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BUSINESS PLAN 5/29/1992
-- v ~~ ~ifI~ - ~ DFlJgSllIFMS \-, \ THOMAS SEIBERT Store Manager -J - ---1 8000 WHITE lANE BAKERSFIE~D, CA. 93:.309' PH.(805) 837-2195 _ ,/ý-!i::~'{ -; BAKERSFIELD CITY I FIRE DEPARTME'·.....-....... I U BARBARA BRENNER HAZARDOUS MATERIAL PLANNING TECHNICIAN (8051 326-3979 FAX (8051 395-1349 2130 "G" STREET BAKERSFIELD, CA 93301 U/tt~"ti -.~ fÒ sþ~ L,'ý:;- ~~ - Hoot' /Vl§(, r;e(7Ø-ts~' stvcK. ,'5 -'(l'C~ :;;;;:z-t:t!V \ V - ':- ...:.. -,.,. \ :,', .~:¿ ----- --- "-.. - .;. - - - . . -. ~ -- -- --- .---'- \ .> \ ---- . ¿~~~~.~.- dL I CA6t·H& .. (AU.êA'S-~~ í~OLl0H ~-\1C6 ~ ~\íQ()~ ~ ~ INFo -n1t2DOC--+! éP6í P{2DNT c¡- GúSken~ l1tQ.OUh\-t \N'ESf ~ cme. ~ ......: l~tt ~\JiN6 CCo42 e ALL l'D N E0f YN RDNT Pt\e1qN0 lOr NeA1Z.. \N'tL1..ß ~C " ........p.. ð " '~ ~ . ,J \L s:: C; c.. Ç> ~ ~ ~ J ¡J) (ó,) ~ " Hl\fÞMP PT A lU.' MAP .LLLli. f' ¡ SITE DIAGRAM I X I FACILITY DIAGRAM Business Name: "A-\.j l~~ 1h-....,í- -S h-r~ Business Address: ~o-o 0 w\......~k .~~ ßI¥ (;.f&M~·dð q '330 9 For Office Use Only Area Map # of NORTH {( First In Station: Inspection Station: t.\ \~ .\1-1 (~~\V ç~rU<' ~'i.6.~){ > "\ -e"..pÇ\..vo , 0¿)c.V->. N" .6~ tr~~ J \<'~ \;V h: \--c, . . L Po N ~ I ~Ib\'t- ~\s '(¡iI ~:rð-'J' \I' ~ ~~ ~ -L ~ ~ )'-- j; \~ \[ \ " t~ ~ .0 _ C) >-~ ,",..J. ;; ~ ') .) '~ 'âVl .) tð ~ <t \ ~ ~ , , " ~\ .~ '. Hl'6MP PLM¡¡ MAP .. SITE DIAGRAM I " I Business Name: Y A-' \-t--ss Business Address: S>o-oo FACILITY DIAGRAM I X bY'''} S ~ wh:k- L~ ßA'K-té:~ tÇ~ C,'š30C¡ For Office Use Only ØiiiJ.. --_._..-----~- ------ Area Map # of NORTH {} _ ____ _____ ,__________,.. __1_..._ " First In Station: Inspection Station: ~'(v / "' ,.J\.; ~- ~ \~\~ \ ~-,)-- \\(0 ~ \tÞ SOV ¿1~O,r ~ ,vV' 'pV ~t))P ~ ~ , .þ- '\P' ~~ Y'0 W ~Vl .)-- ~>-lI~ ~ ...-/I .~ "oJ "L t "j( v-. -- ^~~-' ~\ ""'- ~ ,.. ~veI> ot' ~y-.~ ~ Perna 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 round Storage of Hazardous Materials qagement Program ,.....',".. W t m as e 8000 PERMIT ID# 015-D21.Q00235 PAYLESS DRUG STORE LOCATION ; I \ Issued by: ~!. WHITE Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rdFloor Bakersfield, CA 93301 , Voice (805) 326-3979 FAX (805)326-0576 *~ ph Huey, ffice of ental Servi es .June 30, 2000 Approved by: Expiration Date: ,/'1 " ~, _ ~:,:J:: _ I' a ~--' ., re ((~'~;; Ii \\ /fi§D'¡ u;;, ,~Lç,~ U W LS Ir\\! , I! II SlteID: 215-000-000235 n: SEP 12 1997 ~) BusPhone: (805) 837-2195 _____- -- ¡Map : 123 CommHaz: Low C By Grid: 16C FacUnits: 1 AOV: , - -+..._~-.: e Ï' F PAYLESS DRUG STORE Manager :S"'mt.~ C.~,,'b'hs: Location: 8000 WHITE LN City BAKERSFIELD CommCode: BAKERSFIELD STATION 09 EPA Numb: SIC Code:6512 DunnBrad: Emergency Contact / Title Emergency Contact / Title JAMES CRABTREE / MANAGER / Business Phone: (805) 837-2195x Business Phone: ( ) - x 24-Hour Phone : (805) 833-1633x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Agency-Defined Topic Title p= Hazmat Inventory p== MCP+DailyMax Order Hazmat Common Name... SpecHaz EPA Hazards IH F P IH R IH R IH F IH F IH F DH R IH F DH R IH One Unified List 1 All Materials at Site 1 DailyMax MCP L 600 GAL Hi G 300 FT3 Hi L 240 GAL Hi L 100 GAL Hi L 100 GAL Hi S 1200 LBS Mod L 120 GAL Mod L 90 GAL Mod L 300 GAL Low L 500 GAL Min S 1000 LBS UnR L 360 GAL UnR L 280 GAL UnR L 200 GAL UnR POOL CHLORINE LIQUIDS PROPANE BLEACH POOL ACIDS FUEL ADDITIVES POOL CHLORINE SOLIDS PAINTS PAINT THINNER ANTI-FREEZE COOLANT MOTOR OIL FERTILIZER INSECTICIDES HERBICIDES FUEL I, .dtm9:> C.~:4\\rt-CU:E ('y~orprll1t fIIllYlfl) reviewed the atta~hed hazardou$ materials manag®- ment pian ior~. ~ t.I);,b,n~ tÆ.~ i~ alo~ wãUIri ( e! eoo) any corrections consmu~~ a ©omp~e~a a1BìJ\d oorred malV1- F F IH F IH ~ Do her~b)f zoormy ~h$& i ha¡~iS DH DH agement plan ior my ~cm~. ~·\q.'\1 Oats (, -1- 08/14/1997 ,î.. ~, -- ¡" e e 'i" F PAYLESS DRUG STORE I p= Notif./Evacuation/Medical ~ Agency Notification CALL 9-1-1. SiteID: 215-000-000235 ì Fast Format '9 Overall Site '9 07/24/19921 Employee Notif./Evacuation 07/24/1992 EVACUATION PLAN POSTED ON WALL. SAFETY MEETINGS WEEKLY. Public Notif./Evacuation 07/24/1992 EMPLOYEES TRAINED TO DIRECT CUSTOMERS TO NEAREST EXITS. EMPLOYEES ON SITE. CPR TRAINED Emergency Medical Plan 07/24/1992 ] NEAREST EMERGENCY ROOM. -2- 08/14/1997 " .. e e f PAYLESS DRUG STORE I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-000235 l Fast Format l Overall Site l 07/24/1992 MONTHLY SAFETY INSPECTION OF OUR STORE BY OUR SAFETY PERSON. INSPECTION BY OUR MAIN OFFICE. Release Containment r I I Clean Up Other Resource Activation -3- 08/14/1997 ~, .. t' - ... e e F PAYLESS DRUG STORE I p= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 215-000-000235 1 Fast Format 1 Overall Site 1 I . 07/24/1992 A) GAS - REAR OF BLDG B) ELECTRICAL - NE CORNER C) WATER - REAR OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO OF STORE BY BREAKROOM Fire Protec./Avail. Water 07/24/1992 PRIVATE FIRE PROTECTION - ACE SPRINKLER COMPANY BAKERSFIELD. NEAREST FIRE HYDRANT - FRONT & REAR OF BLDG. Building Occupancy Level -4- 08/14/1997 ~: / ;~ 'i,q e e F PAYLESS DRUG STORE I F Training Employee Training SiteID: 215-000-000235 ì Fast Format ì Overall Site ì 07/24/1992 WE HAVE 28 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHETTS ON FILE AT THE MAIN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES TRAINED IN PROPER USE OF CHEMICAL SPILL KIT. SAFETY TALKS GIVEN MONTHLY. Page 2 [ I I Held for Future Use Held for Future Use -5- 08/14/1997 .' - ,",-þ' t 02/12/96 - ~~(Ç~Ü~~~I ¡j1 PAYLESS DRUG STORE 215-000-0002 - l~age Overall Site with 1 Fac. Unit ?f EB 29 1996 JJ! General Information ',~:) I 1 e Location: 8000 WHITE LN City : BAKERSFIELD Contact Name BRYAN TERHUNE Business Phone: 24-Hour Phone Pager Phone Title / MANAGER (805) 837-2195x (805) 589-4484x () x Map:123 Haz:2 Type: 3 Grid: 16C FlU: 1 AOV: 0.0 Contact Name Title I Business Phone: ( ) x 24-Hour Phone ( ) x Pager Phone ( ) x Administrative Data Mail Addrs: 8000 WHITE LN City: BAKERSFIELD Comm Code: 215-009 BAKERSFIELD STATION 09 D&B Number: State: CA Zip: 93309- SIC Code: 6512 Owner: PAYLESS DRUG STORES NORTHWEST . Address: 9275 PEYTON LN City: WILSONVILLE Phone: (805) 837-2195 State: OR Zip: 97070- . Summary ~ ~V'~µ 1,~~0.