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Home My WebLink AboutBUSINESS PLAN '- ,e ¡f" -- I, 9 7 4 3 2 8 6 5 ABC D - ~ - ¡ - j - j j ¡ ¡ ¡"L" SHAPED ¡ MAURIClors GRILL & ¢ANTI¡NA ¡ 1STRIP1 MALL .............:..(TOP..uST~NG..OF-BUS{INES~ES..·U··..lsxPRE~S........ ¡ OF Ä STRIP MA4L ¡ ¡ ¡ LUBE ~ ! ~ ~ ; wHtTE lANE l.... N "'!'!'!'!".¡................¡................ ..... .¡................i................;.................:....... .., .. ..........:..... .... : ......... . ; ¡DRIVEW~Y ¡ ¡ ~~... ¡ T ¡ j : . . : . / ~v : . "'- ' . : . . ^: . . ., .' /:v . . W KFC . . : . . ''''~:?)' . ., .' / ,</, . . : : : : : j ~V¿:ss;) jI,,# : ...... .....:................,................ : , .................~................_..~,........ ..,..,. .... .....:.. . . ~ .................. ...................-...........: . '/ '-' n ' ,;l,,~ . . n : : : : : ~: "v/,~, n. : ........: · . . , . /~ S;)/. . : ~ ! : rY«.-v.'///v~:~f:S/ ~v~ : j ~ 1-: : : : ~~'-.;'V/~-$-. : ~ : : : : ~ <¿:Y ~ ~<f9 s;)~ / : : 0 : . . : ~ ./ f:S'/: . . · . . , . 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Ü .. .. ·E·..· .....-:.................:..........~ ~ ; ¡ ¡ ¡FOOD ÞARKI~G LOT T -¡SHIRT! ¡ I T :MAX : : : ·....·0· '·.tT·'..ET..··:.. .....:................:................ ......... -....·¡MÄL'C.. ~..~·î~srr·..·....··..*"t 'i L- ¡ ¡ ¡ i ¡ ¡ i i i i . -t KERN COUNTY HAZARDDOUS MATERIAL DIVISION BUSINESS NAME: ARC 0 # 05420 SITE MAP DATE: 01/10/01 HAZZARD DO US MATERIAL PLAN - - SITE ADDRESS: 6450 WHITE LANE BAKERSFIELD, CA 93309 E F G H J @ ~ ... ø IAC ® @ ® (!) - . MSDSI &BP 6 ~ ~ + "" * * ~ c==) IC02 ~ MOI [IT! [9J IEM o *** ITEI ITBI IRRI - SCALE -~- ............... LEGEND SEWER FLOOR DRAIN STORM DRAIN FIRE HYDRANTS & CONNECTIONS SPRINKLER SYSTEM VALVES AIR CONDITIONING SHUTOFF ELECTRICAL SHUTOFF GAS SHUTOFF WATER SHUTOFF EMERGENCY SHUTOFF ( i.a, GAS PUMP} DISPENSER ISLAND FIRE EXTINGUISHER MSDS & CONTINGENCY PLAN I BUSSINESS PLAN SAFETY SHOWER & EYEWASHES PERSONAL PROTECTIVE EQUIPMENT SPill CONTAINMENT & MITIGATION EQUIPMENT FIRST AID EQUIPMENT EMERGENCY ASSEMBLY AREA SENSORS OR PROBES lEAK DETECTOR ALARM MONITORING CONSOLE UNDERGROUND STORAGE TANK C02 LIQUID I GAS CYLINDER DISPENSER SHUTOFF MOTOR Oil FLAMMABLE LIQUID COMBUSTIBLE LIQUID EMERGENCY EXIT ABSORBENT CHAIN LINK FENCE TRASH ENCLOSURE TRASH BIN REST ROOM CASHIER 1 n = 40 Ft DIRECTION + LEGEND ~ SEWER FLOOR DRAIN ~ STORM DRAIN . FIRE HIDRANTS & CONNEcnONS ø SPRINKLER SVS'I'ëM VALVES I AC I AIR CONDmONING SHUTOFF ® ELECTRICAL ~H\1TOFF ® GAS SHUTOFF @ WATER SHUTOFF t¡\ EMERGENCY SHUTOFF \.:.I ( I... GAS PUMP) _ DISPENSER ISLAND . FIRE EXI1NGUISHER IMSDSI MIDI & CONTINGENCY ~ PLAN I BUBSlNESS PLAN ^ SAFETY SHOWER & f-:j. EYEWASHES n':ii5I:J PERSONAL PROTECTIVE ~ EQUIPMENT !'VI SPlu. CONTAINMENT' ~ MITlGAT10N EQUIPMENT + FIRST AID EQUIPMENT "" ~RGENCY ABBEMBLY * SENSORS OR PROBES . LEAK DETECTOR ~ _, ALARM MONITORING CONSOLE C - -) UNDERBROUND _ _ STORAGE TANK I'1'ñI)1 CO2 LIQUID I GAS ~ CYLINDER [!] DISPENSER BH\ITOFF I MOl MOTOR OIL ŒQ FLAMMABLE LIQUID @J COMBUS11BLE LIQUID I EM I EMERGENCY EXIT o ABSORBENT *** CHAIN UNK FENCE I TE I TRASH ENCLOSURE I TB I TRASH BIN I RRI REST ROOM _ CASHIER SCALE 1- = 40 Ft _A_ DIRECTION 511£ I D.=FI ~'1 SITE MAP DATE: 01/10101 HAZZARDDOUS MATERIAL PLAN SITE ADDRESS: 6450 WHITE LANE BAKERSFIELD, CA 93309 B D E F G H I J -: j - ¡ ¡ ! j [ilL" SHAPED MAURICIOrS GRILL & ÇANT~NA j STRIP MALL .........,...... ..(TOp..LJST"NG..O'F..BU'~.NES~ES""" . ........ ·..SXPRES·S..'......·, OF ~ STRip MA4L ¡ ¡ \. LµSE ¡ ; ,....,..;,..,......·......,~·......WH,I:T,E,LA· ·N: E,·..'.."'~N'~·;"""'···"··..·¡' ..,....'......... ....·......,..,..b~~~~Ay ; ~ 1): ... ~ T: ~ : : : :~..: . : : : : /:: W : : : : :~: ., . / . KFC : : : : I' ..:.. ........... ...,.........." ........,......, ....,..........j..................(...............,;.....,...........~/'~~~f:~..,....: ' ~ · · · ~/~~~FÞ .....~..... .I....mi..i,~m~~~~ ..~. .... ....~ Z : : ~ rë'Ul : ~: :I:: ~ . ' ,lËMJ· . ~...J: - , RR: ~ .~...............: ..........,....,!....,.........., '..,.. "....,;........,..,_. ~ ..d.. ..'.....'......'............ ~" 'Z ,....·~....'T ....: j(!): ~ ¡ ¡_ LI.: , : . , . ': " <C : 0: ~7:<!):: :::5 . A, L.!J ' " '0 ",.: io. : ~ ~ ~ ~...... ~ . ~ : IC~I~ : : : , :~ : ~ ..,..............!..... .....+";.. ........,......:......·......~MO .............~,................j.................,~':"'Io;~......, ,....,~............~' , 101 , " "Z ~ .'01. : : : ~ ~ : "-J. ~ 0: IE~~ ~0 ¡ ¡ : ¡ ¡~ ¡ d : ® COOLER [!!] .........,;.................,:..........,.... ........'........:. '...............'¡. ......, .. .~.., ........~...,..............~,.. ..,......, ~ ~: j FOOD PARKING LOl1 T-SHIRT . I:MAX . : 'OUTL·ET..,..:.. ....,....... ....,..........'... ..,;................, .......' ......lMšnsr'~......'......'........ .., ': : uu MALL . . Up. nn.. . KERN COUNTY HAZARDDOUS MATERIAL DIVISION BUSINESS NAME: ARoo FACILITY ID# 05420 A C . " -~ ,\ 1 2 - 3 4 5 .~ 7 8 ~, 9 0, ~',) ~ NORTH w ~ I 5 e e SITE/FACILITY DIAGRAM -FORM 5 OF --' -.~ '-, 1 I- o ~ 19 Z ~ 0:: « (l z w (l o ú.?;..Joð WI? [I). (p '2 SCALE: tYSINESS N~~E: NOT TO SCALE " AM/PM MINI MARKET 15175 DATE: 7/1(}/ 87FACILITY ~A.'tE: (CHECK ONE) SITE DIAGRA~ FACILITY DIAGR.~~ FIRE 6 HYDRANT ASH RD. ~~ #~/ I,) WATER ~"',~ . SHUT-oFF,D ~~'V~'). ~ , '.: ¿ ~~~ , Z I 10!Ç I· ----1 ~ ':141 '" ~o 'tó ~ --- ENTRANCE/EXIT DRIVEWAY GAS ISLAND GAS I ISLAND ENTRANCE/EXIT ~RGENCY FUEL \....Å)HUT-OFFSWITCH EBFIRE EXTINGUISHER SALES FACILITY REST ROOM (Inspector's Comments): -OFFICIAL ,USE ONLY- i-I ICAL - 5A - ~ ,r~ - \:.< ,', . . SITE. MAP 1: Business Name: Address: Phone: o 0:: w I (j) <t I >-1 <XI 3:1 wI ~I 251 ·-.a ., F'L PL ~ ~ GA~~ND -, GAS ISLAND V (12K") ~ \ FL _/"121<\ ( Fl) \. /- -/ 1'12K \ t FL ) '-.../ PL ~ - COOLER SALES AREA 1 DRIVEWAY ---- WH ITE LN AM/PM MINI MARKET #5175 ; 6450 White Lane, Bakersfield, CA 93309 . [805] 398-0393 ~~ , (J) RR PL ~ MAIN ELECTRIC PANELS ® MAIN WATER VALVE CD FIRE HYDRANT NORTH e SITE/FACILITY FORM 5 e DIAGRAM SCALE: BUSINESS NA~E: NOT TO SCALE AM PM MINI MARKET 5175 DATE: 7/101 87 FACILITY ~A.~E: (CHECK ONE) SITE DIAGR~~ ENTRANCE/EXIT FLOOR: OF 1 1 UNIT~: OF FACILITY DIAGR.~~ ffiFIRE WEXTINGUISHER OEMERGENCY FUEL SHUT-OFF SWITCH S ALE S ARE A REST ROOM OFFICE fìj 'MAIN PANEL (Inspector's Comments): -OFFICIAL -USE ONLY- - 5A - 'I " >, , ..' M I F'L I >-1 <II 31 ~I -I cr: o e e PSI #5175 6450 WHITE LANE *NOT TO SCALE QD MAIN ELECTRIC PANELS ® MAIN WATER VALVE <D FIRE HYDRANT ø STORM DRAIN AREA SALES ~ -À ~s~:~ (12K ) ~ \ FL -/42K\ ( Fl ) \. /- -/ /12K \ l FL ) '-..../ PL o 0: w I (f) « \I --- - - DRIVEWAY PL 1 f LN TE l;·-;'·"~-' " -.. ..:~ e Bakersfield Fire Departn¡a¡t Hazardous Materials Divisi" SITE PLAN DRAWING 3 I 4 5 6 7 1 2 A~ N . . F'L COOLEF! @ · . . . . · . . . · . . . . I rl <1:1 3, w · >1. -I ¿s¡ B · . . . . .S~L.E~ f',R.EA · . . . c PL .......~.... ~GA~ f12f0) : GAS~~: .\ .F L:/).;;__. . . . V. . . . . --(12K\ . \. FL.) -: tlZK \ ·t FL ) . "- ../ . . o ·cc · . . . . · . . . D w I (j) .« · . . . . · . . . · . . . E · . . . . · . . . · . . . F PL PL ~-- - -. · . . . . · . . . · 1. .DR! V'GWA '( · . . . G WH ITE LN · . . . . · . . . · . . . · . . . · . . . · . . . · . . . H · . . . · . . . · . . . · . . . · . . . · . . . · . . . I ~ MAIN ELECTRIC PANELS ® MAIN WATER VALVE 0) FIRE HYDRANT Business Name: Address: Phone: AM/PM MINI MARKET #5175 6450 White Lane, Bakersfield, CA 93309 [805] 398-0393 w ~ I $ . .' SXTE/FACILITY DIAGRAM -FORM 5 ú:;J5CJ LcJ/7. [I). SCALE: fYSINESS N~~E: NOT TO SCALE ' AM PM MINI MARKET 15175 DATE: 7!1(Y' 87FACILITY ~A.~E: (CHECK ONE) SITE DIAGRÅ~ FACILITY DIAGRA~ FIRE 6 HYDRANT ASH RD. ~ ICAL OF 1 I- a ,.....J 19 Z Y::: 0::: « 0-. z W 0- a ~:û /<~/I/,I WATER 0 ~~ ~/' SHUT-OFF I ~'V~)- 6;.'. . '.: J}.'V~~ .. Z I 10 ~ I· -1. ~ ,#41 ..~ ~ --- ENTRANCE/EXIT DRIVEWAY GAS ISLAND GAS 1 ISLAND ENTRANCE/EXIT ~RGENCY FUEL ~HUT-OFFSWITCH Ei7FIRE EXTINGUISHER SALES FACILITY EMERGENCY EXIT REST ROOM (Inspector's Comments): -OFFICIAL ,USE ONLY- - SA - · . ~..;,........."" ~.' ---, -""'~'-';''''''''''-'''~'-''.~ t:'- _-.." "':: .~ -~ - "-"--"''--'''- -.' .... .' --.. -,...,~ - ~". --- -.,.. . ..,~ . e - " FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE :L -} \-()~_ Section 2: Underground Storage Tanks Program iJ Routine 0 Combined 0 JOint.Agency 0 Multi-Agency ( " Type of Tank O\W F ~ Number of Tanks Type of Monitoring Ve?dU ót Type of Piping CL- Complaint· 0 Re-inspection , " OPERA TION C V COMMENTS Proper tank data on tile \f , Proper owner/operator data on tile ~ Pennit fees current ? X Certification of Financial Responsibility '" Monitoring record adequate and current )( Maintenance records adequate and current " / Failure to correct prior UST violations' '~,,;, /' Has there been an unauthorized release? , Yes No X " Section 3: Aboveground Storage Tanks Program I TANK SIZE(S) Type of Tank AGGREGATE ÇAP ACITY Number of Tanks OPERA nON Y N COMMENTS SPCC available SPCC on tile with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes. Does tank have overtill/overspill protection? I:~:~:';?J:a~ ~y~ Office of Environmentãl Servi~es (661) 326-3979 N=NO White - Fnv, Sves, Pink - RlIsincss k'OJ1V \ ' /?IIßle[, , Business Site Responsible Party -- e INSPECTION CHECK LIST L YES NO 1) Are fill boxes cleaned? 2) Is there excessive s ilIa e on island? 3) Are all "No Smokin "- "Turn 0 En ine" si ns in lace? 4) Is the address number visible and I" x 5" numbers? 5) Is the ESO (Emer enc Shut-Oft) visible? 6) Are there Pro ane Tanks or Tank(s) at facilit ? 6a) Is it recorded on customer chemical invento ? 7) Is there a Fire Extin uisher on dis enser island? 7a) If not on Island is there an Extin uisher near front door? 8) Are Extin uishers mounted? 9) Is Extin uisher 2A20BC rated? 10) Does UST Facilit have a cookin hood? 11) Has it been serviced and free from rease build-u 12) Are there an extension'cords bein used for ermanent wirin ? 13) Is there minimum of 30" in front of breaker anels? 14) If illuminated exits are all the lam s workin ? 15) Are co2 c linders chained? 16) Are an exit doors bein blocked? 17) Does the fuel monitor device indicate an roblems? 18) Is there a sticker on-the fuel monitor showin service date? 19) If UST site has cathodic rotection is rectifier workin ? 19a) Has it been serviced within (3) three ears? 20) Does customer have MSD's sheets and Emer enc Res onse Procedures? 21) Does customer have ade uate trainin records? 22) Is there sufficient absorbent material (kitt litter) on site? 23) If customer has waste oil is it labeled and have secure lid? f\ \ Í\~\~e. ·M ~~~\V ~ G:\HAZ\SHARED\CORRESPONDENCE\2003-IO\lNSPECfION CHECK LIST sUnderwood.doc 11-03-03 04:05pm From-TAIT ENVI~TAL ;EP 25 2002 10:52 BKSFLD FIRE PREVENTION 714-560-8237 411Þ. T-147 P.OI/OI F-398 (G61)B5~-~1?2 f.2 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 171S Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONIT.ORING CERTIFICATION J'. J'.:.. 1 ,.....,... ;" i... ;'. . ;; . tI , ( .. ,; ': , .. .. . FACD.JTY /kJco ~ S-if Zt:) ADDRESS, "o/$'O WA,*-. ~ OPERATORS NAME B P OWNERS NAME J) P ,".",' ',"'~. ",~' ............. .. to . 'Or.. ....._ ............ .. '. NAMBOFMON1TORMANUfA~' V-e.e..p~· Ape> T DOES FACILlTYHAVE DISPENSER,PANS? ~SA'''~",-, " NO_ TANK ., t ~ '3> , yo~1.JME '{(f\C- . ' " 'Ö ~-~'''''',.,...."...' C () \L . ',' CONTENTS ùl., ¡J)rclM.. ,g rJ i) , . ....- "'-' . '" ....-........ , NAMEOFTESTlNOCOMP~'iii-;";~- Ø'AJÍ; 'Sy:¡;.~ S CONTRACTORS UCENSE #I 5' 6. ~'~¿!;J , ~ NAME&PHONENUMBEROFCONTAcrPERSON~ ~rl:N~~ 711/$"6-' !Þf'/~ DA T.E &. TJM:E TBST IS TO BE C0]IIDU;CfED J 1-7 - [) -.3 (¿ / ¡; :00 A-H-" _vi:: da~ ,.>'¡¿=:;-a3 Á ~~ APPROVED BY " .. ___._.~. .pAm ~~ON!.\TtJRE OF APPlICANT . ..--..-..-......- . . -- -" . ~~V11-,10-,03 01:34pm From-TAIT ENVIROMENTAL e 714-560-8237 T-293 P.02/06 F-667 e MONITORING SYSTEV[ CERTIFICATION . For US~ ~.AJl J¡,¡rÜdicf¡'om Wjfh¡n th(! $tQte o¡CaI!fomio. ,AzJthONty C1teà: ChtU'tsr 6.7. Health a",à $t:if8ty Code; CI1tU'ta .r6, .DMsl'on 3, 'lI"tle23, Cahfol'ni,:¡ Code ofR£f!. ilatto1'l$ This fonn must ~e used to document tesüng and se:vicin¡; ofmorutosin@. equipment.. A 9~p81'&te certification or report rrI', ~st be prep81'f!'d far ~a.chmonitClring syst8!\} control pan81 by 1b.e tec:hr.ic:ian who p eti Of, tI.!: 'the work. A copy öflhis form must be proV': :1.edta the twk system owner/operator. The owner/operator must submit II copy ot U.is fonn to the locà1agency regulating UST sy~ tems withfu 30 days oftUt~&.t8, A. General Inform.atici:n. L~a~~~¥tjJ'T"9.më: Î ÄRcci'PRobucn¡'ëöI\Ï1PAÞTV --- ·ï ~ ¡-SeM~'e ~ía~!?:il:t~:Lls4iõ . .-- .. _. - L.~~~~~~,c.t~~_s_~~__16450 WHiTE LANE . r Cj!LläAKËR:SFÏELj) ".,-- ········IZI:n193: Ô9--·-'--~ ~ _.".~._- [Fäëfhi~c'';~i~~£.tf~i~J hi; l/ ~ l,~ IC ontat:tPhone No.·- .-rZ~7¿;··;;S3-~7- ··'-"·1· ~. ....~ (,c.(J t2N.,. ".,..,',,~..,'1í,.,.,..- .. Ll¥!~!~?,~,i.9iM~£Ùioiiñg-~y-Štëm:T¿/Ë£15Ë 7Z " ~-'7 ¿"i-~ 3-.rð--'j 'J~~!~·~,f.,f.~_~~~,~~~,~~'·L '?Z:;/öi' -I B. Ihvèntory of Equipment Tested/Certified CJœek the . ri2.tè 'hoxe$ to indicaœ eë:ific . :uœnt' ee1ed. ·se rvieed: == TwID: '7 1MkID: $' '""~tJ¡o-·~'Qa.?g!ngPt~~e: . .,.~p~e~::,-: ·:~t'~Gau~g~ro~e:., _~pdel:_L ..... _,~~pa.,~,~,9.t..V~~t_Se~~.~~:.. JIIIC?~~t 7'¡Ý1 , ,~\\lu:S.p~ce;o:Y.a~t~ensox:,.¥?del:_,~~J~ ._ ~,_ê~pry;'~~_~~,ª,~~sor,(~): ,Mo~~,l:" 7:;'-'$ -z.o&' ...~SS.u:tIplT:I'~~cb_~ens?r(s)~ ~_~del: 13'0/ )11.. ~p Sen~o~.,.(~): ..,.''" .. ..... . ,.,!YI.~d,eL 79¥3~,,\ -'UJIJ iI1~ump S!n90l'..(S)~,_ ., _ _, .~?..del: ~ ~~ _,_.ep'þ.~cal)~e,~~akpete.~to,r. .,.M~~~el:. F"..t" vi' !ech.wcal Line ~e~'pe~~~or,M~~~1: .L . eE~~_ruc~,e ~~ak P~.t~c~o~,}J[~~el:... lectronic Line Leak Detector Model: I '~r~SV~~~~le.)el~e:~%od~~hüort·Ëon Pa' e 2 " ~1~2¿ð~~~~,1~~:;~~~e'1t~:~ti~ ~ ònp'a a TwID: 1u.kID: ~~ ñ=t:t ~~~_~_c.~_--~..,f,?_'V,·,',t,.,·,~.'''.··.··~.·,:,·.s,·····ën;¡,O.".r,',·.:.'·',~,~¡'.'.·,",~.'..'....'"...".~.,:,._....:,'.·,',t,;.".', ¡'?7~ ð :rl; ~f.~º~~~g~~~?~",____"",__ _,~~de!:...f- - '"' m .. ]t ·1;~~~.7!~'rr~e.;?ern··..vc-·h·fI.~S"!-n~s~~!~~'" ,_-,..-MM,-~dd'~~el~~. ~ ' ~ SumplTnnch Sensor (s): I ~oð,l: 1?:7~ - ~o. !1?,~~t.iOJ,~~~p.~'~''''''"'~-'~'(~)-l'~''.''-r- eCh~:~~:{?~k[)~tect-ö~:-1-'~'~~:~~ -;: I - boB c': ~~~c~~t:~ì5"etëëïõr:··"'·'~~~:i~'r e ctronic Une Le ~ Det~ctõt""' ¡)i;;dëC 1 ~ ~·ëi.r:~ci~Drie' Leäkb'ef;'eïo¡;", ··..·Mo~~:-r ankosve~~ uile,~el:e:;~o~e~~~~:Ction·Eoñ-pa a-- !~r:s~~~~Iq~~~~i!k~~e;~~:~~~ ÇõnÞiê2'" ..serIQ:.. _, __, 'Z.. 1¡,sl¥lS~I1?:,_ _,.I 37 t.¡ .i ..~;f:..C0.!l~ent~~,nsors:... ~~~el:??¥3' - .0, ~s~:.c:I:)Et,~~~t~_~~~~):,,_..:.~~~~~:. 7~ ,~e8.!~~y.~~.2:_______, _L____:,_..,__ -L" ___,..____,_ ,~I,.._etl1'ya1ye(;J..._, __'. ,,,__.. ' ..~"j", . .. is enserContairnnentFlQa s andCh' s . ispenseJ;CantQimnentFloa.1(;;;) andCha.iri(s) ..~,~!.~º-:,,_,__ \ f ? Is,~se~:H2~,.._ _.._' :;:;r 9' â~t~~:~::~~j:;~~~ 1~;{~Z=::;;~~aJ:~~ ..v~ '_Z" DisEensedD: .. ...... [ls',ensedD: . . .~ - '_Þ.~.!ri?'!~þ~?~j,~e~t,~ens.OE: j M?dt!J:.. .;~~~'~is.pè~s.~r'.¢~~t~e~~s.~s,?r(S):,...........r ¥..~.~~l:... _: ~£le8!_~~~.~.L__ __._._, _, _ ,_u _ _, _ _ ,. ,~ ~ :h~ßr ,\La1y',~_(s}. .. ,__.. ..,. .....1.._ . ........... _. is enserContaitunentFlafí S &nðCh' S 3' ispenserCont&inment.Flaat(::;) andÇhain(s) ·Ifthe facility contaUts more tapks or dispensers, copy this form, lacl ¡d~ information for eV~rj tacl< an4 clisp ens er at t.hj ¡ facility. C. C ertific ation - I tertify tha.t the equipment identified in 1hÏ$ doc: m .ent was ~ec:-œdJse:nril:ed in '.c:ørdame with th manuf3mmeq1 guidelines. Atta£Jted· to . this Certifù~tionis infunna.tÏlln (e.g. ma: lU Fattuters' c:heck1U~) :ncc:eliisuy ÍIt wrify that tJW ürmatiøn is COn-t£1 and 1t P101 Plan showing the b.you1 ofnumi'tnring eq1ÙpmeJlI. for uy el).lÚpment l)~w1e ofge:1Ien.ting s~JI. n )OI'Ù, 1__ _ ~~~~,!.£..~yY.!.~.,~_~!!i..cl!,~_~g, L~~l !:l.2ply')_~, .. _, ~_S~,te~~. :t:.1JII_,_..~ ..~.~:tory ~~ ............, p" "~ .., ¡.._T~~hni,~~~I)me .(Print):: / <¿'Co iV ~ I~ i~a.tU;'~:. . i /n I (...c:,~~£~ti,op,~o.: ,_ __, .... (F..fd. ~ ~ I Licanse þ!o,:. .. ....... i 'J:esli1?:g ç.0!':le~Y_J::l:~~:. I T AIT ENVIRONMENTAL SYSTEM 3 t,.,~_~o?-e_!.'I.o_::.. Page I f 0310 1 11-10-03 01 : 34pm From-TAIT ENVIROMENTAL e 714-560-8237 T-293 P,03!06 F-667 e ~mtoringS~œ.m. Ceriificad.ln ,·.._.....--'-~-l---· ",,- ,,,,,,,,"..'..,,,---- ".. L,~~~~~_~~~ss: 6450 WHITE LAN1j: .-,-,-----....-. ,.. ·1..º,~~:~:~..fI~tin~eíýJ(:~i~,J ;ïtrft5--"·"-r D. R~sult~ Df Testing/Servicing l·----... . -""""'·'''''·''''·''''''''''''-''''''''1''---' ~o.;tw.~~~!..~rsion ItlstaUe~;_ "·"f'f{':·O r - ..--..- -1 Í1 the r..now· checklist: h the audiblè alarm 0 erationa1? 'I:> the visual alum 0 erationa1? Were aU sensors vl.sua11 ins ected. function~~ tu:ttH,i, and confum.ed operational? Were 1111 sensors in$hlled at lowest point of s ec )n4azy cOntilinment and positionecS so that Othl r eqtùpment 1Nill not interfere with their 1'0 e1' 0 eration? If !I111rnLS a.n: nlayed to a remote manitm1.1g :>tation, is 1111 coxnmunicatioDs equipmef) ~ (e,g, mode%1\) op era.t.iona1? For pre:;¡;,,;wized piping Ðystems, does the turllirH: automatically $hut down jfthe p~pìng second try contl1Ìmnent monitorin~ system (Meets a IDa1\. fails to ope~a1ycÆís electricaJly disco~e~yes: wbic~ sansou initiate positive shut-down? (CJxck all that apply) 1!!surnPITtmCh. Sensors; fI1Jispens!~,9~ ,ntSensors, Did you ~o1'l&mpoÐit4.Ve shut-down d~do le¡k~ md øensor1.t1Ì1wl'JfctisCQMec1.íon? l&'f!'Js; :ïi1 ~o. B Yes III ~ For twk systems that utW;e the monitorirJg system 8.19 the prim&1Y tank ovet1'i11 waming device (Ü, no ~/A mechanical· oved511 preY'ention valve is instaJle(~. is the cverim warning a1ðrm visible anó aUt ibIs at the tank fill oin s /Indo etat.in to or Ifso,atwh.ft-percentoftankee.p~citydoesthea1wutrig¡¡!;ez) "..% Was any monitoring equi.pm.ent replaced? If fe;, identify specific sensòr:¡¡. probes, or other eqt.: ,pmentupl~c"d M'ld,hst the n\&nufacturer l'UI.me ~dttl.odel for (n ¡epla.cem.eni p&rl.s in Section ~ below, Was liquid-found inside any seconcllbY cO%"J.ta.i:mcent systems designed as d*Y sY9tems? (Cheffk Q.lltht:tq:py) Product;.. Water, If es, describe cause!) in Section£, below. Wu ,monitorÎn s stem set-u nviewed to en IU!proper set~s? Yes No'" Is alhnonitQrin e ui ment 0 erational 8f ma~fa.cturer's specificatiÒns? -r I. ~ction E below. ðMcrih~ hø,v and w1œn these dtficieJ\Cleg v.ne or will be comc1d. - ~,~~.~~~.~:,...:I"-····'···"· -..- -~ ._. ,,-.- .m....' _.____... '-1 ===1 ~ j I I I j ===1 \ ~ - -~- Page hf:; 03.01 11-10-03 01 :35pm Frcm-TAIT ENVIROMENTAL ¡J~ti!\~~~~s: 16450 WHITEiÄNE .......~..,---. F.. In- T å:nk Gauging I SIR Equipmeut: 6450 WHITE LANE 714-560-8237 T-293 P.04/06 F-667 -...-.,.., ----- "-'T6~f; ~ì¡iV1clii:'--T iT15'7D"?-¡ .... ..,-, .-,~,.. wS _ I I Išj (;tf;cktÞ;is box.íftðrik gauging is used only roriny, ntoty eontto1. 11 ~h ~ 1:10: this b ox if no iank gð.uging or SIR ð quipmen is insta1le d. This section must be completed ìfin-tank gauging eqwpment i:: ued to perform leak. detection monit0rin&.' ComDleœ the folIaww checklist: 'Yes No'" Has allÙ1put wiring been inspected for proper ell Yes , No+ Were all tank gau.;ir¡.gprobu 'VÏsuaUyinspectec Yes No'" Was acc\.1fa()y of !lyshm product level readings Yes !fjNo'" Was a.Ccuracy of .yst~m water level reác1ings te:; Yes INo* W en: ~ pro'o~srl!i.n.st&lle d. properly? Yes '!!iI No* Were aJl items on the equipment manufact\.1fer':II tr rand te.,tiop, including testing for ground j ~ults? fc rda.m.age and r;sidue buildup? ~e::ted? ted? m:¡it!.tenañ.ce check1i;;t completed? .... *1:n:t1œ S~cti.on a, he(ow,.deseribe hpw'.and w1wn tlt.ese.deficienchQ were orwill.b~ çor.rec1d.. G. Line Leak Detectors (lLD): i Chlckthis boxifI.LDs a:Ulotin'tolled, " the fou.w·· checklist: No'" ,For equipm~nt st~up ?t annual equip~e~:~ '~tám~~on, was a l~~. simubtEU:t ~o verify u.r perfantlflnce? NfA (C~ck QU that 13pPIy) Simulated leak rate_ ~ g p.h. , œO.1 g.p.b. . œ¡O.2 g,p,h. Nate:;: 1. Rçquùed for equipment start-up Cef1 jfi, :~tion !n!iannu&! certification: 2, Un1e;¡¡s 'mandated by local agency, c ~rt(ficationreqi.1#'ed only for eleCUQnic LLDstut-u ). Were all liDs confirmed operation&! Mld accurae ·l7.Íthin regmatoty requ.ìtðmentS? . W~S the testing apparatus properly caJibrated? Foonechar¡jca! LlPs, does the LLD restrict produc ~ flow ¡fit detects a 1e6l<? For electJ:ot.IÍc UDs, does the tUrbine automaticf U) shut off if the LLD detects a leak? . For elecU()~c UDs, does the tUrbine a.utornaf.iç¡ill¡r shut offil any poztion of the mornto$g ¡¡ys em is elisa-bled ordiSl;onnected? For electrocic ,LLDs, does the t\\tbine automatic ~ T shut off if any portiOn of the monitoring syste: ,} ma3functions or fails a test? For electronic liDs, ,have aJl accessible wiring connections been v1suaJly inspected? Were allitems on the equipmentrnanufacturer's :neintenance checklist cornpll!teci? != * ¡n the SectiOn H, below. de$erihe hClw <Utd \V hen tJœse c1e6cieJU:fllS: we.re Clr will be cemeœ II. H. CQmments: -f - .~_. --. - ~ ¡ ~ ===1 ¡ I [ ._~-----_._-._. I ¡ I I I ! ¡ r ¡ ~ Page :1 Clf~ 03.01 11-10-03 01 :36pm From-TAIT ENVIROMENTAL . [J!~~:~.iiÏ¥i.~Sš:'~- !645ÕWHïfELANË" -"'~, ,.... . .. . 714-580-8237 T-293 P,05/08 F-887 . ---.·.¡¡¡,¡¡!,Siin-·õMo1il' 17/yil I ~"",_.,.e§.._",_,,...g_,,_,.1. 7' Monitoring System Certifica.tion UST Monitorin~ Site Plan .----- ...d.. ~ --- 'WH'rr£ 't.,..). . . . . . - :0 0" . . 'DI:.s:P~ . . . ;--:-8: 1J (;' . .-~ . ø' , :r;:. \r,¡ .:!:. f'\ ',tS :n~o: o . . . " ..,.- Date map wa:> drawn: _IJJ -2) EJ.... ¡nstruc~!!: !!! If you already have a diagrarothqt shows all required mfonllaion, you may include it, rather than this p ~ge. with your Monitoring System Certification. On your site plan, show tJle general layout of tanks and piping, Clearly identify locations of the following equipment. if installed: roonitorin?; system control panels; sensors roomtorin~ tank annular spaces, sumps, dispenser pans, spill containers, or other secoud.¡ry containment areas; meçhanical or elecl :onic line leak detectors~ and in-tank liqui.d level probes (if used for leak det~ccion). In the space provided. note the date this Site Plan was prepared: Page _(If,__ os~o 11-10-03 01:36pm From-TAIT ENVIROM~ . '. '. .. 714-560-8237 P,06/06 - T-293 ..4.... ~,.. Af(X) Products Company Mechanical Leak Deœ ~tor Test Data Sheet Station #: 5420 6450 WHITE LANE -- Address: Date: 1117/200 3 Product M¡¡nufac:turer Model Full Operating Pressure (psI) Line Bleed Back (mO Trip Time (see) Metering Pressure (psi) FÆ Holding Pressure (psI) Test Leak .Rate (mt/min) (gph) PASSorJ.'AlL Comments: Time: BAKERSFŒLD Test Inf,>rmatioD 1 ß ~ ..~ i <¡ ~ ~ ;t. ~ Z 3 4 S r I k- hI ') '0 .t"> '} ~!.ú :JS This letter certifies that the annual leak detf c10r tests were perfonned at the above referenced facility according to the equipIDt ~n t manufacturers procedures and limitations and the results as listed are to my :rnowledge true and COlTect. The mechanical leak detector test pass/fail is de'eJrnined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor: TAlT ENVIROJ-ntfENTAL SYSTEMS Technician ~:,ï!:",-€ Lic# ~o¿¡lf" Signature: ~~1:'7¿£ - F-667 " 1 _ eermit ~o. ß k - O":S2--/ CITY OF BAKERSFIELD ' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK -~ TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY btMODlFICATION OF FACILITY []NEW TANK INSTALLATION AT EXISTING FACILITY PROPOSED COMPLETION DATE EXISTING FACILITY PERMIT NO. ZIP CODE APN# PHONE NO. ''114 - c. '1 u· 50 30 ~ ZIP CODE ~(..I;) ~ CA LICENSE No.f¡ Qt (, ~ AQ~' CITY ì~ILIlA~"J: ZIP CODE C\l.)ç~ \ BAKERSFIELD CITY BUSINESS LICENSE NO. ('0) M.~\" A ...,,~ \.)~ú t.. A ) ~ WATER TO FACILITY PROVIDED BY N{~ DEPTH TO GROUND WATER M" SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED IV I A ARE THEY FOR MOTOR FUEL V' YES SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ........ YES (, TANK NO, VOLUME TANK NO. VOLUME APPLICATION DATE NO NO SECTION FOR MOTOR FUEL UNLEADED PREMIUM DIESEL A VIA TION REGULAR SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED (NO BRAND NAME) CAS NO. (IF KNOWN) CHEMICAL PREVIOUSLY STORED , ' FOR OFFICIAL USE ONL Y FACILITY NO. NO. OF TANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE A IT ACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. ( THIS FO HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS í TRUE _D CORR .. . / ~ ~ft\tw\\;\.S'. AI.J'\~,.. ~ ~ ~ APPROVED BY: ,APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~~ ~~ u ~ C Q)O --'''0 >0 Go ._ ~ --' E'- L. p, o UI 0 I/') - "'> I (f) ~.- Q) 0 .........g0_...... ü= C<o ::::I ~ O)'Õ ""0 :I: C a.- o £.- L. -q- ~e~~r::: O""~.::i.C......... ..!! L. Q) ........-ou (f) 0..." <0 0.......:; <0 o _-q-o U .- ...... o I ........ ~ I't') (f) a::: N () <0 3: ~ 0.... .:t a:J U c E c a.. c ...J PI#Cf , 65218-E'IR- 184042RT052 61\/SA-I020-EVII 1711T-7065 ISC-2100 VAPOR FSA-400 61WP-I02D-EVII 6J4TT -7065 15C-2100 F1lL W/ DRAIN 61JSK-4400-EVII 61T-7368 2J.MI-4433 J05XPAII00AKEYR 62.1Y P-110-18WT 53YIoL-312O RB-IIOO \/R-71IOO81-OO1 AINIII \/R-780095-001 SWITCH EQUIPMENT LIST .- , œscRIPI10N IlANUFACIIJRER IIOŒL' 1) ~2' DIAIIETER MUln-PQRT SPILL CONTAI~ IMHOI.E ... FIWÆ POIIECO 521 2) PHASE I BRONZE SWIYÐ. ADAPTER OPW 61YSA-E.YR 3) PHASE I VAPOR roP SEAL CII' OPW 1711T-E'IR G) ~~~~~'¡¡GCONTAlNIIENT. 5 GAI.LON opw 1SC-2100 5 FICE SEAL AIW'TER. PHASE I RISER, A10 RISER. ... F1lL RISER OPW FSA-4OO 6 FILL BRONZE S'M'IEl. AIW'TER opw 61WP-EVII 7 F1lL TOP SEAL CII' opw 634TT-EVII 6 't.. ~ CONTAINMENT, 5 GALlON CAST IRON. OPW 1SC-2100 _¡EVIl DRAIN VALlIE 9 JACK SCREW ASSEMBLY IN F1lL BUCKET opw 61.JS1(-4400-E'IR 10 SIRAIGIfT F1lL DROP l\JBE OPW 61T 11 FIT11NG, EXIIIACTOR. TEE. ~"X~ "X3"X3' opw 233 ~ TANK GAUGE PORT COIIPONENTS (CII' ... RING 1<11') MORRISON 8ROS. _A1100A1<EYR 13 11IRDDED PRESSURE VENT CII' opw 62.1Y - 1~ 18' WATER 11GHT 1WIH0lE (ANNUlAR) POMECO_ 15 3' X 12' IW.I.FI.OAT opw 53YIIL-3120 16 WATER SHIElD OPW 17 RISER SUPPORT OPW @ ~ ~/S1ROBE 12rNÞC \lEEDER-ROOT ~. --. - - \ ,I t --f PROPERlY ~ _ ëDNG VENT RISERS [ - - APPROVED BAKERSFIELD FIRE DEPARTMeNT' OFFICE OF ENVIRONMENTAL SERVICES -- --.... .- /'" I I BUIlDING EXIST1NG ~ 1 r E.S.O.~ NOTE: Acce~nce applies to plans as submitted and for con . 'iuction and/or installation thereon, subject to fi . nspecti / I tance, . ! ~ ? - L è "€J '> - Date n - I I I 3 I I " ~ ~ Z o ~ ---10 «< -O c.na::: Zw -:::I:< (/)- m<~ IOe Nw::i QZ< ..- :3 u Iwò r'V-...J w... _ w >:::I:- 3:~ a::: 0::: 0 w >10::'::; W~< tOm 5 ~ ij 8 o .. '" ;¡:!õ_ = biZ" ŒIt":J ~f~Go a ~__u z ~(:!~~ .. ~oi"':!t 11:111 ;dE"'t: .. - ~ ~,¡¡".:J a :-:..ã:~ ¡ :::g~~~ ~II conaultGnt Obi 08804 ma'" ~ de ~"'" 07/31/03 ntenam. FACO!I~fp 11<':;¡- 1 07 FacUlty Prol 05420 IIhHt n""", TK 1 -1 z :3 a.. LaJ !:: (I) CI z ä: a.. cIð ~ (I) ::> 01 I ~ " " 1 A10 CII' AND RIIG I<IT FICE SEAL ADAPTER 1 EXTR.\CTOR FIT11NG (BE'IOND) -"? ØAI.I. FlOAT VAl.1IE ~ LOCATED AT _ CN'ÞaIY -SET ALARII >0- . STRAIGHT --1 DROP l\J8E @ _tî ---.......¡ !! I EXIST. ~/ ~/ ~/ EXISTING PJ,c. UNIT / /. EXISTING DISPENSERS ON ISlAND (n'P,) 0\IERF11.I. ALARII W/ ACICNOWLEDGIIEN SWITCH ® INSTALLATION NOTES: BEfORE STARr OF SAW cumNG, REllrASURE TO CONF1RII THAT EXISTING MANHOLE flWE.JLII!I COIIPAT1BlE WIT!! NEW IIANHOLE LID. IF LÐ IS COIIPAn8I.E. DO NOT CUT UN11I. f1ELD ENGINEER HAS CONFIRIIED A NEED TO REPIN:E MANHOLE FRAIIE. CD CON11IACIOR TO SAW CUT 6' X 8' MINIMUM SECI10NS OF EXISTING TANK ~ AT £AQI _AY IS SHOWN, <D~ON~~ ~ F1U. SPU 8UCKE1S. RD/O\IE EXISTING DROP TUBE FlAPPER VAllIE (F AN't). <D CON11IACIOR TO INSTAl.!. NEW EVIl RISER AIW'TERS. CD CONIRACTOR TO INSTAl.!. NEW 5 GAI.I.ON SPILL CONTAINMENT 8UCKE1S AND IIANHOLE W/ FIWÆ AT £AQI TANI< F1l.L. EVIl \/R-102-8 COIIPlJAIf1'. INSTAl.!. NEW WATER SHIELD AND RISER SUPPOR1S AT £AQI FlU. SUMP. CDCONIRACTOR TO INSTAl.!. NEW F1lL DROP l\JBE AND BAI.I. FLOATS AT £AQI TANK. EYR \/R-I02-B COMPlIANT, (!) CON11IACIOR TO INSTAl.!. NEW RISER CQIIPON[NIS AT EXIST1NG TANK GAUGE RISERS. FIElD \IERIFY EXACT RISER L.OCAl1ON, EYR \/R-102-8 COIIPUNIT. . CD CON11IACIOR TO INSTAl.!. NEW PRESSURE VACUUM VENT VALlIE IS IŒED£D, AT £AQI GASOLINE VENT RISER, EVIl 1/R-102-8 COIIPUNIT, CD CON11IACIOR TO PATCH AI.!. REII<MD CONCRETE TO \lATCH EXlS11NG, <D INSTAl.!. NEW _AY AT EXISTING ANIIJIAA RISER. ® INSTAl.!. NEW \/EEDER-ROOT 0\IERF11.I. AlARM AND ACIOIOWlEDGWENT SWITCH. (VERIFY IF EXISTING) ® CONI1IACTOR TO INSTAl.!. NEW RISER OFFS£T AT VAI'OR RISER TO OBTAIN 16' O,C. FOR F1lL AND VAPOR RISERS, (WHEN EXISTING IS LESS T1IAN 16' O,c. ONLY) ~ V DETAIL (GASOLINE) N.T.s. ~IIIIIIIIIIIIIIIIIIIIIIIIIIIIII ffi;:~. ~ -,---" ~ -, :\.,\ . :\. :\. ::. ~' :\. . ~~. .' . . ¿ .... . .. ~""2' L lUCK SIm. RISER w/ PIPE eN> EXIIIACTOR FIT11NG @ ØAI.I. FlOAT VALlIE LOCATED AT 8~ CN¥QN @ ~TYPICAL TURBINE ELEVATION II.T.s. . WEST COAST PRODUCTS, w: IIASIÐI R£Y1SIONS - - RmSONS BY ~ _ _ 731/03 BID CONST. AS-9U1LT ~ I I 7'>~ : 7 I [5] . I i ¡ ( \ I & j \ II ) I ! I ¡ I I EXIST1NG / DRIVE ~ I / /~ ~ / ., / / '-' ~ STAGE VAPOR RECOVERY & -;;LL AINIII 2O""~"'/~' ACKNOWLEDGE srm. PlATE SWITCH PAINT TO \lATCH SITE 6' . ØOlURD 00NDI110N ~,W{¡ CONe. ~ ESO ~ WI' ENC\.. RECEPT. =~ t:~ I' RGS P\IC _ ¡: COATED ,,. . CONDUIT ~ ~ - DATE NO. NO. ~OVERFILL ALARM II.T.s. .-rAllY &1m ~ ......".. nIS DOa.IEICI' .MID YH! NORIM1JON tØØI MIAIIG 10 FRED f1EDI.ER IHD AS!5OC:W!S ItIG ITS CLDT HAS II!DI f\IIIrISH!D II CONfII!NC:r: RIft nc PRIVATE US! Œ JIIIrHQRIZED PØ!IDNNEL. NO PMr HIEJE7 SIW.L .: COPIED. r:uu::'A1!D. DISI'-.n!D. DISCI.OSED OR ... NIIII..MIZ. TO QIN!R! (lit usm TO lilt IX7IN1 WMU3CJE'iD IXaPI' AS DPRD!L.Y .tI.IIHCINZED .. ..nrc ... fIllED ÆIUJI .MID IiISSOCIIQØ MCJ ns QJÐCI'. IHt f'!RSOH. FI&I OR COII:POM'nON MC!MNG na DOCUMENT. ICJIItYER 0IT'MCm. SNM.L BY wnuE IØUF lIE DEDIID 10 HA.W AGREED 10 TIC .......... RESIIIIC!Ud. # ¡ [, ! f , I 1!1' 8 8 EXISTING CANOPY / / / j ~ -N- ~ I I / - -- PROPERlY LINE - - o EXIS11NG APPIIIW:H .~ ~ GRAPHIC SCALE rt. FUEUNG POSmONS NOZZLES EXISTING k/~¢ ~~, ~~ {¡ ~ \ LANE INTERSIIT1AL IIONIroR (n'P,) <D EXIS11NG FI.L. SUMP (n'P,) ~ 5 6 8 II EXISTING U,G, STORAGE TN«$. EXIS11NG 1UR8INE SUIIP (n'P,) WHITE Underground Service Alert ~ Cat!: TOll FREE 1 -800 227-2600 TWO WORKING DAYS BEFORE YOU DIG ~ o Ë en :~ E 'to « ::¡ CL <D '" '" o ..., o o N " 110 " '" o CI 3 "! ..., o I " o I '" .... o N ... '" o u o "- ./ E .2! en >- VI .. :J "- ./ en ë .. E :J U o '" " ~ u ~ " o u ~ E .. CL o o ..., ./ " CI ¡;; .. '" ./ ... o 110 110 :? VI .... U w o 0:: CL ./ CI ~ ~ '" ./ en <:; .. 'õ' .t « "- "- w I « ./ ê:i , 'tá... o EXISTING TANK SIÆ Th I I I I c c( ~ W :J: tn c( o EXJS', PIANTtR :/ ('/ '" JUN 18 2003 8:10 ( ---- 'C BKILD FIRE PREVEN;T I ON (661)852-2172 - Permit No. 19 1: - 0'3> 0 l- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326..3979 ¡o . :~. PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK ( WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER /f/ /IT NO NO TANK NO. I ;Z .~ VOLUME 1</ Q{¡ ~ ::I.. ()I()() 1~ :0«) TANK. NO. VOLUME I'¥I/l YES YES SECTION FOR MotOR FUEL UNLEADED ;( ¡( ~, REGULAR DIESEL AVIATION PREMfUM . , ¡)( SEmON FOR NON MOTOR FÚEL STORAGE TANKS CHEMICAL STORED (NO BRAND NAME) CAS NO. CHEMICAL PREVIOUSLY STORED (IF KNOWN) ,.. FOR. OFFICIAL USE ONLY APPUCATION DATE FACILITY NO. , NO.OFTANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILI1 COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS F HAS BEEN COMPLETED UNDER PENALTY OF PEiuURY, AND TO THE BEST OF MY KNOWLEDGE, IS TR 'DC .1 ~ . . _8f2t¡}vJ t!tfa11tP~ ~~/ . APPLICANT NAME (PRINT) A L NT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED l ;r:'i-- ARCO #05420 . v'~ <\ '" A/JI1S/'~r /NC- EDMOND l'T:à~~~R !'þ/J'/ðN'D 6450 WHITE LN BAKERSFIELD <'''6'..1 M4SSI9I'¿ 1.ij.~ ~~\.\\ /___ [._...--;;-.s ~ \ ,/ 1/ /' I . 'i::)-J V . SiteID: 015-021-000629 Manager : Location: City BusPhone: Map : 123 Grid: 15A (661) 398-0393 CommHaz : UnRated FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 09 EPA Numb: SIC Code:5541 DunnBrad:51-012-0713 Emergency Contact EDMOND NASSAR Business Phone: 24-Hour Phone : Pager Phone / Title / FRANCHISEE (661) 398 Q39~ ð29:d ( 661) f¿¿~~S; ,._ ~p~'/ 'J ( )- .-: - .-" -':~ Emergency Contact / Title ARCO MISSION CONTRO / Business Phone: (800) 272-6349x 24-Hour Phone ( 800) 272-6349x Pager Phone : ( ) x Fire Press ImmHlth DelHlth Phone: (714) 670-5321x State: CA Zip 90702 Phone: (714) 670-5321x State: CA Zip 90702 TotalASTs: Gal TotalUSTs: = Gal RSs: No Hazmat Hazards: Contact : MICHAEL D. WILSON MailAddr: PO BOX 6038 City ARTESIA Owner Address City BP WEST COST PRODUCTS LLC PO BOX 6038 ARTESIA Period Preparer: Certif'd: ParcelNo: to Emergency Directives: < " &~/ Mt.c;¡ Do hereby certify that 8 h (Type or print name) av reviewed the attached hazardous materials manage ment plan for ~~ 5;1':<{) . (Name of Bu8Ine~) and tha~ It along wit any corrections constitute a complete and correct man- agement plan for my facility. 1f£J·~> Signature . .. ?4¿~ / Date -1- 06/16/2003 -/--- - e v ARCO # 05420 6450 WHITE LANE BAKERSFIELD, CA 93309 Hazardous Materials Business Plan 1. FACILITY INFORMATION SECTION To be completed by all businesses, regardless of program type. Fonns included in this package complies with fonns/attachment required by the appropriate city or county under which the Unified Program Agency applies. This Hazardous Materials Business Plan includes: [gJBUSINESS ACTIVITIES PAGE [gJ BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE [gJEMERGENCY RESPONSE CONTINGENCY PLAN [gJHAZARDOUS MATERIALS INVENTORY LIST [gJF ACILITY SITE MAP 1 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # Page 1 of _ 2, EPA ID # (Hazardous Waste Oilly) CAL000244300 BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3, ARCO #05420 6450 WHITE LANE, BAKERSFIELD, CA 93309 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does our facili ... If Yes, lease com lete these a es of the UPCF... A.HAZARDOUSMATEmALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) 1. Own or operate underground storage tanks? 2. Intend to upgrade existing or install new USTs? 3. Need to report closing a UST? C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? Treat hazardous waste on site? 3. 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5. 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? E. LOCAL REQUIREMENTS 181 YES D NO 4, 181 YES D NO 5, D YES 181 NO 6, DYES 181 NO 7, DYES 181 NO 8, 181 YES D NO 9, DYES 181 NO 10. DYES 181 NO 11. DYES 181 NO 12. DYES 181 NO 13, DYES 181 NO 14, HAZARDOUS MATEmALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Formerly SWRCB Form A) UST TANK (one page per tank) (Formerly Form B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) UST TANK (closure ponion - one page per tank) NO FORM REQUIRED TO CUPAs EP A ID NUMBER - provide at the top of this page RECYCLABLE MATEmALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Forms 1772 A.B,C,D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) REMOTE WASTE I CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 11 %) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249) (You may also be required to provide additional information by your CUPA or local agency,) 15, e e UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION P"JIIT,:o. nf I. IDENTIFICATION FACILITY ID # I I I'J~~I, I I [;!~I I I I I 11. I BEGINNING DATE 100, I ENDING DATE 101. (Agency Use Only) 01/01/2003 12/31/2003 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3, I BUSINESS PHONE 102, ARCO # 05420 661-398-0393 BUSINESS SITE ADDRESS 103, 6450 WHITE LANE CITY 104. I CA ZIP CODE 105, BAKERSFIELD 93309 DUN & BRADSTREET 106, SIC CODE (4 digit #) 107, 03-959-6507 5541 COUNTY 108, KERN BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE llO, EDMOND NASSAR 661-398-0393 II. BUSINESS OWNER ", . . OWNER NAME Ill. OWNER PHONE ll2, BP West Coast Products LLC 714-670-5321 OWNER MAILING ADDRESS: BP West Coast Products LLC 113, P.O. BOX # 6038 CITY 114, I STATE 115, I ZIP CODE ll6, ARTESIA CA 90702-6038 ill. ENVIRONMENTAL CONTACT ., CONTACT NAME 117, CONTACT PHONE ll8, MICHAEL D. WILSON 714-670-5321 CONTACT MAILING ADDRESS: BP West Coast Products LLC ll9, P.O. BOX # 6038 CITY 120, I STATE 121. I ZIP CODE 122, ARTESIA CA 90702-6038 -PRlMARY- IV. EMERGENCY CONTACTS -SECONDARY - '. " NAME 123, NAME 128. EDMOND NASSAR ARCO MISSION CONTROL TITLE 124, TITLE 129. FRANCHISEE BUSINESS PHONE 125, BUSINESS PHONE 130, 661-398-0393 F AX# 661-398-9317 800-272-6349 24-HOUR PHONE* 126, 24-HOUR PHONE* 131. H.661-665-2047 800-272-6349 STORE # 661-398-0303 127, 132. ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete, SIGNA TUfJj/l:B!