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AMPAD REORDER
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Operate
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W aste Unified Permit
Materials/Hazardous
Hazardous
CONDITIONS OF PERMIT ON REVERSE SIDE
IiZI Hazardous Materials Plan
o Underground Storage of Hazardous Materials
o Risk Management Program
o Hazardous Waste On-Site Treatment
Approved by:
Issue Date
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 ID #:: 015-000-000901
S W SPAS, HOME
LOCATION: 6261 WHITE LN
Issued by:
Operil.te
Per
\:
"
Waste Unified Permit
Hazardous
CONDITIONS OF PERMIT ON REVERSE SIDE
This rrnit is issued for the followln
zardous Materials Plan
round Storage of Hazardous Materials
c . agement Program
Waste
PERMIT ill # 015-021-000901
S W SPAS, HOME & LEJ
6261
LOCATION
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Materials/Hazardous
Approved by:
Bakersfield Fire Department
OffiCE OF ENVIRONMENTAL SER VICES
1715 Chester Ave., 3rd Floor
Bakersfield. CA 93301
Voice (805) 326-3979
FAX (805) 326-0576
Expiration Date:
Issued by:
Per...it to Operate
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
r the followin
PERMIT ID# 015-021 ~00901
S W SPAS & POOL SUPPL Y
LOCATION 6261 WHITE
<
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Issued by:
Bakersfield Fire Department Approved by: _
OFFICE OF ENVIRONMENTAL SER VICES
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (805) 326-3979 Expiration Date:
FAX (805)326-0576
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Manager :
Location:
City
S W SPAS & POOL SUPPLY
1
5, W _ Ç'1/{:. S .> H DY\....<.- ~
6261 WHITE LN
BAKERSFIELD
SiteID: 215-000-000901
Phone: (805) 833-6399
CommHaz : Low
FacUnits: 1 AOV:
CommCode: BAKERSFIELD
EPA Numb:
$ C Code:5251
DunnBrad:01-960-2432
Emergency Contact
F SHAKIR
Business Phone:
24-Hour Phone
Pager Phone
/ Title
/ OWNER
(805) 833 -6399x
(805) 397-8732x
() x
Emergency Contact
Title
Business Phone:
24-Hour Phone
Pager Phone
/
/
)
)
)
x
x
x
Hazmat Hazards:
Press React ImmHlth DelHlth
Contact : Phone: (
MailAddr: 6261 WHITE LN State: CA
City BAKERSFIELD Zip 93309
Owner F. SHAKIR Phone: (833) 952-5
Address 4105 PINEWOOD LAKE DR State: CA
City BAKERSFIELD Zip 93309
Period to TotalASTs: =
Preparer: TotalUSTs: =
Certif'd: RSs: No
Emergency Directives:
x
x
Gal
Gal
I,
F S H A K 7 VL-Do ~~rfl~Y ~n~j~ îh~ ~ Û'lS'f(9
:Tvpe or print 0SIr0)
reviewed ths S1iW.c~OO hæar~ous mat&ría!$ mS1n~~®-
S. ~- Ç;fA-S ~ f'ðl/J..¿
manî plan 1öü' þ-Io7"Yl.vf Ú,';S~nd th::\t i~ SlIOJ~@ with
(Nt/JMO of Busi"ôll.'"
any cOIlü"SC1¡~ü1$ oo~~i~u1s a ~vmp~ste and CCi'i'®d Mâ}!Fù-
ag~men~ ¡\)~ú1 ~oü' mlf ~cility.
Signature
//(f6Áf
Date
-1-
11/15/1999
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F S W SPAS & POOL SUPPLY
p= Hazmat Inventory
p== MCP+DailyMax Order
SiteID: 215-000-000901 ì
By Facility Unit ì
Fixed Containers on Site ì
specHaz EPA HazardS Frm DailyMax Unit MCP
E R DH L 80.00 GAL Hi
P R IH L 55.00 GAL Hi
R DH S 1000.00 LBS Mod
Hazmat Common Name...
MURATIC ACID
SWIMMING POOL BLEACH
TRICHLORO-S-TRIAZINETROINE
-2-
11/15/1999
,
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F S W SPAS & POOL SUPPLY
p= Inventory Item 0002
= COMMON NAME / CHEMICAL NAME
MURATIC ACID
SiteID: 215-000-000901 ì
Facility Unit: Fixed Containers on Site ì
Days On Site
365
Location within this Facility Unit
SOUTH END WEST
Map:
Grid:
CAS #
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
#- GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
80.00 GAL
Daily Average
40.00 GAL
%Wt. RS CAS #
31. 00 Muriatic Acid Yes 7647010
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R DH / / / Hi
HAZARD ASSESSMENTS
p= Inventory Item 0007
= COMMON NAME / CHEMICAL NAME
SWIMMING POOL BLEACH
Facility Unit: Fixed Containers on Site ì
Days On Site
365
Location within this Facility Unit
SE SIDE OF STORE
Map:
Grid:
CAS #
7681-52-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
..; .:~ 1. GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
55.00 GAL
Daily Average
50.00 GAL
%Wt. RS CAS #
12.50 Sodium Hypochlorite No 7681529
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies P R IH / / / Hi
HAZARD ASSESSMENTS
-3-
11/15/1999
.
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F S W SPAS & POOL SUPPLY
f= Inventory Item 0008
= COMMON NAME / CHEMICAL NAME
TRICHLORO-S-TRIAZINETROINE
SiteID: 215-000-000901 l
?acility Unit: Fixed Containers on Site l
Days On Site
365
Location within this Facility Unit
DISPLAY AREA BACK OF STORE
Map:
Grid:
. CAS#
STATE - TYPE
Solid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Largest Container
. ';' >;'_ 1.L:) LBS
AMOUNTS AT THIS LOCATION
Daily Maximum
1000.00 LBS
Daily Average
500.00 LBS
%Wt. RS CAS #
99.00 Trichloro-s-triazinetrione No 87901
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R DH / / / Mod
HAZARD ASSESSMENTS
-4-
11/15/1999
..
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Employee Notif./Evacuation
SiteID: 215-000-000901 ì
Fast Format ì
Overall Site ì
06/18/1990 ]
06/18/1990
F S W SPAS & POOL SUPPLY
I
p= Notif./Evacuation/Medical
r=: Agency Notification
CALL 911
VOICE COMMUNICATION AND CALL 911.
Public Notif./Evacuation
06/18/1990 1
06/18/1990 ]
VOICE COMMUNICATIONS
Emergency Medical Plan
NEAREST HOSPITAL
-5-
11/15/1999
..
e
e
SiteID: 215-000-000901 1
Fast Format 1
Overall Site 1
03/11/1993
F S W SPAS & POOL SUPPLY
I
f= Mitigation/Prevent/Abatemt
Release Prevention
STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF ACCIDENTLY IN
APPROVED CANS.
Release Containment 03/11/1993
PRODUCT IS IN SMALL CONTAINER FOR RETAIL SALE
Clean Up
03/11/19931
I
SODA ASH
Other Resource Activation
-6-
11/15/1999
¡
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SiteID: 215-000-000901 1
Fast Format 1
Overall Site 1
I
F S W SPAS & POOL SUPPLY
I
p= Site Emergency Factors
~ Special Hazards
Utility Shut-Offs
04/04/1990
A) GAS - BEHIND THE BUILDING (OUTSIDE)
B) ELECTRICAL - EAST END OF BUILDING THROUGH THE GATE OF STORE HOUSE
(OUTSIDE)
C) WATER - EAST END OF BUILDING
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water
04/04/1990
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS
FIRE HYDRANT - AT THE EAST END INSIDE THE STORE.
Building Occupancy Level
-7-
11/15/1999
"': ,¡. ,..¡
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F S W SPAS & POOL SUPPLY
I
F Training
Employee Training
SiteID: 215-000-000901 ì
Fast Format ì
Overall Site ì
06/18/1990
WE HAVE 3 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE HAVE EXPLAINED MATERIAL SAFETY DATA SHEETS TO
EMPLOYEES. THEY HAVE BEEN TOLD ABOUT HAZARDS OF MIXING ACID AND CHLORINE
TOGETHER. THEY HABE BEEN TOLD TO EVACUATE IN CASE OF SPILLAGE OF ACIDE OR
CHLORINE.
Page 2
I
I
I
",
Held for Future Use
Held for Future Use
-8-
11/15/1999
..
j
--
e,
/'
S W SPAS & POOL SUPPLY
RE\Jt:.\ ~'fû
i.U\V' 4 W9óBusPhone:
.~ . Map : 123
MAT. D\'{P.rid: 15C
HAZ.
