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.BAKERS~LD CITY FIRE DEPJ\iTMENT
HAZAWbous MATERIALS INVENWjRY ~
Jsiness Name
1) INVENTORY STATtlS: N-iÓ Addition ( I
D 2) ~H_' G'f.-Y'JPJI
I ChemlC8l Name:
Aevision ( I Deletion ( J
.1) PHYSICAl.. & HEALTI-f
HAZARD CATEGORIES
~~e_of_
'1\ : ~ -:
Address
-¡,'.
CHEMICAL DESCRIPTION
:?f{~:;
. '.
~.
~ ""
Check if c:hemicei is . NON TRACe SECREt' ~:"TRADE SECRET' [ )
3) COT. (optioMl)
øi.f
AHM ( J
CAS #
Fire
òd'
PHYSICAl..
Reactive ( Sudden Release 01 Pressure [ J
HEALTH
Immediate He8lth (Acute) () Delayed Health (Chronic) (
USE CODE if';;'"
:) WASTE CLASSIF1CA110N
(3-<:1igit c:ode from DHS Form 8022)
-3) PHYSICAl.. STATE Solid [] uquid [] Gas)ó
I-;::~NT AND 11ME ATFACI~TY -;) -¡¡ CIA.. ft ,'.=
\1U1mum Dally Amount: Jil r size 1Ð(Jff Ie.
;'verage Dally Amount: (> C ¡=:r¡-
;'nnua.l Amount: . -r
Largest Size Contamer. C.
(ì ~ Oays On Site ~
3) MI,XTURE: List
'- :he tnree most nazaroous
::1emICAI comooner1ts or
any AHM components
1)
2)
, .
;r'"
3)
, ,
,- -------
'0\ LOca!lon
. ) INVENTORY STATUS: ~~ew}(i ;'dditton { ] Revision ( 1
1) Common Name: fl· - ....,., l.¡ /; IJ º-
Chemlcai Name:
~ \ PHYS¡C;'L & HEAL TI-i
-1AZARD CATEGORIES
Pure ~]
Mixture ( ]
Waste (]
AadIoIICtIw ( )
:;:;;EOC ALL ruAT J.P1Pt.'"
-
-
-
UNITS OF MEASURE
:bs [ ] ;aJ I] 113 [ ]
~unes I J
8) STORAGE CODeS
a) Container:
b) Pressure: 0'(
c) Temperature:
Circle 'Nhich Months: ~ J, F, M. A. M, J. J. A, S. 0, N, D
-
COMPONENT
% 'NT
AMM
¡ ]
CAS #
¡ ]
[ 1
CHEMICAL DESCRIPTION
I
i
i
ì
TRAD~ SECRET (J I
ë]eletion ( ]
Check if chemIcal is & NON TRADE SECRET '\4
3) COT # (optional)
AHM ( !
CAS #
, -,
PHYSIC~L
Fire!)(1 "eactl'le (1 Sueden Release of P'~ssure ( j
HEAL TI-f
immediate Health (Acute) (I Delayed Health (ChronIC) [ 1
Sì WASTE CLASSIFICATiON
USE COCr:
3) PHYSICAL STATE
~3-<:Iiglt cooa from OHS Form 8022\_
Raáioac:tíYe [ ]
Solid {1 ljaUld {j Gas 1+
ï) AMOUNT AND TiME AT FAC:UTY
,'.1axlmum Oaliy Amount:
:"\lerage Oally Amount:
A.nnuai Amount:
Largest Size Container.
" Davs an Site
J 'f 6'Cú"Ft:
flAil $¡ ze \Duff (e.
) ':\.1> Gg Fr:
~H
~Fr.
3) MIXTURE: Ust
:ne three most hazardouS
cl'1emJCaJ components or
any AHM components
1\
2)
JJ
,
11 0) Ux8%ìon
s
JI
-'f1 unae, penCl/tyor law, a1sr, eve persornll'YexammecJ
;mjl;~nn~+: :hh7;U1¡;!dm~a~.
INT Name & Title of Au1honzea Company R.øresentlJtiv.
Y. ..L
- -
--
~-
Pure p(¡ Mixture [J Waste [ ]
;~~C;'( 4l..J.. -...AT APR.'"
