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HomeMy WebLinkAboutES-BUSINESS PLAN 11/8/2001 - --\ ø Cll'Jf1t' OJF IffiA1K.lEn<&§WITlEILlIJ) IFnlRUE lIJ)JEJP'ARTMJENT 01FWITClE ow IEl\;J'VTIIR?ONMIEN1r AIL §lE~V~C!E§ lUNllJFHIElIJ) JP'IR?OGIR?AIW llN§]P'IE<CTllON CJH[!ECKlLll§'}f nïll5 Cfine§~eJr A. \'e'9 yd lFITol[ )r9 ]ffi;nlkeH"sffiieHtrlJ9 CA. 933«»11 ~ FACILITY NAME :Jþ~I\.!'ç:, TiW(J;PétdJiJfï 1111/dJfM- INSPECTION DATE N- cf- () I ADDRESS 7~ , tJ N-i"r:tfL ~'t PHONE NO. 3 ~6 - 777 JI FACILITY CONTACT_ BUSINESS ID NO. 15-210- INSPECTION TIME ~. \S - 3·"lS" ~ 0 I/">. ,'"". NUMBER OF EMPLOYEES §ediollll n: Iffi¡¡¡¡§ñUDe~~ JP>ITsnUD ~UDtrlJ llrm\'eUD~I[ ) j'Y JP> j'(QI~rr.IDmm ~ Routine o Combined 01 Joint Agency OJ Multi-Agency o Complaint ORe-inspection OPERA nON C v COMMENTS Appropriate permit on hand V Business plan contact information accurate v Visible address ¡/ Correct occupancy v Verification of inventory materials V C\JO A t\.)~ç:s ~t: æ...e. S>R.u......s" 1...,5,Î7'd' ¡,Uo W~....-t¡ø f'\\\ r\.c"....c:. I ,'"t-eJ Verification of quantities V \ \0 e.i\r~ W",...Te ò,\ HO 6",\ A¿r:i .-e..,...", Verification of location v o~~.v <. A.(eT~I...... 1õ"'ch IV'" ""IS.'ÞcP Proper segregation of material V Verification of MSDS availability . IV Verification of Haz Mat training V" Verification of abatement supplies and procedures V Emergency procedures adequate V Containers properly labeled V Housekeeping V Fire Protection v Site Diagram Adequate & On Hand V ~ C=Compliance V=Violation &\ A.IffiY fina!ì7laìHrdo1ll1s wsn§~e (QI1ffi sUe?: ~¥e\\) ON(QI Explain: Questions regarding this inspection? Please call us at (660326-3979 ~~~S~ResponSible Party White - Env, Svcs, Yellow - Station Copy Pink - Business Copy Inspector: G ~ 9~ Operate Waste Unified Permit it to Materials/Hazardous Hazardous CONDITIONS OF PERMIT ON REVERSE SIDE o ~~717J"-'~';:;;-'-- ~....('~ ..~??,rr<'".. ~__ " <::.rrf¡f¡'r7l: .ll..'~:" '/0>:)."3.:,,,,,,, ItI Hazardous Materials Plan -:::I-I' " L£¡~=~.-=? /.-i" -' rc, ~ 0 015-000-001855 ¿¡1i ¡ !.' ¡þ,b~ 0\ \"¿;~''':'':::'/'''''''''''');h Underground Storage of Hazardous Materials 'F"",'¡I)?' "-'<'" £fIt ¡ ,~ r:.;:;'~ /~~~ oRI kM ,,"Í' , ! j¡J; /' \ ,n ' / ,- " I ~ , j r' Ì' .~,' /~ S anagement Program . N DE PEN DENT H ON D. Af{ø:þ'-A!C'\'ì~ìS=¡¿?2;':JJ~.¿':!.;!j{":/;r~.r;;;:",~~ 0 Hazardous Waste On-Slte Treatment ~ ~ I!-\ }""U ~~~~~ ...-...¡,.~,- ......_.:¡..,.J.~ --... : \ p.J ....~ ~"'l'i. /('!"Ì¡fl}.t: ~\ N JI~r....:r~~ ,vj¡~},,-''''.R' ,~)-~~"""_"'1.,'\ ,0,~"H'> 7001 WHITE LN 120 /f'. x, . l' "13A"'-':' .",.4' "'Fh' \.: I,'" v " ,,;1 """.;"<~:?..,~Jj\ \',\/, "1:-... - \ ,r7'\',; 'KERS ELD "'f¡¡;- '<',·~·.I3" t<"~'--'" 't'. ',¡1, ~ 1>'" ~ N/1 r :;g~ nð-,\',"<-'--::\ , , '. \ ' . ,\,;í~.t'~, +1Jili1-,. '> --., Ii- ',//'--.: , /Y'" £ ~ -, S \' ~.....";\ ..