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Home My WebLink AboutBUSINESS PLAN 4tTE/FACILITY~~R~ FORM 5 ¡J- q ¡ tJ Nsp " ~ ~" ......, ~.' th~ NORTH SCALE: FLOOR: OF DATE: ! / FACILITY N~~E: (CHECK ONE) SITE DIAGRA~ UNIT #: OF FACILITY DIAGRAM >- ~ 'v ~ Itµ I..c.:.,'-\.~ ~~i- ~t- cttJ v v~.., . e G..) e...~~V-- ~ , ~ v ~if ~~?" ""v ~oJ'" o V;~ ~Q) ~ .'þ t):.r~~ ~~cp+ t1 \..:)~ I.l.n. ~< . _.1; 0'f- :J ~ rr \(-.0° ~ e-- ,\.. ~~ () e- 7' \.~ l-O~ ;ye:.J) u.?~ ~...('- l~"W ,D~ Gr~ ('~~-e... ~~'S-:. '^-€.s S t.h-~:. l..~ l.s -:S+O(,L-~ &\~'Zií- 1;.0 I r l...- I IJ .,.JÞtÁ-' '- Prc; ¿_1M r. _ W\¡v-1o..J (Inspector's Comments): -OFFICIAL USE ONLY- - 5A - S[TE DIAGRAM (Required iteDs) 1. Address: Iden_the principle buil s by the Street nuabers. ~ 4. Dralnaie Canals, Ditches. Creeks. 9. Lock . Box 10. MSDS Storage Box 11. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d. Gates ·t'..·· ~Ñ 2, Street(s), Alleys. Driveways. and Parking Areas adjacent to tha property, Include the street na.es. 3. Store Drains, Culverts, Yilrd Drains 13. Powerl1nes 5. Bulldlngs a. Fraae construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identity the capaci ty In gal. a. Above ground c. Metal construction d. Access Door b. Underground 6. UtilIty Controls a. Gal 16. Diking or Bera b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identity the locaUon where e.ployees will ..et. 7, Fire Suppression Syste.s: a. Fire Hydrants b. Fire Sprinkler Connections 19. Outside Hazardous Walt. Storage c. P.1 re Standpipe Connection. 20. Outside Hazardous Material Storage d. Water Control Valves tor protection systeDI 21. Outside Hazardous Material Uae/Handllng e. Fire Pup 22. Type or Hazardous Material/Waste Stored or Uled (See Below) 8. Fire Depart.ent Access TYPE OF HAZARDOUS MATERIAL P - PI....abl. Z -,lxploalve L . Liquid C - Corroaive 0 . Odd1zer 0 . Oas W .. Water Reactive T . Toxic S - SaUd R . Radiological P - Pohon , H - Cryo¡enlc D . Wute 8 · Bt1ololica1 Exaaple: Plaaaabl. Liquid. FL FACILITY DIAG~ (Required ite.s In addition to the above) 1- Ri."C'a tor Sprinldera a. P1ra Elcapea 2. Part! tione g, Air Conditioning Unit. 3. Stairwaya: Indicate th. 10. Window. levels 8erved t~o. higheat to lowest. U. Inaide Hazardoua Waøte Storal' .. E8calator: Indicate the levela served rro. 13. Inaide Hazardoua hlaheat to lowelt. Xateriala Storace 3. Elevator 13. In.ide Hazardouø Materials Use/Handling ð. At tic Acce.. 14. Sewer Drain Inlet. 7. Sky l1¡hts --.,-- . . May ~~ ~., 1990 TO~ Nina May~r, Accounts Receivable FROM~ Ralph E. Huey, Hazardous Materials Coordinator SUBJECT~ Tim Halls Pool Service Nina, account # HM 435501 has paid $100.00 ior one year, they say they went out oi business in May, 1988, thereiore the remaining balance o£ $102.00 should be written o££. Thanks . 