HomeMy WebLinkAboutBUSINESS PLAN
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.TE/FACILITY DI~RAM tf 79ß' I
FORM 5
1l1JSP I
BUS INESS NAt'lE:
FACILITY DIAGRA'I
(CHECK ONE) SITE DIAGRA;\I _j~;;'4i~:-
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SITE DIAGRAM (Required lte.s)
1, Address: Ident~he
principle buildin~s
by the Street nu.bers.
9. LOCk. Box
10. M505 Stora~e Box
2, 5treet(sl. Alleys.
DriveMays, and Parkin~
Areas adjacent to the
property. Include the
street na.es.
11. Railroad Tracks
12. Fence or Barrier
a. Wire
b. Masonry
c. Wood
d. Gates
13. Powerllnes
14. Guard Station
3, Stor. Drains. Culverts.
Yard Drains
4, Draina~e Canals, Ditches,
Creeks,
5, Buildings
a. Fraae construction
b. Masonry construction
15. Storage Tanks:
Identify the
capacity in gnl.
a. Above ¡round
c. Metal construction
d. Access Door
b. Underground
6. Utility Controls
a. Gas
16. Dikin¡ or Bera
b. Electricity
17. Evacu~tion Route
c. Water
18. Evacuation Area:
Identity the
location where
uployees w111
..et.
7. Fire Suppression Syste.s:
a. Fire Hydrants
b. FIre sprinkler
COMections
19. Outside Hazardous
Waste Storage
c. Pire Standpipe
Connections
20. Outside Hazardous
Material storage
d. Water Control Valves
tor protection syste.s
21. Outside Hazardous
Material
Use/Handline
e. Fire Pup
22. Type ot Hazardoua
Material/Waste
Stored
or Used (See
Below)
8. FIre Depart.ent Accesa
TYPE OF HAZARDOUS MATERIAL
F · FllUlJlable It · Explosive L · Liquid
C · Corrosive 0 · Oxidizer G · Gas
W · Water Reactive T · Todc S · Solid
R . Radiological
P . Pobon
H . Cryo¡enic
D . Waste B . Etiological
Exa.ple: Fla..able Liquid· FL
FACII,ITY DI~GRAN (Required ite.s in addition to the above)
1. Risers tor Sprinklers 8. Fire ¡¡scapes
Z. ParU tlon. II. Air Condition in. Unit.
3. stairways: Indicate the 10. Windoml
levels .e~v.d eroa
hi~hest to low..t. 11. Inside Hazardous Waste
Stouse
... Escalato!": Indicate the
levels served tro. 13. Inlide Hazardous
higheat to lowest. Material. Storace
5. Elevator 13. Inside Hazardous
Materials U.e/HandJin~
6. Attic Acceas
14. Se,,",1' Drain Inlet:!
7. Skyl1¡hts
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. Bakersfield Fire Det.
Hazardous Materials Inspection
R£CflV£D
AUG 9 1989
6/62-/ ~'d......_.
e._.
/7 Date Completed
Business Name: ~~ ~ br/C?,.r
Location: Jp/J <#-f) cJ~.þ)~
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Plan 10 # 215-000 -:¡-75 (Top right comer Business Plan)
Station No. I Shift Æ-" Inspector ~ ~
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Adequate Inadequate
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Verification of Inventory Materials
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments:
®~
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Verification ofMSDS Availability
D
NurnberofEmployees ?'-/l?
Verification of Haz Mat Training
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Comments:
o
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Verification of Abatement Supplies & Procedures
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Comments:
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Emergency Procedures Posted
Containers Properly Labeled
Comments:
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Verification of Facility Diagram
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Special Hazards Associated with this Facility:
æ(
Violations:
FD 1652 (Rev. 3-89)
White-Haz Mat Div. Yellow-Station Copy Pink-Business Office
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4IÞBAKERSFIELD CITY FIRE DEPAR~
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
, /02-- 26 !3
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OFFICIAL USE ONLY
ID# ~ ~s~D
BUSINESS 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: rY'\o",-\-e)s Fko00 C,OO erì ^j
B. LOCATION / STREET ADDRESS: cJo LS UJ e..S+ ,.ù '6 A),D -4!= A
CIT;ßS-Ç l<l ZIP: Q33ö '- BUS.PHONE: (~D5) ,7j;;J..?;-B5:C}t
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
NAME AND TITLE
A..}'\ \ \(e. \.\t:\~\.t~~
B. PAv\.. \)~(.l\.
IN CASE OF EMERGENCY:
E~~L0'ftt
f.Y\ ~l,o ~ -€ (
DURING BUS. HRS.