J:-.<ITS ;:;F I..1EASURE
:~ ¡ ] ;aJ [ ] ~3 [ ]
;:;nes [ ]
8) STORAGE CODES
a, C,;¡ntainer:
b) Pressure: Dr
c) Temperarure:
'\:
CircJe Which Months:
A, M. J, J, A. S. O. N. C
COMPONENT
CAS #
%WT .
AMM
( J
{ 1
\ 1
vn'_W'U.~-J#1f4/
Slgflll6.n ' .
ocumetXa.
eN.va me
'-t.¡-(¡-7~
Daa.
"':;-~:¡'~;'-r...<;;!/".~...
BAKEH~j-ií::LU CITY FiRE Ut:.t-IAHT .'ìiiENT
-- .
OFFICE OF ENVIRONMENTAL SERVICES
1715 CHESTER AVENUE, 3RD FLOOR
BAKERSFIELD, CA 93301
(805) 326·3979
HAZARDOUS MATERIALS INVENTORY
. .~ .
FACILITY DESCRIPTION
,
i
I
CHEC:" IF B!JSINESS IS A FARM [ ]
~-=IJS¡NE£S'-~A:\4,f,.~Clüld1.e-s--~~)'IA5-__f)_f-6¡;/¿ec:5-J,eld=o- - -- ,--- --- -- -. :
:=AC:U7Y NÀME S+ockcWe 8l~.JoIY1Dfì()e Ce/1fer
I SiTE ADDRESS /()6! W~ut t=' ~"'^ -U }j 1 {--') Dd
-,~
. '- \ I .
~- ~ -- () ^
::;¡¡Air: LIt--
ZIP 91.3101
: '\~A ILJ~E CF 3US¡NESS
Ll t'Ofh 0+/ v--e- . f?eplH r
· SiC ::COE ¡;C):;7
JUN & BRADSTREET NUMBEA
PHONljæ) 831f-8'J3J-
¿J
ZIP .9 :;:1 t1 tj
: C\NNE~¡CF=~,ATCR TI}jf>re,<) 31ú.Wef¡dt/
· .'J1AIUNG ACCRESS "/óó! tv~ík ~Il -#//'1
· C;ïiRf1~er$"hetd i. Sï,~7= Û-..
- - *. ---
- -,.. ,,-~- .- ~-- .'- - ,-. -:- . -.-':- ---- - -- -- ._-~. --
, I) Q =ME~GENCY CO NT ÀC7S '
¡~AME ~ J+~I~[re(cI 7iïLE (ì)/)JJI/jer . .
¡ SUS¡NESS "F~ON~g¿b)OJt¡ 4d3J-. 24-HOUR PHONt[ið'J th3'-8/ 7/
¡NAME hl~e :Ik L-lU14- TITLE fhechtÞ1í C--
I ,I BUSINESS rHONr(flvs) g:~V -&;13d-. 24-HGUR PHON(&>0 't'lS-¿/òt
~
s.a- :». 1 SIll
_//\... AII!GICN'I LlPCSTMQAAOF;
: ~,
--::- ~.
.;;--' ~,.
----
.. V ŒI?:;~8~
Overall Site with 1 Fac. Unit /
/ By/
General Information ~/ =====--
1
~
02/07/96
---
Location: 7001 WHITE LN 102 Map:123 Haz:2 Type: 3
City . BAKERSFIELD Grid: 16D FlU: 1 AOV: 0.0
.
,-- Contact Name Title - Contact Name Title
RAYMOND COLEMAN I OWNER JOAN COLEMAN I MANAGER
Business Phone: (805) 834-8232x Business Phone: (805) 834-8232x
24-Hour Phone . (805) 664-0784x 24-Hour Phone · (805) 839-2063x
. ·
Pager Phone : ( ) - x Pager Phone · ( ) - x
·
Administrative Data
Mail Addrs: 7001 WHITE LN 102 D&B Number: 02-107-6252
City: BAKERSFIELD State: CA Zip: 93309-
Comm Code: 215-009 BAKERSFIELD STATION 09 SIC Code: 7538
Owner: RAYMOND COLEMAN Phone: (805) 664-0784
Address: 7001 WHITE LN 102 State: CA
City: BAKERSFIELD Zip: 93309-
r- Summary
¡-;)d-C¡7
111~~d ~ é)L/59 J~v~ rLW-L '-
ð'Yl ~ ~3/ Jqqto, ~~(!t. r
Do hereby certify that I have
reviewed the attached hazardous materials marlage-
ment plan for f!/~~'f:~ ~2~f and that it along with
any corrections constitute a complete and correct man-
agement plan for my facility.