-oPfjRA T,SJR OR DESIGNATED REPRESENTATIVE DATE 134, I NAME OF DOCUMENT PREPARER 135, ì Æ U ..;...;;;;- 02/22/03 Georee Zoumalan. Ramtox NAME ð"F SIGNEI{'(prinl) 136. TITLE OF SIGNER 137, MICHAEL D. WILSON Environmental Specialist _ ,," :ÇI:fY(>F B~KERSFIELJ) '... ' e DOFFICE~FE~IRØNMENTAL SERVI€ES , T 1715ChesterA'\(~¡,B~kersfièld, Ck(66IP26-39179 i I HAZARDOUS MATE IDAL S MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt 2. TYPE/PRINT ANSWERS IN ENGLISH 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner/Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I below for initial submission. SECTION I BUSINESS IDENTIFICATION BUSINESS NAME: ARCO # 05420 LOCATION: 6450 WHITE LANE, BAKERSFIELD, CA 93309 MAILING ADDRESS: BP West Coast Products LLC CITY: P.O. BOX # 6038 STATE: CA ZIP: 90702 PIDMARY ACTIVITY: GASOLINE RETAIL STATION & MIN MARKET PHONE: 661-398-0393 OWNER: EDMOND NASSAR PHONE: 661-398-0393 MAILING ADDRESS: 6450 WHITE LANE, BAKERSFIELD, CA 93309 EMERGENCY NOTIFICATION CONTACT TITLE BUSINESS PHONE 24 HR PHONE 1. EDMOND NASSAR STORE: 661-398-0303 FRANCHISEE 661-398-0393 661-665-2047 2. ARCO MISSION CONTROL 800-272-6349 800-272-6349 I HAZARDOUSMATE~SMANAGEMENTPLAN 4t SECTION II DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Gasoline in underground storage tank can over spill from the top of the fill pipes or leak in the ground and to the surface. Other source of leak/spill is from the dispenser unit, nozzles, and pipes. Potential of fire and explosion exist. If a leak is found the leak probe will sense the liquid release and will set off the alarm. Other hazard is carbon dioxide gas cylinders used for soda drinks. The carbon dioxide gas cylinders are secured by chains in back room. B. EMPLOYEE AND AGENCY NOTIFICATION: In the event of minor to major spill, or fire, employee or owner will call 9-1-1 and local agency. Employees are trained for the use of personal protection equipment to minimize contact with hazardous materials/waste. OFFICE OF EMERGENCY SERVICE: 1-800-852-7550 NATIONAL RESPONSE CENTER: 800-424-8802 BAKERSFIELD ENVIRONMENTAL HEALTH SERVICES: 661-862-8700 C. ENVIRONMENTAL RESPONSE MANAGEMENT: If a large release of gasoline spill or waste occurs, the owner, or store manager, or employees will take immediate action to have all employees leave the premises by the safest exit. All employees will be asked to assemble at a safe assembly area located at North side of the site, or at a safe upwind location. Method of evacuation is verbal. Person responsible for notification is: NAME: EDMOND NASSAR TITLE: FRANCHISEE D. EMERGENCY MEDICAL PLAN: For small injuries the owner or store manager will utilize the first aid kit box. For minor to major injuries, the owner, or store manager will call either 9-1-1, or may contact the closest medical/clinic center, which is located at: NAME OF THE HOSPITAL & TELEPHONE NUMBER: MERCY HOSPITAL 2215 TRUXTUM AVE. BAKERSFIELD, CA 93301 TEL: 661-632-5000 2 e SECTION II RELEASE RESPONSE PLAN e Emerl!encv Procedures: Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials: 1. PREVENTION (prevent the hazard) . Describe the kinds of hazards associated with the hazardous materials present at your facility. What actions would your business take to prevent these hazards from occurring? You may include a discussion of safety and storage procedures. Gasoline spills can result in environmental contamination, fire, and explosion. Releases of gasoline can occur when underground storage tanks are overfilled, when motorists overfill vehicle tanks, or drive off. The releases are prevented by installed overfill devices such as flapper valves, high level alarms, or ball floats. Other spill prevention devices are impact valves, and breakaway devices. Service stations are attended by trained personnel, and gasoline is delivered by trained truck drivers. The on-site coordinator or designee will train all new employees of this facility about the procedures for safe handling of hazardous materials and products for emergency response coordination, and use of emergency response equipment and supplies. Additionally, the on-site coordinator or designee will conduct a refresher-training program for all employees on annual basis. PROCEDURE FOR STORAGE AND DISPOSAL OF HAZARDOUS MATERIALS & HAZARDOUS WASTE: Liquid CO2 cylinders must be secured to wall with chain (this applies for stations that serve soda in the store). Waste absorbent from the gasoline spill, cleanup spills, or used gasoline fuel filters must be stored in a proper UN (DOT) approved container with appropriate hazardous waste label on each container. Each drum or container containing hazardous waste must be stored away from hot or ignition sources and disposed before 90 days from accumulation date. Each container must be kept closed with lid and disposed as hazardous waste and manifested. State manifests of hazardous waste must be kept for three years in compliance kit. The hazardous material handled on daily basis is gasoline. Hazards associated with this product are spill, leak, fire, and explosion. Fire Prevention procedures as follows: 1. The gasoline tanks are equipped with leak detectors that activate an alarm and disable the pump when leak is detected. Few gas stations are equipped with over fill alarm that prevents the spillage of gasoline from over filling the tanks. 2. All the dispensers are equipped with impact valves. 3. Daily inspection of leaks from the pipes, nozzles, and pumps. 4. Any leaks from above mentioned equipment will be fixed immediately. 5. Posting no smoking sign at the dispensers. 6. Monthly inspection of fire extinguishers to ensure that are full and ready to use. 7. Testing of the emergency shut offs located in front of the store. 8. Testing of dispensers' start/stop emergency shut off located on the cash register. 9. Testing the shut offs of turbine pumps. The on/off switch is on the main electrical panel. Gasoline spills will be cleaned-up immediately using absorbent material 3 2. MITIGATION (reduce the had) - Describe what is done to less.he harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, spill, fire, explosion, or airborne release at your business? Mitiaation (continued): In the event of a leak or spill: 1. Attendant should shut off electricity to the pumps/turbines at the main electrical panel and close the impact valves. 2. The on-site emergency coordinator or designee will contact 911 (Fire Department) and explain the emergency and will contact ARCO MISSION CONTROL. If necessary, the On-Site Emergency Coordinator or designee will request an ambulance or other medical assistance. 3. Evacuate. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. There are two exits - front entrance and rear emergency exit. All persons will evacuate through one of these doors and gather in area furthest from danger. Manager on duty will account for all station personnel and customers (when possible). 4. Contain the liquid by constructing berms and/or by covering the spill with a fireproof absorbent material. Prevent liquid from entering storm drains whenever possible. 5. Scene management shall be the responsibility of the On-Site Emergency Coordinator or designees until the arrival of fire or police personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer any assistance that is requested. 6. Immediately following an emergency the On-Site Emergency Coordinator will provide for the disposal of contaminated material as directed by the local Fire Department or County Health Agency. (All spills will be reported to BP Mission Control at (800) 272-6349. The BP Environmental Compliance Specialist will make report to pertinent agencies including NRC,CA OES, Water Board, and County Health Agency.) 3. If neither gives such direction, call ARCO Mission Control for removal and disposal. In the event of a fire employees should: 1. Shout FIRE and call 911 (Fire Department). 2. Stop fluid flow by shutting off electricity to the pumps at the main electrical panels and close impact valves. 3. Evacuate by stopping all traffic on site and direct all personnel and customers to a safe area opposite the danger. 4. Scene management is the responsibility of the On-Site Emergency Coordinator or designees until the arrival of public safety response personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer assistance, as requested. Additional mitiaation procedures: Employees will be informed of the health and safety hazards involved with the handling of hazardous materials such as gasoline. Employees will not smoke, light matches to cause a spark, or ignite flammable liquids or vapors. Employees must know: 1) LOCATION OF EMERGENCY SHUT OFF SWITCHES, HOW TO STOP LEAKS AT NOZZLES AND GAS ISLAND, 2) SHUT OFF PUMPS WHERE ELECTRICAL PANELS ARE LOCATED, 3) LOCATION OF FIRE EXTINGUISHERS, 4) USE OF ABSORBENT MATERIALS TO CONTAIN SMALL GASOLINE SPILLS, 5) CALL 9111N THE EVENT OF A MAJOR SPILL, LEAK, FIRE, OR EXPLOSION. EMPLOYEES WILL BE FAMILIAR WITH THE EMERGENCY RESPONSE PROCEDURE AS OUTLINED IN THE BUSINESS EMERGENCY RESPONSE PLAN. 4. ABATEMENT (remove the hazard) - Describe what you would do to stop and remove the hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing of released materials at your facility? 4 - e In the event that a spill is small, station personnel should apply absorbent to the gasoline spill by sweeping the absorbent onto the spill. Once the absorbent has soaked up the liquid, sweep up the absorbent and place it in a 55-gallon drum. If the spill is larger, call 911, attempt to contain it, and follow the scene management instructions in Section 2, Mitigation. Large spills are cleaned by BP designated contractors, or as designated by the franchisee for franchise service stations. Employee's responsibilities: Employees will know the location of the nearest storm drain(s) and location of absorbent material to be used to prevent the spill from reaching the storm drains. In the event of a major spill, employees are instructed to call 911 and report. The on-site emergency coordinator will provide for the disposal of contaminated materials as directed by the local fire department or County Environmental Health. If neither gives such direction, call ARCO Mission Control (800-272-6349) for disposal. BUSINESS PLAN LOCATION: A copy of business plan and training documents will be kept at all times in a yellow compliance kit or a binder, which is located either near the cashier, or office in back room area. Followin are the emer enc Use Fire Control Spill Control Minor Injury ment of this facili : Location Entrance & kitchen area Back room/Su ly room Inside office or cashier Maintenance Yearly Service Re-stock as needed Inventory twice a year Item Fire extinguisher Spill absorbent First Aid Kit UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE : NO ELECTRICAL: ELECTRICAL PANEL IN THE BACK ROOM WATER: SIDE WALK SPECIAL: LOCK BOX: DYES [gINO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: FIRE EXTINGUISHERS LOCATED AT ENTRANCE DOOR, INSIDE THE STORE, AND IN THE KITCHEN AREA A. B. PRIVATE FIRE PROTECTION DYES [gINO WATER AVAILABILITY (FIRE HYDRANT): N/A 5 e e Emergency review of liquefied ( Cryogenic) Carbon Dioxide Liquefied carbon dioxide is an extremely cold liquid! gas and is stored under high pressure in a gas cylinder. The small gas cylinders, containing 20 to 50 pounds of liquid carbon dioxide, must be stored upright and be finnly secured with chain to the wall. Those large cylinders (containers), which contain 200 to 400 pounds of liquid carbon dioxide, must be either chained or anchored to the floor. Securing the cylinder prevent falling or being knocked over. All the gas cylinder must be capped at all times and transported with drum cart. The extremely cold part of pipes and valves on top of the cylinder will cause moist flesh to stick fast and tear when one attempts to withdraw from it. A leak will result in the fonnation of dry ice, and contact with dry ice, liquid carbon dioxide, or cold gas can cause frostbite to skin, eyes, and exposed tissues. Breathing low concentration of carbon dioxide can cause nausea, dizziness, mental confusion, and visual disturbance, shaking, headache, and respiratory problem. Liquid carbon dioxide has a high evaporation rate and when heated to above 52 Degree C (125 Degrees F) will generate high pressure. Store away from heat and ignition sources and out of direct sunlight. High temperature can generate high pressure in the tank/cylinder and cause rupture if the safe relief valve fails to operate. Do not store the container or cylinders where they come into contact with moisture. Response Plan for Carbon Dioxide Release Carbon dioxide is cold, asphyxiant, and powerful cerebral vasodilator gas. In the event of release, evacuate the store, and allow the liquid! gas carbon dioxide to evaporate and the gas to dissipate. Attempt to close the main source valve to stop the release is not recommended unless if is safe to do so and you have adequate personal protection gears. If the area must -be entered by emergency personnel, Self-Contained Breathing Apparatus (SCBA), Kevlar gloves, and appropriate foot and leg protection must be worn. . Response to Carbon Dioxide Release If there are signs of visible ice on the cylinder or parts such as pipes, it is a sign of a leak and needs to be reported to your manager immediately. In addition, the Facility Manager will contact their vendor immediately. In the event of a major release, call 911 and evacuate the store. Do not attempt to close the main source valve to stop the release. Emergency personnel such as trained fire fighters must wear special protective equipment to safely respond to a leaking C02 cylinder. 6 e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 1-2 PERSONS PER SHIFT, THERE ARE THREE SHIFTS AND TOTAL EMPLOYEES ARE ABOUT 5 MATERIAL SAFETY DATA SHEETS ON FILE: MSDS and business emergency plan is located in the compliance binder, a yellow plastic box, located in the office area BRIEF SUMMARY OF TRAINING PROGRAM: Employees are trained on use of safety equipment and tools to minimize contact with hazardous materials/waste. Employees are trained and required to dial for emergency calls, 9-1-1, and evacuate the premises. Employees are trained in the use of spill clean up , first aid kit, fire extinguishers, electrical and gas shut off and use of telephones. Employees are trained to advise any response agency as to the nature and location of the problem. Initial training is conducted after hiring new employee. Trainer is the owner or manger of the store. Refresher training is done every year. Training topics are such as : 1) hazard communication program, 2) materials safety data sheets, 3) safe handling of chemicals, and 4) emergency equipment& emergency response plan. 7 " ,\ &æLO'r1E·g, rBAINlNG: PR(JGl.ì/tí1. '" ;I:' Employers are required by State law to have a program which provides employees with initial and refresher training. The Business Emergency Plan shall include a training program which is reasonable and appropriate for the size of the business and the nature of the hazardous materials handled. The training program shall take into consideration the responsibilities of the employees to be trained. Training will be conducted upon hire, and refresher training provided at least annually. Hazardous Materials Handlina & Emerqency Response Trainina Will Include: 1. Methods for the safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material and measures employees can take to protect themselves from chemical hazards 2. Procedures for coordination with local emergency response organizations; 3. Correct use of emergency response equipment and supplies under the control of the business 4. The Cal OSHA Hazard Communication Standards 5. The prevention, abatement and mitigation procedures you have developed for your business and explained on the Business Emergency Plan 6. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care 7. Procedures to coordinate with and assist the local emergency personnel that may respond to your business 8. Who and how to call for immediate assistance in the event of an accident involving hazardous materials 9. Procedure for ensuring that appropriate personnel receive initial and refresher training UST Eauipment Operatina and Monitorinq Trainina Will Include: 1. Take tank level measurements 2. Read dispenser meters 3. Inspect equipment 4. Recognize warning signs: dispenser hesitations, meter spins, and odors 5. Manually close dispenser impact valve 6. Replace dispenser filters 7. Shut down the system by knowing the location of electrical panel breakers and emergency shutoff switches 8. Test the electronic monitoring system 9. Respond to alarms, leaks, or equipment problems r j '~t Ail" ·.A~L;E·MR4QYEE··T~INING· $I¡IAIi-:lii!BE Dò,CiQM~Nj~D;~~r.fb''lJpDA:TED"ÄNNUA:I;!iY'';4 ¡ i., ';_<·0 J; Personnel 1. Are there any specially trained hazardous materials emergency response personnel at your business? 0 YES [8J NO 2. Do you have decontamination capabilities for victims of exposure to hazardous materials at your business? 0 YES [8J NO 3. Do you have personnel that will provide site security at your business during and after a hazardous materials incident? 0 YES [8J NO Equipment List the type and location of equipment that can or will be used for response to hazardous materials incidents at your business: Absorbent, a shovel and a broom are located in or near the station supply room. All waste absorbent will be disposed of in a properly labeled hazardous materials drum. 8 The On-Site Coordinator or designee will train all new employees of this facility about the following procedures for the sa*ndling of hazardous materials, procedua for emergency response coordination, and use mergency response equipment and su~s. Additionally, the On-Site coordinator or designee will conduct a refresher-training program for all employees on a semi-annual basis. PROCEDURES FOR SAFE HANDLING OF HAZARDOUS MATERIALS 1. Employees will be informed of the health and safety hazards involved with the handling of gasoline/diesel fuel. 2. Employees will be careful not to spill gasoline, diesel fuel, or waste oil onto themselves or the ground. 3. Employees will not smoke, light matches, cause sparks, or take actions which could ignite flammable liquids or vapors. PROCEDURES FOR EMERGENCY RESPONSE COORDINATION 1. Employees will be familiar with the emergency response procedures outlined in this Business Emergency Response Plan. 2. Employees will know the location and operation of electrical shutoff switches and dispenser shutoff valves. 3. Employees will know the location of, how and when to use dry chemical fire extinguishers that are located on the premises. 4. Employees will know the location and proper use of first aid kit(s), fire extinguisher(s), and absorbent materials that are located on the premises. 5. Employees will know the location of the nearest storm drain(s) and location of absorbent materials to be used to prevent spills reach the storm drain(s). 6. Employees will be familiar with the kinds of emergency situations which will warrant immediate evacuation of premises. Circumstances include: a. Any gasoline, diesel, or other type of fire. b. Any spill, fuel leak, or vapor leak that has the potential for igniting or exploding. c. Any spill or leak where employees or customers notice gasoline vapors. EMPLOYEE TRAINING RECORDS The BP manager, for BP store, or owner/operator (for franchisee) will be responsible for documenting and retaining the types and dates of the "training" that each facility employee has completed (initial and refresher). These documentation records will be retained at the facility for at least 5 years from the date an employee last worked at the facility. Upon completion of said instruction, employee will sign a statement of acknowledgment. One copy kept at the facility. TRAINING SUBJECTS: Training Topic - Procedures for handling hazardous materials, including hazardous wastes Persons Trained: Facility Staff (i.e. cashier, maintenance) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: For minor spillage (i.e. customer gas tank overflow), employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean up equipment is provided at each facility. For major spillage, employees are instructed to call 911 and report. They will then notify the BP manager, for BP store, or owner/operator (for franchisee), or his/her alternate who will then activate the notification process. Training Topic - Procedures for coordination with emergency response agencies Persons Trained: Facility Staff (i.e. cashier, Emergency Coordinator, Alternate) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Facility personnel are instructed to call 911 and report. They will then call the BP manager, for BP store, or owner/operator (for franchisee), or his/her. alternate who will then activate the notification process. Training Topic - Use of emergency response equipment and materials under business' control Persons Trained: Facility Staff (i.e. cashier) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Use and location of absorbent, protective clean-up equipment, first aid kit and fire extinguishers. Review of procedures for proper use of safety and spill control equipment, evacuation and earthquake procedures. Training Topic - Emergency Response Plan implementation Persons Trained: Facility Staff (All Employees) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Review of Emergency Response Plan; evacuation procedures; location of emergency fuel shut-off switches and main electrical shut-off switch; use and location of absorbent, protective clean-up equipment and fire extinguishers; and the list of ALL pertinent people to call in. 9 - e CERTIFICATION I, _ MICHAEL D. WILSON CERTIFY THAT THE ABOVE INFORMATION 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. S DATE ENVIRONMENTAL SPECIALIST TITLE 10 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on oneform) D MATERIAL(NON-WASTE) ~ WASTE DADD I8IREVISE REPORTING YEAR 2003 I. FACILITY INFORMATION DDELETE BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM FACILITY ID # CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) F8 1 of 1 II. CHEMICAL INFORMATION 205 TRADE SECRET Yes 181 No CHEMICAL NAME WASTE ABSORBENT COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER CAS# N/A If Subject to EPCRA. refer to instructions 207 209 EHS* 0 Yes 181 No 208 *If EHS is "Yes", all amounts below must be in Ibs, 210 213 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE Db, MIXTURE 181 c, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) 211 RADIOACTIVE DYes I8INo 212 CURIES 214 LARGEST CONTAINER 55 181 a, SOLID Db, LIQUID D c. GAS 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH De, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT STATE WASTE CODE 25 55 55 221 UNITS' Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in ounds, D a, ABOVE GROUND TANK Db, UNDERGROUND TANK Dc, TANK INSIDE BUILDING 181 d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM D f, CAN D g, CARBOY D h, SILO D i, FIBER DRUM D j,BAG D k, BOX D I. CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D o. TOTE BIN D p, TANK WAGON STORAGE PRESSURE 181 a. AMBIENT D c, BELOW AMBIENT D b. ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D d, CRYOGENIC D b, ABOVE AMBIENT D c. BELOW AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS 89-90 226 WASTE ABSORBENT & DISPENSER FUEL FILTER 227 DYes 181 No 2 230 231 DYes 0 No 3 234 235 DYes 0 No 4 238 239 DYes DNo 5 242 243 DYes DNo CAS # 228 N/A, MIXTURE 232 236 240 244 If more hazardous components are present at greater than 1% by weight If non·carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 3 202 204 206 215 216 220 222 223 224 225 229 233 237 241 245 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) D WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2003. I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM FACILITY ID # GRID# (optional) B8 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 1 of 1 II. CHEMICAL INFORMATION 205 TRADE SECRET DYes CHEMICAL NAME CARBON DIOXIDE COMMON NAME CAS# 124-38-9 FI RE CODE HAZARD CLASSES (Complete if required by CUPA) 207 209 If Subject to EPCRA, refer to instructions EHS" 0 Yes 181 No "If EHS is "Yes", all amounts below must be in Ibs, HAZARDOUS MATERIAL TYPE (Check one item only) 211 RADIOACTIVE DYes I8INo 212 CURIES 181 a, PURE Db. MIXTURE 0 c, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT o a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 400 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 0 d, ACUTE HEALTH D e, CHRONIC HEALTH 200 N/A 217 MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT STATE WASTE CODE 400 221 UNITS' Check one item ani STORAGE CONTAINER Da, GALLONS Db. CUBIC FEET 181 c, POUNDS D d, TONS " If EHS, amount must be in ounds, D a, ABOVE GROUND TANK Db. UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM De. PLASTIC/NONMETALLIC DRUM o f, CAN D g. CARBOY o h, SILO D i, FIBER DRUM D ¡,BAG D k. BOX 1811. CYLINDER o m. GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE 0 r, OTHER D o. TOTE BIN o p, TANK WAGON STORAGE PRESSURE o a, AMBIENT o c, BELOW AMBIENT 181 b. ABOVE AMBIENT STORAGE TEMPERATURE o a, AMBIENT 181 d, CRYOGENIC o b, ABOVE AMBIENT o c. BELOW AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 100 226 CARBON DIOXIDE 227 DYes 181 No 228 124-38-9 2 230 231 DYes 0 No 232 3 234 235 DYes 0 No 236 4 236 239 DYes ONo 240 5 242 243 DYes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION No 3 202 204 206 206 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) 0 WASTE (one Daae Der material Der buildina or area) DADO DDELETE I8IREVISE REPORTING YEAR 2003 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM OR FRONT SHELVES (EPCRA ) DYES 181 NO FACILITY 10 # I I I I I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 06 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET o Yes ~ No 206 MOTOR Oil If Subject to EPCRA, refer to instructions COMMON NAME ENGINE Oil, lUBRICANT MOTOR Oil 207 EHS* DYes 181 No 208 CAS# NI A 209 *If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (CompleteifrequiredbyCUPA) COMMBUSTIBlE LIQUID 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib. MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a. SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER O,25(ONE QUART) FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 20 40 N/A N/A 221. DAYS ON SITE: 222 UNITS' l8Ia, GALLONS Db, CUBIC FEET D c. POUNDS D d, TONS . 365 (Check one item only) . If EHS, amount must be in pounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM o m, GLASS BOTTLE o q, RAIL CAR D b, UNDERGROUND TANK D f, CAN o j,BAG 181 n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k, BOX D o. TOTE BIN D d, STEEL DRUM o h, SILO o I. CYLINDER o p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT D b. ABOVE AMBIENT o c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT D b. ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 O/OWT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 94-95 226 lUBRICANT BASE Oil 227 DYes 181 No 228 N/A, MIXTURE 229 2 5-6 230 ADDTIVES, ANTI-OXIDANT 231 DYes 181 No 232 N/A, MIXTURE 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes ONo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weIght if non-carclnogenlc. or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) IZJ MATERIAL(NON-WASTE) D WASTE (one oaoe oer material per buildinQ or area) DADD DDELETE ~REVISE REPORTING YEAR 2003 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES 181 NO FACILITY ID # I 1 1 1 I I I I I 1 1 1 MAP# (optional) 2031 GRID# (optional) 204 10F1 G-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 PREMIUM If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* DYes 181 No 208 CAS# 8006-61-9 209 *If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (CompleteifrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one ilem only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS· l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d. TONS 365 (Check one ilem only) . If EHS, amount must be in pounds, STORAGE " CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR 181 b. UNDERGROUND TANK D f, CAN D j,BAG D n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k, BOX D 0, TOTE BIN D d, STEEL DRUM D h, SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT D b. ABOVE AMBIENT D c. BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 229 2 0-7 230 ETHANOL 231 DYes ~ No 232 64-17-5 233 3 8-15 234 XYLENE 235 D Yes ~ No 236 1330-20-7 237 4 7-14 238 TOULENE 239 DYes ~No 240 1 08-88-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) [8J MATERIAL(NON-WASTE) D WASTE DADO DDELETE I8IREVISE REPORTING YEAR 2003 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK 3 FACILITY ID # 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 181 No UN LEAD ED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS" DYes 181 No CAS# 8006-61-9 209 "If EHS is "Ves", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAM MABLE LlQU ID, CLASS 1 B, UN 1203 HAZARDOUS MATERIAL TYPE (Check one item only) CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) DYES 181 NO 202 203 GRID# (optional) 204 G4 206 208 210 213 D a, PURE I8Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 215 D a, SOLID I8Ib, LIQUID o c, GAS 214 LARGEST CONTAINER 12,000 216 181 a, FIRE D b, REACTIVE 0 c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 221 222 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT STATE WASTE CODE 220 6,000 12,000 N/A UNITS' Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET 0 c, POUNDS 0 d, TONS . If EHS, amount must be in ounds, D a, ABOVE GROUND TANK 181 b, UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM o f, CAN o g, CARBOY o h, SILO o i, FIBER DRUM D j,BAG D k, BOX D I. CYLINDER o m, GLASS BOTTLE 0 q, RAIL CAR o n, PLASTIC BOTTLE D r, OTHER Do, TOTE BIN o p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT o b, ABOVE AMBIENT o c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a. AMBIENT o b, ABOVE AMBIENT o c, BELOW AMBIENT o d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-7 230 ETHANOL 231 DYes 181 No 232 64-17-5 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 7-14 238 TOLUENE 239 DYes 181 No 240 1 08-83-3 5 242 243 DYes DNo 244 229 233 237 241 245 If more hazardous components are present at greater than 1% by weight If non·carclnogenic, or 0.1 % by weight If carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) IZI MATERIAL(NON-WASTE) D WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2003 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK FACILITY ID # F4 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET 0 Yes No UN LEAD ED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS" 0 Yes 181 No CAS# 8006-61-9 209 "If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (CompleteifrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 1 B HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE 211 RADIOACTIVE DYes I8INo 212 CURIES I8Ib, MIXTURE Dc, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 6,000 N/A 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT STATE WASTE CODE 12,000 221 UNITS· Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS. amount must be in ounds, D i, FIBER DRUM D j,BAG D k, BOX D I. CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D 0, TOTE BIN D p, TANK WAGON D a, ABOVE GROUND TANK 181 b, UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM D f. CAN D g, CARBOY D h, SILO D b, ABOVE AMBIENT STORAGE PRESSURE 181 a. AMBIENT D c, BELOW AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D b, ABOVE AMBIENT D d, CRYOGENIC D c, BELOW AMBIENT O/OWT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-7 230 ETHANOL 231 DYes 181 No 232 64-17-5 3 8-1 5 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 7-14 238 TOLUENE 239 DYes 181 No 240 108-83-3 5 242 243 DYes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carcinogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required infonnatlon. ADDITIONAL LOCALLY COLLECTED INFORMATION 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 LEGEND SEWER FLOOR DRAIN STORM DRAIN oj. e e + FIRE HYDRANTS & CONNECTIONS SPRINKLER SYSTEM VALVES AIR CONDITIONING SHUTOFF ELECTRICAL SHUTOFF GAS SHUTOFF WATER SHUTOFF EMERGENCY SHUTOFF ( La, GAS PUMP) DISPENSER ISLAND FIRE EXTINGUISHER MSDS & CONTINGENCY PLAN I BUSSINESS PLAN PERSONAL PROTECTIVE EQUIPMENT SPILL CONTAINMENT & MITIGATION EQUIPMENT FIRST AID EQUIPMENT EMERGENCY ASSEMBLY AREA SENSORS OR PROBES REST ROOM CASHIER 1" = 40 F DIRECTION C02 LIQUID I GAS CYLINDER DISPENSER SHUTOFF MOTOR OIL FLAMMABLE LIQUID COMBUSTIBLE LIQUID EMERGENCY EXIT ABSORBENT CHAIN LINK FENCE LEAK DETECTOR VEEDER ROOT TLS 350 ALARM MONITORING CONSOLE UNDERGROUND STORAGE TANK TRASH ENCLOSURE TRASH BIN SAFETY SHOWER & EYEWASHES @ ~ ... ø lAC I ® @ ® o - . MSDS & BP ~ ~ ~ + "" * . ~ c==) IC021 [!] IMOI [IT] [£g IEMI o *** ITEI ITBI IRRI - SCALE -~- SITE MAP DATE: 01/10/01 HAZZARDDOUS MATERIAL PLAN - - SITE ADDRESS: 6450 WHITE LANE BAKERSFIELD, CA 93309 E F G H J + KERN COUNTY HAZARD DO US MATERIAL DIVISION BUSINESS NAME: ARCO # 05420 ABC D - - ~ - : - ¡ ~ ¡ ¡ ~"L" SHAPED MAURICIOrS GRILL & CANTI¡NA ¡ [STRIP: MALL um u(TO~UST~NGOFBU~INES~ESuuU . u~XPRE~Su OF A STRIP MAWL ¡ : ~ LUBE ~ ~ ~ ; : : ..uuu..;u.... ._iu...u.........;..u.. uuu..u....u ..uuuu......~......u.u.uu~u.........uuu;.u-u·WHtTE·lANE : N: : : bRIVEW~Y ~ i ~~...: T ~ X: o . . 0 . /~v 0 0 0 : : : : ; /~: ; : W KFC : : : : : /"-:?): : o 0 : 0 . / v 0 . . o : . 0 : ." ~v~s;:) .r' "~~ . .... .. u.:.u uuu.... ...,...... : 0 ..uu.:u..............~..u.uu_.u...._..,...,...."'..I".". .... uu.;u u. . ......I; .u.u....uuu.. uu.................... 0 . 0/ 'V n ",.r..,~ . . n : ; : : ; ~: "v/,~, n. ; ~ . . 0 . 0 /~ S;:)/. . : ~ ~ ; ~«.'v'///v~:~r::5/ ~v~ : ~ ~ ,I-: . : : ~ ~>..;"\.-/ /...~ 0 ~ : : : : 0.... .7 / ø' s;:) / : : 0 : : :: <¿v,/ :/ ~ <:::\r::5/ : : , 0: : : : 0 f/v-v.~~ '+y : ..0.. .....:uuuu....O'...... ....u...I.uu.;. u............;.....u.....u..;.u.............:.u.uu.u......;.....~~u , u.,,/ u..u: u tv': : ......,. ,. ~ 0 LL.. , ' . . ',. ~'",/, 0 , fn: : ; : ;...' 0 ; w: ~ Z ¡ : : ~ IEMI : ~: . ~ I ¡ ~ - . !"RR1"': : ~ : : . en: _ ....~ : ~ ~ : ~:......uuuu~..u..........~u.uu..u.....;.. '<::(' .u..:......uuuZuu.. .....~u.uT uu u'j" ...........u]"Qu... . : Q ~ ¡ : [ ~ ~ ! ø ~ ~7 i~! . i>- . 0 o " ".............-: u.. u u u ............ u~u .... ' , 0 1 "'-:þl uuuuu.................u.u.uu... , ....... . L.....J .uu.u..u.uT .... ;¿;"+':" .........U·'1"··..···..· 'IŸI~ ~ j ~ ~ ~ ; , \Of 0 , 0 . . oW ' Z . ..: , , : . '> : O· 1 EM I ~ ~ f:\ ~ ~ ~ ¡ ¡ ~ : f ~ : ~\!...!. '0: 0 : """" : S @·COOLER.. HrB~ UU......:...........U.U.¡U........ uu.iu u.........iuuu .. u... U uuu T ü u... . E' ... .... u;' U .u. .u.uu u;.......: i : . ¡ : ¡FOOD PARKING LO~ T .:SHIRTu uum uJ. muuu;uu u/ MAX ~ lu'uuuuuu_HmuQ. UT'l'ET" : . . uI UHuMÄLC uu ¡~î~S i tit . . i . ¡ ¡ ~ ~ ~ ¡ ; 2 3 9 4 5 6 7 8 '¡- ;- e - ARCO # 05420 6450 WHITE LANE BAKERSFIELD, CA 93309 Hazardous Materials Business 'Plan 1. FACILITY INFORMATION SECTION To be completed by all businesses, regardless of program type. Fonns included in this package complies with fonns/attachment required by the appropriate city or county under which the Unified Program Agency applies. This Hazardous Materials Business Plan includes: IZ!BUSINESS ACTIVITIES PAGE IZ! BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE IZ!EMERGENCY RESPONSE CONTINGENCY PLAN IZ!HAZARDOUS MATERIALS INVENTORY LISr IZ!FACILITY SITE MAP 1 :- ~ UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTMTIES FACILITY ID # BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) ARCO #05420 6450 WHITE LANE, BAKERSFIELD, CA 93309 Page 1 of _ 2, 1. EPA ID # (Hazardous Waste Only) CAL000244300 3, Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CPR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) 1. Own or operate underground storage tanks? 2. Intend to upgrade existing or install new USTs? 3. Need to report closing a USTI C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or --the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? 3. Treat hazardous waste on site? 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? 5. Consolidate hazardous waste generated at a remote site? 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? E. LOCAL REQUIREMENTS 181 YES D NO 4, 181 YES D NO s, D YES 181 NO 6, D YES 181 NO 7, D YES 181 NO 8, 181 YES D NO 9, DYES 181 NO 10. DYES 181 NO 11. DYES ~ NO 12, DyES 181 NO 13, DYES 181 NO 14, HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Fonnerly SWRŒ Fonn A) UST TANK (one page per tank) (Formerly Fonn B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Fonn C) UST TANK (closure ponion - one page per tank) NO FORM REQUIRED TO CUP As EP A ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Fonn 1232) REMOTE WASTE I CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Fonn 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Fonn 1249) (You may also be required to provide additional infonnation by your CUP A or local a~ency,) IS, · " e e UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 BUSINESS SITE ADDRESS 6450 WHITE LANE CITY BAKERSFIELD DUN & BRADSTREET 03-959-6507 COUNTY KERN BUSINESS OPERATOR NAME EDMOND NASSAR ~np nf 100, ENDING DATE 12/31/2002 BUSINESS PHONE 661-398-0393 101. 