HomeMy WebLinkAboutHAZ-BUSINESS PLAN 12/3/1990
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Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
RECEfVED
OfC 0 3 1990
HAZ. MAT. DIV.
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3DŠ
HAZARDOUS MATERIALS MANAGEMENT PLAN A il L
H- (jtP --
INSTRUCTIONS: OJ (]ý' Ò
ø
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. l ~D
\d-~-
q/qJ3
1.
2.
3.
4.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: JoCY\c ALC~évnt:;+lO-<""
LOCATION: 1"DO l W h ~ l-~ LIpr't'J- :th-. {l =3
MAILING ADDRESS: 1Döl tAJh\.-4. ~ *- \lg
CITY:~~¡¿Sb~-\cL STATE:ŒI4- ZIP:<1.g3t:3 PHONE: ~31-()qé)-Ç-
"Çp¿' T~\,t 'I,D.:::=--
DUN '& BRADSTREET NUMBER: 6;{'1 ,.tf3'" 8CeIQ¡ SIC CODE:
PRIMARY ACTIVITY: ~lY\vl(~~ {¿ {JA-:tIL
OWNER: ~""I\.d~ gð~ a
MAILING ADDRESS: r'1 DO l \ }Jh~h ~€- t±. u~
v
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
TITLE
BUS. PHONE
~ 3-¡-o902.$
24 HR. PHONE
1. R~cl~ ~ò<r (', () l,ù (\.<€.{
2. ,.:JO ~ p(o<jcee=::' .
3~t.( -c::2~ <e P"
1.
FD1'
-',
..
" jj ~:f}' ~':~f:'Hi
_ Bakersfield Fire Dept. e
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
\/i<.\ .Tl\~~;1 t;~¡;\}'1
SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: --J on e...
. MATERIAL SAFETY~A SHEETS ON FILE:
'BIlJIl'K t r <ØS .
BRIEF SUMMARY OF TRAINIf'1G PROGRAM:
}-JD ~{y)~\Ð~~ - DD~ Pb-\- ~p~
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 IICALlFORNIA HEALTH &
SAFETY CODEII FOR THE FOLLOWING REASONS:
WE DO NOT HANDLE HAZARDOUS MATERIALS,
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITlES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I. J f\-rI d@ P.OIY'IO CERTlFYTHA TTHE ABa VE INFO R-
MAnON IS AC RATE, I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE IICALlFORNIA HEALTH AND SAFETY CODEII
ON HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFO ilON /NSTITUTES,/ URY,
..--:---
DATE
2,
FD1590
<;
¡¡¡ .. ro.
e
Bakersfield Fire Dept..
Hazardous Materials Divisi
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name:
~ð('y'tD
Au~ ·rnc¡,+,vt;,-
SECTION 6: NOTIFICÄTION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
Œ-ALL q It "
B. EMPLOYEE NOTIFICATION AND EVACUATION:
--4n Û0m '+LL Dn '0\. fU2GÓÖíì LûDQ.~·(\Gt Ú, ~
6h' ...J -....J
~) l(\ ~Le..0.e.()-\- ~ CÀ- fvvb(lQ(h l ~ L~A-~
~ ~if"",-+ q~ ~cl <!f\'LL C(¡I
C. PUBLIC EVACUATION:
~<l. ÎS lìb lß ,:J:,f(fs 1+.u«:L LMwid I~
fVu.... S,,",'öf· I ~ Q.,U5i-1>~ (!A-nn£Jf- WA-t i:
~I Ir-e.p¡:r;('-S --+:, io.L d~ \/\ ~ Sh"ò~.
D. EMERGENCY MEDICAL PLAN:
gal(" -e'5J- h U5f I -kJL
3.
FDl:>;'
· Bakersfield Fire Dept. A
e Hazardous Materials Division .,
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HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A.
RELEASE PREVENTION STEPS:' "
lú~ DiG <s ¿:,(e,r-ed. \1'1 55 ~A-0 ÙílÁ(hS. µ(\Á(}/}";:> A-f-e <
AA~ (b\- a.ll ~ Cl-vt c\ ~ ey..t ðt dür.é-<0t- "TI~ 6 c(L,
~\ ty fYtA-;~,~~t"~t-~ ~ pLU"\d-uA-.e.s
B.