-...: ,;¡~,~·.·~~/~;/~.v.~}i _-hj'':'~~-), ,~~:1 ~'-~_ ~~/'.~1·':: ~\ '(',," J/~"^' . "0':.£'~""" r. ¡ .- \';.-r:../ :.J,\.,-.z~ .'t\ '. J i'\"'~1 f! ..A-' ",'i:;¥'J,¡~ j i f '\ \., '<.>l}.;' . .._~ G.>- ,1 :~::"'~--:"7 'l/ . I /', \, ¡j\. ·\\'~:_0·f:-.5> ~i, -_. # 17 ~7 r;: ~~..r; \. \'tv, .~ '¿-,"'-.~~.... "f.. &.1':::;'._.-1 \" "">\ /.<.. ", 1'" ), ,1 """"" ~ .......:.' " )' j"'(FI¡';-'" \" 'II. 't'" ,! .~~" .'~ \'"::~-;;i,t¡ ~~;;..;h..,...,-<.~~¿~ ::.~,:/.fr1 ~~~'" ~~~ ____ t ~...;y ¡.. '. , ¡ , '.. "_'<0-_ Ofc_"'5-'''' "'hf ! . ,I ,t·ç:.~. . . \ '.~.~'J 1 '·jì :f . .. "o:~ "'" ... 1.1...· Î ~ .... <r 1 I \ " d". .¡ ,., ç",~;;, -- ..'...Ch-'J;.Þ"i'i"'i..J ., i r ·~f~ ~,¡ "\. /{ . "'~,il .~, t ,t{ ,p'. ':~3/::!~"\~,~l/ '¡ .I,:.' ·:·r~. ¡(~;!~. F~~ ~'i ? \; "'lk '! ¡~¡i.'¡~¡~1:';f'2f1'-5~{Z¡Aj'~0,,,;. :J~ ~1 æ' ..,,:~' \ :.'\ . \\, "~:::::~·..;~~~Zf1i¿¿:P~~)^;/; /~' ):;tJ t:~::)! 'f. .... . ,"- ~ ",- .Å"'~"""P· ~ tA.._.'r~/-!:{'''' /;ft, ..¡, . ß' ., >,j{l 1)-. f\ 11 . - ,...g"N _ \.:£' '\2,,/-.1 .r"· ~.:.-.---....,"', i J (ê..-.... 'fi.... 't,'.J"-""(!( '07"r~ c,~· . , ... .': ' 't ~""'.~ < ~ ~~.\. )< .-'\+';.>' ~.0?- . . r-r J1., \..,\J! t' - \ '\). , ,;:..:,~ . i . A,f,,· "$)'0' 1';;:;" \. Ò. 1., " ,,,.:t.;;, -" ./ . "" \. ...~,"" ',/0> ". Ii;;" "'~". ~ ír;:::·"'.:\ ".' 1'1 ". , . '{:o" '-.\ "'/f " '\.! ",\.,~:-\:.,..." ... ~ ... , ' '// ~..' '.' \'.. v ,~.:.,.;t·p., 'I ~.Q~; "'....{/ . ,'. \If \;;;"-~~"".A'f .~.... 'C·..",hV ~~ \~. "}þý' ,,'.¡ß ~. -.. '\.,,.,,('Þ'!Z "h, ·.);{A a.A· "~ " '"7 -.':~' ..',' ,?f .1 rf' ........:-~}.:;~\ ì\")"-;> . < <,¡Y ~... .-.). 0- ~. ~ ,\ t· '4 - ,,:'.:~, ~"'7/1ß-~~-~\'\-F))"ì-~~' ~» ~W; i . J7 __ ~~w: lor \¡ ~, v,. )1\' . ¡ . ¡! {.7 .' ...' <.j ./ ¡ . "'"'" \,. ¡ . ~,,, . " ___. S..' JJ '...:;'J . ~~' ¡ . . 1,¿;r'Y ~~.~ >"-~.~J"~" }~~~~."-''":~~·i''/.¡.¡ ~~,-btj-~ ., / . .r I' ' ,'.' . . ! : :..ø-. ~-=!¿,~~~ Permit I D #: JOHNS LOCATION: Issue Date Approved by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 'iCES FAX (661) 326-0576 Expiration Date: Issued by: I . SITE DIAGRAM * Business Name: Business Address: \ --~-------~ --~~-- --~-.- - -~----~ fT(J'\D~1 f "., ,I \ V-J.,,~'-... f¿ 1¡i Vw';''-':f. '.;~ , _'¡:¡;..!1 ,,!, it, .,1\\. 1'"" ~ >" . '..', €(1.\·it,-" "J 'i.V'!}:~ :., 1.0 - ·mr.-f'. AT THE SOUTHEAST CORNER OF ~ .0. nrU1TE LANE - 1 lot I(,J ~ao ! 1 ..0 .. ~ . .. f1 9~O '~7a :I' ~eo f . 9$0 1..· 1 ..0 ~ t j- " Il~llmti ~~l , i I Ii, I ~I ~_tDl ---_._-~ - ---~---~--------- WHIn: LANE I Slo<'.'" "w ( --- --li '-1IKfRNCITV ! n_.... ~i! _.