HomeMy WebLinkAboutHAZ-BUSINESS PLAN 7/6/1992
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II. PLEASE DETACH AND SEND THIS COpy WITH REMITTANCE
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STATEMENT OF ACCOUNT
CITY Ot BAKERStIELD
1501 TRUXTUN AVE
BAKERSFIELD, CA 98301-0000
(805) 326-3979
DATE: 3/01/97
TO: SOUTHWEST IMPORTS
6001 AUBURN #149
BAKERSFIELD, CA 93306
CUSTOMER NO:
CUSTOMER TYPE: ESI
3704
3704
----------------------------------------------------------------------------
; - ::I. ._ ~ ~ _" - _
CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT
------ -------- ------------------------- ---------- -------- --------------
0/00/00 BEGINNING BALANCE
PB017 2/13/97 Charge adjustment
FINANCE CHARGE
364.24
3. 06--
2/13/97
FOR QUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE
CALL THE NUMBER AT THE TOP OF THIS STATEMENT.
-------------- -------------- -------------- --------------
CURRENT OVER 30 OVER 60 OVER 90
-------------- -------------- -------------- --------------
~ - -" --
~Jª~.,
3._06
-- ~---"",,-_...._~-
_ ..._-- '" ___ _ ,'A.
348.94
- - ---~.~ -. -- - -------
DUE DATE: 3/31/97
361. 18
$361. 18
PAYMENT DUE:
TOTAL DUE:
DATE:
3/01/91
DUE DATE:
3/31/97
REMIT AND MAKE CHECK
CITY OF BAKERSFIELD
P.O. BOX 2057
BAKERSFIELD
PAYABLE TO:
CA
93303-2057
CUSTOMER NO:
3704
CUSTOMER TYPE: ESI
TOT AL DUE:
3704
$361. 18
¡ ,'. RE;rURN PAYMENJ$ T.o: .' . ,.,
¡ ,..-CITY QFBAi<EBSFIEtD .-......, ..¡.
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PLEASE MAKE CHECKS PAYABLE TO:
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CITY OF BAKERSFIELD
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RETURN PAYMENTS TO:
CITY OF BAKERSFIELD
P.O, E:30X 20;>7
BAKERSFIELD, CA 93303-2057
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STATEMENT OF ACCOUNT
PLEASE MÀKÊ CHECKS PÀVABLE TO'
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* PRINTED ON REGENESIS® POST CONSUMER RECYCLED PAPER
REMITI ANCE COpy
Date Completed
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7- ;). --
,~~~~'W~\R\
ì JUL 6 1992 ~
IÞ Bakersfield Fire Dept. .
. HAZARDOUS MATERIALS DIVISION . ..
Business Name: 90 u r\-\' "" E.> ~
Location: 700 I W ~ ;\ t.
k""
Business Identification No: 215-000 - 0 0 1'.3 '} 'L
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II~
c
Inspector
(fop of Business Plan)
H~~ J v ì c
Station No.
.,
Shift
Verification of Inventory Materials
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments:
Verification of MSDS Availablity
Number of Employees
Comments:
Verification of Abatement Su
Comments:
Containers Properly Labeled
Verification of Facility Diagram
ecial Hazards Associated with this Facility:
Adequate
D
D
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D
Inadequate
D
o
o
o
D
o
D
D
o
o
D
o
Business Owner/Manager
FD 1652 (Rev. 1-90)
All Items O.K. 0
Correction Needed 0
White-Haz Mat Div. Yellow·Station Copy Pink-Business Copy
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-.- ;tiuibd ~tab5 1!Iauhruptct! ([art 9112475-15 3
~ STERN DISTRICT OF CALIFOR~
,!