SIC Code:5251
DunnBrad:01-960-2432
SiteID: 215-000-000901
Operator:
Location: 6261 WHITE LN
City BAKERSFIELD
(805) 833-6399
Ovr1Haz : Low
FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 09
EPA Numb:
Emergency Contact / Title Emergency Contact / Title
F SHAKIR / OWNER /
Business Phone: (805) 833-6399x Business Phone: ( ) - x
24-Hour PHone · (805) 397-8732x 24-Hour PHone · ( ) - x
· ·
Pager Phone · ( ) - x Pager Phone · ( ) - x
· ·
Hazmat Hazards: Press React ImmHlth DelHlth
Contact · Phone: ( ) - x
·
MailAddr: 6261 WHITE LN State: CA
City · BAKERSFIELD Zip · 93309
· ·
Owner · F. SHAKIR Phone: (833) 952-5 x
·
Address · 4105 PINEWOOD LAKE DR State: CA
·
City · BAKERSFIELD Zip · 93309
· ·
Period · to TotalASTs: = Gal
·
Preparer: TotalUSTs: = Gal
Certif'd: EHSs: No
First Response Directives:
f= Hazmat Inventory One Unified List 9
f== MCP+DailyMax Order All Materials at Site 9
Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP
MURATIC ACID R DH L 80 GAL Hi
SWIMMING POOL BLEACH P R IH L 55 GAL Hi
TRICHLORO-S-TRIAZINETROINE R DH S 1000 LBS Mod
I, ~,SHtYJ<lrê
(fype or print name)
Do hereby certify that I have
reviewed the attached hazardous materials manage-
ment plan for S(~ $r,f5~1k~and that it along with
lïïiaroo at Business)
any corrections constitute a complete and correct man-
agement plan for my facility.
\r,
. IlhJ.¡l1C7 -1-
-.
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F S W SPAS & POOL SUPPLY
I F Inventory Item 0002
F== COMMON NAME / CHEMICAL NAME
MURATIC ACID
SiteID: 215-000-000901 9
Facility Unit: Fixed Containers on Site;
Days On Site =
365
CASt
Location within this Facility Unit
SOUTH END WEST
STATE - TYPE
Liquid Mixture
PRESSURE ---- TEMPERATURE
Ambient Ambient
CONTAINER TYPE
PLASTIC CONTAINER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL
80.00 40.00
Dai1yMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL
HAZARDOUS COMPONENTS
%Wt. EHS CASt
31. 00 Muriatic Acid No 7647010
D SE
TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOTt MCP
No No No No/ Curies R DH / / / Hi
UFC Article 80 Control Zone: USDOT Hazards
In Cabinet? Sprinklered Area?
HAZAR AS SSMENTS
Ag.Defined1:
MISC. LOCAL AGENCY DATA
Ag.Defined2: Ag.Defined3: Ag.Defined4:
Ag.Defined6: Ag.Defined7:
Ag.Defined9: Ag.define10:
Ag.Defined5:
Ag.Defined8:
- Ag.Define11
-2-
e
e
F S W SPAS & POOL SUPPLY
f= Inventory Item 0007
F= COMMON NAME / CHEMICAL NAME
SWIMMING POOL BLEACH
SiteID: 215-000-000901 9
Facility Unit: Fixed Containers on Site;
Days On Site =
365
CASt
7681-52-9
Location within this Facility Unit
SE SIDE OF STORE
STATE - TYPE
Liquid Mixture
PRESSURE ---- TEMPERATURE
Ambient Ambient
CONTAINER TYPE
PLASTIC CONTAINER
Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL
55.00 50.00
DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL
AMOUNTS STORED AND IN USE
%Wt. EHS CASt
12.50 Sodium Hypochlorite No 7681529
HAZARDOUS COMPONENTS
TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOTt MCP
No No No No/ Curies P R IH / / / Hi
UFC Article 80 Control Zone: USDOT Hazards
In Cabinet? Sprinklered Area?
HAZARD ASSESSMENTS
Ag.Defined1:
MISC. LOCAL AGENCY DATA
Ag.Defined2: Ag.Defined3: Ag.Defined4:
Ag.Defined6: Ag.Defined7:
Ag.Defined9: Ag.define10:
Ag.Defined5:
Ag.Defined8:
- Ag.Define11
-3-
e
e
SiteID: 215-000-000901 9
Facility Unit: Fixed Containers on Site 9
Days On Site =
365
CASt
F S W SPAS & POOL SUPPLY
I F Inventory Item 0008
= COMMON NAME / CHEMICAL NAME
TRICHLORO-S-TRIAZINETROINE
Location within this Facility Unit
DISPLAY AREA BACK OF STORE
STATE - TYPE
Solid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
PLASTIC CONTAINER
AM UNTS S ORED IN
Lrgst Cont.this Loc LBS DailyMax this Loc LBS DailyAvg this Loc LBS
1000.00 500.00
DailyMax Stored LBS DailyMax Open Use LBS DailyMax Closed Use LBS
o
T
AND
USE
%Wt. EHS CASt
99.00 Trichloro-s-triazinetrione No 87901
HAZARDOUS COMPONENTS
I
I
i.
HAZARD ASSESSMENTS
TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies R DH / / / Mod
UFC Article 80 Control Zone: USDOT Hazards
In Cabinet? Sprinklered Area?
Ag.Definedl:
Ag.Defined5:
MISC. LOCAL AGENCY DATA
Ag.Defined2: Ag.Defined3: Ag.Defined4:
Ag.Defined6: Ag.Defined7:
Ag.Defined9: Ag.define10:
Ag.Defined8:
- Ag.Define11
-4-
e
e
I F S W SPAS & POOL SUPPLY
,
f= Notif./Evacuation/Medical
r=: Agency Notification
CALL 911
r=:: Employee Notif./Evacuation
~ICE COMMUNICATION AND CALL
I Public Notif./Evacuation
. VOICE COMMUNICATIONS
I Emergency Medical Plan
NEAREST HOSPITAL
SiteID:
215-000-000901 9
Fast Format ;
Overall Site 9
06/18/1990 1
06/18/1990
06/18/1990 ]
]
911.
06/18/1990 1
-5-
e
e
F S W SPAS & POOL SUPPLY
I
f= Mitigation/Prevent/Abatemt
Release Prevention
SiteID: 215-000-000901 .,
Fast Format .,
Overall Site .,
03/11/1993
STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF ACCIDENTLY IN
APPROVED CANS.
Release Containment 03/11/1993
PRODUCT IS IN SMALL CONTAINER FOR RETAIL SALE
Clean Up
03/11119931
SODA ASH
Other Resource Activation
-6-
e
e
F S W SPAS & POOL SUPPLY
I
f= Site Emergency Factors
Special Hazards
SiteID: 215-000-000901 9
Fast Format 9
Overall Site 9
Utility Shut-Offs
04/04/1990
A) GAS - BEHIND THE BUILDING (OUTSIDE)
B) ELECTRICAL - EAST END OF BUILDING THROUGH THE GATE OF STORE HOUSE
(OUTSIDE)
C) WATER - EAST END OF BUILDING
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water
04/04/1990
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS
FIRE HYDRANT - AT THE EAST END INSIDE THE STORE.
-7-
1..- f' , .
e
e
SiteID: 215-000-000901 9
Fast Format 9
Overall Site 9
F S W SPAS & POOL SUPPLY
,
f= Site Emergency Factors
Building Occupancy Level
-8-
¿< .' ~. ..
e
e
F S W SPAS & POOL SUPPLY
I
F Training
Employee Training
SiteID: 215-000-000901 9
Fast Format 9
Overall Site 9
06/18/1990
WE HAVE 3 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE HAVE EXPLAINED MATERIAL SAFETY DATA SHEETS TO
EMPLOYEES. THEY HAVE BEEN TOLD ABOUT HAZARDS OF MIXING ACID AND CHLORINE
TOGETHER. THEY HABE BEEN TOLD TO EVACUATE IN CASE OF SPILLAGE OF ACIDE OR
CHLORINE.
Page 2
-9-
.. --~- 'i
~
08/20/96
It
e
I;age
1
S W SPAS & POOL SUPPLY 215-000-000901
Overall Site with 1 Fac. Unit
General Information
Location: 6261 WHITE LN Map: 123 Haz:2 Type: 3
City . BAKERSFIELD Grid: 15C F/U: 1 AOV: 0.0
.
- Contact Name Title --- Contact Name Title
F SHAKIR / OWNER /
Business Phone: (805) 833-6399x Business Phone: ( ) - x
24-Hour Phone · (805) 397-8732x 24-Hour Phone . ( ) - x
· .
Pager Phone · ( ) - x Pager Phone : ( ) - x
·
Administrative Data
Mail Addrs: 6261 WHITE LN D&B Number: 01-960-2432
City: BAKERSFIELD State: CA Zip: 93309-
Comm Code: 215-009 BAKERSFIELD STATION 09 SIC Code: 5251
Owner: F. SHAKIR Phone: (833) 952-5
Address: 3500 AKERS State: CA
City: BAKERSFIELD Zip: 93309-
Summary \1...;1)
.
SfP 1 9 1996
HAZ. MAT. DIV.
P - 5 ~ A K t K--> Do hereby certify that I have
I.
(Type or print name)
reviewed the attached hazardous materials manage·
ment plan for S. w - S P .flj and that it along with
(Name 01 Busineaa)
any corrections constitute a complete and correct man-
agement plan for my facility.
~ ÞJ!!L
rir r 11-6
Date
..
