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HomeMy WebLinkAboutBUSINESS PLAN N HAZ. MAT.:R.W~::2SS lI'I+£ \,$ I . - __I, , )./ ! ~} .~~ j ~, ~_.~ __~ --::1, _~___ ~~-~--~........... .~ <: (j Q.. , f ð I l-- l\fj Cd. IF", I I \1.) -¡ '2 i-î --------- } I . o.lQ .g , Iff ~{ame : - P L ..-\~ \ 1--\P /455 : F-=llITY DIÄGRÄM C II ~'r5MJ A=~a ~a~ = 0: ,/\ / " ~rame ~: AZ"'!a: - - ~tc:--::: ;' \ VPr-u...e:v tJ A- L ù Ë c,c('Ý\-PPrMI Be.HnJi~ ~ ~ (j\ . ~ SIOf?A9 t SHOP> r;:::.. ,~ -- ~; to Vi Q::~ '-./ rt> f'Õ ,~ ----~ -- . ., x!: ê1 ~ :..=:.9 ~-+ ~~ Q I ~I 1-/_ ::1\ L-J - .b Ql,: l- - .:¡ ~ i N.C1\D o I t r;; c+ ~ \ -T' -:I -C V¡ ~ . - .::.F ..::j' '-....,.; ~ ~ ~ ~ _ '-_____ - 'I Q ,~ 'g '? - ¿ ~ @: i I Ç))' i \Ul ~~I l I' \~ - ~--- -, t}l - r--_F ~ ,- , x ;..ç: ~ fV'C ~~ (03' x , ) o -- -----.-- - ------- -:; -:,}: -- -- , . '- o ':) ~ ~ <.. e. \t~ S.TD~ f\<j 6" , ' I ~ i \ \ ~ I -. - '.J o--r~' ce )( wA-rER. SAvT oFÇ - - .__,____ _.__. - 11 --- _.-. -- ..- --. . ---...-.- ". uJ A TT .J 5:7 - - < .....-' A-iR pûR'T "~;,:.;..;;.. '-. , --- ~ ,/) \- Q¿ ,(J '-=t \/). <] ..BlVllVl P SITE DIl'GRAM 0 PLA~ÑI.é\P FAC~ITY DIAGRAM 0 31.ls:;:.ess ~ame: A~ea Map ~ of A, Name of Area: Nor'":~ -- S/tDp E~íJ dj I STDR.ABe, i I I , I , I '- ~ : I V) ¡(¡I ---\ 'J =Þ . ~ : I p (, .J "'; , I '".t" !'!/:'::\ ~\": ¡/;~.7j\¡ ~,)~~, .-. --, ií\( '"U + o {' -Pì C-e ,I s 11) e A--C2f e 1 '.J {' ,) I IJ~ ~ I C ~-- ~ 1'"'" ~' ._-<f' I rLL ff ¡V\ I r: ~ dG:i2_ ~_~~ y~ _ _ · ,..,.... ~- --;:'.--......~ I I ~. , '\ I 1 : i" , -- ---- ~Lói-:.~l~.qtJffl.J¿ 'W4ll- ~e.--L-¡j¡1.1-/ ___ , I 11 aio( ;Q)t(.()1&c< ßo( 0 cA= (¡k.~ __ ; i (p-t(_ dr; ~_ ¿, cz.lxµ):__ : ' j)0 ___ , ' , , , I --- ---- I. -----. I: -C~~QIY)tOJ tøJ _ ______' i! ~tLU)a!O.~ ,; - ~-'~ :', . ci~d~ -=~ , , ... --1-__ __ _____.____ ___ _ _ _ i "-..-.----- ------- -----. I! I , ---- ¡ , : ~ ----- , ' ------ ~-- ---- ~------- -- I, , I I' II ----~ I I , ' - ----------- ----+--¡---- -. e --'-~~ ~~ __ Bakersfield Fire Dept. . HAZARDOUS MATERIALS DIVISION i Date Completed c¡ - :2. t.¡ - ? ~ Business Name: f/~ Wvß2/J~ Location: L¡.o 0 Wa;(;(;ð Ð /W~ Business Identification No. 215-000 00 I [¡. S S- (Top of Business Plan) Station No. 7) Shift C Inspector 9 ~ ~ v ~ ~ ~ ~ ~ ~ ti Comments: ~ .1 Verification of Abatement Supplies & Procedures 'VI rt\ \~I Comments: .~ \}.. <,t . -;.. .."':....., .