)10510 447
9112475 IN RE;
ROBERT S. WILLIAMS LARRY & LYNN WALL
1706 CHESTER#4ù4 7151 HANOVER CIRCLE
BAKERSFIEL.D' CA 933Yj .~~A\ . BAKERSF. IEL. 0.,' C. A. 933..09
.;r-¡tf-9( II rt\,~/~~' . SSN 370-58-2630 AND
1-1....... '1.7ÒI() ( d ,y,.. "A/SOUTHWEST IMPORTS
,-, ,. 'P ,0 SELF-EMPLOYED ID#17-Q173229
CJ~ (¿,~Y 05
ÓÃDER FOR MEETING EDITORS, COMBINED WITH NOTICE THEREOF AND OF AUTOMATIC STAYS
To the debtor, his creditors and other parties n interest:
An order for relief under title 11 U,S,C, chapter 13 having been entered on a petition filed by the above debtor(s) on: MAY
IT IS ORDERED, AND NOTICE IS HEREBY GIVEN, THAT:
A meeting of creditors pursuant to title 11 U,S,C, § 341 (a) shall be held at:
CASE NUMBER
91-12415B-13K
362-72-8210
6,1991
ADDRESSEE/
·<'~:rY~L\t>-<;+
ROOH 228., FEDERAL BUILDING
800 TRUXTON AVENUe
BAKERSfIEUJ, CA
DATE
,JULY 10, 1991
TI i'iE
10.30 A. £'4.
9112475 - 15 -3
CITY OF BAKERSFIELD
POBOX 2057
BAKERSFIELD., CA 93303
CITY
The debtor shall appear in person at that time and place
for the purpose of being examined,
YOU ARE FURTHER NOTIFIED THAT: '
The meeting may be continued or adjourned from time to time by notice
at the meeting without further written notice to creditors,
At the meeting the creditors may file· their claims, examine the debtor,
and transact such other business as may property come betore the meeting.
As a result of the tiling of the petition, certain acts and proceedings against the debtor and his property are stayed as provided In 11 U.S.C. § 362(a) and against
certain codebtora es provided In 11 U.S.C. § 1301. Significant parts of these sections are reproduced on the reverse side ot this notice.
In order to have his claim allowed so that he may share in any distribution from the estate, a creditor must file a claim, whether or not he is included
in the list of creditors filed by the debtor, Claims which are not filed on or before OCTOBER 8, 1991
will not be allowed, except as otherwise provided by law,
A hearing on confirmation ofthe plan will be held ON.JUL Y 10, 1991 AT 1.15 P. M.
AT ROOM 204, FEDERAL BUILDING, 800 TRUXTON AVENUE
BAKERSFI ELi)" CA '
ANY OBJECTIONS TO CONFIRMATION MUST BE FILED PRIOR TO THE CONFIRMATION HEARING.
THE PLAN OF ARRANGEMENT DIVIDES CREDI TORS INTO THE FOLLOWING CLASSES-
GROUP 1 - CREDITORS WHOSE DEBTS ARE SECURED BY A SECURITY 'INTEREST WHICH. THE
DEBTOR HAS ELECTED TO INVALIDA IE UNDER SECTION 522 -F- OF THE BANKRUPTCY CODE
GROUP 2 - CREDITORS WHOSE DEBTS ARE TO BE PAID ON A PRIORITY BASIS.
GROUP :3 - SECURED CREDITORS WHO ARE TO BE PAID AN AMOUNT EQUAL TO THE ACTUAL
VALUE OF THEIR COLLATERAL.
GROUP 4 - CREDITORS HOLDING CLAIMS ON .. WHICH OTHER INDIVIDUALS. ARE LIABLE
WHICH.. UPON FILINö AND ALLOWANCEy ARE TO BE PAID IN FULL.
GROUP 5 - CREDITORS OWED ARREARAGESWHICH ARE TO BE PAID IN FULL OVER THE TEf<
OF THE PLAN. '
GROUP 6 - GENERAL UNSECURED CREDITORS.
GROUP 7 - CREDITORS WHO ARE TO BE PAID OUTSIDE THE PLAN.
GROUP 8 - THIS DEBT IS TO BE PAID IN FULL IN ACCORDANCE WITH THE CONTRACT
BALANCE DUE.
GROUP 9 - COLLATERAL TO BE RETURNED., ANY DEfICIENCY AS UNSECURED.
GROUP 10 - TO RECEIVE NOTICE ONLY. .
THE DEBTORS PLAN ODES NOT PROPOSE PAYHENT·OF UNSECURED CREDITORS.
TRUSTEE: M. NELSON ENHARK., 1343 BULLDOG LANE, FRESNO, CA 93710. 209-225-5671
ATTY FEES $1250.00
ATTORNEY FOR DEBTOR- ROBERT S. WILLIAMS, 1106 CHESTER #404
805-323-7933 8AKERSfIElD, CA 93301
YOUR CLAIM IS SCHEDULED IN GROUP ô .
