C.A.S. Number C.A.S. Number Component 'I Nalle' C,A.S, Number O . Component 12 Nue' C.A.S.,Number IlImedlate ¿. Health COØlponent 13 Name I C,A.S, NUllber C.A.S. NUllber COØlponent.1 Name I C,A,S. Number THte ,{"HfTliõñ-e-- 05 n-s 1qr.ë'ð--' - CITY of BAKERSFIELD ¿ . Average Aflt OHAZARD9US MAT~R~~~S~~~ENTORV , T R A DES E eRE T S ; Paga __..__ of ~~~~~S~~HE:' ~~~RDofDTy~B, FêrHP~òo :-'_. --------....-- CI~Y ~lp: DUN AnB BRADSTREET NUHBfR---'H ----- ,_",_,_u_ ItFMh to-rNSTRUCTIDNS I-UH fJRDPER CODES - - - - ~ 8 9 10 II .12 13 If I VS Cant Cant Cant Use loe.tlon Where I by Nafles of ~ixture{çCflPonents on Ite Type Press Tup Code Stored In facility Wt See Inslruc Ions farm and Agticulture 0 Standard Business EU~IY~ð~·NAHE: ~~~~tl w= lrlns 11~De M~X Code Code Alt I PhYSic~1 fod Health Ha¡ard ICheck a I that apply I I o fire Hazard 0 Reactivity I I ! C.A.S. Humber COllponent .1 Nalle I C.A.S, Number o De Jared o Suddf" Re I ease o . Component.2 Nalle I C.A.S. HUllber ImmedIate Hea th o Pressure Health Component 13 Hale I C.A.S. Humber C.A.S. HUllber Component .1 Hame I C.A.S. NUlber o De Jared o SUddf" Re lease o . Component.2 Nale I C.A.S. HUllber hllledlale Hea th o Pressure Hea I th Halle I C.A.S. NUllber COllponent U PhVSic.1 'od Health Ha¡ard (Check a I that apply, I o fire Hazard 0 Reactivity I I Physi~.1 'nd Health Ha¡ard (Check a I that apply) o flire Hazard 0 Reactivity I I Phy~i¢;1 "Od Health Ha,ard ICheck a I that apply, C.A.S. Number COllponent.1 Nalle I C.A.S. NUllber o DeJayed 0 Suddfn Release Health 0 Pressure O ¡ COllponent.2 Nalle I C.A.S, Number Imled ate Health Component.3 Nalle I C.A.S. NUllber C.A.S. Humber Component.1 Hale' C,A.S. HUlber O dl Component 12 Nalle' C.A.S. Number TII! ~ ate Hea I th Component.3 Nale' C.A.S. Number HIER;GENCY CONTACTS 111R1me ntle 2f1Ir !'hone 112Rue Certifiçatio~ (ReCd and $ign afjf3r cpmpleting, tt17 rc~ctionS) I certl~~ under penaltk 0 la_ th.t I have pe{sona I~l exallnQO and '1 familiar wit the info(lIattøn 'ublltt.d In this and all attaçheØ dQCuments ano t at based on IIY Inqulrv 0 hose IndlVldua s responsible or obtaining the nformatlon. I believe that the subftltted Inforllat on IS true. accurate. and eoJplete. , I . ~~flclal title of owner/operator UN owner/operator's authorized representative STgñature I o fire Hazard o Reactivity o De I ared 0 SUddfn Re I ease Hea th 0 Pressure Title H l!fl'liõ~ Dãte--sr4f.ëd-- ,