HomeMy WebLinkAboutBUSINESS PLAN 8/14/2006
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Materials/Hazardous' W astetU nifiedPermit
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CONDITIONS--,:,OF<P,EBM,ITON R,EVERSE SIDE
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.y ,This permit Is Issued for ~
'It! Hazardous Materials Plan
,0 Underground Storage of Hazardous Materials
o Risk Management Program
q Hazardous Waste On-Slte Treatment
Hazardous
-
Issue Date
:
Approved by:
Expiration Date:
Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SER VICES
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 326-0576
Permit I D #: 015-000-000350
C & R AUTOMOTIVE
LOCATION: 5333 WHITE LN B
Issued by:
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PerDl.it tö Operate
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This permit is issued for the following:
\ ! rdous Materials Plan
Iround Storage of Hazardous Materials
PERMIT ID# 015-O21~00350 agement Program
IS, Waste
C & R AUTOMOTIVE,,,,:,,
LOCATION 5333 WHITE ;::;:!::i\~,::::~ii¡¡
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Bakersfield Fire Department Approved by: Æ
OFFICE OF ENVIRONMENTAL SER VICES - ph
1715 Chester Ave., 3rd Floor flic«
Bakersfield, CA 93301
Voice (805)326-3979 . . Jun
FAX (805) 326-0576 ExplrahonDate:__
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FACI -I TY DIAGRAM
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.~4y~` ~'"~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT
r~a~' ~ OFFICE OF ENVIRONMENTAL SERVICES
~' ~'~ UNIFIED PROGRAM INSPECTION CIIECKi.IST
s .
`w i 1715 Chester Ave., 3'd I{ loor, Bakersfield, CA 93301
~~ ~HL G7(/~ INSPECTION DATE ~ ~~ l) ~ _
FACILITY NAME ~ v _ ~1
ADDRESS S 3 '~T PHONE NO. ~3~ ~ `f (71
FACILITY CONTACT BUSINESS ID NO. 15-21U- O~o3S~
INSPECTION TIME l O wi (1.J _ __ NUMBER OF EMPLOYEES 2- _
Section l: Business Plan and Inventory Program
~outine ^ Combined ^ .Ioint Agency ^Mu1ti-Agency
•
X511
Complaint (~ Re-inspection
OPERATION C V COMMENTS
Appropriate permit on hand
Business plan contact information accurate
Visible address
Correct occupancy
Verification of inventory materials ~ -~ ~` <,~
Verification of quantities
Verification of location
Proper segregation of material
Verification of MSDS availability b
Verification of Haz Mat training '
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance V=Violation
C~ ~"
Any hazardous waste on site?: Yes (~No "~(~
• Explain: M
Questions regarding this inspection? Please call us at (661) 326-39'79 ~ ~ Its/) Busi ass Site Responsible Party
Whig -Env. Svcs. Yellow -Station Copy Pink -Business Copy Inspector: ~ ~ 3
:,•
+ C & R AUTOMOTIVE ____________________________________ SiteID: 015-021-000350 +
Manager
Location: 5333 WHITE LN B
City BAKERSFIELD
BusPhone: (661) 834-9401
Map 123 CommHaz Low
Grid: 15D FacUnits: 1 AOV:
CommCode: BFD STA 13
EPA Numb:
SIC Code:
DunnBrad:
t______________________________________________________________________________t
Emergency Contact / Title Emergency Contact / Title
WILLIAM CARROLL / OWNER RAMON ROSALES / OWNER
Business Phone: (661) 834-9401x Business Phone: (661) 834-9401x
24-Hour Phone (661) 324-9116x 24-Hour Phone (661) 398-9504x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: Fire DelHlth
Contact Phone: (661) 834-9401x
MailAddr: 5333 WHITE LN B State: CA
City BAKERSFIELD Zip 93309
Owner C & R AUTOMOTIVE Phone: (661) 834-9401x
Address 5333 WHITE LN B State: CA
City BAKERSFIELD Zip 93309
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif ' d: RSs : No
ParcelNo:
~ Emergency Directives: ~
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
ENT'p A PR l 4
2006
~~~~d on my inquiry of those individuals
PA~pt~nslble for obtaining the information, I certify
tlfiti~r penalty of law that I have personally
~~arnined end am familiar with the information
3ul",mitted and relieve the information is true,
aCrJurate, and complete.
i+~fl~4ure ~'-C~ Date
-1- 03/14/2006
UNIFLED PROGRAM INSPECTION CHECKLIST ,
C
SECTION 1 Business Plan and Inventory Program
Bakersfield Fire Dept.
