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Home My WebLink AboutHAZ-BUSINESS PLAN 1/17/19997 I" I r) ,.~ H MjI P .. PLAN. MAP SITE DIAGRAM I 'ì< I FACILITY DIAGRAM Business Name: I//o/w 6;'~ /' Business Address: 7$'9, , t---r//7?Z £1"- ~/9-,.k... C,,4-· ?š'"Yo~ For Office Use Only First In Station: Inspection Station: Area Map # of NORTH {} . I ./ p~"'- ~,<.-~ ;I Ur/&/ ¡-;1 ~/L- ..~-,- . r. /.L>LLt £i'--"f'/2/T'-- . I I I I if ..",0., __ . e , ','/ III[)II= U \'O-l-cu. ,_C -~ ~ Lf::= J Ct ///' // ",----,/ January 17, 1997 Ralph Huey 1715 Chester Ave. Ste 300 Bakersfield, Ca 93301 ---------- ------------..--:.:..-..__._-"'----~---- .- -~ -- ~------ ---=---=---:- --- ---,=,--.--~, Dear Ralph Huey: Per our phone conversation on January 17, I am writing to notify you that we do business as a video retail chain and should not get billed for hazardous material handling fees. If you have any questions please feel free to contact me at the number below. Sincerely, I-!j~ Tiffani Lhandez .j r oJ!o»: #y ~ØJMJ- ~~- ~ ~-- ~oy1 r~~~-Î;;~é¡7 -~-- W~·r~\-. ~.L 6'JJL I ~ atct)-(,UV J ~., -,..' '.b~'" , 1\ ð1.., 'ø !) ". " _:ot{ -'<>- >~ i.<-:; 68~1 McDivitt Drive, Suite A · Bakersfield, CA 93313 · Office (805) 397 -7955 · Fax (805) 397 -5982 =.--= ,,~.:...:--=.:....::--~~-::..-- .- ~--"';'---~;;'='-~-':--:--: -=-::-. - ,- =---=~"':"-~--.:.:. .:~-=-;:. ~-~~~'; =-. -<;~=='-~ ~ \~ "It .. ...-:.. . BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 2130 "G" STREET BÀKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN ~,(J¡- J INSTRUCTIONS: 'l ~ 1. To avoid further .action, return this form within 30 days of receipt. AJ(J-1/ /5; ¡c¡q 3 2. TYPE/PRINT ANSWERS IN ENGLISH. . 3. Answer the questions ·Delow foT the business as a whole. - ) ')? l; C·-- 4. Be brief and concise as possible. P :-) . 1'(., >,- " 1-0 SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: 0p/L¿) c!/r-/ , LOCATION: 7g fCJ ?v#'/~ ~ MAILING ADDR'ESS: 7i' fp CITY: g~~ f¡Z'/£¿:'Ò - Vv~ /;r¿¿:. ~. STATE: ð.ß-Z¡p: ?l.33'ð/ PHONE: c?J7- 2C19.s-- DUN &8RADSTREET NUMBER: %?oo -,/ "7"/ '3 7Y-z..SIC CODE: 0/17 PRIMARY ACTIVITY: . .,i? L ;r ~,,¿ ,,¿;-? e'//' S /- ~ >5 -p. ~ /J' '·A -.A. ~~~...... ¿..ó '~~~<t!. OWNER: ~-.;Z-.:;;;;-: --Z¿¿- - -C-ØL/ð.4;;ß,7-/;;;:'c- LÞ.s;'-'r VL'~_ c"-r- MAILING ADDRESS: 6 F s-/' /'0/ eb/ ønr- .s:-..;4- g~. Q4' Ýf3,3 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE ( 1. ~.///?~¿. .~,/£-' r?:j7-;?P?~ ç~-:C-.- 2.~y~/V#^~:z ¿P/~~fi' ~7.6/?;?7F5 ~~ " ,1. , Bakersfield Fire Dept. ~ardous Mäterials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN f ,( ". . 't, .. SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 1.7-- MATERIAL SAFETY DATA SHEETS ON FILE,: y,¿;::; BRIEF SUMMARY OF TRAINING PROGRAM: c'p.v,s-r~ ~ ~ ¿;?; //£?/;,~ 7;4,//# /š ~~/~ =,-2> ~" " . --7/~¿5 ., .. ~ '3 ø ~ /~ÞL/':'.5' ¿;~ ~t'"V/l<'l 7?~"" 1"'-5 ;:>__Æ-. ~ Y "'- , ." -~;¿ ~17~~~'Þz,~--p-£~¿;?;/f- L.Jo/&1~ - -~- ~= c-- ~-.: r3J ~~ £",/?¿> y/-!4£"~ ~£:- ..A'~~£. ~L> 7,..., J'r"ø..¡/G-7";£-,2> h- . ~ ¿::=//L¿¡:" :ž: )(" 77"c.- ~,/ oS ,A"" ÆÁ-L . r.s£ ~r- r', " "': - />' -..L/...;oo-s ~:&- ~c::..~;rÆÞ ø ¿:::::. ¿;J.c...A-Z- //- - é r6.~ ¿¿) /é!/p-¿... c....