3, 102, 103, 106, ZIP CODE 93309 SIC CODE (4 digit #) 5541 105, 104, CA 107, 108, OWNER NAME BP West Coast Products LLC OWNER MAILING ADDRESS: BP West Coast Products LLC P.O. BOX # 6038 CITY' ARTESIA 109, BUSINESS OPERATOR PHONE 661-398-0393 ;I]}':IlUSïNESS;t)'WNER~;~œ03~1<:;<~¡;:',"· ":..;;:'~~;,~',:'..".. .;:.;'<t!;¡';Br 'l;;;~:: ;..... 111. OWNER PHONE 714-670-5321 110, ,,', 0,': ",,' 112, 113, CONTACT NAME MICHAEL D. WILSON CONTACT MAILING ADDRESS: BP West Coast Products LLC P.O. BOX # 6038 CITY ARTESIA STATE CA ·:.·IîïJ;;;)tNVIRONMENîkì1;"~ONîA€:t;~.~·;\':p/ 117. CONTACT PHONE 714-670-5321 114, 115, ZIP CODE 90702-6038 116, 118, 119, NAME EDMOND NASSAR TITLE FRANCmSEE BUSINESS PHONE 661-398-0393 24-HOUR PHONE· H.661-665-2047 STORE # 661·398-0303 STATE CA :{>4"~'<:^'~" '--:c< --, _ ,~~~^:j~;)Jt~~V~i:;'';>;'''':',,>'i'-'i:'p (;ÊN€~·¡(B(:)ÑtÂG; . , ;-- \~-:: A<; :Jl'{:0'AYh~F:,3' >,~~? ,,-;_:_~_,_ ^-\; _" 't:/~\ 123, NAME ARCO MISSION CONTROL 124, TITLE 120, 121. ZIP CODE 90702-6038 .:, ,~^ !:;>^::';;;,4fi"U,_'.:"i ;ý;-',:: -,;-,-,:~-,>, ,dh:t·/'i. ·.~GÔNDmy \' -.- '-: ,',i---;-,>-<;,vt.k0n;';:"!~-Ti~r'-~"·~:~i-:· 122, 129, 125, BUSINESS PHONE 800-272-6349 24-HOUR PHONE· 800-272-6349 130, 126, 131. 127, 132, ADDITIONAL LOCALLY COLLECTED INFORMATION: 133, Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submined and believe the information is true, accurate, and complete. DATE 134, NAME OF DOCUMENT PREPARER 135, 136, 11/15/2002 TITLE OF SIGNER Environmental S ecialist 137, MICHAEL D. WILSON .. '"-?::;'It. ... . . . ".?>"'.. . ....\. ...... .' ',:. .' ." ...... CïT~,OFBAKI;RSFIttJ,:~.^:.. " .' - ,OÉFICË'0F:¡EN¥:i.R()N'MENT1ÙJ~SÊ:RìWeÊst, ;.." ;:6··1~~;F'~ð~4:!i~fØii~~~~~~~1~~1;;· .',." ','.:' HAZARDOUSMATEIDALS~AGEMENTPLAN INSTRUCTIONS: 1. To avoid further action, return this fonn within 30 days of receipt 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. 5. You may also attach Business Owner/Operator Fonn and Chemical Description Fonn(s) to the front of this plan instead of completing SECTION I below for initial submission. SECTION I BUSINESS IDENTIFICATION BUSINESS NAME: ARCO # 05420 LOCATION: 6450 WHITE LANE, BAKERSFIELD, CA 93309 MAILING ADDRESS: BP West Coast Products LLC CITY: P.O. BOX # 6038 STATE: CA ZIP: 90702 PIDMARY ACTIVITY: GASOLINE RETAIL STATION & MIN MARKET PHONE: 661-398-0393 OWNER: EDMOND NASSAR PHONE: 661-398-0393 MAILING ADDRESS: 6450 WHITE LANE, BAKERSFIELD, CA 93309 EMERGENCY NOTIFICATION CONTACT TITLE BUSINESS PHONE 1. EDMOND NASSAR STORE: 661-398-0303 FRANCHISEE 661-398-0393 2. ARCO MISSION CONTROL 800-272-6349 24 HR PHONE 661-665-2047 800-272-6349 1 ::> HAZARDOUS MATERI!S MANAGEMENT PLAN e SECTION II DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Gasoline in underground storage tank can over spill from the top of the fill pipes or leak in the ground and to the surface. Other source of leak/spill is from the dispenser unit, nozzles, and pipes. Potential of fire and explosion exist. If a leak is found the leak probe will sense the liquid release and will set off the alarm. Other hazard is carbon dioxide gas cylinders used for soda drinks. The carbon dioxide gas cylinders are secured by chains in back room. B. EMPLOYEE AND AGENCY NOTIFICATION: In the event of minor to major spill, or fire, employe~ or owner will call 9-1-1 and local agency. Employees are trained for the use of personal protection equipment to minimize contact with hazardous materials/waste. OFFICE OF EMERGENCY SERVICE: 1-800-852-7550 NATIONAL RESPONSE CENTER: 800-424-8802 BAKERSFIELD ENVIRONMENTAL HEALTH SERVICES: 661-326-3979 C. ENVIRONMENTAL RESPONSE MANAGEMENT: If a large release of gasoline spill or waste occurs, the owner, or store manager, or employees will take immediate action to have all employees leave the premises by the safest exit. All employees will be asked to assemble at a safe assembly area located at South side of the site, or at a safe upwind . location. Method of evacuation is verbal. Person responsible for notification is: NAME: EDMOND NASSAR TITLE: FRANCHISEE D. EMERGENCY MEDICAL PLAN: For small injuries the owner or store manager will utilize the first aid kit box. For minor to major injuries, the owner, or store manager will call either 9-1-1, or may contact the closest medical/clinic center, which is located at: NAME OF THE HOSPITAL & TELEPHONE NUMBER: MERCY HOSPITAL 2215 TRUXTUM AVE. BAKERSFIELD, CA 93301 TEL: 661-632-5000 2 .. - e SECTION II RELEASE RESPONSE PLAN Emere:encv Procedures: Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials: 1. PREVENTION (prevent the hazard) - Describe the kinds of hazards associated with the hazardous materials present at your facility. What actions would your business take to prevent these hazards from occurring? You may include a discussion of safety and storage procedures. Gasoline spills can result in environmental contamination, fire, and explosion. Releases of gasoline can occur when underground storage tanks are overfilled, when motorists overfill vehicle tanks, or drive off. The releases are prevented by installed overfill devices such as flapper valves, high level alarms, or ball floats. Other spill prevention devices are impact valves, and breakaway devices. Service stations are attended by trained personnel, and gasoline is delivered by trained truck drivers. The on-site coordinator or designee will train all new employees of this facility about the procedures for safe handling of hazardous materials and products for emergency response coordination, and use of emergency response equipment and supplies. Additionally, the on-site coordinator or designee will conduct a refresher-training program for all employees on annual basis. PROCEDURE FOR STORAGE AND DISPOSAL OF HAZARDOUS MATERIALS & HAZARDOUS WASTE: Liquid CO2 cylinders must be secured to wall with chain (this applies for stations that serve soda in the store). Waste absorbent from the gasoline spill, cleanup spills, or used gasoline fuel filters must be stored in a proper UN (DOT) approved container with appropriate hazardous waste label on each container. Each drum or container containing hazardous waste must be stored away from hot or ignition sources and disposed before 90 days from accumulation date. Each container must be kept closed with lid and disposed as hazardous waste and manifested. State manifests of hazardous waste must be kept for three years in compliance kit. The hazardous material handled on daily basis is gasoline. Hazards associated with this product are spill, leak, fire, and explosion. Fire Prevention ørocedures as follows: 1. The gasoline tanks are equipped with leak detectors that activate an alarm and disable the pump when leak is detected. Few gas stations are equipped with over fill alarm that prevents the spillage of gasoline from over filling the tanks. 2. All the dispensers are equipped with impact valves. 3. Dally inspection of leaks from the pipes, nozzles, and pumps. 4. Any leaks from above mentioned equipment will be fixed immediately. 5. Posting no smoking sign at the dispensers. 6. Monthly inspection of fire extinguishers to ensure that are full and ready to use. 7. Testing of the emergency shut offs located in front of the store. 8. Testing of dispensers' start/stop emergency shut off located on the cash register. 9. Testing the shut ofts of turbine pumps. The on/off switch is on the main electrical panel. Gasoline spills will be cleaned-up immediately using absorbent material 3 2. e . MITIGATION (reduce the hazard) . Describe what is done to less.he harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, spill, fire, explosion, or airborne release at your business? Mitiaation (continued): In the event of a leak or spill: 1. Attendant should shut off electricity to the pumps/turbines at the main electrical panèl and close the impact valves. 2. The on-site emergency coordinator or designee will contact 911 (Fire Department) and explain the emergency and will contact ARCO MISSION CONTROL. If necessary, the On-Site Emergency Coordinator or designee will request an ambulance or other medical assistance. 3. Evacuate. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all !'tmployees and customers will be directed to a safe area opposite the danger. There are two exits - front entrance and rear emergency exit. All persons will evacuate through one of these doors and gather In area furthest from danger. Manager on duty will account for all station personnel and customers (when possible). 4. Contain the liquid by constructing berms and/or by covering the spill with a fireproof absorbent material. Prevent liquid from entering storm drains whenever possible. 5. Scene management shall be the responsibility of the On-Site Emergency Coordinator or designees until the arrival of fire or police personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer any assistance that Is requested. 6. Immediately following an emergency the On-Site Emergency Coordinator will provide for the disposal of contaminated material as directed by the local Fire Department or County Health Agency. (All spills will be reported to BP Mission Control at (800) 272-6349. The BP Environmental Compliance Specialist will make report to pertinent agencies including NRC, CA OES, Water Board, and County Health Agency.) 3. If, neither give~ such direction, call ARCO Mission Control for removal and disposal. In the event of a fire employees should: 1. Shout FIRE and call 911 (Fire Department). 2. Stop fluid flow by shutting off electricity to the pumps at the main electrical panels and close impact valves. 3. Evacuate by stopping all traffic on site and direct all personnel and customers to a safe area opposite the danger. 4. Scene management is the responsibility of the On-Site Emergency Coordinator or designees until the arrival of public safety response personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer assistance, as requested. Additional mitigation procedures: Employees will be informed of the health and safety hazards involved with the handling of hazardous materials such as gasoline. Employees will not smoke, light matches to cause a spark, or ignite flammable liquids or vapors. Employees· must know: 1) LOCATION OF EMERGENCY SHUT OFF SWiTCHES, HOW TO STOP LEAKS AT NOZZLES AND GAS ISLAND, 2) SHUT OFF PUMPS WHERE ELECTRICAL PANELS ARE LOCATED, 3) LOCATION OF FIRE EXTINGUISHERS, 4) USE OF ABSORBENT MATERIALS TO CONTAIN SMALL GASOLINE SPILLS, 5) CALL 911 IN THE EVENT OF A MAJOR SPILL, LEAK, FIRE, OR EXPLOSION. EMPLOYEES WILL BE FAMILIAR WITH THE EMERGENCY RESPONSE PROCEDURE AS OUTLINED IN THE BUSINESS EMERGENCY RESPONSE PLAN. 4. ABATEMENT (remove the hazard) . Describe what you would do to stop and remove the hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing of released materials at your facility? 4 e e In the event that a spill is small, station personnel should apply absorbent to the gasoline spill by sweeping the absorbent onto the spill. Once the absorbent has soaked up the liquid, sweep up the absorbent and place it in a 55-gallon drum. If the spill is larger, call 911, attempt to contain it, and follow the scene management instructions in Section 2, Mitigation. Large spills are cleaned by BP designated contractors, or as designated by the franchisee for franchise service stations. Employee's responsibilities: Employees will know the location of the nearest storm drain(s) and location of absorbent material to be used to prevent the spill from reaching the storm drains. In the event of a major spill, employees are Instructed to call 911 and report. The on-site emergency coordinator will provide for the disposal of contaminated materials as directed by the local fire department or County Environmental Health. If neither gives such direction, call ARCO Mission Control (800-272-6349) for disposal. BUSINESS PLAN LOCATION: A copy of business plan and training documents will be kept at all times in a yellow compliance kit or a binder, which is located either near the cashier, or office in back room area. Followin ment of this facili : Location Entrance & kitchen area Back room/Su ly room Inside office or cashier Maintenance Yearly Service Re-stock as needed Invento twice a ear Item Fire extinguisher S ill absorbent First Aid Kit UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE : NO ELECTRICAL: ELECTRICAL PANEL IN THE BACK ROOM WATER: SIDE WALK SPECIAL: LOCK BOX: DYES ~NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/W ATER AVAILABILITY: FIRE EXTINGUISHERS LOCATED AT ENTRANCE DOOR. INSIDE THE STORE. AND IN THE KITCHEN AREA A. B. PRIVATE FIRE PROTECTION D YES ~NO WATER AVAILABILITY (FIRE HYDRANT): N/A 5 e e Emergency review of liquefied ( Cryogenic) Carbon Dioxide Liquefied carbon dioxide is an extremely cold liquid/gas and is stored under high pressure in a gas cylinder. The small gas cylinders, containing 20 to 50 pounds of liquid carbon dioxide, must be stored upright and be firmly secured with chain to the wall. Those large cylinders (containers), which contain 200 to 400 pounds of liquid carbon dioxide, must be e~ther chained or anchored to the floor. Securing the cylinder prevent falling or being knocked over. All the gas cylinder must be capped at all times and transported with drum cart. The extremely cold part of pipes and valves on top of the cylinder will cause moist flesh to stick fast and tear when one attempts to withdraw from it. A leak will result in the formation of dry ice, and contact with dry ice, liquid carbon dioxide, or cold gas can cause frostbite to skin, eyes, and exposed tissues. Breathing low concentration of carbon dioxide can cause nausea, dizziness, mental confusion, and visual disturbance, shaking, headache, and respiratory problem. Liquid carbon dioxide has a high evaporation rate and when heated to above 52 Degree C (125 Degrees F) will generate high pressure. Store away from heat and ignition sources and out of direct sunlight. High temperature can generate high pressure in the tank/cylinder and cause rupture ifthe safe relief valve fails to operate. Do not store the container or cylinders where they come into contact with moisture. Response Plan for Carbon Dioxide Release Carbon dioxide is cold, asphyxiant, and powerful cerebral vasodilator gas. In the event of release, evacuate the store, and allow the liquid/gas carbon dioxide to evaporate and the gas to dissipate. Attempt to close the main source valve to stop the release is not recommended unless if is safe to do so and you have adequate personal protection gears. If the area must -be entered by emergency personnel, Self-Contained Breathing Apparatus (SCBA), Kevlar gloves, and appropriate foot and leg protection must be worn. . Response to Carbon Dioxide Release If there are signs of visible ice on the cylinder or parts such as pipes, it is a sign of a leak and needs to be reported to your manager immediately. In addition, the Facility Manager will contact their vendor immediately. In the event of a major release, call 911 and evacuate the store. Do not attempt to close the main source valve to stop the release. Emergency personnel such as trained fire fighters must wear special protective equipment to safely respond to a leaking C02 cylinder. 6 e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 1-2 PERSONS PER SHIFT, THERE ARE THREE SHIFTS AND TOTAL EMPLOYEES ARE ABOUT 5 MATERIAL SAFETY DATA SHEETS ON FILE: MSDS and business emergency plan is located in the compliance binder, a yellow plastic box, located in the office area BRIEF SUMMARY OF TRAINING PROGRAM: Employees are trained on use of safety equipment and tools to minimize contact with hazardous materials/waste. Employees are trained and required to dial for emergency calls, 9-1-1, and evacuate the premises. Employees are trained in the use of spill clean up , first aid kit, fire extinguishers, electrical and gas shut off and use of telephones. Employees are trained to advise any response agency as to the nature and location of the problem. Initial training is conducted after hiring new employee. Trainer is the owner or manger of the store. Refresher training is done every year. Training topics are such as: 1) hazard communication program, 2) materials safety data sheets, 3) safe handling of chemicals, and 4) emergency equipment& emergency response plan. 7 Employers are required by State law to have a program which provides employees with initial and refresher training. The Business Emergency Plan shall include a training program which is reasonable and appropriate for the size of the business and the nature of the hazardous materials handled. The training program shall take into consideration the responsibilities of the employees to be trained. Training will be conducted upon hire, and refresher training provided at least annually. Hazardous Materials Handlina & Emeraencv ResDonse Trainina Will Include: 1. Methods for the safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material and measures employees can take to protect themselves from chemical hazards 2. Procedures for coordination with local emergency response organizations; 3. Correct use of emergency response equipment and supplies under the control of the business 4. The Cal OSHA Hazard Communication Standards 5. The prevention, abatement and mitigation procedures you have developed for your business and explained on the Business Emergency Plan 6. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care 7. Procedures to coordinate with and assist the local emergency personnel that may respond to your business 8. Who and how to call for immediate assistance in the event of an accident involving hazardous materials 9. Procedure for ensuring that appropriate personnel receive initial and refresher training UST EauiDment ODeratina and Monitorina Trainina Will Include: 1. Take tank level measurements 2. Read dispenser meters 3. Inspect equipment 4. Recognize warning signs: dispenser hesitations, meter spins, and odors 5. Manually close dispenser impact valve 6. Replace dispenser filters 7. Shut down the system by knowing the location of electrical panel breakers and emergency shutoff switches 8. Test the electronic monitoring system 9. Respond to alarms, leaks, or equipment problems Personnel 1. Are there any specially trained hazardous materials emergency response personnel at your business? D YES ~ NO 2. Do you have decontamination capabilities for victims of exposure to hazardous materials at your business? D YES ~ NO 3. Do you have personnel that will provide site security at your business during and after a hazardous materials incident? 0 YES [g NO Eauipment List the type and location of equipment that can or will be used for response to hazardous materials incidents at your business: Absorbent, a shovel and a broom are located in or near the station supply room. All waste absorbent will be disposed of in a properly labeled hazardous materials drum. 8 The On-Site coordinatlr designee will train all new employees of this facility about the following procedures for the saf ndling of hazardous materials, procedu.or emergency response coordination, and use 0 emergency response equipment and sup s. Additionally, the On-Site coordinator or designee will conduct a refresher-training program for all employees on a semi-annual basis. PROCEDURES FOR SAFE HANDLING OF HAZARDOUS MATERIALS 1. Employees will be informed of the health and safety hazards Involved with the handling of gasoline/diesel fuel. 2. Employees will be careful not to spill gasoline, diesel fuel, or waste oil onto themselves or the ground. 3. Employees will not smoke, light matches, cause sparks, or take actions which could ignite flammable liquids or vapors. PROCEDURES FOR EMERGENCY RESPONSE COORDINATION 1. Employees will be familiar with the emergency response procedures outlined In this Business Emergency Response Plan. 2. Employees will know the location and operation of electrical shutoff switches and dispenser shutoff valves. 3. Employees will know the location of, how and when to use dry chemical fire extinguishers that are located on the premises. 4. Employees will know the location and proper use of first aid kit(s), fire extlnguisher(s), and absorbent materials that are located on the premises. 5. Employees will know the location of the nearest storm drain(s) and location of absorbent materials to be used to prevent spills reach the storm draln(s). 6. Employees will be familiar with the kinds of emergency situations which will warrant immediate evacuation of premises. Circumstances include: a. Any gasoline, diesel, or other type of fire. b. Any spill, fuel leak, or vapor leak that has the potential for Igniting or exploding. c. Any spill or leak where employees or customers notice gasoline vapors. EMPLOYEE TRAINING RECORDS The BP manager, for BP store, or owner/operator (for franchisee) will be responsible for documenting and retaining the types and dates of the "training" that each facility employee has completed (initial and refresher). These documentation records will be retained at the facility for at least 5 years from the date an employee last worked at the facility. Upon completion of said Instruction, employee will sign a statement of acknowledgment. One copy kept at the facility. TRAINING SUBJECTS: Training Topic - Procedures for handling hazardous materials, including hazardous wastes Persons Trained: Facility Staff (i.e. cashier, maintenance) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: For minor spillage (i.e. customer gas tank oveñlow), employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean up equipment is provided at each facility. For major spillage, employees are Instructed to call 911 and report. They will then notify the BP manager, for BP store, or owner/operator (for franchisee), or his/her alternate who will then activate the notification process. Training Topic - Procedures for coordination with emergency response agencies Persons Trained: Facility Staff (i.e. cashier, Emergency Coordinator, Alternate) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Facility personnel are instructed to call 911 and report. They will then call the BP manager, for BP store, or owner/operator (for franchisee), or his/her alternate who will then activate the notification process. Training Topic - Use of emergency response equipment and materials under business' control Persons Trained: Facility Staff (i.e. cashier) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Use and location of absorbent, protective clean-up equipment, first aid kit and fire extinguishers. Review of procedures for proper use of safety and spill control equipment, evacuation and earthquake procedures. Training Topic - Emergency Response Plan implementation Persons Trained: Facility Staff (All Employees) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Review of Emergency Response Plan; evacuation procedures; location of emergency fuel shut-off switches and main electrical shut-off switch; use and location of absorbent, protective clean-up equipment and fire extinguishers; and the list of ALL pertinent people to call In. 9 e e CERTIFICATION I, _ MICHAEL D. WILSON CERTIFY THAT THE ABOVE INFORMATION 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. ENVIRONMENTAL SPECIALIST TITLE /.24r(;Jt, DATE 10 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) 0 MATERIAL(NON-WASTE) (XI WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM FACILITY ID # 3 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) DYES 181 NO 202 CHEMICAL NAME WASTE ABSORBENT 1 of 1 II. CHEMICAL INFORMATION 205 TRADE SECRET 203 GRID# (optional) F8 204 No 206 If Subject to EPCRA, refer to instructions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER CAS# N/A FIRE CODE HAZARD CLASSES (Complete If required by CUPA) HAZARDOUS MATERIAL TYPE (Check one item only) 207 EHS* DYes 181 No 209 *If EHS is "Yes·, all amounts below must be in Ibs. 208 210 213 D a, PURE Db, MIXTURE 181 c, WASTE 211 RADIOACTIVE DYes I8INo 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 215 181 a, SOLID Db, LIQUID Dc, GAS 214 LARGEST CONTAINER 55 216 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH 217 MAXIMUM DAILY AMOUNT 25 55 218 ANNUAL WASTE AMOUNT 55 219 STATE WASTE CODE 220 221 222 UNITS· Check one item ani STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in unds, D a, ABOVE GROUND TANK Db, UNDERGROUND TANK Dc, TANK INSIDE BUILDING 181 d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM D f, CAN D g, CARBOY D h, SILO D i, FIBER DRUM D ¡,BAG D k, BOX D I. CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D 0, TOTE BIN D p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D b, ABOVE AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT 224 D c, BELOW AMBIENT D d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 4 238 227 DYes 181 No 231 DYes D No 235 DYes D No 239 DYes DNo 228 N/A, MIXTURE 229 89-90 226 WASTE ABSORBENT & DISPENSER FUEL FILTER 2 230 232 233 3 234 236 237 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Infonnatlon. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) [g MATERIAL(NON-WASTE) D WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM 3 FACILITY ID # CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 202 203 GRID# (optional) B8 204 CHEMICAL NAME CARBON DIOXIDE COMMON NAME CAS# 124-38-9 FIRE CODE HAZARD CLASSES (Co"1Jlete if required by CUPA) 1 of 1 II. CHEMICAL INFORMATION 205 TRADE SECRET No 206 207 209 If Subject to EPCRA, refer to instructions EHS· 0 Yes 181 No *If EHS is "Yes·, all amounts below must be in Ibs. 208 HAZARDOUS MATERIAL TYPE (Check one item only) 210 213 181 a, PURE Db, MIXTURE 0 c, WASTE 211 RADIOACTIVE DYes I8INo 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 215 o a, SOLID I8Ib. LIQUID o c, GAS 214 LARGEST CONTAINER 400 216 181 a, FIRE 0 b, REACTIVE 0 c, PRESSURE RELEASE 0 d, ACUTE HEALTH 0 e, CHRONIC HEALTH 221 222 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT STATE WASTE CODE 220 200 400 N/A UNITS· Check one item onl STORAGE CONTAINER Oa, GALLONS Db, CUBIC FEET 181 c. POUNDS 0 d, TONS . If EHS. amount must be in unds, o a, ABOVE GROUND TANK Db, UNDERGROUND TANK DC, TANK INSIDE BUILDING o d, STEEL DRUM De, PLASTICINONMETALLlC DRUM o f, CAN o g, CARBOY o h, SILO o i, FIBER DRUM o ¡,BAG o k, BOX 1811. CYLINDER o m, GLASS BOTTLE 0 q, RAIL CAR o n, PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN o p, TANK WAGON 223 STORAGE PRESSURE o a, AMBIENT STORAGE TEMPERATURE o a, AMBIENT 181 b, ABOVE AMBIENT o b, ABOVE AMBIENT o c, BELOW AMBIENT 224 o c, BELOW AMBIENT 181 d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 100 226 CARBON DIOXIDE 227 DYes ~ No 228 124-38-9 2 230 231 DYes 0 No 232 3 234 235 DYes 0 No 236 4 238 239 DYes DNo 240 5 242 243 DYes DNo 244 229 233 237 241 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MA TERIAL{NON-WASTE) D WASTE lone cace per material per building or area) DADD DDELETE I8IREVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM OR FRONT SHELVES (EPCRA ) DYES 181 NO FACILITY ID # I I I I I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 06 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET o Yes ~ No 206 MOTOR OIL If Subject to EPCRA. refer to instructions COMMON NAME ENGINE OIL, LUBRICANT MOTOR OIL 207 EHS' DYes 181 No 208 CAS# Nt A 209 'If EHS is "Yes·, all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) COMMBUSTIBLE LIQUID 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE Dyes I8INo PHYSICAL STATE 215 (Check one item only) o a, SOLID I8Ib, LIQUID DC, GAS 214 LARGEST CONTAINER 0.25(ONE QUART) FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 20 40 NtA Nt A 221 I DAYS ON SITE: 222 UNITS· l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item onlv) . If EHS, amount must be in DOunds, STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTICINONMETALLIC DRUM D i. FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR Db, UNDERGROUND TANK D f.CAN D ¡,BAG 181 n, PLASTIC BOTTLE D r, OTHER DC, TANK INSIDE BUILDING o g, CARBOY o k, BOX D 0, TOTE BIN D d, STEEL DRUM o h, SILO D I, CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT o b. ABOVE AMBIENT o c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT o b, ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 94-95 226 LUBRICANT BASE OIL 227 DYes 181 No 228 NtA, MIXTURE 229 25-6 230 ADDTIVES, ANTI-OXIDANT 231 DYes 181 No 232 NtA, MIXTURE 233 3 234 235 DYes D No 236 237 4 238 239 DYes ONo 240 241 5 242 243 DYes ONo 244 245 If more hazardous components are present at greater than 1% by weight If non.çarclnogenlc, or 0.1% by weight If can:lnogenlç, attach additional sheets of paper capturing the required Infonnatlon. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [g MA TERIAL(NON -WASTE) D WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK FACILITY ID # 203 GRID# (optional) G-4 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) DYES 181 NO 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET No PREMIUM If Subject to EPCRA. refer to instructions COMMON NAME GASOLINE 207 EHS· DYes 181 No CAS# 8006-61-9 209 ·If EHS is "Yes·, all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Complete if required byCUPA) FLAMMABLE LIQUID, CLASS 18, UN1203 HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE I'8Ib, MIXTURE 211 RADIOACTIVE DYes I'8INo 212 CURIES Dc, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERA~E DAILY AMOU,NT D a, SOLID I'8Ib, LIQUID Dc, GAS 214 LARGEST CONTAINER 12,000 1'81 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 1'81 d, ACUTE HEALTH 1'81 e, CHRONIC HEALTH 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 217 MAXIMUM DAILY AMOUNT 6000 N/A 12 000 221 UNITS· Check one item onl STORAGE CONTAINER l'8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in unds, D a, ABOVE GROUND TANK 1'81 b. UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM D f, CAN D g, CARBOY D h, SILO D i, FIBER DRUM D ¡,BAG D k. BOX D I. CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r. OTHER Do, TOTE BIN D p, TANK WAGON STORAGE PRESSURE 1'81 a, AMBIENT D b, ABOVE AMBIENT D b, ABOVE AMBIENT D d. CRYOGENIC D c, BELOW AMBIENT STORAGE TEMPERATURE 1'81 a, AMBIENT D c, BELOW AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-15 230 METHYL TERTIARY BUTYL ETHER ( MTSE) 231 DYes 181 No 232 1634-04-4 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 7-14 238 TOULENE 239 DYes 181 No 240 1 08-88-3 5 242 243 DYes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturtng the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [8J MA TERIAL(NON-W ASTE) D WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK 3 FACILITY ID # CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) DYES 181 NO 202 203 GRID# (optional) 204 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET No UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* DYes 181 No CAS# 8006-61-9 209 *If EHS is "Yes·, all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES {Corr\1Iete if required byCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 HAZARDOUS MATERIAL TYPE (Check one item only) G4 206 208 210 213 D a, PURE I8Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 215 D a, SOLID I8Ib, LIQUID Dc, GAS 214 LARGEST CONTAINER 12,000 216 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT t}.; STATE WASTE CODE 220 221 222 6000 12,000 N/A UNITS' Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in ounds, D a, ABOVE GROUND TANK 181 b, UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM De, PLASTIC/NONMETALLIC DRUM D f, CAN D 9, CARBOY D h. SILO D i, FIBER DRUM D ¡,BAG D k, BOX D I, CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D 0, TOTE BIN o p, TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT 181 a. AMBIENT D b, ABOVE AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE D d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DYes 181 No 232 1634-04-4 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 7-14 238 TOLUENE 239 DYes 181 No 240 1 08-83-3 5 242 243 DYes DNo 244 229 233 237 241 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) D WASTE (one caoe car material car building or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES 181 NO FACILITY ID # I I I 1 I I I I I 11 I MAP# (optional) 2031 GRID# (optional) 204 10F1 F4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET U Yes ~ No 206 UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS" DYes 181 No 208 CAS# 8006-61-9 209 "If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Cof11¡lete if required byCUPA) FLAMMABLE LIQUID, CLASS 1 B 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8:Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8:INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8:Ib, LIQUID D c. GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 18:1 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 18:1 d, ACUTE HEALTH 18:1 e, CHRONIC HEALTH AVERAÇ3E DAilY AMOUNT 2171 MAXIMUM DAilY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6.000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS· l8:Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item only) . If EHS. amount must be in pounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAil CAR 18:1 b, UNDERGROUND TANK D f, CAN D ¡,BAG D n, PLASTIC BOTTLE D r, OTHER Dc. TANK INSIDE BUilDING D g, CARBOY D k, BOX D 0, TOTE BIN D d, STEEL DRUM D h, SilO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 18:1 a, AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE 18:1 a, AMBIENT D b. ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 229 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DYes 181 No 232 1634-04-4 233 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 237 4 7-14 238 TOLUENE 239 DYes 181 No 240 108-83-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ~un 14 02 04:50p 'I\~ V7 p.5 ~.,"".... . . ~N..J;1:- ?~ CITY OF BAKERSFlEW 71 ~() lip z-l1 OFFICE OF ENVIRONMENTAL SERVICES 1715 Cbester Ave.~ Bakersfield, CA (661) 326-3979 P£RMII' APPLICAnONTO CONSTRUCTlMODØY UNDERGROUND STOJlAGE TANK mE OF ~lCATION (CBECXJ [ ]NEW FAOUTY [ )MODtRCATION Of FACILITY [)NEW TANKINSTAlLA'TION AT EXIS11NCi fACUTY STARTING DATE~'''.) . .'~_ PI<OPOS£J)(X)NPLEOON /)AU vifbl\CijffW1/ FAC11JTYNAME ~ D· ,..~ ~ACILtrY~ 'NO. ~B- ii;fi~~'-ClY . ~~~ ':.CODE '}WJì TANKO~ . ~ ~ ~ PHONENO. (~;'¡-cl'ì'~?-Q'~'ß ~ P>',_ . _'.:~' ~. . ~~Kr CAucæ ~~£J~ =~-~{fj,~~tJ¡~{) ;:=;~ln~~4(D~~~~ BRIEfLY DÐCIUIIETHE ~ TO BE"""" ~ \I ñèu\ ~<tirt"'v\ þ'" 1;f'~-:f1""'ri~ {?(\ Z-ì Uf;j: ~tç ,'~L~~+,-~ __ . WATER TO FAClUI'Y1'ROVIDED BY DEP11f TO GJtOUM) 'fI ATER. . NO. OF TAN&S TO BE tNSTAU.ED SPD.L PIlEYENTION CONTROL AND TANK. NO. , VOLUME " TANIt NO. Vot.!JME I~~'", . , - SOIL TYPEDPECTEDATsrrE í W\\(\"I'V"ThL'Y\ AIU: TIŒY fOItMOTOkFUEL YES ER.MEASL'R£SP~ONfJLE \I' YE$ SECTION ¥OIl MOTOR FUEL NO NO ~ REGJl.AIl PREMIUM DIESEL A VIAT10N g.cTION JiQ!tNON M91:PR FtIJ\.~ TANICS CHEMICAL STOlW) CAS NO. CHENICAI,.PlŒVIOUSL" STORED (NO BRAND NAME) (IF KNOWN) FOIt <:1fFlCSAL USE OIQ.y PM:IJIYNo. . , InOFT.\NIS . , fEJE5 S - f T!ŒAPP1JCANT HAS RECEVED, 1JNÐEIS1"ANDS, ANOWB.LCDMPLYWlTHTHE ATrACHEDC'ONDITIONSOP Tf{TS P!RM1T .vm ANY afHEllsrATE, LOCAl. AND FEDERAL REGu1.ATIONS- ~B~LEŒI>u.oEIl~~~-C1#P~y.ANDTOTHE~QfMY~" - APPROVED'(: 10 £...J.Y~ . AlP ~TURE TBJS Al'PLICAnONBECOMi:S A PERMIT WIlEN APPROVED - r- ;- --......... ,'~ c, It . 0/6' --6.2/ --- ¿J(J(} 6 9(, Hazardous Materials Business Plan ARCO # 05420 6450 WHITE LANE BAKERSFIELD, CA 93309 /éX3 /6 A- 1. FACILITY INFORMATION SECTION To be completed by all businesses, regardless of program type. Fonns included in this package complies with fonns/attachment required by the appropriate city or county under which the Unified Program Agency applies. This Hazardous Materials Business Plan includes: [gIBUSINESS ACTIVITIES PAGE [gI BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE ~EMERGENCY RESPONSE /CONTINGENCY PLAN [gIHAZARDOUS MATERIALS INVENTORY LIST [gIFACILITY SITE MAP 1 v UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # Have on site (for any purpose) hazardous materials at or above 55 gaIlons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 707 B. UNDERGROUND STORAGE TANKS (USTs) 1. Own or operate underground storage tanks? 2. Intend to upgrade existing or instaIl new USTs? 3. Need to report closing a UST? C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: -any tank capacity is greater than 660 gaIlons, or --the total capacity for the facility is greater than 1,320 gaIlons? D. HAZARDOUS WASTE 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? Treat hazardous waste on site? 3. 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5. 