Environmental Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel: (661) 326-3979
FACILITY NAME n INSPECTION DATE INSPECTION TIME
ADDRESS PHONE No. No. of Employees
FACILITYCONTACT Business ID Number
w~G~~.4r~r A~12~t~ 15-021- o oo3S~
Section 1: Business Plan and Inventory Program
Routine D Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection
C V \ V=Vio ationn`~ / OPERATION
^ APPROPRIATE PERMIT ON HAND
COMMENTS
^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
^ . VISIBLE ADDRESS
•
ANY HAZARDOUS WASTE ON SITE?: L4l Y ES ^ NO
ExPLAIN: 6~~~ ®L 1 '~ ~~~ ~~ ~ (L ~t L-~ (2 ~_~-~19~(J
QUESTIONS REGARDING THIS 1NSPECTION~ PLEASE CALL US AT ~ss~ ~ 326-3979
- --- -----~- _Jo f~.~. ----. ~~ n ~_..----- - ~ ~---~ ----... _ ____..._- --
In ctor (Please Print) Fire Prevention 1st-INShik of Site
While - Envirommenfal Services Yellow - Sletion Copy
~a~-~~ti.~e~C~
Business Site Responsible Party (Please Print)
Pink - eusinees Copy
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Manager :
Location: 5333 WHITE LN
City BAKERSFIELD
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MAR
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-
F C & R AUTOMOTIVE
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SiteID: 215-000-000350
9 zoao
BusPhone:
Map : 123
_I Grid: 15D
--
(805) 834-9401
CommHaz : Low
FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 05
EPA Numb:
SIC Code:
DunnBrad:
Emergency Contact
WILLIAM CARROLL
Business Phone:
24-Hour Phone :
Pager Phone :
/ Title
/ OWNER
(805) 834-9401x
( 8 0 5) -L@ ï ~ 1 ð '7 4J.. "vtcJH (
( ) - x
Emergency Contact
RAMON ROSALES
Business Phone:
24-Hour Phone :
Pager Phone _
/ Title
/ OWNER
(805) 834-9401x
(805) 398-9504x
( ) - x
-
-
. Hazmat Hazards:
Fire
DelHlth
Owner
Address
City
C & R AUTOMOTIVE
: 5333 WHITE LN B
: BAKERSFIELD
Phone: ( )
State:- CA
Zip : 93309
Phone: (805) 834-9401x
State: CA
Zip : 93309
-
x
Contact :
MailAddr: 5333 WHITE LN B
City : BAKERSFIELD
Period :
Preparer:
Certif'd:
to
TotalASTs: =
TotalUSTs: =
RSs: No
Gal
Gal
Emergency Directives:
I, uJl~4- ~t>o hereby certify that I have
(Type or print namø)
reviewed the attached hazardous mats rials mat :ag9-
ment plan forC $t. /Jy~1v- and that it atm'g with
(NarnGI of BusÏII$S8)
any corrections consmuts a complets and correct man-
agemeni pl~i1l for my ~ciliiy.
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02/28/2000
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F C & R AUTOMOTIVE
f= Hazmat Inventory
p== Alphabetical Order
e
SiteID: 215-000-000350
By Facility Unit
Fixed Containers on Site
L
L
=¡
=¡
=¡
DailyMax Unit/MCP
55.00 GAL Low
110.00 GAL Low
Hazmat Common Name. . .
