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-r ---:./ ,~ , ---" --- ' ,q Q¿. ~ ~ . ßM~tI P PLAN- MAP FACILITY DIAGRAM PIONEER MERCANTILE ca. PRONTO AUTO PARTS 3450 WIBLE RO; . , BAKERSfiELD. CA 93309 SITE DIAGRAM ~ Business Name: Business Address: For Office Use Only . Inspection Station: Area Map # of NORTH 0 First In Station: P l,tt ¡\J cR Þ ) r----r D!WeH P'/l..T i-----!" DfAcU: SuPPGY tA-u Yo ~I\J l.A- ~\Æ-'L ./ U21-frRE CJ _~r~--v - []:l ~ c:D~ #' ~~ ~~ I] \3] 3 - C. LS ?er Su.f(JL'f ~~. ~~;ø ~sflao i Aff)11tf.tt , ø¢ . h "~1"'''' off ~~. L-EJoB'tD ~ I I 'I \ . D \LS 2. srAA'Ý tH-eM I U0 3, ~~ 4-. S?MY r-+1Nß r;. ß~ ~E:. ~ ' -- , zrSlJ,tt OTUA OH10HC¡ . . e- ~OJ 3J!t:~/\J;~~¡.~ H3 ¡~10P1 ;cn 3JdiW l'~i'£ eC[tc A') .OJjliZ'Liiii,tj '---~-----_. . - -'-- ~'- -- - --..' .... "'-.-- ",. ® , ,AfJDto AUTO PARTS PIONEER MERCANTILE CO, 0( CHRIS SOULES ,.. 10 ~f Manager ? " ./. 3450 Wible Road (805) 837-8011 Bakersfield, CA 93309 - '. ',' c~ . '.?> , .190>- .I(w , O/" . ¡'.'" "0· ~? '''-.......,....-..... -'-'".. I <1~ ...1''''1 'V/ ...~. , o,~ · ;z~) '" f - <J·h o ,. <.:¿:> c ,(,' " " 7}ifi~~ - f)C?(~~5SJ7fG~ 0--- ß()j1)~ cjt'( ~ ~5r 7M L.J6P ¡rot! ~ 5S7RV r,,,, ~ .' - .-........""'- JJ\fV.rH2!if.fO' tv in303 3'!2J A'i2fr ::D~ btC1H. Fö tt;~~;C¥~1¡ir[ co· . M~O~UO vruo LW!Z , I 7. .~ ., ,.., PIONEER MERCHANTILE RRrEIVED o Hð, d 34,50 WIBLE RD.$ Ie 'rr: C I.p s {/ BAKERSFIELD. v J 1.. . J:;. 9 'j It -- /lJ¡µ/-~ ~ q ;;L ". . ~ SiteID: 215-000-000013 Manager Location: City BusPhone: Map : 123 Grid: 13A (805) 837-8011 CommHaz : Moderatè FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title CHRIS SOULES / MANAGER SAM IRABARNE / SALESMAN Business Phone: (805) 837-8016x Business Phone: (805) 837-8011x 24-Hour Phone : (805) 836-0730x 24-Hour Phone : (805) 398-9091x Pager Phone ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 3450 WIBLE RD G 1 0 '5 <,j State: CA City : BAKERSFIELD Zip : 93309 . Owner PIONEER MERCHANTILE Phone: (805) 327-8545x Address : 1111 21ST ST State: CA City : BAKERSFIELD ' Zip : 93301 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: Hazmat Common Name. . . One Unified List ì All Materials at Site ì p= Hazmat Inventory p== MCP+DailyMax Order EPA Hazards h . \ I, j.", f1. 5 ( tJ /1) b { I r¡ (Type or print name) reviewed the attached hazardous materials manage- . f f' /C.' r1 f( '- r 1'1 ~ ( ( ?a7tt ~~~î iF ~ong' with ment plan or , (Name of BuSI/19@S) any corrections conSmUî9 a compleîs SInd cOi'fsd man- agement plan ~Oi' my mcility. F P IH L F DH L F DH L Do hereby certify îhat I have DailyMax MCP 60.00 GAL Ext 55.00 GAL Low 135.00 GAL Min MISC SPRAY CANS ANTIFREEZE COOLANT MOTOR OIL ........ 2-, .. 1.- '~, 'i 12/20/1999 -- --- -_.-#_---~_. ---. _._-~_._._--~- --~_.-.- ,._---~----_._-. I , "".,} ¡.~\ - - Per...it· tö Operate Hazardous Materials/Hazardous W aste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-021-000013 PIONEER MERCHANTILE LOCATION .,-- .j Issued by: - i ¡ I II ~'-,- ~-- ~ -----~.,.- Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES -1715 Chester,A ve., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 3450 WIBLE --~..- This permit is issued for the following: zardous Materials Plan . . round Storage of Hazardous Materials --- - agement Program _ Waste Approved by: *~ ph Huey, - ffice of ental Servi es June 30, 2000 Expiration Date: .~ . ~ . Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 @.o ~1G~~~~n lfl JAN 7 1993 U -J.. By :=-- J HAZARDOUS MAT MANA~E~~ fi^- ~~ I-L\.-'B 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. ) SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: þl'tL.e.lv" Mt~ eo - ~ Ilk LOCATION: jy? tJ lU~ W, MAILING ADDRESS: 5~ CITY: ß~ ~ STATE:~ZIP:1J.3/3 PHONE: ZJt--'QOVI DUN & BRADSTREET NUMBER: 06- =rqfo-3 3'70 SIC CODE: PRIMARY ACTIVITY: fTu TD P ~ ~ OWNER: f} drj-tßÍ ~~/; I.e Co. MAILING ADDRESS: Ii) (fD~ 1M? . ßrf/l!) 5.J.Jð V' .¡. . SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS, PHONE 24 HR. PHONE 1. ehrts . , fút-e'J !tJ1/Jt/( Vt~ CÞ/~, tJ" D?Þo ~ J¿lbllle /I J7' 1:-7 of I . 2. , 1. FC ¡' , r~ r;::;;" ..., .., . Bakersfield Fire Dept. . ./ Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN ~--- -- -- SECTION 3: TRAINING: NUMBER OF EMPLOYEES: t/ '. MATERIAL SAFETY DATA SHEETS ON FILE: .~ BRIEF SUMMARY OF TRAINING PROGRAM: W~ ~ fY/fíJS ~~. ;;v~ ~ . ~~~~ 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 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:~IFICA~ I.· {J. ~ C 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. ~. SIGNATURE .. . ~ TITLE . ¿¡.~~ DATE <, --"----.-----.- -.. 2, ~,_ ~ ;I' '. ""¡\. .' Bakersfield Fire Dept. . . ./ Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: f? MPl1Jztv -/ lkik \ SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: '" .1'11 ~ ~ limp ."3~~ ST~ B. EMPLOYEE NOTIFICATION AND EVACUATION: j)~W~~~~ c. PUBLIC EVACUATION: I...Lß- ,ÆJ~ 'Iv ~~ ~~ . ' ì%~ ~w.J ~ I D, EMERGENCY MEDICAL PLAN: f!