THE PLAN PROPOSES PAYMENTS TO THE TRUSTEE OF $365.00 MONTHLY
UNSECURED CREDITORS TO BE PAID NOTHING
THIS CLAIM IS LISTED AS UNSECURED
GROUP 6
FILE CLAIM WITH ATTACHMENTS,
IF ANY, IN-DUPLICATE WITH:
9112475 15- -3
. -UNrf2!)· STATES tlANKRUPTCY COURT
5301 U.S. FEDERAL BLDG. -
Fi:¡-:SNfhC,\ q~721
DATED HAY 10, 1991 BY THE COURT
AT FRESNO, CA
~.¡;. HELTZEL
CLERK OF THE COURT-
. '~r-\ Jil¡::r
PRIORITY
uNSECURED
TOTAL DEBTS
JUl 2 2
A
CITY of HAKEHSf-=
SHAZARDOUS MATERIALS INVENTORY
NON-TRADE SECRETS
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OWNER NAME: Larr
ADDRESS' "'71-5-1 ... .
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submitted Inloraat on IS true, accurate, and complete. '
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EHERGEUCY cOIn ACTS
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Bakersfield Fire Dept. e
HAZARDOUS MATERIALS DIVISION
Business Name:
Location: , Oò t
$0 ~ Tt+WeS1"
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Date Completed
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RECEIVED
J U N 7 1991
Ans'd.
...........
Business Identification No. 215-000
Station No. ~ Shift
ðð.)' ~ (Top of Business Plan)
~ Inspector IJ.'I\' I ,.¡.. t íc:.II~""'-
Verification of Inventory Materials
Verification of Quantities
Verification of Location
Comments:
Proper Segregation of Material
a", +; Q..~(' ~ aJJal
Adequate
o /'
Cv.
~
Inad~
D
D
D
Verification of MSDS Availablity
Number of Employees 1
Verification of Haz Mat Training
Comments:
Verification of Abatement Supplies & Procedures
Comments:
~
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~
D
D
D
Emergency Procedures Posted
Containers Properly Labeled
Comments:
D
~
"'
D
D
Verification of Facility Diagram
Special Hazards Associated with this Facility:
D
Violations:
Business
FD 1652 (Rev. 1·90)
All Items O.K.
Correction Needed
~
White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy
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Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
RECEIVED
SEP 0 5 1990
HAZ. MAT. DIV.
HAZARDOUS MATERIALS 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 brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: Southvlest Imports
LOCATION: 7001 White Lane #110 #111 #112 #113
MAILING ADDRESS:
Same
CITY: Bkf ld
STATE: ~ ZIP: 93309 PHONE: (805) 397-2600
DUN & BRADSTREET NUMBER:
SIC CODE:
PRIMARY ACTIVITY: Auto Repair
OWNER: Larry D Wall
--. -'-- -- - -
MAILING ADDRESS: 7151 Hanover Circle BJcfld Ca. 93309
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
l. Larry ~vall Ovln e r 397-2600 835-0821
2. Troy Ingle Mgr. 397-2600 832-7029
1.
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FD1590
Bakersfield Fire Dept.
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
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SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: Four
MATERIAL SAFETY DATA SHEETS ON FILE:
Yes
BRIEF SUMMARY OF TRAINING PROGRAM:
All employees read a booklet and are briefed by Larry Wall
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE
REPORTING REQUIREMENTS OF CHAPTER 6,95 OF THE "CALIFORNIA HEALTH &
SAFETY CODE" FOR THE FOLLOWING REASONS:
WE DO NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITJES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, Larry D Wall CERTlFYTHATTHEABOVEINFOR-
MATlON IS ACCURATE, I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE IICALlFORNIA HEALTH AND SAFETY CaDEll
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
SIGNATU$OVd
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O"lner
8-1-90
TITLE
DATE
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FD 1590
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Bakersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility U nit Name:
SOUTHWEST TMPORTS
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A, AGENCY NOTIFICATION PROCEDURES:
The owner Mr Wall or Mr Ingle the manager can handle
any problems that may arise. One or the other is always
present.
B, EMPLOYEE NOTIFICATION AND EVACUATION:
The shop is very small and if there was a problem
everyone would know.
All employees have there own overhead door
and are instructed to exit there if any problems.
C, PUBLIC EV ACUA nON:
There is not enough material to cause problems
outside of the shop.