~. <, .. 0: . 't: J! ~\ ~\ ¡¡.\ ¡J~,." I \ QAtlGRllçmtD 8ryndaRe In ¡ . .}R I ctil ~ I ~f&,~~ - ¡ i I~ ,0: a :; ð x w ~ U~~fIED PROGRAM ~N'ECTION CHECKLIST I -"~ p",... <f#_'~,.' ""_"""'_',.-r"'_'"''''~-'''~''"''''' ._,__:"~, "". ""'"""'__~"_'«' ,..,"~"'" ...,!"", -. !"~-VJL"'¡" .3ECU~ON 1 Business Plan and Inventory Program f7Jv~ ()/)(.ßLt..¡ÐÞJ1.d~ 0~ WjÆ.//~~ Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 ADDRESS FACILITY NAME ..:r Ð tt'/MU A-v nJ IlA-o 1:1 vt4 ~ ~~~---=M _~~==~=_~=~~~~~~~~~~ ---==--- INSPECTION DATE INSP/EC~ TIME 10-'1.-oJ S PHONE No~----- No~ of Empïõyees'---- J ¿ ~12 to ______ ~___________ Business ID Number ~. 15-021-1D Ou eb,-~- Section 1: Business !Plan and Inventory Program ~outine LiI Combined LiI Joint Agency LiI Multi-Agency LJI Complaint LiJ Re-inspection ~ '¥J ( C=Compliance ) V=Violation ~ õ1 ApPROPRIATE PERMIT ON HAND --~----~~--------------_.~------- -_._--------_.,-----------~_._._---- --.-------- ~ õ1 BUSINESS PLAN CONTACT INFORMATION ACCURATE if'r::iJ VISIBLE ADDRESS ~ õ1- CORRECT OCCUPANCY -------------~ ~ õ1 VERIFICATION OF INVENTORY MATERIALS ~ VERIFICATION OF QUANTITIES OP!ERAT~ON COMMENTS .-----.----..------------.-.----.-....------- __ _______ u.___..___.._______~_ ____ ___ ___.._____..______ _______u_.__ _________u___._.. ~__..___.__.~_._______ ____.__ ____ .________ --.--+-----------------.----------. - --- __u________+__~_________~ _________________.______________ _... ____________... .____ ____ _u __ __u__..______________.._______.._______.____.__.___._________~___.~_____ ______..____..._.___ -------.------------- .-+--------- - ------ --------~-----_._-------_._------------~- ...._~._---~- .-- ------ ___.~.______. __.____._.......__ ____________________._.__________________~_._ _~. ~._.__._.._ .___.____. ___._ - _on. u _._ _. ____ W õ1 VERIFICATION OF LOCATION -------------------------------. -------------_._-------_.~-----~-~--_._.._----------_.--------.----.- rï?r" õ1 PROPER SEGREGATION OF MATERIAL ~ õ1 VER;FICATION OF MSDS AVAILABILI~-;--------------- ----------.--..--------- --.--...-----.----------- ----------.---.- ---- ----..----.---...----- --..----_._- -~-_.- ._._----~ - ----..--------------------------------------.. rp/' õ1 VERIFICATION OF HAT MAT TRAINING ---.------.------------.----...----- _____~__..___..________..___.__.._______..______.____.._._.____ __.u __________.___.___. õ1 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~~~ERG~NCY~~~~E~UR~ ADEQ~~=-=~~~~=~-_~~-í-~~~=~~~~~~::~=-~-~-~~=~=:-~~~-~~~~=~~_~~~~~~~~ ~ õ1 CONTAINERS PROPERLY LABELED ---------------------------.------ ..-------.-- -.--.------.