6. Need to report the closurelremoval of a tank that was classified as hazardous waste and cleaned onsite? E. LOCAL REQUIREMENTS ~YES 0 NO 4, ~YES 0 NO s, o YES ~ NO 6, o YES ~ NO 7. o YES ~ NO 8, ~YES 0 NO 9, DYES ~ NO 10, DYES ~ NO 11. DYES ~ NO 12, DYES ~ NO 13. DYES ~ NO 14. Page 1 of _ EPA ID # (Hazardous Waste Only) CAL000244300 2, 3, HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Formerly SWRCB Fonn A) UST TANK (one page per tank) (Formerly Fonn B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Fonn C) UST TANK (closure portion - one page per tank) NO FORM REQUIRED TO CUPAs EPA ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Fonns 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Fonns 1m A,B,C,D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Fonn 1232) REMOTE WASTE I CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Fonn 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Fonn 1249) (You may also be required 10 provide additional information by your CUPA or local agency,) IS. " e e UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION 'P!lnp. nf ,_. . A 100, ENDING DATE 12/31/2002 3, BUSINESS PHONE 661-398-0393 101. FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 BUSINESS SITE ADDRESS 6450 WHITE LANE CITY BAKERSFIELD DUN & BRADSTREET 03-959-6507 COUNTY KERN BUSINESS OPERATOR NAME EDMOND NASSAR 102, 103, 106, ZIP CODE 93309 SIC CODE (4 digit #) 5541 105, 104, CA 107, 108, :<-, ·/":Y;.~i ·.,;n~\:,JJUSJNESS;'ØW1ŠJilR>. 113, 109, 110, , , OWNER NAME BP West Cost Products LLC OWNER MAILING ADDRESS: BP West coast Products LLC P.O. BOX # 6038 CITY ARTESIA 114, CONTACT NAME MICHEAL D. WILSON CONTACT MAILING ADDRESS: BP West Cost Products LLC P.O. BOX # 6038 CITY ARTESIA STATE CA ···;III~:';jfËÑWR6NMEm-.Å:Jj;ç6NT.Å:~ì':;··· 117. CONTACT PHONE 714-670-5321 115, 116, 119, 120, '< ,~- ~-' >" '~ "'-, '," 'h',','_'__ ,. "~~RY- ',. STATE CA '··I,t:;¡;~~M~~~Cr.'q9~A~~~~:'·:;,··. 123, NAME ARCO MISSION CONTROL 124, TITLE 121. ZIP CODE 90702-6038 . ··~ECO~Äk¥+t,.. 122, "\:.:',,' "-,, NAME EDMOND NASSAR TITLE FRANCmSEE BUSINESS PHONE 661-398-0393 24-HOUR PHONE· H.661-665-2047 STORE # 661-398-0303 129, 125, BUSINESS PHONE 800-272-6349 24-HOUR PHONE· 800-272-6349 130, 126. 131. 127, 132, ADDITIONAL LOCALLY COLLECTED INFORMATION: 133, Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete, 04/09/2002 TITLE OF SIGNER Environmental Specialist 135, W:t/0PEV DESI,::TED REPRESENTATIVE NAME 0 SIGNER (print) 136, MICHEAL D. WILSON DATE 134, Ramtox 137, ,. >. , .. , ç:,ltY OF ~AKERSFIELD" , , ,..,' ,,' e' . OFF:ICE Òr ENVIRONMENTAL SERVIèES:' . l715ChesterAv~.,Bakersfield, CA(661) 3'26-3~79 . HAZARDOUS MATEIDALSMANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt 2. TYFE/PRINT ANSWERS IN ENGLISH 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner/Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I below for initial submission. SECTION I BUSINESS IDENTIFICATION BUSINESS NAME: ARCO # 05420 LOCATION: 6450 WHITE LANE, BAKERSFIELD, CA 93309 MAILING ADDRESS: BP West Coast Products LLC CITY: P.O. BOX # 6038 STATE: CA ZIP: 90702 PIDMARY ACTIVITY: GASOLINE RETAIL STATION & MIN MARKET PHONE: 661-398-0393 OWNER: EDMOND NASSAR PHONE: 661-398-0393 MAILING ADDRESS: 6450 WHITE LANE, BAKERSFIELD, CA 93309 EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR PHONE 1. EDMOND NASSAR STORE: 661-398-0303 FRANCHISEE 661-398-0393 661-665-2047 2. ARCO MISSION CONTROL 800-272-6349 800-272-6349 I ~ e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Gasoline in underground storage tank can over spill from the top of the fill pipes or leak in the ground and to the surface. Other source of leak/spill is from the dispenser unit, nozzles, and pipes. Potential of fire and explosion exist. If a leak is found the leak probe will sense the liquid release and will set off the alarm. Other hazard is carbon dioxide gas cylinders used for soda drinks. The carbon dioxide gas cylinders are secured by chai~s in back room. B. EMPLOYEE AND AGENCY NOTIFICATION: In the event of minor to major spill, or fire, employee or owner will call 9-1-1 and local agency. Employees are trained on the use of personal protection equipment to minimize contact with hazardous materials/waste. OFFICE OF EMERGENCY SERVICE: 1-800-852-7550 NATIONAL RESPONSE CENTER: 800-424-8802 BAKERSFIELD FIRE DEPARTMENT: 661-326-3979 C. ENVIRONMENTAL RESPONSE MANAGEMENT AND EVACUATION PLAN: If a large release of gasoline spill or waste occurs, the owner, or store manager, or employees will take immediate action to have all employees leave the premises by the safest exit. All employees will be asked to assemble at a safe assembly area located at North side of site, or at a safe upwind location. Method of evacuation is verbal. Person responsible for notification is: NAME: EDMOND NASSAR TITLE: FRANCHISEE NAME OF THE HOSPITAL & TELEPHONE NUMBER: MERCY HOSPITAL 2215 TRUXTUM AVE. BAKERSFIELD, CA 93301 TEL: 661-632-5000 2 e e SECTION II RELEASE RESPONSE PLAN Emere:encv Procedures: Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials: PREVENTION (prevent the hazard) - Describe the kinds of hazards associated with the hazardous materials present at your facility. What actions would your business take to prevent these hazards from occurring? You may include a discussion of safety and storage procedures. Gasoline spills can result in environmental contamination, fire, and explosion. Releases of gasoline can occur when underground storage tanks are overfilled, when motorists overfill vehicle tanks, or drive off. The releases are prevented by installed overfill devices such as flapper valves, high level alarms, or ball floats. Other spill prevention devices are impact valves, and breakaway devices. Service stations are attended by trained personnel, and gasoline is delivered by trained truck drivers. The on-site coordinator or designee will train all new employees of this facility about the procedures for safe handling of hazardous materials and products for emergency response coordination, and use of emergency response equipment and supplies. Additionally, the on-site coordinator or designee will conduct a refresher-training program for all employees on annual basis. PROCEDURE FOR STORAGE AND DISPOSAL OF HAZARDOUS MATERIALS & HAZARDOUS WASTE: Liquid C02 cylinders must be secured to wall with chain (this applies for stations that serve soda in the store). Waste absorbent from the gasoline spill, cleanup spills, or used gasoline fuel filters must be stored in a proper UN (DOT) approved container with appropriate hazardous waste label on each container. Each drum or container containing hazardous waste must be stored away from hot or ignition sources and disposed before 90 days from accumulation date. Each container must be kept closed with lid and disposed as hazardous waste and manifested. State manifests of hazardous waste must be kept for three years in compliance kit. 3 e e The hazardous material handled on daily basis is gasoline. Hazards associated with this product are spill, leak, fire, and explosion. Fire Prevention procedures as follows: The gasoline tanks are equipped with leak detectors that activate an alarm and disable the pump when leak is detected. Few gas stations are equipped with over fill alarm that prevents the spillage of gasoline from over filling the tanks. All the dispensers are equipped with impact valves. Daily inspection of leaks from the pipes, nozzles, and pumps. Any leaks from above mentioned equipment will be fixed immediately. Posting no smoking sign at the dispensers. Monthly Inspection of fire extinguishers to ensure that are full and ready to use. Testing of the emergency shut offs located in front of the store. Testing of dispensers' start/stop emergency shut off located on the cash register. Testing the shut ofts of turbine pumps. The on/off switch is on the main electrical panel. Holine spills will be cleaned-up immediately using absorbent material MITIGATION (reduce the hazard) - Describe what is done to lessen the harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, spill, fire, explosion, or airborne release at your business? Mitiaation (continued): the event of a leak or spill: 1. Attendant should shut off electricity to the pumps/turbines at the main electrical panel and close the impact valves. 2. The on-site emergency coordinator or designee will contact 911 {Fire Department} and explain the emergency and will contact ARCO Maintenance. If necessary, the On-Site Emergency Coordinator or designee will request an ambulance or other medical assistance. 3. Evacuate. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. There are two exits - front entrance and rear emergency exit. All persons will evacuate through one of these doors and gather In area furthest from danger. Manager on duty will account for all station personnel and customers (when possible). 4. Contain the liquid by constructing berms and/or by covering the spill with a fireproof absorbent material. Prevent liquid from entering storm drains whenever possible. 5. Scene management shall be the responsibility of the On-Site Emergency Coordinator or designees until the arrival of fire or police personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer any assistance that is requested. 6. Immediately following an emergency the On-Site Emergency Coordinator will provide for the disposal of contaminated material as directed by the local Fire Department or County Health Agency. (All spills will be reported to BP Mission Control at (800) 272-6349. The BP Environmental Compliance Specialist will make report to pertinent agencies including NRC, CA OES, Water Board, and County Health Agency.) 3. If neither gives such direction, call ARC 0 Mission Control for removal and disposal. In the event of a tire employees should: 1. Shout FIRE and call 911 (Fire Department). 2. Stop fluid flow by shutting off electricity to the pumps at the main electrical panels and close impact valves. 3. Evacuate by stopping all traffic on site and direct all personnel and customers to a safe area opposite the danger. 4. Scene management is the responsibility of the On-Site Emergency Coordinator or designees until the arrival of public safety response personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer assistance, as requested. 4 e e In the event that a spill is small, station personnel should apply absorbent to the gasoline spill by sweeping the absorbent onto the spill. Once the absorbent has soaked up the liquid, sweep up the absorbent and place it in a 55-gallon drum. If the spill Is larger, call 911, attempt to contain it, and follow the scene management instructions in Section 2, Mitigation. Large spills are cleaned by PSI designated contractors, or as designated by the franchisee for franchise service stations. Employee's responsibilities: Employees will know the location of the nearest storm drain(s) and location of absorbent material to be used to prevent the spill from reaching the storm drains. In the event of a major spill, employees are Instructed to call 911 and report. The on-site emergency coordinator will provide for the disposal of contaminated materials as directed by the local tire department or County Environmental Health. If neither gives such direction, call ARCO Mission Control (800-272-6349) for disposal. 4. BUSINESS PLAN LOCATION: A copy of business plan and training documents will be kept at all times in a yellow compliance kit or a binder, which is located either near the cashier, or office in back room area. Followin are the emer ene Item Use Fire extinguisher Fire Control S ill absorbent S ill Control First Aid Kit Minor Injury ment of this faeili : Location Entrance & kitchen area Back room/Su ly room Inside office or cashier Maintenance Yearly Service Re-stock as needed Inventory twice a year UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE : NO ELECTRICAL: ELECTRICAL PANEL IN THE BACK ROOM WATER: SIDE WALK SPECIAL: LOCK BOX: DYES [gNO IF YES, LOCATION: PRIVATE FIRE PROTECTIONIW A TER AVAILABILITY: FIRE EXTINGUISHERS LOCATED AT ENTRANCE DOOR. INSIDE THE STORE. AND IN THE KITCHEN AREA A. B. PRIV ATE FIRE PROTECTION DYES [gNO WATER AVAILABILITY (FIRE HYDRANT): ON THE CORNER OF STATE HWY 65 & 77TH RD. 5 e e HAZARDOUSMATEIDALSMANAGEMENTPLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 1-2 PERSONS PER SHIFT, THERE ARE THREE SHIFTS AND TOTAL EMPLOYEES ARE ABOUT 5 MATERIAL SAFETY DATA SHEETS ON FILE: MSDS and business emergency plan is located in hazard communication kit, a yellow plastic box, located in the office area BIDEF SUMMARY OF TRAINING PROGRAM: Employees are trained on use of safety equipment and tools to minimize contact with hazardous materials/waste. Employees are trained and required to dial for emergency calls, 9-1-1, and evacuate the premises. Employees are trained in the use of spill clean up , first aid kit, fire extinguishers, electrical and gas shut off and use of telephones. Employees are trained to advise any response agency as to the nature and location of the problem. Initial training is conducted after hiring new employee. Trainer is the owner or manger of th'e store. Refresher training is done every year. Training topics are such as: 1) hazard communication program 2) materials safety data sheets, 3) safe handling of chemicals, and 4) emergency equipment& emergency response plan. 6 e e /. . ". . .. . . . ~. .. .n_ d.. , ,-.y .,....:::'~¡¡.,:."'."P7'ji;·p~r··<·<"':·"·'·,.,,"''', .;: "", .. ....;"... . . ""'p' .'''' ;·"'··C. cj '.' ". '" ': :."'/\r." ·"C.; """',P'," .,;;C'0A;:fðld'XVC'0C'0 TmAININn"R' r)n.mA;M· . ,,,,. Ax ,_'·';-_;<::'~.~:t~::~t~~;'^~Ä:tr>'~:':?'C'lv'r'L.-W:\l:,r=c:::;,. r'ßf7'" ...' '. ~_\3 .::" .'" .~-\:J_1XH '_~";:>~~'. ,~::~.:.:;- '1' .>' .>' ..'e,",::?':: " ',"',; ;:1 ' . ," . ","-' ...,_t~. '."'''_. '. " ' ,. :' >,,-£' ''''<:j ~ ~~'. ,i_,'oJ,', . Employers are required by State law to have a program which provides employees with initial and refresher training. The Business Emergency Plan shall include a training program which is reasonable and appropriate for the size of the business and the nature of the hazardous materials handled. The training program shall take into consideration the responsibilities of the employees to be trained. Training will be conducted upon hire, and refresher training provided at least annually. Hazardous Materials Handlina & Emeraency Response Trainina Will Include: 1. Methods for the safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material and measures employees can take to protect themselves from chemical hazards 2. Procedures for coordination with local emergency response organizations; 3. Correct use of emergency response equipment and supplies under the control of the business 4. The Cal OSHA Hazard Communication Standards 5. The prevention, abatement and mitigation procedures you have developed for your business and explained on the Business Emergency Plan 6. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuàte, and the closest location to obtain appropriate emergency medical care 7. Procedures to coordinate with and assist the local emergency personnel that may respond to your business 8. Who and how to call for immediate assistance in the event of an accident involving hazardous materials 9. Procedure for ensuring that appropriate personnel receive initial and refresher training UST Equipment Operatina and Monitorina Training Will Include: 1. Take tank level measurements 2. Read dispenser meters 3. Inspect equipment 4. Recognize warning signs: dispenser hesitations, meter spins, and odors 5. Manually close dispenser impact valve 6. Replace dispenser filters 7. Shut down the system by knowing the location of electrical panel breakers and emergency shutoff switches 8. Test the electronic monitoring system 9. Respond to alarms, leaks, or equipment problems :.;~>:;_:~!~_>··f-~-2 ' , ,·ÄL['E ,< ~ ~'" . '¥ES:,~AAINiNG:SflÄQt;~B.ËiÖ'()GLJME·NmEÐ;ÃN[j':tJRDÃ'1(;Eb·'Ãt<lNWÄ1:t:¥:::,,:~:;, ,,,,*,"" -~"" <.-, _'J ,,-_-,-__' _"n'.,_ -",,_ Æ. ,- u -,'_'L > "i,i'. .',' ~", .,.,..---.,--__ ,. .'..._.._ '^ L ~'w..",O" , ," "'" ,.d __ , <. ^' ._ ',.""", _ "," .', '" ""' ". __",,-,--. . -'.. __ .^ ___." . < '.'_( ",;.. '^. ."" ., ".,--- l.",.~ .'-" E".»-' , ';"'_ ~·o·:",f,:,i-;..~,< <-;: ',~<''- - Personnel 1. Are there any specially trained hazardous materials emergency response personnel at your business? 0 YES I8J NO 2. Do you have decontamination capabilities for victims of exposure to hazardous materials at your business? 0 YES I8J NO 3. Do you have personnel that will provide site security at your business during and after a hazardous materials incident? 0 YES I8J NO Equipment List the type and location of equipment that can or will be used for response to hazardous materials incidents at your business: Absorbent, a shovel and a broom are located in or near the station supply room. All waste absorbent will be disposed of in a properly labeled hazardous materials drum. 7 The On-Site Coordinator or designee will train all new employees of this facility about the following procedures for the safe.dling of hazardous materials, procedur....or emergency response coordination, and use 0 ergency response equipment and suP.. Additionally, the On-Site coordinator or designee will conduct a refresher-training program for all employees on a semi-annual basis. PROCEDURES FOR SAFE HANDLING OF HAZARDOUS MATERIALS 1. Employees will be informed of the health and safety hazards involved with the handling of gasoline/diesel fuel. 2. Employees will be careful not to spill gasoline, diesel fuel, or waste oil onto themselves or the ground. 3. Employees will not smoke, light matches, cause sparks, or take actions which could ignite flammable liquids or vapors. PROCEDURES FOR EMERGENCY RESPONSE COORDINATION 1. Employees will be familiar with the emergency response procedures outlined in this Business Emergency Response Plan. 2. Employees will know the location and operation of elec,trical shutoff switches and dispenser shutoff valves. 3. Employees will know the location of, how and when to use dry chemical fire extinguishers that are located on the premises. 4. Employees will know the location and proper use of first aid kit(s), fire extinguisher(s), and absorbent materials that are located on the premises. 5. Employees will know the location of the nearest storm drain(s) and location of absorbent materials to be used to prevent spills reach the storm drain(s). 6. Employees will be familiar with the kinds of emergency situations which will warrant immediate evacuation of premises. Circumstances Include: a. Any gasoline, diesel, or other type of fire. b. Any spill, fuel leak, or vapor leak that has the potential for Igniting or exploding. c. Any spill or leak where employees or customers notice gasoline vapors. EMPLOYEE TRAINING RECORDS The PSI manager, for PSI store, or owner/operator (for franchisee) will be responsible for documenting and retaining the types and dates of the "training" that each facility employee has completed (initial and refresher). These documentation records will be retained at the facility for at least 5 years from the date an employee last worked at the facility. Upon completion of said instruction, employee will sign a statement of acknowledgment. One copy kept at the facility. TRAINING SUBJECTS: Training Topic - Procedures for handling hazardous materials, including hazardous wastes Persons Trained: Facility Staff (i.e. cashier, maintenance) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: For minor spillage (i.e. customer gas tank oveñlow), employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean up equipment is provided at each facility. For major spillage, employees are instructed to call 911 and report. They will then notify the PSI manager, for PSI store, or owner/operator (for franchisee), or his/her alternate who will then activate the notification process. Training Topic - Procedures for coordination with emergency response agencies Persons Trained: Facility Staff (i.e. cashier, Emergency Coordinator, Alternate) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Facility personnel are instructed to call 911 and report. They will then call the PSI manager, for PSI store, or owner/operator (for franchisee), or his/her alternate who will then activate the notification process. Training Topic - Use of emergency response equipment and materials under business' control Persons Trained: Facility Staff (i.e. cashier) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Use and location of absorbent, protective clean-up equipment, first aid kit and fire extinguishers. Review of procedures for proper use of safety and spill control equipment, evacuation and earthquake procedures. Training Topic - Emergency Response Plan implementation Persons Trained: Facility Staff (All Employees) Training Time: 1/2 hour Refresher Frequency: Annually Training Content: Review of Emergency Response Plan; evacuation procedures; location of emergency fuel shut-off switches and main electrical shut-off switch; use and location of absorbent, protective clean-up equipment and fire extinguishers; and the list of ALL pertinent people to call in. 8 e e CERTIFICATION I, _ MICHEAL D. WILSON CERTIFY THAT THE ABOVE INFORMATION 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. ./7 / / ENVIRONMENTAL SPECIALIST {Y/~ TITLE 9 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) D MATERIAL(NON-WASTE) ~ WASTE DADD I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION DDELETE BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM FACILITY ID # CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) E8 10F1 II. CHEMICAL INFORMATION 205 TRADE SECRET CHEMICAL NAME WASTE ABSORBENT COMMON NAME ABSORBENT WASTE CAS# N/A FIRE CODE HAZARD CLASSES (Cofr4!lete if required by CUPA) HAZARDOUS MATERIAL TYPE (Check one item only) If Subject to EPCRA. refer to instructions 207 EHS· 0 Yes 181 No 209 ·If EHS is "Yes·, all amounts below must be in Ibs. RADIOACTIVE DYes I8INo 212 CURIES 211 o a. PURE Db, MIXTURE 181 c, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 181 a, SOLID Db, LIQUID o c, GAS 214 lARGEST CONTAINER 5 181 a, FIRE 0 b, REACTIVE 0 c, PRESSURE RELEASE 0 d, ACUTE HEALTH 0 e, CHRONIC HEALTH 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 5 50 10 221 UNITS· Check one item ani STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET 0 c, POUNDS ,0 d, TONS . If EHS, amount must be in unds, o a, ABOVE GROUND TANK Db, UNDERGROUND TANK DC, TANK INSIDE BUILDING o d, STEEL DRUM o i, FIBER DRUM o ¡,BAG o k, BOX o I, CYLINDER o m, GLASS BOTTLE 0 q, RAIL CAR 181 n, PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN Op, TANK WAGON De, PLASTICINONMETALLlC DRUM o f, CAN o 9, CARBOY o h, SILO STORAGE PRESSURE 181 a, AMBIENT o c, BELOW AMBIENT o b, ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT o d, CRYOGENIC o b, ABOVE AMBIENT o c, BELOW AMBIENT O/OWT HAZARDOUS COMPONENT (For mixture or waste only) EHS 100 226 MIXTURE OF WASTE Oil, HEAVY 227 DYes 181 No PETROLEUM DISTillATES AND SILICATES 2 230 231 DYes 0 No 3 234 235 DYes 0 No 4 238 239 DYes DNo 5 242 243 DYes DNo CAS # 228 N/A, MIXTURE 232 236 240 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Infonnatlon, ADDITIONAL LOCALLY COLLECTED INFORMATION No 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [g MATERIAL(NON-WASTE) D WASTE (one paQe per material per building or area) DADD DDELETE ~REVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM (EPCRA ) DYES ~ NO FACILITY ID # I I I I I 'I I I I I 1 I MAP# (optional) 203\ GRID# (optional) 204 10F1 B6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET U Yes ~ No 206 CARBON DIOXIDE If Subject to EPCRA. refer to instructions COMMON NAME 207 EHS* D Yes ~No 208 CAS# 124-38-9 209 *If EHS is "Yes"; all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (~ete if required by CUPA) 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) 181 a, PURE Db, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 50 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 50 200 N/A N/A 221 I DAYS ON SITE: 222 UNITS' Da, GALLONS Db, CUBIC FEET 181 c, POUNDS D d, TONS 365 (Check one item onlv) . If EHS. amount must be in pounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTICINONMETALLlC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR Db, UNDERGROUND TANK D f, CAN D ¡,BAG D n, PLASTIC BOTTLE D r, OTHER Dc. TANK INSIDE BUILDING D g, CARBOY D k, BOX D 0, TOTE BIN D d, STEEL DRUM D h, SILO 1811. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE D a, AMBIENT 181 b, ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE D a, AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT 181 d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 CARBON DIOXIDE 227 D Yes ~ No 228 124-38-9 229 2 230 231 DYes D No 232 233 3 234 235 DYes D No 236 237 4 236 , 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non<arclnogenlc. or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ~ UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [8J MATE RIAL(N 0 N -WASTE) D WASTE DADO DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION BACK ROOM OR FRONT SHELVES FACILITY 10 # GRID# (optional) D6 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 10F1 II. CHEMICAL INFORMATION 205 TRADE SECRET CHEMICAL NAME MOTOR OIL COMMON NAME ENGINE OIL, LUBRICANT MOTOR OIL 207 CAS# N/A 209 FIRE CODE HAZARD CLASSES (Cofrc¡leteifrequlred byCUPA) COMMBUSTIBLE LIQUID HAZARDOUS MATERIAL TYPE (Check one item only) If Subject to EPCRA. refer to instructions EHS· 0 Yes 181 No *If EHS is "Yes·, all amounts below must be in Ibs. D a, PURE I8Ib, MIXTURE 211 RADIOACTIVE DYes I8INo 212 CURIES Dc, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT D a, SOLID I8Ib, LIQUID Dc, GAS 214 LARGEST CONTAINER 0.25(ONE QUART) 181 a, FIRE D b. REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH 40 100 N/A 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT STATE WASTE CODE 221 UNITS· Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in unds, D a, ABOVE GROUND TANK Db, UNDERGROUND TANK Dc, TANK INSIDE BUILDING . D d, STEEL DRUM D i, FIBER DRUM D ¡,BAG D k, BOX D I. CYLINDER o m, GLASS BOTTLE 0 q, RAIL CAR 181 n, PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN o p, TANK WAGON o e, PLASTICINONMETALLlC DRUM o f, CAN o g, CARBOY D h, SILO STORAGE PRESSURE 181 a, AMBIENT o c, BELOW AMBIENT Db, ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D d. CRYOGENIC o b, ABOVE AMBIENT D c, BELOW AMBIENT O/OWT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 94-95 227 DYes 181 No 231 DYes 181 No 235 DYes 0 No 239 DYes DNo 240 226 LUBRICANT BASE OIL 228 N/A, MIXTURE 2 5-6 230 ADDTIVES, ANTI-OXIDANT 232 N/A, MIXTURE 3 234 236 4 238 5 243 DYes DNo 244 242 If more hazardous components are present at greater than 1'10 by weight If non-carclnogenlc, or 0,1'10 by weight if carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION No 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [8J MA TERIAL(NON-W ASTE) o WASTE DADD DDELETE I8IREVISE REPORTING YEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK FACILITY ID # G-4 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET No PREM I U M If Subject to EPCRA, refer to Instructions COMMON NAME GASOLINE 207 EHS· 0 Yes 181 No CAS# 8006-61-9 209 ·If EHS is "Yes·, all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (CoIrpIeteirrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 18, UN1203 HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE I8Ib, MIXTURE 211 RADIOACTIVE DYes I8INo 212 CURIES Dc, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT D a, SOLID I8Ib, LIQUID Dc, GAS 214 LARGEST CONTAINER 12,000 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 217 MAXIMUM DAILY AMOUNT 6,000 N/A 12,000 221 UNITS· Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in unds, D a, ABOVE GROUND TANK 181 b, UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM D i, FIBER DRUM D ¡,BAG D k, BOX D I, CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D 0, TOTE BIN D p, TANK WAGON De, PLASTICINONMETALLlC DRUM D f, CAN D g, CARBOY D h, SILO STORAGE PRESSURE 181 a, AMBIENT D c. BELOW AMBIENT D b, ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-15 230 METHYL TERTIARY BUTYL ETHER ( MTBE) 231 DYes 181 No 232 1634-04-4 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 7-14 238 TOULENE 239 DYes 181 No 240 1 08-88-3 5 242 243 DYes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 " UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [g MA TERIAL(NON-W ASTE) D WASTE DADO DDELETE of I2!REVISE REPORTING VEAR 2002 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK FACILITY 10 # G4 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET No UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS' 0 Yes 181 No CAS# 8006-61-9 209 'If EHS is "Yes·, all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Conl>Iete if required byCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE I8Ib. MIXTURE 211 RADIOACTIVE DYes I8INo 212 CURIES Dc, WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAiNER 12,000 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 6000 N/A 12,000 221 UNITS' Check one item onl STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET 0 c, POUNDS 0 d, TONS . If EHS. amount must be in unds, o a, ABOVE GROUND TANK I8Ib,UNDERGROUNDTANK DC, TANK INSIDE BUILDING o d, STEEL DRUM De, PLASTIClNONMETALLlC DRUM o f, CAN o g, CARBOY o h, SILO o i, FIBER DRUM o ¡,BAG o k, BOX o I, CYLINDER D m, GLASS BOTTLE 0 q, RAIL CAR o n, PLASTIC BOTTLE 0 r. OTHER o 0, TOTE BIN o p, TANK WAGON STORAGE PRESSURE 181 a, AMBIENT o c, BELOW AMBIENT o b, ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT o d, CRYOGENIC o b, ABOVE AMBIENT o c, BELOW AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DVes 181 No 232 1634-04-4 3 8-15 234 XYLENE 235 o Ves 181 No 236 1330-20-7 4 7-14 238 TOLUENE 239 DVes t?:SI No 240 1 08-83-3 5 242 243 DVes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Infonnation. ADDITIONAL LOCALL V COLLECTED INFORMATION 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 . '" UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [8J MA TERIAL(NON-W ASTE) D WASTE DADD DDELETE of I8IREVISE REPORTING YEAR I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 CHEMICAL LOCATION UNDERGROUND STORAGE TANK FACILITY ID # F4 CHEMICAL LOCATION CONFIDENTIAL (EPCRA ) 0 YES 181 NO 203 GRID# (optional) 10F1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET No UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* 0 Yes 181 No CAS# 8006-61-9 209 *If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Corrq¡leteifrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 1 B HAZARDOUS MATERIAL TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 181 a, FIRE D b. REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 6000 12,000 N/A 221 UNITS· Check one item on STORAGE CONTAINER l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS . If EHS, amount must be in unds, De, PLASTIClNONMETALLlC DRUM D 1. CAN D g, CARBOY D h, SILO D i, FIBER DRUM D ¡,BAG D k, BOX D I, CYLINDER D m, GLASS BOTTLE D q, RAIL CAR D n, PLASTIC BOTTLE D r, OTHER D 0, TOTE BIN D p, TANK WAGON D a, ABOVE GROUND TANK 181 b, UNDERGROUND TANK Dc, TANK INSIDE BUILDING D d, STEEL DRUM STORAGE PRESSURE 181 a, AMBIENT D c, BELOW AMBIENT D b, ABOVE AMBIENT STORAGE TEMPERATURE 181 a, AMBIENT D d, CRYOGENIC D b, ABOVE AMBIENT D c, BELOW AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DYes ~ No 232 1634-04-4 3 8-15 234 XYLENE 235 o Yes ~ No 236 1330-20-7 4 7-14 238 TOLUENE 239 DYes ~No 240 1 08-83-3 5 242 243 DYes DNo 244 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required Infonnation. ADDITIONAL LOCALLY COLLECTED INFORMATION 3 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 SITE MAP DATE:0111CW1 ~DRAIN KERN COUNTY MATERIAL DIVISION . HAZZARDDOU8 MATERIAL PLAN ® N BUSINESS NAME: ARoo FACIUTY ID# 06420 . SITE ADDRESS: 84SO WHITE lANE ~ rra a BAKERSFIELD, CA 93309. N8 . ABC D E F G H I J ø 8Y8TEM j ¡ j j j ! ¡ f.Ln SHAPED ~ IQNIG 1 I MAU~IClqS GRILL & pANT~NA I ~TRI~ MALL ~ ':""" ..····..··..·....1"(TO~..LIST~NG..Of..BU~INES'ES··....t' ........ ..exPRESS......···.. @) rtOPF 2 ¡ OF A STRip MA4L ¡ ¡ ¡ LUBE ¡ @) ~~ · . . . . . . .. - ,_........ .. : . : : : : : : :: ...-.- '. . .... ....,.. ... ..j ................. ~........... ...... +................+.. ... 'WHITE'lANE" ....... ·~V·"""·;···"·······""·!"·"·········"·. :IUI8II!R · . ~ . , . . . . ; PRIVEW : y ; ;, ~. ; ;; lm mNØI!NC\' · . , . 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[§!!] EMlRGENCYEXrT ·..·....··....···r.. : ~ . ~ ~ ~ ~ : . : : . : : :: ® All8Ct1I&n' 8 f¡~D¡ þARKI~GLO~ T-!SHIRTi I I . == : , ........... ······H··MriST..·· ......·..........:..........0· UTL,ET..·.:.· ........ ......~.................;.........,....... (!!] ......... .................... .... "" ........-..... :MALL :. :: .::: IfVWR"I-., : : :: :::: riiiiI AE8T-' 9 ¡ ¡ ¡ ¡ : ¡ ¡ ¡ ¡ ~ ~ · . . . . . . . . : : : : : : : :: SCALE 18. 40 Ft · : : : : : : :: -* : . . -' . . . .. DIRECTION - S . ASSORBI1m ~ Cj' .j. .- 0/ S -o,;2j - () óÓ{,dc; .. . " -~ --~ ,., IIBP West Coast Products LLCII ARCO # 05420 6450 WHITE LANE BAKERSFIELD, CA 93309 Hazardous Materials Business Plan 1. FACILITY INFORMATION SECTION To be completed by all businesses, regardless of program type. Forms included in this package complies with forms/attachment required by the appropriate city or county under which the Unified Program Agency applies. This Hazardous Materials Business Plan includes: [gIBUSINESS ACTIVITIES PAGE [gI BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE [gIEMERGENCY RESPONSE /CONTINGENCY PLAN [gIHAZARDOUS MATERIALS INVENTORY LIST [gIFACILITY SITE MAP 1 l j' "' UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # I. FACILITY IDENTIFICATION Page 1 of_ EPA ID # (Hazardous Waste Only) CAL000244300 2. 3 ARCO #05420 6450 WHITE LANE, BAKERSFIELD, CA 93309 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does our facilit .., If Yes, ¡ease com lete these a es of the UPCF.., A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emer enc Ian is re uired ursuant to 10 CFR Parts 30, 40 or 70? B, UNDERGROUND STORAGE TANKS (USTs) I, Own or operate underground storage tanks? 2, Intend to upgrade existing or install new USTs? 3, Need to report closing a UST? C, ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ---the total capacity for the facility is greater than 1,320 gallons? D, HAZARDOUS WASTE I, Generate hazardous waste? 2, Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143,2)? Treat hazardous waste on site? 3, 4, Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5, 6, Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on site? E, LOCAL REOUIREMENTS ~YES D NO 4. ~YES D NO 5. DYES ~ NO 6. D YES ~ NO 7. D YES ~ NO 8. ~YES D NO 9. DYES ~ NO 1o, DYES ~ NO Ii. DYES ~ NO 12. DYES ~ NO 13. DYES ~ NO 14. HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Formerly SWRCB Form A) UST TANK (one page per tank) (Formerly Form ß) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) UST TANK (closure portion - one page per tank) NO FORM REQUIRED TO CUPAs EP A ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly OTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly OTSC Forms 1772 A,ß,C,O and L) CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249) (You may also be required to Drovide additional infonnation by your CUPA or local agency,) 15. ~, i: e ~ . UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY ID # (Agency Use Only) I. IDENTIFICATION BEGINNING DATE 11/0112001 ENDING DATE 101. BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO # 05420 BUSINESS SITE ADDRESS 6450 WHITE LANE CITY BAKERSFIELD DUN & BRADSTREET 03-959-6507 COUNTY KERN BUSINESS OPERATOR NAME EDMOND NASSAR 104, II. BUSINESS OWNER OWNER NAME BP West Cost Products LLC OWNER MAILING ADDRESS: BP West coast Products LLC P.O. BOX # 6038 CITY 114, STATE ARTESIA CA III. ENVIRONMENTAL CONTACT 117. CONTACT NAME CARLOS RODRIGUEZ CONTACT MAILING ADDRESS: BP West Cost Products LLC P.O. BOX # 6038 CITY 120, ARTESIA STATE CA IV. EMERGENCY CONTACTS -PRIMARY- p~(JP nf 3. 103. 100. 102. CA ZIP CODE 93309 SIC CODE (4 digit #) 5541 105. 106. 107. 108, 109. 110. BUSINESS OPERA TOR PHONE 661-398-0393 111. 112, OWNER PHONE 714-670-5402 113, 115. ZIP CODE 90702 116. CONTACT PHONE 714-670-5402 118, 119. 121. ZIP CODE 90702 -SECONDARY- 122. NAME EDMOND NASSAR TITLE FRANCHISEE BUSINESS PHONE 661-398-0393 24-HOUR PHONE* H.661-398-0393 STORE # 661-398-0303 123. NAME 128, ARCO MISSION CONTROL 124. TITLE 129. 125, BUSINESS PHONE 130, 800-272-6349 126. 24-HOUR PHONE* 131. 800-272-6349 127, 132. 133, ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am a i¡iar with the information submitted a believe the information is true, accurate, and complete, DATE 134. 137. 135, 136. 11/0112001 TITLE OF SIGNER Environmental Specialist N 1- ,i' '",.., CITY OF BAKERSFIEL4 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this fonn within 30 days of receipt 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. 