RELEASE CONTAINMENT AND/OR MINIMIZATION:
;}.,~ ~'tft\~lA~ ~ ~\'lJ- ~~f'\J.. ~.
Oì0 ÐrL\.fY1S. U'l~ C>'õ\--"b(~IY)A-b(~. Q~~Ø;>~.
m~+t£i ~L ..
C.
CLEAN-UP PROCEDURES: ~~ v-n hiU... fu-a.<d-~4f~
~&* \ ~hD0eJ ~<4- [) ,~p4..e. ~ f++ A"f) ft-(Jf>(opr(A:--tb
Lù'~ ~{>~~btt'(LlLt~ l"n Ql!J[~~ l).}1'k-- ~ír4+-f-
QPfLt<l~ ~ '"' ~%~M-(bf\S .
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATÙRAL GAS/PROPANE: ()-vY\.L-
ELECTRICAL: W-etnt4L (1Ùúi- ~ et'\v,cbi.!'f~· /ydf:)ft\. ,{lJ1T1 ,'~
, (Y\Þ--I;....· t.h-c.e<T-t~ ì~ LæM'€<! \,... Pz>\O-eÁ teoOP"l ~ t" ~~ ~
WATER: (\I\A-:L \Þ~r l hJud2... l.:ttL~ i)'\ @.r..ae?.t1J~Lù(.+å:o cpr:u.)@.I(' ~
SPECIAL: pt ~
LOCK BOX: :';fES/@ IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABILlTY:
A.
PRIVATE FIRE PROTECTION: I. c..' L I ., ./1,1 L.{¿
~e..... (}r~ (\~l\<e-\.e$'" p0e..ffU.A-d-. dfrl n ~~~ ¡VJfïtV .
PN.... VYlcdl.¿ ~A-(O ,~c..,.~ar~·I~ó-fL.er 'EM ~~~f\-s.t ~1YU
WATER AVAILABILITY (FIRE HYDRANT):
B~ }.,. (-.e- h '::)d íA1\...\: L~Ul-4cl 'lX\. ~ Se LA- % ~ t Q~R..tI-R.-r
V b ~ y- -eA12- dr\ \.Ie ' ~~A-'~ F0159\
B,
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SIT E t'AGRAM 0
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F-=ILITY DIAGRAM C
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NAME OF THIS FACILITY:!)~rnD
STANDARD IND. CLASS CO~-'-
DUN AND BRADSTREET NUMBER--'
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Standard
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BUSINESS NAME:
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and Agticu
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mmediate Component
Health
C
o
Sudden Release
of Pressure
Number
o
Delared
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o
th Haiard
applYI
Reactivity
o
PhYsic~1 'nd Heo
(Check a I that
Hazard
re
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Number
Number
C,A.S
C.A,S
Nalle
Name
t2
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Immediate Component
Health
Component
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De Jar ed
Hea th
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o
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Number
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C.A,S
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Name
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Health
Component
o
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of Pressure
Number
o
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'nd Health Halard
a I that applYI
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re
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Number
C.A.S
Nallle &
Name
t2
t3
mmediate Component
Health
Component
o
Suddfn Re 1 ease
o Pressure
o
C,A,S
o
th Hlalard
app YI
o
'nd Hea
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(Check
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Number
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ty
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React
r e Hazard
Certifjçatio" fReed and $ign af1ßr cÇ)mp7et
I certIfy under enalt 0 la th t J have persona h exanl n 0 0 d 1\
attaçhed dQcUllenfs, an~ t at ~ase~ on IIY InQuiry 0 lhose Inålvl~ua's
sUbmlt~ Infor;atlon IS ue, accurate, and co~plete
~'f;ie ~rõ~
this ond all
J believe that the
,ubllitte~ in
Information
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Tft'. u_
ing, ç¡". sec~ions)
familiar with the Information
responsible for obtaining the
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EMERGENCY CONTACTS
STgñãture
v~~or UN owner/~o~~horlleo repr
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<':1 f'Y 01- BAKER51-1HIJ
P.O. BOX 2057 "
BAKERSFIELD, CALIFORNIA 93303·2057
ADDRESS CORRECTION REQUESTED
DO NOT FORWARD· ,,:
..