~--~.:::': Comments: Number of Employees ~' ~ ~ Comments: -, Adequate Verification of Inventory Materials D Verification of Quantities D Verification of Location D Proper Segregation of Material D Verification of MSDS Availablity D Verification of Haz Mat Training D D Emergency Procedures Posted Containers Properly Labeled D D D Verification of Facility Diagram Special Hazards Associated with this Facility: / RECEIVED SfP 2 5 1992 HAZ. MAT. DIV. D D D D D Violations:. ~ ~ßL/)VJ ~r a>r~£~ h~v.. t/n~¥~~ /x~~/J~ All Items O.K. D Correction Needed D Business Owner/Manager FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 07/03/91 AMERIttM WELLHEAD SERVICES 215_iIL001455 -~~ra11 Site with 1 Fac. u~tIJ Page 1 General Information Location: 400 WATTS DR Map: 124 Hazard: Moderate Ident Number: 215-000-001455 Grid: 08C Area of Vul: 0.0 ....--- Contact Name Title Business Phone - 24 Hour Phone WARREN WEST MANAGER (805) 397-5733 x ( ) - ANDY HEATER MANAGER (805) 397-5733 x ( ) - Administrative Data Mail Addrs: D&B Number: 17-759-0361 City: State: Zip: - Comm Code: 215-005 BAKERSFIELD STATION 05 SIC Code: Owner: AMERICAN WELLHEAD SERVICES Phone: (805) 397-5733 Address: P. O. BOX 272202 ., State: TX City: HOUSTON Zip: - Summary 07/03/91 AMERIttu WELLHEAD SERVICES 215-'· 001455 Hdllbt Inventory List in MCP er Page 2 02 - Fixed Containers at Site PIn-Ref Name/Hazards Form Quantity MCP 02-002 ACETYLENE Gas 562 High Fire, Pressure, Immed Hlth FT3 02-003 CAUSTIC SODA Liquid 160 Moderate Reactive, Immed Hlth, Delay Hlth GAL 02-001 OXYGEN Gas· 562 Low Fire, Pressure, Immed Hlth FT3 07/03/91 AMERI\ WELLHEAD SERVICES 215-- 001455 - Fixed Containers at s~1I' Pa,ge 3 Hazmat Inventory Detail in MCP Order 02-002 ACETYLENE Fire, Pressure, Immed Hlth Gas 562 High FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING ----'Daily Max FT3 562 Daily Average FT3 300.00 Annual Amount FT3 6,240.00 Storage r Press T Temp ~ Location PORT. PRESS. CYLINDER Above Ambient NE CORNER INSIDE SHOP - Conc l 100.0% Acetylene Components r= MCP -rList High 02-003 CAUSTIC SODA Reactive, Immed Hlth, Delay Hlth Liquid 160 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL 160 Daily Average GAL 160.00 Annual Amount GAL 385.00 Storage ABOVE GROUND TANK r Press T Temp ~ Location Ambient AmbientlNE CORNER OUTSIDE SHOP - Conc l 10.0% Sodium Hydroxide Components r; MCP -:-rList Moderate I 02-001 OXYGEN Fire, Pressure, Immed Hlth Gas 562 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3 562 Daily Average FT3 I 300.00 I Annual Amount FT3 6,240.00 Storage r Press T Temp ~ Location PORT. PRESS. CYLINDER Above AmbientlNE CORNER INSIDE SHOP - Conc l 100.0% Oxygen, Compressed Components r:::- MCP -rList ,Low , 07/03/91 AMERI4IÞ~ WELLHEAD SERVICES 215-'001455 .