ù~ Do hereby certify that I "''''va ype or pnnl name) ¡ i <;¡\ reviewed the attached hazardous materials ma ;z¡qe- ment plan fO~~c,(àVG<) and thN it .A!ono '~it.h ame 0 Inose) . ,. any corrections constitute a complete and correct man- agement plan for my facility. ¡ ".r~ ' · Î e e I 02/12/96 PAYLESS DRUG STORE 215-000-000235 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-001 BLEACH Liquid 240 High ~ Reactive, Immed H1th GAL 02-003 PROPANE Gas 300 High ~ Fire, Pressure, Immed H1th FT3 02-008 POOL ACIDS Liquid 100 High ~ Reactive, Immed H1th GAL 02-009 POOL CHLORINE LIQUIDS Liquid 600 High ~ Immed H1th GAL 02-011 FUEL ADDITIVES Liquid 100 High ~ Fire, Immed H1th GAL 02-004 PAINTS Liquid 120 Moderate ~ Fire, Immed H1th GAL 02-005 PAINT THINNER Liquid 90 Moderate ~ Fire, Delay Hlth GAL 02-010 POOL CHLORINE SOLIDS Solid 1200 Moderate ~ LBS 02-013 ANTI-FREEZE COOLANT Liquid 300 Low ~ Reactive, Immed Hlth GAL 02-002 MOTOR OIL Liquid 500 Minimal ~ Fire, Delay Hlth GAL 02-006 INSECTICIDES Liquid 360 Unrated ~ Fire, Delay Hlth GAL 02-007 HERBICIDES Liquid 280 Unrated ~ Fire, Immed Hlth GAL 02-012 FUEL Liquid 200 Unrated ~ Fire, Immed Hlth, Delay Hlth GAL ,02-014 FERTILIZER Solid 1000 Unrated ~ Reactive, Immed Hlth LBS - - 02/12/96 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 BLEACH ~ Reactive, Immed Hlth Liquid 240 High GAL CAS 4t: 7681-52-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL 240 ----¡ Daily Average GAL 90.00 I Annual Amount GAL -- 2,500.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l 100.0% Sodium Hypochlorite Components r= MCP -.Guide IHigh I 45 02-003 PROPANE ~ Fire, Pressure, Immed Hlth Gas 300 High FT3 CAS 4t: 74-98-6 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: HEATING Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 300 I 55.00 I 3,000.00 Storage r Press T Temp ~ METAL CONTAINR-NONDRUM Above Ambient Location - Conc l 100.0% Propane Components r; MCP -.Guide Extreme I 22 02-008 POOL ACIDS ~ Reactive, Immed Hlth Liquid 100 High GAL CAS 4t: 7647010 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 100 I 55.00 I 100.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l 100.0% Muriatic Acid Components r; MCP -rGuide High I 15 I 02/12/96 e e PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 4 Hazmat Inventory Detail in MCP Order 02-009 POOL CHLORINE LIQUIDS ~ Immed Hlth Liquid 600 High GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 600 I 100.00 I 600.00 Storage PLASTIC CONTAINER r Press T Temp ~I Ambient Ambient Location Cone 0.0% 0.0% Components I: MCP :ruide High 45 Moderate 60 Sodium Hypochlorite Sodium Hydroxide 02-011 FUEL ADDITIVES ~ Fire, Immed Hlth Liquid 100 High GAL CAS #: 11-45-01 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL ---- Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 100 I 55.00 I 100.00 Storage :::r Press ì Temp ~I PLASTIC CONTAINER Above Ambient METAL CONTAINR-NONDRUM Above Ambient Location Cone 0.0% 0.0% 0.0% Components ~ MCP :rUide High 28 Moderate 26 Low 27 Methyl Alcohol Methyl Ethyl Ketone Ethylene Glycol e e 02/12/96 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 5 02-004 PAINTS ~ Fire, Immed Hlth Liquid 120 Moderate GAL CAS #: 64742-47-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 120 55.00 120.00 Storage r Press T Temp -:ì METAL CONTAINR-NONDRUM Above Ambient Location Cone 0.0% 0.0% 0.0% 0.0% 0.0% --0.0% Components Mineral Spirits Ethylbenzene Toluene Xylene, Mixed Methyl Ethyl Ketone n-Butyl Acetate MCP Moderate Moderate Moderate Moderate Moderate Moderate uide 27 26 27 27 26 26 02-005 PAINT THINNER ~ Fire, Delay Hlth Liquid 90 Moderate GAL CAS #: 64742-88-7 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: PAINTING Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 90 I 55.00 I 90.00 Storage r Press T Temp -:ì METAL CONTAINR-NONDRUM Ambient Ambient Location Cone 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Components Aromatic Hydrocarbon Toluene n-Propanol n-Butyl Acetate Xylene, Mixed Methanol MCP Moderate Moderate Moderate Moderate Moderate High uide 27 27 26 26 27 28 - e 02/12/96 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 6 Hazmat Inventory Detail in MCP Order 02-010 POOL CHLORINE SOLIDS ~ Solid 1200 Moderate LBS CAS #: 87-90-1 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: CLEANING Daily Max LBS ----r-- Daily Average LBS --r-- Annual Amount LBS -- 1,200 I 800.00 I 1,200.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location Conc 0.0% 0.0% Components Trichloro-s-triazinetrione Dichloroisocyanuric Acid I: MCP ~uide Moderate 45 Moderate 45 02-013 ANTI-FREEZE COOLANT ~ Reactive, Immed Hlth Liquid 300 Low GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 300 I 30.00 I 1,000.00 Storage PLASTIC CONTAINER r Press T Temp ~ Location Ambient Ambient WAREHOUSE & SALES FLOOR. Conc 0.0% 0.0% Components Œ MCP ¡Uide Low 27 Low 27 Ethylene Glycol Diethylene Glycol 02-002 MOTOR OIL ~ Fire, Delay Hlth Liquid 500 Minimal GAL CAS #: 8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 500 I 200.00 1 5,000.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l Components 100.0% Motor Oil, Petroleum Based ,-; MCP ----rGuide Minimal I 27 I 02/12/96 e e PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 7 Hazmat Inventory Detail in MCP Order 02-006 INSECTICIDES ~ Fire, Delay Hlth Liquid 360 Unrated GAL CAS #: 7757-82-6 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: INSECTICIDE Daily Max GAL ----r-- 360 I Daily Average GAL 120.00 I Annual Amount GAL -- 360.00 Storage, PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l 100.0% Insecticides Components I~ MCP ----rGuide Unrated I 0 02-007 HERBICIDES ~ Fire, Immed Hlth Liquid 280 Unrated GAL CAS #: o Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: HERBICIDE ---- Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 280 I 100.00 I 280.00 Storage ~ Press 1 Temp ~ PLASTIC CONTAINER Ambient Ambient GLASS CONTAINER Ambient Ambient Location - Conc l 100.0% Herbicides Components ~ MCP ----rGuide Unrated I 0 02-012 FUEL ~ Fire, Immed Hlth, Delay Hlth Liquid 200 Unrated GAL CAS :it: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 200 I 60.00 I 2,000.