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e
08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
Hazmat Inventory List in MCP Order
Page
2
02 - Fixed Containers on Site
PIn-Ref Name/Hazards Form Max Qty MCP
02-002 MURATIC ACID Liquid 80 High
· Reactive, Delay Hlth GAL
02-007 SWIMMING POOL BLEACH Liquid 55 High
· Pressure, Reactive, Immed Hlth GAL
02-008 TRICHLORO-S-TRIAZINETROINE Solid 1000 Moderate
· Reactive, Delay Hlth LBS
e
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08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
02 - Fixed Containers on Site
Page
3
Hazmat Inventory Detail in MCP Order
02-002 MURATIC ACID
~ Reactive, Delay Hlth
Liquid
80 High
GAL
CAS :It:
Trade Secret: No
Form: Liquid
Type: Mixture Days: 365 Use: WATER TREATMENT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
80 I 40.00 I 200.00
Storage
PLASTIC CONTAINER
r Press T Temp ~ Location
Ambient Ambient SOUTH END WEST
- Conc l
31.0% Muriatic Acid
Components
~ MCP ---p;uide
High I 15
02-007 SWIMMING POOL BLEACH
~ Pressure, Reactive, Immed Hlth
Liquid
55 High
GAL
CAS :It: 7681-52-9
Trade Secret: No
Form: Liquid
Type: Mixture Days: 365 Use: WATER TREATMENT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
55 I 50.00 I 500.00
Storage
PLASTIC CONTAINER
r Press T Temp ~ Location
Ambient AmbientlSE SIDE OF STORE
- Conc l
12.5% Sodium Hypochlorite
Components
~ MCP ---p;uide
High I 45
02-008 TRICHLORO-S-TRIAZINETROINE
~ Reactive, Delay Hlth
Solid
1000 Moderate
LBS
CAS :It:
Trade Secret: No
Form: Solid
Type: Mixture Days: 365 Use: WATER TREATMENT
Daily Max LBS ----r-- Daily Average LBS --r-- Annual Amount LBS --
1,000 I 500.00 I 2,000.00
Storage
PLASTIC CONTAINER
r Press T Temp ~ Location
Ambient AmbientlDISPLAY AREA BACK OF STORE
- Conc ~ Components
99.0% Trichloro-s-triazinetrione
r; MCP ~Guide
Moderate \ 45
e
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08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
4
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
VOICE COMMUNICATION AND CALL 911.
<3> Public Notif./Evacuation
VOICE COMMUNICATIONS
<4> Emergency Medical Plan
NEAREST HOSPITAL
e
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08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
5
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF ACCIDENTLY IN
APPROVED CANS.
<2> Release Containment
PRODUCT IS IN SMALL CONTAINER FOR RETAIL SALE
<3> Clean Up
SODA ASH
<4> Other Resource Activation
,'" ,.:. ..
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e
08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
6
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - BEHIND THE BUILDING (OUTSIDE)
B) ELECTRICAL - EAST END OF BUILDING THROUGH THE GATE OF STORE HOUSE
(OUTSIDE)
C) WATER - EAST END OF BUILDING
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS
FIRE HYDRANT - AT THE EAST END INSIDE THE STORE.
<4> Building Occupancy Level
r ~. .
e
e
08/20/96
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
7
<G> Training
<1> Employee Training
WE HAVE 3 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE HAVE EXPLAINED MATERIAL SAFETY DATA SHEETS TO
EMPLOYEES. THEY HAVE BEEN TOLD ABOUT HAZARDS OF MIXING ACID AND CHLORINE
TOGETHER. THEY HABE BEEN TOLD TO EVACUATE IN CASE OF SPILLAGE OF ACIDE OR
CHLORINE.
: <2> Page 2
I
<3> Held for Future Use
I <4> Held for Future Use
,...
S .'AS & POOL SUPPLY 215-00.)00'301
Ove1"~all Si te with 1 Fac. U~ RECE\VED
Ge'(le1"~ë.il I'(!fo1"~mat ic<'(' a \992-
----------t}€C.J)...L
~a;;_;_23 IlIIA"a~MT~\Y· - ~ I
G1"~ i d: 15C F / U : 1 ~OV: (>. 0
Title ---.-¡- Busi¡r,ess Phc<'(¡e ---·T 24-Hc,u1"~ Phc,)",el
I (805) 833-'3525 x (805) 397-8732
_____.1 ( __~___._.__J~_~___~=_._.I
Page
1
03/13/'38-
'-
----------
Locatiecn: 6261 WHITE LN
Community: BAKERSFIELD STATION 0'3
-------
[ CCI)"¡t act Name --.-----
R. SHAI·q R !
__ J,_
Administrative Data
D&B Num~e',....: --~) 1-.I36~)'-2432 I
State: CA Zip: '3330'3-
SIC Cc.de: 5251
Mail Addrs: 6261 WHITE LN
City: BAKERSFIELD
Cecmm Code: 215-00'3 BAKERSFIELD STATION 0'3
--------
--..------------
O\o'me1"~ : F. SHAK I R
Address: 3500 AKERS
City: BAKERSFIELD
Phone: (833) '352-5
State: CA
Zip: 9330'3-
--
,~ .--
~~ (l~~ _~ðtCi
~. !fl/', ~,
---..---..----....-........--
Summa1"~y
----....--.--..-----..-...-.-
~-~~~~
--_.
......-................__.._-....-
//
,qq\
-----
------.-..--..----..--
fJ'/' ð·
~¡f .ro~f)
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,/
03/13/92
S W SPAS & POOL SUPPLY
Hazmat Inventory List
215-000-000901
i Y-I tr1CP Oi"'det~
Page
;::~
02 - Fixed Containers on Site
PIn-Ref Name/Hazards
Fo.,.~m
QuaY-It i ty
tr1CP
02-001
·LL PURE
Reactive, Delay Hlth
Liquid
80 High
GAL
------..
----..-........
HYDROCHLORIC ACID
Fire, Reactive, Immed Hlth, Delay Hlth
Liquid
55 High
GAL
..--------....---------
..-..---....----..--......-
MURATIC ACID
Reactive, Delay Hlth
Liquid
80 High
GAL
......--..-----..-..-......--......
.. --..........-------..-...-
SPRAy'AINT
F i t~~_~
SWIMMING POOL BLEACH
Pressure, Reactive, Immed Hlth
Liquid
70 High
GAL
..----------------
Liquid
55 High
GAL
--------.-..-..
----------..-..--......----
02"-004
THINN~
Fi re, Ì'M.rlled HI th
Liquid
60 High
GAL
--..--....--.----..-....---....--
0;:::-003
PAINT
Fit~e, ~ed Hlth
Liquid
55 Miì'"iÌmal
GAL
---
--........--.....------...------...--..------...-..------..-
~.
it
-
03/13/93
S .'AS &. POOL SUPP~Y 215-00~00901
02 - Flxed Contalners on S~
P¿:'Ige
,~
..:'J
HazMat Inventory Detail in MCP Order
02-001 ALL PURE
Reactive, Delay Hlth
Liquid
80 High
GAL
.----..-
CAS #:
T...~ade Sec...~et: No
F o...~m: L i q 1.1 i d
Type: Mixture Days: 365 Use: WATER TREATMENT
Dai ly Max GAL --r- Dai ly Ave...~age GAL --¡-- A....J'i"Iual AMolmt GAL -
80 I 40.00 500.00
St CI"r~age
PLASTIC CONTAINER
--r Press T TeMp ~
¡AMbient Ambient I SOUTH END
Locat iO....1
- C.:I....'C --r;--"
12.5% ,SodiuM Hypochlorite
Compo.... e....d.:s --.---'-r;-: ¡VICP -l-List
IHigh
.-.--..-..-----.
02-006 HYDROCHLORIC ACID
Fire, Reactive, IMmed Hlth, Delay Hlth
Liquid
55 High
GAL
------
CAS #: 7647-01-0
T...~ade Sec...~et: No
Fe'...~m: Liquid
Type: Mixture Days: 365 Use: WELDING SOLDERING
---- Dai ly Max GAL -¡-' Dai ly Ave...~ag;_ G~~ -,- A....mual Amou....';¡_ ~A~.-
55 I ~Q.QU ~Ju.uu
----,- Sto...~age
PLASTIC CONTAINER
r P...-'ess 1" Temp -'1- Locatio....,
AMbient AMbient LEFT SIDE OF STORE BEHIND PART IT
- Conc -~
31.5% ¡Hydrochloric Acid
Campo.... e....'t s
I~ J'l1CP ---rL i s t
High I
-....--------
02-002 MURATIC ACID
Reactive, Delay Hlth
Liquid
80 High
GI:¡L
--...
CAS #:
T...~ade Sec...~et: Ne,
FO"'~M: Liquid
Type: Mixture Days: 365 Use: WATER TREATMENT
--- Dai ly Max GAL --·-r-'- Dai ly Ave...~age GAL -T Annual Amolmt GAL -
80 40.00 200.00
Sto...~age
PLASTIC CONTAINER
T P...~ess T Temp ':-r;:-----.---- Lacat ic,....1
Ambient AMbient SOUTH END WEST
Co....'c
31.0% rMuriat~c Acid
-- Cc1mpo....'e....lt s
..-' MCP --¡List
High I
ii.;r
03/13/92
S W SPAS & POOL SUPPLY 215-000-000901
02 - Fixed Containers on Site
Page
4
Hazmat Inventory Detail in MCP Order
----..---......-..------
02-005 SPRAY PAINT
Fi ...~e
Liquid
70 High
GAL
--..----..-----.------....--..-..-----..---..-....-....-..----------
CAS #: 68476-86-8
T...~ade Sec...~et: N,:.
F cl...~m: L i qui d
Type: Mixture Days: 365 Use: AEROSOL/INFLATION
-- Dai ly Max GAL -,- Dai ly Ave...~age GAL ---··-1--- AY"IY",ual ATllOl.mt GAL --
70 I 70.00 70.00
I~ETAL C~~~~~~~-~~~~·~)~~~~:~t TA:~~r~l~Y",~r~~~~- WALL IN ~~~~~~ iOY"1 --..-------,-
,- CoY",c --r -------- CompoY',eY'lt s ----.-------~ tr1CP --'~-L i s t
32.0% Propane-ButaneCPropylene) High
42.0% Acetone Moderate
8.0% Toluene Moderate
------.