ROMO AUTOMOTIVE
7001 WHITE IN -5TE 113
BAKERSfIELD, CA 93313
- - - -
1111 1./1...1. . ..II II
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HM691601
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Per
Waste Unified Permit
Materials/Hazardous
Hazardous
CONDITIONS OF PERMIT ON REVERSE SIDE
"
~ Hazardous Materials Plan
a Underground Storage of Hazardous Materials
a Risk Management Program
a Hazardous Waste On-Site Treatment
~ 2001
Date
JAN
93309
roved by:
or
PERMIT ID # 015-021-002193
COMPLETE AUTOMO
7001
LOCATION
Issued by:
~
Issue
Expiration Date:
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UNIFIED PROGRAM IN'ECTION CHECKLIST
.SECTION 1 Business Plan and Inventory Program
Bakersfield Fire Dept.
Enironmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
FACILITY NAME
CO",",
ADDRESS
~~~VL_í_e-\?~£__.~_________.___________
W h ;\e L.v ::a- -il5-'---------- OC1 2. 9 7.\)\)~__
INSPECTION DATE INSPECTION TIME
1()~..:-_o3. _L5_~~_~__
P~E No, No. of Employees
--~-------
~3.2v<¡S;t~O
Business ìD Number
15-021- Ó .;1IG3
700\
FACILlTYCONTACT
Section 1: Business Plan and Inventoryprogram
o Combined
LJ Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
C V
( C=Compliance )
V=Violation
OPERATION
COMMENTS
t;j 0 ApPROPRIATE PERMIT ON HAND
-----,----------'------- -...-.---.-----------.------.----.-------.-----..-.-.--.__.__.....__.._.._-----~..__..--
IJ 0 BUSINESS PLAN CONTACT INFORMATION ACCURATE
-------.------....---.-----...--.----.--- .--. -_._~_._----,------~_._._--_._.._...-. -_..~------------ ----.- --_._---._...---~._._-_._--_._. .--------
~ 0 VISIBLE ADDRESS
I
._.~-------_.._-----._-_.._-----~-- - -..------------- ---.-.---.----.---.--------------.-----.-. --_._-----~- -.----.-.-----. ----
La 0 CORRECT OCCUPANCY
¡g¡ 0 VERIFICATION OF INVENTORY MATERIALS
--.---------.--- ---~_..-._---_.. --.-------. _.---_._-_.-_._---------------~-----_._-_._------------ -
--------------------.-- .--- _._------_.._-----~-_._--------------_._---_._---------.------.--. .--.- ..---------.-
~ 0 VERIFICATION OF QUANTITIES
.
~--------._------------_.-_._---_.~----_._"""'----- -------------------.---_._------------~------_._.__.---.~._-----_._--_._-_._-_.
~ 0 VERIFICATION OF LOCATION
~--~----~-----~--~---------- --------~-~--_._--_._-._---------~---_._.__._-_..._--------~._--.-
131 0 PROPER SEGREGATION OF MATERIAL
_._----~._----------_..__._---- -..------..------------ --_.~"'._-------------- ------.---.--- ,-.-.-.---
9!1 0 VERIFICATION OF MSDS AVAILABILlTYE
--------..------ .-.----.--- -~-_._.__._-------- ----_._-_._-------_._--_...._------------~--------_.-
~ 0 VERIFICATION OF HAT MAT TRAINING
----..-----.-----...----
-~-------_._.._-~---------_._--_.-----------~_.__._---._.__._-~--_._-_..__._-----
I)t 0
~ 0
~ 0
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
_~_~__._.________.__.._.___ ______.__._____.__..___.___.__.______...____~_____._._____<_e___·____
EMERGENCY PROCEDURES ADEQUATE
-----_._~----------.-._- -_.._-~-----_.__._-_._-_._------_._------_.-----,--_...----.------------------.-..----
CONTAINERS PROPERLY LABELED
~~------~-----------_._--------_._--_._._. --~------_._-----------_.__.._----_._---_._---_.- -.-..----.-----.-----.----.-
¡¡ 0 HOUSEKEEPING ___ __ _______j=___~____________________________________
I)iI 0 FIRE PROTECTION
--~----------------------------- -------~---------_.---------- -- - --- -- -------
~ 0 SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?: 1\ YES
o No
~
EXPLAIN: ()J+-s. T~ 0 I L
.