/~ . ItA- > -/~~ J( tV--t-UJ ~. ~~ 3. ~~AA~ ~ I "~ ~,f_~ ~,'" . Bakersfield Fire Dep. Hazardous Materials Divi_l -' HAZARDOUS MATERIALS MANAGEMENT PLAN , I , I SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: I'\Cr~¡c,&S ~~ ~ eN She:.lve$ 0(' \:"1 'ooiES. ~CL'l-ìfY\0n\...; C\) Ì~~l\t(,.t~ \ <è)t\LLCO. .~~ ~~d1:>i01 w) (:,h(\S ~~S B, RELEASE .CONTAINMENT AND/OR MINIMIZATION: C. CLEA~ED~ ~ ~ ~wÆ, cþ .~~ SECTION 8: UTllITYSHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ~ &-,¡ ~ ~ þØ/~ ELECTRICAL: ~A ~ /1/.'-././ ~. kU~ WATER: ~.:ct.. J r¡ &v~''å SPECIAL: LOCK BOX: YE~ IF YES. LOCATION: I , SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABILITY: A, PRIVATE FIRE PRqTECTION: ~ ~~.. /J.-? WATER AVAILABILITY (FIRE HYDRANT): fn~ ~ /1;i!: B, 4, _/~ ---~ \' --" BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 2130 "G" STREET '::.-: . BAKERSFIELD, CA. 93301 ~..ìj~~W-~UW~~ (805) 326-3979 I (~? , . , i;' JAN· 7 1993 HAZARDOUS MATERIALS INVEN "RY . . i By . FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [] BUSINESS NAME íJ Ofjeeí 1J7t:/CPr¡jif {3; . FACILITY NAME S' f.I.M £ ~ , ~ SITE ADDRESS ,rcJ5D WllSúC- ?Ø . . ó2¡¿5 fkO . 4Ó1lþ,/Jup ~ (~...~, . SIC CODE ST À TE (!A--- . ~rV flff47 S~ DUN & BRADSTREET NUMBER {)o- ::¡fG- 33CJ 0 ZIP 13)07 , CITY NATURE OF BUSINESS OWNER/OPERATORJIb'n-u.( ~~k to MAILING ADDRESS f!/J, rtliX /-fdl CITY ß /¿,!Jt¡; " PHONE ~Z>¡-.~ðSY5 STATE o ZIP 'JJf()2- BUSINES~ PHONE t' ] :r-Wt I EMERGENCY CONTACTS \ TITLE 1J?1þt~~ 24-HOUR PHONE 73~- 0::;30 NAME Cft¡¡L hu Ltg - NAME S"4r;. +~~é BUSINESS PHONE <tJr'-fD}( TITLE ~~ 1}1 ~J 24-HOUR PHONE ,f97-~ð7' / , , ~ ...... .... ........ September 30, 1992 REGIONV LEPC STANDARD FORM Business Name \) ~ "'" .~" ,..,... BAKERS.LD CITY FIRE DEPAa-MENT HAZARDOUS MATERIALS INVENroRY 7\""",,~'I Page_of_ Address 1) INVENTORY STATUS: New Addition [ ] Revision [ CHEMICAL DESCRIPTION ,// / \/ ~ CAS # Deletion [ ] Check if chemical is a NON TRADE SECRET TRADE SECRET [ ] 2) Common Name: ~ø -(-zrt... ~ ~~'~ Chemical Name: 4) PHYSICAl-& HEALTH HAZARD CATEGORIES 5) WASTE CLASSIFICATION 6) PHYSICAL STATE 3) DOT # (optional) AHM [ ] Fire ()( PHYSICAL Reactive [] Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) [ ] USE CODE ~ (3-digit code from DHS Form 8022) Solid [] liquid!)d' Gas [ ] Pure ).I<! Mixture [] . Waste [] CHECI<All. THAT APPtY Radioactive [ ] 7) AMOUNT AND TIME AT FACIUTY ~ Maxil)'1uni Daily Amount: . " Average Daily Amount: Annual Amount: . largest Size Container: # Days On Site 9) MIXTURE: list the three most hazardous chemical components or any AHM component~ 8) STORAGE CODES ./ 0 a) Container: b) Pressure: I c) Temperature: r UNITS OF MEASURE Ibs { ] gal \XI ft3 [ ] curies [ ] . · Circle Which Months: F, M. A, M, J, J,; A. S, 0, N, D 1) 2) 3) ~ POM~, - ~ a?/~, AHM I] [ ] [ ] CAS # %WT bdD - 10) location CHEMICAL DESCÁIPTION \/ 2) Common Name: 1) INVENTORY STATUS: New Þ<fÃddition [ ] Revision I ] Deletion[ ] 3) DOT # (optional) Check if chemical is a NON TRADE SECRET [] TRADE SECRET I ] Chemical Name: 4) PHYSICAL & HEALTH HAZARD CATEGORIES 5) WASTE CLASSIFICATION . 6) PHYSICAL STATE ~ CAS # AHM I] PHYSICAL Fire I] Reactive [] Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) Delayed Health (Chronic) I] (3-digit code from DHS Form 8022) ~1 USE CODE Solid [] liquid !;xl Gas [ ] Pure)<1 Mixture [] Waste [] CHECK AI..l.. THAT APPlY Radioactive [ ] 7) AMOUNT AND TIME AT FAC. ¡UTY ~ Maximum Daily Amount: 0 Average Daily Amount: . , Annual Amount: . largest Size Container: '/ r ¿? " # Days On Site '? b> 9) MIXTURE: list the three most hazardous chemical components or any AHM components UNITS OF MEASURE Ibs [ ] gal V'P ft3 [ ] curies I ] 8) STORAGE CODES a) Container: b) Pressure:' c) Temperature: /1; (~ Circle Which Mont J, F, M, A, M, J, J, A, S, 0, N, D 1) £H¡ ~OMP~~ 2) :CAS# %WT þz7D AHM I J [ ] [ ] I> U::> /' PRINT Name & Title of Authorized Compåny Repres :>.oIM\~3Q 1992 AEGlCNV lEPCSTANDAAOFæM ~- \) BAKERS.LD CITY FIRE DEPAeMENT ¡' HAZARDOUS MATERIALS INVENTORY ...,'..ìi ~~,.~. .:r- (' ./ / / Business Name /" Address Page_of_ CHEMICAL DESCRIPTI~' 1) INVENTORY STATUS:· New ~Addition [ ] Revision [ ] Deletion [ ] fiheck if chemical is a NON TRADE SECRET..fIq TRADE SECRET [ ] 2) Common,Name: ~ ~ (' ~ 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4)'PHYSICAL & HEALTH HAZARD CATEGORIES Fire PHYSICAL Reactive [] Sudden Release of Pressure HEALTH . Immediate Health (Acute) Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION 311 (3-digit code from DHS Form 8022) USE CODE Solid [] Uquid!XI G~ 7) AMOUNT AND TIME AT FACIUTY... Maximum Daily Amount: VJ() Average Daily Amount: Annual Amount: largest Size Container: # Days On Site 6) PHYSICAL STATE· Pure [] Mixture!