----..----
02-007 SWIMMING POOL BLEACH
Pressure, Reactive, Immed Hlth
Liquid
55 High
GAL
-------..-..-------------
-..-....--..........-.-.....--
CAS #: 7681-52-'']
Trade Secret: No
F cl...~m: L i q 1.1 i d
Type: Mixture Days: 365 Use: WATER TREATMENT
-..- Dai ly tr1ax GAL -¡- Dai ly Ave...~age GAL T- A'(' nual Amol.nr,t GAL --
55 I 50.00 . 500.00
----- St o...~age
PLASTIC CONTAINER
'T A~~~~:~t T A~~~r~l~Y' ~T~~--~;~-··;;;--~T~~~at i 01'" -,-,-.......
- CCI'(',C ---r:------
12.5% ¡Sodium Hypochlorite
CCtrIl pCI'(' eY'lt ~~ --------------'-~ i :~p list
-
e
03/13/'32
s ¡..e:IAS &, POOL SUPP~ Y 215-(H)~0090 1
02 - Flxed Contalners on S~
Page
I::
.J
Hazrnat I~ve~tory Detail i~ MCP Order
02-004 THINNER
F i 1"~e, Irl1flled Hit h
Liquid
60 High
GAL
------------------
CAS #: 75-09-2
T1"~ade Sec1"~et: No
Fc,rrn: Liquid
Type: Mixture Days: 365 Use: CLEANING
- Dai ly Max Gt=\L -'r-' Dai ly Average GAL 1-- A~'(lual Amolmt GAL --
60 60.00 60.00
I
1~~~AL.-C~~~~~~~-NO~~~UM-rA~~~:~tTA~~7~~~-;AC;-~AL-C~ ~~~~~iO~
--..------
CCr'(IC
85.01.
CornpO'(lel"lt s --
MCP -Jist
High
High
le'de"ate
3Jr5%
D i ch 1 ol'~ornet ha'(le
Metha~c,l
T CI luene
¡.. Oi'~
-..----
______ø
02-003 PAINT
Fire, Irnrned Hlth
Liquid
55 Minimal
GAL
CAS #: 6:~-67-7
TI'~acJe Sec1"~et: No
F01"~m: Liquid
Type: Mixture Days: 365 Use: PAINTING
-- Dai ly MaH GAL -r Dai ly Ave1"~age GAL ---y-- Armual Ar(\olmt GAL -
55 50.00 I 55.00
I
'--- StcII"'age r P1"~ess T Temp :-r:--.---- LClcat iCI'(1
METAL CONTAINR-NONDRUM Ambient Ambient/BACK WALL IN STORE
---
CO'(IC -',- ----,-
10.41. ITita~ium DioHide
13.11. ¡CalCium Carbonate
CClrnpO'(lent s
~ MCP :fist
¡VI i '(Ii ffla I
tr11 rli fI1ëll
-- NCltes
-------
03/13/92
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
(D) Notif./Evacuation/Medical
..--.--.-------..-
(1) Agency Notification
CALL 911
(2) Employee Notif./Evacuation
-------
--..--
VOICE COMMUNICATION AND CALL 911.
(3) Public Notif./Evacuation
VOICE COMMUNICATIONS
(4) Emergency Medical Plan
-----..
NEAREST HOSPITAL
e
-e
Page
6
...-------.---..-....----
03/13/r:38
S ¡...4Þ='AS 8, POOL SUPPLY 215-00_00901
00 - Overall Site
Page
l
(E) Mitigation/Prevent/Abatemt
..-..------------..--..
(1) Release Prevention
---------.--
STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF ACCIDENTLY IN
APPROVED CANS.
(2) Release Containment
--..-----------
<3} Clear, Up
-------
<4} Other Resource Activation
---
.~
\"
03/13/'32
_J
S W SPAS & POOL SUPPLY 215-000-000'301
00 - Overall Site
Page
8
(F) Site Emergency Factors
..---- -......-........---
(1) Special Hazards
(2) Utility Shut-Offs
A) GAS - BEHIND THE BUILDING (OUTSIDE)
B) ELECTRICAL - EAST END OF BUILDING THROUGH THE GATE OF STORE HOUSE
<OUTS I DE )
C) WATER - EAST END OF BUILDING
D) SPECIAL - NONE
E) LOCK BOX - NO
(3) Fire Protec./Avail. Water
----..
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS
FIRE HYDRANT - AT THE EAST END INSIDE THE STORE.
(4) Building Occupancy Level
......-----
..
e
e
03/13/93
S .'AS & POOL SUPPLY 215-00_¡0090 1
00 - Overall Site
Page
9 .
<8> T1"~a i ....Ii ....Ig
-...-..------.----....-....-....---..
< 1> Page 1
----
WE HAVE 3 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE HAVE EXPLAINED MATERIAL SAFETY DATA SHEETS TO
EMPLOYEES. THEY HAVE BEEN TOLD ABOUT HAZARDS OF MIXING ACID AND CHLORINE
TOGETHER. THEY HABE BEEN TOLD TO EVACUATE IN CASE OF SPILLAGE OF ACIDE OR
CHLORINE.
(2) Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
----
......--
03/13/'32
S W SPAS & POOL SUPPLY 215-000-000'301
00 - Overall Site
( Tn lrlspect ic<rls
----
:')age 1 (I
..------.--
0'3/02/88 FOLLOW UP
--..-.---
-..--------.
08/30/8'3 OK
HNSON
11/27 /'30 O~,
10/13/88 FOLLOWUP OK
e
.
ANSON
...
------.
.._00__-
03J13J93!
S .'AS & POOL SUPPLY 215-001~0090 1
00 - Overall Site
Page 11
(M) Everlts "tr1" OveY"all List
..-..--..-----
-----
09/02/88 FOLLOW UP
FOLLOI.-J UP
-----
10/13/88 FOLLOWUP OK
------....-----..-..
ANSON
08/30/89 m<
MSDS SHEETS BEING ORDERED ON MURATIC ACID AND POOL CHLORINE - PAINTS BEING
PH(..)SED OUT.
ANSON
11/27/90 OK
PAINTS, THINNER, SPRAY PAINTS REMOVED FROM STORE
-...----..
i' .~
. . ~~iG~U'ì#~';:
S W SPAS & POOL SUPPLY 215-000-000901~1 MAR 9 1993Pa~
Overall Site with 1 Fac. Unit -
1
~
02/11/93
General Information
By
.
Location: 6261 WHITE LN Map: 123 Hazard: Low
Community: BAKERSFIELD STATION 09 Grid: 15C F/U: 1 AOV: 0.0
~ Contact Name Title Business Phone --:- 24-Hour Phone
F SHAKIR OWNER (805) 833-6399 x (805) 397-8732
( ) - x ( ) -
Administrative Data
Mail Addrs: 6261 WHITE LN D&B Number: 01-960-2432
City: BAKERSFIELD State: CA Zip: 93309-
Comm Code: 215-009 BAKERSFIELD STATION 09 SIC Code: 5251
Owner: F. SHAKIR Phone: (833) 952-5
Address: 3500 AKERS State: CA
City: BAKERSFIELD Zip: 93309-
Summary
I, F- S; H A /¿/ fê.. Do hereby certify that t have
(Type Of print name)
reviewed the attached hazardous materials manage-
ment plan for and that it along \Yith
(Namo of Business)
any corrections constitute a complete and correct man..
agement plan for my facility.
~
gG
~
~
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02/11/93
S W SPAS & POOL SUPPLY 215-000-000901
Hazmat Inventory List in Reference Number Order
Page
2
02 - Fixed Containers on Site
PIn-Ref Name/Hazards
02-002 MURATIC ACID
. Reactive, Delay Hlth
Form Quantity MCP
Liquid 80 High
GAL
02-007 SWIMMING POOL BLEACH
. Pressure, Reactive, Irnmed Hlth
Liquid 55 High
GAL
ir
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e
02/11/93
S W SPAS & POOL SUPPLY 215-000-000901
02 - Fixed Containers on Site
Page
3
Hazmat Inventory Detail in Reference Number Order
02-002 MURATIC ACID
~ Reactive, Delay Hlth
Liquid
80 High
GAL \
CAS #:
Trade Secret: No
Form: Liquid
Type: Mixture Days: 365 Use: WATER TREATMENT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
~ 80 I 40.00 I 200.00
Storage
PLASTIC CONTAINER
r Press T Temp ~ Location
Ambient Ambient I SOUTH END WEST
- Conc l
31.0% Muriatic Acid
Components
r; MCP ---¡-Guide
High I 15
02-007 SWIMMING POOL BLEACH
~ Pressure, Reactive, Immed Hlth
Liquid
55 High
GAL
CAS #: 7681-52-9
Trade Secret: No
Form: Liquid
Type: Mixture Days: 365 Use: WATER TREATMENT
---- Daily ~~. Ma GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
~ 55 I 50.00 I 500.00
Storage
PLASTIC CONTAINER
r Press T Temp ~ Location
Ambient Ambient SE SIDE OF STORE
- Conc l
12.5% Sodium Hypochlorite
Components
r; MCP ---¡-Guide
High I 45
~ e e.