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc Components MCP ---¡Guide e e 02/12/96 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 8 Hazmat Inventory Detail in MCP Order 02-014 FERTILIZER ~ Reactive, Immed Hlth Solid 1000 Unrated LBS CAS #: Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: Daily Max LBS ----r-- Daily Average LBS --r-- Annual Amount LBS -- 1,000 I 200.00 I 3,000.00 Storage I Press 1 Temp Location BAG Ambient Ambient WAREHOUSE, SALES FLOOR, NURSERY POUND. - Conc Components MCP ~uide e e 02/12/96 PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 9 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 9-1-1. <2> Employee Notif./Evacuation EVACUATION PLAN POSTED ON WALL. SAFETY MEETINGS WEEKLY. <3> Public Notif./Evacuation EMPLOYEES TRAINED TO DIRECT CUSTOMERS TO NEAREST EXITS. CPR TRAINED EMPLOYEES ON SITE. <4> Emergency Medical Plan NEAREST EMERGENCY ROOM. '. e e I 02/12/96 PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 10 <E> Mitigation/Prevent/Abatemt <1> Release Prevention MONTHLY SAFETY INSPECTION OF OUR STORE BY OUR SAFETY PERSON. INSPECTION BY OUR MAIN OFFICE. ALSO INSPECTIONS BY OUR PARENT COMPANY K-MART. <2> Release Containment <3> Clean Up <4> Other Resource Activation ",' . '.. e e 02/12/96 PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 11 <F> Site Emergency Factors , <1> Special Hazards <2> Utility Shut-Offs A) GAS - REAR OF BLDG B) ELECTRICAL - NE CORNER OF STORE BY BREAKROOM C) WATER - REAR OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ACE SPRINKLER COMPANY BAKERSFIELD. NEAREST FIRE HYDRANT - FRONT & REAR OF BLDG. <4> Building Occupancy Level ~' , ~ '~ I 02/12/96 e e PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 12 <G> Training <1> Employee Training WE HAVE 28 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHETTS ON FILE AT THE MAIN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES TRAINED IN PROPER USE OF CHEMICAL SPILL KIT. SAFETY TALKS GIVEN MONTHLY. <2> Page 2 <3> Held for Future Use <4> Held for Future Use ~ ~ "i 04/ds/94- · e - / PAYLESS DRUG STORE 215-000-000235 Overall Site with 1 Fac. Unit Page 1 General Information , ' Contact N9,qle TONI 5EIß~K'r J>~ ~ Location: 8000 WHITE LN / Community: BAKERSFIELD STAT70N 09 V Title ~~ ~ / Map:123 Haz:2 Grid: 16C FlU: 1 Business Phone (805) 837-2195 x (805) 837-2195 x Administrative Data Mail Addrs: 8000 WHITE LN City: BAKERSFIELD Comm Code: 215-009 BAKERSFIELD STATION 09 D&B Number: State: CA Zip: 93309- SIC Code: 6512 Owner: PAYLESS DRUG STORES NORTHWEST Address: 9275 PEYTON LN City: WILSONVILLE Phone: (805) 837-2195 State: OR Zip: 970 7vO- Summary , AHochdc . '1\..(~fnÁ. ~Q-r.t:I.fÁ(JlH7 ~t.er:a-t¿ ~ll ((I-I t;íj / f..tlf; ý¡; oV1 Jo r('n '? · RECEIVED fi~R'IÅ~IL..wJJl:- Do h~rsby certify that I h1w~APR 2 5 1994 (Type or MMe) . H. fi'Sviewsd ~h9 a~achsd' hazardous ma~eV1~$ mtòlU'IJalgje- J12', ""4 r. 01\1. 1i'üW~ [P)~~lníf©)? M ~SS J)R.tJG.~OO~IIï1Slt U a~©U'bg wñ~1Iï1 (Name of Buslrlaeo) $ID1? ~Q)ffìl® OOVb~%iiUi~ ~ OOffìíi)[9)~®\l® ~OO OOITooR ffìíi)~rru- ~®ffl®mm (9)~ffìl1/@rr ffìíi)1? ~tad~D~ 0 ~# e e 04/d5/94 " 'PAYLESS DRUG STORE 215-000-000235 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP ( 240 High 02-001 BLEACH Liquid ~ Reactive, Immed Hlth GAL 02-003 PROPANE Gas 300 High ~ Fire, Pressure, Immed Hlth FT3 02-008 POOL ACIDS Liquid 100 High ~ Reactive, Immed Hlth GAL 02-009 POOL CHLORINE LIQUIDS Liquid 600 High ~ .Immed HI th GAL 02-011 FUEL ADDITIVES Liquid 100 High ~ Fire, Immed Hlth GAL 02-004 PAINTS Liquid 120 Moderate ~ Fire, Immed Hlth GAL 02-005 PAINT THINNER Liquid 90 Moderate ~ Fire, Delay Hlth GAL 02-010 POOL CHLORINE SOLIDS Solid 1200 Moderate ~ LBS 02-002 MOTOR OIL Liquid 500 Minimal ~ Fire, Delay Hlth GAL 02-006 INSECTICIDES Liquid 360 Unrated ~ Fire, Delay Hlth. GAL 02-007 HERBICIDES Liquid 280 Unrated ~ Fire, Immed Hlth GAL 02-012 FUEL Liquid 200 Unrated ~ Fire, Immed Hlth, Delay Hlth GAL e . 04/05/94 . PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 BLEACH .~ Reactive, Immed Hlth Liquid 240 High GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL ~., Daily Average GAL --r--Annual Amount GAL-- 240. I 90.00 I 2,500.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location _. Conc l 100.0% Sodium Hypochlorite Components r; MCP ----p;uide High I 45 02-003 PROPANE ~ Fire, Pressure, Immed Hlth Gas 300 High FT3 CAS #: 74-98-6 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: HEATING Daily Max FT3 ~ Daily Average FT3 --r--. Annual Amount FT3 -- 300 I 55.001 3,000.00 Storage r Press T Temp .~ METAL CONTAINR-NONDRUM Above Ambient \, Location - Conc l 100.0% Propane Components r; MCP ----rGuide Extreme I 22 02-008 POOL ACIDS ~ Reactive, Immed Hlth Liquid 100 High GAL CAS #: 7647010 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WATER TREATMENT Daily Max GAL ~ Daily Average GAL --r--' Annual Amount GAL -- 100 I 55.00 100.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l 100.0% Muriatic Acid Components I~ MCP ----rG. uide High . I 15 - e, 04/0'5/94 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 4 Hazmat Inventory Detail in MCP Order 02-009 POOL CHLORINE LIQUIDS ~ Immed Hlth Liquid 600 High GAL CAS #: 7681-52-.9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL ~ Daily Average GAL --r-- Annual Amount GAL -- 600 I· 100.00 I 600.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location Components Œ MCP :ruide High 45 Moderate 60 Conc· 0.0% 0.0% Sodium Hypochlorite Sodium Hydroxide 02-011 FUEL ADDITIVES ~ Fire, Immed Hlth Liquid 100 High GAL CAS #: 11-45-01 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL ---- Daily Max GAL ~. Daily Average GAL --r-- Annual Amount GAL -- 100. I . 55.00 I 100.00 Storage :::r Press ì Temp ~ PLASTIC CONTAINER . Above Ambient METAL CONTAINR-NONDRUM Above Ambient Location Components ~ MCP :rUide High 28 Moderate 26 Low 27 Conc 0.0% 0.0% 0.0%. Methyl Alcohol Methyl Ethyl Ketone Ethylene Glycol . . I 04/0'5/94 c. PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 5 02-004 PAINTS ~ Fire, Immed Hlth Liquid 120 Moderate GAL CAS #: 64742-47-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GAL ~ Daily Average GAL --r-- Annual Amount GAL -- 120 I 55.00 I 120.00 Storage r Press T· Temp ~ METAL CONTAINR-NONDRUM Above Ambient Location Cone 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Components Mineral Spirits Ethylbenzene Toluene. Xylene, Mixed Methyl Ethyl Ketone n-Butyl Acetate MCP Moderate Moderate Moderate Moderate Moderate Moderate uide 27 26 27 27 26 26 02-005 PAINT THINNER ~ Fire, Delay Hlth Liquid 90 Moderate GAL CAS #: 64742-88-7 Trade Secret: No Form: Liquid Days: 365 Use: PAINTING Type: Pure Daily Max GAL ~ Daily Average GAL --r-- Annual Amount GAL -- 901 55.00 I ' 90.00 Storage r Press T Temp ~ METAL CONTAINR-NONDRUM Ambient Ambient I Location Cone 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Components MCP Moderate Moderate Moderate Moderate Moderate High Petroleum Distillate Toluene n-Propanol n-Butyl Acetate Xylene, Mixed Methanol . Guide 27 27 26 26 27 28 . . 