ßr~~d<1<VN d- - IVlt
na re ' Dale
"....
......__.-'Ã
- e
02/07/96 CLUTCHES PLUS 215-000-000390 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
PIn-Ref Name/Hazards Form Max Qty MCP
02-001 TRANSMISSION FLUID Liquid 55 Low
~ Fire, Delay Hlth GAL
02-003 GEAR OIL Liquid 32 Low
~ Fire, Delay H1th GAL
02-004 WASTE OIL Liquid 200 Low
~ Fire, Delay Hlth GAL
02-002 MOTOR OIL Liquid 32 Minimal
~ Fire, Delay Hlth GAL
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CLUTCHES PLUS 215-000-000390
02 - Fixed Containers on Site
Page
3
Hazmat Inventory Detail in MCP Order
02-001 TRANSMISSION FLUID
~ Fire, Delay Hlth
Liquid
55 Low
GAL
CAS #:
o
Trade Secret: No
Form: Liquid
Type: Pure
Days: 365 Use: LUBRICANT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
55 I 55.00 I 500.00
Storage
DRUM/BARREL-METALLIC
r Press T Temp ~ Location
Ambient Ambient NEW OIL STORAGE
- Cone _I Components
100.0% Transmission Fluid (Petroleum-Based)
I~ MCP ~uide
Low I 27
02-003 GEAR OIL
~ Fire, Delay Hlth
Liquid
32 Low
GAL
CAS #: 64742-57-0
Trade Secret: No
Form: Liquid
Type: Pure
Days: 365 Use: LUBRICANT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
32 I 16.00 I 190.00
Storage
DRUM/BARREL-METALLIC
r Press T Temp ~ Location
Ambient Ambient NEW OIL STORAGE
- Cone l Components r; MCP ~uide
100.0% Light Machine Oil Minimal 27
02-004 WASTE OIL Liquid 200 Low
~ Fire, Delay Hlth GAL
CAS #: 221 Trade Secret: No
Form: Liquid
Type: Waste
Days: 365 Use: WASTE
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
200 100.00 I 1,200.00
Storage
DRUM/BARREL-METALLIC
r Press T Temp ~ Location
Ambient Ambient/WASTE OIL STORAGE ALONG WALL
- Cone ~ Components
100.0% Waste Oil, Petroleum Based
~ MCP --rGuide
Low I 27
"
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CLUTCHES PLUS 215-000-000390
02 - Fixed Containers on Site
Page
4
Hazmat Inventory Detail in MCP Order
02-002 MOTOR OIL
~ Fire, Delay Hlth
Liquid
32 Minimal
GAL
CAS #:
8020835
Trade Secret: No
Form: Liquid
Type: Pure
Days: 365 Use: LUBRICANT
Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL --
32 I 16.00 190.00
Storage
DRUM/BARREL-METALLIC
r Press T Temp ~ Location
Ambient Ambient NEW OIL STORAGE
- Cone ~ Components
100.0% Motor Oil, Petroleum Based
r; MCP ----rGuide
Minimal I 27
~
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CLUTCHES PLUS 215-000-000390
00 - Overall Site
Page
5
<D> Notif./Evacuation/Medical
<1> Agency Notification
DIAL 9-1-1 FOR FIRE DEPT.
<2> Employee Notif./Evacuation
WORD OF MOUTH.
<3> Public Notif./Evacuation
N/A
<4> Emergency Medical Plan
MERCY EMERGENCY.
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CLUTCHES PLUS 215-000-000390
00 - Overall Site
Page
6
<E> Mitigation/prevent/Abatemt
<1> Release Prevention
MATERIAL CONTAINED IN MANUFACTURERS DRUMS.
<2> Release Containment
WASTE OIL PICKED UP BY EVERGREEN.
<3> Clean Up
USE SAND OR RAGS FOR SMALL SPILLS.