- - .-- -- --
-~ ~~-
D, EMERGENCY MEDICAL PLAN:
Employees are to report to Mr Wall or Mr Ingle
for any medical emergencys.
Memorial Medi Center is the nearest.
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OWNER NAME:_Larr Wall
ADDRESSl' ;¡ 15.1 Han9Vf'!r...;..::~'~r,:£_I~-
~ÀÒYf; 3.P·-Bak-tH:OflCld 3-@--
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SHAZARDOUS MATERIAL INVENT~RY
) NON-TRA SECRETS
HAKEHSrlELU
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NAME OF T~IS FACILITY:
STANDARD ilND. CLASS CODE.
DUN AND ~RADSTREEl NUMBER
- -
DE
ness
Standard Bus
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culture
BUSINESS NAME
LOCATION;..
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Certifiçatioq (Reed and $ign afjßr cÇ>mp1~ting ~ 77 seciiions)
I certify under enall 0 la th t I have pe(sona J~ exam!n Qed n familIar it the InformatIon
attaçhed dQcu~enfs an~ t at ~ase~ on ny InquIry 0 lhose Inålvl~ua's responsib1e ~or obtaIning the
submItted Inforllatlon 15 true, accurate, anð cOllpfete \
It
CY CONTACTS
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Bakersfield Fire t.
Hazardous Materials Inspection
, t..........--
-~..- -. ~....
........._--~ ~~._-.
-
c- /~-{(j
Date Completed
Business Name: 5 au +\, \¡ve5~~ ~
Location: 700 \ 'vJ~: ~f h~ ~ ill
~:.t¿Cl;i\;"EU
·JUN 2 6 \990
..........-
Plan ID # 215-000~O()1332.. (Top right comer Business Plan)
l' Shift C--- Inspector -1tf"\. J2 or ~ c. [<Çà "î
HA2. MAT. DIV.
Adequate Inadequate
o
o
o
OJ-
Verification of Inventory Materials
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments(O~ - A r"jö.... VV\ I x ~--- 1- so cv, -Q..~
Verification ofMSDS Availability
eM-
Number of Employees
5
Verification of Haz Mat Training
ß
Comments:
Uð'
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o
o
o
o
Verification of Abatement Supplies & Procedures
ŒJ
Comments:
o
Emergency Procedures Posted
o
Œf'
Containers Properly Labeled
Comments:~ ó fo)~J
f~o ~ eJv~, 5
Verification q(Facility Diagram. . ~ I
N <)- eX \ 0\ :1 y-. 0\..... \J"" -~h f r, ...-, CN 1
Special Hazards ASSociated with this Facility:
~
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o tJÁ- 0
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CITY of BAKERSFIELD
"IVE CARE"
RECEIVEO
APR 6 1989
D. W 0..\ \ . Ans·d............
ló~
T
h 0. '{ 'f "-\
(tYDe or prlnt name)
REv¿¡ \;è,j
APR 0 6 I~Ö~
Do hereby certify that I ha-\-e revieh-ed th1-lAZ.MAT.D'V.
attached Hazardous Materials bU$iness plan
for
SO Ù\\t\ \.Ò e$ç T '«' ~O ~~~
(name of business)
and that it along with the attached additions
or correctidns constitute a complete and correct
Business Plan for my facility.
l- 3-ð'1
date
\
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CITY of BAKERSFIELD
.
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HAZARDOUS MATERXALS XNVENTORY
NON-TRADE SECRETS
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NAfolE OF TinS ~AJ~JL1.TY:
STJ\NDARD IND. CLASS CODE
DU" AND BRADSTREET NUMBER
- -
n,ss
Stðndard BU5
turf
BUSINESS
LOCATION:
CITY, ZIP:
PHONE (I:
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SIt Instructitlll
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_ERGENCY COIITAC1S
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of
that based DII "f inquiry
Clr ¡cation (Rttad and sign after co.pJeting all sttctionsJ
I Clrti/.V, under IIIIIlty of 1.. thet J hay, ptrSDllany "...ined and, .. f..i!i.r with tlw info....tiDII su.Hted in this and .11 ~reched doc_t., and
for obt,'inln9 tlw inf_tiDII, J btl11Y' that tilt .u.ttttd Into....tlon IS trllf. accur.tl, and Cti=PI I. ~
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BAKERSFIELD CITY FIRE DEPAR~~
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979 \ð -\ \o\)
9 '1-~ Q
RECEIVEn
J U L 1 3 1988
Ans'd..