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-
~11~LC--------------~~S_:_
Inspector Badge No,
White - Environmental Services
Yellow - Station Copy
Pink - Business Copy
~u
e
V',/
~~ ~
. f· "~OMPLETE AUTOMOTIVE R"IR
SiteID: 015-021-002193
Manager :
Location: 7001 WHITE LN 115
City BAKERSFIELD
'Lø
~:~~ \ ~
BusPhone:
Map : 123
Grid: 16D
(661) 834-4899
CommHaz : Low
FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 09
EPA Numb:
SIC Code:7538
DunnBrad:
Emergency Contact
KIRK LOWE
Business Phone:
24-Hour Phone :
Pager Phone :
/ Title
/ OWNER
(661) 832-8280x
(661) 834-4899x
( ) - x
,} Emergency Contact / Title
Jo",r~~ LOWE / OWNER
Business Phone: (661) 837-6060x
24-Hour Phone : (661) 834-4899x
W \ Pager Phone : (\J)\J}\ );;xß -\~ x
Hazmat Hazards:
Fire
DelHlth
Period :
Preparer:
Certif'd:
ParcelNo:
to
Phone: (661) 834-4899x
State: CA
Zip : 93307
Phone: (661) 834-4899x
State: CA
Zip : 93307
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Contact : KIRK LOWE
MailAddr: 8828 CLYDESDALE
City : BAKERSFIELD
Owner
Address
City
KIRK LOWE
: 8828 CLYDESDALE
: BAKERSFIELD
Emergency Directives:
I, 'fOÇ'¡f\Q.. Lcl\.'f> Do hereby certity that j N!M19
(Type Of print name)
Mviewad the attached hæardous materials mana~®--
ment plan ~Q)~~ and that it along with
(Nmne Gf lußlneœ)
any ooi1'edions constitute a complete and correct man-
~(B meni p;!an mf my facility.
C ~~\~.
Signature
~I/ { 0 ~
Date
-1-
08/04/2003
,<'(
~
. \
F COMPLETE AUTOMOTIVE RE~IR
I
f= Notif./Evacuation/Medical
Agency Notification
-
SiteID:
015-021-002193 ì
Fast Format ì
Overall Site ì
01/03/2001
Employee Notif./Evacuation
01/03/2001
CHECKED VISUALLY AND BY CRANES WASTE OIL WHEN THEY PUMP THE TANKS, MONTHLY.
YQ(){\C-
EMPLOYEE WOULD CONTACT OWNERS/EMPLOYEES, KIRK & ¥SNNA IOWE AFTER
AUTHORITEIS SUCH AS 911 AND/OR OFFICE OF EMERGENCY SERVICES AT
1-800-852-7550 FOR ALL SPILLS THAT ARE A THREAT TO LIFE, SAFETY
ENVIRONMENT. SPILLS NOT CLASSIFIED ABOVE ARE TO BE REPORTED TO
PROPER
OR
LOCAL OFFICE
Public Notif./Evacuation
01/03/2001
IT IS A HAZARDOUS SPILL. ~~LOWE WILL
COMPANIES. KIRK WILL MAKE SURE BLDG IS
FOR EMERGENCY RESPONSE TEAM.
OWNER KIRK LOWE WILL DECIDE IF
NOTIFY AUTHORITIES AND CLEANUP
EVACUATED IF NEED AND BE THERE
=Emergency Medical Plan
\ (,')f'\{\~
OR KIRK WILL CALL 911
WOULD BE KMC HOSPITAL.