Ph# . "jd-.,,-ft:{fJ1
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Ph#
AFTE~ BUS. HRS.
81 ~- Id. S 1
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SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
~. NAT. GAS/PROPANE: No¡..se...
. /ìELECTRICAL: ß c.\.( wC'\r¡,t\~~J~ t,. N Q..)(T
C. WATER: <: IU.
. D. SPECIAL: ~
E. LOCK BOX: YES'l~IF YES, LOCATION:
IF YES. DOES IT CONTAIN SITE
FLOOR
PLANS? YES / NO MSDSS? YES / NO
PLANS? YES / NO KEYS? YES / NO
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE r I j .
bm~ \O~E.is o...r~~: kM uJ °c*,- e)( r t ~ VO~~rº-
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
c., \ OS.~ ~ +- H- 0 s f' ~ '1-õJ - (Y\Q.., Y'Cj 0 n trlA.)< +O"Y\ A v ~ .
Se\J~'¿j S~~5 ~~s ;rù ~\~O
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
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS: . . .". . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .
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:..... , .
I~ITIAL REFRESHER
0Y NO YES NO
YES NO YES NO
YES NO YES NO
@ NO YES NO
YES ~ YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MAT. ERIAL IN QUANTITIES~ THAN 500 POU~1d(
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:.... .. ~~
I ,JV\O ~\e. l, 14An.lt¥~ ~ " " certify that the abo~e 1nformat1on 18 accurate.
I understand that this informat1on 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.
SIGNA'L'URE ~ J, ~ TITLE OW µ t"-
DATE Jv~..t1../-&'l
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
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OFFICIAL USE ONLY
ID#
------
BUSINESS NAME:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
I, 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# <:1 FACILITY UNIT N.""",,,.YYJO¡/J Je..s} r/ /I dl~AJL
(l. ~·IJ:. /...I...tl--L+. t r / OOJe- (/)(),¡:,J I" (J
SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDtffiES
IV ð h A- z.. IQ. RJ:\ CJlA-:=:' rr\Q k ì ~ \ 5 CL\- %ì.s
\)j\)\t *8' f:-~~~+@:;9~\\o-t\ f:ð~e- t
Mlá; 4- \-- \001( 0..6 h<2-S\\J~ w\\\clÁ IS (lJO
í 0 0 PM" C o-f\ 1...{ V'L0Ý S-
Ill/ ~ßU /HC/J~ ê5?'f7-c<:.- AÞVe ~øfr:,
SpðVI['- k/~
SECTION 2: NOTIFICATION ~~ EVACUATION PROCEDURES AT THIS UNIT ONLY
()", ~ ~ Eo- ,Ú!'S - ~ r<rl\+ o-Ç(;ce áOö( r ,Uo..v-e hð1A.'S.e 01 ~
ì JV ~ i1 Se. ð ~ Q)I'IIQn~!!.M (~ m 0 So -\- \ r.>.R u ~ +hr- V -Kv e doocs
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES~
YESt)
A. Does this Facility Unit contain Hazardous Materials?...,.
If No, complete a separate hazardous materials inventory
form marked: NDN-TRADE SECRETS ONLY (white form #4A-l)
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
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SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E}ŒRGENCY RESPONDERS
SECTION 6: LOCATION
A. NAT. GASíPROPANE:
f\Jo 3A~
B. ELECTRICAL, ' + it ß
NO ekck-;~oJ S~lÀ+ c:-Ç-.ç 'I~. ~~~,\'.w \)J~house
o \torte¿ C '\ rC\J-\- '00 '/.... \ N I . . f L !
c. WAT&: \ " A '\J ~ ~\lLd .\-0, er :
1.N b~+ydt5)'t\ ~V\e.l St Nf-) ( I, ~ i
S!?( \ 1\ ~ \ e$ ~ .(\) ð IJ--\- - ê)~, ce ~ \Úo1 Q. \J'ù{ s'C ·
OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
ìN+h\~
LJ lI\ \ +- tl: 6
D. SPECIAL:
¡¡)f+-
E. LOCK BOX, YES B IF YES. LOCATION,
IF YES, SITE PLANS? YES í NO
FLOOR PLANS? YES í NO
MSDSs? YES í NO
KEYS? YES í XO
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Page
LD CITY FIRE
FORM 4A-l
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
DEPARTMENT
BAKERSFIE
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CITY, ZIP: "P,Ks-Ç\d. C'A-L¡,.ç. q ~~O ~
PHONE #: ~<D to - .;l3 79 IOFFICIAL USE CFIRS CODE
ONLY
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T
CODE AMOUNT AMOUNT. UNIT CODE CODE FACILITY UNIT liJ: A CHEMICAL OR COMMON NAME CODE GUIDE
P , IDG-A-I "606't\ ~A-\ 04- a Q.. (\ +s2- \' 1<. e.o... (' 0 T _ ~ ro DtU(\ e..,. . 1=L L~
w C\... ("' ~ ¥\.(') ú ç Q.,
ì)1f. 90 ¿5()() G-~\ % 0:;[ E AS-\-S~Ò.~ of- \)Jo..~ou<:,e__ J:le-:;.:>:,s F \E \ (..oÚQV'ì ~ .!~~~ìvQ. f:N'-CV .