..........
OFFICIAL USE ONLY
ID#'
u01332
US INESS ~A.\fE
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
~ 2
~Gr·6
INSTRUCTIONS:
'~
~'i
1. To avoid further action, return this form by
2. TYPE/PRINT k~SWERS IN ENGLISH.
3. Ans~er the questions below for the business as a whole.
4. Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
k
I:
A. BUSINESS NAME:
c. .
_ .JO u~ We.-.....+ ,
". ," -~. ,:~'.:-~' : -",-~: " ," '. .
I "'/\ ~o rt ç -.._.---~,--,- .__~__,_'"_'~.~c..._
W \1\\ \--e. ~CA..,^e. ~ \ I \ # 1\2 4# LOt:¡ #- I/O
~33{q BUS.PHONE: (~S) f537-7{fol{
B. LOCATION I STREET ADDRESS: ,00 l
CITY: 'ßlrLý\cÀ ~ ~
ZIP:
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
E~PLOYEES TO NOTIFY IN CASE OF E~ERGENCY:
NAI'>fE AND TITLE
A. !:..c-..I( ('4 - D WO\.\.~ 0 W V\e..r
,
B. :Jo '" '^ S \\ ,.i\.~)\ N
..ç:" '(" 'IV' Q..'^
Ph#' f:~7-2t¡~'f
AFTER BUS. HRS.
Ph#' <íS3S-ó'is";;tl
Ph#' 32"2- 'i()OJ-
DURING BUS. HRS.
Ph#' f{ 37 -- Z WI\.{
SECTION 3:' LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. ~AT. GAS/PROPANE: .N/ A
B. ELECTR I CAL: , tV S , p!. Wo..\~ \,.)"'-1 Co ~~-k.r ( ¡:: b \d. I
C. WATER: 5"""""iZ..
O. SPECIAL: ?:f§:5A
E. LOCK BOX: YES ~O IF YES, LOCATION: Ala
IF YES. DOES IT Cm¡TAI~ SITE PLANS? YES / ~O MSOSS? YES I NO
FLOOR PLA~S? YES I :iO KEYS? YES I ~O
- 2A -
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SECTImr J.: PR IVATE RES?miSE TE:\."'- f'OR BIJSEESS AS .-\ ~iHOL;::
cÜ\ 0 M~'(Ti~~S ClO U\cÀ Y\O\wÂle.. (]\.VI'-{ pvob(evVI>
r.:: i:., " ;;,(j Wl~,^ (Ä'(Il{ ~W\er5ell\Clf~
SECTIO~T'5: LOCAL EMERGE:¡CY '!EDICAL ASSISTANCE :-OR VOUR 3USI~ESS AS A \'¡HOLE
"
W~\-\e ~\I\Q.. c.\~I\;<... \<) 'N W\7te ~i'OW\ -\-'^-C SlAop
SECTION 6: EMPLOYEE TRAINING
E;'!PLCYERS ARE REQCIRED TO HAVE ..\ PROGRA~I \-¡'HICH PROVIDES :::,¡PLCY:.:ES ;'iITH I)IITr.~L A~D
REFRESHER TRArXI~G I~ THE FOLLOWI~G AREAS.
CIRCLE YES OR SO
A. ~ETHODS FOR SAFE HANDLING OF HAZARDOGS
y!A TER I AL S: , . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. PROCEDURES FOR COORDI~ATI~G ACTIVITIES
WITH RESPONSE AGE~CIES:..... ... .... .... ... ... ....
C. PROPER USE OF SAFETY EQUIP~EXT:..... ..........,..
D. E~ERGEXCY EVAC~ATIO~ PROCEDURES: '.,.,..."., . , ". '
E. DO YOU )~INTAI~ EMPLOYEE TRAI~ING RECORDS:".....
IXITIAL REFRESHER
:;-0 YES ~
::0 YES
NO YES
® YES
YES ~O YES
SECTION 7: HAZARDOUS ~1'ERIAL
C IRCLE ~ - :ro - NONE
DOES YO~3GS IXESS HA:-:DLE HAZARDOGS )l<\TERIAL Dr QUANTITES LESS T:~AX son ?OC::DS OF A
SOLID. 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A CO~PRESSED GAS:...... YES ~
I. k({y W~.\\ , certify that the above infor:nation is accurate.
r understãRd thàt this information will be used to fulfill my fir:n's obligations under
the new California Health and Safety code on Hazardous ~aterials (Div. 20 Chapter 6.95
Sec. 25500 Et AI.) and that inaccurate information constitutes perjury.