01/03/2001
IF EMEREGENCY INDICATES. FACILITY OF CHOICE
-6-
08/04/2003
-
--
.
CITY OF BAKERSFIEI.D FIRE DEPARTMENT
OFFICE OF ENVIRONMENT AI.. SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd F'loor, Bakersfield, CA 93301
~P1...E. Ta.
FACILITY NAMFAuïO rze-PAlt<.
ADDRESS ,e>e>' w \-t 'Te- I-N #- I \C;;
FACILITY CONTACT j.c:::..t Z.¥-, L.CJWg
~
INSPECTION TIME ¡ 5 WI ìY\ \ '-\.... \ "::>
INSPECTION DA TE_' t - \ ~ ,. b 2,
PHONE NO. (Go Go I) 6~ - '-t'tib9 9
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES L-
Section 1:
Business Plan and Inventory Program
C2l Routine
o Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
e
OPERA TION C V COMMENTS
Appropriate pennit on hand V
Business plan contact infonnation accurate V
Visible address V
Correct occupancy V
Verification of inventory materials 1/ ,;'
Verification of quantities t/
Verification of location v'
Proper segregation of material vV'
Verification of MSDS availability 1./ :/ 2-1 ilk ~ +c.... rl"'-,;' r':), ,J.I,,- \-I ~¿
Verification of Haz Mat training ¡VI;
Verification of abatement supplies and procedures Iv
Emergency procedures adequate IV
Containers properly labeled Il/
Housekeeping IV
Fire Protection Iv
Site Diagram Adequate & On Hand ~ V-}.
I
\Zlz./t52-
C=Compliance
V=Violation
Any hazardous wasteøe?:
. Explain: ötl 4 /)"" ., PeZ€"
Questions regarding this inspection? Please call us at (661) 326-3979
~es
ONo
White - Env, Svcs,
YeHow - Station Copy
Pink· Business Copy
........
"
~~~~
-
--
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
l :>-::'-(<0 r{ <1\
HAZARDOUSMATEmALSMANAGEM~LAN
1 rJ ( n ~ \\~\.J \\rý' ~
INSTRUCTIONS: l ~ ~U f \ t/;1rf> \
1. To avoid further a . , return this fo within 30 days of receipt.
2. TYPEIP NSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
5. You-may a1so- attach Business-OwnerfOperator Förm and Chemic-al Description-Fonn(s) -- -
to the. front of this plan instead of completing SECTION I. below for initial submission.
, .
SECTION I: BUSINESS IDENTIFICATION DATA
RECE'VED
DEC , 9 ~nnn
EN'J\~o~t c;f..fN,CëS
. ,.~\
BUSINESS NAME;~\)~~ \\~~~\I<0 ~ '\X-
LOCATION: (~\ ~J\\\\~,~ ~D~ )~~ C\~
MAILING ADDRESS%~cl¿ ~~ \~
CIT~~cl~ STAT~ ZI~HONE:\.\'t<.)\ '6~ 4C69<i
PRIMARY ACTIVITY: ~~~~\\¡~ \=\~~\~
OWNER:~\~ ~~.. PHONE~\t)\ ~ ~q9
MAILING ADDRES~~ QJ."~~%<t:~ ~\(~\~) ~<:'Ç>.. S':>~ì
EMERGENCY NOTIFICATION
CONTACT
LV;~'Ç~ ~
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HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 11.1: DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND M9NITOFJNG PROCEDURE.S: I A:ì,' (
C-he.~ J.è.v-o-tly .~.~ bV~W"\-~ <; vVC:-~f~ C,..I
W~-t~ ~o'\CI\p -t<.~lS moY\+~ly
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- - .. -. Í3~' :'-E'"MPLOYEE AND AGENCY NOTIFICATION: " .-.- ..-=---== - -~--I
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C. ENVIRO~NTAL RESPONS~ MANAGEMJ?NT: .. 0...... _~r, ~t\\ .C'
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D. EMERGENCY MEDICAL PLAN:
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HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
NUMBEROFEMPLOYEES:d, - D~ ~\,y--'£vy~ ~~
MATERIALSAFETYQATASHEETSON.FILE~\~ ~\è.s¿- ç~\'f\S
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BRIEF SUMMARY OF TRAINING PROGRAM:
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CERTIFICATION
I, \-\ \-f-'K. \ QU...R.. 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 AZARD US MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND
THAT C INFORMATION CONSTITUTES PERJURY.
