HomeMy WebLinkAboutBUSINESS PLAN 1/20/2003
. CITY OF BAKERSFIELQIi
OFftCE OF ENVIRONMENTAL S)!{VICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER I OPERATOR IDENTIFICATION
FACILITY INFORMATION So.S ó~~ ~
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CITY
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I COUNTY KG1Z.N Co/AJ'rly
OPERATOR NAME
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ZIP
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105 ,
106 SIC CODE
(4 Digit #) 753"2-
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109 I OPERATOR PHONE
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NA S OF 0 NER/OPERA TOR (print)
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. 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 in this inventory and believe the information is true, accurate, and complete.
.. SIGNA E OF OWNER/OPERATOR ; DATE 134 NA OF DOCUMENT PREPARER
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136 i TITLE OF OWNER/OPERATOR .. 137
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. CITY OF BAKERSFIEL.
OFFÌ~E OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
Section 11.1 - DISCOVERY AND NOTIFICATIONS
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BUSINESSNAME(SameasFACILlTYNAMEorDBA·DoingBusinessAs) " "", ". ' " "",'
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ADDRESS (For IocaIIJS& only)
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FACILITY ID II
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DISCOV~RY ,,_'~','
A. LEAK DETECTION AND MONITORING PROCEDURES: {)A/ sh-op hA..$ ''V\.;O ß tV cvu_~ Of. frof
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B. ' EMERGENCY AND AG~CY NOTIFICATION PROCEDURES: 1f~eµ., \;J¿fi- D\.. ~e.rllfVlS ~Jpn~/
~W\OlO'-tu.... V'OItLd. ~O+-t1] ~OWV\L({~ ClN\.tl \.vl- W~\A.lGt GaJ.,l £W1<-{~tMU1 t SOrß~ C{)y\~'"f
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I C. 'SPECIFIC RESPONSIBILITIES OF EMPLOYEç~: wkD ...¡.h . '1 c~~4k
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I EMERGENCY MEDICAL PLAN ' '
i~ D. CL<?SEST LOCAL MEDICAL FACILITY: d +-OW _5~'Y'--Ar')+:-aÙi, ICL t, t..r' II ~l4.-~ ~., ~¿~..
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Hdo~s MATERIALS MANAGEME.PLAN
Section 11.2 - RELEASE RESPONSE PLAN
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A. HAZARD ASSESSMENT AND PRE~E~TI~~ ~~~~~~~. ,,' ,...,.,.",.' ",
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B. RELEASE CONTAINMENT AND MITIGATION: ' ' . ,'" ,,' ,.",i~J:~~·· .'.
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FOLLOW-UP ACTIONS "
C. CLEAN-UP AND RECOVERY PROCEDURES;
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HAZARDOUS MATERIALS MANAGEMENT PLAN
Secti~n 111.1 - FACILITY AND LOCALITY INFORMATION
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LOCATION OF SHUT-OFFS AT YOUR FACILITY:
NATURAL GAS I PROPANE: f)u.,+-sìk 6b j~ blAl fe.( ,..;.\ ltb~ lok~ .ftD~ð"f iøor
ELECTRICAL: t\l\ Çl~ ~ 0'1\ \IV (Ú, ( "uv fI1A.--fIt mm
WATER:
SPECIAL: .
LOCK BOX: YES I NO
IF YES, LOCATION:
""PRIVAT~'FIRE)RÓTEÇTiÓN ¡'WATER::AVÄiLAä:ILlrI'<' .., "" "
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A. PRIVATE FIRË PROTECTION: :5 en'\ 5/R \11'<... £x'~""'-J ""t.~ku:s
f\(I(.. h--, Ð~~ 6'"b s'v\Þ¡p O\.\oD~ \ S ~t:.--t- .çì-o"-'
B. WATER AVAILABILITY (FIRE HYDRANT): OiNt-" \V\~
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A. NUMBER OF EMPLOYEES: ,
B. MATERIALS DATA SHEETS ON FilE: ~ ~S \Arú!tf C.D~ 11\+r0'\+ Wf' \'V\ bt",tiv
C. BRIEF SUMMARY OF TRAINING PROGRAM: @w""¡tS rt.),o"s,bk.. iì>r -+he.. -þtt1I"j of e;p\,\l"
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CERTIFICATION
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i 8asecI on my Inquiry of those individuals responsible lor obtaining the InformaUon, I c:ertìfy under penalty of law that I ha I' '
, information Is true, accurate. and complete, ve personna y exalnlnecl and am hlrnillar with the information subml\ted and believe the
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I SlGNATU F OWNER I OPERATOR OR ~IGNA TED REPRESENTATIVE
I DATE
JtlY'l 'Ur-
477,
03>
478, TITLE OF SIGNER
479.