- ~ 7;:;-r';""'" -' ø'- 7"""'- ¿t;... t:Z-S . ' (£) ¡fÇ/~r~e-/ //~¿; ~2:> .s;~TY /p¿~7/'"YS ~L ß£/"'-...f ~~....c::,,-~~ ~ð./kLé... ø- ~O,,^- l' ' SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAíMY BUSINESS IS,EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: :£.f1 -,ß.. 4WE DO NOT HANDLE HAZARDOUS MATERIALS. " ¿~ P QE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO __~_.;O.__ ___..c.,_~u.· T\M~.1kE£o.JHE_MIt\!lMUM REPORTH~LG-QUA~JrrJES.-~~ ,_. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: . I. ~ ,;é!//,::>~ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CAUFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (ON. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄ T INACCURATE INFORMA T¡ON·CONSTrrUTE~, PERJURY. .~ . ¿_·W /Ma~4 c:::.----' SIGNATURE . -- TITLE t""'¿J-/9-9~ DATE ""'-~...-. 2. FOt~ . :----.-.-,.- -, ..:.....:,.:-. , ~ì , /:i' '~ ~ '.-~' .'" , t . r ..-...;'" --e Bakersfi~ld Fire Dept. - Hazardous Materials Divisio. HAZARDO us. MATERIALS MANAGEMENT PLAN ". Facility Unit Name: ¡/¡ òÆ-¿J CI/TY , SECT10N 6: NOT1F1CAT10N AND EV ACUAT10N PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: {!ßu- t? // ~ -- - - ~ - -- - I B. EMPLOYEE NOTIFICATION AND EVACUATION: ¡/£.~ B,4£-. C. PUBLIC EV ACUAT¡ON: o t?£ 'S ¡lC-o-r /?/;:>~-7 --. -----~- D. EMERGENCY MEDICAL PLAN: ¡v ¿~£s.;r- A /'?ïI7/7"/?-t:- " /~ ~é~">jC/2..¿'}, ,- 3. R:)I$I -". '. _ Bakersfield Fire Dept. e Hazardous Materials Division I' ,~' ,\ ' 'f.: ........... HAZARDO'US MATERIALS MANAGEMENT PLAN SECTlo.N 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: // £? r ;___..-r ~'-~ è:> ~,:z 5,. /'- 0 r--- /~ (./ o~ l/ ¿ - ~c.-€~ -""',- B, RELEASE'CONTAINMENT AND/OR MINIMIZATION: --- ~-~ -- .~ .- .------.~~~- ~ "";;=Ä- -- - _ ff/~o t/E:,ð /' //l-"£~~ V~/Z.JzD ,,- Cc?~rÁ-;/C-t!. Á C. CLEAN-UP PROCEDURES: ¡V~L SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): /? ... I j - ¿j.r-- ó¿..'/c,l::)/..... c l C-é^,~ ( L~T~~ j NATURAL GAS/PROPANE: L¿~ , WATER: - ..... L ~A-;l- ð,c... h ¿//L, D/-./ j --. ~~ - ?ðC~")-~ 7t.--- ~ho--r---óF-~~ ~ ELECTRICAL: SPECIAL: LOCK BOX: YE~ IF YES, LOCATION: .·r· SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABIliTY: A. PRIVATE FIREPROTECnON: -7;C-- ~~ ð_ S~~f¿ _ - / __ , _ hL'Ý ~'j£/SZ :-yv/'.$/Î<i.LS ~ '> /' WATER AVAILABILlTY (FIRE HYDRANT): ' ..... B. /- ç,<..o--r (J)'-- ~/ ;v,.. .J. L1. #1-~ - '~ BA4ÞERSFIELO-CITY FIR~EPARTMENT - HAZARDOUS MATERIALS DIVISION 2130 "G" STREET BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [1 BUSINESS NAME Ò~A t/'/¿:?£ o. \ C/'T;:Y - ..s¿.-<--b $7:. 27L /__ C!- . - --.---.... - --- --- ~- FACILITY NAME j/ / /::::>Æð c/;~ , SITE ADDRESS 7&'90 v-- ,J/ /;r.t£ ¿,A../ 'CITY' ßÆ~~/f-.J~;L.£":> STATE C'Ä-. ZIP 7'5:50?, NATURE OF BUSINESS / ¿ .-r.A-.;~ ?:P~t.:> .4'~/,-j-~.#z-"'¿S SIC CODE ¥~9 DUN & BRADSTREET NUMBER ''8'911(')'- /1'/ :5 7r~ z.. OWNER/OPERA TOR \ MAIUNG ADDRESS \ CITY ~~, \ ß.6&"-£· ?E~ , PHONE ',3c;P- 9755 ¿:.~ S'/ ~¿ ,ò//;/rr ,:51/. A- STATE ¿.#-' ZIP 593.5'/3 EMERGENCY CONTACTS NAME ~ /!!/PÆ.~ . TITLE #/£-f.4- 24-HOUR PHONE P'1/,/L :J'8l> - () //2. BUSINESS PHONE ??37- '20 7~ , NAME ~;4-/S ~e¿~7 - , BUSINESS PHONE 73?