specHazEPA HazardS Frm I
WASTE ANTIFREEZE
WASTE OIL
F
F
DH
DH
-2-
02/28/2000
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SiteID: 215-000-000350 ì
Facility Unit: Fixed Containers on Site 1
F C & R AUTOMOTIVE
F Inventory Item 0002
= COMMON NAME / CHEMICAL NAME
WASTE ANTIFREEZE
Days On Site
365
Location within this Facility Unit
SW CORNER
Map:
Grid:
CAS #
107-21-1
STATE - TYPE
Liquid Waste
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
..sS GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
55.00 GAL
Daily Average
30.00 GAL
%Wt. RS CAS #
30.00 Ethylene Glycol No 107211
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
HAZARD ASSESSMENTS
F Inventory Item 0001
F= COMMON NAME / CHEMICAL NAME
WASTE OIL
Facility Unit: Fixed Containers on Site 1
Days On Site
365
Location within this Facility Unit
SW CORNER
Map:
Grid:
CAS #
221
STATE - TYPE
Liquid Waste
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest
C<;~iner
S~ GAL
HAZARDOUS
AMOUNTS AT THIS LOCATION
Daily Maximum
110.00 GAL
Daily Average
20.00
GAL
%Wt. RS CAS #
100.00 Waste Oil, Petroleum Based No 0
COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
HAZARD ASSESSMENTS
-3-
02/28/2000
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Employee Notif./Evacuation
SiteID: 215-000-000350 ì
Fast Format ì
Overall Site ì
02/26/1991 1
02/26/1991 1
02/26/1991
F C & R AUTOMOTIVE
I
p= Notif./Evacuation/Medical
r=: Agency Notification
LCALL 911
~
EMPLOYEES
Public Notif./Evacuation
IN CASE OF EMERGENCY CUSTOMERS ARE MOVED TO PARKING LOT NORTH SIDE OF
Emergency Medical Plan
02/26/1991 ]
NEAREST HOSPITAL
-4-
02/28/2000
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SiteID: 215-000-000350 ì
Fast Format 1
Overall Site ì
02/26/1991
F C & R AUTOMOTIVE
I
p= Mitigation/Prevent/Abatemt
Release Prevention
OIL IN AUTOS USED OIL STORED IN 55 GALLON CONTAINER
Release Containment
02/26/1991
OIL OR ANTIFREEZE DRAINED INTO CATCH PAN TRANSFERRED TO 55 GALLON CONTAINER
Clean Up
02/26/1991
IN CASE OF OIL SPILL OIL IS WIPED OFF FLOOR AND FLOOR MOPPED.
Other Resource Activation
-5-
02/28/2000
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SiteID: 215-000-000350 1
Fast Format ì
Overall Site 1
I
F C & R AUTOMOTIVE
I
p= Site Emergency Factors
[:: Special Hazards
Utility Shut-Offs
02/26/1991
A) GAS - NONE
B) ELECTRICAL - NORTH SIDE - INSIDE BUILDING
C) WATER - NORTH SIDE - OUTSIDE OF OFFICE
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water
02/26/1991
PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM IN SHOP FIRE DEPARTMENT NOTIFIED
IN ACTIVATED. FIRE EXTINGUISHERS.
FIRE HYDRANT - 300 FEET WEST ON WHITE LANE
Building Occupancy Level
-6-
02/28/2000
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F C & R AUTOMOTIVE
I
F Training
r=: Employee Training
L:ELF EMPLOYEED
Held for Future Use
SiteID: 215-000-000350 ì
Fast Format ì
Overall Site ì
02/26/1991 1
I
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I
Page 2
r
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I
Held for Future Use
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-7-
02/28/2000
,-
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CUST"~ & NO. ES - 3S1 l
-
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE3-/~ -~
NEW ACCOUNT 1
ADDRESS CHANGB
CLOSE ACCT I
: FINANCE CHARGE
, OTHER ADJ I
CUSTOMER NAME r ~ d2.- L-\-oMD-\-\ 1/ e...
MAILING ADDRESS CS ~ ~ 3 vJ~~ 1 ~_ ~
CllY ¿s,..l.e.F~~¡ e-tcl STATE r * ZIP CODE Q7:,3Lß.
SITE ADDRESS
PARCEL NUMBER
(IF APPUCABlE)
ADJUSTMENT
ADJUSTMENT AMOUNT
R~;S:b~; ~b ~Ù(G-ha~~ s.lojJ-'Vt"_
APPROVED BY oÇ~ ..
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Business Name: C 111< AU;TlJMðT/i/E
Location: 6" 3>.ß ~ U.J /-J J TE J-AJ ~ :#-í$
Business Identification No. 215-000 tllJiJ to ZJ
Shift '6 Inspector
...
Station No.
Comments:
-
/JD~ ~tyL .
H~m:=~~~~~~~~ ~;;rÜ II-(~·ql_ I
Date Completed jJQJ/. 7 f q I
/3
.
