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51 T E DIAGRAM ~ F A~L' TY DIAGRAM ..
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(805) 834011841
1475 While Lane
Bakersfield. CA 93307
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~M IMAGINE THAT 215-000-000004
Overall Site with 1 Fac. Unit
Page
1
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02/23/94
General Information
Location: 1475 WHITE LN
Community: BAKERSFIELD STATION 01
Map: 124 Haz:1 Type: 1
Grid: 18C FlU: 1 AOV: 0.0
Contact Name
LORA LEE ROUNDY
HEIDI ROUNDY
Title
OWNER ;131- ~öl S-
MOTHER
Business Phone 24-Hour Phone
(805) 834-1184 x (805) 397-7603
(805) 861-0570 x6451 (805) 834~1746
Administrative Data
Mail Addrs: 1475 WHITE LN
City: BAKERSFIELD
Comm Code: 215-001 BAKERSFIELD STATION 01
D&B Number: 550-41-3870
State: CA Zip: 93307-
SIC Code:
Owner: LORA LEE ROUNDY
Address: 1475 WHITE LN
City: BAKERSFIELD
Phone: (805) 834-1184
State: CA
Zip: 93307-
Summary
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02/23/94
IMAGINE THAT 215-000-000004
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
PIn-Ref Name/Hazards
Form
Max Qty MCP
02-001 HELIUM
~ Fire, Pressure, Immed Hlth
Gas
Page
2
976 Minimal
FT3
--------~
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e
02/23/94
IMAGINE THAT 215-000-000004
02 - Fixed Containers on Site
Page
3
Hazmat Inventory Detail in MCP Order
02-001 HELIUM
~ Fire, Pressure, Immed Hlth
Gas
976 Minimal
FT3
CAS #: 7440-59-7
Trade Secret: No
Form: Gas
Type: Pure
Days: 365 Use: OTHER
Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 --
976 I 488.00 I 7,320.00
Storage r Press T Temp ~ Location
PORT. PRESS. CYLINDER Above AmbientlSW WALL BY COUNTER
- Conc l
100.0% Helium
Components
r; MCP -¡Guide
Minimal I 12
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02/23/94
IMAGINE THAT 215-000-000004
00 - Overall Site
Page
4
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
WE WOULD CONTACT FLINTCO IF WE HAD A PROBLEM WÌTH OUR HELIUM TANKS.
<2> Employee Notif./Evacuation
WE HAVE A FRONT AND BACK DOOR EXIT FQR EMPLOYEES AND CUSTOMERS. WE ALSO
HAVE A PANIC BUTTON WITH OUR ALARM SYSTEM WHICH WOULD NOTIFY THE POLICE IN
CASE OF AN EMERGENCY.
<3> Public Notif./Evacuation
WE HAVE FRONT AND BACK DOOR EXITS.
<4> Emergency Medical Plan
NEAREST HOSPITAL
e
e
02/23/94
IMAGINE THAT 215-000-000004
00 - Overall Site
Page
5
<E> Mitigation/Prevent/Abatemt
<1> Releage Prevention
HELIUM TANK CHAINED TO WALL. TANK COVERS LEFT ON WHEN NO IN USE.
<2> Release Containment
TANK VALVE CLOSED EACH NIGHT.
<3> Clean Up
<4> Other Resource Activation
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02/23/94
IMAGINE THAT 215-000-000004
00 - Overall Site
Page
6
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - NONE
B) ELECTRICAL - EAST WALL BY BACK DOOR
C) WATER - NONE
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - OVERHEAD SPRINKLERS, FIRE EXTINGUISHER BY BACK
DOOR (EAST WALL, BURGLAR ALARM.
FIRE HYDRANT - CORNER OF SOUTH H & WHITE LANE (BY WENDY'S)
<4> Building Occupancy Level
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02/23/94
IMAGINE THAT 215-000-000004
00 - Overall Site
Page
7
<G> Training
<1> Page 1
WE HAVE 4 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE SELL HELUIM BALLOONS - EVERYONE KNOWS TO SHUT
VALVE OFF EACH NIGHT. OUR TANK IS CHAINED TO THE WALL. HELIUM IS USED ONLY
FOR BALLOONS.
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
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, ~. ..
02/23/94
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IMAGINE THAT 215-000-000004
00 - Overall Site
Page
8
<M> Inspections
R WATKINS
R HUEY
R. WATKINS
08/04/92 FOLLOW UP
/ /
08/10/92 FOLLOW UP OK
/ /
08/12/93 OK
/ /
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02/23/94
IMAGINE THAT 215-000-000004
00 - Overall Site
Page
9
<M> Events "M" Overall List
R WATKINS 08/04/92 FOLLOW UP
/ /
NEED MSDS SHEETS
EXTINGUISHER NEEDS SERVICE
R HUEY 08/10/92 FOLLOW UP OK
/ /
R. WATKINS 08/12/93 OK
/ /
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Bakersfield Fire DepttÞ
HAZARDOUS MATERIALS DIVISION
Date Completed 8 - 4 - q-z.