-~95 r- TITLE ¡/;::'Þ Þ-s 2.4-HOUR PHONE 5C> !3'- 8'2 t:/ 2- Seøemoet:xl. 1S11õ1:Z AE<iION V I.EPC STNlOAP.c : \ . , BAKERSFI-,D CITY FIRE DEPAR"ENT HAZARDOUS MATERIALS INVENTORY Page_of~ F/ßb ~ , Business Name /-r~ Address 7<[ 7'a ¿v#/r£ 4u 6~. (!;4. . J?3 3 qJ , , I /' \ CHEMICAL DESCRIPTION ¡ . 1) INVENTORY STATUS: New { J Addition { I Revision { ¡ Oeletion { I Check if chemical is a NON TRADE SECRET { J TRADE SECRET ( ¡ I ~¿'/';;I?' I 2) Common Name: 3) DOT # (optional) I . Chemical Name: // AHM ['] CAS# 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFlCATlON (3-digit code from DHS Fon'n 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid '" Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHEOC AU. THAT »PtY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES . Maximum Daily Amount: ;} / 7' ~ v. ~r. Ibs [ ] gal [] 1t3;<J- a) Container: ð¥ þ)ñc-r /9ß'-L -r~ '" - - """--""'-.---, Average Daily Amount:=~ /,s;:"p ~CVd;;,Ç.-"~~~ .C' ,_ curies [ ] b) Pressur~: , ~ - Annual Amount: :2 ~., c) Temperature: .. Largest Size Container: ;J.J7 ~v. r=r. ~J. # Days On Site ~/L ¥E:A-.L Circle Which Mònths: F, M. A. M. J. J. A, S. O. N, D - 9) MIXTURE: Ust ~ Ç,OMPONENT CAS # %WT AHM the three most hazardous 1) Z?-/V/""t [ ] chemical components or any AHM components 2) [ ] 3) [ ] ! 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ r Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL &. HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE -. - .. - . , .. - - - - --~.- -- ~ - - ---.- 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CHECXAU. rHAr APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ I a) Container. Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: I # Days On Site Circle Which Months: All Year, J. F, M. A. M. J. J, A. S, 0, N, D I . 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemicaÍ' components or .' [ ] any AHM components 2) 3) [ ] 10) Location certlfy uncter penalty ot law, that I have personally examined and am familiar With the mtomatJon sUOmltted on thIS and all attached documents. I, eel/eve the ", -... submitted informatÍon is true, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date -- .... AECIOI V \.£PC Sf,lifilQNllO 1=0''' 37'- \ ~ BAKEfW=IELD CITY FIRE DEilttRTMENT H~RDOUS MATERIALS INVmTORY , Pagè_of_ Susiness Name Address I \ CHEMICAL DESCRIPTION \ ') INVENTORY STATUS: New [] Addition [ J Revision [ 1 Deletion ( J Check if chemical is a NON TRADE SECRET [ I TRADE SECRET [ J 2) Common Name: 3) DOT /I (optional) i Chemical Name: AHM [ 1 CAS # , 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ J Reactive [ J Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFlCATlON (3-digit code from DHS Form a022) USE CODE 6) PHYSICAL STATE Solid [ 1 Uquid [ ] Gas [ 1 Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] CUEOC).ll TUAT A.PPL r 7) AMOUNT AND TlME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] fi3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: ' . Largest Size Container: # Days On Site Circle Which Months: All Vear. J. F, M, A, M. J. J, A. S, O. N, 0 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ 1 3) [ J 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ r Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] : 2) Common Name: 3) DOT # (optional) ¡ Chemical Name: AHM [ ] CAS # 4) PH.YSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ 1 Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas [. j Pure [ ] Mixture [ ] Waste ( ] Radioactive [ ] CHECK AU THA T A.PPL Y ! 