#¡o?;JJ1
(j
TITLE 0 wvtev-
DATE
7 -7-'ë/ir
'srG~AT,[RE
,) n
~~
iI;)
:J
Page
IELD CITY FIRE
FORM 4A-1
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
DEPARTMENT
I1AKERSF
#
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C:O/lE
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7- _ - -c, ~\;~v:~' -m~í\) ÃÖDRËSS':---- ~m'~~ke --,.zd... -t\ 2& FAC I L I TY U.... ......_.
P:.lliz--M C-I\ '\33ò~ CITY. ZIP: ß'e.-t1tÁ a..'3~o"
(MS) ~3ì":Z.l(O~ PHONE #: ~5S-0~Z.l 10FFICIAL USE CFIRS
I ONLY
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD
rODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE _
)P ì 06ftL SbO b!rL bf\L. 0 ~ '2..<:, I~e~~ ~O(> 5 l;JcI.\\ /o(J% 0 II (;)?? 0 ~ rLL&
~ SS 366 bAL Db Z<O S¡ E Cf)nr\e.r tCd10 ~~ 0 ¡( /5q ð Ô\lME'
-,- ~o 100 <;A-L-- 6b 0<6 W S'1c.le M\J.~lectfW71.H 100% Solv~vt+ (sÞ\f'£í'( t\a:;..",) CML-Q.
30 Cf 0 6 fç.L 0 b at s <é. CO'o\Y\ev--- 10Cf10 ÛA(b C t~~./ C /VI L.Q
__ 3 ~ 6 AL 0 b {q S £ (0 <Ø.rJ fV&r lOa 10 b f'\S E~P L ._
\ ~ . 1 ~
~JAME: -.k0\1('(V\ \,J.J()...\ TITLE: -OINlI\er SIGNATURE: //)rU./{fv'Cuv DATE: '0/:
EMERGENCY CONTACT: SC7\<MQ..... T ITI.E: V( J PHONE # BUS HOURS: ~5ì-c-U.(}t1:,
\\
s
y'
I
~ ~._---
'32 z- C¿ooó ~.._Ì??::?qº:1
5'05fl-
AFTER BUS HRS:
PHONE # BUS HOURS
AFTER BUS HRS:
-to t .M()\¡V'\
TITLE
""\{
CO NT ACT: :Jô,^V\
BUSINESS ACTIVITY
EMERGENCY
PRINCIPAL
~. <t,'. .ï;
...
e
e
....
.
BAKERSFIELD CITY FIRE DEPARTNE~T
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL CSE O~LY
ID#
------
BUSINESS NA~rE:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoid further action, this form must be returned by:
2. "TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT#
FACILITY UNIT NAME:
SECTION 1: MITIGATION, PREVE~ïION. ABATEME~ï PROCEDL~ES
o\l \5> ~€.~ \V\ 6-' .sS- 6~c- þ.çv,^,\ I Wctl.-t '^- c.a(>,.
SECTION 2: NOTIFICATION AND EVACUATION PROCEDt.ffiES AT THIS L~IT O~LY
() U~ O-.'P\,-\ Q V\e. ~
q/¡
b d.oors
~ &JJ2fl
""
- 3A -
e
-
,;, ..4.·
.'
, .
-.
SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLY
A. Does this Facility Unit contain Hazardous f.olaterials?.... .~:m
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES ~
If No, complete a separate hazardous materials inventory
form marked: ~ON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
Spn\l\\--¿\¿'( S<-(~
o 1\ ~'-\
4
~
..~.~~_<...:~; ···~,>~i~~~;';;L:":'~~:"~::~*f!~~;;;·:·'.;,·.. . -',
..
SECTION 5: LOCATION OF WATER Su~PLY FOR USE BY EMERGENCY RESPONDERS
....-..
tV\
c.ell\.\-e-r c) f'
c-oN\fle( ( W(Í\.\\cW<A.1
SECTION 6: LOCATION OF UTILITY SHUT-OF'FS AT THIS u~IT Om-Y,
A. NAT. GAS/PROPANE:
..