~4IÞ 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification NATIONAL RESPONSE CENTER 1-800-424-8802 FIRE DEPARTMENT 911 <2> Employee Notif./Evacuation EMPLOYEE TO SHOP FOREMAN, SHOP FOREMAN WILL MAKE PHONE CALLS OR BRANCH ADM WILL ANNOUNCE EVACUATION ON P.A. SYSTEM <3> Public Notif./Evacuation NONE LISTED <4> Emergency Medical Plan NONE LISTED 07/03/91 AMERI-T WELLHEAD SE'RVICES 215-'001455 '~4IÞ 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention OXYGEN AND ACETYLENE ARE SEPARATED (EMPTY & FULL) FULL ONE ARE CHAINED. OUR VAT IS A BIODEGRADABLE MIXTURE OF WATER AND OAOH IN A SECURED VESSEL. PEOPLE WEAR EYE PROTECTION AND RUBBER GLOVES AROUND VAT. <2> Release Containment OXYGEN AND ACETYLENE ARE SEPARATED (EMPTY & FULL) FULL ONES ARE CHAINED. OUT VAT IS A BIODEGRADABLE MIXTURE OF WATER AND NAOH. DEPT IN A SECURED VESSEL. PEOPLE WEAR EYE PROTECTION AND RUBBER GLOVES AROUND VAT. <3> Clean Up NEUTRALIZE RESIDUES WITH DILUTE ACID AND RINSE WITH WATER. <4> Other Resource Activation 07/03/91 AMERI4IL WELLHEÄD' SERVICES 215-'001455 '~4IÞ 00 - Overall Site Page 6 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - ALONGSIDE NORTH SIDE OF OFFICE - 40 FEET FROM NORTHWEST CORNER B) ELECTRICAL - ALONGSIDE NORTH SIDE OF OFFICE - 40 FEET FROM NORTHEST CORNER C) WATER - ALONGSIDE NORTH SIDE OF OFFICE - 40 FEET FROM NORTHWEST CORNER D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF WATTS & SHORT STREET <4> Building Occupancy Level 07/03/91 AMERI~WELLHEAD SERVICES 215-'001455 ~ 00 - Overall Site Page 7 <G> Training <1> Page 1 WE HAVE 13 EMPLOYEES AT THE FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: WE HAVE ACETYLENE AND .PROPANE FOR CUTTING MATERIAL - EMPLOYEES ARE AWARE OF NOT PLACING NEAR FLAMMABLE SUBSTANCES. <2> Page 2 as needed <3> Held for Future Use I <4> Held for Future Use e . 1 . Bakersfield Fire Dept. t!. HAZARDOUS MATERIALS DIVISION - /- b...,2B-1t R.E.t.E I V E 0 J UN 1 1991 Ans/d............ Station No. 5 Shift C- (Top of Business Plan) Inspector ~.. 6-t#I Business Identification No. 215-000 Verification of Inventory Materials Verification of Quantities Verification of Location I J ('\, . Proper Segregation of Material ~mments: :::tf> 11.0{ ~..rr /:A(J;4c f(J\ Verification of MSDS Availablity lJ Number of Employees , Verification of Haz Mat Training Comments: Adequate ~ ~ ~/ o ~ ~edA> . D D Inadequate o D D D D D D Verification of Abatement Supplies & Procedures Comments: ~ Emergency Procedures Posted Containers Properly Labeled Comments: ~ ~ D D o Verification of Facility Diagram Special Hazards Associated with this Facility: ~. Violations: FD 1652 (Rev. 1-90) All Items O.K. D Correction Needed D White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy B -..... ~~, I"'" t ,.:;;;. .J',); Bakersfield Fire Dept.R'Et É I VE D Hazardous Materials Division. . ~A'N t '_ . 2130 "G" Street ?2{j , . Bakersfield, CA. 93301 l02-¿ .",,:,,:::: aA3 . . ~r" ~æLT' --, GEMENT PLAN ....... ,- , ., ; . I I jV... HAZARDOUS MATERIALS MA INSTRUCTIONS: 1 . 