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HAZARDOUSMATEmALS MANAGEMENT PLAN
SECTION 11.2: RELEASE RESPONSE PLAN
A.
HAZARD ASSESSMENT ANp PREVENTION MEAS~S: , ,,_ .,. _~....., ..e-
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RELEASE CONTAINMENT AND/OR MITIGATION:
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C. CLEAN-UP AND RECOVERY PROCEDURES:
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UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROP ANE:
ELECTRlCAL: g~~~ ~c.~
WATER: :t'^ ~_ -=-_~ø
- -- - -- ~ -SPECIAL: --- -~ -. ---
LOCK BOX: YES/NO IF YES, LOCATION:
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PRIVATE FIRE PROTECTION/W A TER AVAILABILITY
A. PRlV ATE FIRE PROTECTION: ~,('(.... b ' ,.,,1
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B. WATER AVAILABILITY (FIRE HYDRANT):
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. CITY OF BAKERSFIEL"
OFn"'CE OF ENVIRONMENTAL SJm.VICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER I OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page
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100 i Year E~i~g _, ,
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I OWNER NAME
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104 I CA I ZIP S~
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106 I SIC ,C~:>DE
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105
107
108
109 I OPERATOR PHON~\
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123 NAME
125 TITLE 130
126 131
24-HOUR PHONE 127 24-HOUR PHONE 132
PAGER # 128 PAGER # 133
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Inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined
in ati submitted in this inventory and believe the information is true. accurate, and complete.
OPE TOR DATE 134 NAME OF DOCUMENT PREPARER 135
\ \-\C\-C?()
136 TITLE OF OWNER/OPERATOR 137
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.. CITY OF BAKERSFIELIa
OFFTéE OF ENVIRONMENTAL S~VICES
1715 Chester Ave" CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
,_~~E~,_____-.9_ADD ___~~~TE
200
o REVISE
. " ,;,,:. II.C~EMIç:ALINFO~MATION.;.>;
. " , . ". Y' ,
(one fa"" par matarial par bUitdi".9.Jr araa)
Page d- of .::>-
.---.-----...--..--..---.--'--.-. '-. --- -----~ _._----- - .-- -.- -
201: CHEMICAL LOCATION
i CONFIDENTIAL (EPCRA)
203 GRID # (optional) .
3---
o Yes 01 No 202
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CHEMICAL NAME
~obar 0: \ I
I COMMONNAME0\~ D,\
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CAS #
! TRADE SECRET 0 Yes ~ No 206
If Subject to EPCRA, refer to instructions
207
EHS'
o Yes til No 208
209 'If EHS is'V os,' all amounts below must be in IbS-
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
TYPE
211
RADIOACTIVE
o p PURE
o m MIXTURE
PHYSICAL STATE
214
LARGEST CONTAINER
iii I Llau 10
o s SOLID
o g GAS
DYes ~No
~ C9.cl Lon.. ç
210
212
CURIES
,
. 213
215
01 FIRE
o 4 ACUTE HEALTH
216
FED HAZARD CATEGORIES
(Check all that apply)
ANNUAL WASTE
AMOUNT
o 2 REACTNE
o 3 PRESSURE RELEASE
217
MAXIMUM ~ /' I _" ___ 218 l AVERAGE
DAILY,.,UNT ^ V<-I UJV" J ! DAILY AMOUNT
~ GAL t 0 ct CUFT 0 Ib LBS 0 In TONS
. If EHS, amount must be in Ibs,
UNITS'
o 5 CHRONIC HEALTH
219
ST~ ~A\TE CODE
DAYS ON SITE
20
222
220
221
223
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
OJ TANK INSIDE BUILDING
ðl'd STEEL DRUM
~ AMBIENT
De PLASTIC/NONMETALLIC DRUM
Of CAN,
o g CARBOY
0, h SILO
o j FIBER DRUM
OJ BAG
o k BOX
o I CYLINDER
STORAGE PRESSURE
o m GLASS BOTTLE
o n PLASTIC BOTTLE
o 0 TOTE BIN
o p TANK WAGON
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
o ba BELOW AMBIENT
o aa ABOVE AMBIENT
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226
o q RAIL CAR
o r OTHER
224
"';'.',,"
o c CRYOGENIC
225
~:;·······:.·E:'- Si;:·i
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227
o Yes 0 No 228
229
233
2
230
237
234
231
o Yes 0 No 232
241
4 i
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238
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235
o Yes 0 No 236
239
o Yes 0 No 240
243
o Yes 0 No 244
245
DATE 246
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. .........