5. You may also attach Business Owner/Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I below for initial submission. SECTION I BUSINESS IDENTIFICATION BUSINESS NAME: ARCO # 05420 LOCATION: 6450 WHITE LANE, BAKERSFIELD, CA 93309 MAILING ADDRESS: BP West Coast Products LLC CITY: P.O. BOX # 6038 STATE: CA ZIP: 90702 PRIMARY ACTIVITY: GASOLINE RETAIL STATION & MIN MARKET PHONE: 661-398-0393 OWNER: EDMOND NASSAR PHONE: 661-398-0393 MAILING ADDRESS: 6450 WHITE LANE, BAKERSFIELD, CA 93309 EMERGENCY NOTIFICATION CONTACT BUS. PHONE 24 HR PHONE TITLE 1. EDMOND NASSAR STORE: 661-398-0303 661-398-0393 661-665-2047 FRANCHISEE 2. ARCO MISSION CONTROL 800-272-6349 800- 272-6349 1 ,¡ e e HAZARDOUS MATEmALS MANAGEMENT PLAN SECTION 11.1 DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITOmNG PROCEDURES: GASOLINE IN UNDERGROUND STORAGE TANK CAN OVER SPILL FROM THE TOP OF THE FILL PIPES OR LEAK IN THE GROUND AND TO THE SURFACE. OTHER SOURCE OF LEAK/SPILL IS FROM THE DISPENSER UNIT, NOZZLES, AND PIPES. POTENTIAL OF FIRE AND EXPLOSION EXIST. ALL THE UNDERGROUND STORAGE T ANKS HAVE DOUBLE WALL CONTAINMENT AND IF A LEAK IS FOUND THE LEAK PROBE WILL SENSE THE LIQUID RELEASE AND WILL SET OFF THE ALARM. OTHER HAZARD IS C02 GAS CYLINDERS USED FOR SODA DmNKS. THE C02 GAS CYLINDERS ARE SECURED BY CHAINS IN BACK ROOM. B. EMPLOYEE AND AGENCY NOTIFICATION: IN THE EVENT OF MINOR TO MAJOR SPILL, OR FIRE, EMPLOYEE OR OWNER WILL CALL 9-1-1 AND LOCAL AGENCY. EMPLOYEES ARE TRAINED ON THE USE OF SAFETY EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/WASTE. OFFICE OF EMERGENCY SERVICE: 1-800-852-7550 LOCAL OFFICE: 661-326-3979 C. ENVIRONMENTAL RESPONSE MANAGEMENT: IF A LARGE RELEASE OF GASOLINE SPILL OR WASTE OCCURS, THE OWNER, OR STORE MANAGER, OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO HAVE ALL EMPLOYEES LEAVE THE PREMISES BY THE SAFEST EXIT. ALL EMPLOYEES WILL BE ASKED TO ASSEMBLE AT A SAFE ASSEMBLY AREA LOCATED AT SOUTH SIDE OF MT. VERNON AVE., AT PARKING LOT OF HOLLYWOOD VIDEO, OR AT A SAFE UPWIND LOCATION. PERSON RESPONSIBLE FOR NOTIFICATION IS: NAME: EDMOND NASSAR TITLE: FRANCHISEE D. EMERGENCY MEDICAL PLAN: FOR SMALL INJUmES THE OWNER OR STORE MANAGER WILL UTILIZE THE FIRST AID KIT BOX. FOR MINOR TO MAJOR INJUmES, THE OWNER, OR STORE MANAGER WILL CALL EITHER 9-1-1, OR MAY CONTACT THE CLOSEST MEDICAL/CLINIC CENTER, WHICH IS LOCATED AT: NAME OF THE HOSPITAL & TELEPHONE NUMBER: MERCY HOSPITAL 2215 TRUXTUM AVE. BAKERSFIELD, CA 93301 TEL: 661-632-5000 2 " " SECTION 11.2: RELEASE RESPONSE PLAN A. HAZARD AI:SSMENT AND PREVENTION MlsURES HAZARD ASSOCIATE TO THIS RETAIL GASOLINE STORE IS: GASOLINE, FLAMMABLE LIQUID, CLASS lB, UN1203 GASOLINE IN UNDERGROUND STORAGE TANK CAN OVER SPILL FROM THE TOP OF FILL PIPE OR LEAK INTO 'OR ON THE GROUND AND TO THE SURFACE. OTHER SOURCE OF LEAKS/SPILLS IS FROM THE DISPENSER UNIT, NOZZLES, AND PIPES. POTENTIAL OF FIRE AND EXPLOSION EXIST. ALL THE UNDERGROUND STORAGE TANKS HAVE DOUBLE WALL CONTAINMENT, IF A LEAK IS FOUND, THE LEAK PROBE WILL SENSE THE LIQUID RELEASE AND WILL SET OFF THE ALARM. OTHER HAZARD IS C02 GAS CYLINDERS USED FOR SODA DRINKS. THE C02 GAS CYLINDERS ARE SECURED BY CHAINS IN BACK ROOM. B. RELEASE CONTAINMENT AND/ORMITIGATION IF A LARGE RELEASE OF GASOLINE SPILL OR WASTE OCCURS, THE OWNER, OR STORE MANAGER, OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO HAVE ALL EMPLOYEES LEAVE THE PREMISES BY THE SAFEST EXIT. ALL EMPLOYESS WILL BE ASKED TO ASSEMBLE AT SOUTH SIDE OF MT. VERNON AVE., AT PARKING LOT OF HOLLYWOOD VIDEO. FOR SMALL FIRE, OWNER OR EMPLOYEE WILL USE PORTABLE FIRE EXTINGUISHER. FOR SMALL SPILL, OWNER OR EMPLOYEE, WILL USE ABSORBENT MATERIAL FOR MAJOR SPILLS OR LEAKS, CALL ARCO MISSION CONTROL: 800-272-6349 C. CLEAN UP AND RECOVERY PROCEDURES THE OWNER OR MANAGER WILL MAKE SURE THAT ELECTRIC POWER AND NATURAL GAS ARE TURNED OFF AND THAT ALL EMPLOYEES WILL BE EVACUATED FROM THE PREMISES. OWNER WILL SHUT DOWN THE WHOLE OPERATION OF GASOLINE PUMP BY PRESSING THE EMERGENCY SHUT OFF PUMPS LOCATED EITHER AT THE CASHIER OR OUTSIDE AND WILL SHUT OFF TURBINES CIRCUIT BREAKER LOCATED AT THE ELECTRICAL PANEL AREA. HAZARDOUS WASTE FROM SPILL CONTAINMENT WILL BE DISPOSED BY CALLING ARCO MISSION CONTROL: 800-272-6349 . Followin are the emer ene e ui ment of this faeili : Item Use Location Maintenance Fire extinguisher Fire Control Entrance & kitchen area Yearly Service Spill absorbent Spill Control . Back roomfSu ply room Re-stock as needed First Aid Kit Minor Injury Inside office or cashier Inventory twice a year UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURALGAS/PROPANE: NO ELECTRICAL: ELECTRICAL PANEL IN THE BACK ROOM WATER: SIDE WALK SPECIAL: LOCK BOX: DYES [gINO IF YES, LOCATION: PRN ATE FIRE PROTECTION/W ATER AVAILABILITY: FIRE EXTINGUISHERS LOCATED AT ENTRANCE DOOR, INSIDE THE STORE, AND IN THE KITCHEN AREA A. B. ASHE RD. PRN ATE FIRE PROTECTION DYES [gINO WATER AVAILABILITY (FIRE HYDRANT) : ON THE CORNER OF WHITE LN. & HAZARDOUS MATERIALS MANAGEMENT PLAN 3 ,. SECTION III: TRAINING -- NUMBER OF EMPLOYEES: e 1-2 PERSONS PER SHIFT, THERE ARE THREE SHIFTS AND TOTAL EMPLOYEES ARE ABOUT 5 MATERIAL SAFETY DATA SHEETS ON FILE: MSDS AND BUSINESS EMERGENCY PLAN IS LOCATED IN HAZARD COMMUNICATION KIT, A YELLOW PLASTIC BOX, LOCATED IN THE OFFICE AREA BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON USE OF SAFETY EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/W ASTE. EMPLOYEES ARE TRAINED AND REQUIRED TO DIAL FOR EMERGENCY CALLS, ESPECIALLY 9-1-1, AND EVACUATE THE PREMISES. EMPLOYEES ARE TRAINED IN THE USE OF SPILL CLEAN UP SUPPLIES, FIRST AID KITS, AND FIRE EXTINGUISHERS, ELECTRICAL AND GAS SHUT OFF AND USE OF TELEPHONES. EMPLOYEES ARE TRAINED TO ADVISE ANY RESPONSE AGENCY AS TO THE NATURE AND LOCATION OF THE PROBLEM. INITIAL TRAINING IS CONDUCTED AFTER HIRING NEW EMPLOYEE. TRAINER IS THE OWNER OR MANGER OF THE STORE. REFRESHER TRAINING IS DONE EVERY YEAR. TRAINING TOPICS ARE SUCH AS : 1) HAZARD COMMUNICATION PROGRAM 2) MATERIALS SAFETY DATA SHEETS, 3) SAFE HANDLING OF CHEMICALS, AND 4) EMERGENCY EQUIPMENT & EMERGENCY RESPONSE PLAN. CERTIFICATION I, CARLOS L. RODRIGUEZ CERTIFY THAT THE ABOVE INFORMATION 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. ENVIRONMENTAL SPECIALIST SIGNATURE TITLE 4 r. '. UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) D MATERIAL(NON-WASTE) [g WASTE (one oaoe oer material cer buildino or area) DADO DDELETE !8JREVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM (EPCRA ) DYES !8J NO FACILITY 10 # I I IJ[J'~j I I I ~~I I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 B-6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes !8J No 206 WASTE ABSORBENT If Subject to EPCRA, refer to instructions COMMON NAME ABSORBENT WASTE 207 EHS' DYes I8J No 208 CAS# NI A 209 'If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a. PURE Db. MIXTURE 181 c, WASTE 211 RADIOACTIVE DYes 181 No PHYSICAL STATE 215 (Check one item only) 181 a, SOLID Db. LIQUID D c. GAS 214 LARGEST CONTAINER 5 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c. PRESSURE RELEASE D d. ACUTE I:JEAL TH D e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 5 10 50 221 221 I DAYS ON SITE: 222 UNITS· l8Ia. GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item only) . If EHS, amount must be in Dounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q. RAIL CAR D b, UNDERGROUND TANK D f. CAN D j.BAG 181 n, PLASTIC BOTTLE D r, OTHER Dc. TANK INSIDE BUILDING D g, CARBOY D k. BOX D 0, TOTE BIN D d, STEEL DRUM D h. SILO D I. CYLINDER D p. TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT Db. ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT Db. ABOVE AMBIENT D c, BELOW AMBIENT D d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 MIXTURE OF WASTE Oil, HEAVY 227 DYes !8J No 228 N/A, MIXTURE 229 PETROLEUM DISTillATES AND SILICATES 2 230 231 DYes 0 No 232 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 It more hazardous components are present at greater than 1% by weight if non-carcinogenic, or 0,1% by weight It carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 16. e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) IZI MATERIAL(NON-WASTE) 0 WASTE (one page oer material oer buildino or area) DADD DDELETE [8REVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM (EPCRA ) DYES [8 NO FACILITY ID # I I Ij~j~~fjjl I I 1:1 I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 B6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes [8 No 206 CARBON DIOXIDE If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS' DYes [8 No 208 CAS# 124-38-9 209 'If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) 181 a, PURE Db, MIXTURE DC, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) o a, SOLID I8Ib. LIQUID o c. GAS 214 LARGEST CONTAINER 50 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a. FIRE o b. REACTIVE 0 c. PRESSURE RELEASE o d, ACUTE HEALTH De. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 50 200 N/A N/A 221 I DAYS ON SITE: 222 UNITS' Oa, GALLONS Db, CUBIC FEET 181 c. POUNDS o d. TONS 365 (Check one item only) . If EHS, amount must be in pounds. STORAGE CONTAINER o a, ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM o i, FIBER DRUM Om, GLASS BOTTLE o q. RAIL CAR Db. UNDERGROUND TANK o f. CAN o j.BAG On. PLASTIC BOTTLE o r, OTHER DC. TANK INSIDE BUILDING o g. CARBOY o k. BOX o o. TOTE BIN o d, STEEL DRUM o h. SILO 1811. CYLINDER Op, TANK WAGON 223 STORAGE PRESSURE o a. AMBIENT 181 b, ABOVE AMBIENT o c. BELOW AMBIENT 224 STORAGE TEMPERATURE o a. AMBIENT o b, ABOVE AMBIENT o c. BELOW AMBIENT 181 d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 CARBON DIOXIDE 227 DYes [8 No 228 124-38-9 229 2 230 231 DYes DNo 232 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carcinogenic, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ¡' I'; ,-" e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MA TERIAL(NON-WASTE) D WASTE (one page per material per building or area) DADD DDELETE I8JREVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM OR FRONT SHELVES (EPCRA ) DYES I8J NO FACILlTYID # I I I~I I I l;i~~1 I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 06 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes I8J No 206 MOTOR Oil If Subject to EPCRA, refer to instructions COMMON NAME ENGINE Oil, lUBRICANT MOTOR Oil 207 EHS" DYes I8J No 208 CAS# N/ A 209 "If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) COMMBUSTIBlE LIQUID 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a. PURE I8Ib, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes 181 No PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER O,25(ONE QUART) FED HAZARD CATEGORIES 216 (Check all that apply) 181 a. FIRE D b. REACTIVE D c. PRESSURE RELEASE D d. ACUTE HEALTH De, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 40 100 N/A N/A 221 I DAYS ON SITE: 222 UNITS' 181 a , GALLONS Db, CUBIC FEET D c. POUNDS D d, TONS 365 (Check one item only) . If EHS, amount must be in pounds. STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m. GLASS BOTTLE D q. RAIL CAR D b, UNDERGROUND TANK D f,CAN D j.BAG 181 n, PLASTIC BOTTLE D r. OTHER Dc, TANK INSIDE BUILDING D g. CARBOY D k, BOX Do. TOTE BIN D d, STEEL DRUM D h. SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT D b. ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a. AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT D d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 94-95 226 lUBRICANT BASE Oil , 227 DYes I8J No 228 N/A, MIXTURE 229 2 5-6 230 ADDTIVES, ANTI-OXIDANT 231 DYes I8J No 232 N/A, MIXTURE 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carcinogenic, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ~ '" .. UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) [8J MATERIAL(NON-WASTE) D WASTE (one oace oer material Der buildinc or area) DADD DDELETE I8IREVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES 181 NO FACILITY ID # I I æ I I I~!~I I I I I I I 1 I MAP# (optional) 203/ GRID# (optional) 204 10F1 G-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 PREMIUM If Subject to EPCRA. refer to instructions COMMON NAME GASOLINE 207 EHS· DYes 181 No 208 CAS# 8006-61-9 209 ·If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (CompletelfrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a. FIRE D b. REACTIVE D c. PRESSURE RELEASE 181 d. ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS· l8Ia. GALLONS Db, CUBIC FEET D c. POUNDS D d. TONS 365 (Check one item only) . If EHS, amount must be in pounds. STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i. FIBER DRUM D m. GLASS BOTTLE D q. RAIL CAR 181 b, UNDERGROUND TANK D f, CAN D j.BAG D n, PLASTIC BOTTLE D r. OTHER Dc, TANK INSIDE BUILDING D g. CARBOY D k. BOX D o. TOTE BIN D d. STEEL DRUM D h. SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a. AMBIENT D b. ABOVE AMBIENT D c. BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 229 2 0-15 230 METHYL TERTIARY BUTYL ETHER ( MTBE) 231 DYes 181 No 232 1634-04-4 233 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 237 4 7-14 238 TOULENE 239 DYes 181 No 240 1 08-88-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carcinogenic, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 . i:o~ " UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) IZI MA TERIAL(NON-WASTE) 0 WASTE (one page per material per building or area) DADO DDELETE IZIREVISE REPORTING YEAR 2002 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES IZI NO FACILITY 10 # I I I ;~I I I I"~:;~I I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 G4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes IZI No 206 UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* DYes IZI No 208 CAS# 8006-61-9 209 *If EHS is ''Yes'', all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAMMABLE LIQUID, CLASS 1 B, UN1203 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a. PURE I8Ib, MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a. SOLID I8Ib. LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a. FIRE D b. REACTIVE D c. PRESSURE RELEASE 181 d. ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 , DAYS ON SITE: 222 UNITS· l8Ia, GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item onlv) . If EHS, amount must be in pounds. STORAGE CONTAINER D a, ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m. GLASS BOTTLE D q, RAIL CAR 181 b. UNDERGROUND TANK D f, CAN D j.BAG D n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k. BOX D 0, TOTE BIN D d. STEEL DRUM D h, SILO D I. CYLINDER Dp. TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a. AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS ' CAS # 1 1-5 226 BENZENE 227 DYes IZI No 228 71-43-2 229 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DYes IZI No 232 1634-04-4 233 3 8-1 5 234 XYLENE 235 DYes IZI No 236 1330-20-7 237 / 4 7-14 238 TOLUENE 239 DYes IZI No 240 1 08-83-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1 % by weight If non-carcinogenic, or 0,1 % by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 i ;¡" ~. - UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) D WASTE (one page per material per building or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES 181 NO FACILITY ID # 1 I r~~;ÃI I 1 m I I I "I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 F4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* DYes 181 No 208 CAS# 8006-61-9 209 *If EHS is "Yes", all amounts below must be in Ibs, . FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAMMABLE LIQUID, CLASS 1 B 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a. SOLID I8Ib, LIQUID D c. GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b. REACTIVE D c. PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS' l8Ia, GALLONS Db. CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item only) . If EHS. amount must be in pounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM o m, GLASS BOTTLE D q, RAIL CAR 181 b. UNDERGROUND TANK D f, CAN D j.BAG o n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g. CARBOY o k, BOX o o. TOTE BIN o d, STEEL DRUM D h. SILO D I. CYLINDER D p. TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT Db. ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT Db, ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 229 2 0-1 5 230 METHYL TERTIARY BUTYL ETHER 231 DYes 181 No 232 1634-04-4 233 3 8-15 234 XYLENE 235 DYes 181 No 236 1330-20-7 237 4 7-14 238 TOLUENE 239 DYes 181 No 240 1 08-83-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight if non·carclnogenlc, or 0,1 % by weight If carcinogenic, attach additional sheets of paper capturing the required Information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ~ ,~ .. e e SITE MAP DATE:01I10101 DRAIN KERN COUNTY HAZARDDOU8 MA1ERW.. DMSION . HAZZARDDOU8 MATERIAL PlAN ® BUSINESS NAME: ARCO FACIUTY lOtI 06420 srrE ADDRESS: 84SO WHJTE LANE ~ I BAKERSFIELD. CA 93309 a I ABC D E F G H I J ø IY81'I!II 1 I MAuk,C'O'S GRILL & CANTiNA: rLR SH~ED ~ ::.. j . : . : . ¡ ~TRI~ MALL @ fF ··..·....·..·....(TO~..LIST~NG··Of..BU~INES~ES··....t· ........ ··ExPRESS..·........ @) mJFF 2 ¡ OF ~ STRip MAL¡.L ¡ ¡ ¡ LUBE ¡ @) ~ · . . . . , . " _ ,_&aIft : : : : : : . :: ~-...... .,........ ....... ¡ ...:....... ......¡.... ............. {.... ... .......... .~. ....' ·wHiTE·LANE··..···· "~"""""f"'"'''' ........ ¡.. ................ ItÍIII!R · . ti. . . . . . . : DRIVEW ' Y : : ~' : :: IIi!ii5II ImNGINC'f' 3 : : : : : ~/. ..: : ~. lI.!eJ _PLAN KFC : : : ; :,#: : ;' ð. ¡wø. ¡ ¡ ~ ¡ ~ ,.";' ¡ ¡ ·..··....·......·1.· ·..······......j,····....····,·..t....··......·..·~..............·..¡:;¿,-:· ~~.,).~1i)....t. ........ ·....t..·....·..~..·..·........·.. Q!J7 ~PMm!CTM! : : : : ~ ""'/ "".D. ~/~ : ~ "'" .....CONTMllENTI <4 .... ¡ ¡ ¡ ¡ ~~~ -,&.0;"'" /. r'" ') ¡..:;c IðI 1II11CM11ON fQIJPI&II' 0: ; : : ~ ~~ ;,,#/. ",Q/: :. 0 + PlAlTNDECIUIPI8IT : : : : ~ '"(~"/ ." 0"'''''': : , ..... ¡¡¡,¡J...'..¡. ...............j.................~..................(................j....... ~..;! ..~..·..t· .c. ......;............,.~................. lilt SlER8ENC'Y~8E. ~ · . . ..... ~ "'" . a::. ""'- MIlA 5 C) ¡ ¡ ¡ ¡ ~ ¡ ~: "/ ¡ W ¡ ~ .:« IEItICRIORPRDIEI ~ ¡ .: ¡ : I EM ¡ ¡ ¡:I: ¡::) . UWCDEJ1!CTOR ~: : : , : : :(f.J: - IFiiI ..·..~..···T .... "T' ..............1'............ ;....·..........~..·..'........r'......·........f· 'ë::(' ·..·..¡..·........·Z..·.............., I:..:J ~ a:::: : :~: ® ~ : : : --: C--) ~ 8 <C ¡ ®: [!]~ ¡ ¡ ¡ ¡ ¡::e -- S1'CIWIETMK a.. : ~Ð :,: : : :> : 0 ~ I GAS ....... ,..... ....¡. .... :+.!.. .......... ....1....·· ....... r~1 .. ........., ¡ ............ ..... ¡.. ............. '''1' ~.. .... . ....,~ ...... ......d·.. ......... ..... [!] ,MnaPF · .. . . . .. ·1 . Z ~ 7 ¡.; : ; ¡ ¡ ~ ¡ O· ffL1 IUQIJID rail ' : : : : :: I!:!:J' ~. . . . . . . .. [gJ ,................¡. .... '.. . @~..~ ....GPQ.L..e.a... ..........I.ps··..·......L..............lº...... ......L...........q................. ~ ~:m · c .. .... ~ : ".:::: fí:\ : . . . . . . .. ~ r 8 ¡¡FOOD P; ARKI~GLOT T.!SHIRT¡ ¡ ¡ *** ÆNCE ·MAX .. '. . " ~ ........' ·....·¡MALC.. ......... ·....R·PØT(..........··...·..·O~TlET···i.. ....... ·....t·..........·..·..¡..·..·....·...... ~ 9 ¡ ¡ ¡ 'II'~1T'1T ¡ ¡ ¡ ¡ -=- : ~ ~ ¡ ~ ~ ~; SCALE : ......, J · ....... - -~ --.,. . ! r' IÞ -- i$~~ ~:w.. , . ARCO FACILITY ID# 05420 6450 WIDTE LN. BAKERSFIELD, CA 93309 ARCOPRODUCTSCOMPANY ARCO FACILITY ID# 05420 Hazardous Materials Business Plan 1. FACILITY INFORMATION .~ SECTION ARCp FACILITY ID# 05420 645Ó WHITE LANE. / ,/ BAKERSFIELD, CA 93309 To be completed by all businesses, regardless of program type. Forms included in this package complies with forms/attachment required by the appropriate city or county under which the Unified Program Agency applies. This Hazardous Materials Business Plan includes: IZBUSINESS ACTIVITIES PAGE IZ BUSINESS OWNER/OPERATOR IDENTIFICATION PAGE IZEMERGENCY RESPONSE /CONTINGENCY PLAN IZHAZARDOUS MATERIALS INVENTORY LIST IZFACILITY SITE MAP 1 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) ,. Page 1 of _ EPA ID # (Hazardous Waste Only) CAL000032607 2. 3. ARCO AMPM STORE ID # 05420, 6450 WHITE LANE, BAKERSFIELD, CA 93309 II. ACTMTIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does our facilit ... If Yes, lease com lete these a es ofthe UPCF... A, HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B, UNDERGROUND STORAGE TANKS (USTs) I , Own or operate underground storage tanks? 2, Intend to upgrade existing or install new USTs? 3, Need to report closing a UST? C, ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ---the total capacity for the facility is greater than 1,320 gallons? D, HAZARDOUS WASTE I. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per H&SC §25143.2)? Treat hazardous waste on site? 3. 4, Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? 5, 6, Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? E, LOCAL REQUIREMENTS ~ YES D NO 4. ~ YES D NO 5, D YES ~ NO 6. D YES ~ NO 7. D YES ~ NO 8, ~YES D NO 9. DYES ~ NO 10. DYES ~ NO 11. DYES ~ NO 12, DYES ~ NO 13, DYES ~ NO 14, HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Fonnerly SWRCB Fonn A) UST TANK (one page per tank) (Fonnerly Fonn B) UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Fonnerly Form C) UST TANK (closure portion - one page per tank) NO FORM REQUIRED TO CUPAs EPA ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Fonns 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Fonnerly DTSC Fonns 1772 A,B,C,D and L) CERTIFICATION OF FINANCIAL ASSURANCE (Fonnerly DTSC Fonn 1232) REMOTE WASTE I CONSOLIDATION SITE ANNUAL NOTIFICATION (Fonnerly DTSC Fonn 1196) HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Fonnerly DTSC Fonn 1249) (You may also be required to provide additional information by your CUP A or local agency,) 15. e e UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO AMPM STORE, FACILITY ID # 05420 BUSINESS SITE ADDRESS 6450 WHITE LANE CITY BAKERSFIELD DUN & BRADSTREET 18-314-5036 COUNTY KERN BUSINESS OPERATOR NAME EDMOND NASSAR 0110112001 104, II. BUSINESS OWNER OWNER NAME ARC 0 PRODUCTS COMPANY OWNER MAILING ADDRESS P.O. BOX # 6038 CITY AR TESIA 114. STATE CA ffi. ENVIRONMENTAL CONTACT 117, CONTACT NAME CARLOS RODRIGUEZ CONTACT MAILING ADDRESS ARCO PRODUCTS COMPANY, P.O. BOX # 6038 CITY ARTESIA 120. STATE CA -PRIMARY- IV. EMERGENCY CONTACTS NAME EDMOND NASSAR TITLE FRACHISEE BUSINESS PHONE 661-398-0393 24-HOUR PHONE* H.661-665-2047 STORE # 661-398-0303 123, NAME HARlSH PATEL TITLE MANAGER BUSINESS PHONE 661-398-0393 24-HOUR PHONE* H.. 661-834-4913 CELL # 661- 303-6856 124. 125. 126. 127. ADDITIONAL LOCALLY COLLECTED INFORMATION: 3. p':)(J~ of 101. 102, 103. 105, 107. 108, 110. CA ZIP CODE 93309 SIC CODE (4 digit #) 5541 106. 109. BUSINESS OPERATOR PHONE 661-398-0393 111. OWNER PHONE 714-670-5402 112. 113. 115, ZIP CODE 90702 116. CONTACT PHONE 714-670-5402 118. 119. 121. ZIP CODE 90702 -SECONDARY - 122. 128. 129. 130. 131. 132. 133. Certific 'on: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am fa ili r w'th the information submitted and lieve the information is true, accurate, and complete, DATE 134, NAME OF DOCUMENT PREPARER 135. CARLOS RODRIGUEZ UPCF hwf2730 (1/99) - 1/2 01/26/01 136, TITLE OF SIGNER Environmental Specialist, ARCO http://www.unidocs.org 137. Rev. 04/17/00 · -. CITY OF BAKERSFIELD e OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATE IDAL S MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this fonn within 30 days of receipt 2. TYPEIPRINT ANSWERS IN ENGLISH 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner/Operator F onn and Chemical Description F onn( s) to the front of this plan instead of completing SECTION I below for initial submission. SECTION I BUSINESS IDENTIFICATION BUSINESS NAME: ARCO AMPM STORE ID # 05420 LOCATION: 6450 WHITE LANE, BAKERSFIELD, CA 93309 MAILING ADDRESS: ARCO PRODUCTS COMPANY CITY: P.O. BOX # 6038 STATE: CA ZIP: 90702 PIDMARY ACTIVITY: GASOLINE RETAIL STATION & MIN MARKET PHONE: 661-398-0393 OWNER: EDMOND NASSAR PHONE: 661-398-0393 MAILING ADDRESS: 6450 WHITE LANE, BAKERSFIELD, CA 93309 EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR PHONE 1. EDMOND NASSAR STORE: 661-398-0303 FRANCHISEE 661-398-0393 661-665-2047 2. HAIDSH PATEL CELL: 661-303-6856 MANAGER 661-398-0393 661-834-4913 1 e e .. HAZARDOUS MATERIALS MANAGEMENT PLAN ;; SECTION 11.1 DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: GASOLINE IN UNDERGROUND STORAGE TANK CAN OVER SPILL FROM THE TOP OF THE FILL PIPES OR LEAK IN THE GROUND AND TO THE SURFACE. OTHER SOURCE OF LEAK/SPILL IS FROM THE DISPENSER UNIT, NOZZLES, AND PIPES. POTENTIAL OF FIRE AND EXPLOSION EXIST. ALL THE UNDERGROUND STORAGE TANKS HAVE DOUBLE WALL CONTAINMENT IF A LEAK IS FOUND THE LEAK PROBE WILL SENSE THE VAPOR RELEASE AND WILL SET OFF THE ALARM. OTHER HAZARD IS C02 GAS CYLINDERS USED FOR SODA DRINKS. THE C02 GAS CYLINDERS ARE SECURED BY CHAINS IN BACK ROOM. LEAKS ARE DETECTED BY VEEDER-ROOT TANK MONITOR CONSOLE. THIS MONITOR ALSO HAS ABILITY TO DETECT LEAKS USING A VAPOR SENSOR WHICH IS LOCATED IN ANNULAR SPACING OF THE DOUBLE WALL TANK. ONCE SENSOR DETECTS LEAKS OF GASOLINE OF TANKS, THE ALARM GOES OFF. B. EMPLOYEE AND AGENCY NOTIFICATION: IN THE EVENT OF MINOR TO MAJOR SPILL, LEAK, FIRE & EXPLOSION EMPLOYEE, OR OWNER, WILL CALL 9-1-1 AND LOCAL AGENCY. EMPLOYEES ARE TRAINED ON THE USE OF ANY REQUIRED SAFETY EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/W ASTE. EMPLOYEES ARE TRAINED TO REQUIRED EMERGENCY CALLS, ESPECIALLY 9-1-1.0FFICE OF EMERGENCY SERVICE: 1-800-852-7550 LOCAL OFFICE: 661-326-3979 C. ENVIRONMENTAL RESPONSE MANAGEMENT: IF A LARGE RELEASE OF GASOLINE SPILL OR WASTE OCCURS, THE OWNER, OR STORE MANAGER, OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO HAVE ALL PERSONS LEAVE THE PREMISES BY THE SAFEST EXIT. ALL PERSONS WILL BE ASKED TO ASSEMBLE AT A SAFE ASSEMBLY AREA AT THE BACK OF THE STORE, IN THE PARKING LOT, OR AT A SAFE UPWIND LOCATION. PERSON RESPONSIBLE FOR NOTIFICATION IS: NAME: EDMOND NASSAR TITLE: FRANCHISEE D. EMERGENCY MEDICAL PLAN: FOR SMALL INJURIES THE OWNER OR STORE MANAGER WILL UTILIZE THE FIRST AID KIT BOX. FOR MINOR TO MAJOR INJURIES, THE OWNER, OR STORE MANAGER WILL CALL EITHER 9-1-1, OR MAY CONTACT THE CLOSEST MEDICAL/CLINIC CENTER WHICH IS LOCATED AT NAME OF THE HOSPITAL & TELEPHONE NUMBER: MERCY HOSPITAL 2215 TRUXTUM AVE. BAKERSFIELD, CA 93301 TEL: 661-632-5000 2 e e SECTION 11.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES HAZARD ASSOCIATE TO THIS RETAIL GASOLINE STORE IS : GASOLINE, FLAMMABLE LIQUID, CLASS lB, UNl203 GASOLINE IN UNDERGROUND STORAGE TANK CAN OVER SPILL FROM THE TOP OF FILL PIPE OR LEAK INTO OR ON THE GROUND AND TO THE SURFACE. OTHER SOURCE OF LEAKS/SPILLS IS FROM THE DISPENSER UNIT, NOZZLES, AND PIPES. POTENTIAL OF FIRE AND EXPLOSION EXIST. ALL THE UNDERGROUND STORAGE TANKS HAVE DOUBLE WALL CONTAINMENT, IF A LEAK IS FOUND, THE LEAK PROBE WILL SENSE THE VAPOR RELEASE AND WILL SET OFF THE ALARM. OTHER HAZARD IS C02 GAS CYLINDERS USED FOR SODA DRINKS. THE C02 GAS CYLINDERS ARE SECURED BY CHAINS IN BACK ROOM. B. RELEASE CONTAINMENT AND/OR MITIGATION IF A LARGE RELEASE OF GASOLINE SPILL OR WASTE OCCURS, THE OWNER, OR STORE MANAGER, OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO HAVE ALL PERSONS LEAVE THE PREMISES BY THE SAFEST EXIT. PERSON WILL BE ASKED TO ASSEMBLE AT THE BACK OF THE STORE, IN THE PARKING LOT. FOR SMALL FIRE, OWNER OR EMPLOYEE WILL USE PORTABLE FIRE EXTINGUISHER. FOR SMALL SPILL, OWNER OR EMPLOYEE, WILL USE ABSORBENT MATERIAL FOR MAJOR SPILLS OR LEAKS, A CLEAN UP COMPANY WILL BE CALLED. NAME OF THE COMPANY IS INDUSTRIAL WASTE UTILIZATION: 805-925-0391 C. CLEAN-UP AND RECOVERY PROCEDURES IN CASE OF EMERGENCY, THE OWNER OR MANAGER WILL MAKE SURE THAT ELECTRIC POWER AND NATURAL GAS ARE TURNED OFF AND THAT ALL PERSONS ARE EVACUATED FROM THE PREMISES. OWNER WILL SHUT DOWN THE WHOLE OPERATION OF GASOLINE PUMP BY PRESSING THE EMERGENCY SHUT OFF PUMPS LOCATED EITHER AT THE CASHIER OR OUTSIDE AND WILL SHUT OFF TURBINES CIRCUIT BREAKER LOCATED AT THE ELECTRICAL PANEL AREA. HAZARDOUS WASTE FROM SPILL CONTAINMENT WILL BE DISPOSED BY INDUSTRIAL WASTE UTILIZATION: TEL# 805-925-0391 Followin are the emer ene e ui ment of this faeilit : Item Use Location Maintenance Fire extinguisher Fire Control Entrance & kitchen area Yearly Service Spill absorbent Spill Control Back room/Sup ly room Re-stock as needed First Aid Kit Minor Injury Inside office or cashier Inventory twice a year UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE : NO ELECTRICAL: ELECTRICAL PANEL IN THE BACK ROOM WATER: SIDE WALK SPECIAL: LOCK BOX: DYES ~NO IF YES, LOCATION: PRIV A TE FIRE PROTECTION/WATER AVAILABILITY: FIRE EXTINGUISHERS LOCATED AT ENTRANCE DOOR . INSIDE THE STORE. AND IN THE KITCHEN AREA A. B. ASHE RD. /' PRIVATE FIRE PROTECTION D YES ~NO WATER A V AII.ABILITY (FIRE HYDRANT) : ON THE CORNER OF WHITE LN. & 3 e e HAZARDOUS MATEIDALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 1-2 PERSONS PER SHIFT, THERE ARE THREE SHIFTS AND TOTAL EMPLOYEES AREA ABOUT 5-7. MATEIDAL SAFETY DATA SHEETS ON FILE: MSDS AND BUSINESS EMERGENCY PLAN IS LOCATED IN HAZARD COMMUNICATION KIT, A YELLOW PLASTIC BOX, LOCATED IN THE OFFICE AREA BIDEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE USE OF ANY REQUIRED SAFETY EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATEIDALS/W ASTE. EMPLOYEES ARE TRAINED AND REQUIRED TO DIAL FOR EMERGENCY CALLS, ESPECIALLY 9-1-1, AND EVACUATE THE PREMISES. EMPLOYEES ARE TRAINED IN THE USE OF SPILL CLEAN UP SUPPLIES, FIRST AID KITS, AND FIRE EXTINGUISHERS, ELECTIDCAL AND GAS SHUT OFF AND USE OF TELEPHONES. EMPLOYEES ARE TRAINED TO ADVISE ANY RESPONSE AGENCY AS TO THE NATURE AND LOCATION OF THE PROBLEM. INITIAL TRAINING IS CONDUCTED AFTER HIRING NEW PERSON. TRAINER IS THE OWNER OR MANGER OF THE STORE. REFRESHER TRAINING IS DONE EVERY YEAR. TRAINING TOPICS ARE SUCH AS : 1) HAZARD COMMUNICATION PROGRAM 2) MATERIALS SAFETY DATA SHEETS, 3) SAFE HANDLING OF CHEMICALS, AND 4) EMERGENCY EQUIPMENT EMERGENCY PLAN CERTIFICATION I, CARLOS L. RODIDGUEZ CERTIFY THAT THE ABOVE INFORMATION 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. ENVIRONMENT AL SPECIALIST ~ 1'..2 '0 I TITLE 4 e e Employee Training Program Check all boxes which apply. 1. Personnel are trained in the following procedures: 2. Chemical Handlers are additionally trained in the following: 3. Emergency Response Team Members are capable of and engaged in the following: J. Recordkeeping: 1. Check all boxes which apply. The following records are maintained at the facility. [Note: Items marked with an asterzsk (*) are required.}: A copy of the Inspection Check Sheet (s) or Log(s) used in conjunction with required routine self- inspections of your facility must be submitted with your HMBP. (Exc~tion: Available from your local agency is a Hazardous Materials/ Waste Storage Area Inspection Fonn that you may use If you do not already have your own fonn. If you use the example provided, you do not need to attach a copy.) e e INSPECTION LOG INSPECTION DATE OBSERVATION CORRECTIVE ITEM & ACTIONS TIME TAKEN AND DATE Hazardous materials storage area: Leaks, containers stored closed, secondary containment intact; labeled Hazardous waste storage area: Leaks, containers stored closed; secondary containment intact; accumulation date; hazardous waste label Safety equipment:Adequate supplies; broken or missing; out of date Monitoring equipment:Tested; working properly;Not in alarm condition Emergency Equipment:Adequate supplies; broken or missing; out of date Security and containment:Tested regularly; no breaches in fence; NFP A placard at entrance; storage of haz. Wastes and materials secure . UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) 0 MATERIAL(NON-WASTE) IZI WASTE (one oaoe oer material oer buildino or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AMPM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 INSIDE THE GARAGE AND OUTSIDE YARD (EPCRA ) DYES 181 NO FACILITY ID # I I 1>1 I I I 1 1 I 1 1 I 1 1 1 MAP# (optional) 2031 GRID# (optional) 204 10F1 C5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 WASTE ABSORBENT If Subject to EPCRA. refer to instructions COMMON NAME ABSORBENT WASTE 207 EHS' DYes 181 No 208 CAS# Nt A 209 "If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE Db, MIXTURE 181 c, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 5 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c. PRESSURE RELEASE D d, ACUTE HEALTH D e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 ~AXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 2 50 221 221 1 DAYS ON SITE: 222 UNITS' l8Ia, GALLONS Db, CUBIC FEET D c. POUNDS D d, TONS 365 (Check one item only) . If EHS. amount must be in pounds, STORAGE CONTAINER D a. ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR Db. UNDERGROUND TANK D f,CAN D j,BAG 181 n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k. BOX D 0, TOTE BIN D d. STEEL DRUM D h, SILO D I. CYLINDER D p. TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT D b. ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT D b. ABOVE AMBIENT D c, BELOW AMBIENT D d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 MIXTURE OF WASTE Oil, HEAVY 227 DYes 181 No 228 Nt A, MIXTURE 229 PETROLEUM DISTILLATES AND SILICATES 2 230 231 DYes 0 No 232 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 e e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on oneform) ~ MATERIAL(NON-WASTE) 0 WASTE (one page per material per building or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AMPM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM (EPCRA ) DYES 181 NO FACILITY ID # I I t,;1 I I 1,:~~1 I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 B6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 CARBON DIOXIDE If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* DYes 181 No 208 CAS# 124-38-9 209 *If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) 181 a. PURE Db, MIXTURE Dc, WASTE 211 RADIOACTIVE DYes 181 No PHYSICAL STATE 215 (Check one item only) D a. SOLID Db, LIQUID 181 c, GAS 214 LARGEST CONTAINER 83 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH D e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 166 250 N/A ' N/A 221 I DAYS ON SITE: 222 UNITS' Da. GALLONS I8Ib, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item onlv) . If EHS, amount must be in pounds. STORAGE CONTAINER D a. ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR Db, UNDERGROUND TANK D f, CAN D j,BAG D n, PLASTIC BOTTLE D r. OTHER Dc. TANK INSIDE BUILDING o g, CARBOY o k. BOX D 0, TOTE BIN D d. STEEL DRUM o h. SILO 1811. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE D a, AMBIENT 181 b, ABOVE AMBIENT o c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 CARBON DIOXIDE 227 DYes 181 No 228 124-38-9 229 2 230 231 DYes 0 No 232 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 tit e UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) D WASTE (one page per material per building or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AMPM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BACK ROOM OR FRONT SHELVES (EPCRA ) DYES 181 NO FACILITY ID # I I I "I 1 I 1··1 I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 06 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 MOTOR Oil If Subject to EPCRA, refer to instructions COMMON NAME ENGINE Oil, lUBRICANT MOTOR Oil 207 EHS* DYes 181 No 208 CAS# N/ A 209 *If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required byCUPA) COMMBUSTIBlE LIQUID 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib, MIXTURE Dc. WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a. SOLID I8Ib. LIQUID D c, GAS 214 LARGEST CONTAINER .25(ONE QUART) FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE D d, ACUTE HEALTH De, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 40 300 N/A N/A 221 I DAYS ON SITE: 222 UNITS· l8Ia. GALLONS Db, CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item only) . If EHS, amount must be in pounds. STORAGE CONTAINER D a, ABOVE GROUND TANK De. PLASTIC/NONMETALLIC DRUM D i. FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR Db. UNDERGROUND TANK D f, CAN D j,BAG 181 n, PLASTIC BOTTLE D r, OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k, BOX D 0, TOTE BIN D d. STEEL DRUM D h, SILO D I. CYLINDER Dp, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT Db. ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT Db. ABOVE AMBIENT D c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 94-95 226 lUBRICANT BASE Oil 227 DYes 181 No 228 N/A, MIXTURE 229 2 5-6 230 ADDTIVES, ANTI-OXIDANT 231 DYes 181 No 232 N/A, MIXTURE 233 3 234 235 DYes 0 No 236 237 4 238 239 DYes DNo 240 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0.1% by weight If carcinogenic, attach additional sheets of paper capturing the required information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 è . UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) D WASTE lone pace per material per buildinc or area) DADD DDELETE I8IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AM PM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 , (EPCRA ) DYES 181 NO UNDERGROUND STORAGE TANK FACILITY ID # I I I j 1 I I«.il I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 G5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes 181 No 206 PREMIUM II Subject to EPCRA. refer to instructions COMMON NAME GASOLINE 207 EHS" DYes 181 No 208 CAS# 8006-61-9 209 "If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (CompleteifrequiredbyCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a. PURE I8Ib. MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d, ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS' l8Ia, GALLONS Db, CUBIC FEET D c. POUNDS D d, TONS 365 (Check one item on Iv) . If EHS, amount must be in Dounds, STORAGE CONTAINER D a. ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR 181 b. UNDERGROUND TANK D ¡,CAN D j,BAG D n, PLASTIC BOTTLE D r. OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k, BOX D 0, TOTE BIN D d. STEEL DRUM D h, SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes 181 No 228 71-43-2 229 2 0-15 230 METHYL TERTIARY BUTYL ETHER ( MTBE) 231 DYes 181 No 232 1634-04-4 233 3 8-1 5 234 XYLENE 235 DYes 181 No 236 1330-20-7 237 4 7-14 238 TOULENE 239 DYes 181 No 240 1 08-88-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenic, or 0,1% by weight If carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 " UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) 0 WASTE (one pape per material per building or area) DADD DDELETE !8:IREVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AMPM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES !8:1 NO FACILITY ID # I I I I I I II I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 G4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes !8:1 No 206 UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS" DYes !8:1 No 208 CAS# 8006-61-9 209 "If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required byCUPA) FLAMMABLE LIQUID, CLASS 1B, UN1203 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Jb. MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8JNo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Jb, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) I8J a, FIRE D b, REACTIVE D c, PRESSURE RELEASE I8J d, ACUTE HEALTH I8J e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS' l8Ja, GALLONS Db. CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item onlv) . If EHS, amount must be in Dounds, STORAGE CONTAINER D a, ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m, GLASS BOTTLE D q, RAIL CAR I8J b. UNDERGROUND TANK D f, CAN D j,BAG D n. PLASTIC BOTTLE D r. OTHER Dc, TANK INSIDE BUILDING D g, CARBOY D k. BOX D 0, TOTE BIN D d. STEEL DRUM D h, SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE I8J a, AMBIENT D b, ABOVE AMBIENT D c, BELOW AMBIENT 224 STORAGE TEMPERATURE I8J a, AMBIENT D b, ABOVE AMBIENT D c. BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes !8:1 No 228 71-43-2 229 2 0-15 230 METHYL TERTIARY BUTYL ETHER 231 DYes !8:1 No 232 1634-04-4 233 3 8-1 5 234 XYLENE 235 DYes !8:1 No 236 1330-20-7 237 4 7-14 238 TOLUENE 239 DYes !8:1 No 240 1 08-83-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight if non-carclnogenlc, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information, ADDITIONAL LOCALLY COLLECTED INFORMATION 246 õ . ,. UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION Indicate material OR waste ( Do not combine material and waste on one form) ~ MATERIAL(NON-WASTE) 0 WASTE (one oaoe Der material Der buildina or area) DADD DDELETE ~REVISE REPORTING YEAR 200 I Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ARCO AMPM STORE, FACILITY ID # 05420 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UNDERGROUND STORAGE TANK (EPCRA ) DYES ~ NO FACILITY ID # I I [~"AI I I IFFI I I I I I I 1 I MAP# (optional) 2031 GRID# (optional) 204 10F1 F4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET DYes IZI No 206 UNLEADED If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS' o Yes ~ No 208 CAS# 8006-61-9 209 'If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAMMABLE LIQUID, CLASS 1 B 210 HAZARDOUS MATERIAL 212 I CURIES 213 TYPE (Check one item only) D a, PURE I8Ib. MIXTURE Dc, WASTE 211 RADIOACTIVE DYes I8INo PHYSICAL STATE 215 (Check one item only) D a, SOLID I8Ib, LIQUID D c, GAS 214 LARGEST CONTAINER 12,000 FED HAZARD CATEGORIES 216 (Check all that apply) 181 a, FIRE D b, REACTIVE D c, PRESSURE RELEASE 181 d. ACUTE HEALTH 181 e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATEWASTECODE 220 6,000 12,000 N/A N/A 221 I DAYS ON SITE: 222 UNITS' l8Ia. GALLONS Db. CUBIC FEET D c, POUNDS D d, TONS 365 (Check one item only) . If EHS, amount must be in pounds, STORAGE CONTAINER D a. ABOVE GROUND TANK De, PLASTIC/NONMETALLIC DRUM D i, FIBER DRUM D m. GLASS BOTTLE D q, RAIL CAR 181 b, UNDERGROUND TANK D t, CAN D j,BAG D n, PLASTIC BOTTLE D r. OTHER Dc, TANK INSIDE BUILDING D g. CARBOY D k, BOX D 0, TOTE BIN D d, STEEL DRUM D h, SILO D I. CYLINDER D p, TANK WAGON 223 STORAGE PRESSURE 181 a. AMBIENT D b, ABOVE AMBIENT o c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a. AMBIENT D b, ABOVE AMBIENT o c, BELOW AMBIENT D d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE 227 DYes IZI No 228 71-43-2 229 . 2 0-1 5 230 METHYL TERTIARY BUTYL ETHER 231 DYes ~ No 232 1634-04-4 233 3 8-1 5 234 XYLENE 235 D Yes ~ No 236 1330-20-7 237 4 7-14 238 TOLUENE 239 DYes ~No 240 1 08-83-3 241 5 242 243 DYes DNo 244 245 If more hazardous components are present at greater than 1% by weight If non-carclnogenlc, or 0,1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 " "- . e ARC{) -/t§J1tp IPS¡1fS/~ / // MINI MARKET #5420 / // / ",/ SiteID: 015-021-000629 "" AM PM Manager Location: 6450 WHITE LN City BAKERSFIELD BusPhone: Map : 123 Grid: 16D (661) 398-0393 CommHaz : Low FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 09 EPA Numb: SIC Code:5541 DunnBrad:51-012-0713 Emergency Contact MARIA GONZALEZ Business Phone: 24-Hour Phone : Pager Phone / Title / MANAGER (661) 398-0393x (661) 827-0212x () x Emergency Contact / Title iffi,\) IN K.I:ŒD AðO l7JJ;cWh~ISO Business Phone: (661) ~09 12Q31C 4-Hour Phone (661) ~1~ 6349A Pager Phon Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : MailAddr: City F6-:50X 5&9-7 .p(). t3ðZ'fLß~ Bn:EÞrz~ pn'RK ~ì1 ~RE3TleE STA~IONß~ ~ PO BOX 50"'''~~ BUENA rAnK M''fESJA Phone: (714) 670-~J6À State: r;ð. Zip : '-986225011 9()7a2- Phone: (714) 670-~J6x State: CA ..,Ço/Ð2 Zip 906225077 Owner Address City Period Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: I, ~~tM~' reviewed the attached h e by certify that I have ous materials manage- ment plan for ,4ætJo 5¥ 2.. '0 . (Name of Business) and that It along with any corrections constitute a complete and correa man- agement plan for I'RY facility. t2¿ ,¡' Signature , . -1- 10/31/2000 .. e e " F AM PM MINI MARKET #5420 SiteID: 015-021-000629 ì STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: AM PM MINI MARKET #5420 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : K.l:!ivIN !tEED J't-RW Phone: (G61) S89 4.:2 () ûc~ Address: (J/C() 0:;V" SlID2- City : State: Zip: Type : TANK OWNER INFORMATION Name : _K~rtlI:n REED .~ Phone: ..(661) 5651 i~()1z Address: é/t¡) ~~O '--~O'2.,¡ City : State: Zip: Type : BOE UST Fee# : 000506 Finane 'I Resp: SELF INSURED Legal Notif : Tank Owner Mailing Address ~:;:~~~~~/;~~ ~~CL- Phone: +714} 6'76 S407x Ttl:ENVIR. ADMIN. ?rl()(t:/)(YõW~~ State~t:JST # : 1998 Upg Cert#: 00769 " f= Hazmat Inventory One Unified List ì p== As Designated Order All Materials at Site ì Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP GASOLINE-MIDGRADE-UNLEADED F IH DH L 12000.00 GAL Mod GASOLINE ARCO UNLEADED F IH DH L 12000.00 GAL Mod GASOLINE ARCO SUPER UNLEADED F IH DH L 12000.00 GAL Mod CARBON DIOXIDE F P IH G 448.00 FT3 Min -2- 10/31/2000 ~ e e - F AM PM MINI MARKET #5420 f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME GASOLINE-MIDGRADE-UNLEADED SiteID: 015-021-000629 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ----r-; P~ESSURE --r TEM~ERATURE I CONTAINER TYPE =LlqUld ___pure ~mblent ---1 Amblent ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 3300.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS ~I CAS#a006619 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME GASOLINE ARCO UNLEADED Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ----r-; P~ESSURE --r TEM~ERATURE -I CONTAINER TYPE =Llquld ___pure ~mblent ---1 Amblent ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 6000.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS ~I CAS # I 8006619 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH I / / Mod HAZARD ASSESSMENTS -3- 10/31/2000 .. e e . F AM PM MINI MARKET #5420 p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME GASOLINE ARCO SUPER UNLEADED SiteID: 015-021-000629 9 Facility Unit: Fixed Containers on Site 9 Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ~ P~ESSURE ~ TEM~ERATURE I CONTAINER TYPE =Llquld __pure ~mblent ---1 Amblent ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 4000.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS CAS # I 8006619 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0004 F= COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Facility Unit: Fixed Containers on Site 9 Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 124-38-9 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 448.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 448.00 FT3 Daily Average 224.00 FT3 %Wt. RS CAS # 100.00 Carbon Dioxide No 124389 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -4- 10/31/2000 e e F AM PM MINI MARKET #5420 I p= Notif./Evacuation/Medical r=: Agency Notification LCALL 911. Employee Notif./Evacuation SiteID: 015-021-000629 9 Fast Format 9 Overall Site 9 12/08/19991 12/08/1999 IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (IE. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. Public Notif./Evacuation 03/20/1990 EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. Emergency Medical Plan 12/08/1999 MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 AND BAKERSFIELD CITY FIRE DEPT STATION #7 - 4030 SORANNO AVE - 398-0295. -5- 10/31/2000 e e SiteID: 015-021-000629 ì Fast Format ì Overall Site ì 12/08/1999 F AM PM MINI MARKET #5420 I p= Mitigation/Prevent/Abatemt Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SW END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. Release Containment 12/08/1999 FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPlLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTIAL RISK AND HAZARDS. Clean Up 03/20/1990 CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. Other Resource Activation -6- 10/31/2000 e e F AM PM MINI MARKET #5420 I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 015-021-000629 ì Fast Format ì Overall Site ì I 12/08/1999 A) GAS - N/A B) ELECTRICAL - NE CORNER OF BLDG C) WATER - NE SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO Fire Protec./Avail. Water 12/08/1999 PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LN AND ASH RD. Building Occupancy Level -7- 10/31/2000 -,' . e e ; F AM PM MINI MARKET #5420 I f= Training Employee Training SiteID: 015-021-000629 ì Fast Format ì Overall Site ì 12/08/1999 WE HAVE 12 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN INSTRUCTION ON COMPLYING WITH THE CITY OF BAKERSFIELD BUSINESS EMERGENCY PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. Page 2 [ I I Held for Future Use Held for Future Use -8- 10/31/2000 , .. .- AM PM MINI MARKET #5420 -- SiteID: 215-000-000629 Manager : Location: City NOV-,~ 0 1999 - ~ 6450 WHITE LN / .._ BAKERSFIELD . )3x.:--: BusPhone: (805) 398-0393 Map : 123 - CommHaz : Low Grid: 16D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 09 EPA Numb: SIC Code:5541 DunnBrad:51-012-0713 Emergency Contact / Title Emergency Contact / Title MARIA GONZALEZ / MANAGER KEVIN REED / FIELD SUPERVISO Business Phone: (805) 398-0393x Business Phone: (805) 589-4203x 24-Hour Phone : (805) 827-0212x 24-Hour Phone : (000) 272-6349x Pager Phone : ( ) - x Pager Phone : ('~œC9 ) 91 f - 5g'33c Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: PO BOX 5077 State: CA City : BUENA PARK Zip : 906225077 Owner PRESTIGE STATIONS Phone: (714) 670-5136x Address : PO BOX 5077 State: CA City : BUENA PARK Zip : 906225077 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: Hazmat Common Name... SpecHaz EPA Hazards One Unified List 1 All Materials at Site 1 DailyMax MCP L 12000.00 GAL Mod L 12000.00 GAL Mod L 12000.00 GAL Mod G 448.00 FT3 Min f= Hazmat Inventory p== MCP+DailyMax Order GASOLINE-MIDGRADE-UNLEADED GASOLINE ARCO UNLEADED GASOLINE ARCO SUPER UNLEADED CARBON DIOXIDE i j \.A \ \ e. ~ Ç:\ ~E>f S [Do hersby csrmy ~hB1~ ~ hav~ (Ty~ or print Nlmo) reviewed ~he attached hazardous ma~srials manage- \\) ..JI. 5 4d. 0 ment plan jor a.. \'t\ ., \'\\ . and ~ha~ it ai~ng with (Na~ of Booineœ) any correctioW'i~ constih.Ats a complet~ and oom~d man- F F F F P IH DH IH DH IH DH IH agement plan ioV' my ~cmty. -0/* 11/29/1999 e F AM PM MINI MARKET #5420 p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME GASOLINE-MIDGRADE-UNLEADED e SiteID: 215-000-000629 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ~P~ESSURE -¡ TEM~ERATURE -, CONTAINER TYPE =LlqUld __pure ~mblent ---1 Amblent ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 12000.00 GAL 3300.00 GAL %Wt. RS CAS # 100.00 Gasoline No 8006619 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME GASOLINE ARCO UNLEADED Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA~E I TYPE ~ P~ESSURE -¡ TEM~ERATURE I =Llquld __pure ~mblent ---1 Amblent ~ AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL CONTAINER· TYPE UNDER GROUND TANK Largest Container GAL Daily Average 6000.00 GAL HAZARDOUS COMPONENTS ~ CAS#a006619 I %Wt. I 100.00 Gasoline TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS -2- 11/29/1999 e f AM PM MINI MARKET #5420 F Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME GASOLINE ARCO SUPER UNLEADED e SiteID: 215-000-000629 ì Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit SW CORNER Map: Grid: CAS # 8006-61-9 [ ~TA'~E I TYPE ~ P~ESSURE -¡ TEM~ERATURE -I =Llquld __pure ~mblent ---1 Amblent ~ AMOUNTS AT THIS LOCATION Daily Maximum 12000.00 GAL CONTAINER TYPE UNDER GROUND TANK Largest Container GAL Daily Average 4000.00 GAL %Wt. RS CAS # 100.00 Gasoline No' 8006619 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS F Inventory Item 0004 = COMMON NAME / CHEMI CAL NAME CARBON DIOXIDE Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 124-38-9 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 448.00 FT3 Daily Average 224.00 FT3 %Wt. RS CAS # 100.00 Carbon Dioxide No 124389 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -3- 11/29/1999 e e F AM PM MINI MARKET #5420 I p= Notif./Evacuation/Medical r=: Agency Notification ~ALL 911 Employee Notif./Evacuation SiteID: 215-000~000629 ì Fast Format ì Overall Site ì 03/20/1990 ] 03/20/1990 IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (I.E. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. Public Notif./Evacuation 03/20/1990 EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. Emergency Medical Plan 03/20/1990 MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 BAKERSFIELD CITY FIRE DEPARTMENT - 4030 SORANNO AVE - STATION #7 -4- 11/29/1999 e e SiteID: 215-000-000629 ì Fast Format ì Overall Site ì 03/20/1990 F AM PM MINI MARKET #5420 I p= Mitigation/prevent/Abatemt Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SOUTHWEST END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN ORR YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. Release Containment 03/20/1990 FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPlLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK' SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTIAL RISK AND HAZARDS. Clean Up 03/20/1990 CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. Other Resource Activation -5- 11/29/1999 e e F AM PM MINI MARKET #5420 I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 215-000-000629 ì Fast Format ì Overall Site ì I 03/20/1990 A) GAS - N/A B) ELECTRICAL - NORTHEAST CORNER OF BUILDING C) WATER - NORTHEAST SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO Fire Protec./Avail. Water 03/20/1990 PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON LOCATION OF FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LANE AND ASH ROAD. Building Occupancy Level -6- 11/29/1999 / :# ,,' 1 ~ e e í AM PM MINI MARKET #5420 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000629 j íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format j íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site j íëë Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 03/20/1990 j o 0 o WE HAVE 12 EMPLOYEES AT THIS FACILITY o o o o WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE o o o o BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN o INSTRUCTION ON COMPLYING WITH THE cITY OF BAKERSFIELD BUSINESS EMERGENCY o PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN 0 o ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY 0 o MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. 0 o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Page 2 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Held for Future U se ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë j o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëeëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf - . CUSTTY4&NO. ES 30ci7 MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE {;; - J 7-9<6 NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT i : FINANCE CHARGE I ; OTHER ADJ 11 M PM tA ì (\', mar k~+ ~~<{ dO p.o. P0D'( bD~~ STATE r J\ ZIP CODEg070~ toL\csO LOh;\-~ ~ CUSTOMER NAME MAILING ADDRESS CITY ArtLS\O I " SITE ADDRESS PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT CHARGE CODE ~ APPAOVEDBY 1;¡ ~ -/¡ ; - -07/26/96 e e. AM PM MINI MARKET #5420 215-000-0006 Overall Site with 1 Fac. Unit General Information Location: 6450 WHITE LN City : BAKERSFIELD Map: 123 Haz: 2 Type:~ 3 Grid: 16D FlU: 1 AOV: 0.0 Contact Name MARIA GONZALEZ Business Phone: 24-Hour Phone Pager Phone Title I MANAGER (805) 398-0393x p¡gO) 5SJ 6246^ ÛJ () x Title I FIELD SUPERVISO ",--SO§) J98 9J9Jx ® (~) 353 624ðx GD () x Contact Name eMIU B \IARR ® Business Phone: 24-Hour Phone Pager Phone Administrative Data Mail Addrs: _P 0 BOX 6~~5 (£; City: ARTESIA(G; J Comm Code: 21S-009JSÁKERSFIELD STATION 09 D&B Number: 51-012-0713 State: CA Zip: Q0792 (2) SIC Code: 5541·' Owner: PRESTIGE STAT~S Address: ~ 0 BOX 62~5~ City: 1n<'l't;~l~ Phone:_(310) 402 1278 10 State: CA Zip+- 997g~ (jj; Summary TANKS: HAS OWNER-OPERATOR AGREEMENT HAS FINANCIAL RESPONSIBILITY HAS SPILL RESPONSE AND MONITORING PLAN ð) (ç 0 S-) <6'.;2.ì - 0 ;t.t).. @ K~\I;" ~d ø (~OS") s-fq... £.().0'3 (¡j; (~t:J\» ~(;2...- Co ""'::Þ'1Cj @ pc> g.,)t ço 11 (Q> Øv~c... y7 o...d:. G) 9oCø~;¡' - ,)"011 (i; po rto)t. 5"071 (J; Bv e..1 ç.. r' 0... ("' k.. @ (7 I'{) (¿, 7 t> - s-,~ b ® 9o(.,;;?.;~ - Sbìì I, Noel ~t:ÀYl 0..Y' Do hereby certify that I have (Type or print namp) reviewed the attached hazardous materi~ls manage- ~It~ M¡,,-,. MCt-r{:..e.+ It 5'17 S- ment plan for and that it along with (N&me of BU8IlIÐ$S) any corrections constitute a complete and correct man- agement plan for my facility. ÞL--!:::(//-o ~(,. ;õ ., e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-003 GASOLINE ARCO SUPER UNLEADED Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-002 GASOLINE ARCO UNLEADED Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-001 GASOLINE-MIDGRADE-UNLEADED Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL 02-004 CARBON DIOXIDE Gas 448 Minimal ~ Fire, Pressure, Immed Hlth FT3 .'1 ....i e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-003 GASOLINE ARCO SUPER UNLEADED ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 12,000 I 4,000.00 I 170,000.00 Storage UNDER GROUND TANK r Press T Temp ~I Ambient Ambient SW CORNER Location - Conc -I 100.0% Gasoline Components r; MCP ----rGuide Moderate I 27 02-002 GASOLINE ARCO UNLEADED ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 12,000 I 6,000.00 I 1,300,000.00 Storage UNDER GROUND TANK r Press T Temp ~I Ambient Ambient SW CORNER Location - Conc -, 100.0% Gasoline Components r; MCP ----rGuide Moderate 27 02-001 GASOLINE-MIDGRADE-UNLEADED ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 12,000 I 3,300.00 I 200,000.00 Storage UNDER GROUND TANK r Press T Temp ~ Ambient AmbientSW CORNER Location - Conc l 100.0% Gasoline Components r; MCP ----rGuide Moderate I 27 e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 02 - Fixed Containers on Site Page 4 Hazmat Inventory Detail in MCP Order 02-004 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 448 Minimal FT3 CAS #: 124-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 448 I 224.00 I 5,824.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Ambient Ambient Location - Cone l 100.0% Carbon Dioxide Components ~ MCP ----rGuide Low I 21 e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 00 - Overall Site Page 5 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (I.E. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. <3> Public Notif./Evacuation EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 BAKERSFIELD CITY FIRE DEPARTMENT - 4030 SORANNO AVE - STATION #7 e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 00 - Overall Site Page 6 <E> Mitigation/Prevent/Abatemt <1> Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SOUTHWEST END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN ORR YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. <2> Release Containment FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPILAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK' SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTIAL RISK AND HAZARDS. CONTAINMENT SHALL BE COMPLETED BY DIKING WITH ABSORBANT/OTHER MATERIAL. <3> Clean Up CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. <4> Other Resource Activation e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 00 - Overall Site Page 7 <E> Mitigation/Prevent/Abatemt <4> Other Resource Activation (Continued) ~',. ,~. _' "õÞ...... e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 00 - Overall Site Page 8 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - NORTHEAST CORNER OF BUILDING C) WATER - NORTHEAST SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON LOCATION OF FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LANE AND ASH ROAD. <4> Building Occupancy Level ... .' ',.... ~ c . ~, e e 07/26/96 AM PM MINI MARKET #5420 215-000-000629 00 - Overall Site Page 9 <G> Training <1> Employee Training WE HAVE 12 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN INSTRUCTION ON COMPLYING WITH THE cITY OF BAKERSFIELD BUSINESS EMERGENCY PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. <2> Page 2 I <3> Held for Future Use <4> Held for Future Use .. ' - (J5L ePrfUAJ C6' ~~ J:t5"Vì/() .' !. .. ~ 01/31/95 AM PM MINI MARKET #5175 215-000-000629 Overall Site with 1 Fac. Unit Page 1 General Information Location: 6450 WHITE LN City : Bakersfield Map:123 Haz:2 Type: 3 Grid: 16D FlU: 1 AOV: 0.0 Contact Name MARIA GONZALEZ Business Phone: 24-Hour Phone Pager Phone Title I MANAGER (805) 398-0393x (~05) 836 1954x (~ ) tro''1 -01 ~ x Title I FIELD SUPERVISO (805) 834 2978x ?113- (800) 553-6246x () x 9-3 Administrative Data Mail Addrs: P.O. BOX 6225 City: ARTESIA Comm Code: 215-009 BAKERSFIELD STATION 09 D&B Number: 51-012-0713 State: CA Zip: 90702- SIC Code: 5541 Owner: PRESTIGE STATIONS Address: P.O. BOX 6225 City: ARTESIA Phone: (310) 402-1278 State: CA Zip: 90702- Summary o - 0- ~~W~~ ~ FEB 1 3 1995 /y By TANKS: HAS OWNER-OPERATOR AGREEMENT HAS FINANCIAL RESPONSIBILITY HAS SPILL RESPONSE AND MONITORING PLAN I, Gemma) ° Cor'b¡ Do hereby certify that I have (Type or JIIInt Mme) reviewed the ~ed hazardous materials mana9Ð- fr11 / (1/1 fvll ~ i MOIl fle;t tt If/~ ment plan for and that it along with (Name of Business) ! any eorrections constitute a complete and CO"ect man- agement plan for my facility. . . h~ a./:.hr ~ e . 01/31/95 AM PM MINI MARKET #5175 215-000-000629 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-003 GASOLINE ARCO SUPER UNLEADED Liquid 12000 Moderate ~ Fire, Irnrned Hlth, Delay Hlth GAL 02-002 GASOLINE ARCO UNLEADED Liquid 12000 Moderate ~ Fire, Irnrned Hlth, Delay H1th GAL 02-001 GASOLINE-MIDGRADE-UNLEADED Liquid 12000 Moderate ~ Fire, Irnrned Hlth, Delay Hlth GAL 02-004 CARBON DIOXIDE Gas 448 Minimal ~ Fire, Pressure, Irnrned Hlth FT3 .. e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-003 GASOLINE ARCO SUPER UNLEADED ~ Fire, Irnmed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 12,000 I 4,000.00 I 430,Q09.60 l.-;rv (ê) 00 Location Form: Liquid Days: 365 Use: FUEL Type: Pure Storage UNDER GROUND TANK r Press T Temp ~ Ambient Ambient SW CORNER - Conc l 100.0% Gasoline Components r; MCP ~Guide Moderate 27 02-002 GASOLINE ARCO UNLEADED ~ Fire, Irnmed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 -¡ Daily AV~T r Press T Temp ~/f)OèJ Ambient Ambient SW CORNER Storage UNDER GROUND TANK - Conc l 100.0% Gasoline Components r; MCP -rGuide Moderate 27 Annual Amount ~. 1 ,000.00 J (700 ~ Locatioh ( 02-001 GASOLINE-MIDGRADE-UNLEADED ~ Fire, Irnmed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 12,000 ----r-- Daily Average GAL ~ I ~I Press Temp 0? 0(;> rAmbientTAmbien~sW CORNER Storage UNDER GROUND TANK - Conc l 100.0% Gasoline Components r; MCP ~Guide Moderate! 27 Annual ~~~n~ ~uo.OO Location ï,.-fYZJ t cn1) e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 02 - Fixed Containers on Site Page 4 Hazmat Inventory Detail in MCP Order 02-004 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 448 Minimal FT3 CAS #: 124-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 448 I 224.00 I 5,824.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Ambient Ambient Location - Conc l 100.0% Carbon Dioxide Components ~ MCP ---rGuide Low I 21 e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 00 - Overall Site Page 5 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (I.E. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. I <3> Public Notif./Evacuation EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 BAKERSFIELD CITY FIRE DEPARTMENT - 4030 SORANNO AVE - STATION #7 e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 00 - Overall Site Page 6 <E> Mitigation/Prevent/Abatemt <1> Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SOUTHWEST END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN ORR YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. <2> Release Containment FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPILAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK' SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTIAL RISK AND HAZARDS. CONTAINMENT SHALL BE COMPLETED BY DIKING WITH ABSORBANT/OTHER MATERIAL. <3> Clean Up CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. <4> Other Resource Activation ~ e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 00 - Overall Site Page 7 <E> Mitigation/Prevent/Abatemt <4> Other Resource Activation (Continued) ~ e e 01/31/95 AM PM MINI MARKET #5175 215-000-000629 00 - Overall Site Page 8 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - NORTHEAST CORNER OF BUILDING C) WATER - NORTHEAST SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON LOCATION OF FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LANE AND ASH ROAD. <4> Building Occupancy Level c ~. ~ ~ ' e . 01/31/95 AM PM MINI MARKET #5175 215-000-000629 00 - Overall Site Page 9 <G> Training <1> Employee Training WE HAVE 12 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN INSTRUCTION ON COMPLYING WITH THE cITY OF BAKERSFIELD BUSINESS EMERGENCY PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. <2> Page 2 <3> Held for Future Use <4> Held for Future Use i; ~~~~ . e t 02/04/93 AM PM MINI MARKET 215-000-000629 Overall Site with 1 Fac. Unit Page 1 General Information Location: 6450 WHITE LN Map: 123 Hazard: Low Community: BAKERSFIELD STATION 09 Grid: 16D Flu: 1 AOV: 0.0 ~~I~Contact Name Title Business· Phone - 24-Hour Phone IMÁ~IA GONZALEZ MANAGER (805) 398-0393 x (805) 836-1954 LU OZCELIK FIELD SUPERVISOR (805) 834-2978 x (800) 553-6246 Administrative Data Mail Addrs: P.O. BOX 6225 D&B Number: 51-012-0713 City: ARTESIA State: CA ,Zip: 90702- Comm·Code: 215-009 BAKERSFIELD STATION 09 SIC Code: 5541 Owner: PRESTIGE STATIONS jf 6i 1.(' Phone: (310) 402-1278 Address: P.O. BOX 6225 State: CA City: ARTESIA Zip: '90702- Summary TANKS: HAS OWNER-OPERATOR AGREEMENT HAS FINANCIAL RESPONSEABILITY HAS SPILL RESPONSE AND MONITORING PLAN I. NANCY B. WALIL- Do hereby certify that I have (Type orprlntname~ reviewed the attached hazardous materials manage·- . If' AM/Pt~ MINI MARTdM7tbatit along with ment p an or (Name 01 BusIrIeÙ) any corrections constitute a complete and correct man- agement plan for my faci8ty. ti~ - .. y' " - ~~l ,:r\ / 2/22/~3 ~-- " ; -. 'e - 02/04/93 AM PM MINI MARKET 215-000-000629 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards Quantity MCP 02-003 GASOLINE (REGULAR) 12000 Moderate ~ Fire, Immed Hlth, GAL 02-002 GASOLINE (SUPER UNLEADED) Liquid 12000 Moderate ~ Fire, Immed Hlth, Delay GAL 02-001 GASOLINE (UNLEADED) Liquid 12000 Moderate ~ Fire, Immed Hlth, GAL 02-004 CARBON DIOXIDE Gas 448 Minimal ~ Fire, Pressure H1th FT3 ---- ~ ~ J.JV-- 'i . e 02/04/93 AM PM MINI MARKET ,215-000-000629 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-003 GASOLINE (REGULAR) ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL --r- Daily Average GAL ---r- Annual Amount GAL - 12,000 2,000.00 549,000.00 Storage UNDER GROUND TANK r Press T Temp ~ Ambient AmbientSW CORNER Location - Cone l 100.0% Gasoline Components r; MCP --,-Guide Moderate 27 02-002 GASOLINE (SUPER UNLEADED) ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL --r-. Daily Average GAL ---r- Annual Amount GAL - 12,000 . 2,000.00 549,000.00 Storage UNDER GROUND TANK r Press T Temp ~ Ambient AmbientSW CORNER Location - Cone l 100.0% Gasoline Components r; MCP --,-Guide Moderate 27 02-001 GASOLINE (UNLEADED) .~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL --r- Daily Average GAL ---r- Annual Amount GAL - 12,000 I 4,000.00 585,000.00 Storage UNDER GROUND TANK r Press T Temp -:-1 Ambient Ambientlsw CORNER Location - Cone l 100.0% Gasoline Components r; MCP --,-Guide Moderate I 27 ·- 1 e - 02/04/93 AM PM MINI MARKET 215-000-000629 02 - Fixed Containers on Site Page 4 Hazmat Inventory Detail in MCP Order 02-004 CARBON DIOXIDE . Fire, Pressure, Immed Hlth Gas 448 Minimal FT3 CAS #: 124-38-9 'Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3 ~ Daily Average FT3 --r-- Annual Amount FT3 -- 448 I 224.00 I 5,824.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Ambieht Ambient Location - Conc -, 100.0% Carbon Dioxide Components r; MCP --¡Guide Minimal I 21 Î \ e e 02/04/93 AM PM MINI MARKET 215-000-000629 Page 5 00 - Overall .Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (I.E. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. <3> Public Notif./Evacuation EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 BAKERSFIELD CITY FIRE DEPARTMENT - 4030 SORANNO AVE - STATION #7 ;; ,\ e e 02/04/93 AM PM MINI MARKET 215-000-000629 Page 6 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SOUTHWEST END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN ORR YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. ' <2> Release Containment FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPILAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK' SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTiAL RISK AND HAZARDS. CONTAINMENT SHALL BE COMPLETED BY DIKING WITH ABSORBANT/OTHER MATERIAL. <3> Clean Up CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. <4> Other Resource Activation , i '. e e 02/04/93 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 7 <E> Mitigation/Prevent/Abatemt <4> Other Resource Activation (Continued) ~ · , ~ - , ~ e e 02/04/93 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 8 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - NORTHEAST CORNER OF BUILDING C) WATER - NORTHEAST SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO I <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON LOCATION OF FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LANE AND ASH ROAD. <4> Building Occupancy' Level ; ';, 'it 'iJ e e 02/04/93 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 9 <G> Training <1> Page 1 WE HAVE 12 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN INSTRUCTION ON COMPLYING WITH THE cITY OF BAKERSFIELD BUSINESS EMERGENCY PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use I /' **REVISED** 2/22/93 5541 52-012-0713 Name of this Facility: Standard Ind. Class Code: Dun & Bradstreet Number & FederallD # 93301 INC. #5175 PRESTIGE STATIONS, P. O. BOX 6225 ARTESIA, CA 90702 [310} 402-1278 LOCATION: CITY, ZIP: PHONE It: .' of 1 14 Names of Mixture/Components See Instructions Gasoline-MIDGRADE Unleaded Methyl Tertiary-Butyl Ether (1634..04-4) Xylene (1330-20-7) Toluene (108-88-37) Gasoline-ARGO UNLEADED Hydrocarbons (none) Methyl Tertiary-Butyl Alcohol (75-65-0) Methyl Tertiary-Butyl Ether (163~..04-4) Gasoline-ARGO SUPER UNLEADED Hydrocarbons (none) Methyl Tertiary-Butyl Alcohol (75-65-0) Methyl Tertiary-Butyl Ether (163~) GARBON DIOXIDE CARBON DIOXIDE (124-38-9) 1 E!Qe 13 %by Wt ~ 8 to 15 7to 14 CITY OF BAKERSFIELD HAZARDOUS MATERIALS INVENTORY HAZARDOUS MATERIALS DIVISION, 2130 "G" Street. Bakersfield. GA o Farm and Agriculture ~Standard Business BUSINESS NAME: AMlPM MINI MARKET #5175 6450 White Lane Bakersfield, CA 93309 [805] 398-0393 OWNER NAME ADDRESS: CITY, ZIP: PHONE it: REFER !Z'O INSTRUCTIONS FOR PROPBR CODBS 5 678 Annual Measure # Days Cont Est Units On Site T 460,000 GAL 36501 C~S.Number 16~ 12 Location Where Stored in Facility Southwest comer 01 lot Southwest comer 01 lot 11 Use Code - 19 19 T 10 Cont Teœp 4 4 9 Cont Press 1 T 1 r 1 6 5rO 1--1, d' 1__1 mme late Health )G A L IJ 1634-04-4 1-- L_iSudden Release of Pressure 11.4 million C~S. Number 4 Average Amt - 4,400 1-' I1'JDelayed Health 1 6,600 9 o 1 9 o 1 o 0 **Used In soft drink dispensing [805] 836-1954 24-hr Phone [800] 553-6246 24-hr Phone Facility Manager Title Field Supervisor Title 1--1, mad, 1__1 m late Health Maria Gonzalez Name #2 Luke Ozcelik Name 9 1 1 ! 1 1 1--1 I.!' _,Sudden Release of Pressure #1 1-' I.!tJDelayed Health 1 2 3 Trans Type Max i Code Code Amt I U M 12,000 V Physical and Health Hazard Check all that apply [x]Fire Hazard [= ] Reactivity V LXJRre Hazard L _ ~ ReactMty j U M 12,000 Physical and Health Hazard Check all that apply .., ....-, ~X...!Fire Hazard !. _ !ReactMty EMERGENCY CONTACTS 1 Southwest comer 01 lot Storage Area ** 19 99 I T 4 4 I T 1 1 I 6 sTo 41 1 51 0 6 I Ilmmadiate 1__1 Health IG A L G 16~ .--. !_ _! Immediate Health 1F T 313 124-38-9 L_:Sudden Release of Pressure 1430, 000 C~S. Number ....