04/0'5/94 PAYLESS DRUG STORE 215-000-000235 02 - Fixed Containers on Site Page 6 Hazmat Inventory Deta~l in MCP Order 02-010 POOL CHLORINE SOLIDS ~ Solid 1200 Moderate LBS CAS =It: 87-90-1 Trade Secret: No Form: Solid --, Type: Mixture Days: 365 Use: CLEANING Daily Max LBS ----r-- Daily Average LBS --r-- Annual Amount LBS -- 1,200 I 800.00 I 1,200.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location Components Trichloro-s-triazinetrione Dichloroisocyanuric Acid ~ MCP ~uide Moderate 42 Moderate 42 Conc 0.0% 0.0% 02-002 MOTOR OIL ~ Fire, Delay Hlth Liquid 500 Minimal GAL CAS =It:. 8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 500 I . 200.00 I 5,000.00 Storage PLASTIC CONTAINER r Press T Temp ~ . Ambient Ambient Location - Conc _I Components 100.0% Motor Oil, Petroleum Based r; MCP --.Guide Minimal I 27 02-006 INSECTICIDES ~ Fire, Delay Hlth Liquid 360 Unrated GAL CAS =It: 7757-82-6 Trade Secret,: No Form: Liquid Type: Pure Days: 365 Use: INSECTICIDE Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL -- 360 I 120.00 I 360.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Conc l 100.0% Insecticides Components I~ MCP -----rG.uide Unrated I 0 · e 04/0'5/94' . PAYLESS DRUG STORE 215-000-000235 02- Fixed Containers on Site Page 7 Hazmat Inventory Detail in MCP Order 02-007 HERBICIDES ~ Fire, Immed Hlth Liquid 280 Unrated GAL CAS =It: o Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: HERBICIDE ---- Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL -- 280 I 100.00 I 280.00 Storage ~ Press 1 Temp ~ PLASTIC CONTAINER Ambient Ambient GLASS CONTAINER Ambient Ambient Location - Cone l 100.0% Herbicides Components ~ MCP ---¡Guide Unrated I 0 02-012 FUEL ~ Fire, Immed Hlth, Delay Hlth Liquid 200 Unrated GAL CAS =It: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL Daily Max ·GAL ~ Daily Average GAL ~ Annual Amount GAL -- 200 I 60.00 I 2,000.00 Storage PLASTIC CONTAINER r Press T Temp ~ Ambient Ambient Location - Cone Components MCP -¡Guide · e 04/05/94" . PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 8 <D> Notif./Evacuation/Medical I <1> Agency Notification CALL 9-1-1. I I I <2> Employee Notif./Evacuation EVACUATION PLAN POSTED ON WALL. SAFETY MEETING~ WEEKLY. <3> Public Notif./Evacuation EMPLOYEES TRAINED TO DIRECT CUSTOMERS TO NEAREST EXITS. CPR TRAINED EMPLOYEES ON SITE. <4> Emergency Medical Plan NEAREST EMERGENCY ROOM. e e 04/0'5/94' PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 9 <E> Mitigation/Prevent/Abatemt <1> Release Prevention MONTHLY SAFETY INSPECTION OF OUR STORE BY OUR SAFETY PERSON. INSPECTION BY OUR MAIN OFFICE. ALSO INSPECTIONS BY OUR PARENT COMPANY K-MART. <2> Release Containment <3> Clean Up <4> Other Resource Activation e . ..~ '"" '. 04/05/94' / PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 10 <F> Site Emergency Factors <1> Special Hazards \ \ <2> Utility Shut-Offs A) GAS - REAR OF BLDG B) ELECTRICAL - NE CORNER OF STORE BY BREAKROOM C) WATER - REAR OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ACE SPRINKLER COMPANY BAKERSFIELD. NEAREST FIRE HYDRANT - FRONT & REAR OF BLDG. <4> Building Occupancy Level - e ...' ;;; .,' '. .. 04/05/94' / / PAYLESS DRUG STORE 215-000-000235 00 - Overall Site Page 11 / <G> Training , " <t> Page 1 WE HAVE 28 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHETTS ON FILE AT THE MAIN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES TRAINED IN PROPER USE OF CHEMICAL SPILL KIT. SAFETY TALKS GIVEN MONTHLY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ¡ \; , ~~~:d' Bakersfield Fire Depte HAZARDOUS MATERIALS DIVISION Date Completed r¡....A 6 - 9") Business Identification No. 215-000 - O"'O:l."}'I (Top of ~~s p~an) / Station No. o¡ Shift C Inspector ~ \1 _I,tl Ov~ -1±~7 -\.. ~) . Business Name: ~ 'PO; 5' 0 .....¡~ 5 tel \r ~ Location: <6000 \V~ ~ ~ c ~ "" Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of M~teriaJ Comments: <:t.. \ 60ò \ \'7 ~.r-t~ ¡ ~ fro- Number of Employees Verification of MSDS Availablity 36 Comments: tJ,,) Verification of Haz Mat Training tvt <; 0 j ,~ q t-o\r~ j ~ Adequate (~~,. ~ Inadequate D m- D {if. r!r o ~ D RECEIVED AUG 3 0 1993 HA7. MAT nlv. C\<.JJ\.f.¡72 .... o ~ rEr o Verification of Abatement Supplies & Procedures Comments: ~ D Emergency Procedures Posted Containers Properly Labeled 'Comments: ~ rn.- D D uv Verification of Facility Diagram fl- O "" c¡, \.o¡ C) ~; cc c:J"""" Special Hazards Associated with this Facility: · D Violations: xæ ;;i~o> . Business Owner! anager . FD 1652 (Rev. 1-90) All Items O.K. 0 Correction Needed ~ White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy ~, .-¿ l:i <' . ;" ... BAKERSFIELD CITY FIR'DEPARTMENT y..../ HAZARDOUS MATERIALS DIVISION 1715 CHESTER AVE.. BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS FACILITY DESCRIPTION: Check if your business is a farm. Enter the full legal name and site address of your business. Do not use post office box numbers. Give a brief description of the nature your business activities. ., Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on page 4. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Deve!opment Department by giving them your employer number, from the U.S. Labor Department or from the Standard Industrial Classification Manual. Enter the· Dun & Bradstreet or federal tax identification number for your business. Enter the name of the owner, their mailing address and phone number. EMERGENCY CONTACTS: List two persons who have full access to the facility, including locked areas, andl that are knowledgeable about your materials and process. CHEMICAL DESCRIPTION: Make as many copies of the chemica! description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of a gas. Enter the full legal name and site location of your business at the top of the form. Enter the page number in the right hand corner. " Each of the instructions below correspond to the entry field with the same number on the chemical description form. Seøemcer:xl 1 gg:z 1 REGiON V I.E'C ST ANCAAD FQRM e . !:' .... 1. Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Check nontrade secret unless the chemical composition meets the criteria for trade secret status per Section 6254.7 Of the California Government Code and Section 1060 of the California Code of Evidence. Copy trade secret pages onto yellow paper before submitting your inventory so that they will be easily identified. 