HomeMy WebLinkAboutHAZ-BUSINESS PLAN 9/12/2003
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Prevention Services Unified Permit
SUBJECT TO CONDITIONS OF PERMIT
PERMIT ID #015-021-002850
GAS-N-GO
2601 WHITE LANE '
BAKERSFIELD, CA 93304
Issued by:
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THIS PERMIT IS ISSUED FOR THE FOLLOWING:
o Hazardous Materials Plan
o Underground Storage of Hazardous Materials
o California Accidental Release Program
o Hazardous Waste Generator and/or Treatment
o Above ground Storage Storage of Petroleum
o Paint Spray Booth
o Industrial Hood Suppression System
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Bakersfield Fire Department
O&7CE OF PREVENTION SERVICES
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 852-2171
Approved by:
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ph Huey, Director
Prevention Services
Expiration Date:
dune 30, 2006
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HAZARDOUS MATERIALS MANAGEMENT PLAN-FORMS
Section Discovery and Notification
Page 1 of2
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
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 business as a whole,
4, Be as brief and concise as possible.
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BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
A. LEAK DETECTION AND MONITORING PROCEDURES:
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B. EMPLOYEE AND AGENCY NOTIFICATION
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C, ENVIRONMENTAL RESPONSE MANAGEMENT:
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D. EMERGENCY MEDICAL PLAN:
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A. HAZARD ASSESMENT AND PREVENTION MEASURES:
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B. RELEASE CONTAINMENT AND/OR MITIGATION:
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C, CLEAN·UP AND RECOVERY PROCEDURES:
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Page 2 of 2
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UTILITY SHUT.QFFS (LOCATION OF SHUT.QFFS AT YOUR FACILITY)
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ELECTRICAL _p ~(. +- G
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NATURAL GAS/PROPANE:
WATER:
SPECIAL:
LOCK BOX: a YES 'f:NO IF YES, LOCATION:
PRIVATE FIRE PROTECTIONlWATER AVAILABILITY
A {(9 ~"cr~
B. WATER AVAILABILITY (FIRE HYDRANT):
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Based on my inquiry of those individuals responsible forobtaining the information, I certify under penalty of law that I have personnaly
examined and am familiar with the information submitted and believe the information is true, accurate, and complete,
OR DESIGNATED REPRESENTATIVE
DATE
477
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478 TITLE OF SIGNER
479
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HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
~
DADO
D DELETE
D REVISE 200
I. FACILITY INFORMATION
BUSINESS NAME (Sarna as FACILITY NAME or DBA - Doing Business As)
~\~ I-N.
Bakersfield Fire Dept.
D Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
(one form per material per building or area)
Page1 of
201 CHEMICAL LOCATION 202
CONFIDENTIAL (EPCRA) 0 Yes 0
C(J 3lJ c¡
203 GRID No, (optionan
204
CHEMICAL NAME
II. CHEMICAL INFORMATION
206
COMMON NAME
CAS No.
FIRE CODE HAZARD CLASSES (Complete ~ requested by local fire chief)
TYPE
~MIXTURE
o w WASTE
o p PURE
PHYSICAL STATE
{]..r(ÍÓUID
OgGAS
o s SOLID
FED HAZARD CATEGORIES
(Check all that apply)
C1"FIRE
~EACTlVE
o 3 PRESSURE RELEASE
220
227 DYes o No 228 229
231 DYes o No 232 233
235 DYes o No 236 237
239 DYes ONo 240 241
243 DYes o No 244 245
,. UI. SIGNATURE " ..
SIGNATURE DATE 248 to
'- Q-I.;2-o 00
0
N
:E
ANNUAL WASTE
AMOUNT
217 MAXIMUM
DAILY AMOUNT
e-
tJ
UNITS' 0 ga GAL
1t EHS, amount must be in Ibs,
o cf CU FT 0 Ib LBS 0 In TONS
STORAGE CONTAINER O~A OVEGROUND TANK
(Check all that apply)
UNDERGROUND TANK
o c TANK INSIDE BUILDING
o d STEEL DRUM
o e PLASTIC/NONMETALLIC DRUM
Of CAN
D 9 CARBOY
D h SILO
o i FIBER DRUM
OJ BAG
STORAGE PRESSURE
o aa ABOVE AMBIENT
AMBIENT
STORAGE TEMPERATURE
o aa ABOVE AMBIENT
%WT
HAZARDOUS COMPONENT
JSC
2
3
234
4
238
5
242
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205 TRADE SECRET 0 Yes (l.H(
If Subject to EPCRA, refer to instructions
207
~DNo
EHS'
208
209
'If EHS is'Yes," all amounts below must be
in Ibs.
210
211
212 CURIES
213
RADIOACTIVE 0 Yes Q-,qõ
214 LARGEST CONTAINER
215
ÑS
216
~E HEALTH
~RONIC HEALTH
219 STATE WASTE
CODE
218 AVERAGE
DAILY AMOUNT ê-
221 DAYS ON SITE
222
223
Ok BOX
D I CYLINDER
o m GLASS BOTTLE
D n PLASTIC BOTTLE
o 0 TOTE BIN
o P TANK WAGON
D q RAIL CAR
o r OTHER
o ba BELOW AMBIENT
224
o ba BELOW AMBIENT
D c CRYOGENIC
225
EHS
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HAZARDOUS MATERIALS MANAGEMENT PLAN
~ SITE & FACILlTY'DIAGRAM
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SITE DIAGRAM I ~.
Business Name:
Business Address:
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
FACILITY DIAGRAM I
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