02/11/93 S W SPAS & POOL SUPPLY 215-000-000901 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
VOICE COMMUNICATION AND CALL 911.
<3> Public Notif./Evacuation
VOICE COMMUNICATIONS
<4> Emergency Medical Plan
NEAREST HOSPITAL
'i
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e
02/11/93
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
5
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF ACCIDENTLY IN
APPROVED CANS.
<2> Release Containment
p O.ð......1.A,.. ,".
.~ 'v.:J.:;-J~ ...~
JI\j
..9Jî1A'l L
t-wvTA 7 ¡V.lÁ!2-
-F9tf2-
~71P L g-~'4t
<3> Clean Up
SOi)A
ASff
I <4> Other Resource Activation
Q. ~. ,
e
-
02/11/93
S W SPAS & POOL SUPPLY 215-000-000901
00 - Overall Site
Page
6
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS- BEHIND THE BUILDING (OUTSIDE)
B) ELECTRICAL - EAST END OF BUILDING THROUGH THE GATE OF STORE HOUSE
(OUTSIDE)
C) WATER - EAST END OF BUILDING
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS
FIRE HYDRANT - AT THE EAST END INSIDE THE STORE.
<4> Building Occupancy Level
:). .) ,I .~
e
e
02/11/93
S W SPAS & POOL SUPPLY 215-0DO-000901
00 - Overall Site
Page
7
<G> Training
, <1> Page 1
WE HAVE 3 EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING: WE HAVE EXPLAINED MATERIAL SAFETY DATA SHEETS TO
EMPLOYEES. THEY HAVE BEEN TOLD ABOUT HAZARDS OF MIXING ACID AND CHLORINE
TOGETHER. THEY HABE BEEN TOLD TO EVACUATE IN CASE OF SPILLAGE OF ACIDE OR
CHLORINE.
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
?t- /.
\)
.....:::'
."
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
2130IG"-STREET
BAKERSFIELD, CA. 93301
(805) 326-3979
HAZARDOUS MATERIALS INVENTORY
FACILITY DESCRIPTION
CHECK IF BUSINESS IS A FARM [vr--
BUSINESS NAME Seufl.!WUJ r5'¡lASJ f .Pro¿ ?Ývy1/U~
FACILITY NAME
SITE ADDRESS C;; b0 !
CITY 13J(?t/i)
NATURE OF BUSINESS
w 1') /r~ L¡J 1:J:: ( éJ 2-
STATE ~
1-' () 01- - 5'þ1 f pI-I µ
ZIP
c¡~~ D1
SIC CODE
. i:2-S-1
DUN & BRADSTREET NUMBER
OWNER/OPERATOR ; & ARt fL--
PHONE ýOS--óS3, 61 L(
MAl LI NG ADDRESS
5~,
CITY
STATE
ZIP
EMERGENCY CONTACTS
NAME
'f, S1\ ~K, a-
BUSINESS PHONE
TITLE
24-HOUR PHONE 317 ~.)7
NAME C1\ S'~ kí\))E.e
BUSINESS PHONE ~ ~ '] 0 'l2fb
TITLE
24-HOUR PHONE 342ðm
September 30. 1992
REGION V LEPC STANDARD FORM
\)
/
~,
'----, J-' I
BAKERSFIAD CITY FIRE DEPARenENT
HAZARDOUS MATERIALS INVENTORY
Page_of_
Business Name
Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition ~vision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [~E SECRET [ ]
2) Common Name: 7¡¿/CN L-(!) r¿ 3) DOT # (optional)
Chemical Name: 11</ C r/ "'01<-0- S --772//17 i N £712D / JJ~ AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL H~ ~ -
HAZARD CATEGORIES Fire [ ] Reactive ~udden 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~qUid [ ] Gas [ ] Pure [ ] Mixture ~aste [ ] Radioactive [ ) .
CHfCKAti THATAPPtY
7) AMOUNT AND TIME AT FACIUlY / DO ð I b UNI~ MEASURE 8) STORAGE CODES 10
Maximum Da¡ly Amount: Þ 100 [ gal [] ft3 [ ] a) Container:
A~.... 0"",, Amo,"" ~! curies [ ] b) Pressure: ~
Annual Amount:
Largest Size Container: ~ 0 1> jÞ- ~ )yV c) Temperature: .
Circle Which Months: All Year, J, F. M, A, M, J, J, A. S, 0, N, D
# Days On Site ~ b
9) MIXTURE: List ~ COMPONENT ~I A'Z-¡ 'AJfT!2õINI:: CAS # %WT AHM
the three most hazardous 1 ) I~ I 1:1-{ L-1) 12 /(1 - .s q9~/ [ ]
chemical components or 'v
any AHM components 2) [ ]
3) [ ]
10) Location ÎJ5 þLAY II IZ/iA I3ACjc- eJ'F-.. ~
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 [ ]
CHEcx. AU. THAT APPt Y
7) AMOUNT AND TIME AT FACIUlY 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 # %WT AHM
the three most hazardous 1 ) [ ]
chemical components or .-,-
any AHM components 2) [ ]
3) [ ]
10) Location
certify under penalty of law, that I have personally examined and am familiar wlm me mfomation SUDmltted on this and all attached documents. I Del/eve me
submitted information is true, accurate, and complete.
I'
PRINT Name & Title of Authorized Company Representative
Signature
Date
~.cUmÞer30 1992
REGlQtr,I Y lEPC ST~OAAD FCR"
(o~
e
e
CITY of BAKERSFIELD
"WE CARE"
~cJ.Q~ - uf:J
FIRE DEPARTMENT
S. D. JOHNSON
FIRE CHIEF
.2101 H STREET
BAKERSFIELD, 93301
326-3911
February 10, 1993
Dear Mr. Shakir:
NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE
-----------------------------------------------
-----------------------------------------------
In the inspection of your business S. W. Spas and ppol
supplies located at 6261 White Lane, Bakersfield, Ca.93309 on
2/10/93 the following Hazardous Materials regulation
violations were identified:
1) Hazardous Materials were present above the reportable
quantities after you filed for an exemption for not having
reportable quantities on 1/3/93
.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 total 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.
VIOLATION OF CH. 6.96 CALIFORNIA HEALTH
& SAFETY CODE 25509(a)11-4)
(a)The-~nnual inventory form shall include, but
shall not be limited to, information on all of the
following which are handled in quantities equal to or
¿' '" ~
e
e
greater than the quantities specified in subdivision (a)
of Section 25503.5:
(1) A listing of the chemical name and common names
of every hazardous substance or chemical
product handled by the business.
(2) The category of waste, including the general
chemical 'and mineral composition of the waste
listed by probable maximum and minimum
concentrations, of every hazardous waste
handled by the business.
(3) A listing of the chemical name and common names
of every other hazardous material or mixture
containing a hazardous material handled by the
business which is not otherwise listed pursuant
to paragraph (1) or (2).
(4) The maximum amount of each hazardous material
or mixture containing a hazardous material
disclosed in paragraphs (1), (2), and (3) which
is handled at anyone time by the business over
the course of the year.
A revised business plan and inventory must be filed and
returned to this office by February 26 1993 in order to avoid
further regulatory action.
The department will schedule a re-inspection of your facility ì
to verify compliance. If you have any questions regarding
this notice, please contact Ralph Huey at 326-3979.
~. Si2;;Ae~
.. ..... uy-w~ ."-
Ralph E.Huey
Hazardous Materials Coordinator
~
:f ~
e
.
CITY of BAKERSFIELD
"WE CARE"
FIRE DEPARTMENT
S. D. JOHNSON
FIRE CHIEF
2101 H STREET
BAKERSFIELD, 93301
326-3911
February 10, 1993
Dear Mr. Shakir:
NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE
-----------------------------------------------
-----------------------------------------------
In the inspection of your business S. W. Spas and pool
supplies located at 6261 White Lane, Bakersfield, Ca.93309 on
2/10/93 the following Hazardous Materials regulation
violations were identified:
1) Hazardous Materials were present above the reportable
quantities after you filed for an exemption for not having
reportable quantities on 1/3/93
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 mixt~re
containing a hazardous material which has a quantity at
anyone time during the reporting year equal to, or
greater than, a total 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.
VIOLATION OF CH. 6.96 CALIFORNIA HEALTH
& SAFETY CODE 25509(a)(1-4)
(a)The annual inventory form shall include, but
shall not be limited to, information on all of the
following which are handled in quantities equal to or
~,~
_e
e
greater than the quantities specified in subdivision (a)
of Section 25503.5:
(1) A listing of the chemical name and common names
of every hazardous substance or chemical
product handled by the business.
(2) The category of waste, including the general
chemical and mineral composition of the waste
listed by probable maximum and minimum
concentrations, of every hazardous waste
handled by the business.
(3) A listing of the chemical name and common names
of every other hazardous material or mixture
containing a hazardous material handled by the
business which is not otherwise listed pursuant
to paragraph (1) or (2).
(4) The maximum amount of each hazardous material
or mixture containing a hazardous material
disclosed in paragraphs (1), (2), and (3) which
is handled at anyone time by the business over
the course of the year.
A revised business plan and inventory must be filed and
returned to this office by February 26 1993 in order to avoid
further regulatory action.
The department will schedule a re-inspection of your facility
to verify compliance. If you have any questions regarding
this notice, please contact Ralph Huey at 326-3979.