>¢l Waste [] CHECK ALl. THAT APPlY Radioactive [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: UNITS OF MEASURE 100 [ ] gal ßd 113 [ ] curie! 1 ] /5 :¡... 1'- Circle Which Months: F, M, A, M, J, J, A, S, 0, N, D 10) Location CAS # 9) MIXTURE: Ust the three most hazardous chemical components or any AHM components ~ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] %WT AHM [ ] [ ] [ ] 2) Common Name: 3) DOT # (optional) Check if chemical is a NON TRADE SECRET [ TRADE SECRET [ ] Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire [] Reactive [] Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [] Uquid [] Gas [ ] Pure [] Mixture [ CHECK. AlL THAT APPlY Waste [] Radioactive [ ] 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: largest Size Container: # Days On Site UNITS OF MEASURE Ibs[]gal[] 113[] curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Tempe.~ature: Circle Which Months: All Year, J, F, M, A. M, J, J, A. S, O. N, D 9) MIXTURE: Ust the three most hazardous chemical components or any AHM components COMPONENT CAS # 1) 2) %WT AHM [ ] [ ] s.cr~~3Q, 1992 AEGlOIIY lEPCSTANDAADFæM \J ~ ...............? BAKERS.LD CITY FIRE DEP6MENT HAZARDOUS MATERIALS INVENTORY Page_of_ Business Name Address / CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [. I Addition [ I Revision [ I Deletion [ ] Check if chemical is a NON TRADE SECRET [ I TRADE SECRET [ I , 2) Common Name: . . .. "3) oQr # (optional) Chemical Name: AHM [ I CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ], Reactive [ ] Sudden Release of Pressure ,[ ) Immediate Health (Acute) [ ], Delayed Health (Chronic) [ I 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid [ I Gas:[ ] Pure [ I Mixture [·1 Waste, [ ] Radioactive [ ] OIECX.AL.L THAT APPLY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGECODE,S Maximum DaiIY,Amount: Ibs[]gal[1 ft3 [ ] a) Coritåi~èr:(t; Average Daily Amount: curies [ ] b) 'Pressure: Annual Amount: c) Temþer~turex:,: Largest Size Container: " # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, ~, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location . .. CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ I Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET { ] TRADE SECRET ( ] 2) Common Name: 3) DOT # (optional) j Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] ~udden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] I 5) WASTE CLASSIFICATION (3-digit code ~om DHS Form 8022) USE CODE I 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture { ] Waste {] Radioactive ( ] CIIECJ<AIl. OOT APPlY 7) AMOUNT AND TIME AT FACIUTY ¡ UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: I Ibs[]gal[] ft3 [ I a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site \ Circle Which Mçmths: All Year, J, F, M, A, M, J, J, A, S, O. N. D 9) MIXTURE: Ust \ COMPONENT CAS # %WT AHM \ the three most hazardous 1) \ [ ] chemical components or \ any AHM components 2) .. \ ( ] \ 3) \ [ I 10) Location \ certify under p~naJty at law, that I have personally examined and am tamillar with the mtomation submItted on thIS and all attached documents. I believe the submitted information is true, accurate, and complete. -' " PRINT Name & TitJe of Authorized Company Rep;esentative Signature Date s.øe.,ber30. 1992 AECiIC'N V L£PC STNtUW\O FæM .f:;; .-r~ FIRE DEPARTMENT S. D. JOHNSON FIRE CHIEF .' . CITY of BAKERSFIELD "WE CARE" ~ ()(l ~~,.Y{k.Ù-- ~. (- 1/ - c:; d-- 'Rec:¿ I_ \\A~ o ~ ¡ßß 2101 H STREET BAKERSFIELD, 93301 326-3911 December 12, 1992 Attention: Store Manager NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE ----------------------------------------------- ----------------------------------------------- In the inspection of your business, Pronto Auto Parts located at 3450 Wible Rd., Bakersfield, CA 93301 on 6-10-92 the following hazardous materials regulation violations were identified: 1. A hazardous materials management plan and inventory had not been submitted. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25503.5 (a) Any business, except as provided in subdivision (b), which handles a hazardous material or mixture containing a hazardous material which has a quantity at anyone time during the reporting year equal to, or greater than, a totq) weight of 500 pounds, or a total volume of 55 gallons, or 200 cubic feet at standard temperature and pressure for a compressed gas, shall establish and implement a business plan for emergency response to a release or threatened release of a hazardous material in accordance with the standards in the regulations adopted pursuant to Section 25503. The above violations must be corrected by January 11, 1993. At the time of the inspection, I spoke with Chris Soules and explained that he needed to report any hazardous materials inventory items that are stored in quantities exceeding 500 pounds of solids, 55 gallons of liquids and 200 cubic feet of gases. Neither a completed plan nor a request for exemption ........ .~,." .þ . . was ever submitted. Use the enclosed forms to prepare the hazardous materials management plan and inventory. If quantities of hazardous materials will not equal or exceed the reportable amounts, use Sections I and 5 of the hazardous materials management plan to request an exemption. Failure to correct these violations will result in enforcement action. The department will schedule a re- inspection of your facility to verify compliance. If you have any questions regarding thii notice, please contact me at 326-3979. ~Cer;IY, n 'Û~('Qa(6-V~ ~ Barbara Brenner Hazardous Materials Planning Technician cc: Ralph Huey, Hazardous Materials Coordinator Michael Allford, Deputy City Attorney ~ I . . :,: :P(òn~ AJ1v 'POtr15 - , '0 '1 Ods :: I' ;1 ,: 'j 3C¡ 6f~ .Y G~ IifP Chý/~~ ~(f4 Î2efС:k¿ ol\/PcrL j(7lJ€l1-fo~ t»t pA~ ¡;)'-22--'9¿ :. /3tt.75 9110 ~ ;i !! (;)50 x 15 '::/. D2 X ..oéX957 L X . 2I£¿i~ ~rfl.- = 3~~_ F{ () 2 L Qllo 'I. Ie, EL--"2-¥- . 0;11'57 L. y, 4 ;;><o<.[~,~~ ~ d(pÆ~ t'l 07- L ~o-er- ~-I"2- a.¡. 30 \bs.x 3.115 ~ ; \90vS ~""\3 Lb - "Lp Wí LL- 'R~cl.ùûV -1-D ~ I Y. 'éQ \b ~~Cl~f\e.r '" " '0' . ~\\e: . 'T - ~ , ' i' I' I~- '" ~~ d k-..; ;;(~----'i'!L = orM ~. I ~ :-£4~~ ~ I , I 'I " ~ ~(1D~ eN-i<e, ~ :1 . ,^Je"~:J (;) "'f""L( I ~. ~~ o.i~~~-8~· " ~ " I , , - ! '/ 4 . ?- I . ¡:¡le 1 fuull -- -----~t, ~ !q J \472. d\ 3D G S-r· ~~Q..\~I C¡3ðJ\ HAZARDOUS MATERIALS MANAGEMENT PLAN INST~UCTIONS ~- ----- ---.-- TYPE OR PRINT LEGIBLY. Section 1 - Business Identification Data: List business name, street address of the physical location of the business, mailing address and phóne number of the business. If you are not familiar with your Dun and Bradstreet number or SIC code, contact your bookkeeper,. financial officer or consultant. Section,2 - Emergency Notification: List two persons who have full access to the facility including locked areas and that are knowledgeable about your materials and processes. () SECTION 3 - TRAINING: List the number of employees that are working! in the area of the hazardous materials, use or storage. include all emp~oyees who have any occasion to be ,in those areas. Give a,brief summary of your Hazardous Materials Training Program. Employees are required by state law to have 'a program which provides employees witI'}. initial and refresher training in the following areas: 1) Methods for safe handling of the hazardous materials used by your business. 2) The Cal OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4) The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business. 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. 1 . . ~~ "' --- -- ---- - ----_.~-~- HAZARDOUS MATERIALS MANAGEMENT PLAN Section 4 - Exemption Request: I f you feel you are exempt from the Hazardous Materials reporting requirements of Chapter 6.95 of the California Health and Safety Code, check the appropriate box~ Section 5 - Certification: . Sign, date and return before the due date to avoid further action. Section 6 - Notification and Evacuation Procedures: A) Agency Notification Procedures: What agencies and or corporate officials are notified in case of a haza~dous materials spill or emergency -- What procedures are used to notify these parties. B) Employee Notification and Evacuation: How are your employees notified in case of a hazardous materials emergency. What evacuation procedures exist for the orderly and sa~e evacuation and accounting of all employees incase of an emergency requiring . evacuation. C) Public Evacuation: What, if any, contingency plans do you have for the evacuation of surrounding public, in case of a hazardous materials emergency at your facility. D) Emergency Medical Plan: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facili ty capable of handling an accident involving a hazardous materials exposure involving Hazardous Materials used at your business. (, Section 7 - Mitigation, Prevention and Abatement Plan: A) Release Prevention Steps: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B) Release Containment and/or Minimization: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. 2 ~ .¡ --- ~--- --- ---~ --~- . ¡. .N> .,' HAZARDOUS MATERIALS MANAGEMENT PLAN C) Clean-up Procedures:, Explain what clean up procedures will be implemented in case of a release at your business. This shoùld address small spills,' as well as a major release of material once the material is contained. Section 8 - Utility Shut-Offs: List locations of shut offs using compass points and known or obvious landmarks. If you have a lock box, list its location also. Section 9 - Private Fire Protection/Water Availability: A) Private Fire Protection: Describe on-site fire protection for your business or facility unit, including sprinklers, fire extinguishers, alarm systems and private response, teams. B) Water Availability (Fire Hydrant): Give the location of the clòsest water supply or fire hydrant to be used by the Fire Department in case of an emergency. NOT E If your business covers either a large geographical area or consists of several facili ties (separate manufácturing or storage areas) , Sections 6, 7, 8, and 9 of the (HMMP ) must be completed for each facili ty. You must also complete a separate inventory, and facility diagram for each facility unit 9r building. -<~ . < "'-~--<"~ ""'-'--"""",,,,"..