--------------- ._._--_._-_._._---------------------_._~----- - õ1 õ1 HOUSEKEEPING =1= ~- ~F~E PROTECTIO~~-=~~_=~_~~-=~-==~~_ ____~=~=-~~~-~_. --~~~~==~~-~_~==~~:--_~_~_-~_ õ1 õ1 SITE DIAGRAM ADEQUATE & ON HAND ~ ANY HAZARDOUS WASTE ON SITE?: ~ [j No EXPLAIN: (j) ,., ~ {AN; 1uk e I-c:. ' [1/ 1- ~ HmO!(>3 I . --------~-------~ Badge No, White - Environmental Services Yellow - Station Copy Pink - Business Copy -qL -. -- - JOHNS INDEPENDENT HONDA & ACURA SiteID: 015-021-001855 Manager : Location: 7001 WHITE LN 120 City BAKERSFIELD CommCode: BAKERSFIELD STATIO B'ff: EPA Numb: RFr:ì8lrVED ,:~iN 11 2001 usPhone: ap : 123 rid: 16D (805) 396-7778 CommHaz : Minimal FacUnits: 1 AOV: IC Code:7538 DunnBrad: Emergency Contact / Title Emergency Contact / Title JOHN JACOBSON / OWNER KERRI JACOBSON / SPOUSE Business Phone: (805) 396-7778x Business Phone: (805) 839-5272x 24-Hour Phone : (805) 845-4601x 24-Hour Phone : (805) 845-4601x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : Phone: (805) 396-7778x MailAddr: 7001 WHITE LN 120 State: CA City : BAKERSFIELD Zip : 93309 Owner JOHN JACOBSON Phone: (805) -8454x601 Address : 4501 N WHEELER RIDGE RD State: CA City : ARVIN Zip : 93203 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List l All Materials at Site l p= Hazmat Inventory p== As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP MOTOR OIL SOLVENT F" F DH DH L L 55.00 GAL Min 5.00 GAL Mod l.-=r°~ -::r~w g,'50eJ Do hereby «;Œm1i~ ~htði~ ij ~al\f® (Ty~ or print nama) revIewed }~~;~í~1~!:e:2:&~~~rfff~ ~~~®úitæ~$ mantæg~- ment plan ýor ~i1<õ1 ~hBl~ ij~ ~!©n~ w¡~h (Nam3 of BUIJinøss) any correc~¡ons C0t1s~i~IU~0 tal cöm~ls~® tãli1d e©rr®ct mtàlf]- '~" " ,.. r ;,' ~" 12/12/2000 h ¡ -- e F JOHNS INDEPENDENT HONDA & ACURA p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME MOTOR OIL SiteID: 015-021-001855 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit REAR OF SHOP Map: Grid: CAS # 8020835 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. RS CAS # 100.00 Motor Oil, Petroleum Based No 8020835 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME SOLVENT Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit REAR OF SHOP Map: Grid: CAS # STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 5.00 GAL Daily Average 5.00 GAL I l~~~ôoINaPhtha HAZARDOUS COMPONENTS ~ CAS # I 8030306 HAZAR ME TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod 0 D ASSESS NTS -2- 12/12/2000 It e F JOHNS INDEPENDENT HONDA & ACURA I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-001855 ì Fast Format ì Overall Site ì 02/23/1998 CALL 911 CALL BAKERSFIELD CITY HAZ MAT DIVISION Employee Notif./Evacuation 02/23/1998 ] 02/23/1998 r EMPLOYEES