N~
I';'
B. ELECTRICAL:
Ce I/\-\-e.. \( O.ç: CO Nt r \ey (w ~ \ ~ wc-..'1 J
.;,:;
C. WATER:
Ç.o... 1M t:.
w:,. I\:t> CI v -e..
D. SPECIAL:
¡JJA
-
E. LOCK BOX, YES ~IF YES, LOCATION,
IF YES. SITE PLA~S?
FLOOR PLANS?
YES / ~.¡o
YES / NO
~!SOSs?
KEYS?
'lr: s
YES
:\0
NO
- 33 -
_ ~ (f~
Bakersfield Fire Dept.
Hazardous Materials Inspection
"
L[-G @
Date Completed
ï\-30-î1
Business Name:
ð'ov'"fti) W~ t
Wf,Ùtf
~O(¿¡t5
LtJ J:L " D
7001
/33:J-
Plan ID # 215-000 ./-0 Sip (Top right comer Business Plan)
Location:
Station No.
? Shift
If
Inspector
fhv 5tH..}
RECEIVED
DEC 0 6 '989
H~7. MAT. DIV.
Adequate Inadequate
Verification of Inventory Materials
[!{
[Ø'
[]1
u.;:r
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments:
D
D
D
D
Verification ofMSDS Availability
[H'
Number of Employees
fù 0 Ne..
Verification of Haz Mat Training
c¿(
Comments:
D
D
Verification of Abatement Supplies & Procedures
Œ1
Comments:
D
Emergency Procedures Posted
ffi
~
Containers Properly Labeled
Comments:
D
D
Verification of Facility Diagram
[kr
Special Hazards Associated with this Facility:
D
Violations:
FD 1652 (Rev. 3-89)
White-Haz Mat Div. Yellow-Station Copy Pink-Business Office
e
3 'C'-~ ..' ..,_., . .~. - .~,. "F--' I''''''
...."t.:\:),' ,___ '.... ~ .;\1:. l.J.;- ,\'. .-
, ,
.:.::.:U '. ~ o. STIEET
SAKE~S~~ELJ, CA 93301
RECEIVED
OCT 5 1987
Ans'd.... ........
OF?!C:AL USE ONLY
~us 1 \..1 &55
rnSï:'RuC'!'! ONS :
HAZARDOUS M.A.TERI AI. ~ ik_ rJx£2?,3
BUSINESS PL~~ AS A W OLE)VQ
FORM 2.A. ~ Or I
Mo\J G t) - No WvJér£ f2
OX cy Pre-
t33 d-
~
ID:
I.;S INESS :-1A.'1E
1. To avoid ~urther ac~ion. ~e~~r~ this fo~
Z. TYPE/PRINT Ai.'iSWE.~S rn ~!GL.:Sñ.
3. Answer the ques~ions below for the busi as a whole.
4. Be as brief ~à concise as possible.
SEC':"!ON 1: BUSrm:SS LDEm'n'IC:.-r:rnf DATA
..
-._.. ~. _', --0_'_.. __;,""'~......'-:___ .........;.... . ".
B. taC~T!aN I STREE7 .~DRESS:
C:!'Y: fu \z.efS \-\.'e.\tt
'ov\ ~ \N'e s\ ..\-
5'3'5
A. BUSI~SS ~~~E;
(,330'(
~O,)~e- ~b
BUS. ?HmŒ: (805') çç- 37-'2 L( 0 t{
SEC":"ION
In case of an emer~~!1C7 involvin~ the t"elease or' threa~ened t"elease of a
hazardous ma~erial. c~ll 9 _ and 1-800-352-í350 or 1-916-~21-~341. This ~ill ao~ify
your local fire depar<::ne!1 and ~tle State Of::ce of E:ner~~!1c7 S~r·'ic~s as ~~qtli=~d by
law,
E:·!P!.OYE::S TO XOTI?? r~ CASE OF ~·!E?GE:'iC·{:
~~:>fE t2~~ /rTLb Ph;:. Dù~I~G7~Yi·l{g~s. Ph;: AL~;2; ~óJ~'
o
Ph;:
Ph;:
8.