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Business Name:
l ¡vi. A6t,~ ~ ~lAT
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Location: l4'15 U1t1tTS L~
Business Identification No. 215-000 OéY)(X) 4_ (Top of Business Plan)
Station No. 5 Shift ß Inspector l0A1K u\)5 / TZ-Dr_
f
Adequate Inadequate RECEIVED
~ LJ
Verification of Inventory Materials
~ LJ 'AUG 0 6-1992
Verification of Quantities
Verification of Location ~ LJ HAZ. MAT. DIV.
Proper Segregation of Material ~ LJ
Comments:
~
Verification of MSDS Availablity
Number of Employees
~
Verification of Haz Mat Training
ments:
Verification of Abatement Supplies & Procedures
Comments:
D
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Emergency Procedures Posted
Containers Properly Labeled
Comments:
Verification of Facility Diagram
Special Hazards Associated with this Facility:
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LJ
D
Violations: ~~ MATéRt.A\ <5dE--ry ~ATA 'SHE:ß-r
é~ t \N6 l) \5 H ES 1<- N E:E:Ì)S Sc{<--\I l CE,.
~~ ~f.àge~~ ~ M.---'
FD 1652 (Rev. 1-90)
All Items O.K.
Correction Needed
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White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy
OK
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Bakersfield Fire Dept.
Hazardous Materials Dìvisìon
2130 "G" Street
Bakersfield, CA. 93301
REr.~IVED
FE 8 2 2 1991
Ansid........... .
#~ &Jbn i
HAZARDOUS MATERIALS MANAGEMENT PLAN~G--I
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 brief and concise as possible.
~ECTION 1: BUSINESS IDENTIFICATION DATA j)
BUSINESS NAME: ,~fY}rY"17rf)e- r¡-ha~t r
/'-1 7/; LA) hlfe- LQI)fJ/
(5;)me
STATE: Cd- ZIP: W¿?7PHONE: X3V-)J rLj
LOCATION:
MAILING ADDRESS:
CITY: R }{ +-d
¡:: ¿ T ~.-,t I. D . :it--
DUN ~ BRADSTREET NUMBER: t;qJ-Lj /~ 5 D'70 SIC CODE:
PRIMARY ACTIVITY: ~f)/nM ,Ç/OI1 V' fi'H ¡ßOI/ f¡fI/~ /
OWNER: L()ß,) k_ ß//J1d/. .
, )
MAILING ADDRESS: ~YY)e'/
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
1. LoRrP, l~() (J/!rrJ¡
2, /Ip/c!' ~tll1t11
TITLE
OVJ7'f;e.-
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BUS, PHONE
24 HR, PHONE
C¡-W-/J it¡
1b1-[))7() 1.</5J
39}-7ba<;
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_ Bakersfield Fire Dept. e
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
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SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: tf
MATERIAL SAFETY DATA SHEETS ON FILE:
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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 IICALlFORNIA HEALTH &
SAFETY CODEII FOR THE FOLLOWING REASONS:
./ WE DO NOT HANDLE HAZARDOUS MATERIALS.
/' ;U;-O HAND~~ltfÒÙ~A TERIALS, BUT THE QUANTITIES AT NO
TlMEEXCEED THE MINIMUM REPORTING QUANTITIES.
~(
OTHER (SPECIFY REASON)
I, CERTIFY THAT THE ABOVE INFOR-
MA 10 S A CURATE. I DERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM1S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODEII
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURAT INFORMATION CONSTITUTES PERJURY.
TITLE
DATE
2.
FD159' I
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Bakersfield Fire Ðepe
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name: ~(:rl/)~ff
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A,
. ~ oL(}b Jd a/
B. EMPLOYEE NOTIFICATION AND EVACUATION:
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ú)11'~. ' V;.~, 7;Jvak/ Jl4f!: CU ¡aði#0
~J~ (){,V?J! cwa/Ym :~ .wf(icJv þM
(I~.~ ~,¡/n AXMiJa! Mi ~;ørY' .
C. PUBLIC EVACUATION:
(j)J/ ~ fM'ii "t ~,JZjdøøv ~
D, EMERGENCY MEDICAL PLAN:
Th~ ~&&
3.
R)1~
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:
H ~Li (,HVt ~ /( (),/th/ eIJ TO iAí8t-L "
,f}ðJ1< Ú)1IfW) t-e-¡r OrJ ~ NOr )}J .Me
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
T7}N/<.' V lYL-1I e i GL 0 ~ fli) e{jd 146 h 'T
C. CLEAN-UP PROCEDURES:
~4
SECTION,S: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE: AjA
ELECTRICAL: £w l-v'e-tL- b 7 b~ 1JtJðfr
WATER: ¡V/4
SPECIAL:
LOCK BOX: YE@ IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
B,
PRIVATE FIRE PROTECTION:. }.v' cJr~e-r hy b~~ ÐtYiJy (eljsrwß1..&)
() vr¿.¡-/fe+Þ >Ph'ìvKlet'1/ P¡ re ~n fJ '.)
bu r6Lßr ft1,.1:YY)'V\ .