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NAME : -ÍÛ.oñ~ U.-Q,O\QSS TITLE:~..ßlÜ=~)2" SIGNATURE: '-Y'^ ~ -:"\ Il. Lt.. D_ l.'\ - DATE: (I')--d O-F'J7
mi\Ze \4.,.QraQ\~<.( .TITLE: --\".1\Jc.,~\le.\f PHONE # BUS -HOURS: 3á~ -g~()q
~~L ~~r.'tíL- TITLE, -:t-~~~K AFTER BUS HRS: ~7/- ¡á.S7
PHONE # BUS HOURS: ~~~ - 5I5D9
AFTER BUS HRS: ;; In fn - C¡o f-.f
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#: 232
MATERIAL SAFETY DATA SHEET
HMIS
NFPA 704
MANUFACTURER'S NAME:
THE W.W. HENRY COMPANY
5608 SOTO STREET
HUNTINGTON PARK, CA 90255
EMERGENCY TELEPHONE: 213/583-4961
DATE OF PREPARATION: 85/10/28
HEALTH: 1
FLAMMABILITY: 3
REACTIVITY: 0
PERS.PROT.EQUIP: A
--------------------------------------------------------------------------.----_.
SECTION I - PRODUCT IDENTIFICATION
--------------------------------------------------------------------------------
PRODUCT NUMBER: J232
PRODUCT NAME: ASPHALT CUTBACK ADHESIVE
PRODUCT CLASS: ASPHALT CUTBACK
--------------------------------------------------------------------------------
SECTION II - HAZARDOUS INGREDIENTS
---------------------------------------------------------------------------------
INGREDIENT:
PERCENT:
OCCUPATIONAL VAPOR
EXPOSURE LIMITS PRESSURE:
TLV: PEL:':
-------------------------------------------------------------------------------.
PETROLEUM DISTILLATE 30 - 35% 500 PPM 500 PPM 10 MN @ 60 DEG.]
CAS"# 64742898
PETROLEUM OIL 2 - 5% 5MG/CU M 5MG/CU M NIL
CAS # 8012951
ASBESTOS 2 - 5% . NOT APPLICABLE*
CAS # 1332214
* ASBESTOS FIBERS ARE COMPLETELY ENCAPSULATED BY ASPHALT SO NO DUSTING OCCURS.
-------------------------------------------------------------------------------.
SECTION III - PHYSICAL DATA
-------------------------------------------------------------------------------.
BOILING RANGE: 257-310 DEG.F VAPOR DENSITY: HEAVIER THAN AIR
EVAPORATION RATE: SLOWER THAN ETHER % VOLATILE VOLUME: 40%
WT/GAL: 7.9 LBS. % WATER VOLUME: 0%
.
.
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-----------------------------------------------------------------------------
SECTION IV - FIRE AND EXPLOSION HAZARD DATA
--------------------------------------------------------------------------------
FLAMMABILITY CLASSIFICATION:
OSHA: II· FLASH POINT: 56 DEG.F
DOT: FLAMM. LEL: 1%
EXTINGUISHING MEDIA:
FOAM: X "ALCOHOL"
FOAM:
::::::: ::::F:::T:::L:::::D:::::D::K::J:OWN
C02: X DRY CHEMICAL: X
WATER FOG:
OTHER:
---------------------------------------1-----------------------------------------
SECTION V - HEALTH HAZARD DATA
___ I
EFF::~:-::-:~::::::::::~-::::::~:::-::l::::::~::~::-~:::::-::~-::::~:::~:~--::--
LONG TERM LABORATORY TESTS TO DETERMINE CHRONIC EFFECTS. CONTAINS AN INGREDIENT
SIMILAR TO MINERAL OILS REPORTED TO INduCE CANCER IN LABORATOR~ ANIMALS. THERE
IS NO EVIDENCE OF ANY ADVERSE EFFECTS dN HUMANS IF SIMPLE PRECAUTIONS ARE TAKEN
USING PROTECTIVE EQUIPMENT AND GOOD PE~SONAL HYGIENE.