Public Notif./Evacuation EXIT THROUGH FRONT DOOR PUBLIC IS NOT ALLOWED IN WORK AREA. Emergency Medical Plan 02/23/1998 FIRST AIDE KIT POSTED DIRECTIONS TO URGENT CARE -3- 12/12/2000 e e F JOHNS INDEPENDENT HONDA & ACURA I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-001855 ì Fast Format ì Overall Site ì 02/23/1998 WHAT STEPS DO YOU TAKE TO PREVENT A SPILL FROM HAPPENING????????? Release Containment 02/23/1998 HOW WOULD YOU CONTAIN OF MINIMIZE A SPILL?????????????? Clean Up 02/23/1998 ] I ABSORBANT MATERIAL FOR OIL SPILLS. Other Resource Activation (It, .t:< ¿~; ..Q ~..J 'c . . i( '\\ ~ It. t ((, '? .l v; ~",-I;,.,-- I {-- 'Î ...:- 1'--. . . ,-" '. \Ct~, V\' \. ; " _"'- _I. (") ( ¡ \'- -:," . ,,'\ ''\ 1@ '" ~ .. , 0 + z ,\' '/ .' - " í '/,,~. ,~; hI::: Cí:---:,--~ "''-'v', : t')~ (¡., ,',_,-.1. S tA..(,{ê\·¡> L. I f-Ì{,-, ',~ " ~),,-- "'/""" \~ J ".-\ ['""~.!l"\\~"r" (: ,I,_r·, ~" ,,,,,,"-. ,.> , ,\, , , . '\ ,.. ~ '"' J'" '- ~ \..:. '\ t -. -4- 12/12/2000 e e F JOHNS INDEPENDENT HONDA & ACURA I p= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 015-021-001855 ì Fast Format ì Overall Site ì I 02/23/1998 A) GAS - NONE B) ELECTRICAL - MAIN PANEL IN CENTER OF BLDG C) WATER - MAIN SHUT-OFF IN CENTER OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 02/23/1998 PRIVATE FIRE PROTECTION - AUTOMATIC FIRE SPRINKLERS AND 2 FIRE EXTINGUISHERS INSIDE BLDG. WHERE IS YOUR NEAREST FIRE HYDRANT - ?????????????? Building Occupancy Level -1 -) l' ! '" , \[0 I ..... \~~~-~:~- --~ ;. ;ì~It'~~'" ?- Fi~Jz- t~-'1 d2c.,. ~y,- .,j e, eN ".....J :\.{ -, " \ 'j t \1.J..:0'/ ~ ""-- , I" I.- c-, ~) ¡¿ -5- 12/12/2000 · . ~ " e e F JOHNS INDEPENDENT HONDA & ACURA I F Training Employee Training SiteID: 015-021-001855 ì Fast Format ì Overall Site ì 02/23/1998 WE HAVE NO EMPLOYEES AT THIS FACILITY. DO YOU HAVE MATERIALS SAFETY DATA SHEETS ON FILE??????????? GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: Page 2 r I I Held for Future Use Held for Future Use I ,-- {\ell.)v c· )(') ft; I" 1 pe 15 tt~, i ~..~ ~1..) ,,' /) J: hCtVE ,~c.A~rf"~~G:0s.S[1 ¡..Ar:~,· ~:"~:, I' r ~ \. ~ ),1'., ~?) !, : '.11"\. ':' ,\\ \ ',- . ' '-', -6- 12/12/2000 Per it to Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: zardous Materials Plan Iround Storage of Hazardous Materials PERMIT ID# 015-o21~01855 tQ,agement Program JOHNS INDEPENDENT HON Waste LOCATION 7001 WHITE ...::.. Issued by: Bakersfield Fire Department Approved by: _ OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rdFloor Bakersfield, CA 93301 Voice (805) 326-3979 Expiration Date: FAX (805)326-0576 --- - e .-,' ,'.--,.--- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave Id, CA (805) 326-3979 ( /~55 /,~~ HAZARDOU MATERIALS INVENTOR~{ Dt;!f¡IIUJ,~ (+~ l,{'öl I /0, 279 if) FACILITY DESCRIPTION '--~--'.Y~ .. '91 V/J IdS-lIoO ~~~ CHECK IF BUSINESS IS A FARM [ ] C¡~ø t --~I BUSINESS NAME . \l- FACILITY NAME ~, '- t:- 'É/í SITE ADDRESS ~ If h/fr - !Jr~ =# f ¿)() CITY /ftr1 t __ e_~- STATE CJ4- _ ZIP 93361 NATUREOFBUSINESS~P ({o-jXÛC SIC CODE ì 5:1 ~ DUN & BRADSTREET NUMBER OWNER/OPERATOR~6An JO/.f)by.!h PHONE ~Lf'5~VfoOl MAILING ADDRESS, '-j5()) M L1JA%er A/~tfA CITY }~Uln STATE ~Il- ZIP __ _ EMERGENCY CONTACTS NAMEJoh(\ Ja(oh.:5(JY] BUSINESS PHONE Õ ~Lo ~ 77 ) 7? NAME }{'eJf~ì ,J a cóh<.ðn BUSINESS PHONE ~ ~ 0/ --s ;( )~ TITLE '()W1l8r 24 HOUR PHONE 0 if ()~·lf (d)/ TITLE 5po{}dCZ., ' 24 HOUR PHONE gy S -Lj /Jf) / 1 HAttRDOUS MATERIALS INVENTO_ \ h I. 1 ð ~t- '. Page ~~of--=- Business Name, Q " ;:) rL~ I - -. Addœss ! OD 1iJ!~,:k W n'e.. . . ~ct ~ A0u-re CHEMICALDESC~<ft ;jf)~1 Ú/j f33ð9 -..- .- I) INVENfORY STAlUS: New b(J Addition [ J Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret[ J 2) Common Name: fV\ó -bY'" 0 ñ J 3) DOT # (optional) Chemical Name: ARM [ ] CAS# 4) Physical & Health PHYSICAL REAL TII Hazard Categories Fire [þ(] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ 5) WAS1E CLASSIFICATION '~'l.. , (3-digit code from DHS Fonn 8022) USE CODE ] Delayed Health (Chronic) [ ~(p 6) PHYSICAL STA1E Solid [ J Liquid [~ Gas [ ] Pure r)<! Mixture [ J Waste [ J Radioactive [ 7) AMOUNT AND TIME AT FACILITY Maximwn Daily Amount=tr= Average Daily Amount .' Annual Amount Largest Size Container ðJ 5 # Days on Site '3 V UNITS OF MEASURE Lbs [ ] Gal LXJ ft3 [ ] Curies [ ] 8) STORAGE CODES. a) Container: 0 (0 b) Pressure: 1/ c) Temperatw'e !l ~ J, F, M, A, M, J, J, A, S, 0, N, D CAS# % wr Circle Which Months: 1) 2) 3) lO)LOCATION ~ of- h ~ toOJ - d- ( 1) INVENfORY STA lUS: New Addition [ ] Revision [ S 9)~: List the three most hazardous chemical components or any ARM components COMPONENT ARM [ ] [ ] [ ] ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) ARM [ ] CAS # Chemical Name: 4) Physical & Health Hazard Categories Fire [}Q Reactive [ 5) W AS1E CLASSIFICATION rl-. ~ ~ PHYSICAL REALTII ] Sudden Release of Pressure [ ] Immediate Health (Acute)[ ] Delayed Health (Chronic)[ USE CODE (J 0 (3-digit code from DHS Fonn 8022) 6) PHYSICAL STA1E Solid [ ] Liquid [;<l Gas [ ] Pure [~ Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STO~GE CODES 6:) Maximwn Daily Amount .5 Lbs [ ] Gal [~ ft3 [ a) ContaIner: ¡/ ~ Average Daily Amount 5 Curies [ ] b) Pressure: Annual Amount ~ c) Temperature j Largest Size Container ~ # Days on Site . Circle Which Months: ~J, F, M, A, M, J, J, A, S, 0, N, D 9)~: List COMPONENT CAS# % wr ARM the three most hazardous 1) [ ] chemical components or 2) [ ] any ARM components 3) [ ] lO)LOCATION ~ I certify lUlder penalty of law, that I have personally e ' and am famili~, e infonnation on t1ús and all attached docwnents. I believe the SUb¡ïtted infonnation iSj~' accurat,e and complete. '~ ~~~ " ' Jôß1n En KJ¿aJo:5617 ,~.