HomeMy WebLinkAboutBUSINESS PLAN
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SITE DIAGRAM Ó
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Business Name: We )+..5 AI44"t.> Vv{'K ~
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FACILITY DIAGRAM
Business Address:
For Office Use Only
First In Station:
Inspection Station:
Area Map # of
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HM739701
Account Number
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ACCOUNTS RECEIVABLE ADJUSTMENT
March 3. 1994
Date
Esther Duran
From
New Address
Close Account
Service Chan e
Other Ad ustments X
Fire Department - Hazardous Materials Division
Department/Division
WALTS AUTO WORKS UNLIMITED
Billing Name
1922 V STREET
Billing Address
Site Address
Parcel # (if Applicable)
Landlord Name & Address (If Applicable)
ADJUSTMENT
Last Billed Correct Billing Adjustment to Effective Date of
Billing Change
110.00 0 <110.00> 1-1-94
13.21FC 0 <13.21 > 3-1-94
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APpr~·· .
Remarks: LAST YEAR WHEN CUSTOMER WAS BILLED HE TURNED IN HIS 55 GAL DRUM OF
WASTE OIL FOR A 30 GAL ONE. HE MENTIONED IT TO OUR OFFICE BUT NEVER FOLLOWED UP
WITH A REVISION TO HIS HAZ MAT PLAN. HE BROUGHT IN PROOF THAT HE ONLY HAS A 30 GAL
DRUM. WHICH IS REMOVED EVERY 90 DAYS BY PETROLEUM RECYCLING CORP.
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Page: 1
Account Billing/Collection Activity Inquiry
SUTLI08
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Acct
SSN
Name
Svc Add:
739701 Cyc St: CL Bill St~ NO
Parcel:
WALTS AUTO WORKS UNLIMITED
1922 V ST
Cyc: 5 Rt: 1
Svc CIs :e
Seq:
--------------------------------------------------------------------------------
Amt due:
Lst Pmt:
Pmt Dte:
Prior
Date
01/01/94
01/01/93
06/01/92
123.21
-5.60
03/09/93
Bills --
Balance
110.00
0.00
0.00
Current
Period Postings
Date
03/01/94
03/01/94
Amount
11. 00
2.21
Receipt * '
Type Desc
B91 PENALTY
B92 FINANCE CHARGE
3\U- (
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Enter 'I' For Billing History, 'pi To Print Report, 'D' For Detail Page, or
tic' For Credit and Deposit History or 'XX' To Exit
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WALT'S AUTO WORKS UNLIMITED
" -';- ~ 1922 V St. a
. Bakersfield, CA 93307 ..,
(805) 323-1117
BAR No. AH127013
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ESTIMATE AND
REPAIR ORDER
-0001253
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Car Owner .. - , Business Phone Date
'-"~'- ~.~...__._. CITY 7' T
Address Home Phone Est. No
Repair "
Insurance Co. Phone Order No.
Retain D Customer Initial
I.D. Adjuster Ports
~
Parts
.... "..' . ." e e ':e" e" . '. .:e" "." ,'.,
/Jez-;,r, £::;f-<.-
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PI e ~..)e... ¡:::; ,/,q.. '// C' £/1-'\ -P
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MY S'" .Ç" ;' 0;;: ~ ç.-)7(5
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i ~ 11 / ryo ~ II"\. ~"-¡- deAY
01 L
OJ/] ~ h n V~ h.e.-e /"I /A f e I ...., e:¡
v- 30 c;..-c::>'- I) ,.... v. ~
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en 7:.. ro.. c; -e <:;
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HRS, OF LABOR @ $_PER HR, $
The above estimate is based on our inspection and does not cover additional ports or lobor ESTIMA TE AMOUNT $ PARTS
which may be required after the work has started. Worn or damaged ports. not evident on first PAINT
inspection. may be discoye,.ed ond you will be contacted fa,. outhorization for additional MATERIALS
Revised Estimate $
w/)rk. Ports prices subject to change without notice. This estimate is good for days. BODY
Customer's O,K, By MA TERIALS
S.................. Insurance Deductible Estimator.......................... . ............. .............
ACKNOWLEDGEMENT: I have read and understand the above estimate and authorize repair SUBLET
service be perlormed. including sublet wo,.k and acknowledge receipt of this estimate. An Time I Dote Called I By Whom I
express mechanic's lien is he.-eby acknowledged on above ca.-. truck. 0.- vehicle to secure TAX
the amount of repairs thereto.