~ W\p\Ci'(~5
SEC7:0N 3:
OF ITT!L:7! Shü~-~FPS ?OR 3USTNESS AS A WROLE
A. ~AT, GAS/R.a?.'\~E:
B, E!.EC7R I C' T-N
C, WATE:\:
0, S?::C:..\L.
c.. lOC:\: 30:-\: YES ::0 ,.. I£3, :'·:JC;;:-:;J~;:
e.. ~ + dC10r
w~.5T- COIf/µer
AID
L Y::S JOE::
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SECTION 5: LOCAL EMERGE~CY ~EDICAL ASSIST~~CE FOR YOUR BUSINESS AS A WHOLE
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SECTION 6: EMPLOYEE TRAINING
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E~PLOYERS ARE REQUIRED TO HAVE A PROGRA}I WHICH PROVIDES EMPLOYEES WITH INITIAL ~~
REFRESHER TRAr~ING I~ THE FOLLOWI~G AR~~S.
CIRCLE YES OR :IO IXITIAL REFRESHER
A. ~ETHODS FOR SAFE HANDLING OF HAZARDOUS
:vIATERIALS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES :-¡O YES :-¡O
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPO~SE AGENCIES: . . . . . . . . . . . . . . . . . . . . . . . . . . YES :m YES NO
C. PROPER USE OF SAFETY EQUIP~E::T: . . . . . . . . . . . . . . . . . . YES NO YES NO
D. E~ERGENCY EVACUATION PROCEDURES:................ . YES NO YES NO
E. DO YOU MAINTAIN E~PLOVEE TRAINING RECORDS: , . . . . . . YES NO YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
-=DOES~ _YO GR--B GS-I-N-E-SS-HAND LE~HAZ.A·RÐf)US -':1.ð/fE-R-L<t~I~-QUA:NTITIES ~~CES S-TF.:<X:\ -300--Pölr!!SlJFA-
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A CO~PRESSED GAS:, ...,. ~ ~O
I, ~,^\rtW('A..\\ , certify that the above information is accurate.
I understand that this information will be used to fulfill my firm's obl~gations under
the new California Health and Safety code on Hazardous ~aterials (Div. 20 Chapter 6.95
Sec. 25500 Et AI,) and that inaccurate information constitutes perjury.
SIGNATt'RE
;0 0 .1\0~ TITLE
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DATE
10/';).. Ir¿ 7
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BUS EESS :\A~Œ:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoià furthe~ ac~ion. this form must be r~turneà by:
2. TYPE.:PRIXT YOUR AXStvE;ZS IX E;¡GLISH.
3. Answe~ t~e questions aelow for THE FACILITY r~IT LIS7ZD 3ELCW
4. g-e=ãs 8RI::? 2..n'à~CO:;C:SE as possible~-
FACILITY u¡.¡TT~
FACILITY UNIT ~A~:
SEC7ION 1:
~ITTGA7TO~.
?~~rc:'IT:O~. ABATE~E:7T PROC~t~ES
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SEC7TON 2:
'iOT:?:CAT:ON.l,\-:J ::V~C::,.l,T::8:\ ~?OCEJí2ES AT :::.:.5
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S:::CTI()~ 3: HA7.¡\RDOC::ï "fAT:':RIALS FOR THIS TNIT axT.V
A. Does this Facility Unit r.ont:é1.:'n Haz:1l'åous ~{ate!"L1L,?,.... @ ~o
If YES, se~ B.
If NO, continup. with SECT¡O~ 4.
B. Are any of the hazaråous mate!'ials a bona fide Tr:Jde Secret YES ®
If No, complete a se?arate hazardous materials inventory
form marked: :\OX-TRADE SECRETS OXLY (white form =4A-l)
If Yes. complete a hazaråous materials in~p.ntory form markp.d:
Trl4DE SECRETS O~LY (yellow for~ #4A-2) in aùdition to the non-trade
secr~t for~. List only the trade secre~s on form 4A-2.
SECTION 4: ?RIVÃTI: F'TREPRdTÉCTfo~
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SEcrIOX 5: LOCATION OF WATER Sü??LY FOR USE BY ~Gz:.CY RES?O~~ERS
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SC:CTIO~ 1;: tOCATIO~ OF TITILIT! Smrr-DF'::'S AT THIS ~TT OXLY.
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FORM 4A-1
NON-TRADE SECRETS
AZARDOUS MATERIALS INVEN
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