I
MEDICAL CONDITIONS PRONE TO AGGRAVATIONI BY EXPOSURE: UNKNOWN
PRIMARY ROUTE(S) OF ENTRY: DERM~L: INHALATION: X INGESTION:
EMERGENCY AND FIRST AID PROCEDURES: MOV¡E PERSON TO FRESH AIR. APPLY ARTIFICIAL
RESPIRATION IF NEEDED. WASH SKIN WIH SOAP AND WATER. WASH EYES WITH WATER 15
MINUTES. I
---------------------------------------¡-----------------------------------------
SECTION VI - REACTIVITY DATA
______________________________________J_______________--------------------------
STABILITY: STABLE HAZARDOUS POJYMERIZATION: WILL NOT OCCUR
HAZARDOUS DECOMPOSITION PRODUCTS: BLAC~ SMOKE, OXIDES OF CARBON
I
CONDITIONS TO AVOID: SOURCES OF IGNITION AND HEAT
I
INCOMPATABILITY (MATERIALS TO AVOID): MAY REACT WITH STRONG OXIDIZING MATERIALS
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--------------------------------------------------------------------------------
SECTION VII - SPILL OR LEAK PROCEDURES
.-------------------------------------------------------------------------------
;TEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: EXTINGUISH ALL
;OURCES OF COMBUSTION IN THE AREA. CLEAN UP SPILLS AS SOON AS POSSIBLE.
lASTE DISPOSAL METHOD: SCOOP MATERIAL INTO METAL CONTAINERS AND REMOVE TO SAFE
'LACE. ALLOW TO DRY BY EVAPORATION OR DISPOSE OF BY BURNING IF PERMITTED.
--------------------------------------------------------------------------------
SECTION VIII - SAFE HANDLING AND USE INFORMATION
--------------------------------------------------------------------------------
:ESPIRATORY PROTECTION: PROPER VENTILATION SUFFICIENT
'ENTILATION: TO KEEP VAPOR CONCENTRATION BELOW 350 PPM
'ROTECTIVE GLOVES: NONE EXCEPT TO KEEP HANDS FROM BECOMING BLACK AND STICKY.
~YE PROTECTION: GLASSES TO AVOID SPLASHES
ITHER PROTECTIVE EQUIPMENT: NONE
¡YGIENIC PRACTICES: WASH SKIN WITH SOAP AND WATER OR WATERLESS CLEANER
EYES: FLUSH WITH WATER FOR 15 MINUTES
.-------------------------------------------------------------------------------
SECTION IX - SPECIAL PRECAUTIONS
.-------------------------------------------------------------------------------
'RECAUTIONS TO BE TAKEN IN HANDLING AND STORING: KEEP AWAY FROM HEAT AND FLAME
)R OTHER SOURCES OF IGNITION
ITHER PRECAUTIONS! NONE
--------.------------------------------------------------------------------------
SECTION X - TRANSPORTATION DATA
.-------------------------------------------------------------------------------
J.O.T. - UNREGULATED:
REGULATED: X
SHIPPING NAME: ADHESIVE, FLAMMABLE LIQUID
HAZARD CLASS: FLAMMABLE LIQUID
LABEL REQUIRED: RED
..M.C.O. - UN(NA)
NO: 1999
CLASS: 3.2
PAGE: 3068
(j~
HAZARD~US MATERIALS Ir!PECTION
BUSINESS NAME: jty\ o'V\;~E..S floC) \" ~-v e-r·'....--3
LOCATION: dJ)/5 ¿:, I X' W e-5.!w'\~d
INSPECTION DATE: q - IS..... 8' õ'
INSPECTOR: ßL ~ If:.
VERIFICATION OF INVEN'l'ORY MATERIALS
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VERIFICATION OF QUANTITIES
VERIFICATION OF LOCATION
PROPER SEGREGATION OF MATERIAL
COMMENTS :
jJ~
lIIILð f e.
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W~",1e
VERIFICATION OF BAZ MAT TRADlDfG
I~I
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VERIFICATION OF MSDS AVAILABLE
COMMENTS :
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES 1____1
COMMENTS :
EMERGENCY PROCEDURES POSTED
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CONTAINERS PROPERLY ~Rt:T.1m
COMMENTS :
VElUFICATIOR OF FAaLITY DIAGRAM
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SPECIAL IlAZARDS ASSOCIATED WITH THIS FACILITY:
VIOLATIONS:
RF:rJ:'!VFO
SEP 1/t 1988
Ans'd.
...........