<4> Other Resource Activation
, ~
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02/07/96
CLUTCHES PLUS 215-000-000390
00 - Overall Site
<F> Site Emergency Factors
Page
7
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - NONE
B) ELECTRICAL - OUTSIDE RESTROOM WALL
C) WATER - SHUT OFF NOT LISTED
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLER SYSTEM.
NEAREST FIRE HYDRANT - WITHIN 300 FT
I <4> Building Occupancy Level
~ ,. .....
02/07/96
e
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Page
8
CLUTCHES PLUS 215-000-000390
00 - Overall Site
<G> Training
<1> Employee Training
WE HAVE 3 EMPLOYEES AT THIS FACILITY.
DO YOU HAVE MSDS SHEETS ON FILE?? YES OR NO
BRIEF SUMMARY OF TRAINING PROGRAM: PRIOR EXPERIENCE WITH MATERIAL.
<2> Page 2
<3> Held for Future Use
<4> Held for Future Use
e
~~~~t.
HAZARDOUS MATERIALS DIVISION
.¡/
Date Completed
C¡-~-97
Business Name:
c ( v t- c:L t>5
\tJ "': ~v
PI uC;
l",- 1i, 01..
Location: 70 () \
Business Identification No. 215-000 000 3'1 0 (Top of Business Plan)
Station No. '1 Shift C Inspector H e"'\ j y-; (:;. L 5 (\ V'
I~ JÔ 10 Ouf- _ I Ó 2..1
Adequate
Inadequate T; '^"" ~
)7
Verification of Inventory Materials 0 D
~~ Verification of Quantities t:kr 0
Verification of Location ~ D RECEIVED
Proper Segregation of Material G- O SfP 0 9 1993
,J,¿:I' Comments:
'\)s
tb v nJ Number of Employees
cJ'í' Verification of Haz Mat Training
# Comments:
fì¥T Verification of Abatement Supplies & Procedures
U .i· Comments:
\
Verification of MSDS Availablity
~
o
m--
o
~
o
Emergency Procedures Posted
Containers Properly Labeled
~
B"
D
D
Comments:
Verification of Facility Diagram
Special Hazards Associated with this Facility:
o
Œ(
Violations:
All Items O.K. 0
Correction Needed ~
FD 1652 (Rev. 1-90)
White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy
e
e
Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street-
Bakersfield, CA. 93301
RECEWED
OCT , 9 1992
lØf-
1<oQ5b\
AZARDOUS MATERIALS MANAGEMENT PLAN
HA7, MAT.otV.'
INSTRUCTIONS:
)tæG· ð
1,
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.
I ð?:' - I b 0
l}- q6
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: C.,¿ l1í(!j!£5 PLt¡S
LOCATION: '700/ wI/ f 1£ 4 jJ é"" Ù/t)/I,;/r /QJ..j;t1
MAILING ADDRESS:-S/jry¡ f'
CITy:8Jt£lZsfìE(o STATE: CA- ZIP:933q PHONE~5'" &3$i.--~t:f-3d--
VA ~rs; ~ Ie...
DUN & BRADSTREET NUMBER: oa~ )07-0;) 5:)", SIC CODE: ~~~~~ -
PRIMARY ACTIVITY: oLt reJf ;<£ PArf'2-
OWNER: R/t1/Y/Oµl) CoL£m/tù
MAILING ADDRESS: A~ ,A./30 u¡¿
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
1. 1J10¡)J) CoLEmAµ
2, Jtxt0 C<9LEIJ1I},J
24 HR. PHONE·
2'05 b~cf.-o7~
(~c6) <!39-c:J003
h1.rf-:
"
, 1.
I
FC
Þ #' ...;¡
.'
~ ~-
<!:¡¡
e Bakersfield Fire Dept.