~ ,/;{-l-f/¡ PRINT Name & Title of Authorized Company Representative C. 'S' ture Date e e :- .. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 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 as brief and concise as possible. Qac.-;;x2( I qq 7 SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: joh~5 {f\dr- peY1d Gilt tIoflrJa cr fk~()[(j' LOCATION: MAILING ADDRESS: °7oo! [{)h//-to~ LQl1e CITY: 1?)C~Þs~'eM STATE:~ZIP:~HONE: 39}¡¿-77)'g DUN & BRADSTREET NUMBER: Iii ':' SIC CODE: "] j') 0 OWNER: PRIMARY ACTIVITY: MAILING ADDRESS: CONTACT TITLE L jD~r) Jaéóbjûy\ 6vn-er- 2. J<erri J (1{LJh,"'1:Jh 5¡ø1l.5e BUS. PHONE 24 HR. PHONE 3 9 ro--ì7) g olf 5 '-If (dJ / If 3 7-5;¿),J. y-~ )-~6t1 1 e e f .. HAZARDOUS MATEWALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: J2f MATERIAL SAFETY DATA SHEETS ON FILE: 3 "ir'5 ù B~~YCo~rk~:5 /)J(\~p~tm SECTION 4: EXEMPTION REOlÆST 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 QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, J ~fI\ Ja( ê)~.:.tJb CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TIllS 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 _ C AL. . ,~", . ~T INACCURATE INFORMATION CONSTITUTES PERJURY. ~l,J <C "~Q!'lA TITLE DATE 2 ~-.1- e e ,¡ ,'" ;--" HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EY ACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: taH cru (aU /0rvI (;P, Ha~ (hif, D(ln- B. EMPLOYEE NOTIFICATION AND EY ACUATION: (\u, E(V\pJrs~e~5 C. P~~~VAiT::;~ ~m~ P v ð v ~ ./1 ~ \ / wor-J¿ CJ!j1'éJJL ul/c ì j nOT Q¡/()!I()EO n D. EMERGENCY MEDICAL PLAN: h0+ fl)òe kì+ C P06tc0 Òìí"ed-¡'(jV)j fa ¡)~ ore 3 ·... , . ~ ~~ '.- .{". e e HAZARDOUSMATEWALSMANAGEMENTPLAN SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: ' f2 . 'I II o ; ¡ a b·~5CYr kÚ1 f-;II'1.Cr~'ttLQ . rDY' 0 ~ ¥ 7tl5 SECTION 8: UTllJTY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE: ¡~Dn.Q. ELECTRICAL: M:iìn fc¡'f1J:(l ~br of' bl¿ì{(};C4- . , , WATER:_LJJcJbr~ tnQJr ~)¡dbff Uy¡y~.fi- [--¡Jf!ðIIP¡ SPECIAL: LOCK BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/W ATER AVAILABILITY . it[ ^. J~. -At¡cfii!¡/Jri iJi::J: LJ) Ù1;}} 'd0, A. PRIVATE FIRE PROTECTION. f\¡V1JA.;,fOfVV , ,~r(} .. \.d bvrd rÇ, bVllcJhD¡r' ;), -A~ ext)fl¡Uì~ /(\51 t:: I I'd B. WATER AVAILABILITY (FIRE HYDRANT): ~es 4