ADVANCE
Deposit $ CHARGES
THIS WORK AUTHORIZED BY DATE
WORK ACCEPTED BY: DATE Chgs. if not Repaired $ TOTAL
\..
, 'SHEET NO.
OF
SHEETS
ERO,660·2
* CODE
N,NEW
U·USED
R,REBUILT
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REMIT TO:
Petroleum Recycling Corp.
2651 Walnut Avenue
Signal Hill, CA 90806
CAD 981696420
Phone (800) 824-6939
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INVOICE-F 53013
Date ~? --;;J.3 -::J;/
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1
PRC
CUSTOMER INFORMATION:
BILL TO:
---------.- -
. Name 0Ä'LTY" 1Jf.~
Address /~ 2.:2- // /,St-
City 7Aé'..:PAS~/CLt:J.. ~ #-
Zip Code 93 ']"0/
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Name
'S:~E
Address
City
Zip Code
Area Code & Phone #
DESIGNATED FACILITY:
o PRC - Patterson' 0
13331 Highway 33
Patterson, CA 95363
CAD 083166728
Area Code & Phone #
Petroleum Recycling Corp,
1835 E, 29th Street
Signal Hill, CA 90806
CAT 080011059
D~e·um Recycling Corp, 0
13579 Whittram Ave,
Fontana, CA 92335
CAT 080025711
Petroleum Recycling Corp,
1921 National Ave,
San Diego,CA 92107
CAD 982028748
DESCRIPTION
MOUNT
P,O.
WASTE PETROLEUM OIL, COMBUSTIBLE LIQUID
NA1270 (221)
o NON RCRA HAZARDOUS WASTE LIQUID (ANTIFREEZE,
WATER, OIL) (134)
REQUIRES CUSTOMER EPA #
3 Ô;j è"
o WASTE COMPOUND, CLEANING, LIQUID, COMBUSTIBLE
LIQUID NA1993 (213)
REQUIRES CUSTOMER EPA #
o DRAINED, USED OIL FILTERS, NON-HAZARDOUS WASTE
o
MANIFEST # 93 J..5'"'9ff¿Y
r
CUSTOMER CONTACT PERSON
CUSTOMER'S SIGNATURE
PLEASE PAY FROM THIS INVOICE
A service fee of 1 '12% percent per month shall be charged on all past due accounts,
In the event this account becomes delinquent and it is necessary to institute legal
proceedings, purchaser agrees to pay reasonable attorney's tee and court cost.
DUE ON RECEIPT OF INVOICE
FUll ENVIRONMENTAL SERVICES AVAilABLE: WASTE Oil SERVICES,
ANTIFREEZE SERVICES, CLARIFIER AND SUMP PUMPING. AND DRUM SERVICES,
F32792MMP
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;~.·:·.::;,$TATE MANOÞ.:TED PROGRAMAOK . Y·TH . : . f."..:., -',' 01/291<13 ·f!,..f...."t, .:r::--;<~9.4 .00
}!k.;E:,~AI HAT tiA~OLINGFEe":<: ,;:.' .:-:':~ ,~. 11'~~OÒ '. .;~.~,;3~k':;~~~~~:f:'::·;5~~:,::.:,:;~::<·.
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I,IN~UIRIES cONcERNiÑGY~1S BILL.J>LEASEPHqNÈ:'., . ' . :,,' .,.. . . '''h , . ~,-
I .'. .'... . . "" (S05)'32ó~391C¡- ..,.';>','..:
I, INVOICE NUMBER ' 1Al T5 AUTO I>!ORKS lJHll MITfO' 'H"739101
I 1922 v: STREET·. '" ,.::;;;:-
l . CUSTOMER COpy ßAXERSF tEL..D, CA 93301,/' '.
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CwAL rs (5)<
AUTO WORKS UNLIMITED
. Spot Repair & Complete Auto Refinishing
. Foreign & Domestic Maintenance & Rebuilding
Tune-Ups. Carburetors. Brakes. Transmissions. Air Conditioning
1922 "V" St.
Bakersfield, CA 93301
(805) 323-1117
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WALT ARVIZU
Owner
1:)~'10\
HAZARDOUS MATERIALS MANAGEMENT PLAN
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Bakersfield Fire Dept.
, Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
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INSTRUCTIONS:
l.
2.
3.
4.
To avoid further action, return this form within 30 days of receipt.
TYPE/PRINT ANSWERS IN ENGLISH.
Answer the questions below for the business as a whole.
Be brief and concise as possible.
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MAY 1 4 "9.t1
HA~, MJ\.T. DIV.
103 -3átß
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SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: -illf~ Ao.jvlÛø(k~ Unl<: m; +~d
LOCATION: ,q~~ V Sf-·
MAILING ADDRESS: S An1E
CITY: _ßA/(JfP-S F 1(Çt.'D STATE: ~ ZIP: q3~/ PHONE::~d-3--/II)
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY: Qepa1< ( ikctJ S
OWNER: w+ ,~v ì ZU
MAILING ADDRESS: < Iq~d. \/ s;t
SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION:
Q
CONTACT
TITLE
BUS. PHONE
1. U.h\tD( ~ef\ MvìLY OwtJ£VS
2, _"'¡¿HC>Y) ß(ð~.w
4<e--n ~y VÎz.u
3)-3-tlll
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24 HR. PHONE
~Î J~75qlf
834-1¢là-
FD1591
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_Bakersfield Fire Dept. 'e
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
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OJ A }~~
~~CTI;Obl43:, ,~T~AINING:
NUMBER OF EMPLOYEES: ~
MATERIAL SAFETY DATA.SHEETS ON FILE: ~ fS
BRIEF SUMMARY OF TRAINING PROGRAM: ,-lad fv~sbs ~
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OF PERJURY 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 QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES,
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFETY CODE" ,
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
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SIGNA TURE
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TITLE
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DATE
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FD1590
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Bakersfield Fire De"
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
lli9JL- q \ ~
B. EMPLOYEE NOTIFICATION AND EVACUATION:
\JWJ~
C, PUBLIC EVACUATION:
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D. EMERGENCY MEDICAL PLAN:
01Q0JiJ-ilL ~ Ø'L /Y'f\LdJ.-~. if-~
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e Bakersfield Fire Dept. e
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A,
RELEASE PREVENTION STEPS: ". _ 'n '
~ ~ ~étu ~) --U-U-UL~'^Có
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CLu-J~
B, RELEASE CONTAINMENT AND/OR MINIMIZATION:
~ ßkuu
C,
CLEAN-UP PROCEDURES: ~ fJ'tu {J....; ~~ ~
jJJNJ- ~ flvM~
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE:
ELECTRICAL: (JY\iH.dL
\J~
WATER: 6uJ C.fJlJMJu
SPECIAL: ~
LOCK BOX: YES~ IF YES, LOCATION:
3tù 00vv\.uu
fY7f~ ~. ~~'tö
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAilABILITY: .
A. PRIVATE FIRE PROTECTION: q ~ ~u.AA-J
B,
WATER AVAILABILITY (FIRE HYDRANT): d()~ + \!
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4.
FDI590
CITY OF BAKERSFIELD
HAZARDOUS MATERIALS INVENTORY
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o Farm and Agriculture 0 standard Business
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Page_of ~j ?
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. CITY, ZIP' ~~s. , l .
PHONE #:: () - I
NON - TRADE SECRET
OWNER NAME' lJJÞrt..... 1\ nJ \ Z- ~
ADDRESS: a~ ~Q eb/<:- ~ .4-".. ,
~~~~É ~~P ~ 7'¡':of š F,'{ ELW 1 'þ. Q;r{x"
NAME OF THIS FACILITY:
STANDARD IND. CLASS CODE:
DUN AND BRADSTREET NUMBER/FEDERAL ID #
- - --
1
Physical and Health Hazard C.A.S. Number component II 1 Name & C.A.S. Number
(Check all that apply)
~ire Hazard cz( Sudden Release '0 Reactivity ø 0 Component II 2 Name & C.A.S. Number
lnunediate Delayed
of Pressure Health Heal ttf Component 1/ 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number Component. II 1 Name & C.A.S. Number
(Check all that apply)
0 0 0 0 Component II 2 Name & C.A.S. Number
0 Fire Hazard Sudden Release Reactivity lnunediate Delayed
of Pressure Health Health Comp<;>nent 1/ 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number Component II 1 Name & C.A.S. Number
(Check all that apply)
- component II 2 Name & C.A.S. Number
CI Fire Hazard t:1 Sudden Release Q Reactivity 0 lnunediate 0 Delayed
of Pressure Health Health Component II 3 Name & C.A.S. Number
EMERGENCY CONTACTS
#1
\. J I' Pt2-.