-, !.. _ !Sudden Release of Pressure 15,824 cu.ft. C~S. Number 4 ac~Delayed Health I 4, 000 ..., !l'! Delayed Health I 2 2 familiar with the information submitted in this and all attachèd documents, and that based on my believe that the submitted information is Certfflcatlon (Read and sign after completing all sections) I certify under penalty of law that I have personally examined and am inquiry of those indMduals responsibility for obtaining the information, 2/22/93 Date Signed Signature NANCY B. WAL TI, Manager-Environmental, Health & Safe Name and official title of owner/operator OR owner/operato~s authorized representative ~, . · · · <>1 :TERIAL SAFETY OAT! SHEET MSDS No. APPC 308 Rev. Date 09/17/92 ARCO MIDGRADE UNLEADED GASOLINE ARCO PRODUCTS COMPANY DIVISION OF ATLANTIC RICHFIELD COMPANY 1055 WEST SEVENTH STREET LOS ANGELES, CALIFORNIA 90051 IMPORTANT: Read this MSDS before handling and disposing of this product and pass this information on to employees, customers, and users of this product II. GENERAL TELEPHONE NUMBERS: Emergency: 213/222/3212 LA POISON 800/424-9300 CHEMTREC Customer Service: 800/322-2726 INFO ONLY TRADE NAME ARCO MIDGRADE UNLEADED GASOLINE OTHER NAMES ARCO CLEAR GASOLINE, UNLEADED MOTOR VEHICLE GASOLINE, UNLEADED REGULAR GASOLINE OR PETROL GENERIC NAME PETROLEUM NAPHTHAS (BLENDED) CHEMICAL FAMILY PETROLEUM HYDROCARBONS CAS NUMBER 0008006-61-9 COMPANY ID NUMBER 1009710096 DOT PROPER SHIPPING NAME GASOLINE UN/NA NUMBER UN 1203 DOT HAZARD CLASS 3 -FOR "DISCLAIMER OF LIABILITY·, SEE THE STATEMENT ON PAGE 12"*" Page 1 of 12 e e :...., ARCO MIDGRADE UNLEADED GASOLINE III. IMMEDIATE HAZARDS MSDS No. APPC 308 ~ DANGER HIGHLY FLAMMABLE! OSHA/NFPA CLASS-I A FLAMMABLE LIQUID. KEEP A WAY FROM HEAT, SPARKS, AND OPEN FLAME. MAY CAUSE IRRITATION TO EYES, SKIN, AND RESPIRATORY SYSTEM. AVOID BREATHING VAPORS OR MISTS. USE ONLY WITH ADEQUATE VENTILATION. ABSORPTION OF LIQUID THROUGH THE SKIN OR INHALATION OF VAPORS CAN CAUSE CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION AND/OR SYSTEMIC EFFECTS. HARMFUL OR FATAL IF SWALLOWED. CONTAINS PETROLEUM DISTILLATES! IF SWALLOWED, DO NOT INDUCE VOMITING SINCE ASPIRATION INTO THE LUNGS MAY CAUSE CHEMICAL PNEUMONIA. OBTAIN PROMPT MEDICAL ATIENTION. BASED ON THE RESULTS OF ANIMAL STUDIES, COMPONENTS OF THIS MATERIAL HAVE PRODUCED TOXIC EFFECTS ON THE LIVER, KIDNEY, AND OTHER INTERNAL INTERNAL ORGANS AND THE FETUS. LONG TERM EXPOSURE TO COMPLETELY VAPORIZED GASOLINE HAS CAUSED CANCER IN LABORATORY ANIMALS. GASOLINE MAY SENSmZE THE HEART TO SYMP A THOMIMETICS LIKE EPINEPHRINE RESULTING IN IRREGULAR HEART BEATS. SEE SECTIONS IV AND XI FOR ADDITIONAL INFORMATION. . . Page 2 of 12 '; . . . ~~I ~r 1m. e e ARCO MIDGRADE UNLEADED GASOLINE MSDS No. APPC 308 Rev. Date 09/17/92 FIRE AND EXPLOSION FLASH POINT METHOD=( 0-56) AP _450 F AUTO IGNITION TEMP. METHOD = (E-659) GT 6000 F FLAMMABLE LIMITS (% VOLUME IN AIR) AT NORMAL ATMOSPHERIC TEMPERATURE AND PRESSURE LOWER: AP 1,3 UPPER: AP 7.6 BASED ON GASOLINE HAZARD RATINGS NFPA RATINGS HEALTH HAZARD RATING: (1)SLlGHT FIRE HAZARD RATING: (3)HIGH REACTIVITY HAZARD RATING: (O)INSIGNIFICANT FIRE AND EXPLOSION HAZARDS HIGHLY FLAMMABLE! THIS MATERIAL RELEASES VAPORS AT OR BELOW AMBIENT TEMPERATURES, WHEN MIXED WITH AIR IN CERTAIN PROPORTIONS AND EXPOSED TO AN IGNITION SOURCE, THESE VAPORS CAN BURN IN THE OPEN OR EXPLODE IN CONFINED SPACES, BEING HEAVIER THAN AIR, FLAMMABLE VAPORS MAY TRAVEL LONG DISTANCES ALONG THE GROUND BEFORE REACHING A POINT OF IGNITION AND FLASHING BACK, EXTINGUISHING MEDIA HALON, FOAM, WATER FOG, C02, OR DRY CHEMICAL. CONSULT FOAM MANUFACTURER FOR APPROPRIATE MEDIA, APPLICATION RATES AND WATER/FOAM RATIOS, WATER AND WATER SPRAY MAY COOL THE FIRE BUT MAY NOT EXTINGUISH THE FIRE. SPECIAL FIREFIGHTING PROCEDURES FOR FIRES INVOLVING THIS MATERIAL, DO NOT ENTER ANY ENCLOSED OR CONFINED FIRE SPACE WITHOUT PROPER PROTECTIVE EQUIPMENT, THIS MAY INCLUDE SELF- CONTAINED BREATHING APPARATUS TO PROTECT AGAINST THE HAZARDOUS EFFECTS OF COMBUSTION PRODUCTS AND OXYGEN DEFICIENCIES, IF FIREFIGHTERS CANNOT WORK UPWIND TO THE FIRE, RESPIRATORY PROTECTIVE EQUIPMENT MUST BE WORN, COOL TANKS AND CONTAINERS EXPOSED TO FIRE WITH WATER. -FOR 'OISCLAIMER OF LIABILITY', SEE THE STATEMENT ON PAGE 1:r" Page 3 of 12 e e . ARGO MIDGRADE UNLEADED GASOLINE MSDS No. APPG 308 IV. HEALTH HAZARDS ~ SUMMARY OF ACUTE HAZARDS LIQUID, MIST OR VAPORS CAN CAUSE EYE, SKIN AND RESPIRATORY TRACT IRRITATION AND CNS DEPRESSION, ASPIRATION INTO THE LUNGS MAY CAUSE CHEMICAL PNEUMONIA. ROUTES OF EXPOSURE INHALATION -- PRDMARY ROUTE VAPORS OR FUMES FROM THIS MATERIAL CAN IRRITATE THE NOSE, THROAT, AND LUNGS, AND CAN CAUSE SIGNS AND SYMPTOMS OF CENTRAL NERVOUS SYSTEM DEPRESSION, ( DIZZINESS, LOSS OF COORDINATION, COMA AND DEATH) DEPENDING ON THE CONCENTRATION AND DURATION OF EXPOSURE. EYE CONTACT EYE IRRITATION MAY RESULT FROM CONTACT WITH LIQUID, MIST, AND/OR VAPORS, SKIN CONTACT NO SIGNIFICANT SYSTEMIC EFFECTS ARE EXPECTED UNDER NORMAL USE CONDITIONS. COMPONENTS OF THIS MIXTURE CAN BE ABSORBED THROUGH THE SKIN AND MAY PRODUCE CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION OR OTHER TOXIC EFFECTS, DEPENDING UPON THE CONCENTRATION AND DURATION OF EXPOSURE. SKIN IRRITATION MY OCCUR UPON SHORT TERM EXPOSURE. INGESTION MAY CAUSE IRRITATION OF THE MOUTH, THROAT AND GASTROINTESTINAL TRACT LEADING TO NAUSEA, VOMITING, DIARRHEA, RESTLESSNESS AND CENTRAL NERVOUS SYSTEM DEPRESSION SIMILAR TO THAT CAUSED BY VAPOR INHALATION. . SUMMARY OF CHRONIC HAZARDS AND SPECIAL HEALTH EFFECTS PROLONGED OR REPEATED SKIN CONTACT MAY PRODUCE SKIN IRRITATION OR MORE SERIOUS DISORDERS. MAY SENSITIZE THE HEART TO SYMPATHOMIMETICS LIKE EPINEPHRINE RESULTING IN IRREGULAR HEARTBEATS AND POSSIBLE CARDIAC ARREST, A CHRONIC INHALATION STUDY WITH A GENERIC UNLEADED GASOLINE FORMULATED BY API, CAUSED KIDNEY DAMAGE AND KIDNEY TUMORS IN MALE RATS AND LIVER TUMORS IN FEMALE MICE. THE EXACT RELATIONSHIP BETWEEN THESE RESULTS AND POSSIBLE HUMAN EFFECTS IS NOT KNOWN, CONTAINS BENZENE, A KNOWN HUMAN CARCINOGEN. OVEREXPOSURE TO VAPORS OR LIQUIDS MAY CAUSE LEUKEMIA, APLASTIC ANEMIA OR OTHER BLOOD DISORDERS OR IMMUNOTOXICITY, PERSONNEL WITH PRE-EXISTING CNS DISEASE, SKIN DISORDERS,IMPAIRED LIVER OR KIDNEY FUNCTION OR CHRONIC RESPIRATORY DISEASES SHOULD AVOID EXPOSURE. SEE SECTION XI FOR ADDITIONAL INFORMATION, . Page 4 of 12 ~~I . "',. Iv. . e ~ e e ARCO MIDGRADE UNLEADED GASOLINE PROTECTIVE EQUIPMENT I CONTROL MEASURES RESPIRATORY PROTECTION FOR VAPOR/MIST CONCENTRATIONS IN EXCESS OF THE OCCUPATIONAL EXPOSURE LIMITS IN SECTION VI, USE A NIOSH/MSHA APPROVED ORGANIC VAPOR/MIST, SUPPLIED AIR OR SELF CONTAINED BREATHING APPARATUS. RESPIRATOR SHOULD FOLLOW OSHA 29 CFR 1910,134 OR EQUIVALENT. EYE PROTECTION EYE PROTECTION SHOULD BE WORN. IN THE LIKELIHOOD OF SPLASHING OR SPRAYING, CHEMICAL TYPE GOGGLES AND/OR A FACE SHIELD SHOULD BE WORN. IF CONTACT LENSES ARE WORN, CONTACT THE SAFETY DEPARTMENT FOR USER POLICY OR AN EYE SPECIALIST FOR ADDITIONAL PRECAUTIONS, SUITABLE EYE WASH WATER SHOULD BE AVAILABLE IN CASE OF EYE CONTACT WITH MATERIAL. SKIN PROTECTION AVOID PROLONGED AND/OR REPEATED SKIN CONTACT. IF CONDITIONS OR FREQUENCY OF USE MAKE PROLONGED CONTACT LIKELY, CLEAN AND IMPERVIOUS CLOTHING SUCH AS GLOVES, APRON, BOOTS, AND FACIAL PROTECTION SHOULD BE WORN. ENGINEERING CONTROLS USE ADEQUATE VENTILATION TO KEEP VAPOR AND MIST CONCENTRATIONS OF THIS MATERIAL BELOW THE OCCUPATIONAL EXPOSURE LIMITS SHOWN BELOW IN SECTION VI. ELECTRICAL EQUIPMENT SHOULD FOLLOW NATIONAL ELECTRICAL CODE (NEe) STANDARDS. OTHER HYGIENIC PRACTICES USE GOOD PERSONAL HYGIENE PRACTICES, IN CASE OF SKIN CONTACT, WASH WITH MILD SOAP AND WATER OR A WATERLESS HAND CLEANER, IMMEDIATELY REMOVE SOAKED CLOTHING AND WASH THOROUGHLY BEFORE REUSE, DISCARD GASOLINE-SOAKED SHOES, OTHER WORK PRACTICES RESPIRATOR USE SHOULD COMPLY WITH OSHA STANDARDS 29 CFR 1910.134 OR EQUIVALENT, MAINTAIN EXPOSURE LEVELS BELOW 1 PPM BENZENE IN ADDITION TO THE 300 PPM GASOLINE TLV, NEVER SIPHON GASOLINE BY MOUTH, SEE SECTION XI, FOR ADDITIONAL INFORMATION, MSDS No. APPC 308 Rev. Date 09/17/92 -FOR "DISCLAIMER OF LIABILITY", SEE THE STATEMENT ON PAGE 12'"'" Page 5 01 12 e e AReo MIDGRADE UNLEADED GASOLINE MSDS No, APpe 308 I VI. OCCUPATIONAL EXPOSURE LIMITS ~ SUBSTANCE SOURCE DATE TYPE VALUE/UNITS TIME BENZENE ACGIH 1992 TWA 0,1 PPM 8 HRS OSHA 1992 PEL 1 PPM 8 HRS STEL 5 PPM 15 MIN CUMENE ACGIH 1991 TWA 50 PPM 8 HRS OSHA 1991 PEL 50 PPM ' 8 HRS CYCLOHEXANE ACGIH 1991 TWA 300 PPM 8 HRS OSHA 1991 PEL 300 PPM 8 HRS ETHYL ALCOHOL ACGIH 1991 TWA 1000 PPM 8 HRS OSHA 1991 TWA 1000 PPM 8 HRS ETHYL BENZENE ACGIH 1991 TWA 100 PPM 8 HRS STEL 125 PPM 15 MIN OSHA 1991 PEL 100 PPM 8 HRS STEL 125 PPM 15 MIN GASOLl N E ACGIH 1991 TWA 300 PPM 8 HRS STEL 500 PPM 15 MIN OSHA 1991 PEL 300 P P M 8 HRS STEL 500 PPM 15 MIN N-HEXANE ACGIH 1991 TWA 50 PPM 8 HRS OSHA 1991 PEL 50 PPM 8 HRS N-OCTANE ACGIH 1991 TWA 300 PPM 8 HRS STEL 375 PPM 15 MIN OSHA 1991 PEL 300 PPM 8 HRS STEL 375 PPM 15 MIN TOLUENE ACGIH 1992 TWA 50 PPM 8 HRS STEL 150 PPM 15 MIN OSHA 1992 PEL 100 PPM 8 HRS STEL 150 PPM 15 MIN TRIM ETHYL BENZENE ACGIH 1991 TWA 25 PPM 8 HRS OSHA 1991 PEL 25 PPM 8 HRS XYLENE ACGIH 1991 TWA 100 PPM 8 HRS STEL 150 PPM 15 MIN OSHA 1991 PEL 100 PPM 8 HRS . STEL 150 PPM 15 MIN I VII. EMERGENCY AND FIRST AID INHALATION IMMEDIATELY MOVE PERSONNEL TO AREA OF FRESH AIR, FOR RESPIRATORY DISTRESS, GIVE OXYGEN, RESCUE BREATHING OR ADMINISTER CPR ( CARDIO PULMONARY RESUSCITATION), OBTAIN MEDICAL ATTENTION, EYE CONTACT FLUSH WITH CLEAN LOW-PRESSURE WATER FOR AT LEAST 15 MINUTES.. OCCASIONALLY LIFTING THE EYELIDS, IF PAIN OR REDNESS PERSISTS AFTER FLUSHING, OBTAIN MEDICAL ATTENTION, SKIN CONTACT IMMEDIATELY REMOVE CONTAMINATED CLOTHING, WASH AFFECTED SKIN THROUGHLY WITH SOAP AND WATER. IF IRRITATION PERSISTS, OBTAIN MEDICAL ATTENTION. INGESTION DO NOT INDUCE VOMITING, OBTAIN PROMPT MEDICAL ATTENTION. EMERGENCY MEDICAL TREATMENT PROCEDURES SEE ABOVE PROCEDURES, . Page 6 of 12 · · · ~~I "'~ I VIII. ~RCO MIDGRADE UNLEADED !SOLlNE SPILL AND DISPOSAL PRECAUTIONS IF MATERIAL IS SPILLED OR RELEASED ELIMINATE ALL POTENTIAL SOURCES OF IGNITION, HANDLING EQUIPMENT MUST BE GROUNDED TO PREVENT SPARKING, STOP SOURCE OF RELEASE WITH NON-SPARKING TOOLS, VENTILATE ENCLOSED AREAS TO PREVENT FORMATION OF FLAMMABLE OR OXYGEN DEFICIENT ATMOSPHERES, WATER SPRAY MAY BE USED TO REDUCE VAPORS, AVOID VAPOR CLOUD EVEN WITH PROPER RESPIRATORY EQUIPMENT. ISOLATE THE HAZARD AREA AND DENY ENTRY TO UNNECESSARY PERSONNEL. DIKE AND CONTAIN LARGE SPILLS, SOAK UP RESIDUE WITH AN ABSORBENT SUCH AS CLAY, SAND, OR OTHER SUITABLE MATERIAL. PREVENT SPILLED MATERIAL FROM ENTERING SEWERS, STORM DRAINS AND OTHER UNAUTHORIZED TREATMENT DRAINAGE SYSTEMS AND NATURAL WATERWAYS, NOTIFY FIRE AUTHORITIES AND APPROPRIATE FEDERAL, STATE AND LOCAL AGENCIES, IMMEDIATE CLEANUP OF ANYSPILL IS RECOMMENDED, IF SPILL OF ANY AMOUNT IS MADE INTO OR UPON U.S, NAGIVABLE WATERS, THE CONTIGUOUS ZONE, OR ADJOINING SHORE LINE, NOTIFY THE NATIONAL RESPONSE CENTER (800) 424-8802 WASTE DISPOSAL METHODS MAXIMIZE PRODUCT RECOVERY FOR REUSE OR RECYCLING, UNUSED LIQUID SHOULD BE DISPOSED ON BY APPROVED TREATMENT, TRANSPORTERS, AND DISPOSAL SITES IN COMPLIANCE WITH ALL APPLICABLE LAWS, TANK BOTTOMS AND TANK WATER BOTTOMS MAY BE HAZARDOUS TO HUMAN, ANIMAL, AND AQUATIC LIFE, IF SPILL IS INTRODUCED INTO A WASTEWATER SYSTEM THE CHEMICAL AND BIOLOGICAL OXYGEN DEMAND WILL LIKELY INCREASE, SPILL MATERIAL IS BIODEGRADABLE IF GR.A.DUALl Y EXPOSED TO MICROORGANISMS, A POTENTIAL DISPOSAL METHOD IS INCINERATION, IF PROPERLY PERMITTED, MSDS No. APPC 308 Rev. Date 09/17/92 -FOR "DISCLAIMER OF LIABILITY", SEE THE STATEMENT ON PAGE 12- Page 7 of 12 I - I e e ARCO MIDGRADE UNLEADED GASOLINE COMPONENT NAME GASOLINE WHICH CONTAINS: CAS NUMBER CARCINOGEN 1 N/AP MSDS No, APPC 308 %<O".05ITIO. BY VOLU"'~ IX. COMPONENTS (This may not be a complete list of components,) 08006-61-9 EQ 100 BENZENE 71-43-2 1,2,3,4 AP 1-5 98-82-8 N/AP LT 1 110-82-7 N/AP LT 2 64-17-5 N/AP AP 0-10 100-41-4 N/AP AP 1-3 1634-04-4 N/AP AP 0-15 110-54-3 N/AP AP 2-5 111-65-9 N/AP LT 1 108-88-37 N/AP AP 7-14 95-63-6 N/AP AP 1-4 25551-13-7 N/AP LT 5 1330-20-7 N/AP AP 8-15 CUMENE CYCLOHEXANE ETHANOL ETHYL BENZENE METHYL TERTIARY BUTYL ETHER ( MTBE ) N·HEXANE N-OCTANE TOLUENE 1,2,4 TRIMETHYL BENZENE TRIM ETHYL BENZENE XYLENE ~Listed by: 1 =NTP, 2=IARC, 3=OSHA, 4=Other See qualification below, Compositions given are typical values, not specifications. . Qualifications EQ - Equal L T - Less Than GT - Greater Than AP - Approximately UK - Unknown TR - Trace NIP - No Applicable Information Found NIAP - Not Applicable NIDA - No Data Available . Page 8 of 12 . . . . ~~I ~~ Ix. . I -ARCO MIDGRADE UNLEADED SOLlNE MSDS No. APPC 308 Rev. Date 09/17/92 PHYSICAL AND CHEMICAL DATA BOILING POINT AP 350 TO 4370 F PH N/AP FREEZING POINT N/AP DRY POINT A P 430F SPECIFIC GRAVITY (H20= 1 AT 39.2° F) AP .7 TO ,8 VOLATilE CHARACTER ISTICS APPRECIABLE VISCOSITY UNITS, TEMP. (METHOD) N/AP SOLUBILITY IN WATER SLIGHT VAPOR PRESSURE AP 5 TO 15 (PSI AT 100 F) STABILITY STABLE VAPOR SP GR (AIR =1 AT 60° . 90° F) AP 4,0 HAZARDOUS POLYMERIZATION NOT EXPECTED TO OCCUR OTHER CHEMICAL REACTIVITY N/AP OTHER PHYSICAL AND CHEMICAL PROPERTIES WATER IN CONTACT WITH OXYGENATED GASOLINE CAN CON- TAIN UP TO 80% OXYGENATE & HYDROCARBON MATERIALS, APPEARANCE AND ODOR COLORLESS TO STRAW-COLORED LIQUID; PETROLEUM NAPHTHA ODOR. CONDITIONS TO AVOID HEAT, SPARKS, AND OPEN FLAME, AND BUILD UP OF STATIC ELECTRICITY, MATERIALS TO AVOID HALOGENS, STRONG ACIDS, ALKALlNES AND OXYDIZERS, HAZARDOUS DECOMPOSITION PRODUCTS BURNING OR EXCESSIVE HEATING MAY PRODUCE CARBON MONOXIDE AND OTHER HARMFUL GASES/VAPORS INCLUDING OXIDES AND/OR OTHER COMPOUNDS OF SULFUR, -FOR ·DISCLAIMER OF LIABILITY', SEE THE STATEMENT ON PAGE 1~ Page 9 of 12 e . ARCO MIDGRADE UNLEADED GASOLINE I XI. ADDITIONAL PRECAUTIONS HANDLING STORAGE AND DECONTAMINATION PROCEDURES STORE AND TRANSPORT IN ACCORDANCE WITH ALL APPLICABLE LAWS, KEEP AWAY FROM HEAT, SPARKS, AND OPEN FLAME! KEEP CONTAINERS CLOSED , PLAINLY LABELED, AND OUT OF CLOSED VEHICLES, CONTAINERS SHOULD BE ABLE TO WITHSTAND PRESSURES EXPECTED FROM WARMING OR COOLING IN STORAGE, GROUND ALL DRUMS AND TRANSFER VESSELS WHEN HANDLING, STORE IN COOL (80F OR BELOW) vvELL VENTILATED LOCATION. ALL ELECTRICAL EQUIPMENT IN STORAGE AND/OR HANDLING AREAS SHOULD BE INSTALLED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE NATIONAL ELECTRICAL CODE, (NEC), KEEP OUT OF REACH OF CHILDREN! EMPTY CONTAINERS RETAIN SOME LIQUID AND VAPOR RESIDUES, AND HAZARD PRECAUTIONS MUST BE OBSERVED WHEN HANDLING EMPTY CONTAINERS, AVOID CONTACT WITH SKIN, AVOID INHALATION OF VAPORS OR MISTS, USE IN A WELL VENTILATED AREA AWAY FROM ALL IGNITION SOURCES. ADDITIONAL TOXICOLOGY INFORMATION COMPONENTS SEVERAL COMPONENTS OF THE GASOLINE LMIXTURE HAVE BEEN FOUND TO AFFECT EITHER MALE OR FEMALE REPRODUCTIVE CAPACITY OR TO BE TOXIC TO THE FETUS IN LABORATORY STUDIES, INHALATION EXPOSURE TO HIGH CONCENTRATIONS OF MTBE ( 4,000 TO 8,000 PPM ) HAS CAUSED FETAL TOXICITY AND MALFORMATIONS ( CLEFT PALATE, SKELETAL VARIARIONS) IN LABORATORY ANIMALS, MATERNAL TOXICITY WAS REPORTED AT THESE LEVELS, THE NO OBSERVED EFFECT LEVEL (NOEL) FOR FETAL EFFECTS WAS REPORTED TO BE 1000 PPM, EXPOSURE TO OTHER COMPONENTS OF GAS LINE SUCH AS BENZENE, TOLUENE, XYLENE, ETHYLBENZENE, TRIMETHYLBENZENE AND N-HEXANE HAVE ALSO BEEN SHOWN TO AFFECT REPRODUCTIVE CAPACITY AND/OR FETAL DEVELOPMENT IN LABORATORY ANIMALS, . THE EXACT RELATIONSHIP BETWEEN THESE EFFECTS AND HUMANS IS NOT KNOWN, EXPOSURE TO N-HEXANE, A COMPONENT OF GASOLINE, HAS BEEN ASSOCIATED WITH PERIPHERAL NEUROPATHY IN HUMANS. CHRONIC EXPOSURE TO VERY HIGH LEVELS (8000 PPM) OF MTBE HAS PRODUCED URINARY SYSTEM EFFECTS ( NEPHROSIS, NEPHROPATHY OR ABNORMAL KIDNEY EFFECTS) IN LABORATORY ANIMALS. THE RELATIONSHIP BETWEEN THESE EFFECTS AND HUMANS IS NOT KNOWN, BUT COMPARABLE HUMAN EXPOSURES WOULD BE CONSIDERED HIGHLY UNLIKELY UNDER TYPICAL USE CONDITIONS, MSDS No. APPC 308 ~ . . Page 10 of 12 , . . . ..., ~ \ ~~ I XII. . I ARCO MIDGRADE UNLEADED G SOLlNE MSDS No. APPC 308 Rev. Date 09/17/92 REGULATORY INFORMATION SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT OF 1986 (SARA), TITLE '" SECTION 311/312 HAZARD CATEGORIES DELAYED (CHRONIC) HEALTH HAZARD FIRE HAZARD SECTION 313 THIS PRODUCT CONTAINS THE FOllOWING CHEMICALS SUBJECT TO THE REPORTING REQUIREMENTS OF SARA TITLE III, SECTION 313 AND 40 CFR 372: BENZENE CUMENE ETHYL BENZENE TOLUENE 1,2,4 TRIMETHYl BENZENE XYLENE TOXIC SUBSTANCES CONTROL ACT (TSCA) All COMPONENTS OF THIS PRODUCT ARE LISTED ON THE TSCA INVENTORY, COMPREHENSIVE ENVIRONMENTAL RESPONSE, COMPENSATION AND LIABILITY ACT (CERCLA) THIS PRODUCT CONTAINS THE FOllOWING CHEMICALS SUBJECT TO THE REPORTING REQUIREMENTS OF CERClA: BENZENE CUMENE CYCLOHEXANE ETHYL BENZENE TOLUENE XYLENE REPORTABLE QUANTITY (RQ), LBS 10#/4,54KG 5000#/2270KG 1000#/454KG 1000#/454KG 1000#/454KG 1000#/454KG CALIFORNIA SAFE DRINKING WATER AND TOXIC ENFORCEMENT ACT OF 1986 . PROPOSITION 65 THIS PRODUCT CONTAINS THE FOllOWING CHEMICAL(S) LISTED BY THE STATE OF CALIFORNIA AS "KNOWN TO THE STATE OF CALIFORNIA TO CAUSE CANCER", AND/OR REPRODUCTIVE TOXICITY, BENZENE TOLUENE -FOR 'DISCLAIMER OF LIABILITY', SEE THE STATEMENT ON PAGE 12- Page 11 of 12 e e . ARCO MIDGRADE UNLEADED GASOLINE I XIII. MSDS No. APPC 308 SUPPLEMENT ~ I XIV. DISCLAIMERS Disclaimer of Liability The information in this MSDS was obtained from sources which we believe are reliable, HOWEVER, THE IINFORMATION IS PROVIDED WITHOUT ANY WARRANTY, EXPRESS OR IMPLIED, REGARDING ITS CORRECTNESS. The conditions or methods of handling, storage, use and disposal of the product are beyond our control and may be beyond our knowledge, FOR THIS AND OTHER REASONS, WE DO NOT ASSUME RESPONSIBILITY AND EXPRESSLY DISCLAIM LIABILITY FOR LOSS, OR DAMAGE OR EXPENSE ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE HANDLING, STORAGE, USE OR DISPOSAL OF THE PRODUCT. This MSDS was prepared and is to be used only for this product. If the product is used as a component in another product, this MSDS information may not be applicable, . . Page 12 of 12 e BUSINESS PLAN and CHEMICAL INVENTORY UPDATE FORM e FACILITY NAME: ADDRESS: AM/PM MINI MARKET #5175 6450 White Lane Bakersfield, CA 93309 BAKERSFIELD FIRE DEPARTMENT, HAZARDOUS MATERIALS DIVISION 2130 "G" STREET BAKERSFIELD, CA 93301 CONTACT PERSON: Maria Gonzalez, Facility Manager BUSINESS PHONE NUMBER: [805] 398-0393 ANNUAL INVENTORY UPDATE ~ No significant changes In Inventory have occurred since the last business plan or Inventory was submitted. o NEW INVENTORY FORMS ARE ATTACHED. o REPLACE PREVIOUS INVENTORY WITH ATTACHED INVENTORY. o REPLACE ONLY DESIGNATED PAGES OF INVENTORY. SPECIAL INSTRUCTIONS: BIENNIAL REVIEW AND RECERTIFICATION ~ I CERTIFY THAT THE BUSINESS PLAN HAS BEEN REVIEWED AND THE INFORMATION CONTAINED IN THE BUSINESS PLAN IS ACCURATE AND COMPLETE AS OF THIS DATE WITH THE BELOW CORRECTIONS. OTHER UPDATES ~ Please incorporate the following information into the business plan for this facility. FACILITY MANAGER: Maria Gonzalez MANAGER HOME PHONE: [805] 836-1954 FIELD SUPERVISOR: Luke Ozcelik SUPERVISOR HOME PHONE: [805] 834-2978 I declare, under penalty of perjury, that the information provided herein is true and correct to the best of my knowledge. Signature: Printed Name: ~tlJw~ Date: 12/31/92 Nancy B. Walti, Manager-Environmental, Health & Safety NOTE: DEHS provides this information to local police and fire jurisdictions. Please provide three (3) copies of all update information. ...' (!)~ RECEIVED \992 ssW?, MAT 01V. 52-012-0713 , , MAR 4/:2qo/ Name of this Facility: Standard Ind. Class Code: Dun & Bradstreet Number & FederallD # PRESTIGE STATIONS, INC. 15175 P. O. BOX 6225 ARTESIA, CA 90702 CITY OF BAKERSFIELD HAZARDOUS MATERIALS INVENTORY HAZARDOUS MATERIALS DIVISION, 2130 "G" Street, Bakersfield, CA 93301 o Farm and Agriculture ~Standard Business BUSINESS NAME: AMlPM MINI MARKET #5175 LOCATION: 6450 White Lane CITY, ZIP: Bakersfield, CA 93309 PHONE #: [805] 398-0393 OWNER NAME ADDRESS: CITY, ZIP: PHONE #: [310] 402-1278 REFER 2'0 INS2'RUC2'IONS FOR PROPER CODES - - 6 7 Ie 14 Names of Mixture/Components See Instructions Gasoline-ARCO UNLEADED Hydrocarbons (none) Methyl Tertiary-Butyl Alcohol (75-65-0) Methyl Tertiary-Butyl Ether (1634-044) Gasoline-ARCO SUPER UNLEADED Hydrocarbons (none) Methyl Tertiary-Butyl Alcohol (75-65..Q) Methyl Tertiary-Butyl Ether (1634-044) CARBON DIOXIDE CARBON DIOXIDE (124-38-9) of 1 Page 13 %by Wt 9 o 9 1 12 Location Where Stored in Facility Southwest corner of lot 11 Use Code 19 10 Cont Teœp 4 9 Cont Press 1 8 Cont !æe o 1 Measure # Days Units On Site GAL 3 6 5 1634-044 5 Annual Est 2.07 iñiiiiõñ C.A.S. Number 4 Average Amt - 12,000 1 2 3 Trans Type Max Code Code Amt I U M 24,000- Physical and Health Hazard Check all that apply 1 1 Southwest corner of lot 19 T 4 I 1 T 1 5rO 6 .-~ I 1 Immediate '--' Health ]G A L [] 1634-04-4 --, ISudden Release --' of Pressure 1550,000 C.A.S. Number -, !~Delayed Health I 4, 000 ¡- - ¡ Reactivity 1__1 I U I M I 12,000 Physical and Health Hazard Check all that apply -. ~~Fire Hazard 9 ° 1 o 0 9 1 1 1 Storage Area ** 99 I 4 1 1 6 5LO 4 I r-, ! _ ..! Immediate Health 1FT 3r3 124-38-9 1--1 1 . Sudden Release of Pressure 15,824 cu.ft. C.A.S. Number -I !!Delayed Health I 2 2 4 1--1 !_ _! Reactivity ~~ Physical and Health Hazard Check all that apply r1 IXIFire Hazard "Used In soft drink dispensing T T T T = ]immediate Health T i l T ! =: Sudden Release of Pressure 1 C.A.S. Number !:Delayed Health T 1- -I Reactivity 1__1 T I I Physical and Health Hazard Check all that apply .-¡ L J Fire Hazard [805] 836-1954 24-hr Phone [805] 589-2507 24-hr Phone Facility Manager Title Field Supervisor Title -~ 1 Immediate --' Health . 1 . of Pressure - #1 Maria Gonzalez Name #2 Everado Velasco Name ,-... I ISudden Release 1__1 -, I Delayed -. Health ¡- -¡ Reactivity 1__1 BMERGENCYCONTACTS -~ 1 . Fire Hazard .... 3/6/92 Date Signed based on CettiflcatJon (Read and sIgn B/Jer compl&tJng all sections) I certity under penalty of law that I have personally examined and am familiar with the information submitted in this and al inquiry of those individuals responsibility for obtaining the information, I believe that the submitted information is NANCY B. WAL TI, Manager-Environmental, Health & Safe' Name and official title of owner/operator OR owner/operator's authorized representative .--..':':;'i ,...--- . e ~ . t 02/20/92 AM PM MINI MARKET 215-000-000629 Overall Site with 1 Fac. Unit Page 1 General Information Location: 6450 WHITE LN Community: BAKERSFIELD STATION 09 Map: 123 Hazard: Low Grid: 16D FlU: 1 AOV: '0.0 Administrative Data D&B Number: 51-012-0713 State: CA Zip: 909D1'='- 907D SIC Code: 5541 f¡~~) 1f¡-~d(f CA -90701 - 907ð'2- Phone: State: Zip: Title MANAGER FIELD SUPERVISOR Mail Addrs: PO BOX 6225 City: CERRI~OS tkLT~'k Comm Code: 215-009 BAKERSFIELD STATION 09 Owner: PRESTIGE STATIONS Address: P 0 BX 6225 Ci ty: GERRI'PGS It£- TtS I It- Summary RECE\VED t.1AR , , \992. HAZ. MAT. OW. I, NIt¡1/e.J' Æ. W /ft.-íl Do hereby carmy that I have (TyPe or print nerne) reviewed the attached ha-::~;d;,iUS materials manage- 1t11/¡J1-1 /t1/!f( f1#J<gf Itsns ment plan fcr.__._,..____.. .__......,~_;;¡.:·Kì that it along wiih {¡\;.r;l~':''';~ ~ ~·..i~::'.J~~) . an)! correc:dem3 co; :~::~:t.. '3 a :omplete and corred man- agement plàn for my facility. 11. ø {;JJ( " SIgnature 3/~ (t¡v Date ~- ~ . . -." ¡ ~ 02/20/92 AM PM MINI MARKET 215-000-000629 02 - Fixed Containers on Site Page 1 Hazmat Inventory Detail in Reference Number Order 02-001 GASOLINE (UNLEADED) ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 12,000 I 4,000.00 I 585,000.00 Storage UNDER GROUND TANK r Press T Temp ~ Ambient Ambient SW CORNER Location - Conc l 100.0% Gasoline Components r; MCP -:-¡List Moderate 02-002 GASOLINE (SUPER UNLEADED) ~ Fire, Immed Hlth, Delay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 12,000 I 2,000.00 I 549,000.00 Storage UNDER GROUND TANK r Press T Temp -:I Ambient AmbientlSW CORNER Location - Conc -I 100.0% . Gasoline Components r; MCP -:-¡List Moderate . 02-003 GASOLINE (REGULAR) ~ Fire, Immed Hlth, D~lay Hlth Liquid 12000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL I, I I Daily Max GAL ----r--Daily Average GAL --r-- Annual Amount GAL -- 12,000 I· 2,000.00 I 549,000.00 Storage UNDER GROUND TANK r Press T Temp -:I Ambient AmbientSW CORNER Location - Conc l 100.0% Gasoline Components ~ MCP -:-¡List Moderate I " . ;"::-, . . f 02/20/92 AM PM MINI MARKET 215-000-000629 02 - Fixed Containers on Site Page 2 Hazmat Inventory Detail in Reference Number Order 02-004 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 448 Minimal FT3 CAS #: 124-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER ---- Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 448 I 224.00 I. 5,824.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Ambient Amb~entl Location - Conc l 100.0% Carbon Dioxide Components r; MCP -=---rList Minimal I - ~ e e ~ 02Î20/92 AM PM MINi MARKET 215-000-000629 00 - Overall Site Page 3 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation IN THE EVENT OF ANY MAJOR INCIDENT, OUR FACILITY PERSONNEL (I.E. FACILITY MANAGER, ASSISTANT, CASHIER OR MAINTENANCE) WILL IMMEDIATELY CALL 911 AND REPORT. IF EVACUATION IS NECESSARY, AND AFTER 911 HAS BEEN CALLED, EMPLOYEES ARE DIRECTED TO A SITE OPPOSITE THE DANGER AREA. FACILITY PERSONNEL WILL THEN CALL AND NOTIFY EMERGENCY CONTACT PERSONNEL. <3> Public Notif./Evacuation EMPLOYEES WILL EVACUATE PUBLIC THROUGH NEAREST EXIT. ALARM SHALL BE GIVEN BY SHOUTING. <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 BAKERSFIELD'CITY FIRE DEPARTMENT - 4030 SORANNO AVE - STATION #7 \- e e ~ 'i 02í20/92 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 4 <E> Mitigation/Prevent/Abatemt <1> Release Prevention FACILITY UTILIZES THREE 12,000 GALLON UNDERGROUND TANKS LOCATED AT THE SOUTHWEST END OF THE SITE. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN ORR YOUR ENGINE", AND "DO NOT TOP OFF TANK" SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZED POTENTIAL RISK AND HAZARD. FOR MINOR SPILLAGE (I.E. CUSTOMER GAS TANK OVERFLOW) EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED AT EACH FACILITY. FOR A MAJOR SPILLAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY EMERGENCY CONTACT PERSONNEL. <2> Release Containment FOR MINOR SPILLAGE, EMPLOYEES ARE INSTRUCTED TO CLEAN AND DISPOSE OF MATERIALS SAFELY. PROTECTIVE RUBBER GLOVES AND CLEAN-UP EQUIPMENT IS PROVIDED. FOR A MAJOR SPILAGE, EMPLOYEES ARE TO CALL 911 AND REPORT. THEY WILL THEN NOTIFY THE EMERGENCY RESPONSE PERSONNEL. INVENTORIES ARE MONITORED DAILY AND ARE KEPT AT A MINIMUM TO MINIMIZE RISK. "NO SMOKING", "PLEASE TURN OFF YOUR ENGINE", AND "DO NOT TOP OFF TANK' SIGNS ARE POSTED IN CLEAR VISION OF CONSUMER AND EMPLOYEES. COMPLIANCE TO POSTED SIGNS MINIMIZES POTENTIAL RISK AND HAZARDS. CONTAINMENT SHALL BE COMPLETED BY DIKING WITH ABSORBANT/OTHER MATERIAL.- <3> Clean Up CLEAN UP PROCEDURES INCLUDE USING ABSORBANT, EVAPORATION, AND A LICENSED HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL COMPANY, IF NECESSARY. <4> Other Resource Activation '" \- e e' .. i 02/20/92 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <4> Other Resource Activation (Continued) . ¡ . \ e , ~ .; ~ ~ .... 02/20/92 A AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 6 <F> Site Emergency Factors <1> Special Hazards <2> utility Shut-Offs A) GAS - N/A B) ELECTRICAL - NORTHEAST CORNER OF BUILDING C) WATER - NORTHEAST SIDE OF SITE BETWEEN OUR FACILITY AND KENTUCKY FRIED CHICKEN BY THEIR DUMPSTER D) SPECIAL - EMERGENCY FUEL SHUT-OFF LOCATED ON CASH REGISTER E) LOCK BOX - NO <3> Fire Protec./Avai1. Water PRIVATE FIRE PROTECTION - EMPOLYEES ARE INSTRUCTED ON LOCATION OF FIRE EXTINGUISHERS AND THEIR LOCATION. INSTRUCTION IS GIVEN ON USE AND OPERATION. INSTRUCTION IS ALSO GIVEN ON LOCATIONS OF EMERGENCY FUEL PUMP SHUT-OFF SWITCHES. FIRE HYDRANT - ON CORNER OF WHITE LANE AND ASH ROAD. <4> Building Occupancy Level \ _ .." 'i~"" ":¡-' '- ¡;; e . 02/20/92 AM PM MINI MARKET 215-000-000629 00 - Overall Site Page 7 <G> Training <1> Page 1 WE HAVE 12 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: ALL PERSONNEL, NEW AND EXISTING, ARE GIVEN INSTRUCTION ON COMPLYING WITH THE cITY OF BAKERSFIELD BUSINESS EMERGENCY PLAN. UPON COMPLETION OF SAID INSTRUCTION, EMPLOYEE WILL SIGN AN ACKNOWLEDGE SLIP. IN ADDITION, A TRAINING LOG WILL BE KEPT BY THE FACILITY MANAGER TO ENSURE THAT INSTRUCTION HAS BEEN CARRIED OUT. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use I.¡;. - ~ e e of( Bakersfield Fire Department Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 ~....'" ..;.JV~1;.~~ :> .}~~, RECE\\IEO 'JUN 2 5 W90 HI.\7, MAT. D1V. :~:~:~:~:~:~:~:::~::::::::I::::::::::::::::::::I:::::::::::::::::::::::::::::~:~:::::::::::::::::::::::::~:::::::::::::~:~:~:::::::::::::::::::::::::~:::::~:~:::~:~:::::::::::::::::::::::::::::::::::::::::::~:~:~:::~:::::::::::::~:::::~:::::::::::::::::::::::::::::::::I::::::::::::::I:::::::::::::~:::::::::::~:~:~:~:~:~:~:::~:~:~:~:~:~:~:~:::::::::::::II::::::::::::::~:~:~:~:~:::~Ip.UII;:::~:~:~IIZIIZBº: HAZARDOUS MATERIALS MANAGEMENT PLAN 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. ~d9 ::;..---- SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: AM/PM MINI MARKET #5175 LOCATION: 6450 White Lane, Bakersfield, CA 93309 BUSINESS PHONE: [805] 398-0393 MAILING ADDRESS: Prestige Stations, Inc. #5175 Attn: Environmental Analyst P. O. Box 6225 Cendtos,CA 90701 PHONE: [213] 402-1278 DUN & BRADS1REET NUMBER: 51-0120713 SIC CODE: 5541 PRIMARY ACTIVI1Y: Convenience store with retail gas sales OWNER: Atlantic Richfield Company OPERATOR: PRESTIGE STATIONS, INC. P. O. Box 6225 Cendtos,CA 90701 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR PHONE l. 2. Everado Valesco Ron Taft Facility Manager Field Supervisor [805] 398-0393 [805] 837-0141 [805] 589-2507 [8051 837-0141 1 ~ ~. " e - Bakersfield Fire Department Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: Average total 12 for the faciUty Shift 1= 3; Shift 2= 2; Shift 3= 1 " MATERIAL SAFE1Y DATA SHEETS ON FILE: FaciUty copies of MSDS is located in the yellow HAZARD COMMUNICATION PROGRAMS binder BRIEF SUMMARY OF TRAINING PROGRAM: All employees are instructed as follows: 1. For minor spillage (i.e. customer gas tank overflow), employees are instructed to clean and dispose of materials safely. protective rubber gloves and clean up equipment is provided at each !acUity. For major spillage, employees are instructed to call 911 and report. They will then notify the Emergency Coordinator or his alternate who will then activate the NOTIFICATION procedures. 2. Use and location of absorbant, protective clean-up equipment and f'ue extinguishers. Annual inspection and maintenance of safety equipment (fire extinguishers, rubber gloves and clean up equipment), and review of procedures for proper use of safety and spill control equipment. 3. Review of Emergency Response Plan: evacuation procedures: location of emergency fuel shut-off switches and main electrical shut-off switch: use and location of absorbant, protective clean-up equipment and fire extinguishers: and the list of ALL pertinent people to can in case of an emergency. Make sure employees know the location of the Emergency Response Plan. SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALlY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM TIlE REPORfING REQUIREMENTS OF CHAPTER 6.95 OF TIlE "CALIFORNIA HEALTIl & SAFE1Y CODE" FOR TIlE FOLLOWING REASONS: WE DO Nar HANDLE HAZARDOUS MATERIALS WE DO HANDLE HAZARDOUS MATERIALS, BUT TIlE QUANTITIES AT NO TIME EXCEED TIlE MINIMUM REPORTING QUANTITIES. arHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, MITCHELL K. NG. CERTIFY THAT TIlE .ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TIllS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATION UNDER TIlE "CALIFORNIA HEALTH AND SAFE1Y CODE" ON HAZARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. Mana,er, Admin. Svcs. 06/22/90 NG 2 :;." " e e Bakersfield Fire Department Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: 'AM/PM MINI MARKET #5175" SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A AGENCY NOTIFICATION PROCEDURES: Fire Pollce Ron Taft, Field Supervisor 911 911 [805] 837-0141 The Field Supervisor will then notify: Bruce Taylor PSI CORPORATE OFFICE MAINTENANCE CaUfornia Office of Emergency Services Environmental Protection Agency National Response Center [213] 838-5670 213-402-1299 800-553-6246 800-852-7550 415-974-8131 800-424-8802 B. EMPLOYEE NOTIFICATION AND EVACUATION: Job Title: Facillty Manager a. For any emergency, call 911 and report. b. Evacuate, if necessary, to a site opposite danger area. c. Call your Field Supervisor; give details of emergency. d. Your Field Supervisor will notify Atlantic Richfield maintenance, Area Manager and main office. Job Title: Facillty Personnel (i.e. cashier, maintenance). a. For any emergency, call 911 and report. b. Evacuate if necessary, to a site opposite danger area. c. Call your Facillty Manager; give details of emergency. d. Your Facility Manager will call Field Supervisor and report. e. Your Field Supervisor will notify Atlantic Richfield maintenance, Area Manager and main office. C. PUBLIC EVACUATION Alarm shall be given by shouting. D. EMERGENCY MEDICAL PLAN CALL 911 AND REPORT - PARAMEDICS WILL RESPOND 3 \. '" . e Bakersfield Fire Department Hazardous Materials Division tit HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: Facilities are equipped with red jacket leak detectors which shuts down if leak occurs. Inventories are monitored daily and are kept at a minimum to minimize risk. "No Smoking", "Please Tum Off Your Engine", and "Do Not Top Off Tank" signs are posted in clear vision of consumer and employees. CompUance to posted signs minimizes potential risk and hazards. B. RELEASE CONTAINMENT AND/OR MINIMIZATION: For minor spillage (i.e. customer gas tank overflow) employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean-up equipment is provided. For a major spillage, employees are to can 911 and report. They win then notify the emergency response personnel. Inventories are monitored daily and are kept at a minimum to minimize risk. "No Smoking", "Please Turn Off Your Engine", and "Do Not Top Off Tank" signs are posted in clear vision of consumer and employees. CompUance to posted signs minimizes potential risk and hazards. Containment shall be completed by Diking with Absorbant/Other Material. C. Cleanup Procedures Cleanup procedures include using Absorbant, Evaporation, and a Licensed Hazardous Waste Treatment, Storage, and Disposal Company, if necessary. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: NONE ELECTRICAL: Northeast comer of building WATER: Northeast side of site between our facility and Kentucky Fried Chicken by their dumpster SPECIAL: Emergency Fuel Pump Shut-Off Switch is located in the sales area near the cashier LOCK BOX: YES/[NOJ IF YES. WCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: NONE B. WATER AVAILABILITY (FIRE HYDRANT): South corner oflot off White Lane 4 CITY of BAKEHSr gHAZARDOUS MATERIALS INVENTORY NON-TRA SECRETS lELU Page _~___ of 1_ NAME On THIS FACltITYò' Æ~/PM MINI MARKET # 5]75 T NOA 0 NO. C S C 0 :!L!..S541 -,------ Eu~ AN BÀADSTRh .NUNBfR-'-· .-- -- -, ,----- - :?1._ - _ .! :?" - 9 1 11 DE ~NER NAME'P A ORES~I' c/~ --- ~ TY ~ P:tt R tpHk to-¡,lSTRÚÏ::TIDNS--roR-PROPER CODES Standard BusIness o JSINE~S NAME' AM/PM MI )C TIN . 11 Y ! Þ:7BslttJfI ON~ . __ ( 805) 398 õ393.~-====- MARKET NI ture Farll and Agticu U ~i.ture{ço'conents Instruc Ions MUles of See 3 , by n 10 Cont Te!llp 9 Cont Press 8 Cont lype 6 Measure Units 5 Annua Est . Average Allt 3 ICax Allt 2 Tyøe Code I r~ns ode 4 1 01 GAL M U ( none) Toluene {108-88-3 Methyl Tert Hydrocarbons 00 13 15 NUllber NUllber NUllber C.A.S Halle C.A,S Hille I C.A.S Nalle COllponent IlImediate Co~ponent '2 Health Component t3 o SUddf" Re I ease o Pressure NUllber o C.A.S S--Oe lared Hea th hysic,1 end Health Harard (Check all that apply/ Reactivity o Huard ~e Ethe 1 ARGO UNLEADED GASOLINE none E-3 5 C.A.S Pg , 19 COllponent . 01 365 GAL 585.000 4,000 o U 00 NUllber NUllber NUllber Nalle Halle I C.A.S Nllle . C.A.S Immediate COllponent .2 Hea I th COllponent t3 1634-04-4 HUllber C.A.S th Haurd aøply/ Physical eod Hea (Check all tha t 10 11 o Sudden Re I ease of Pressure o r;:or"" De lared U Hea th Reactivity o re Hazard ~i Ether ARGO SUPER UNLEADED GASOLINE 0-3 5 Pg /, M U Hydrocarbons none Methyl Tertiary-Butyl Alcohol (75-65-0) Methyl Tertiary-Butyl Ether (1634-04-4 00 NUllber NUllber C.A.S C.A.S , , Nalle Nalle . Ø2 COMponent I d' COMponent IIlIe late Hea I th COllponent 1634-04-4 Number r(oe lared Hea th C.A.S th Ha~ard apply/ end Hea a II that ~e PhY$ ica (Check 10 11 NUllber C.A.S I NIII8 13 o 04 SUddfn Release o Pressure 365 o Reactivity o Hazard 124-38-9) de i ox i Ga rbon 0 00 NUllber NUllber NUllber C.A.S C.A.S C.A.S I I Nllle Nalle NSlle . IlImediate Component '2 Health COllponent t3 COllponent 124-38-9 ~~dd n Release !.:J'"":iUOU Pressure NUllber C.A.S th Haurd apply/ 'nd Hea a I that P~H~~~ o Delared Hea th o Reactivity o re Hazard o ~ It 1 Everado RI i d drink soft n EMERGENCY CONTACTS i used = **99 805-837-0141 2t -11 f T1im- 6-22-90 DHrsf~r.~- Field Supervisor Ttt the S1qñHure- "2 Ron Taft RfIi, end all leve that $ubllitte~ in this Inforllltlon, I be 805-589-2507 24 Hr Phone- erlificatioq (Reed and sign afjer c()mp7eting a17. rce.Cf1ionS) certify unOer enall 0 la th t I have persona )) exallln 0 ,0 I fali1la( It the Inforllatlon t~.açhed docullen~sl anÒ t at ~ase~ on ., Inquiry 0 lhose In~lvlaua's responslb'e or obtaIning the ú~ftltted Inforllatlon IS true. accurate, anG co~plet.. M~tchell K. Ng, Manager-Administrative Services !~f'."p~rTëTIr-r1 horlzea repflf!ñtatlve f4gr ty i 1 Faci Ttt esco ~ ".....-..., ./ e e CALL: 911 ARca #: 5420 PSI #: 5175 STATION MANAGER: [805] 589-2507 Everado Verasco FIELD SUPERVISOR: [805] 837-0141 Ron Taft AREA MANAGER: [213] 313-0134 Fernando Sendejas MAINTENANCE: [800] 553-6246 [213] 402-9126 PSI Maintenance ARCO Maintenance WHEN CALLING ARCO MAINTENANCE, GIVE ONLY THE ARCO # CERRITOS MAIN OFFICE: 213-402-1299 , ., . . .' .:". : :. . ..:.. .':' ' .. "':':"'::';:'.:: ...... ,'. ......:. .... :":. '~"::'.::.,:' :.:::. .. .... :..... . ..:.... . ...... :: :: .:. ....: ..::. ... .... .:. .... .:. :.:..:. .... ..... '.. . ATTACHMENT AA ! ,. "" " e e "1', Bakersfield Fire Department Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN Instructions: l. To avoid further action, return this form within 30 days of receipt. 2. 1YPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: AM/PM MINI MARKET #5175 LOCATION: 6450 White Lane, Bakersfield, CA 93309 BUSINESS PHONE: (805) 398-0393 MAILING ADDRESS: Prestige Stations, Inc. #5175 Attn: Environmental Analyst P. O. Box 6225 Ce~tos,CA 90701 PHONE: (213) 402-1278 DUN & BRADSTREET NUMBER: 51-0120713 SIC CODE: 5541 PRIMARY ACTIVflY: Convenience store with retail gas sales OWNER: Atlantic Richfield Company OPERATOR: PRESTIGE STATIONS, INC. P. O. Box 6225 Ce~tos, CA 90701 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR PHONE 1. 