>-,,",,' '- I b-cl.5.~ : i I V~( ~~ C1cu-~ ç.À-~ ~ ~~ ~~~ w~~\?~~ ~. 3 ...:.., ._._ ..' .'_... _~ ...c.._ _..'." ~ ..'~ .._......_. ~'.-_-~ ,__":..u _'." .._~. ..~, .,...... .... .,,~ .' . Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: , . To avoid furthér action, return this form within 30 days of receipt. . 2. TYPE/PRINT ANSVýERS .IN ENGLISH. 3. Answer the questions below for the bUsiness as a whole. 4. Be brief and concise as possible. I SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAILING ADDRESS: CITY: STATE: _ ZIP: PHONE: DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT . TITLE BUS, PHONE 24 HR. PHONE 1. 2. ~-----_....-_. -_..- 1. FD159 · Bakersfield Fire Ðept: Hazardous Materials Division '. ""- ¡~ ~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: 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: \, 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 CONSTITUTE$ PERJURY, SIGNA TURE TITLE DATE - -. ~---_._-- - -'-- 2, o FD1590 ;5. ~.~ -'-7<" / . I I " . Bakersfield Fire Dept.. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION ,PROCEDURES: . 'A. AGENCY NOTIFICATION PROCEDURES: B, EMPLOYEE NOTIFICATION AND EVACUATION: '. C, PUBLIC EVACUATION: D, EMERGENCY MEDICAL PLAN: 3. ; I R)1J '. Bakersfield Fire Dept. '. Hazardous Materials Division ~, ',-.~' -.,~ HAZARDOUS MATERIALS MANAGEMENT" PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): . NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: , SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, PRIVATE FIRE PROTECTION: B, WATER AVAILABILITY (FIRE HYDRANT): -"--- ------.. - - 4, FD1590 o Farm and Agriculture ~tandard Business CITY OF BAKERSFIELD HAZARDOUS MATERIALS INVENTORY t "- , ';;, Page_of_ BUSINESS NAME:JIb)\'td Y'nlj~~le r 4) LOCATION: 3'l~Q WI~'-~ iLV) CITY, ZIP: ¥I:\\,L(Ït1} q1,)D'1 PHONE #: "ö11' ~H NON - TRADE SECRET OWNER NAME: JtOrl¿e.{ h.o.tc.. Co - ADDRESS: (1 (I 1.-1 ~ ~-r CITY, ZIP: l),<"ffi ¡ ~'3JO( PHONE #: l 3 L~' 'f, ') \.f )' NAME OF THIS FACILITY: J(O{1f-o Iff P STANDARD IND. CLASS CODE: DUN AND BRADSTREET NUMBER/FEDERAL ID # - - -- CODES 12 Location Where Stored in Facility 13 \ by wt 14 Names of Mixture/Components See Instructions Ph~l and Healt~ Hazard C.A.S. Number Component II 1 Name & C.A.S. Number (Check all that apply) g Fire Hazard 0 o Reactivity D 0 Component II 2 Name & C.A.S. Number> Sudden Release Immedia'te Delayed of Pressure Health Health 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 o Delayed Component 1# 2 Name & C.A.S. Number 0 Fire Hazard Sudden Release Reactivity , Immediate of Pressure Health Health Component 1# 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component 1# 1 Name & C.A.S. Number (Check all that apply) I) ~ire Hazard 0 0 0' o Delayed component 1# 2 Name & C.A.S. Number Sudden Release Reactivity IlIUDediate of Pressure Health Health Component 1/ 3 Name & C.A.S. Number EMERGENCY CONTACTS #1 C.A.S. Number . Component /I. 1 Name & C.A.S. Number 0 0 component 1/ 2 Name & C.A.S. Number Reactivity IlIUDediate o Delayed. Health Health Component 1/. 3 Name & C.A.S. Number q,,'" '01' 1.0 #2, 24 Hr. Phone' Name Title Physical and Health Hazard (Check all that apply) o Fi're Hazard D Sudden Release, of Pressure : HAME' I.' : L (READ AND SIGN AFTER COMPLETING ALL SECTIONS) er peanlty of law that I haver personally examined and am familiar with the information'submitte~in this and all attached documents and that based on my inquiry of those esponsibl for obtaining the information. I believe that the submitted information is true, a I e, and c plete. . .. .,. '23~9v GNATURE DATE. SIG D '.- , . . ..., - - ~.. ;. . . $ '"' 12/01/92 PIONEER MERCHANTILE 215~000-000013 Overall Site with 1 Fac. Unit Page 1 General Information Location: 3450 WIBLE RD Map: 123 Hazard: Unrated Community: BAKERSFIELD STATION 07 Grid: 12A FlU: 1 AOV: 0.0 r--- Contact Name ~ Title [ Business Phone 1¡24Tur ~honl ) - x ) - x Administrative Data Mail Addrs: 3450 WIBLE RD. D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-007 BAKERSFIELD STATION 07 SIC Code: Owner: PIONEER MERCHANTILE Phone: (805) 327-8545 Address: 1111 21ST ST State: CA 'City: BAKERSFIELD Zip: 93301- Summary K. . {O@ ¡ro®rr~ œ~ th~~ J h~® '~Cf~~ [evåewed ~he a~@hed h~ardo4JJ® m~ri* ~~~ " moot lPitillî tgr (NüI __0=_' __,,__~!1d ~hi~ ~ 0!/,¡)11111<'<1 ~¡ro ¡"¡~ 0; !:IusÍll3wt ~~ I ~~~ 008]$muie ~comp!