Title
Component 1/ 1 Name & C.A.S. Number
Component II 2 Name & C.A.S. Number
Component II 3 Name & C.A.S. Number
Name Title
Physical and Health Hazard
(Check all that apply)
o Fire Hazard D Sudden Release
of Pressure
C.A.S. Number
o Reactivity 0 lnunediate 0 Delayed
Health Health
Name
Certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS)
I certify under peanlty of law that I haver personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those
individuals responsible for obtaining the information. I believe that the submitted information is true, accurate, and complete.
Wi} ,7- IJ· J4 l' jJl'2. t...-, OW nA' r
NAME AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED REPRESENTATIVE
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SIGNATURE
5- 14-Q""L
DATE SIGNED
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD. CA 93301
(805) 326-3979
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RECEIVED
J U L 1 6 1987
Ans·d............
OFFICIAL USE ONLY
ID#
BUSINESS NAME
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
000595
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
CITY: ß Il\ J(.e~ ,c,'-e(.n
'AIATCI \¡../ot'K.5
J q 2-- 2- V S7'.
ZIP: otl)o I
(¡\ y) L. 1(",", ,. ITd
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A. BUSINESS NAME: \JAL.TS
B. LOCATION / STREET ADDRESS:
BUS. PHONE: ( 10))
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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.
A. R Pr Y ß f'. ::J t?.., Ph# '32..-1- / J / J
B. fJWn~0-ofJ. \N'AL--"t' f) /1'1/ ¡'¿'^-Ph# '31.-3-/ /1)
AFTER BUS. HRS.
Ph# ')1...-- <? . q ~ 6]
Ph# «(7 I - J 2- C, /
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE: -A 0 1"\ ...e -
B. ELECTRICAL: ..<\CJ l..'\. '1- ""' ,-,-e...s l
C. WATER: SO IA. rt- h. (.Lo-..() 'S-r-
D. SPECIAL: h ¡( .v'\ ~
E. LOCK BOX: YES / NO IF YES, LOCATION:
c. () În. e..,..-
Cd~~(?_.r-
.p 11 t-..fr r
Lv)¡¿~ ¡t::lJ v~r -t11 ~ (}t-,¿'O.l/'¡J)
Y)(JI"\-e_
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
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
/i ~J ¡.~ 1~7: {~ ~l
't.... ~ e """. -ro.1·.' "1....1
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 REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS ®
MATERIALS: . . . -. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO YES NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES:.......................... 6P NO YES NO
C. PROPER USE OF SAFETY EQUIPMENT: . . . . . . . . . . . . . . . . . . ~ NO YES NO
D. EMERGENCY EVACUATION PROCEDURES:................. N9 YES NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:..... . . YES é!; YES NO
1- SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUN~F A
SOLID, 55 GALLONS OF A LIQUID OR 200 CUBIC FEET OF A COMPRESS~. . . . . . ES NO
_ () ~ S ~ "-I J ~ ... r ......e...c:..oe or-
I, /f)/tdf:¡;} ~ kJ/)trt" /J ðt'tt /¿~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 I/ì(¡jk.~-;./
TITLE ðVh..((") ^05S DATE C-¿Z--q7
- 2B -
. ;r;/- :..\ì~¡;- -~;
e
e
BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
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 ÙNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY OOIT# /(jr I FACILITY UNIT NA.'Œ,: WtK.:7~ A"'1u ltl(\rK{.l4nL/r't'<r-:~
. r-_
SECTION 1: MITIGATION, PREVENTION, ABATEME~l PROCEDURES
Cc.s We.-¿ O.er f.>61fz:e (' a,....e-· l'-.h a. :l"1ed !Ju.......,,"'.·
~""'~ II Ar""'Ic.JlA"'r S lJ"&/r"o v:..Clr-.e T-~e..h S-ed\.ll(ji'l.r;'/()¡t::. íh/>?I')~rf
,()..I"'t:--", 4...-"" "'" ".......rJ lJ....-r oV)c.-e....]; F ~T -:;:¡'OI.A'I-O (1.:e. en{Jc.-~e-1If oll-lr
" l.V e. t...J u t..f ¿ 0 S ~ e..<Þ_ p {h 10 e.. V ().. yref ú...T {() ') -, :/A VJ 0 C- L e Çi....r.. r h €....
vlr~,^- I .
