HomeMy WebLinkAboutBUSINESS PLAN
.'
;;~
~'
'>.
..
INSTRUCTIONS~
,/....\"
i
I. To avoid fì:.1rther action, return this fonn within 30 days of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the:: questions below for the business as a whole.
4. Be as brief and concise as possible.
5. You may a]tso attach Business Owner / Operator Form and Chemical Description Fonn(s)
to the front of this plan instead of completing SECTION I. below for initial submission.
SECTION I: BUSJ[NESS IDENTIFICA TION DATA
BUSINESS NAME:
\/ ~
V1\ \ ~ , tlA.~ t-
t )M I () N
~.
g. {JLI\I () '" 4"L
STATE: é.ß:-. ZIP:9'33Ð 7 PHONE:(Ú(tJ I ~ 3r¡q"<'oIS2.-
, ~k~ ()~
Av^L
i '
(
I
LOCATION: _ (n Ç'o (
MAILING APDRESS:
CITY: _8 ~.çÁ
(0 t; 0 (
PRIMARY ACTMTY:
ba ~
OWNER: (rail 9 r{)lfV\.rff.
MAILING ADDRESS:
PHONE:
EMERGENCY NOTJ[FICA TION
CONTACT
TITLE
BUS. PHONE
24 HR. PHONE
l.~fl(ll)(V1&r JL. 'f{(\('aV\c¡ At,,~. Ô.ÙÑí c'(o "3f~~(/lIS''2 ~Cn("(¡,5,-{-'o.sl.{o \
2.J(I.. I \.~ hlb IJ\ ~ N O.fo,v.. f t)(VI'\L r lJ¡ <Q l - 3 y\, ~ {(II ç L {¡¡ú (-5'19 - 01 79
: i
1
HAZ.OUS MATERIALS MANAGE{\¡'. PLAN
SECTION eLl: DeSCOVER Y AND NOTeFeCA TIONS
A. LEAK. DETECTION AND MONITORlNG PROCEDURES:
\
(J({dc.\ t(O()+- TkSr 3{'O
B.
EMPLOYEE AND AGENCY NOTIFICAT~ON: /
q{l oc ßfCJV
I
I (~'
c.
ENVIRON1vŒNTAL RESPONSE MANAGEMENT:
ÌL l ~" . h J-<r' Ù' ~( l (,\ S CA. 1'\ Cl C)~ ~f"tXH\. f
~ll-k~('o.( . I
..
D.
EMERGENCY MEDICAL PLAN: ". /
l.f/\ tk e.VCt-tf- t){- l ~Ut't V ,
C?V¡"f (4) 'ftL UJ d ( l.:,L W«.I\.( -\.() NCG\.tc {,,1
hlJ,~fAðL\
'(
2
'.
'-'.
~-,
~
.,..~,~
.
"
\
(
(
I
. I
l
· ,
·l~\
I'
I (
I
I
(
>-
..
H"RDOUS MATERIALS MANAGeENT PLAN
SECTION III: TRAINING
NUMBER OF EMPLOYEES: 3 0 ('"
MATERIAL SAFETY DATA SHEETS ON FILE:
~'f-\- ¿
BRIEF SUMMARY OF TRAINING PROGRAM:
e ú.tl e~lo... '-<-- 'm!l -\ I'o.l" ,d Ir.o ~
4Ð O~L -+kl~
(
(
CERTIFICATION
!, P.PI tL ~ J1 A ~ î () A eA Ñb- CERTIFY TIJAT TIlE ABOVE INFORMATION
IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER mE "CALIFORNIA HEALTH AND SAFETY
CODE" ON HAZ;ARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND
THAT INACCURATE INFORMATION CONSTITUTES PERJURY.
£.uJ-- ~
SIGNATURE
O(ù}J(ifL
TITLE
IIAZ MAT MNOMHT PLAN A INS,TRUC
4
5jJ~ /()~
,
DATE
<-
HAZAWUS MA TE UALS MANAGEM~ PLAN
'ij,l
.
;::.~'
.
SECTION lI.2: RELEASE RESPONSE PLAN
A.
HAZARD ASSESSMENT AND PREVENTION M AS S:
ttR'1 k,-~\ JSaJ t, 19 5fl {( ~ C q ((
B.
RELEASE CONTA1NMENT AND/OR 7ION:
td('1 ~,-kr /
C.
CLEAN-UP AND RECOVERY PRO.CE~
fctl,{ y ~\..{(( ~.{Qf(J l(lt ~ ýa{(Ol\f .b.;cld-
(
'.
UTILITY SHUT-OFFS OCATION OF SHUT-OFB AT YOUR FACILI
NATURAL GAS/P~~PM§:
ELECTRICAL: . '" ,
WATER:' ~\A(' -
SPECIAL:
LOCK BOX: YE@'O
PRIVATE FIRE PROTECTIONIW ATE
A. PRIVATE FIRE PROTECTION:
B. WA.:rERA Y AILABILlT.y'(FIR:E~.
3