@~~ ~f'i©1 OO(78'~ Mino ",pJrmb',~~o '·iiIfi·'····· '.-', ", ,.;;~.,~~,. . ..~.' ......... ~ ... b . . . ... ~ . . ? 12/01/92 PIONEER MERCHANTILE 215-000-000013 00 - Overall Site Page 2 <D> Notif./Evacuation/Medica1 <1> Agency Notification <2> Employee Notif./Evacuation <3> Public Notif./Evacuation <4> Emergency Medical Plan -. . . :? .. 12/01/92 PIONEER MERCHANTILE 215-000-000013 00 - Overall Site Page 3 <E> Mitigation/Prevent/Abatemt <1> Release Prevention <2> Release Containment <3> Clean Up <4> Other Resource Activation ~ . . ~ ~:. 12/01/92 PIONEER MERCHANTILE 215-000-000013 00 - Overall Site Page 4 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs <3> Fire Protec./Avail. Water <4> Building Occupancy Level '", . . ::os.". ., :,. 12/01/92 PIONEERMERCHANTILE 215-000-000013 00 - Overall Site Page 5 <G> Training <1> Page 1 <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use / I'l' ~ . . . BAKERSFIELD CITY FIRE DEPARTMENT --' , I HAZARDOUS MATERIALS DIVISION 2130 "GII STREET BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS FACILITY DESCRIPTION: Check if your business is a farm. Enter the full legal name and site address of your business. Do not use post office box numbers. Give a brief description of the nature your business activities. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on page 4. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department by giving them your employer number, from the U.S. Labor Department or from the Standard Industrial Classification Manual. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the name of the owner, their mailing address and phone number. EMERGENCY CONTACTS: List two persons who have full access to the facility, including locked areas, and that are knowledgeable about your materials and process. CHEMICAL DESCRIPTION: Make as many copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of a gas. Enter the full legal name and site location of your business at the top of the form. Enter the page number in the right, hand corner. Each of the instructions below correspond to the entry field with the same number on the chemical description form. September 30, 1992 1 REGION V LEPC STANDARD FORM \ ~ e . '\¡, 1 . Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Check nontrade secret unless the chemical composition meets the criteria for trade secret status per Section 6254.7 of the California Government Code and Section 1060 of the California Code of Evidence. Copy trade secret pages onto yellow paper before submitting your inventory so that they will be easily identified. 2. Enter the common name or the manufacture's product name. Enter the standard chemical name. If a pure material is an acutely hazardous material (AHM), check the box labeled AHM. Report the components of mixtures under item 9 below. 3. Enter the Dept. of Transportation (DOT) identification number and the Chemical Abstract Service (CAS) number for this chemical. CAS numbers are commonly found on Material Safety Data Sheets. 4. Check the box(es) which describe the physical and health hazards associated with the chemical. 5. If the material is a waste, enter the appropriate three-digit California waste code. California's nonrestricted waste codes are listed on page 4 of these instructions, Questions regarding the waste classification codes and requests for hazardous waste manifest form #8022 may be addressed to the Department of Health Services, Toxic Substances Control Program at (916) 322-3670. Enter the appropriate use code from the following list. USE COOES 01. Additive 02. Adhesive 03, Aerosol 04, Anesthetic 05, Bactericide 06, Blasting 07. Catalyst 08. Cleaning 09, Coolant 10. C091ing 11, Drilling 12. Drying 13, Emulsifier/demulsifier 14, Etching 15. Experimental 16. Fabrication 17. Fertilization 18, Formulation 19, Fuel 20. Fungicide 21. Grinding 22. Heating 23. Herbicide 24. Insecticide 25, Instructional 26. Lubricant 27. Medical aid/process 28. Neutralizer 29. Painting 30. Pesticide 31, Plating 32, Preservative 33, Refining 34. Sealer 35, Spraying 36. Sterilizer 37, Storage 38. Stripper 39. Washing 40. Waste 41. Water Treatment 42. Welding/soldering 43, Well injection 44, Oil treatment 45. Resale 46. Aircraft systems 47. Battery electrolyte 48. Breathing air 49, Drafting aid 50. Finished product 51. Fire protection 52, Hydraulic equipment 53. Road/Hwy maintenance 54, Testing 55. Wholesale chemicals 99. Other - specify September 30, 1992 2 REGION V LEPC STANDARD FORM \, .. ? . . 6. Check the boxes which describe the physical state of the chemical. Pure materials are 1000% of the chemical listed in item #2. Chemicals that have been diluted with water or combinations of two or more chemicals should be reported as mixtures and the components listed in under item #9. 