2. Enter the common name or the manufacture's product name. Enter the standard chemical name. If a pure material is an acutely hazardous material (AHM) I check the box labeled AHM. Report the components of mixtures under item 9 below. 3. Enter the Dept. of Transportation (DOT) identification number and the Chemical Abstract Service (CAS) number for this chemical. CAS numbers are commonly found on Material Safety Data Sheets. 4 Check the box(es) which describe the" physical and health hazards associated with the chemical. 5. If the material is a waste, enter the appropriate three-digit California waste code. California's nonrestricted waste codes are listed on page 4 of these instructions. Questions regarding the waste classification codes and requests for hazardous waste manifest form #8022 may be addressed to the Department of Health Services, Toxic Substances Control Program at (916) 322-3670. Enter the appropriate use code from the following list. USE CODES 01. Additive 02. Adhesive 03. Aerosol 04, Anesthetic 05. Bac:encide 06, 6!asi.ing 07, Cai.aìyst 08, C:eaning 09, C00iam 10, C':oling 11, Drilling 12. Drying 13, Emulslfier/demulsifier 1.<1, E,ching 15, ~.xoenmental 1 6. Fabrication 17, Fertilization 18, Formulation 19. Fuel 20. Fungic:de 21. Grinding 22. Heating 23. Herbtc:de 24. Insectic\de 25, instructlonai 26, Lubricant 27, Medical aid/process 28, Neutraiizer 29, PaintIng 30, Pesticide 31, Plating 32. Preservative 33, Reiining 34, Sealer 35, Spraying 36. Sterilizer 37, Storage 38, Stnpper 39. Washing 40. Waste 41, Water Treatment . <12. Weiding/soldering 43. Weil inlec~ion 44, Oil treatment 45, Resaie 46, Aircraft sysi.ems 47, Battery electrolyte 48. Breathing air 49. Drafting aid 50. ¡:iníshed product 51, Fire protectIon 52, Hydraulic eauipment 53. Road/Hwy maintenance 54, T eSi.ing 55. Wholesale chemicals 99, Other - specify 2 REGiON" LE?C STANOAAOFOPM $eel_mot( JO. 1 SI92 1\ '~ ~ ~~. '"" tit . . e 6. Check the boxes which describe the. physical state of the chemical. Pure materials are 100% of the chemical listed in item #2. Chemicals that have been diluted with water or combinations of two or more chemicals should be reported as mixtures and the components listed in under item #9. 7. Enter the maximum daily amount, the average daily amount and the total annuaJ amount of material in storage or use at your facility. Enter the largest container 'size and the number of daysiyear that the material is on site. Circle the months that the material is on site. Enter the units of measure. Report solids in pounds, liquids in gallons, gases in cubic feet and radioactive materials in curies. 8. Select the appropriate storage codes from the lists below. a) CCNTAINERCODES 01, Underground tank 02. Aboveground tank 03. Fixed Pressurized tank 04. Portable pressurized cylinders 05. Insulated tank (indudes cryogenics) 06: Drums or barrels - metallic 07. Drums or barrels - non-metallic 08, Carboy(s) 09. Glass container(s) 10, Plastic container(s) 11, Box(es) 12. 8ag(s) 13. Metal containers (not drums) 14, In machinery or processing equipment 15, 8in(s) 99, Other - specify b) PRESSURE CODES 1 . The material is stored at ambient (normal atmospheric) pressure. 2 - The material is stored at greater than amDient pressure. 3 - The materials is stored at less than ambient pressure. c) TEMPERATURE CODES 4 - The material is stored at ambient (surrounding) temperature. 5 - The material is stored at greater than ambient temoerature. 6 - The material is stored at less than ambient temperature. 7 - The material is stored under cryogenic conditions 9. Enter the maximum % concentration by weight of the three MOST hazardous components in the material. Round up to the nearest whole number percentage. Enter the CAS number for each component of the mixture. If the component is an acutely hazardous material, check the box labeled AHM. / 10. Briefly describe the location of the material within the building/faCility using compass directioris and obvious landmarks. . s.eøemDef :n 1 992 3 REGION V lE?C ST ANQAAO FORM COMMON STANO 0111 Wheat productIon 0115 Com productiOn 0131 Cotton productIon 0139 Fieid crops. except casn grams 0161 VeqetaDles &. melons 0172 Graces 0173 Tree nuts 0174 Citrus fruitS 0175 DecIduouS tree fruIts 01 79 Other tree InJlts &. nuts 0192 Gener&¡ farms. pnm8l11y crop 0241 Dairy farms 0252 ChicKen eggs 0253 ïuri<ey eggs 2851 Paint manutacture 0291 Generai farm.. pnm8l1ly livestocK & animai specialties D INDUSTRIAL CLASSIFfCATI 0724 Cotton ginning 0541 Grocery Store 1541 Dry cleaners 2911 Oil refineries 3441 Weldinglfabncation - structurai 344.3 Welding/fabncation, boiler 3569 Machine snop 4222 Cold storage 4925 Compressed gas suoplier 5<)93 Automobile saivage 5169 Chemical supply 5511 Motorvehicle dealers (new &. used) 5521 Motor venide (used only 5531 Auto & home suopiy stores 5541 Gasoline servIce stations CODES " Eating places Drinking places (alcohol service) 5983 Fuel 011 dealers 5964 LPG dealers 7342 Pest control 7~2 Auto top. body. upholstery reoair Auto oaint shoos 7533 Auto exhaust repair 7~6 Auto glass replacement 7~7 Auto transmission repair 7538 GeneraJ auto repair 7542 Car washes 5071 Chemlcall.D.boratory NONRESTRICTED WASTE CODES ~ Descnction InoroantCS 111 Acid solution 2< pH <7 with metais ( antimony. arsenic. barium,berytlium. cadmium. chromium. cob8Jt. copper. lead. mercury. mOlybdenum, niCKel, selenrum. silver, thallium, "8l1edium end ZInc) 112 Acid sOlutlon.without metals ,,3 Unsoeciiied aCId solution 121 All<allne SOlution pH > 12,5 with metais (see 111) '22 AII<a1ine SOlution W1thout metaJs '23 Unsoecl1îed aikaiine solution 131 Aoueous solution i2<pH<12,51 containing reactive anions (azIde, oromate, chlorate. cyanide. ~uOrlde. hypocnlonte ,nitrite. percnlorate and sulfide anions 1 132 Aoueous solutIon with metalS (see 111) 133 Aqueous solution W1th totai organic residues 10% or more 134 Ao.ueous solution wrth totaJ organic residues less than 10% 135 Unsoecrñed aqueous solution 141 Off-soec. aged. or surplus inorganics 151 Asbestos containtng waste 161 FCC 'Naste 162 Other soent =taJyst 171 ~.1eta¡ sludge (see 111) 172 Metal dust ana macnining waste (see 111) 181 Other Inorganic sOlid waste Orqanlcs 211 ~aiogenated soivents (metnYlene chlOrlae, c:1loroform. ïC2. ïCA) 212 Oxygenated solvents (acetone, :'utanol. MEK) 213 Hyorocarcon solvents (stoddaro solvent. X'flene) 214 Unsceclñea solvent mixture 221 Waste 011 and mixed 011 222 Oillwater separation siuoge 