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e CITY OF/BAKERSFIEL:e
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
DNEW
DADD
D DELETE
D REVISE
200
(one form per material per building or area)
Page of
o Yes 0 No 202
204
COMMON NAME
CAS #
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FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
210
TYPE D p PURE D m MIXTURE D w WASTE 211 RADIOACTIVE Dyes
PHYSICAL STATE o s SOLID o I LIQUID D 9 GAS . 214 LARGEST CONTAINER
FED HAZARD CATEGORIES 01 FIRE o 2 REACTIVE D 3 PRESSURE RELEASE o 4 ACUTE HEALTH o 5 CHRONIC HEALTH
(Check all that apply)
216
ANNUAL WASTE
AMOUNT
tÎ ~~l
217
~~~~UNT . 7) <!)~-\,,( 3 218 ~:'~:~UNt ~ ·lO <3"j é1
o ga GAL 0 d CUFT 0 Ib LBS 0 In TONS
. If EHS, amount must be in Ibs,
219
STATE WASTE CODE
220
UNITS·
221
DAYS ON SITE
222
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
D b UNDERGROUND TANK
Dc TANK INSIDE BUILDING
D d STEEL DRUM
De PLASTIClNONMETALLlC DRUM
Of CAN
D 9 CARBOY
o h SILO
o i FIBER DRUM
OJ BAG
Ok BOX
o I CYLINDER
D m GLASS BOTTLE
o n PLASTIC BOTTLE
o 0 TOTE BIN
Dp TANK WAGON
o q RAIL CAR
o r OTHER
223
STORAGE PRESSURE
o a AMBIENT
D aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
STORAGE TEMPERATURE
o a AMBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
o C CRYOGENIC
225
226
,
I 2 230
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. ! 3 234
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, 4 238
227 o Yes 0 No 228
231 o Yes D No 232
235 o Yes 0 No 236
239 o Yes 0 No 240
243 o Yes D No 244
229
233
237
241 I
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! PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE
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SIGNATURE
DATE
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S1TÉ'DIAGRAMr J¡ FACILI1'Y!GRAMe
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Bu'" Name: :...
Business Adm.:
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CITY OF BAKERSFlEtD FIRE DEPARTMENT
OFFICE OF ENVIRONMENT At SERVICES
UNIFIED PROGRAM INSPECTION CHECKI..IST
1715 Chester Ave., 3rd I-Ioor, Bakersfield, CA 9330J
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INSPECTION DATE U _ { (O'"L.
PHONE NO, <g'3 I - II Ç4
BUSINESS ID NO. 15-21 0- ~-r..J
NUMBER OF EMPLOYEES
9c,
FACILITY NAME X~lZGSs'o¡02-
ADDRESS 6 ~ \ W4 In;;; '%t- H -- 4- C!..¿¡)
FACILITY CONTACT ZAU\...· GM.c-IÄ
INSPECTION TIME
Section I:
Business Plan and Inventory Program
o Routine r,grombined
o Joint Agency 0 Multi-Agency
o Complaint
ORe-inspection
OPERA nON C v COMMENTS
Appropriate pennit on hand NE:W PC-RI\A I <'í 51~
Business plan contact infonnation accurate
,
Visible address
Correct occupancy
Verification of inventory materials t....J.Ac. --r£ pA,....rí -n..t /lv,J&z,.
Verification of quantities 30 b-A<-. MAX. ( !ex> GAL(ý~
Verification oflocation 1"'<>. ()~ Sw Cf2NYL ~ '5 -#uP
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled .. " ~>?}
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Housekeeping ,}/
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance V=Violation
White· Env, Svcs,
Yellow· Station Copy
Pink - Business Copy
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Business Site Responsible Party
Inspector: uJ ' Ñ(?5
Any hazardous waste on site?: ~ Yes 0 No
Explain: SM.Au.. CQ~I1"'Y ~ 11: <S>C...tWz..A-7Ut
Questions regarding this inspection? Please call us at (661) 326-3919