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
. CITY OF BAKERSFIELIa
OFFTéE OF ENVIRONMENTAL SIMVICES
1715 Chester Ave., CA 93301 (661) 326-3979
_~~~______D ADD
o DELETE
o REVISE
200
(one form per malenal per buildiO!l..{;r 3",a)
Page 3.. of ..J-
,.____.__.____.._._____.~_... _. _·_··ø...__._.. ______~..._
I. FACILITY INFORMATION
'--'-'Ñ'èss NAME (Same as FACiliTY NAME or DBA - Doing Business As)
u___~_ ' 2L~~~\~~ ~~,~
CHEMICAL LOCATION
--3-
-- --~_._-----,.~-
FACILITY 10 # I
I
I
11 MAP 1# (optional)
!
203
201: CHEMICAL lOCATION
CONFIDENTIAL (EPCRA)
GRID # (optional)
DYes ~ No 202
'---204
' . "-. .
- .,'.11. CHEMICAL INFORMATION ;,
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";....,;
\ -
205 TRADE SECRET 0 JIg '
Yes J IIooI No 206
If Subject to EPCRA. refer to instructions
CHEMICAL NAME
....
CAS#
207
i
i
i
1
I,
I
i
---
EHS'
DYes t1 No 208
209
·If EHS is'Y es." all amounts below mUst bci in Ibs.
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
217 MAXIMUM
DAILY AMOUNT
218 ! AVERAGE I /"'!. L ~ ..
' DAilY AMOUNT l,9C. v r "
219 Sr.
210
, 213
215
216
CODE 220
222
223
TYPE
o p PURE
~~RE
o w WASTE
211
RADIOACTIVE
DYes ~No
212
CURIES
PHYSICAL STATE
o s SOLID
LARGEST CONTAINER
GttØVL ":>
FED HAZARD CATEGORIES
(Check all that apply)
ANNUAL WASTE
AMOUNT
01 FIRE
o 2 REACTIVE
o 3 PRESSURE RELEASE
o 4 ACUTE HEALTH
o 5 CHRONIC HEALTH
UNITS"
ga GAL <\_ 0 cf CU FT
"If EHS, am~e in Ibs,
o Ib lBS
o In TONS
221 I DI!!!:l:!:/ITE
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
Db UNDERGROUND TANK.
g;. TANK INSIDE BUilDING
ïrd STEEL DRUM
De PLASTIC/NONMETALLIC DRUM
Of CAN
o g CARBOY
o h SilO
o i FIBER DRUM
OJ BAG
o k BOX
o I CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTLE
o 0 TOTE BIN
o p TANK WAGON
o q RAil CAR
o r OTHER
STORAGE PRESSURE
~MBIENT
~MBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
STORAGE TEMPERATURE
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
o c CRYOGENIC
225
-.,.... ,""",1
CAS#." I
226 229
227 Dyes 0 No 228
231 DYes 0 No 232
235 o Yes 0 No 236
239 o Yes 0 No 240
243 o Yes 0 No 244
233
2
230
234
237
4
238
241
242
245
'" '.,'.'
,,,;'.
DATE 246
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-----~~
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PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE
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UPCF (7/99)
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