7) AMOUNT AND TlME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: 100 [ ] gal [ ] fi3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: AU Year. J, F, M. A. M. J, J. A. S. O. N. 0 9) MiXTuRE: Ust COMPONENT CAS # "IoWT AHM the three most hazardous 1) [ ] : chemical components or any AHM components 2) ,. [ ] 3) [ J 10) Location certIfy under penaJtyot law, that I nave personaJJy exammed anet am fami/iar Wltn tne mfomatJon submitted on tnlS and aJl altBched document:s. I oelleve the submitted information is tnJe, ac'curate, and complete. PRINT Name & Title of Authorized Company Representative' Signature Date --- ~"\.iP'Cst#lMQollrllQFQUr.II BAKERSFIáLD CITY FIRE DEPAfi¡MENT HAZAÅ!fOUS MATERIALS INVENTðftV - ,~, ",,-,.:; Page_of_ 9usiness Name Address I CHEMICAL DESCRIPTION I ') IN'ÆNTORY STATUS: New [ ] Addition [ ] Revision ( ] Deletion ( ] Check if chemical is a NON TRADE SECRET [ J TRADE SECRET ( J I 2) Common Name: 3) DOT /I (optional) , Chemical Name: AHM ( 1 CAS # I , ¡ 4) PHYSICAL &. HEALTH PHYSICAL HEALTH I HAZARD CATEGORIES Fire [ 1 Reactive ( ] Sudden Release of Pressure [ 1 Immediate Health (Acute) ( ] Delayed Health (Chronic) [ 1 \ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODe ¡ 6) PHYSICAL STATE Solid [ 1 Uquid [ 1 Gas ( 1 Pure [ 1 Mixture [ 1 Waste [ 1 Radioactive [ I CHEC<AU. THAT APPlY I 7) AMOUNT AND TIME AT FACIUìY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily. Amount: Ibs [ 1 gal [ 1 tt3 ( 1 a) Container: I Average Daily Amount: curies ( ] b) Pressure: I - Annual Amount: --~~ ~ '-- - ~ - c} Temperature: Largest Size Container: I # Days On Site Circle Which Months: All Year. J. F. M. A. M, J. J. A, S. 0, N. D ¡ I 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ 1 I chemical components or any AHM components 2} [ 1 I I 3) [ ] 1 I I 10) Location I I CHEMICAL DESCRIPTION 1) IN'ÆNTORY STATUS: New [ r Addition [ 1 Revision [ 1 Deletion ( ] Check if chemical is a NON TRADE SECRET [] TRADE SECRET [ 1 2) Common Name: 3) DOT # (optional) Chemical Name: AHM[ 1 CAS # 4) PHYSICAL &. HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ( 1 Reactive ( ] Sudden Release of Pressure ( ] Immediate Health (Acute) [ 1 Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE COOE 6) PHYSICAL STATE . Solid [ 1 Uquid ( ] Gas [ ] Pure [ 1 Mixture [ ] Waste ~ ] Radioactive [ 1 CHEC>< AU. "'AT )þp, Y 7) AMOUNT AND TIME AT FACIUìY UNITS OF MEASURE 8) STORAGE COOES Maximum Daily Amount: Ibs [ 1 gal [ 1 tt3 [ ] a} Container: Average Daily Amount: curies [ 1 b} Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J. F. M. A. M. J. J. A. S, O. N. D 9) MIXTURE: Ust COMPONENT CAS # "IoWT AHM the three most hazardous 1) [ 1 chemical components qr any AHM components 2) [ I 3} [ I , 0) Lacation certify under penalty ot Jaw, t!7at I have personallyexammed and am familiar With the mtomatJOn sUlJmltted on thiS and all attached documents. I Del/eve the submitted information is true, accurate, and complete. PRINT Name & Title of Authorized Company Representative' Signature Date --- MDCJ111I \.SIC ST.MoIOMO ¡acRW