HomeMy WebLinkAboutBUSINESS PLAN
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RSFIELD CITY FIRE DEPARTMEe R E eEl V E 0
2130 "G" STREET J U L 2 9 1987
BAKERSFIELD, CA 93301
(805) 326-3979 A Ans'd
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OFFICIAL USE ONLY
ID#
USINESS NAME
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
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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:
(!¡+,eLD ,~
M 13éE3
M. [).
.
B. LOCATION / STREET ADDRESS: 3g0f ul1/f)n A"£I1(JV
CITY: 6~ ZIP: q3::iJ'~ BUS.PHONE: (gv6) ð~?--,3:)33
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 /1
A. C/+IR.CD5 ~û6L~ It( f)
B. SAN DCA .fA6L~u-R¡J
DURING BUS. HRS.
Ph# L::S.;<;2 -ðtJ.3.~
Ph#
AFTER BIJS. HRS.
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Ph# 3~~-3n53
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SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE: O(}~{)V-h' ~(~,
B. ELECTR I CAL: / ~'o::.. ~(!·f:;_O~ %1
C. WATER: O{)-t'...:J/ De cuM¿.-
D. SPECIAL:
E. LOCK BOX: YES /~ IF YES, LOCATION:
IF 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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SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
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SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRA1'\f WHICH PROVIDES D1PLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATER IALS: . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:.......
INITIAL REFRESHER
@ NO ~ NO
j NO YES NO
S' NO YES NO
E~ YES NO
YES 0 YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS ~4TERIAL IN QUANTITIES LESS THAN 500 POUNDS OF~
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: , . . . ., YES ~
I, QAR.CO~ RôÍ;JI es Iv!. (} , 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 '-Ó~tQ f) lí?e\?kè, f1" .(JTITLE cf;tCCJLUL)
DATE fo ~3c -ßT
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BAKERSFIELD CITY FIRE DEPART~E~T
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL CSE O~LY
ID#'
------
BUS INESS NA~!E:
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 CONCliE as possible.
FACILITY UNIT NA.'IE: C.l::r12LOS 5,~Db e:s µ. () ,
FACILITY UNIT#'
SECTION 1: MITIGATION, PREVENTION, ABATEME~l PROCEDURES
FotlDGù
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SECTION 2: NOTIFICATION .~\~ EVACUATION PROCEDuKES AT THIS L~IT ONLY
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CITY of BAKERSFIELD
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FIRE DEPARTMENT
D, S. NEEDHAM
FIRE CHIEF
2101 H STßEET
BAKERSAELD,93301
326-3911
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Dear Business Owner:
Enclosed please find a copy of your response to the Hazardous Material Business
Plan request. We have found it necessary to reject your plan for the following
reason(s) as checked below.
o Illegible Business Plan (please print or type information in English).
Form 2A 0 Missing orD Incomplete
Form 3A 0 Missing or [j¿f Incomplete .5t24 :t...
Form 4A 0 Missing or I]2t Incomplete - é)2 - 1../ s-T: 01 rJLþr-
NZ NIt:~jeN Á.I s t IN åQL .
Form SA 0fec1:¡o~ ZvCtst-e -6 Q.N'I \-I.Jst" IN pOu..NJ~ .
Site Diagram 0 Missing or o Incomplete
Facilities Diagram 0 Missing or 0 Incomplete
Thi s is to be corrected and resubmitted with i n 30 days to: q - '1 ~ y 7
Bakersfield City Fire Department
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA 93301
If additional copies of any forms are needed they can be picked up from the
Hazardous Materials Division at 2130 "G" Stree~ in person.
Sincerely Yours,
Coordinator
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