7. Enter the maximum daily amount, the average daily amount and the total annual amount of material in storage or use at your facility. Enter the largest container size and the number of days/year that the material is on site. Circle the months that the material is on site. Enter the units of measure. Report solids in pounds, liquids in gallons, gases in cubic feet and radioactive materials in curies. 8. Select the appropriate storage codes from the lists below. a) CaNT AINERCODES 01. Underground tank 02, Aboveground tank 03, Fixed Pressurized tank 04. Portable pressurized cylinders 05. Insulated tank (includes cryogenics) 06. Drums or barrels - metallic 07, Drums or barrels - non-metallic 08. Carboy(s) b) PRESSURE CODES 09. Glasscontainer(s) 10. Plastic container(s) 11. Box(es) 12. Bag(s) 13, Metal containers (not drums) 14. In machinery or processing equipment· 15, Bin(s) 99, Other - specify 1 - The material is stored at ambient (normal atmospheric) pressure, 2 - The material is stored at greater than ambient pressure, 3 - The materials is stored at less than ambient pressure. c) TEMPERATURE CODES 4 - The material is stored at ambient (surrounding) temperature. 5 - The material is stored at greater than ambient temperature. 6 - The material is stored at less than ambient temperature. 7 - The material is stored under cryogenic conditions 9. Enter the maximum % concentration by weight of the three MOST hazardous components in the material. Round up to the nearest whole number percentage. Enter the CAS number for each component of the mixture. If the component is an acutely hazardous material, check the box labeled AHM. 10. Briefly describe the location of the material within the building/facility using compass directions and obvious landmarks. September 30. 1992 3 REGION V LEPC STANDARD FORM or> \ COMMON STAARD INDUSTRIAL CLASSIFIC.ON (SIC) CODES 0111 Wheat production 0724 Cotton ginning 5821 Eating places 0115 Com .production 0541 Grocery Store 5813 Drinking places 0131 Cotton production 1541 Dry cleaners (alcohol service) 0139 Field crops, except cash grains 2911 Oil refineries 5983 Fuel oil dealers 0161 Vegetables & melons 3441 Welding/fabrication - structural 5984 LPG dealers 0172 Grapes 3443 Welding/fabrication - boiler 7342 Pest control 0173 Tree nuts, 3569 Machine shop 7532 Auto top, body, 0174 Citrus fruits 4222 Cold storage upholstery repair 0175 Deciduous tree fruits 4925 Compressed gas supplier Auto paint shops 0179 Other tree fruits & nuts 5093 Automobile salvage 7533 Auto exhaust repair 0192 General farms, primarily crop 5169 Chemical supply 7536 Auto glass replacement 0241 Dairy farms 5511 Motorvehicle dealers (new & used) 7537 Auto transmission repair 0252 Chicken eggs 5521 Motor vehicle (used only 7538 General auto repair 0253 Turkey eggs 5531 Auto & home supply stores 7542 Car washes 2851 Paint manufacture 5541 Gasoline service stations 8071 Chemical Laboratory 0291 General farm, primarily livestock & animal specialties NONRESTRICTED WASTE CODES Code Description Inorganics 111 Acid solution 2< cpH <7 with metals ( antimony, arsenic, barium,beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, silver, thallium, vanadium and zinc) 112 Acid solution without metals 113 Unspecified acid solution 121 Alkaline solution pH > 12,5 with metals (see 111) 122 Alkaline solution without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12,5) containing reactive anions (azide, bromate, chlorate, cyanide, fluoride, hypochlorite, nitrite, perchlorate and sulfide anions) 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues 10% or more 134 Aqueous solution with total organic residues less than 10% 135 Unspecified aqueous solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 1 61 FCC Waste 162 Other spent catalyst 171 Metal sludge (see 111) 172 Metal dust and machining waste (see 111) 181 Other inorganic solid waste Organics 211 Halogenated solvents (methylene chloride, chloroform, TCE, TCA) 212 Oxygenated solvents (acetone, butanol, MEK) 213 Hydrocarbon solvents (stoddard solvent, xylene) 214 Unspecified solvent mixture 221 Waste oil and mixed oil 222 Oil/Water separation sludge 223 Unspecified oil - containing waste 231 Pesticide rinse 'water 232 Pesticides and other waste associated with pesticide production 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste 261 PCB's and material containing PCB's 271 Organic monomer waste (includes unreacted resins) September 30. 