::;;;~~ ~
ìral~h E.Huey
Hazardous Materials Coordinator
~
CITY of HAKEHS~IELO
HAZARDOUS MATERIALS INVENTORY
Farm and AgtlCulture [] Standard Business []
~ NON-TRADE SECRETS Page of
BUSINESS NAME:~ ~ ~ ~NER NAME: . NAME OF THIS FACILITY: _
LOCATION: DRESS- STANDARD IND. CLASS COOE:- ---
~M~È HP:---- ---- ,-=-- ~Àl;V ¡~P:------- - DUN AND BRADSTR~ET NUMB~R-- -
-- REF~~ TO--INSTRUCTIONS-roR-PROPER CODES - - - - - --
-- -
I 2 3 4 5 6 1 8 9 10 11 12 13 U
CTr~ns TYDe Max Average Annual Hea$ure . Dys Cont Cont Cont Use Loc~tion ~he(e 'by Ilues of lIixture{corponents
ode Code Allt Allt Est Units on Site Type Press Temp Code Stored In Facility lit See Instruc Ions /'
~ ~O I 4--0 I 3'"'oo~t=RJ 36' )1 , () I I I 4- 141 I ¿lalA', H ~IVJ:; AL.L. PIAIZ£- ~/
Ph(YSical onld Health Halard C,A,S, Number Component 11 Nallle & C.A,S. NUlllber I)..' $o'DI/.tfY1.. l-NI'()¿f/LI12/У
Check a I that apply) _
. . Component.2 Name & C,A,S, Number
Fife Hazard Q1ieactivity 8"Õelayed [] Sudd~n Release [] Immediate
Health of Pressure Health -
Component.3 Name & C,A,S. Number ~ ~
.s Dt.17 Ii E NJ) lV!J.J ì _
C,A.S. Number Component.1 Name & C,A,S. Number
- ---
Component'2 Name & C,A,S, Number
[] Fire Hazard' [] Reactivity [] Delayed [] Sudd~n Release [] Immediate
Health of Pressure Health - -
Component'3 Name I C.A,S. Number
- -
- -
Physical ond Health Halard C,A,S, Number Component'l Name I C,A,S, Number
(Check all that apply) _ _
Component'2 Name I C,A.S, Number
[] Fire Hazard [] Reactivity [] Delayed [] Sudd~n Release [] Immediate
Hea I th of Pressure Hea Ith -
Component'3 Name I C.A,S. NUllber
-- -
Physical 'nd Health Halard C,A,S, NUllber Component'l Name & C,A,S, Number
¡Check a 1 that apply) _
Component'2 Name & C,A.S. Number
o Fire Hazard [] Reactivity [] Delayed [] SUddfn Release [] Immediate
Health 0 Pressure Health -- -
Component'3 Nallle & C,A,S. Number
EMERGENCY CONTACTS #1 "2
R!tIe ntle 2TlInfiõñr-- Rame TitTe - Z411rT¡¡~-
Certifiotioq (Rer:d and $ign 8.fjßr cÇJmpleting. Ç11'. sections) . .
I certify un1er enall 0 la th t I have pe(sona J~ exam\n Q 0 d m famllla( It the in(o(matlon $U mltte~ In his end all
attaçhed dQCUllen~SI an~ t at ~ase~ on my InQuiry 0 lhose Inålvl~ua's responslb1e ~or obtaining the In~ormatlon. 1 believe that 1ft
submItted Inforllatlon IS true, accurate, and cOllplete, r . ' 2- I
!1()
ŒíFTiìõõnmnt raW UN ol/ner/operator's author1ZeO representãtlve OHniQ¡¡H
..... /
. . ' .. J, ~.....,...
:'h
,\- . "j
.- --¡. - "":
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/';::~
'O~v7':~R~~,\
., . . ~.\
..J.. ,__,. ~\\
""........ ("
:.0 =_)"A"r---... Oi '\
[. -:-..'''''(,c~ .
.\, -~,..,,/
\\ ~~ -'.\ ,',
,\ .. J.
.... '.C'''-'''... . ,'. ,
...'...."1/.-,....,.;1\'1:-'
, '--:-~Qß.I~. '/
"~
.. rYE CARE"
010 \
'1~
IIi¡ I
\\\\\\,~'U.,__ .
~11'\.,'d) :..--'~
... .', -- ./.,:......~~~
.:§/f \,~. /j' -......:~
=~;; \\ ;~j ~~-
.= ~ < :' ':':' -: ~ ==
;S~:::O '. ~\~
--.. I I
-::::.... ~ '" I
~;.~:-.:-:~\\,~, :I~
ùí'J!fíÍj~
CITY of BAKERSFIELD
ï
r: S I/A K/ f2-
(tYDe or prln~ name)
~
RECEIVED
Do hereby cert i fy- tha t I ha ",'e revi eh"ed the 'MAR 2 2 1989
HAZ. MAT. ON.
attached Hazardous Materials business plan
for
Sc9t-1/A G!U f ,;;ít/l-e-lk~
(name of business)
and that it along with the attached additions
'-
"
",
or correctibns constitute a complete and correct
i
Business Plan for my facility.
~;(I-,
si.gnat.ure
5/16/01
date
,
jl
-~
/ .~~v
r¿p~cI
l, 11J
\;. 1
Oì. rJ5/ ~
ÓW~(~
H
BUSINESS NAME SOUTHWEST TRUE VALUE HARDWARE
LOCATION 6261 WHITE LN
i
22222222222222222222222222222222222222222222222222222222222222222222222'
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ID NUMBER 215-000-000901
HIGH HAZARD RATING 3
1. OVERVIEW
LAST CHANGE 07/14/88 BY ESTER
JURIS CODE 215-009 JURIS BAKERSFIELD STATION 09
MAP PAGE 123 GRID 15C FACILITY UNITS 1 HAZARD RATING 3
RESPONSE SUMMARY
2A SEC 4) NO PRIVATE RESPONSE TEAM
EMERGENCY CONTACTS 2A SEC 2)
R. SHAKIR - 833-9525 OR 397-8732
UTILITY SHUTOFFS 2A SEC 3)
A) GAS - BEHIND THE BLDG (OUTSIDE) B) ELECTRICAL - E END OF BLDG THROUGH THE
GATE OF STORE HOUSE (OUTSIDE) C) WATER - E END OF BLDG D) SPECIAL - NONE
E) LOCK BOX - NO
2. NOTIFICATION / PUBLIC EVACUATION
LAST CHANGE / / BY
1/ éJ ( (-Ii ÚM7
' 1?JL.{ IV I e,l~T 10 ¡V
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 1
03/13/89 12:14
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
"
e
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BUSINESS NAME SOUTHWEST TRUEVALUE HARDWARE
LOCATION 6261 WHITE LN
ID NUMBER 215-000-000901
HIGH HAZARD RATING 3
3. HAZ MAT TRAINING SUMMARY
LAST CHANGE / / BY
.- ..' ~
/fiIiI lI' _
-~_. ~~ ~""::::"'''
"
.... -1' .....
... -. lmrn-rTlmclt
.. ~I.I ..
,.... ~ ..
bOe ~W ¿. c{zj/¿' 1/1,¿¿1
~~ A~'YL ~/1- ~U
e.-A/MinL ~/~,
~y kv¿ ~ r-61v1 -t
J l1öd p-¿.,. f?Álø"7~~
< NO INFORMATION RECORDED FOR THIS SECTION> ,L
;d o/' Em¡D/ð/,!E'.5
-fm;d0þ& , ( -3 )
)/~~! oj.J?fJ:?7} 4cJot 6/J1d
/J15 PS' -dJ
Cl.hOPl /-'
£:11 to\. ~.G-, fi
~ C~ f
512'ï/ ~
4. LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 07/14/88 BY ESTER
2A SEC 5) WHITE LANE MEDICAL - 5401 WHITE LN - 832-2000
PAGE 2
03/13/89 12:14
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
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OVERALL
I
ID NUMBER 215-000-000901
I
HIGH HAZARD RATING r
HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 10/06/88 BY ESTER I
MAX AMT UNIT HAZARD
USE I
/)'0 I
~ GAL EXTREME
PAINTING I
HAZARD LISTS
I
MODERATE
I
MODERATE
I
MODERATE
I
MODERATE
I
MODERATE
I
UNKNOWN
I
BUSINESS NAME SOUTHWEST TRUEVALUE HARDWARE
LOCATION 6261 WHITE LN
FACILITY UNIT 01
A.
ID
TYPE NAME
LOCATION
CONTAINMENT
1
MIXTURE PAINT
SOUTH WALL
ID PERCENT
1118.00 40.0
1130.00 10.0
1203.07 5.0
1168.00 5.0
1203.00 5.0
::<::,-
~
Ì'Q.g GAL
BACTERIètDE
i
HAZARD
I
HIGH
I
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H[GH
I
I
HAZARD
I
HIGH
¡
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LISTS
METAL CONTAINERS
COMPONENTS
Xylene, Mixed
Toluene
Mineral Spirits
n-Butyl Acetate
Naphtha
2
MIXTURE LIQUID CHLORINE
NORTH WALL
ID PERCENT COMPONENTS
1165.00 90.0 Sodium Hypochlorite
:ZŠ
ì'G.Q GAL
NEUTRALIZER
PLASTIC CONTAINER[S]
LISTS
3
MIXTURE MURATIC ACID
NORTH WALL
ID PERCENT COMPONENTS
1078.02 33.0 Muriatic Acid
PLASTIC CONTAINER[S]
B. FIRE PROTECTION / WATER SUPPLIES
LAST CHANGE 07/14/88 BY ESTER
,
I
3A SEC 4) AUTOMATIC SPRINKLER SYSTEM & FIRE EXTINGUISHERS FOR FIRE PRO~ECTION.