223 Unsoeclñed oil· contamlng waste 231 PestiCide nnse water 232 Pesticides and other waste associated wltn pesticide productIOn 241 ïar1Í( boctom waste 251 Still bottoms WIth haJogenated organics 252 Otner stIli bottom waste 261 PCS's ana matenal containing PCS's 271 Organic monomer waste (incluaes unreac:ed resins) Seøemcet:)Q. , 9!n ~ Descnction 272 Polymeric resin waste 281 Adhesives 291 Latex waste 311 PharmaceutlcaJ waste 321 Sewage sludge 322 8iological waste other than sewage sludge ~1 Off-spec. aged or surplus organics 341 Organic liquids (nonsoivents) witn haJogens 343 Unspeciñed orgaJ1ìc liquid mixture 351 Organic solids with halogens ~ 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 Sutfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 431 Tetraethyt lead sludge 491 Uns¡Jeciñed sludge waste Miscellaneous 511 Empty pesticide containers 30 gai or more 512 Other empty containers 30 ç¡al or more 513 Emoty container1i less than 30 gal 521 Drilling mud 531 ChemlcaJ tOilet waste 541 Photo chemlcaJ/pnotd processing waste 551 Laboratory waste chemicaJs 561 Detergent and soac 571 Fly asn, :¡attom asn. and retort ash 551 Gas scrubber waste 591 Saghouse waste 611 Cont8rT1lnaIeo so,l trom site c:ean-ucs 612 Housenold wastes (Restncted waste codes are listed on the oaCK of Iorm #8022) 4 REGõON v l.E."C ST ANOAl'lO FORM ~ '-, ~ ",," 8AK~SFIELD -CITY FIRE rMPARTMENT ! ' - HAZARDOUS MATERIALS DIVISION 1715 CHESTER AVE. . BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME-:?&<fl.oG'S5 )/RUG- JrOflE r FACILITY NAME SITE ADDRESS .~ û CD r-¡',c "\ -E:- L.AN G· . ' C¡~ (£R5 ~l~_1;..:D STATE C-A. NATURE OFBUSINESS-=-K~-(..A:VL -pi< \} (_ SIC CODE DUN & BRADSTREET NUMBER ZIP c?33DC¡ OW~ER/OPERA TOR , PHONE \ MAILING ADDRESS \ CITY STATE ZIP Seøemcer:JO. ,ggz F\EßION V LE!'C STANCAI'\C F- BAKERSFLáLD CITY FIRE DEPAPãMENT HAZA~US MATERIALS INVENTdl!fy ~ :J'1" Page_of_ 3usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ( ] Addition ( ] Revision ( ] Deletion ( ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM ( ] CAS# ! i 4) PHYSICAL & HEALTH PHYSICAL HEALTH I 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 ( ] Liquid ( ] Gas [ ] Pure ( ] Mixture [ ] Waste [ ] Radioactive [ ] CHEC1: ALl. THAT APPLY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs ( ] gal [ ] ft3 ( ] a) Container: Average Daily Amount: curies ( ] 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, 0, N, D 9) MIXTURE: List COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] . . , 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion ( ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # I 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 [ ] Liquid ( ] Gas ( ] Pure ( ] Mixture [ ] Waste [ ] Radioactive ( ] CHECK AU. THAT APPlY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal ( ] ft3 [ ] a) Container: Average Daily Amount: curies ( ] 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. 0, N, D 9) MIXTURE: List COMPONENT CAS # %WT AHM the three most hazardous 1 ) [ ] chemical components or any AHM components 2) [ ] . .. [ ] 3) 10) Location certify under penlifty or law, that J have personally examined and am Tamiliar With the, Intomatlon submitted on thiS and all attached documents. I believe the submitted information is true. accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date AEGl(NY L£PCST..,..~FœM <)¡eøiWlltw3Q 1œ2 <:~ ,>~..' ~ BAKERiilELD CITY FIRE CEP¿RTMENT H~RDOUS MATERIALS INVEPPtORY Page_of~ 5 ~~ Ö~¡¿.- ~ 1:1>6- Address ,',' . ,Business Name , . CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON ~DE SECRET [ ] TRADE SECRET [ ] 2) Common Name: . ,-. - '3) DOT # (optionaJ) , ....~- Chemicai Name: AHM [ ] , CAS#' -, ...- 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] React,ive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICA1l0N (3-digit code from DHS Form 8022) USE CODE '. 6) PHYSICAL STATE Solid [ ] Uquid [ ) Gas '[ ] Pure [ ] Mixture' [ ] Waste [ ] Radioactive [ ] CHfCX ALl1}/AT APPlY 7) AMOUNTAND llME AT FA~IUTY . UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ J gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: AnnuaJ Amount, c) Temp~raiure: Largest Size'Container: # Days On Site Circle,W'hich Months: All Year. J, F, M, A. M, J. J, A, S, O. N. D 9) MIXTURE: Ust COMPONENT CA;S # %WT AHM the three most hazardous i) [ ] chemicai components or any AHM components 2) [ ] ., 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ I Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optionaJ) . ChemicaJ 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 [ ] CHfCl( AU. mA T APPlY 7) AMOUNT AND llME AT FACIUTY UNITS OF MEASURE 8) STORAGE·CçmES Maximum Daily Amount: Ibs [ ] gaJ [ ] ft3 [ ] a) Contai¡,ér: Average Daily Amount: curies [ J b) Pressure: AnnuaJ Amount: c) Temper!lture: Largest Size Container: f # Days On Site Circle W'hich Months: All Year. J, F, M. A. M. J, 'J: A, S. 0, N. D 9) MIXTURE:- Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemicai components or , , any AHM components '2) , [ I " , , , . [ ] 3) 1 0) Location ceroty unaer penalty or laW,tf7at I have personally exammeo and am familiar Wltf7 tf7e mtomaaon suomltteo on tf7/s and all attacneo documents. I believe ttle submitted i~formation is true, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date AECIOiIIV l£PCn,fr¡fII¡ ()NIQFCI'U $CIr...o. 30. 1 S&2 BAKERSFLELD CITY FIRE DEPAalMENT HAZA~OUS MATERIALS INVENT~Y Page_of_ cg()OO IJ.)~!;;'~ ~~~f-.rgL1? ~33 t¥f .~ . ~ .,." Address CHEMICAL DESCRIPTION Check if chemical is a NON TRADE SECRET [) TRADE SECRET [ ) 2) Common Name: ~ 3) DOT # (optionaJ) Chemical Name: AHM [ ) CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES Fire [ ] [ ] H EAL.J}:d Immediate Health (Acute) j,;f Delayed Health (Chronic) [ ] " 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE Pure [I Mixture 0 Waste [I CUECKALL mAT APPlY Radioactive ( ] 6) PHYSICAL STATE Solid (] Uquid vr Gas [ ] 7) AMOUNT ANO ~ME ATFAe'UlY ;i;oO Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size"Container: ~ # Days On Site ----3il- UNITS OF MEAjURE Ibs [ J gal [A' ft3 [ J curies [ J 8) STORAGE CODES / ^ a) Container: _~ b) Pressure: ..j.., c) Temperature: V' CHEMICAL DESCRIPTION 1) INVENTORY STAìUS: New ( I Addition [~iSiOn [ I Deletion [ I Circle Which Months: A, M, J, J, A. S. O. N. 0 9) MIXTURE: List the three most hazardous chemical components or any AHM components CAS # /0 7"1-J ../ III.. -f6... £ %WT AHM [ J [ I [ J 10) Location Check if chemical is a NON TRADE SECRET [I TRADE SECRET [ ] 2) Common Name: t=' ~ {<... T t:: L r;:... 