1992 ~ Description 272 Polymeric resin waste 281 Adhesives 291 Latex waste 311 Pharmaceutical waste 321 Sewage sludge 322 Biological waste other than sewage sludge 331 Off-spec, aged or surplus organics 341 Organic liquids (nonsolvents) with halogens 343 Unspecified organic liquid mixture 351 Organic solids with halogens Sludges 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 Sulfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 Tetraethyllead sludge 491 Unspecified sludge waste Miscellaneous 511 Empty pesticide containers 30 gal or more 512 Other empty containers 30 gal or more 513 Empty containers less than 30 gal 521 Drilling mud 531 Chemical toilet waste 541 Pho,to chemical/photo processing waste 551 Laboratory waste chemicals 561 Detergent and soap 571 Fly ash, bottom ash, .and retort ash 581 Gas scrubber waste 591 Baghouse waste 611 Contaminated soil from site clean-ups 612 Household wastes (Restricted waste codes are listed on the back of form #8022) ., 4 -.., REGION V LEPC STANDARD FORM \) - r.. BAKERSFIELD CITY FIRE DEtRTMENT HAZARDOUS MATERIALS DIVISION 2130 "G" STREET BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY L FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [] BUSINESS NAME FACILITY NAME SITE ADDRESS CITY STATE ZIP NATURE OF BUSINESS SIC CODE DUN & BRADSTREET NUMBER OWNER/OPERATOR MAILING ADDRESS . . PHONE CITY STATE ZIP EMERGENCY CONTACTS NAME TITLE BUSINESS PHONE 24-HOUR PHONE NAME BUSINESS PHONE TITLE 24-HOUR PHONE September 30. 1992 REGION V LEPC STANDARD FORM \i ... BAKERSa:LD CITY FIRE DEP4TMENT HAZ~DOUSMATERIALS INVENTORY -~ Page_of_ Business Name Address CHEMICAL DESCRIPTION 1} INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHECK ALL THAT APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: : # Days On Site Circle Which Months: All Year, J, F, M. A. M, J. J, A. S. 0, N. D 9) MIXTURE: List COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ J 5} WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ J Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHECK ALl.. THAT APPlY 7} AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A. M. J, J. A, S, 0, N, D 9) MIXTURE: List COMPONENT CAS # %WT AHM the three most hazardous 1 ) [ ] chemical components or -" any AHM components 2) [ ] 3) [ ] 10) Location certiry unaer penalty ot law, tnat I nave personally exammed ana am tamlllar Wltn tne mtomatJon suomltted on tnlS ana all attached documents. I Oelleve tne submitted information is true,. accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date $<IOI~ber30. 1992 REGlO\IV L.EPCSTANOARDFœM \) ¿~- BAKERSF"O CITY FIRE OEPAlill,MENT HAZARDOUS MATERIALS INVENT~Y Page:.-of_ Business Name Address CHEMICAL DESCRIPTION , 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid [ 1 Gas [ 1 Pure [ 1 Mixture [ 1 Waste [ 1 Radioactive [ 1 ( CHECK ALl THAT APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ 1 gal [ 1 ft3 [ 1 a) Container: Average Daily Amount: curies [ 1 b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S. 0, N,D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ 1 chemical components or any AHM components 2) [ 1 I 3) [ 1 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ 1 Addition [ 1 Revision [ 1 Deletion [ 1 Check if chemical is a NON TRADE SECRET [ 1 TRADE SECRET ['1 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ 1 CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ 1 Reactive [ 1 Sudden Release of Pressure [ 1 Immediate Health (Acute) [ 1 Delayed Health (Chronic) [ 1 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ 1 Liquid [ 1 Gas [ 1 Pure [ 1 Mixture [ 1 Waste [ 1 Radioactive [ 1 CHfCKALL mA.T APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ 1 gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ 1 b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F. M, A. M, J, J, A,S, 0, N,D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1 ) [ 1 chemical components or any AHM components 2) [ 1 3) [ 1 10) Location certify under penalty of law, that I have personally exammed and am familiar with the mfomation submItted on this and a/l attached documents. I believe-the ',I submitted information is true, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date AE~ V LEPC STANDMO FCFIM s.ø.."W3Q, 1Si192 \ì ~- BAKERSlELD CITY FIRE DEP4TMENT C HAZAADOUSMATERIALS INVENTORY ~ Page_of_ Business Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHECXAli THAT APPlY 7) AMOUNT AND TIME AT FACiliTY UNITSÒF MEASURE 8) STORAGE CODES Maximum Daily Amount: 100 [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J, F. M, A, M. J. J, A. S, 0, N, D 9) MIXTURE: List COMPONENT CAS # %wr AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] r Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHECK ALL THAT APPt Y 7) AMOUNT AND TIME AT FACiliTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J. F, M, A. M, J, J, A, S, O. N. D 9) MIXTURE: List COMPONENT CAS # %wr AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location ¡ certify under penalty of law, mat I nave personally exammea and am familiar with the mfomation submitted on this and all attacned documents. I believe the submitted information is true, accurate, and complete. Signature Date PRINT Name & Title of Authorized Company Representative 5cJI~~3Q 11Bl REGlCJII V LEPC STANDARD FeR"