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. x'4-0~ L--. ' l:j r:; c SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: f.)mfRI'cArJ We-eLK-tAb ~ERuice..-s LOCATION: ~ 00 uJ a.... -rr1' DR.. MAILING ADDRESS: L-IoO CITY: 'B~J(~(sB-e..\cL STATE:CrLzIP: Q33D'TPHONE: gOS-397~S13J' DUN & BRADSTREET NUMBER: PRIMARY ACTIVITY: (),L((tLù 3erv,'ce OWNER: . ~or po(a 1-7 on I MAILING ADDRESS: PO, 130 x J r¡ 2202- SIC CODE: ~~ /011 7/';).77- d ~o 'd- SECTION 2: EMERGENCY NOTIFICATION: CONTACT 1. W4R2£,d WEST 2. AJJb II /-Iet)¡ ~f2 I TITLE BUS, PHONE IV) q fl IVIqR 397--5?33 391,5733 1 , 24 HR, PHONE 3/-trì1G' ~f}-w)~ FD1S':'( )j ..3 ~i ¡ :~:J :3 ) \ I Bakersfield Fire Dept. e Hazardous Materials Divisio. HAZARDOUS MATERIALS MANAGEMENT PLAN ~ - ,,,,it " , , \ I I, ,1 I .I~ p.,," ^ 14 " ) .,,;:!!.! ,: it ß.. '._ ....SECTIÒN' 3: TRAINING: NUMBER OF EMPLOYESS: / J MATERIAL SAFETY DATA SHEETS ON FILE: ye-S BRIEF SUMMARY OF TRAINING PROGRAM: W6 f(/)tlé /1(!ErY¿(ÇlI/c I ,PI?Of>19ttJC FôR (JUTn,A!f h1'T¿ -7> émp/oyetU' are /!wtlre ~?- Nor fJlrteINf.. (1/ r?f)- It PL II ffI /Yl1J13 ¿ 'E- .j(j ß J' 1"Yi-/V(! ~ J' 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 "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: ;~ ~ NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES, / OTHER (SPECIFY REASON) :.1. SECTION 5: CERTIFICATION: I, 4 (VillI< I; (.} tJ· \^h~LLl{f-(1i) 5~r\fÌ cQ.S CERTIFY THA T THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFill MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC, 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ifk~~\ ,S~~~rAw3 SIGN URE ~ I n1 j¿1\- TIT L:E '1-l1-8~ DATE 2. FD15': 4ð'" "-¿~ , Bakersfield Fire Dept.. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: C . ..L A . ) h II O;<YfJe n ~, A- c e1ÿ {fe. ne Clre. Sc: p Q..r-o.. += c\ e (Y) p 71 ~ Fù ~ ~() one,f àre c.h~,(}.ed ()l,\.( UCv\" is' ©." b~Q~~srctdo\.b~ 'M\X.+ú(@ of' wo..ter.$ Ne<.-pH '. k'ep+ IN CL ~ecu,'(t~~ç.~ U()S',\'Q_ ¡~J=èopl~ Whare e 't~ p nJ -\ e C +\ 0 (ì (À.Ý") d. R. \J b ~(? r51 ~ ¡ ~ r \.) \J fH::( ~j Q{ t: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: S ct rv1e Cl,s- A ... ' , . C, CLEAN-UP PROCEDURES: N Q I..l ire.. \ \' 2..e.. reS!' L!tJ(~\r w \ ~ d ¡ I u. t (? a c " d ª'- ñel t ¡ t1J6 W ¡ +t; w ~ t-e.r, SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): 1../0, F+ From N ,W, NATURAL GAS/PROPANE: Q- Lorv~ s: ide ~o r-+h S'ì de. ð-P 0 1t-ï ce . e...o \' Yìe..r ELECTRICAL: S A t'Y) E- WATER: SA-mE; SPECIAL: LOCK BOX: YES/@ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, s, PRIVATE FIRE PROTECTION: . Ff(e ~tfiG\J5lÅiS '\ers WATER A V AILABILITY (FIRE HYD RANT): .J- ~©rl1 e.r tJ~ wer=tl:r i' J" ))f)F?' JrtC& T 4. FD1S';'ü A Bakersfield Fire Dept. ..