'Z-~áL-. 3) DOT # (optional) Chemical Name: AHM [ I CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES Fire [ ] P~ICAL Reactive ((I Sudden Release of Pressure [ I HEALo/ Immediate Health (Acute) L...r'" Delayed Health (Chronic) [ I 7 CHECI< AU. rnA r APPlY [ ] Radioactive [ I 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) 6) PHYSICAL STATE Solid ~ Liquid [] Gas [ I Pure [I Mixture 7) AMOUNT AND TIME AT FACIUTY /~/'J-'1 Maximum Daily Amount: I Vc/u.P Average DailY Amount: ?ff Annual Amount: Largest Size Container: # Days On Site 30 UNITS ~ MEASURE Ibs ¡,.f gal [ ] ft3 [ I curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: J~ ~ Circle Which Months: All Ye81. J, F. M, A. M. J. J. A. S. O. N, 0 10) Location COMPONENT ~ CAS # 1) 7 .r. M 6: -r,U Ý L-.A-M,1 ~ s;-rtT IX- . if YJ:eJ.fWr¿'PtJ 1::.O\éfM..&'r;t-L '2)llvMbí# y ¿.AIk r.()6 5Ã-L...-¡- a::J. ;;;-~LJ' -cJ1t-l)«Of~Pf 3) vf1,V,,«'fiAMç...Ø·SAt.-"í~ Yr?Â-A( ,61~1l.ÞalLa2¿'~O-A.v~ tJ (¡¿ S 6-R- % ~ AHM ,:::J~ [ ] ".25 [] · ()Ç [I 9) MIXTURE: Ust the three most haz81dous chemical components or any AHM components AEI30IW L£PCST ll frl lQMQFOAM ':Ì«II~3Q,r¡¡q ~. 'tic . tit CITY of BAKERSFIELD "WE CARE" ,J.~ IscL '\ FIRE DEPARTMENT S, D. JOHNSON . FIRE CHIEF 2101 H STREET BAKERSFIELD, 93301 326·3911 June 29, 1992 Dear Mr T. Sieber: NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE =============================================== In the inspection of your business Payless Drug Store, located at 800 White lane, Bakersfield, Ca 93309 on June 29, 1992, the following hazardous materials regulation violations were identified: 1) Reportable quantities of Hazardous Materials on hand but no business plan or inventory on file. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25503.5 i I I (a) Any business, except as provided in subdivision (b), which handles a hazardous material 6r mixture containing a hazardous material which has a quantity at anyone time during the reporting year equal to, or greater than, a total weight of 500 pounds, or a total volume of 55 gallons, or 200 cubic feet at standard temperature and pressure for a compressed gas, shall establish and implement a business plan for emergency response to a release or threatened release of a hazardous material in accordance with the standards in the regulations adopted pursuant to Section 25503. VIOLATION OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(a)(1-4) (a)The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (1) A listing of the chemical name and common names of every ,hazardous substance or chemical product handled by the business. J ~ .... /' " / -..-' .... / -- . (2) The category of waste, including the general chemical and mineral composition of the waste listed by probable maximum and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing a hazardous material handled by the business which is not otherwise listed pursuant to paragraph (1) or (2). (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which ,.is handled at anyone time by the business over the course of the year. 2) Hazardous Materials training inadequate. VIOLATION OF UFC 80.106 Personnel, Training and Written Procedures. Persons responsible for the operation of areas in which hazardous materials are stored, dispensed, handled or used shall be familiar with the chemical nature of the materials and the appropriate mitigating actions necessàry in the event of fire, leak pr spill. , , Responsible persons shall be designated and trained to be liaison personnel for the fire department. These persons shall aid the fire department in preplanning emergency responses and identification,of the locations where hazardous materials are located and shall have access to Material. Safety Data Sheets and be knowledgeable in the site emergency response procedures. 3) Material safety data sheets not available. VIOLATION OF UFC 80.104 (d) Material Safety Data Sheets (MSDS) shall be readily available on the premises for hazardous materials regulated by this article. The above violations must be corrected by July 15th 1992. Please be advised that failure to comply may result in legal action against you. ' I / I ~_,~ , / /t". :// I I \- It It The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. Materials Coordinator ~""P -ð.~r l': e e Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street- Bakersfield, CA. 93301 .. ;. ,....' 1~~(Ç~U~~fR\ ~ JUL 211992 ~l By HAZARDOUS MATERIALS MANAGEMENl PLAN ~ \bC INSTRUCTIONS: . \d 'J' . -q ç, 1, To avoid further action, return this form withi~ daÝ(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, of- SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: PAy J ~5) 0/2 v ¿,v STð¡:¿£ LOCATION: ?/'){'y) W I--L'TÈ t...J4NE MAILING ADDRESS: . CITY: ßAILe.I2-<F, '-eltJ &WIn e- STATE: fYA:- ZIP: DUN & BRADSTREET NUMBER: VØz Gv' S- PHONE: ö:.'57- Z 115 SIC CODE: PRIMARY ACTIVITY: J£'TA 1\ \ OWNER: ~\A1~,5S cf)2üQ ~o-D-P< 1\/0-QTH uJE'(T MAILING ADDRESS: C¡2-75 PEY~A/ ¿"N. lAJ/'/~<)ð),/')/'lle ÓIL. C¡7CJ7CJ SECTION 2: EMERGENCY NOTIFICATION: CONTACT 1. 70ßJ SelY3r~ 2. Sß I I)',q 114¡¿~ TITLE BUS. PHONE 24 HR, PHONE {VJ4J..IAl!pl2. g:~ 7- 2(1S' FI1:6I¿ Jt/¡4J.!J4(e12- 2J'?7-2/1S 665 -svt"S '-?9g' ~79S ~ " 1 . I I FD159j 'Bakersfield Fire Dept. azardous Materials Division . ~...;.--;~ HAZARDOUS MATERIALS MANAGEMENT, PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: '2- 8 MATERIAL SAFETY DATA SHEETS ON FILE: AT (V1A,' ¡J ðFF¡'¿e BRIEF SUMMARY OF TRAINING PROGRAM: ~¡11I/ðlf~£S ,MáJ£{) /N fR-Df-ete. 5ft'J I JI)-r. 6J4Fay /ï4IKS g/vè¡../ uS E Or C!He¡/j/I'~141 f1/lð¡JTH /1 SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6,95 PF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TlMEEXCEED THE MINIMUM REPORTING QUANTITIES. ÓTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: , \, SA: t S'A l (\62- t CERTIFY THAT THE ABOVE INFOR- - MATlON IS ACCURATE, I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6,95 SEC, 25500 ET Al.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY, TITLE -s-27-9?- DATE --~-~ --~ --- - 2. FD1590 ·~.,..'~. ..,... . -' --- ..' .:. . '.' -,-. ,- ,. -. I ,~,=,"'¢':-;;¡: ,':)¡ ~ /~ tit Bakersfield Fire Dept. . Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN FC!cility Unit NC!me:_ p~< {JiL1l?: Sf(2/2£' ~ tf2f~ SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: C!