2. Everado VaIesco Ron Taft Facility Manager Field Supervisor (805) 398-0393 (805) 837-0141 (805) 589-2507 (805)837-0141 1 ~ e e ~ Bakersfield Fire Department Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: Average total 12 for the facility Shift 1= 3; Shift 2= 2; Shift 3= 1 MATERIAL SAFE1Y DATA SHEETS ON FILE: Facility copies of MSDS is located in the yellow HAZARD COMMUN1CATION PROGRAMS binder BRIEF SUMMARY OF TRAINING PROGRAM: All employees are instructed as follows: 1. For minor spillage (i.e. customer gas tank overflow). employees are instructed to clean and dispose of materials safely. protective rubber gloves and clean up equipment is provided at each facility. For major spiUage. employees are instructed to call 911 and report. They will then notify the Emergency Coordinator or his alternate who will then activate the NOTIFICATION procedures. 2. Use and location of absorbant. protective clean-up equipment and fire extinguishers. Annual inspection and maintenance of safety equipment (fire extinguishers. rubber gloves and clean up equipment). and review of procedures for proper use of safety and spill control equipment. 3. Review of Emergency Response Plan; evacustion procedures; location of emergency fuel shut-off switches and main electrical shut-off switch; use and location of absorbant. protective clean-up equipment and fire extinguishers; and the list of ALL pertinent people to call in case of an emergency. Make sure employees know the location of the Emergency Response Plan. SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENAL1Y OF PERJURY THAT MY BUSINESS IS EXEMPT FROM TI-lE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTI-l & SAFE1Y CODE" FOR THE FOLLOWING REASONS: . WE DO Nor HANDLE HAZARDOUS MATERIALS WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. orHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I. MITCHELL K. NG. CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TI-lIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATION UNDER TI-lE "CALIFORNIA HEALTH AND SAFE1Y CODE" ON HAZARDOUS MATERIALS (DN. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. S~tJ~~NG Manlller. Admin. Svcs. 3/7/90 2 .- e e " Bakersfield Fire Department Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: 'AM/PM MINI MARKET '5175" SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A AGENCY NOTIFICATION PROCEDURES: Fire PoUce Ron Taft, Field Supervisor 911 911 (805)837-0141 The Field Supervisor win then notify: Bruce Taylor PSI CORPORATE OFFICE MAINTENANCE CaUfomia Office of Emergency Services Environmental Protection Agency National Response Center (213) 838-5670 213-402-1299 800-553-6246 800-852-7550 415-974-8131 800-424-8802 B. EMPLOYEE NOTIFICATION AND EVACUATION: Job Title: Facility Manager a. For any emergency, caU 911 and report. b. Evacuate, if necessary, to a site opposite danger area. c. CaD your Field Supervisor; give details of emergency. d. Your Field Supervisor wi11 notify Atlantic Richfield maintenance, Area Manager and main office. Job Title: Facility Personnel (I.e. cashier, maintenance). a. For any emergency, caD 911 and report. b. Evacuate if necessary, to a site opposite danger area. c. CaD your Facility Manager; give details of emergency. d. Your Facility Manager wi11 caD Field Supervisor and report. e. Your Field Supervisor win notify Atlantic Richfield maintenance, Area Manager and main office. C. PUBLIC EVACUATION Alarm shall be given by shouting. D. EMERGENCY MEDICAL PLAN CALL 911 AND REPORT - PARAMEDICS WILL RESPOND 3 .... e e . Bakersfield Fire Department Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN: A RELEASE PREVENTION STEPS: FacWties are equipped with red jacket leak detectors which shuts down if leak occurs. inventories are monitored daily and are kept at a minimum to minimize risk. "No Smoking", "Please Turn Off Your Engine", and "Do Not Top Off Tank" signs are posted in clear vision of consumer and employees. CompUance to posted signs minimizes potential risk and hazards. B. RELEASE CONTAINMENT AND/OR MINIMIZATION: For minor spillage (i.e. customer gas tank overflow) employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean-up equipment is provided. For a major spillage. employees are to call 911 and report. They will then notify the emergency response personnel. inventories are monitored dally and are kept at a minimum to minimize risk. "No Smoking", "Please Turn Off Your Engine", and "Do Not Top Off Tank" signs are posted in clear vision of consumer and employees. CompUance to posted signs minimizes potential risk and hazards. Containment shall be completed by Diking with Absorbant/Other Material. C. Cleanup Procedures Cleanup procedures include using Absorbant. Evàporation. and a Licensed Hazardous Waste Treatment, Storage. and Disposal Company, if necessary. SECTION 8: UTD..ITY SHUT-oFFS (LOCATION OF SHUT-OFFS AT YOUR FACILI1YI NATURAL GAS/PROPANE: NONE ELECTRICAL: Northeast comer of building WATER: Northeast side of site between our facWty and Kentucky Fried Chicken by their dumpster SPECIAL: Emergency Fuel Pump Shut-Off Switch is located in the sales area near the cashier LOCK BOX: YES/[NO) IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTIONIWATER AVAlLABD..ITY: A PRIVATE FIRE PROTECTION: NONE B. WATER AVAILABILITY (FIRE HYDRANT): South corner of lot off White Lane 4 u ,- E· .. g =, :J en & "" ë IL e Prestige Stations, Inc. .. .~ 17215 Studebaker Road Cerritos, California 90701 Harch 22, 1989 Ralph E. Huey City of Bakersfield Fire Dept. Hazardous Materials Division 2130 G Street Bakersfield, CA 93301 Re: Business Emergency Response Plans Various Locations Dear Ì'1r. Huey, . þdq MAR 2 7 1989 HAZ. MAT. DIV. Enclosed for your review are 8 Business Emergency Response Plans for various locations that we operate within your jurisdiction. If you should have these plans on file then consider the enclosed as an update. PSI#535 PSI#589 PSI#593 PSI#6l3 PSI#5175 PSI#5191 PSI#5l99 PSI#5238 4203 Ming Ave. 1501 California Ave. 1701 Brundage Ln. 1129 Union Ave. 6450 White Lane 4100 California Ave. 4800 Fairfax Rd. 900 Monterey Ave. Bakersfield Bakersfield Bakersfield Bakersfield Bakersfield Bakersfield Bakersfield Bakersfield I will be your contact for any additional information or questions that you may have. My number is (213)402-1299. Sincerely, /It Ng Administrative Services Enc cc: M. M. Zawacki C. T,¡. Connor F. Seguin wlo Enc wlo Enc wlEnc ARca ·~ 'e ~// ß, ..~. e STANDARD BUSINESS EMERGENCY RESPONSE PLAN FOR CITY OF BAKERSFIELD I ; ***************************************** Address Where Business Is Conducted: 6450 White Lane Bakersfield, CA Zip Code: 93309 Unit Type: Unit Number: WORK PHONE NUMBER Business OWner Name: PRESTIGE STATIONS INC. t 5175 (213)402-1299 On-Site Manager: Everado Velasco ( 805 ì 398-:0,393. Emergency Contact: Everett Velasco EMERGENCY PHONE NUMBER C24-HOUR) (805)589-2507 1-800-553-6246 ( 213) 4 0 2 -912 6 'Alternate Emergency Contact: CHARLIE CONNOR ARCa MAINTENANCE . ¡ 'Standard Industrial Classification (SIC) Code of Business: 9200 'Below 1s your mailing address. Please make corrections on the space provided to the left. AM/PM MINI MARKET '5175 P.O. BOX 6225 ATTN: ADMIN. SVC. CERRITOS, CA 90701 ;;Describe the business operations that use or handle hazardous materials: I; CQNVENIENCE STORE WITH GAS SALES Maximum number of employees: 12 Total square footage of facility: 2.000 EST er or Authorized Representative Manager Änm; n !=:,rf"" c:: Title 16 Þ4~R~9 Date ,I Office Use Only I 902: ¡ Insp. J.D.: Date: D/E I.D.: Date: of BAKERSFIELD CIT}T .' MATERXALS XNVENTORY TRADE SECRETS HAZARDOUS NON- ~ ~ ,~ L.-..I tUre far. and Aqricu '''J, of Pa,e NAME OF TR1s ~Ç~L~TY: STANDARD IND. CLASS CODE DUN AND BRADSTREET NUMBER - - Standard 8U51ness NAME BUSINESS LOCATION: CITY. ZIP PHONE II: 5 Annue Est 1 .... "t M 12,000 ----------...----- 2 Tyøe Code , 'rans Code U C,A.S. SucIdIn ..,.... :)[] I..t.t. of Pres_ ....Ith [X~ ~)G h'.yetI tlNlth PhysiUI end H..lth HlllreI f r.twck .11 thet 'Ily) ,.-., L_..I ~x~ 01 1 ---, - ....--ª.906-61-9 ~_~'?_!..Q2_gJ~?:. C.A.S. IlNet hi ty H.urd _~_?_!_9.9_9_ i... M U UNLEADED Ploys icll end tIN Ith H".reI (C'-ck .11 thet ,"Iy) ,.-., .. _..I IIHctivtty c:a.o.-t . c:a.o.-t12 CcIIIponent .1 ---l-__l___________L____________L_________L__..I___l__l---L-l___-1____ Ploysiul IIId H..1th IIII.reI C.A,S. ...... c:a.o.-t . (C'-ck .11 thet .,,1,) ,.-, ,.-, C.....t L _ J fire H".rd .. _..I CcIIIponent rr-0~J GA?OLINE SUPER UNLEADED SudcMn ..I.... DC] I..tn. of p,.._ ....Ith # 5175 OWNER NAME: PRESTIGE ST - ADDRESS: P .0. BOX 6225 iõ9 CITY. ZIP;- CERRITOS, CA = PHONE.: ~ t 213 ) 4 02 -12 9 9 RDØ ro IIISDfucrIOIIS "'It norD CODD , . , " 11 nu" . /)yI Cont Cont Cont Un lOQt1on ..... , by .... of .iJltUl'l/c-tl an Sit. TJIII ,..... '''' Code Stored In Feet Itty lit _ IlIItl'UCtiOl'll ~ ~-Wes± C~.c!l('J:__ 100 Gl},S.Q.L.I.N.L__. ....... __ 8006 - 61 =2- c:a.o.-t"'" . u.s. ...... REGULAR -- --------- CoIIgnnt.2 .... C.A.S. ...... ; CcIIIponent'1 .... C.A.S. ...... OU.'+h-Wls+CC2£~L.IO 9 _~!\.§21INE c:a.o.-t" .... C.A.S. ...... c:a.o.-t'2 .... C.A.S. ..... c:a.o.-t IJ C.A.S, ....... 01 .....--ª.906-61-9 365 ,.'V., ,.V., L~..I o.lav-1 L~..I ....Ith 2,000 --------.... i... Hlz.rd UiM 12,000 ---- --.------- Physic.' end HIIlth HllIreI (Chtc:k .11 thet .",Iy) ,.-, L _..I Rllct ivity X] ,. '" ...... ..... ...... .A.5. · C.A.5 ... C.A.S T" Sudden "Ien. "_..I of P""su,,, ,.X' L_..I "X" L_..I o.l'¥Hh ""It ~~ Ftre H.lIrd ,. L - ...... ..... . C.A.S. · C.A.5. ... ... I..i.t. ....Ith · C.A.S ... '2 1..I.t. HIIlth ,.-, "-..I Sudden Relen. of Pressure ,.-, L_..I D.l.yetI H..lth ,.-, L_J lløc:t ivity ......r . C.A,S ... .1 664,...7875 n"1l,.-PNIIII------- Fld e" .. ntfi---&--""-M.P-eL:3lll.QI '2':'~__ R~ç@S n3~-~~9-3-9..1- Mf¡ilªg,êX-------------- II Everado Velasco Hi.- ---- -- ------ -- - ------- -------------- liE RGENCY COIITACTS (Røad and sign aft~r co.pletlng all 5~ctions) I heve \IIrson.lly ....inlll IIId .. fHi h.r with the Infor.. i.ve thlt the subaittld into....tion i, tMII. .ccur.t.. end co.pl.t. Cer ¡cat ion I c.rtlfy under lllM1ty of ,.. thet lor obl.inlnq the infOl'Ntlon. I be II responsibl. 16 March 89 Diti·Siijñ¡a---------------------------- tndividue ,. those of thet NslII on ., inquiry -------1=------------------ IIId doc_t. .- - ì1.I~rH E,LLf,NÇ; ..c.--MÞ-.tlAG-~DRR-6---l).7Qt[I:tN~.---ßf~JIY"lÇ~§-f -f--- 4" an. cirne"," e õl QW1er,ooerator -'er ooera or 5 au nur1Z~ rell"HIII a Ive !' 'e e STANDARD BUSINESS PLAN BP-5 (b) MEDICAL ASSISTANCE - in the event of a reportable hazardous materials or waste release or threatened release: V. List all local emergency medical facilities that will be used: Fire Department Dial - 911 (c) EVACUATION PLAN - How will immediate notification and evacuation of the business be done? (Include a description of the steps needed to evacuate employees and/or residents of the area surrounding the business in the event of a spill or release.) Are all new employees who may be impacted trained on evacuation procedures? Check one: -!!-Yes ____No. Are all employees who may be impacted given refresher training on evacuation proedures? Check one: ~Yes ____No. Evacuation routes, emergency exits, and staging areas for employees at the facility: Work. area: Facility Sales Area Evacuation route: Leave facility; go to area opposite danger. Two doors only. Emergency ex its: Staging area: Area opposite danger zone. Work area: Office/Storage Evacuation route: Leave facility; go to area opposite1ianger. ~' Eme rgency ex its: Staging area: Two doors only. Area opposite danger zone. '" ·e e STANDARD BUSINESS PLAN BP-S 6. EMERGENCY RESPONSE PLANS (a) NOTIFICATION PROCEDURES - in the event of reportable hazardous f11dterials or waste release or threatened release: I. Will the State Office of Emergency Services, OES, (telephone number 1-800-852-7550 or 1-916-427-4341) immediately be notified? Check one: XX Yes No II. Will local emergency respnse personnel immediately be notified by dialing 911? Check one: XX Yes No If business has an additional emergency response notification system, explain here. Job Title: Facility Manger For any emergency, call 911 and report. Evacuate, if necessary, to a site opposite danger a rea. Call your Field Supervisor; give details of emergency. Your Field Supervisor will notify Atlantic Richfield maintenance, Area Manager and main office. III. How will people within the business facility who must respond to an incident be notified? Job Title: Facility Personnel (i.e. cashier, maintenance), For any emergency, call 911 and report. Evacuate, if necessary, to a si te opposi te danger a rea. Call your Facility Manager¡ give details of emergency. Your Facility Manager will call Field Supervisor and report. Your Field Supervisor will notify Atlantic Richfield ma in tenance, Area Manager and ma in 0 ffice. (.. 'f ·e - STANDARD BUSINESS PLAN BP-S (d) MITIGATION (RECUE THE HAZARD) - Describe what procedures will be followed to reduce any harm or damage to persons. property. or the environment. "NO Smoking". "Please Turn Off Your Engine". and "Do Not Top Off Tank" signs are posted in clear vision of consumer and employee. Compliance to posted signs minmizes potential risk and hazards. Facility personnel are instructed to clean-up minimal spills and dispose of properly and to report any major incident by calling 911. If needed. personnel will proceed to call all pertinent people listed on Attachment AA. (e) ABATEMENT (STOP THE HAZARD): Describe what actions your business will take to stop any hazard caused by the release of a hazardous ma ter ia 1 or was te. For minor spillage (i.e. customer gas tank overflow), employee's are instructed to clean and dispose of II1dterials safely. Protective rubber 910 es and clean-up equipment is provided at each facility. For major spillage. employee's are instructed to call 911 and report. They wi 11 then noti fy personnel 1 i sted on Attachment ÄA. . 7. PREVENTION PLAN - (how will an unathorized release be prevented?) Facilities are equipped with red jacket lead detectors which shuts system down if leak occurs. In addition, inventories are also monitored on a daily basis and are k.ept at a minimum to minimize risk. 8. NEW EMPLOYEE TRAINING (a) Employees handling hazardous materials: All personnel, new and existing. are given instruction on complying with the City of Bakersfiel~usiness Emergency Plan. Upon completion of said instruction, employee will sign ankknowledge Slip (Attachment C). In addition, a Training log (Attachment D) will be kept by the facility manager to ensure that instruction has been carried out. One copy is kept at the facility and one copy is kept in employee's file located at 17215 Studebaker Road. Cerritos. CA, in Employee Relations Department. 'e e STANDARD BUSINESS PLAN BP-5 (b) Employees responsible for coordinating with first responders: Facility personnel are instructed to call 911 and report. They will then call all pertinent people listed on Attachment AA and report. (c) Employees responsible for deployment of emergency equipment: Employee's are instructed on location of fire extinguishers and their proper use and operation. Insttuction is also given on locations of emergency fuel pump shut-off switches. See Attachments A and B. (d) Employee training on Emergency Response Plans: Personnel are instructed to call 911 and report emergency. Personnel are then instructed to proceed to a site opposite danger. If needed, personnel will proceed to call all pertinent people listed on Attachment AA. All secondary entities will then be notified. 9. REFRESHER TRAINING (a) Employees who handle hazardous materials: A Training Log (Attachment D) will be kept at facility to ensure that initial instruction has been carried out. Said training log will also be used for refresher training of said employee commensurate with employee's anniversary date. (b) Employees responsible for coordinating with first responders: Facility personnel are instructed to call 911 and report. They will then call all pertinent people listed on Attachment AA a nd report. Co ' . . '. e STANDARD BUSrNESS PLAN BP-S (c) Employees responsible for deployment of emergency equipment: E~ployee's are instructed on location of fire extinguishers and their proper use and operation. Instruction is also given on locations of emergency fuel pump shut-off switches. See Attachments A and B. (d) Refresher training on Emergency Response Plan: A Training Log (Attachment D) will be kept at facility ~o ensure that initial instruction has been carried out. Said training log will also be used for refresher training of said employee commensurate with employee's anniversary date. Learn How To Pass . ---- 1. Pull - Pull the pm Some unllS require the releasing 01 a lock lalch, presSing a punclUle lever, or olher motion I Although Ihe majorltV 01 elltlngUlshers work Wilt our dllee:tlons, Ihere are ellcet)tlons RCdd the IIIslrue"ons 00 your ellhngUlsher lor vallatlons File a plClure 10 your mind Ihat will ht the loslruc"ons 00 the ellhogulsher you will be uSing 2, "'here's a lire, get everyone outside. Call the lire depar1meol. Then lIght a small "re only, If the lire gels large, get out. Close doors 10 slow the lire spread, Stay belWeen the hre and an elCil. Don't leI lire block your escape path In case II goes oul 01 conlrol, This Is How Most Fire Extinguishers Work - 2.Aim - Am Ihe ellhngtllsher nOllle (horn. or hose) allhe base 01 Ihe lue --------------) (-------------- --------------) -------------- 2. 3. ze - Squeeze or press the handle 4. Sweep - Sweep Irom side 10 side al the base 01 Ihe hre until It goes oul 5hul 011 lhe ellhngulsher Walch for rellash and reacllVale the ellllOgUlsher II nt.'CesSétry Foam and waler ellhnguIshers lequlfe sllghlly dlflerenl achon Uead Ihe In~lruchons Learn Not To Bum 3 Make sure you don" use one type extinguisher on anolt~ type 'lfe-II may make the hre worse Common enors (they can be 'atal) are uSlOg waler (A) on a grease 01 on an electflcal hre (8 or C) 3. þf T 1- " '} .,. J ) ) t II - File exlinguishers whe'e you wo,k ills m;"litell'""'"1 s 1"11 In h,llll! I!. hlllII....' "., ... ,111,1.1 i\hlt! 1m use all(/ VIIIII elh lu ""nw how ""'V w..... BuyIng and maintainIng an ..tlngullh.,. I Ellllngulshers come in dry c.hemlcal.loam, ca,bo" dlOllllJe, wale'. 01 halon IVIM!S Wh¡¡lever Ivpe you lIuy. II shookl lie latleled by a lesl" KJ lahu' alory 2 The hlghe' lhe numbe, ,aling on Ihe ellllnguishe,. Ihe more IlIe.1 puis oul IhfJh 'illed ones a'e often (nol always) Ihe heavle' models. Make su'e you can hold and operale Ihe one you mighl buy 101 home use 01 be reqUlled 10 use al WOIk. 3 Ask VOUf dealer how 10 have your extinguisher serviced and Inspeeled Recha,ge II aller ANY use A partially used OIle mlghl as well be empty. ... E IIlinguishers should be Inslalled away "om polenllal"re halards and near an eSCal)8 roule, S FOf mOf8 delails. see Slandard IOf Portable fire Extinguishers, NFPA 10, n'~..nlly p¡clog'ams haveco/lle 11'111'1 use These plClure In lItue lhe Ivr>e 01 'lie un whICh all ellllnyulshet IS 10 be IISt.'" Shown 10 hl;l(;k Wllh a If'" slash aut ,)'Clu'es ul '..es on whIch Ihe ellhl~IIII5he1 1'0011000 IIsed FII' ell ample. ()f\ a class 'A Iype.lhe loIlowlI'Y I¡¡bel woutd appear . ¡ ~ 1m~ " ~~- NFPA 10. Slandard lor Pottable File EllhngUlShe,S, recommends lhal ellllngu,she'5 be labeled Wllh PlClo- grams ttowevef lheuser mayltndlhe I,ad,llonal A,B,C,O label.. 01 bolh lhe plCloglïams and lhe A.B,C.O läbel. on an ellltngOlshet' You need ., .lIlngul.her .1 This Is Your New ABCD's Of Portable Fire Extinguishers ^ '"" f'!1I"''9"IShf'lIS A slew age cunl.unc, '01 An ell"n· IIIII!>INI"I ~t.'I11 SlIch AS wal"r III chollllCals illS dcs,goed II) pul ouaalimafl h,e, nol it bey ol\e home. If you plan 10 buy one extlnguish8f, a mulll·purpose dry chemk:allabeled A8C puis oul mosllVpeS 01 lI.es - wood, paper. and cloth,llammable liquid. 01 elecl.lcallires, II you buy more I~""one. you mighl wanllo gel a 8C '01 Ihe k,lchen, an A lor Ihe hVIlIfJ ,oom, and an ABC lorlhe basemenl and ga,age ^o e"'''9",$hel IS labeled acCOIdlno 10 whelher lhe IHe 011 whICh 11.5 10 be used occurs in wood 01 clolh. lIanvnable liquids. electrICal, 01 melal SOUlCes USll10 ulle Iype ellllOQlIlsher on iW)()lher Iype h,e can make lhe IlIe much worse So learn how eallOQul$he,. are labt:led and used I'adlhonallylhelaœlsA.8.C,OI o have been used 10 'OIlIeale lhe IVpe 01 hre on whICh an ellhngu,stle' IS 10 be used - <d)fi~ Ordlruuy Combuatlbl.. Files In P8P8f, cloth. wood, rubbef, and many plaslics require a waler type eldinguisher labeled A, e .-....... ------.----- ~ t. · . · . · . · . · . · . · . t. · . · . · . · . , . · . · , Electrtcal Equipment Fires In wirlng,luse boaes, enet· glled eleclflcal equipmenl and other eleclrical SOUICes 'equlte an eldinguisher labeled C, --.- «~~)) (0N}!~ . . ..... Met.l. Combusllble melals such as mag neslum and soolum r6<luir8 spedal eldingu'shanls labeled 0 f?l -;. ...' - - rnlË1 --- 8 * :Þ n- n- AI () :T S CD :::1 !'+ tp L1 --- --- FI.mmaba. liquid. Files In 011., gasoline. some palnlS, lacque's, g,ease 111 a Irylng pan or In Ihe oven, solvents and Olh8f lIammable lIQuidS requi'e an eldln· gUlsher lõabeled 8, . ~j ," . - . ... '" 1 , c ~ , <ÌÍ t . ~ -:-./ ·e e Prestige Stations. Inc. National Headquarters 17215 Studebaker Road Cerritos. California 90701 ACKNOWLEDGMENT SLIP I have been instructed on the use of the Business Emergency Plan Manual and have read and understand all the information and instruçtions as stated. Further, I agree to abide by the statements and guidelines outlined. I further acknowledge that failure to conduct my actions in compliance with these guidelines may result in the termination of my employment. Signed this day of , 19 Employee Signature Facility Number Witnessing Supervisor Signature Attachment C EMERGENCY TRAINING LOG BUSINESS \ . TITLE DATE OF TRAINING EMPLOYEE'S SIGNATURE INSTRUCTOR'S SIGNATUR~~ , ~ " " , :3 CD ::3 n- O ---y- '. i- I;"'" .. 9" ." 'e - ~ IN CASE OF EMERGENCY CALL: 911 STATION MANAGER Everado Velasco (805)589-2507 FIELD SUPERVISOR R. Reger (805)664-7875 AREA MANAGER J. Barker-Klein (702) 873-5168 MAINTENANCE 1-800-553-6246 BOB ELKINS 213/402-9126 ARCa . 5175 PSI t 5420 WHEN CALLING ARCO MAINTENANCE GIVE ONLY THE ARCO .. CERRITOS MAIN OFFICE: 213/402-1299 Atta.chment AA '- ~.-"" .... - - e _ HAZARDOUS rv1ATERIALS INSPECTION 0' ~ '1 ~ ~ BUSINESS NAME: fì{YI/pv11 mINt (Y\M~EI , v LOCATION: (.s;¡ t-t 50 ,-0l+ l Ti~ LN INSPECTION DATE: ~ -l \ -- 'ð ß INSPECTOR: 6~ VY1~~ ~\ ()E VERIFICATION OF INVENTORY MATERIALS o (2J [2Í o VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL COMMENTS : VERIFICATION OF HAZ MAT TRAINING cszr VERU"ICATION OF MSDS AVAILABLE D COMMEm"S: ~~~~ ~~ ~ Lyy)SOS VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES [12' COMMENTS: EMERGENCY PROCEDURES POSTED ø [12] CONTAINERS PROPERLY ~Rm-.1m COMMENTS: VERIFICATION OF FACILITY DIAGRAM ßZf SPECIAL HAZARDS ASSOCIATED WITH THIS FACILITY: VIOLATIONS: oK -;/z!4Ø-- \ -3---- 398-0593 93309 (805 5175 Phone INC PRESTIGE STATIONS 6450 WHITE LANE BAKERSFIElD CA Operator Name Address Name Mail Title: Yn~ Phone iCJs---5'8r J ;z.St:> 7 g4!lo 'f>s3 ,,::z. Y {¿, Phone (213 402-3166 24 Hr Emergency Contact Name:~ ~1Jt.dC-ð Phone ~oS'.599-ð3C¡3 ARCO MAINTENANCE (213) 404-5356 Name: Phone 24 Hr STORAGE CODES AND LOCATIONS (Non-Confidential) Storage Code Storage Location Bï4 1988 to December 31 I January From Reporting Period check one) have attached a site plan of list I have attached a site coordinate abbreviations 05420 93309 04-542-6723 Facility Identification Name : ARCO FACILITY NO Street Address: 6450 WHITE LANE City and State: BAKERSFIELD CA SIC Code 5541 Dun & Brad No ID # FOR OFFICIAL USE ONLY --------- TIER TWO EMERGENCY AND HAZARDOUS CHEMICAL INVENTORY Specific Information By Chemical No of Days On-site days 365 ""lf3 04 Date Received INVENTORY Avg Daily Amount code instructions before completing form Max Daily Amount code Fire Sudden Release of Pressure x Reactivi ty Immediate (acute) x PHYSICAL AND HEALTH HAZARDS check all that apply CHEMICAL DESCRIPTION -------------------- CAS: 008006-61-9 Chem. Name PETROLEUM NAPTHAS (Blended Gasoline) Type LIQUID ONLY Read all Important e Attachments Optional I chronic (Read and sign after completing all sections I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the su itted information is true, accurate, and complete d ..~~-~q Date Signed Delayed Certification e C & M ADMINISTRATOR Owner/Operator or Authorized Representative SEGUIN FRED T e _ BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD. CA 93301 (805) 326-3979 \~~-\bD G) J~5f o¡ OFFICIAL USE ONLY , ID* BUS INESS ~A."'E HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A 000629 INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: AM/PM MINI MARKET #5175 B. LOCATION / STREET ADDRESS: 6450 White Lane CITY: Bakersfield ZIP: 93309 BUS. PHONE: (213) 402 -1299 SECTION 2: EMERGENCY NOTIFICATIONS In case of an e.errency involving the release or threatened release of a hazardous material. call 911 and 1-800-8~2-7~50 or 1-916-427-4341. This will notify your local fire depart.ent and the State Office of Eaer¡ency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF E.'fERGENCV: **ALSO SEE PAGE 2C** NAME k'ID TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Bruce Wilkes Ph_ 213/402-1208 Ph. 509/754-3174 B. Ron Rose Ph' 213/402-1299 Ph' 916/487-5500 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSI1ŒSS AS A WHOLI A. NAT. GAS/PROPANE: N/A B. ELECTRICAL: Located in back room storaae area (see Paae 5A) C. WATER: Located at the Whtie Lane driveway (see Paae 5A) D. SPECIAL: Emerqency fuel shut-off located on cash reqisterIsee Paqe 5A) E. LOCK BOX: YES / NO IF YES. LOCATION: No IF YES. DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSS? YES / NO KEYS? YES / ~O - 2A - . e SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE For a minor spillage (i.e. customer gas tank overflow), employees are instructed to clean and dispose of materials safely. Protective rubber gloves and clean-up equipment is provided at each facility. For major spillage, employees are instructed to call 911 and report. They will then notify personnel listed on Page 2C. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE The following is the closest facility to our business: M~rcy Hospital 2215 Truxtin Avenue (805) 327-3371 Bakersfield City Fire Department Station #7 4030 Soranno Avenue (Emergency medical technician on site) SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROG~~ WHICH PROVIDES E~LOYEES WITH INITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS ~TERIALS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6iJ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:...... ................... .¡NO C. PROPER USE OF SAFETY EQUIPMENT:. .......... ....... NO D. EMERGENCY EVACUATION PROCEDURES:.... ..... ........ S NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:....... NO SECTIOR 7: HAZARDOUS MATERIAL REFRESHER éiiJ NO INO S NO . NO NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THk' 500 POt~DS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: . . . . " YES SO I, Mi tchell Nq , certify that the above intormation is accurate. I understand that this intormation will be used to tultill IIY tirm's obli¡ations under the new Calitornia Health and Satety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et AI.) and that inaccurate intormation constitutes perjury. 1TL£ R;'tail Operations DATE 7 {j} 1,7 Ana1.yst ...:L.f!!-/-l!- SIGNATURE - 2B - - e IN CASE OF EMERGENCY CALL: 911 STATION·MANAGER EVERADO'VALASCO (805) 589-5993 FIELD SUPERVISOR BRUCE WILKES (509), 754-3174 AREA MANAGER RON ROSE (916) 487-5500 . MAINTENANCE VINCE CORSELLO (213) 402-8026 ARCO .5420 PSI.5175 WHEN CALLING ARCO MAINTENANCE GIVE ONLY THE ARCO t. Cerritos Main Office: (213) 402-1299 402-1203 I r-.J (J I e e BAKERSFIELD CITY FIRE DEPARTME~L 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL ~SE ONLY ID# - - -' - - - BUSINESS NA.'Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action. this form must be returned by: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT N~~: SECTION 1: MITIGATION, PREVENTION. ABATEME~~ PROCEDURES Facility utilizes three 12,000 gallon underground tanks located at the S.W. end of the site. Inventories are monitored daily and are kept a~ a minimum to minimize risk. nNo Smoking-, nPlease Turn Off Your Enginen, and nDo Not Top Off Tankn signs are posted in clear vision of consumer and employees. Compliance to posted signs minimizes potential risk and hazards. For minor spillage (i.e. customer gas tank overflow) employees are instructed to clean and dispose of materials safely. Pro~ective rubber gloves and clean-up equipment is provided at each facility. For a major spillage, employees are to call 911 and report. They will then notify personnnel listed on Page 2C. SECTION 2: NOTIFICATION AND EVACUATION PROCEDL~ES AT THIS u~IT OYLY In the event of any major incident, our facility personnel (i.e. facility manager, assistant, cashier or maintenance) will immediately call 911 ~nd report. If evacuation is necessary, and after 911 has been called, employees are directed to a site opposite the danger area. Facility personnel will then call and notify personnel listed on Page 2C. - 3A'- e e SECTIO~ 3: HAZARDOUS MATERIALS FOR THIS U~IT o,tY A Does this Facility Unit contain :1az;u'dolls :-Iate!'ir\~s?"",. ~ xo If YES. see 8. If XO. continue with S~CTIOX 4. 8. Are any of the hazardous materials a bon~ fide Trade Secret YES~ If No. complete a separate hazardous m~terials inventory form marked: :\ON-TRADE SECRETS OXT,Y (~..hi te form ~·lA-l) If Yes. complete a hazardous materiAls inv~nto~y form ma~kp~: TRAOE SECRETS OXLY (yellow form *~A-2) in addition to the non-trade s~cret form. List only the trade sec~~ts on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTIO~ Employees are instructed on location of firè extinguishers and their location. Instruction is given on use and operation. Instruction is also given on locations of emergency fuel pump shut-off siwtches. See Attachment A and B. SECTION 5: LOCATION OF WATER S¡;PPLY FOR USE BY E~RGENCY RESPONDERS Fire hydrant located on corner of White Lane and Ash Road. SECTION 6: LOCATION OF L~ILITY SHUT-OFFS AT THIS ~IT ONLY. ,.1.. XA T. (~,\S' PROPAXi::: N/A B. ELECTRICAL: Main electrical panel located in the back room storage area (see Page SA) C. WATER: Water shut-off located at the White Lane driveway (see Page SA) D. SPECTAr.: Emergency Pump Shut-Off SWitch/located on cash register (see Page SA) E. LOCK BOX: YES ®!F YES, LOCATIO~: IF YES, SITE PlA~S? FLOOR PLAXS? YES / NO YES .I ~O ~SDSs? KEYS? YES YES \"0 \"0 - 3B - 1 of 1 Page IEI.D CITY FIRE PORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY DEPARTMENT "AKERSF t o I , Inc. FACILITY UNIT FACILITY UNIT NAME 90701 Çerritos, CA 213/402-1299 OWNER NAME ADDRESS:_ CITY,ZIP: PHONE ,: , Market PM Mini AM NAME P BUSINESS ADDRESS: CITV. ZI PHONE t: USE CFIRS CODE 10 HAZARDID.O,T ...£Q.I!.E 0 U I D £ FLLQ fOFF I C I AL ONLY 9 CHEMICAL OR COMMON NA~ Gasoline (Unleaded) /I~:t 8 ~ BY -!!.L. 100% IN THIS UNIT 7 LOCATION FACILITY 5 6 ICONTIUSE 'll!.!1 CODE CODE ~al 4 3 ANNUAL AMOUNT 2 MAX AMOUNT 1 TYPE CODE e Southwest of lot 19 01 000 , 624 000 { 4 p gallon 000 , one 12 FLLQ !Jf;), ) (Super Unleaded Gasoline 100% Southwest of lot 19 01 gal 400 , 374 400 , 2 p gallon 000 , one 12 e I~ DATE: 7/1Q t7 213/402~1299 509 754-3174 213 402-1299 91fj/4A7-'1Snn Oper AnalYSTSIONATURB'~ TITLE: Field Supervisor PHONE' BUS OURS APTER B HRS: PHONE , BUS HOURS epa1r AFTER BUS flR~: FLLQ II ~ -:L- Regular) ( Gasoline ~ 100% Southwest of lot gallon 000 , one 12 Rtl : 19 TITLE 01 AME: Mitchell N~ HERGENCY CONTACT: Bruce Wilkes gal 400 , 374 400 , 2 p . . Area Manaqer TITLE: as' Station -serve ~ERGENCV CONTACT. Ron Rose RINCIPAL BUSINESS ACTIVITY: e Learn How To Pass ---- 1. Pull - Pull the pin, Some units require the releasing of a lock latch, pressing a puncture lever, or other motion, - 2. Aim - Aim the extinguisher nozzle (horn, or hose) at the base of the fire, 4. - Sweep from side to side at the base of the fire until it goes out Shut off the extinguisher. Watch for reflash and reactivate the extinguisher if necessary. Foam and water extinguishers require slightly different aclion. Read the instructions, ... - ze the handle, Learn MotTo Bum 1 . Although the majority of extinguishers work with our directions, there are exceptions Read the instructions on your extinguisher for variations Fix a picture in your mind that will fit the instructions on the extinguisher you will be using 2,f there's a fire, get everyone outside, Call the fire department. Then fight a small fire only,f the fire gets large. get out. Close doors to slow the fire spread, Stay between the fire and an exit. Don't let fire block your escape path in case it goes out of control. 3, Make sure you don't use one type extinguisher on another type fire-it may make the fire worse, Common errors (they can be fatal) are using water (A) on a grease or on an electrical fire (8 or C). ., . , ... This Is How Most Fire Extinguishers Work 3. - Squeeze or press 3. )I rt rt QI o § (1) ::s rt )I e e Fire extinguishers where you work, It is managements job to have exhnglllsh~ls aViJl1 able lor lIse and your lob to know how Ihey work Buying and maintaining an extinguisher. 1, Extinguishers come in dry chemical, loam. carbon dioxide, water. or halon types, Whatever type you buy, it should be labeled by a tesling laboratory, 2. The higher Ihe number rating on Ihe extinguisher, Ihe more lire il puIs oul. High raled ones are onen Inot always) the heavier models, Make sure you can hold and operale Ihe one you mighl buy lor home use or be required 10 use al work, 3, Ask your dealer how 10 have your extinguisher serviced and inspecled, Recharge il alter ANY use, A partially used one mighl as well be emply, 4, Extinguishers should be inslalled away lrom potenlial fire hazards and near an escape roule, 5, For more details, see Standard lor Portable Fire Extinguishers, NFPA 1O, ó~~ L1 ~ ~ I C. L_ · J .:J .1 .) -å-- .) I. - --- · J .} :-::: ~:-.... ' (. ,. · I . I · It. «+2J @ Recently piClograms have come ;nlo use These picture in blue the type of fire on which an extinguisher is to be lIsed. Shown in black with a red slash are pictures at lires on which the extinguisher I~ not to be used For example. on a class "A" type, the lollowing label would appear: j t J~. NFPA 10. Standard lor Portable Fire Extinguishers, recommends that extinguishers be labeled with picto- grams, However the user maylind the traditional A,8.C,D labels, or both the pictograms and the A,8,C,D labels on an extinguisher, You need an extinguisher at home. II you plan to buy one extinguisher, a multi-purpose dry chemical labeled ABC puts oul mas I Iypes 01 lires - wood, paper, and clolh, flammable liquid, or electricallires, _ If you buy more tttårf'one, you might want 10 get a BC for the kitchen, an A tor the living room, and an ABC lor the basement and garage. This Is Your New ABCD's Of Portable Fire Extinguishers A lire extinguisher is a storage container tor an extin- guishing ilgent such as wilter or chemicals" is designed to put oul a small lire, not a big one An exlinguisher is labeled according to whether the lire on which it is to be used occurs in wood or cloth. lIammable liquids, electrical, or metal sources Using one type extinguisher on another type lire can make the lire much worse So learn how extinguishers are labeled and used Tradilionafly Ihe labels A,8,C, or D have been used to indicale the type of fire on which an extinguisher is 10 be used Ordinary Combustibles Fires in paper, clolh, wood, rubber, and manv plastics require a water Iype extinguisher labeled A, Flammable Liquids Fires in oils, gasoline, some paints, lacquers, grease in a Irying pan or in the oven, solvents and other flammable liquids require an extin' guisher labeled B. Electrical Equipment Fires in wiring, fuse boxes, ener- gized electrical equipment and other electrical sources require an extinguisher labeled C, Metals Combustible metals such as mag- nesium and sodium require special extinguishants labeled 0, f71 rn£ËJ @) * )I rt rt þI o § ID = rt tJ' '. ~.J:j'. !r'~~ t>' ;, , ,':,,,........ - EMERGENCY TRAINING LOG BUSINESS INSTRUCTOR TITLE DATE OF TRAINING EMPLOYEE'S SIGNATURE INSTRUCTOR'S SIGNATURE ... '. t Ù .5 ~ .2 1ã u¡ .~ 'Iii ~ Ó E e e Prestige Sfations, Inc. National Headquarters 17215 Studebaker Road Cerritos, California 90701 ACKNOWLEDGMENT SLIP I have been instructed on the use of the Business Emergency Plan Manual and have read and understand all the information and instructions as stated. Further, I agree to abide by the statements and guidelines outlined. I further acknowledge that failure to conduct my actions in compliance with these guidelines may result in the termination of my employment. Signed this day of , 19 Employee Signature Facility Number Witnessing Supervisor Signature