- . Hazardous Materials DivisiOle . ~! -. .:-'"i/'II '" HAZARDOUS MATERIALS MANAGEMENT' PLAN ~ Facility Unit Name: A h'\èn ê tin W@ \ ~ \v t\. d ~ f ¡J) (e~ SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: lif ß{) 'ift Ç7 1M iAJ ~ í?e. ~pOf) ff {!~ n if r I=- ¿¡ ()CJ ~ 'Ý 6- If <Þ f!ffO 2-. n.Rft btf r . e4-ll~~ OM /:)bVNE B. EMPLOYEE NOTIFICATION AND EVACUATION: r~.~[0/b~. '.{'.í': ~~A~ flx"Ç,l-;J; l1J,i C,:;v¡ìt; tfJ; V-V'(¡ 1/; , (j/" 11:'. I' . 'I Shl!J¡f); {0rrø t.JJ ~11 Will "'1'~"'~tÄKE rA{;)..(f:.':: ficø.//¡ tr ðr- Bre~VÞêA !4r51M ~~\II QI1PléU1{'f -e'¡¡qCucr/-/~ 'OM R 14} ~ -tLj S1-t WI . C, PUBLIC EVACUATION: µjÆJ D. EMERGENCY MEDICAL PLAN: 3. R)15'\.' CITY of BAKERSFIELD ( S £; E AT11t c tflE--b ) .~ DHAZARDOUS MATERIALS INVENTORY Farm and Agticulture [] Standard Business NON-TRADE SECRETS Page BUSINESS NAME: lÏJ,..~n'c""'"" tJel/le..../ kPl/}(y; OWNER NAM~: CÐ' NAME OF THIS FACILITY: lfuJ. [ LOCATION: .t¡~~~ ADDRESS' '1 :> '0. <1:. c:>, L STANDARD IND. CLASS CODE: CITY ZIP: . .0,' 1. ::f_-s' vB CITY zìp: s f~ DUN AND BRAI;JSJ;REEL fW1:1BER---'·'-;----:---' PHONÈ ,,: 8~- .- 7~J PHONÈ II: - f-' ,'1>.) < L'Z - r.J 5'1 - 0 3 b 1 . ' REFER TO T UC IONS-mR-PROPER CODES - - 1 2 3 (5 1 8 9 10 11 12 13 U Trans TYQe ~ax Average Annual 1 Oys Cont Cont Cont Usa location Where 'by Hailes of ~ixture{çOI!lPonents Code Code Allt A lilt Est on SIte Type Press Temp Code Stored In FacIlIty \It See Instruc Ions 300 . 0 .2... tV-E: d Health Ha~ard I that apply/ : I I I of -1, -. ~..:1~:__ o Reactivity o oelared o . Component 12 Name & C.A,S. Number ImmedIate Hea th Health Compo.nent .3 C.A.S. Number o De18{ed ~el"'e o Component .2 Name & C.A,S, Number Immediate Hea th o Pressure Health Component 13 Name & C.A,S, Number 3BS Ph!,ic.1 I'd ~"Ith ~ Component .1 ( heck a I t at apply o Suddr Re 1 ease ¿;: , Component 12 Name & C.A,S, Number o Fire Hazard Reactivity Immed1ste o Pressure Health Component .3 Ph~sic~1 ,nd ~ealth Hatard C,A,S. Number Component .1 Name & C,A,S, Number ( hec a I t at apply o Fire Hazard o Reactivity o De1ared o SUddf" Re I ease o ,Component 12 Name & C.A,S. Number ImmedIate Hea th o Pressure Health Component 13 Name & C,A,S. Number EMERGENCY CONTACTS #1 #2 1TlWfñone- D~tl;J. ~ , v, ,,- ..... , . '.' - 11-' I"" {'II'" 'I f"""""",,~" ....' f \.~ I T -" ... .. .--- -... '-"""'.- 1""'1'--.' -. - r : !""'. ~ _'!:: : _ ~\i!!: :\1 , 'J1~r. -- . "'" -... ";-::''' ~.,.......~-- \: \,., ~ ~== 1 C J' '1'-=::: c:: :: : J:: n CA a ~ ~ lì 1 ....''''\1\..., .\."oj u__....., -. ........""'.... I (80C:::¡ ~2t::-~a7Q I,Jf........ "'....1.... ~( kJ0IJ:4 C~¡:;¡C:AL U32 CNL~' BUSINESS NAME I D # --- -- - ---- -- -- --- - ~- .' HAZARDOUS MATErilALS ' BUSINESS PLAN AS A WHOLE - - - - . - - -- - - -- FORM 2A RECEIVED JUt 2.,4 1989. HAZ. MAt. OlV. INSTRUCTIONS: t._ To avoid further action, return this fro~ within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the bu~ine5s as a whole. 4. Be as brief and concise a~ possible. . SECTION I: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME:--.F 1+ie..'lDes-r LL.J e... \ \ ~~tR::> B. LOCATION I STREET ADDRESS: ,-\00 VI A--t--r-S ~v'av~ CITY: B'A-~eV$.ç: Q,,,, ZIP: CJ"330 7 BUS. PHONE: (e») 3&f 7 - 5755 SECTION Z: EMERGENCY NOTIFICATIONS L.. u In case of an e~ergency involving the rel~ase Qr threatened rel~ase Qf a hazardous Ma1erial, call 911 and I-S0Ø-85Z-75SØ or 1-916-427-4341. This ___~~ll notify your local fire_depa~±~ent and the5tate Qffic~ Qf E~er;2ncy Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. W A-/? j(J £. /lI ¿¿; 'f' S r- PH# ~S" 3Q7-5'?"?"?PH# SC¡ J -¥7d-~ 8. PH#' PH# SECTION 3: LOCATION OF UTILITY ~HUT-aFFS FOR BUSINESS AS A WHOLE A. NATURAL GAS/PROPANE: B. ELECTR I C,IìL : c. ',lATER: O. SPECIAL: ,E. LOCK BOX: YE~ I NO . IF YES, LOCATION: IF YE~, DOES IT CONTAIN SITE PLANS? FLOOR PU~NS? YES Yc:: ~- ¡IO MSG::S? on=-= f',IO v'E'/S? IES NO NO . . 4\ '" ,. ~ECTION~: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHQL~ " " '......-...., SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR SUSINESS ~c ~ WHOLE '::1 r" ,..,,~. -... t1::.. \, ¡-:)..¡~.;1¡ , '(i -'" ~ (', !t!L ,_-~_"___ ~(J-\:.L"L.~.-.tŸ"""::'---_-~--,-~~· SECTIO~5: EMPLOYEE TRAINING .ViO ,TAM .,;-. o.n EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES E¡1PLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MI1TERIALS. .~~.. ~..-. "..... _~_-=_-~=--, _. -0.:-_ _ ___ -.o.--~ _ -:::: ~ _, A. NUMBER OF EMPLOYEES AT THIS FACILITY 8. 00 YOU HAVE MSOS (MATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL YOU HANDLE ? C. GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM: SECTION 7: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE CALIFORNIA HEALTH ~ND SAFETY CODE FOR THE FOLLOWING REASONS: , !- ~O-=---=--"-_ -~ "1Jl::-c, Ðe--NO:r~HANOtE-jiAi-AP.O 0 t:J S-t1A-Tl::f'nAt:3 . -~ '1 WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8: CERTIFICATION I, tAJA-R. r?e.r\.1:::... We..~ . certify that the above inforMation is accurate. I understand that this inforMation will be used to fulfill MY firM'~ obligations under the new California Health and Safety code on Hazardous Materials (Div, 20 Chapter 6.95 Se·;:. 2S5ØØ E: A!.) and that inaccurate inforMation constitutes perjury. SIGì'!ATU¡:;'EW~W~ TITLE V'('eS~\)ev1+ DATE 7-/?-f}r