WATER AVAILABILITY (FIRE HYDRANT): /, '-ve,j'[)""'\) \
{,or-(liý DJ 5~~ If. 11 Í/¡'lr~ L~ l b r f ~
/}0o by k,~c,
4.
FD159\'
A.
CITY of BAKERSFIELD
~HAZARDOUS MATERIALS
. NON-TRADE SEC
OWNER NAME: J...orlf tee !<Ou.,./f)
ADDRESSl· L<:Jõ ~~.
~TY~ Z P:- ~'
P ON t: It: . 0
R FER TO U;
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INVENTORY
of
Page -L__
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RETS
NAME OF THIS FACllITYÒ'
STANDARD IND. CLASS C
DUN AND BRADSTREET NUM
BusIness
Standard
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and Agticulture
Farm
U
~ixture{ço~conents
Instruc Ions
J
, by
Wt
CODES
12
on Where
n FacI' Ity
11
Use
Code
10
Cont
Temp
9
Cont
Press
8
Cont
Type
1
Dys
SIte
6
Measure
UnIts
5
Annua
Est
4
Average
Amt
3
Max
Allt
2
TYQe
Code
1
Tr&ns
Code
Nalles of
See
loc~t
Stored
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on
by {O(A..~
s:w. ""t1tL
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2.
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~6S-
FT3
?'1)0 fr3
FTj I L.f ~8' PíJ
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\?ol HeL/úl"Vt
Number
Number
C,A.S
C.A,S
Component 11 Name
He¿,~~
Component 12 Name
mmediate
Health
Component 13 Name
o
Number
)¡¡r, Sudden Re I ease
p.J of Pressure
S
Delayed
Health
C.A
o
and Health Ha~ard
a II that apply I
Reactivity
o
Hazard
re
pr~~~~f
o
Number
C.A,S
NUllber
Number
Number
C.A.S
C.A.S
C.A.S
NUle &
Name
Name
Component I
.2
.3
Immediate Component
Health
Component
o
Sudden Release
of Pressure
NUlllber
o
De 1ayed
Health
C,A.S
o
Physical aod Health Ha~ard
(Check all that applYI
Reactivity
o
re Hazard
o
Number
Number
NUllber
C,A.S
C.A.S
C.A.S
&
Nallle
Nallle
Name
Component I
12
13
Immediate Component
Health
Component
o
Sudden Re I ease
of Pressure
Number
o
S
De J ayed
Health
C,A
o
ty
v
th Ha~ard
applYI
React
o
ond Hea
a 11 that
Hazard
Fire
PhyS i ca
(Check
o
NUllber
C.A.S. NUllber
C.A.S
Nalle
Name
I
'2
Component
mmediate Component
Health
Component
o
Sudden Release
of Pressure
NUllber
o
s
Delayed
Health
C.A
o
Physics I and Health Hla~ard
(Check all that app YI
o
o
Number
C,A,S
Name
13
Reactivity
re Hazard
1311 - , I) 1(6
zrlWT1i~
1~?-')b01
~r phone
subllitte~ in this and all
Inforllatlon. I belIeve that
(If~~ÍI/eNC~
Ttt-
Certifjçatjoq fReed and $ign afjßr c9mpleting Ç117 sections)
1 certIfy under enal~ 0 Is th t I have persona Iy exam)n Q a d III familIar it the informatIon
attaçhed docÚllen~sl an~ t at ~ase~ on IIY InquIry 0 lhose Inâlvl~ua's responslb1e ~or obtaInIng the
submItted Infor~atlon IS true, accurate, and cOllplete
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EMERGENCY CONTACTS
lIDefr'ãofic
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CITY of BAKERSFIELD
"WE CARE"
FIRE DEPARTMENT
D. S. NEEDHAM
FIRE CHIEF
January 24, 1991
2101 H STREET
BAKERSFIELD, 93301
326-3911
Imagine That!
1475 White Lane
Bakers£ield, Ca.
93307
Attention: Laura
It has come to my attention that in July Barbara Brenner £rom
the Hazardous Materials Division paid you a visit and requested
that you £ill out a Hazardous Materials Management Plan £or the
h€li~m used in your store. This plan was due by August 1, 1990.
C<9/r.pres~d 9C<St""i
At this time I am sending you a new packet o£ in£ormation in
case you have lost it. We do need to have these £orms filled out
and returned to this o££ice by February 8, 1991. 1£ we have not
received the £orms or heard £rom you by this date you could incur
civil liabilities up to $2,000.00 per day £or each day o£ non
compliance.
Please do not hesitate to contact us i£ you have any questions
or problems with the £orms.
Sincerely,
Valerie Pendergrass
Hazardous Materials Division
ENCLOSURES