3A SEC 5) FIRE HYDRANT AT THE EAST END INSIDE THE STORE.
PAGE 3
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
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03/ 1 3/189
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12:14
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BUSINESS NAME SOUTHWEST TRUE VALUE HARDWARE ID NUMBER 215-000-000901
LOCATION 6261 WHITE LN HIGH HAZARD RATING¡3
D. EMPLOYEE NOTIFICATION / EVACUATI0N
LAST CHANGE 07/14/88 BY ESTER I
3A SEC 2) VOICE COMMUNICATION AND CALL 911.
I
I
I
I
I
I
E. MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE 07/14/88 BY ESTER I
I
3A SEC 1) STORED ON SHELVES ATTACHED TO THE WALL. CANNOT BE KNOCKED OFF
ACCIDENTLY IN APPROVED CANS.
PAGE 4
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03/13/89 12:14
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 I
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~ HAZARDO'US MATER:%: ALS :I: NVENTORY'
NON-TRADE SECRETS
-
CITY of BAKERSFIELD
,~
L.......I
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. PICJ'
NAME OF Tft'1:Š ~A_ÇJL.lT..!:~
STANDARD IND. CLASS CODE
DUN AND BRADSTREE):. NUMBER hJ
~L - :t~~ -'¿~.3l-
of
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Standard Bus In.ss
turf
Aqdcu
BUSINESS
LOCATION:
CITY. ZIP:
PHONE .:
Fa... MHI
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See IMtructillll
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lit
to.panInt .1
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to.panIntlJ
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'rant Tyøe III. a_. annua
Cod. Cod. Aat Aat Est
~ - - -
__~~\l_E~L_~ð·.-1 59-___.:5 ð____
P~iCll III1cIHealth Kalil'll
r.htck a II that allØ Iy)
,.\.-< r-.,
L;<-'t Fi... Haurd I. _ oJ
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SuckMn "1_ ;£'J I"'t,to
of '....1UrI . ....1 th
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OIlar-d I. _.I
Health
Røctiyity
,.-.,
OIlar-d 1._.1
Hea Ith
r-.,
L._~
Jl.l~J_____qi~______§__º______
Physical III1cI Health Hllard
(Chtck all that apply)
,.-\ri r-.,
Y'< Fi... Haurd I. _.I RHctiytty
I-.eltat.
11M Ith
...... -
r-"
I._oJ
Sudden lit I,",
of P.....u...
C.A.S.
J c:; .._
,.-.,
I._oJ
OIlayM
HNlth
,.-,
'-_oJ
!.l_lM__2~__ J:.~__~
Physical and IIMlth Harard
(Chtck all thlt '1IIIIy)
,.-.,
Fire Hazard '- - oJ Qflctiyity
~~
R~¿ A71:VJ'~~7 ð 7?f"6
nnr----~--- fhil'-I'NIIII-----
. C.A.S. .......
. C.A.S. ......
Qii__è.- :1.:..J~A f2€(!;-_____
rv, r-,
>,-+oJ OtI.yM I._oJ
HNlth
;"Hy
.,r:=. S II ¡:} /q ifZ- tyU.}"LVl..--
.1 -----:-----...--------------.-------- nfl¡--------------------
1-
I4fRGENCY CClTACTS
thet besed on W'f inquiry of those indivtdual. ........ibl.
Da-i?~~qn~¡I'¿r~----------------------
and
C.r ÎCat;on (Read and sign after co.pJetJng all sectJons)
I c.rtlfy \lnd.r Iinílty of 1.. that-1-hav'-Dlrson.l1y .....iñid -1riiI"-fiilm.r-with tilt -in-forilltion su"itted in thts -ïnd .1fettec-hId cIoc"';t.
for obtain;nq tilt inforelltion. I bill". thl!., tilt lu"itted ;nt_tion i. true. accurat., and coaol.t.. ~//./ 1.
t,;,»)'7..VI/' r- Sl/~ /CIte.- ~/t"'- K~
114"- ãña-ÕJJiéi.l-fini-õr-õWñir Toiiirãtõ;:-OrõMi¡;:7åDi;:¡tõr~nütliõrii¡a_¡:¡jj;:išiñt¡(iÿ¡ ----------:-
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CITY of BAKERSFIELD
~ HAZARDO·US MATERIALS INVENTORY "
,~
FðrM ðnd Aqr icu I turp '--J Stðndard BUS1npS5
NON-TRADE SECRETS . Pe9P~ of ~
~ 7fiq£~~£
BUS I NESS NAME ~ ~ )/liES I OWNER NAME: NAME OF Tn1S ~~JL~TY:
LOCATION: ADDRESS: STANDARD IND. CLASS CODE
ZIP: - DUN AND BRADSTREET NUMBER
CITY, - - CITY, ZIP:
PHONE #: PHONE t1: - -
- - - - - - - - --
IUU'IUl TO INSTRUC'l'IOIrS 'OR PROPIUl CODKS
I 'r~n' -
2 3 . 5 17 13 11
Type 1Ie~ Avpreq. Annua , lacltlan ....1'. ,by NalllS of ixtu.../C~t.
(ode Codp AIIt bt Est Stored In Fie II Ity lit See Instruct ian.
_~l.¿LS~____~__~____ __ _ ~ s,!/é qé ~_.~____ _é12_ ~";ÿ.. !f~_~_ _ Li;;~~__.
Physical and H.alth Hazard Co. OMIIt 1\ ....., U.S. IMber .~ _~~.Qh.:t..__&Pq~~Æ: ~
IOlPCk al1 that apply)
.--, X ~ ,.-, ~ CoaQonent 12 ....., C. A. S. IMber .~ _ ~~~A../- X-~
L_-' Firp Hazard .I Reactivity '- h'a~ '-_.I Sudden Relel" l-.dllt. ...---------
Hpa I th of Pres.ur. H..I th
CoaIIonent n ....., C. A.S. .......
~ --- ------- '--- ---- -----
P~ical and Htalth Hazard C.A.S. IIwbtr ------- Coeponent 1\ 11_' C.A,S. bber --
( heck all that apply) ...- ----- ------
.--, ,.-, ,.-, ,.-, ,.-, to.øonInt 12 11_' C.A.S. IIuIIbw
L_oJ Fir. Hazard '-_.I Reactivity '-_.I Delayed '-_.I Sudden R.,.." '-_.I '--'lltt --
H..lth of Pl'Itsu... 1I..1th
--- --- --
p~ica' end HNlth HiliI'd C .A.S. IIuIIbtr - , C.A.S. .....,.,.
( heck a 11 that app Iy) --.. -----..
r-, ,.-, ,.-, ,.-, 11_ , C.A.S. IIu.btr
L --' Fire lIazard '-_.I Rpaetivity '-_.I h1ayPd '-_.I Sudden Rp1pasp -
Hulth of Pressure
C~t n "_, C,A.S. lluebtr
. ._l____l____________l_____________l__________J_____ I ------------
p~ ica' end Htllth Hllard Coepontnt II
( hKk ,II that ,pply)
. ------------
.--, , ..-, ,.-, Coeøonent 12
L --' Firp Hazard '-_.I h1ayPd '-_.I Sudden Relpul! '-_.I l-.diat.
Hea Ith of Pressurp Hpa I th ----------------------------..-----------------
_..T , --
~F RGEHCY CONTACTS II 12
Ai.@ - ~ --- - - - ----- -- - ---------- ----- ------ nn¡------------- ---------- lIi.----------------------------- T1tl'----------------------- 7.-R~-PI\llll'-------·
- '
C@nifiCðtion (Read and-·sil!n- after co.pleUnl! alJSe~ atlan 5ubllitttd In this ,nd 111 Inte'*' daculMllts. and that ba5ed an wy inquiry of those Indlvlclull. rlS IOIIsibl.
I c@rtHy under III'Ialty of law that I have pprsona11y eUIII;nl!d and a a.iliar with the
for obtaining the inforution. I ~1ievl! that thP sutMIiUed inforution is trup. accura eoep ¡pte.
R :;iõ~ - iña - õ f f ì ë ì ¡¡ 1 - t ì f 1@-õT-õiõñ@¡:Toõ¡¡:¡¡tõ¡:-01¡-õWñ@¡:7õ¡¡¡mõ¡:'š-¡ütliõ¡:ì ¡in¡õ¡:¡šiñt ¡{iŸi Sìijñitü;:¡ DitëSiijñ¡a
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979 \;t3 - \ 'S c.....
® :WSf ~
OFFICIAL USE ONLY
ID#
C)<K1 t~
()OC901
!BUSINESS NAME
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
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.
RECErVED
AUG 5 t987
Ans'd... .
....."......
INSTRUCTIONS:
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NAME: SOUíH W£S I '1Ku£ VAL. U £. l'¡A¡:D,^It1~t
B. LOCATION / STREET ADDRESS: 6:Z 61 úJtllr£ I-rv'
CITY:
Il>fJK£f!.S ~/ £tD
ZIP:
cn 935rJ'1 BUS.PHONE: (cgdf) &33 6391
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS;
A. r. S'flAKIR Ph# 33'3 9S2S- Ph#.3 77 ~7?L
B.