08q-5 ~ ~, I J) ~K.L& tD ~ ()h ~ pho"'-L. .~. ~ .~& ~ LÙ~lJLcl2 . uyy).JL L.ö ~L ~ lJ..>.-t- ~ I (JLJ ~ ~.tJv;J .&.oJ-éJ ~ ~ ~; Iqg9.~ fYY)~& to.;¿C I i a'~~ ~,t'YIo...¡ ~ /qgf{. WL I ~ ~~ ~~~'ð ~ð)ry LJ-~ ~~ ~ ~- vu I ~ ~(J\..L ~(\'\...L~ CLf ~~ ~. LùJL LÙOLJ& Þ-L;)' ~ l.JJ.L ~ cD 1fM I P ~ ~(Nì....- ~ t:UlJY"Ù lJ-U-. w.D I ~J) ~~.lJJ-.L w.0 ~ au ..JßJJ'-'-jJ ~ 0 ."'\:JJ G/' &h\J.JL ~ .~ \..0--'l-J ~ I .~cQ. ~ Q/w1 ð'l-v'~. l}~ ~ ~ w~dl ~ t 7 ·ðO '~ .0-0 d~û-A..t:v ~ '3(~~ k~ ·~~·J2~r~ ,. , J-/.;); YYv\ f} ~ ~ 1+ tn lJ 3 SS-Õ . ~S ~~ Nitro-Dur'" (nitroglycerin) Transdermal Infusion System _ The most widely prescribed nitroglycerin of its kind. RECEIVED . Bakersfield Fire D.. [) CT 1 G 1989 Hazardous Materials Inspection Ans'd............ Date Completed / D -/ ;z.. - "l?9 Business Name: /1 IV¿ MiL S po OL Location: ., I Jt/2..~ T/;;---¡?N D If Plan 10 # 215-000 1/0 (Top right comer Business Plan) 5k-rrI/ICC , - Inspector 0 V Li7J ' r LJÙ A~~a~{tquate )ÚC1 Verification oflnventoty Materials . - {/~/ / ~y J~j) Verification of Quantities , \ ~~Jvtj)., ~ ~ ~ ~ ~.J>,r~? FD ~D Verification of Location ~ 'IJ v'~ LV' \ _ . Proper Segregation of Material D D o~ Comments: ("LQS~7J- NOT 1- ¡3uS/¡VL::::-5 5 1N'f N/O/fL::' o 0 Station No. 3 Shift c Verification ofMSDS Availability Number of Employees Verification of Haz Mat Training D D Comments: Verification of Abatement Supplies & Procedures D D Comments: Emergency Procedures Posted D D D D Containers Properly Labeled Comments: Verification of Facility Diagram D D Special Hazards Associated with this Facility: Violations: \ \ \ FD 1652 (Rev. 3-89) White-Haz Mat Div, Yellow-Station Copy Pink-Business Office , . ,- "~ ,fCAiJJJL· .~ , ~ - . .- ....¡~:.~~J! .~;~ . .,j ":tr 4IÞBAKERSFIELD CITY FIRE DEPAR~ 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 J œ - '65'0 CD ;JJusP 3 OFFICIAL USE ONLY ID# - 01"6000 {)C:OC(fO BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A 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~~'.t:\_~~~.>\~~ l \.l~ 4&1 '» ~O I $e-t-Ur4?-, B. LOCATION / STREET ADDRESS: ~ ~ Lû e... ~-iL~!A. ~ (' CITY: .ß~~. ZIP: '133D1 BUS.PHONE: q;oS) 3~5 -3¡-~'7 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 TITLrl n A. ~\ t~ '~~ß.~ B.¿Arf' y ~/A,U fH- IM.~ ¥-~ DURING BUS. HRS. Ph#~ 4- 75''1 Ph#3" ~ l;;l ~ ~ AFTER BUS. HRS. Ph# ,~;):; .(?({,ye¡ Ph# &- ~ ,-=-[ ?¡¡ ~ 0 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: ~ C. WATER: s;'" D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: e..- IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - . . I" <', , ... . SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE Nú~¿ SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE \f\A~~ ~ 't ~~ ~ ~~ ~r--v)l~ M~. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. '5 CIRCLE YES OR NO ~\O E~~\a\( t..-~ INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATER IALS: . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. YES 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:....... REFRESHER YES YES YES YES @ (!) ¡ YES NO YES NO YES NO YES NO YES ~O SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~F A. SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: , . , . . . (2]ß/ NO I ~ . ~e ~~ C:,., ~V1 , 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. I ~ . SIGNAT~ d.1Å.Ji TITLEt)~ V\ ~V" DATE ç,- 1 ()-~ 1 - 2B - '" r1 ~,¡ r .~ ~ . .' 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 UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT N~~E: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES M~~\~ ~~-L S~(j'e.,¿" ~~ ~~~t\ qv~t~-L-<) ~~~'~~J-4 S~'::.~'?~ \~ ~~\N:)Vul ~~'i e.-~~~~-3 SECTION 2: NOTIFICATION k~ EVACUATION PROCEDURES AT THIS UNIT ONLY Ð~4\ Ô¿ ~( U(V(r~~\,~~~~:s<) -, 3A - . . SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials?.. . .. YES If YES, see B. If NO, continue with SECTION 4. B. NO hazardous materials a bona fide Trade Secret If No, complete a separate hazardous materials inventory form marked: NON- RADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form m rked: TRADE SECRETS ONLY ellow form #4A-2) in addition to he non-trade secret form. List 0 y the trade secrets on form 4 2. SECTION 5: SECTION 4: PRIVATE FIRE PROTEC Y EMERGENCY RESPONDERS SECTION 6: LOCATION A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / ~O IF YES, LOCATION: \ IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / ~O - 3B - 0' .. '. , .. - ...\ of _1 Page BAKERSFIELD CITY FIRE FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY DEPARTMENT # D I FACILITY UNIT # FACILITY UNIT NAME ~H OWNER NAME ADDRESS:_ CITY,ZIP: BUSINESS ADDRESS:. CITY, ZIP F - - ~-~-~ ---~ - '-J --- -- , ~~~c?~gr~ ~ PHONE #: .3 ~~~ (] ~ &-<1 IOFFICIAL USE CFIRS CODE ONLY l' 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAJ, CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE f 8"DQ~ \ ') ~~~ I HJ ;»)] Sa~LS"~ .~ ~f\r~.!~ p ("A Lo I()N " . I ffi<t Cf'W\+ qql /oqz F' ~ - S()(.:I~clL<ÐÇ: b-À("~~ ft I Pl<J. . L~ -.-, jf)qcJ, J20 ql( ¿ /0 2-)( /ø:? t1 UR.ot--1 c. .·~tr1 t.)~CL ~£M( p. /0'6 .30 ~S'~ ~e. ()SÇ~(A!!Je.... ..... /bo f'ðI(Nds D7 ë~ I Cl5/ r Q tJA,-t;-j/"")li1 0 r.> .;). bb Y C.RMi" . ...... ~/(hLOR.O l&oc.YQ.NLol~1 c IIc,J . . . NAME: \ ',~~' ~'""- ~ &..!r;Jt ~J l ~ TITLE: Ð\..Y~~ SIGNATURrc. ........." ß c=;rífo ...¿:{\\ U\ h tJ /J DATE: 1l'"J..ff-·~' EMERGENCY CONTACT: 5~~~ TITLE: PH~E # BUS HOURS: ~ r1~ <~ M ?_ AFTER BUS HRS: PHONE # BUS HOURS AFTER BUS HRS: 4A-l - TITLE ~~ ." ACTIVITY EMERGENCY CONTACT: PRINCIPAL BUSINESS