SECTION 2: NOTIFICATION AND EVACUATION PROCEDlJRES AT THIS UNIT' ONLY
O"^--- 5';,,,,0 ¡::/r<- Dr'" ,'III S'//I,¡QLe. -('PIe- ~Ftrl....- OePCAr TV"\enr
}') 1;\ t'101 Þ.tü- ti-f-Lb Y ..,.. ^ e- ,0 A 11 f'I .e- r.. Lv LA ù j 1/ fLl"" bl4¿' , -0 a rY'\ ," Þ1 ~ 'h,A r ¿ ~
Or'" ,. (;....Z,ArJov'd ~ pI/II' -the.-Y'\ \..4...;¿ vuu.¿".o 'H-e~!> F.:.- ' ïh¿ 1J
- 0
n e,^,re..5t CJl:::~'H"'_'- - tê-)( rt-~ C6)1 " ¡I) ~ 0 k.,- r-ô OI'\L it.,-.. 0 f h .e.,-
r() ~ '^ 1<' e .s tJ.-"'- ~ W ..e.. IÁ. / ( , 9 o-r ( .J t.A-r ..s t\. Fe ~ y .
- 3A -
e
e
A~~"'~_' ,;to-
SECTION 3: H.I\ZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this Facility Unit contain Hazardous Materials?,...,' ..<!È~ NO
f'éú- í"'\ (l.ðU! V"
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-1)
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
~-e.... Me:.. V ~ FeJ v-..~ '-'^.~ ~e... 1\) 1 f1 c.v-f{) .5 <::
1"" h e- ~ (: L F ðl n d J: CA.. ,.- €- i- ra. f ¥'I c:¿., ¡ Y\ ç;o ¡"" ", e.d D "
(?re-v~",+.l;il"\ f"'C--Lv-.¿¡C¡,,,'5 holv T1:> frop-e,Y"''-Y
- 0 ìt.-- I4nði 5'DL././€v'('/ Rtt.g..s_
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~~ERS
I
I
F ,. /"-e- e."{ I¡/\~ "^¡S he'S.
t=' .. r -e S (;. ~ð' y <: ..;
o /S Po ~ -e. 4-- Co t1 tzu' r:::'!
A c.. ""-0 s.s -r-" e- S r r~,e..·T- !.IV <=- S I
00 r n ..e,--
(.J V\ 1"11\ e- nor"'t '" - '- eSt
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A, NAT. GAS¡PROPAN~~
" Ò Y\ -e--
B. ELECTRICAL:
:¡:: n 'S ¡ Q.f:-. (} (.A... ,'(.... 0 i " "
In
50 <.A.-rÎ"\ Lv e.r' Úð /' Y\e.~
C. WATER:
o (A .,..
S i oe.
ßl.A.iLO ('7~
-SOVLíh.
Lve.1r G:;¡r I')~
0, SPECIAL: /''It>Y\.€-
E. LOCK BOX: YES í ~O IF YES, LOCATION:
n()^~·
IF YES, SITE PLANS? YES / NO
FLOOR PLANS? VES í NO
MSDSs?
KEYS?
YES I NO
YES / NO
- 3B -
BAKERSFIELD CITY FIRE DEPARTMENT
FORM 4A-1
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
OWNER NAME :-Lð/ Ai..- ( A . A R 11 ) 2 6L. . FACILITY UNIT #: I
ADDRESS: ~tf¿:¡ 1 SJ,e. JJf'i'Y FACILITY UNIT NAME: 5h,,¡O
CITY, ZIP : ~ ~r~ 1= ,'eL I? ~
PHONE #: 81 J - G.- q J
. '~~$ I
LOf~
I. D. #
Page
BUSINESS NAME:
ADDRESS:
CITY, ZIP:
PHONE #:
IN THIS
8
% BY
WT.