Ade~ Inad~ale
~/ 0
~/ 0
Proper Segregation of Material ~ 0
( ,
fJL.£A.ç~ ~ A-rrtftJl€J) "ßUf.U.Jt-s.-S fJLI1~ (!t-f/fA16e
æ(" 0
'* Verification of Inventory Materials
*" Verification of Quantities
Verification of Location
Verification of MSDS Availablity
Number of Employees
Verification of Abatement Supplies & Procedi:Jre~
Comments:
Verification of Facility Diagram
Special Hazards Associated with this Facility:
Comments: '
Comments:
~
.~/
0/
o
Verification of Haz Mat Training
Emergency Procedures Posted
Containers Properly Labeled
8'/
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g
o
Violations:
All Items O.K. 8"/
Correction Needed 0
FD 1652 (Rev. 1-90)
White-Haz Mat Div. Yellow·Station Copy Pink-Business Copy
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08/09/r:31
/ .2 -II - 90
A)e!fa 6(", J rI'.jp
GeYH~ral Irlfonl1at: iorl t0Cw in ~Òl,)( Q'{é'C¡
1-----'-- -----,----------,----------------------- ----'-'-ì
I -r---'--------------,-.__________________,____________---_. '_'_______________'__'__, I
I I Location: 5333 WHITE LN B _ Map: 123 Hazard: Low I I
II Iderlt Numbet~:__ 2~~:5~000_=~:.~~35~~___________,____-.:._______"__:~~~d :__~5D__~~~~_~f ~~_~~..~__ O. (J I
[--- Ce'j'"ltact Name -]------ Tit Ie ---- - BI_lsj,j'"¡ess Ph'::'y",e -'-T i:::'+ HO:'IJt~ Phorlf2,
WILL! AM CARROLL O.JNER ß()8) ß~ ~ 9; (> , X "''''''''''I (805) B73-1 0741
_~AI't1O~~~:ALES ____ OW~~~R _________ ___.._(80~)~,_~~~~~~~~_ (8(~5)_..~:_8"-':~594 I_
-,----------- Adm i rl i st t~ t i ve Data -------"---------,-,-- 11
Mail Addrs: 5333 WHITE LN B D&B Number: I
City: BAKERSFIELD State: CA Zip: 93309- I
Comm Code: 215-005 BAKERSFIELD SIC Code:
e.?: R AUTOtr1OT I VE 21S--000-:-((e50
Overall Site with 1 Fac. Unit
Page
1
I
II
I r Summat'Y
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1______----------,---,-------
..------------
--------------
----------..----.--
Owner: C & R AUTOMOTIVE
Address: 5333 WHITE LN B
City: BAKERSFIELD
Phone: (805) 834-9401
State: C(..)
Zip: 93309-
I
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~-.mat I nventCl'l'~Y Ll S',t 1 '(', MCP"de)'~
02 - Fixed Containers On Site
PIn-Ref Name/Hazards
F Ct)'~rll
------------..---.-..-....---..-----......---------..-..----...-..--..---.----......-..-
Lc.w
02-001 WASTE OIL
Fi1-~e, Delay Hlth
Quarlt it Y
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Liquicj 110
--------..---
Gf.~L
Pa~~e
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tv1CP
02-00¡;:';:· HnCTE f)t;.IT 'f FREF'Z..E
-F-i I e, Dc: 1 :.'">'Y 1-414: tl
Liquid
...-----..------...----
LOlrJ
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P LGJ4-5£ Ìj{;lE:-æ:;- A-NT7 ~7.£ -
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Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
f'
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RECEIVED
JAN 2 9 J991
HAZ. M.~ T, OlV.
1.
2.
3.
4.
HAZARDOUS MATERIALS MANAGEMENT PLAN L
~
INSTRUCTIONS: +t~ 6
-(øCY
/3 ~ /3 ß
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 ànd concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: C. i' (L 4u1-0 ý}10 +/~
LOCATION: ~ 33:) Jj cJ /'t: +'C.- Lit- N F
MAILING ADDRESS: S/t-¡,M-e A-r A J:)o U"é:-
CITY: ~¿tto f't.e'/¡() STATE: G4 ZIP:' Q]307 PHONE: FJ3 y--c¡ 1/ 0/
DuJ&0BJ~6~R~i:~ NUMBER: j} OµI? SIC CODE:
PRIMARY ACTIVITY: v.t D V1/Lð t-I~
. OWNER:W I LL I A .... C'J. rLto LL - e~oµ 12m 4- L,. '- 'I1-¡;]PflJJk;¡ )
MAIUNGADDRESS:370: rlAL~ r/Ó+J) -lltd:--e~Jh.;/rJ ~ Cj330C¡
. 2. 9' OJ ;J, !-f¡;r¿fruot;¡J - /14 ~e ¡ZJ' ¡:;; Jtq c?4 ~ J jV /
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
1, uJ, L L, ¡~
2, J,A-(\I1 D JJ
TITLE
o R.,(lD L L' ())/ tiE It--
R Q.SA L ez... ÐvJµÇ
BUS. PHONE
83- <f-7'YD /
~~~;stDI
24 HR. PHONE
ßí3 - I07tf
3q8- c¡,s-of
1.