Hazardous Materials Division e
. HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NuMBER OF EMPLOYEES: -.3
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
~~~~-
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE
REPORTING REQUIREMENTS OF CHAPTER 6,95 OF THE "CALlFORNIA HEALTH &
. SAFETY CODE" FOR THE FOLLOWING REASONS:
WE DO NoT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. '
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
\, CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE, I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFETY CODE"
ON ·HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6.95 SEC, 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
SIGNATURE
TITLE
DATE
- -------.-----
2,
FD1590
.-:-,"~ '
I
I ç. ;- f) .. 4
~ ,1\'
~ ~
'=
e Bakersfield Fire Dept. e
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name: CLq Te/lE5 f J. L¡ S
SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES:
A, AGENCY NOTIFICATION PROCEDURES:
Pdq(~'/Jf
J~/tY-yr
B, EMPLOYEE NOTIFICATION AND EVACUATION:
/)Jo-J (~
C. PUBLIC EVACUATION:
~/A
D, EMERGENCY MEDICAL PLAN:
~ '¿'J~'(f
3,
FOlfOO
- .
::- ..' ,..',"-~, ~
e
Bakersfield Fire De:ai..
Hazardous Materials DhWon
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A, RELEASE PREVENTION STEPS:
??J~ ~~.?>:.. ~7~ ¿)~
B, RELEASE CONTAINMENT AND/OR MINIMIZATION:
t1J~ ~ rf'~ --7 ~';jW4~
C, CLEAN-UP PROCEDURES:
(k¿ 4¡V,~ h/ ~ fv ß¿~ ~
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
/'
NATURAL GAS/PROPANE: ¡J (J) fIJ t:::.
ELECTRICAL: (J) /J . 811£ ? J.../J þ.)
WATER:
,
SPECIAL:
LOCK BOX: YE@
IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILAF3IL1TY:
A,
PRIVATE FIRE PROTECTION:
(]
WATER AVAILABILITY (FIRE HYDRANT):
,W~ 3øo r
4.
,:-:W'-" .
~)
,"
1
page_of--6.
,
OF BA.KER.SFIELD
MATERIALS
CITY
HAZARDOUS
INVENTORY
and Agriculture 0 Standard Business
o
ID
NAME OF THIS"FACILITY:
STANDARD IND. CLASS CODE:
DUN AND BRADSTREET NUMBER/FEDERAL
- --
TRADE SECRET
NON
OWNER NAME:
ADDRESS: ..22.ß
CITY, ZIP:£
PHONE .#: . ~()
Farm
BUSINESS
LOCATION:
CITY, ZIP:
PHONE #:
14
Names of Mixture/Components
See Instructions
CODES
-
12
Location Where
Stored in Facility
FOR PROPER
6
4
Average
Amt
'55 ~,
3
Max
Amt
55 IrJJL
1
Number
Niunber
& C.A.S
& C.A.S
Name
Component # 2 Name
Component # 1
o
Number
D
C.A.S
o
Ph,l and Health Hazard
\ k all that apply)
Fi 0
Number
& C.A.S
Name
Component # 3
Delayed
Health
Immediate
Health
Reactivity
Sudden Release
of Pressure
Hazard
re
ø",
3~5"
3..2 (, Al_
/L SAf.3DW
()
Number
& C.A.S
Name
Component It 1
Number
C.A.S
Physical and Health Hazard
(Check all that apply)
o 0
Number
& C.A.S
Name
Component It 2
o
o
o
1'ù Ci,6/f¿
tJlL-.
Number
& C.A.S
& C.A.S
& C.A.S
& C.A.S
Name
Name
Component It 2 Name
NalllB
Component It 3
Component It 1
II 3
Component
Delayed
Health
Immediate
Health
Reactivity
Sudden Release
of Pressure
Fire Hazard
& C.A.S
& C.A.S.
Name
Component It 2 Name
Component # 1
Number
C.A.S
Physical and Health Hazard
(Check all that apply)
:~1
certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS)
I certify under peanlty of law that I haver personally examined and am familiar with the information submitted in this and all attached documents
individuals rèsponøible for 'obtaining the information. I believe that the submitted information is true, accurate, and complete.
; ~~
NAME AND OFFICIAL
& C.A.S.
Component * 3 Name
Delayed
Health
o
IlIII1Iediate
Health
o
o Reactivity
Sudden Release
of Pressure
u
".... '
~
EMERGENCY CONTACTS
,0
Fire Hazard
o
Name
those
of
my inquiry
-z.-
based on
and that
AUTHORIZED REPRESENTATIVE
OWNER/OPERATOR'S
OWNER/OPERATOR OR
OF
TITLE