OFFICIAL USE CFIRS CODE
ONLY
1
TYPE
CODE
2
MAX
AMOUNT
3
ANNUAL
AMOUNT
4
9
10
HAZARD D.O.T
CODE GUIDE
UNIT
CHEN I AI. OR COMMON NAME
/(jot
-
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cJWY)~
TITLE:
SIGNATURE:
Fc.>1'" """ ¿;.... 1"""1
IW
P~ON~S HOURS:
AFTER BUS HRS:
PHONE # BUS HOURS:
AFTER BUS HRS:
DATE: - Î I
~ 1-- ~ /I ~ I
. -3 f..Y-<.}tO]
72,....'3-11 )}
1 Î /- 1 '""2.... tï. J
NAME: ¡
EMERGENCY CONTACT: ~
. þ- O~~~ .
EMERGENCY- I,;UNTACT: LV)l LT (".
PRINCIPAL BUSINESS ACTIVITY:
- 4A-l -
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SITE/FACILITY DIAGRAM
FORM 5
NORTH
SCALE: -f 1.- BUSINESS NAJ'IE:
/0 '} '-- .,-¡ of
DATE:? /1 /&7 FACILITY NAi'fE: <,
SA Y""\¿
I OF 1-
#: OF
I "2-
/
(CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM
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(Inspector's Comments):
-OFFICIAL USE ONLY-
..
- 5A -,
...
SITE DIAGRAM (ReqUir.temS)
e
b. Electricity
9. Lock (key) Box
10. MSDS Storage Box
11, Railroad Tracks
12. Fence or Barrier
a. Wire
b. Masonry
c. Wood
d. Gates
13. Powerlines
14. Guard Station
15. Storage Tanks:
Identify the
capacity in gal.
a. Above ground
b. Underground
16. Diking or Berll
17. Evacuation Route
18. Evacuation Area;
I den t1 fy the
location where
employees will
lIeet.
.._'~
1. Address: Identify the
principle buildings
by the Street numbers.
2. Street(s), Alleys,
Driveways, and Parking
Areas adjacent to the
property. Include the
street names.
3. StorlD Drains. Culverts,
Yard Drains
4. Drainage Canals, Ditches,
Creeks.
5. Buildings
a. Frame construction
b. Masonry construction
c, Metal construction
!
i.
,
I'
I
d. Access Door
6. Utility Controls
a. Gas
c. Water
...
7. Fire Suppression Systems:
a. Fire Hydrants
b. Fire Sprinkler
Connections
19. Outside Hazardous
Waste Storage
c. Fire Standpipe
_ Connections
20. Outside Hazardous
Material Storage
d. Water Control Valves
for protection systems
21. Outside Hazardous
Material
Use/Handling
e. Fire Pump
22. Type of Hazardous
Material/Waste
Stored
or Used (See
Below)
8. Fire Department Access
TYPE OF HAZARDOUS MATERIAL
F - Flulllable E - Explosive L - Liquid
C - Corrosive 0 - Oxidizer G .. Gas
W .. Water React! ve T - Toxic S .. SoUd
R .. Radiological
P .. Poison
H - Cryogenic
D .. Waste B .. Etiological
Example: Flammable Liquid - FL
o
FACILITY DIAGRAM (Required items in addition to the. above)
1- Risers for Sprinklers 8. Fire Escapes
,. Partitions 9. Air Conditioning Units
3. Stairways: Indicate the 10. Windows
levels served frolD
highest to lowest. 11. Inside Hazardous Waste
Storage
4. Escalator: Indicate the
levels served from 12. Inside Hazardous
highest to lowest. Materialo Storage
5. Elevator 13. Inside Hazardous
Materials Use/Handling
6. Attic Access
14. Sewer Drain Inlets
7. Skylights
.'
.
.....
NORTH
À/
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-S
4tXTE/FACILITY D~GRAM
FORM 5
SCALE: BUSINESS Nk~E:
, "f h lI\
DATE:'1/Q /<27 FACILITY NAME:
(CHECK ONE)
;/
SITE DIAGRÆ~
FACILITY DIAGRA~.:'
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(Inspector's Comments):
-OFFICIAL USE ONLY-
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ttITE/FACILITY D~GRAM
FORM 5
SCALE: BUSINESS N~~E:
LJ S £A;: 0 Wol';¿
DATE: / I FACILITY S~~E:
NORTH
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FACILITY DIAGRA;\f.:·
(CHECK ONE) SITE D I AGRA~
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~-=-"--- -
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-OFFICIAL USE ONLY-
- 5A -,