Ph#
Ph#
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE:
B. ELECTRICAL: £a.sf
C. WATER: z.Mr 'h
D. SPECIAL:
E. LOCK BOX: YES I::i9> IF YES, LOCATION:
)Î4)
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
MSDSS? YES / NO
KEYS? YES / NO
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
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SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
1tJ~ Iff L/lN E
JÎ1Ef)t Cf/¿. CE-fym/E
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING A~EAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS: . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES ~ YES NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: . . . . . . . . . . . . . . . . . . . . . . . . . . YES "..~ YES NO
C. PROPER USE OF SAFETY EQUIPMENT:.................. YES 1NQ) YES NO
D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . . . YES ~ YES NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:..., .. . YES YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:... ... ~ NO
I, f'l:JkHIZUDDJ JÝ S 11;1'11</ Jë. ,certify that the above information is accurate.
I understand that this information will be used to fulfill my firm's obligations under
the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec. 25500 Et AI.) and that inaccurate information constitutes perjury.
'SIGNATURE~L
TITLE
~v
DATE 7 /If/ ð/
- 2B -
-....~-:??'..-- '~
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
------
BUS INESS NA~IE:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoid further action. this form must be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questiuns below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT#
FACILITY UNIT NAME:
SECTION 1: MITIGATION, PREVE~~ION, ABATEME~l PROCEDú~ES
S 7õJf?E7) t!)^" S/lB-.YE..s I) 77 ACHE))
¡( No¿. KEV 7) FI' /J¿c f VE iÝ7 L Y .
"L C,l'IdY (/'I(fT 13£
TO '1'!-If IN n .L,. n
I IV Il P?jZ lJ;/£ø ¿/¡i4Jy .
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY
VðlGt
COmrnUIVIC~A711)J/
ø {};i!J C( / I
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
C,
\
A. Does this Facility Unit contain Hazardous Materials?...,. § NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES ~
If No, complete a separate hazardous materials inventory
form marked: NON-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
{.1U-rOMA'TIC- 5PfZIN(:.¿£JZ- S1S'TE 117
nlZ £. E-XTì1YG-t<t¡JI-' £'e-.s ~ ÞA
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~~ERS
(j) Ilí EAsr EN]) 1/'/511)/£ rtl£; 57þj?.£ ~// d' Of'{ '"TIlE 14AL¿)
@Jw '7ME ~Arw;z¡)"'"~ '
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT. GAS/PROPANE:
ß.th;,Ÿ1cJ.. Sðl1-1t... W...J) ðv. -J(... ðV\ tSI~ ÞJ -l-P..t. 1WlA~
B. ELECTRICAL:
~ IV)..... ').." ~~
1. /lit.... í h ~~~
C. WATER:
rJ jlt
11-) .fL. f I~
a.J ~. ,º-o..s ~ ~A ð1r-- ~ ~ ~ 51 Jv..,.
D. SPECIAL:
E. LOCK BOX: YES / NO IF YES, LOCATION:
}JO
IF YES, SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
MSDSs?
KEYS?
YES / NO
YES / NO
- 38 -
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Page
LD CITY FIRE
FORM 4A-l
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
'f}?{)£ IIln.vE. F SI-/A K 11Z
DEPARTMENT
BAKERSFIE
#
D
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.5¿;I.1'ÍHW£',; ,.
ADDRESS: £;2 r; I tvµ Ire L¡yI ADDRESS: &;Jt 3-ý--;¡;¡;; A¡':é~-X FACILITY UNIT NAME:
CITY, ZIP: (6AK£~.<; ¡flétAD f:4't. c::r3~':>''::¡ CITY,ZIP:
PHONE #: 1:tJ~ <6'33 .6 3 91 PHONE #: 10FFICIAL 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. WT. CHEMICAL OR COMMON NAME CODE GUIDE
~ 2. 5"0 GIH. -?g; b-A 2- H11- 13 2'1 .f tJ Lt 7J.I WA L-L lS"l i ·r:(l/lY~,7.r-. ,_ I ~12 Y.(rç ±~3r~~ -=-,- CM L~
1 ~l /lJ1J Grit. 6-,4 '2..- 13 21 I, !jÁI§/IA ~) I IJo 7. PA I/YT /)-)-1 lVAlžF¿ GÚN~'1S\1)f) CfV)L~
;2) I () D (fAL '"" C(õX - 02'8'~ o~
5ov&A1. 61fL ID Q-S- . NDK..TH wALL L', ,?U ID (\1 L.O R 1 ",h. L \ \A, 'to Crfll..fi¿
3) I D06f\L 5b tX::rA1... &f\L 1(') . :l'?' I , , 33-/ M.\..\~I\1"I'- I\L l Þ (~~~~~) CMlfQ
, Q~ . (P£N"E-D( L. )
50QI- .2.(W tZ~ 10 26 ~~ ~ .5HfLIJt loot. f'/\.;)-r: 0 '12 ð i L CMLQ
loD~r ;2..ð1) cQ ~ t(~ oq 3:J , IDD% IJÝc-Ec7/Ç(J)£J Hef201.('ÒEA.,.~~~ CML~
, r') LAw"; f &A~ùt ~ ùf.Fr
)t> r/- þt . ~ 1,my1, (fqZof-IJuV£ Fv£I- - CMLQ
10 f f-~ 01 /9 Ibœs S £C7' I/ )}t)
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R '" ¡ J L Til, OJ( J...Q,w~ 1.s~Dtt- C!.. AA
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WeeJ ß @tÞl>J.p . FJ-e€ f5 G -:>Al,q
P- An!Jp . / ,-
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F· 5 HII /'í 11<- TITLE: (}VJ/Ý E SIGNATURE:~~~^~' DATE: 7/3/ /F'7
K
F 5HI/KII!.. TITI,E: tIvrJ ~ PHONE # BUS HOURS: 'Î/33 6'3 qq 'JI-{J9
FACILITY UNIT #
NAME
OWNER
NAME
BUSINERS
AFTER BUS HRS:
PHONE # BUS HOURS
AFTER BUS HRS:
~
4A-l
f{
ACTIVITY
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EMERGENCY CONTACT:
PRIN01PAL BUSINESS
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SITE/FACILITY DIAGRAM
FORM 5
NORTH SCALE: BUS INESS NAr.IE: S~7)4""~J7 Tf<.U.E. V'Al..U! FLOOR: OF
DATE:? /.3¡/P¡ FACILITY NAi'IE: UNIT #:. OF
1(7/ l' JIJL
(CHECK ONE) SITE DIAGRA)I FACILITY DIAGR.~'I V
f'L~ ~ lit/~
(Inspector's Comments):
-OFFICIAL USE ONLY-
- 5A -
SITE DIAGRAM (ReqUi~ite.s
b. Masonry construction
e
9. Lock (key) Box
10. MSDS Stora¡e Box
1t. Railroad Tracks
12. Fence or Barrier
a. Wire
b. Mosonry
c. Wood
d. Gates
13. Power Unes
14. Guord Station
15. Storare Tanks:
Identify the
capacity in ¡a I.
a. Above ¡round
b. Under¡round
16. Dikina or Bers
17. Evacuation Route
..._-,
.--.,
".~ ~ ":'...../-I.~
.
1, Address: Identity the
principle buildin¡s
by the Street nusbers.
.~i
2, Street(s), Alleys.
Driveways, and Parkin¡
Areas adjacent to the
property. Include the
street na.e..
3. Star. Drains. Culverts.
Yard Draina
4. Draino¡e Canals. Ditches,
Creeks.
5. Buildings
a. Frase construction
c. Metal construction
d. Access Door
6, Utility Controls
a. Gas
b. Electricity
c. Water
7. Fire Suppression Systess:
a. Fire Hydrants
18. Evacuation Area:
Identity the
location where
e.ployeea wi 11
s.et.
b. Fire Sprinkler
Connection.
19. Outside Hazardous
Waste Stora¡e
c. Fire Standpipe
Connections
20. Outside Hazardous
Material Storsge
d. Water Control Valves
tor protection syate.s
21. Outside Hazardous
Material
Use/Handline
e. Fire Puap
22. Type at Hazardous
Material/Wute
Stored
or Used (See
Below)
8. Fire Depart.ent Access
TYPE OF HAZARDOUS MATERIAL
F - Flu.able B - Explosive L - Liquid
C - Corrosive 0 - Oxidizer G . Ga.
W . Water React! ve T . Toxic S - Solid
R . Radiolo¡ical
P . Poison
H - Cryo¡enic
o - wute 8 . Etiolo¡ical
Eaa.ple: Pla..able Liquid. FL
FACILITY DIAGRAM (Required ite.. in addition to the above)
1. Riaers tor Sprinklers 8. Pire Escapes
2. PDrt1t!onø II. Air Condition!n¡ Unit.
3. Stairways: Indicate the 10. Windon
levels serv.d tros
hi¡hest to lowest. 11. Inside Hazardou. Waste
Stora¡e
4. Escalator: Indicate the
levels served froB 12. Ineide Hazardous
hi¡heet to loweat. Materiala Stor_e_
5. Elevator 13. Inside Hazardous
Materials Uae/HandlinK"
6. Attic Access
14. Sewer Drain Inlets
7. Sky l1iM.
j
(0
o~
/0//)
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