FD150
Cl~?\:: .: ~.·,):'1~
- Bakersfield Fire Dept. ·
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
"
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~'...,. ,..;
'"
VI" ;<"I t' tÀ~.
:'(~¡ ": ,:I n.. v
.vH$E'ëtl'ð~~t~ TRAINING:
NUMBER OF EMPLOYESS;
p)oµ(Ç
¡Jo¡JG'
MATERIAL SAFETY DATA SHEETS ON FilE:
J Jd'J1 he
BRIEF SUMMARY OF TRAINING PROGRAM: ¡v t/'V~
---
wadê)mPj
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:
WE DO NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS. BUT THE QUANTITIES AT NO
TlMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I. CERTIFY THATTHE 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.
J d:- ( qwdJ
SIGNATURE
v ¡J.) 1Jt?!l
TITLE
/_/o~q!
DATE
2.
FOI59'-'
,
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Bakersfield Fire Dep'
Hazardous Materials Division
4_'--;:--~
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name:
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Au,toM,of, ~
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NqTIFICATION PROCEDURES:
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B. EMPLOYEE NOTIFICATION AND EVACUATION:
µo ErvtfJ¡oi~ eJ
C. PUBLIC EVACUATION:
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D. EMERGENCY MEDICAL PLAN:
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· Bakersfield Fire Dept. e
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMEN'f PLAN:
A.
RELEASE PREVENTION STEPS:
Lu e C ill 1T-vV7 ~ 0; L
5-1v/lCø /tJ SS 9AL
fl.} AL-(k, ç
Co ¡J-!A- I ¡.I È: fL
JJEtJ
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B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
(() ~ L ó ¡¿ /.)~f, f;t~CZ-e Û2-ft~¡}-E() ì¡J!ð CA-fch {J,u
<
jtAµ! ¡; 112. ~ O-j-v ~ 9 fJ-L Œv ¡-lIke t-J 1:' rL
C. CLEAN-UP PROCEDURES:
IV CA-J' E éJF ()¡'L sf! L { 0;[ ,Zj uJ¡jJelJ ~
-- çf R6ò/l- IUOI¡JetJ
T U>8,L
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE: . ;.JOIJ~
ELECTRICAL: ~ J ottth _ '5 ¡D-L - /~ ,ð<: h...u L,¡) /.;'7
WATER: ;)ro¡¿+h S ¡IJ-<-- - ouls ID~ r!( oFFt ~
SPECIAL:
LOCK BOX: YES€) IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A, PRIVATE FIRE PROTECTION: J Pil-I J ILl ~A. S~·~ I J
S'hof f;(J£ {le¡J/ ¡UvlïÞwIJ iF 4øvt4 4
B, WATER AVAILABILITY (FIRE HYDRANT):
3oo'f-{ LA)¿Jt {)¡J-tUh/k ¿A,uÇ
4.
FD 1 S9C
CITY of BAKERSFIELD j;
.,
., d ' OHAZARDOUS MATERIALS INVENTORY ~
~rm and Agtlculture .[] Standar BusIness ~
,,' ~ . -í NON-TRADE SECRETS Paqe -Ì of 1_
BÚSINESS NAME: C~ 12 lJ.~oÆ...ø ~,/:.. {. ~WN~~ NAME: NAM~ O~ THIS FACILITY' c4t. Ih.tlojll/Up!-l,(J ..
L9CATIONþ~~~~~ e t.- 90 sr STn OA 0 ÄNO. CLASS cðOr-:-- . -'-------==
C TV iI : p ~~{)7 ~ bY !P: . OU AND B AOSTR~ET NUHB_ R---,Uo'~'-----'--
PHON~ :. - _ R~F~~ TOJ:N5TRUCTIONS FUH PROPER CODES - - - - - - - - -
I 2 3 o~ ~He 8 9 10 11 ,12 1 (
Tr~ns Ty~e Max ~ont ~ont ~ont us~ Loc~tlon he~e Na~es of Mixture{CO~Donents
Co e Co e ' Allt ype ress emp Co e Store In FacI Ity See Inslruc Ions
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tV IJ 'j b J--- 10 tf 1-6-";0 S,U) Co¡¿IU~ì?
Ph~~ic~1 ,nd ~eallh Haiard Component It Nalle & C.A.S. Number
I ec a I l at apply
o Fire Hazard [] Reactivity o Oelared o Sudden Release COMponent'2 Nalle & C.A.S. Number
[] IIImediate
Hea th of Pressure Health
Component'3 Nalle & C.A.S. Number
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Component It Nalle & C.A,S. Number
o Fire Hazard o Reactivity [] De Jared o Suddf" Release [] Component.2 Nalle & C.A,S. Number
IlIlIIediate
Hea th o Pressure Hea Ith -
Component.3 Nalle & C.A.S. NUllber
-
Ph~sical ,nd ~ealth HaJard C,A.S, Number Component.t Nalle & C,A.S. Number
( heck a I t at apply ---
, 0 Reactivity [] DeJa{ed [] SUddf" Re I ease Component.2 Nalle & C.A.S, NUllber
o Fire Hazard [] IlImediate
Hea th o Pressure Hea Ith '
Component'3 Nalle I C,A,S, NUllber
-
-
Phlsic~1 ,~d ~eallh Hafard C,A,S, NUllber Component It Nalle & C,A.S, NUllber
(hec a t at apply - -
o Reactivity [] De Jared [] suddfn Release [] Component'2 Nalle & C.A.S. Number
o Fire Hazard Immediate
Hea th o Pressure Health _.
Component.3 Nalle & C.A,S. NUllber
Le~ () ¡J..)¡JelL- ~p{;~ #2 W ¡LLt~ g37-lo7 ,-
EMERGENCY CONTACTS 111 4-lMðt[ TRWµ~7¿
If! ntle me - z¡ -lIfTM¡;e----
rertifil3tio~ çReCfl and ~jrn af1~r C9mf7ftjl19, ÇJl1. fcf¡c~jons) , , ,
certl un er enal 0 a th t I av persona exam!n 0 n famllla( It he nfo(matl n $U øltte~ In hIs ond all
,tt.tbed'doci.enf" .nl t It ~,'e! 0' ., "¡'ir, ¡ tbose 1,!,.,j,.I, ,e,po,slbl. or obt,""g tg. ',IL;::)' 0'. I belle.e tb.t tbe
sub~ltted In or O~IS true, accµrate, an comp ete ~ ~ /-/O~71
W ILL! ~ Juw..d '.;1L:- ~
me ~rð'or wner hor I zed reoresenta ST9ñã1üfë Vm~fqr.ë~--
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Bakersfield Fire Dept.
HAZARDOUS MATERIALS DIVISIOr
/
C i R AU7l)MO-rtV¡:-
5 33"3 I;J If rrt LI't¡V~ #- d
Business Name:
Location:
Date Completed / J.. - / / - 'î6
Station No.
/}
Shift ~
,
(Top of Business Plan) /110 ¡:; LAN 0 AJ ¡:¡ l£
Inspector ~¡;>~ / ÆIiI'P / €¡AlS7E"/¡J
Business Identification No. 215-000
- - - -
Verification of Inventory Materials
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments:
- -Adequate Inadequate
0 0
0 0
0 0
0 0
D
D
Verification of MSDS Availablity
Number of Employees
Verification of Haz Mat Training
Comments:
D
o
D
D
Verification of Abatement Supplies & Procedures
Comments:
Emergency Procedures Posted
Containers Properly Labeled
Comments:
o
o
D
o
o
Verification of Facility Diagram
Special Hazards Associated with this Facility:
D
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ø1:) S-.s-6/fL I#~J~ (J)lJL.I,~ /J~
All Items O.K , LJ
Correction Needed D
Business Owner/Manager
FD 1652 (Rev. 1-90)
White·Haz Mat Div. Yellow·Station Copy Pink-Business Copy
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C & R AUTOMOTIVE
Auto Repair & Smog
Open Weekends
Id'?>- 150
S-S~
Ph, 834-9401
5333 White Ln,
Bakersfield, CA
Bill Carroll
Ramon Rosalez
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