-\it H Cj J I B. EMPLOYEE NOTIFICATION AND EVACUATION: £ t/f1c.(}A ()It; IJ PiAIJ PðgeD ,t);J WA r{ S'AFÇT'j ¡IVt'eeTt /-Jt$ W€-e~\ l{. ;SEE A7TAC!..t-fe.fj £VI4(!vÆl,'~Á{ -FlA./V C, PUBLIC EVACUATION: £"¡1J1 p lb ~ e es TJ2f\ 1\ f..I eo ---r6 fJ 1\ íLe CT C' () ~ <T ð Y\^ -eJ.2S ID N~ÂiL~ ~X.,T$', C-p12- ¡A.A:¡'lJêO £MfJlt9'-f'e'-es. ðA( <;;/,(: D, EMERGENCY MEDICAL PLAN: N e f\fLe5T £fr1el26-e ¡J ~ ï !2.ððf/ÞL 3. FDl~ e Bakersfield Fire Dept. . Hazardous Materials Division '-~~'J ,,~,"",_ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: (11p¡J¡t-IL-'j iA~ery fN:5fét!/í~d ¿;Ø';::'~. ~íð~. ßt¡ ðUfL $lIrery fJe1!6ðP, ¡).f'>f/e/J¡;hAl I3If ð()/L jVl¡4¡If'/ C>h I~e_ fJ/5o ¡ír:I.J'l!-&flÍb/f/.f 15'1 ~ f¥llLeNT {!ðP''1J'/lftly /L -¡1/lI1/L'G B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: p-eA/Ù t9F ßu.,t W/U~ ELECTRICAL: !\l £. C óil.JÝt#l . OF ~7óILe· ß4 tJ'êf:..AIÚ2.ØØ~ WATER: ~t4¡Q 6-'F fJJu../' DI(¡...J~ SPECIAL: LOCK BOX: YÈs(fi9) IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, PRIVATE FIRE PROTECTION: )-l(!E 5Pd)fJl(~¡¿ {Jð/f/f,4Jlly I~A ¡¿t¡¿5Þ,'.e I ø WATER AVAILABILITY (FIRE HYDRANT): B. ri2&Nr cr ¡2et-l-í2 6)ç ßi///O/¡J(I 4. FD1S - - ClîY OT ~AKt:K~¡-lt:LU OHAZARDOUS MATERIALS INVENTORY Farl and Agticulture [] Standlrd Business : NON-TRADE SECRETS Page BUSINi~S NAME: 1>A-'fIc.J3:$ 'Dt'.,Iq.. ~k--c- OWNER NAME: 1>A- I<-ðS }.t.Þy~ NAME OF THIS FACILITYò' ; LOC¢T N' ~O'tI(!) ""'~J:.J:1:- i-'f,:¡ ADDRESS' ;l.ìS t.. STANDARD IND. CLASS C DE: en Ë IP: 1> A-K ¿: ,l.~ ,'"' e,Üt eI~Y~ zl: w, . <- :>-r DUN AND BRADSTREET NUMBER----- PHON : ~_ 7 óLl~_ ; PH N JI' S"'QJ 6 ~!1..IO-o RE E TO--rTQ::; I /"Wc.; I .l uN::; rUt( ¡.;RuPER CODES - - - - 7 8 9 10 II 12 13 11 I Drs Cant Cant Cant Use loc~tion Where I by Nalles of Iixture/Ç~!'conents on Site type Press Telp Code Stored In FacilIty See lnstru:tlons )0 if ßl~ -" , J of \ I trans Code N t.tO Ph~sicaT end Health HI~lrd I Check III thlt app I r C.A.S. NUllber [] Fire Hazard o Delayed 0 Sudd~n Release Health of Pressure Ii I , I ! I ¡¡-firo Hazard 0 Reict;,;t" II I µ-o ¡. !Physical ~nd Health Ha~ard 1\ '\ (Che:k all that app,IJI I: ! [ÿrire Hazard 0 Reactivity . ~ayed 0 Sudd~n Release Health of Pressure ~Imd 0 Sudd~n Release Health of Pressure COllponent II Nalle & C.A.S. NUlber \ ~ ~. COllponent 12 Nile & C.A.S. NUllber Lyu~~d1Bte Health COllponent 13 Nale & C.A.S. NUllber COllponent 11 Nalle' C.A.S. NUllber COllponent 12 Nalle & C.A.S. NUllber DIlled i ate Health COIIPonent 13 Nalle & C.A.S. NUllber .yov' COllponent 12 Nale & C.A.S. NUllber o lllllediate Health COllponent 13 Nalle & C.A.S. NUllber ?JDo I I' Ph" i" ,·"d Hili th H.¡ard {Check all that apply - COllponent 11 Nalle & C.A.S. NUllber ~Fire.za.rd o De Jayed [YSíídd~n Re I ease Health of Pressure o Reactivit~ ; __~ Component'2 Nalle & C.A.S. NUllber ~ III!~diate Hea I th COlponent 13 Nale & C.A.S. ~lIber 3'18'ò79J 1Tlfr rnone 1 EHERGE.Y CONTA~TS. ~1RM"I)'\ <;~ ~ 11t~~ yo 2ffr~n~~ej' 12H8II~-t. \ ~~,lc..",,"; n5eÚJc-r ~, yo 1,::\ ~ertjfit!tio" fRet:d-and sign af1f3r completing all sections) , . -, . 1 certify under øenalh 0 - flit that I havé persona Iy exalllneQ and ell fudlm with the inforllatlon $UQlI1tted In thIs and all~~ z~tacheá docVllents, anO t .at based on IIY InquirY,Q those IndiVIduals responsible for obtaining the IntOrllatlon, 1 belIeve that the . Ii SUÞllltted Inforlatlon 15 true, accuritt, and cOllplete. ~ II qtr1J+5 ~ ~ 6~¡" , ß 'H"Ye..-r 7!2-e;¡9z.- I Hie er 0 IC wn. ø r r owner per r S au or1 e represen a tv SIgn ure onrrQffi- I ! ----"-- -_.._._.~ ------ .---.-__..__~_____ ___ __ ~_ 0"' __ Standard Business ~AZARDOUS MATERIALS INVENTORY : ~ NON-TRADE SECRETS P~e I. BUSINi~S NAME: \ü~ ,\.,.; ðto'{(:..... OWNER NAME: VA-11~-.ss ~ o~v) ~ t- NAME OF THIS FACILITVò' : . LOCAT Hi.. Be <D w ,L. ADDRESS!' '-(J-J. ~~e-~..... t..-N STANDARD IND. CLASS C Dt: I ~¡,¡,~~ .f": > - ~ ~ÅX~~ t P: ".;f"6~it:o ;' ~.,o.,o DUN AND BRADSTREET NUHB~R----- I REFER TO~ / ~u / uN::; ¡-UK ,.,fWPER CODES - - - - 7 8 9 10 11 12 13 U . DJs Cant Cant Cont Use location Where 1 bv Nms of /ixture{C:!'conents on SIte 1Jpe Press 1m Code Stored In FacIlIty n' See Instruc Ions , ðbS \2> V(k\'~ Farm and Agticulture [] I ;)..,0 PhI~ic.1 end Health Hafard (t:heck a II that app I y) ,~ Hazard I o React,ivitJI, \ o Reàctivity ¡ I II &0 i I Phys i ca 1 end Hea 1 th Ha~ard ¡ i (t:heck all that apply) ! I rvfire Hazard 0 Reactivity C.A.S. Humber ri1ayed 0 Suddfn Release Health 0 Pressure ~ayed 0 Suddfn Release Health 0 Pressure CItY ot bAKì:K~t-lì:LU ",' ,J of \ Component., Name I C.A.S. Number \ ~~ COlponent.2 Nale I C.A.S. Number ~ Immediate Hea I th Component.3 Nale I C.A.S. Number ~ A- ,'",,, ~, ~ COlponent 12 Name I C.A.S, Number o lll1ediate Health Component.3 Name I C.A.S. Number EMERGElftv CONTACTS. ~1~~ S¿lib¿ - rft~ r ~~~;n~n~8E 112N~\ ~ LVy'"', ntri>r ~y II ~!rtjfif!tiO" rRer;dand sign afrer c9mp7eting a77 sections} . -, ¡ 1 certl y under penalty 0 rav th.t I havé pmona Iy exulneQ eod em fulilur with the inforll8tlon $ubllitted In thIs end all ~ "t"h.; ;",..nts. .., t .t b.s.' o. .r In,,;ry., those 1,"";U,ls r.sponslbl. for obt.,.,ng the ,nfor.'t'o., j b.II", th~t the '" ! SUDll1tted Intormatlon IS true, accuràtt, and complete. _ _ /f ¡ !"e e,. 0 IC wn. r or ~t per~ or S ~ or1 reoresen a IV " -SIgna ure ~ ~ , ! 180 Physical"end Health Hafard It:heck all that apply) ~,m'd 0 ReactiYit~ C.A.S, NUlllber ~ved 0 Sudden Release Health of Pressure C.A.S. NUllber ¿yed 0 Sudden Release Health of Pressure Component 11 Name' C.A.S. Number Component 12 Nale I C.A.S, Number o Immediate Health COlllponent 13 Name' C.A.S. Number - L, Go ~ tl COlponent.2 Name I C.A.S. Number o 1I1Iediate Hea I th Component 13 Nale & C.A.S. ~mber '3'1 f 0795 ZTl1r fnOne oZr!.fl:/¡C¡2- ------ --- -.- .-. i I ¡d' d . '1Q.,HAZARDOUS MATERIALS INVENTORY Farm and Agticulture [] Stan ar BUSIness ~ . I NON-TRADE SECRETS I BUSINiiS NAME: rA-'i10S 'hrvr shÝQ.. OWNER NAME: rA-1J~ ~ð~"'CA1"t- NAME OF THIS FACILITVö' L¥¥ÿT N' A~DRES~' ~~ 5 p~ ~ f- N STA~DARD ~ND. C~A¥S C Dr '. ~HÒN~ ~Þ: I ~HÅ~~ i~P: io.7I ~~v :;'0 OY:} ~ 70;0 DUN AND B ADSTR E NUMB R---- REFER TO"'7 Sf ffU(; f 1 uN::; rUK f'ROPE:R CODES - - - - 1 8 9 10 11 .12 u I Dys Cont Cont Cont Use loc~tlon Where NalleS of Iixture/C~r~onents on SIte ,lype Press 1eIlP Code Stored In FacIlIty '. See Instmtlons , 2> b5\ J A-(,~ ~ ! C.A.S. NUllber COllponent II Nalle I C.A.S. NUllber o Fire Hazard ~ COllponent 12 Nalle I C.A.S. NUllber o Delaled o suddfn Release IlIlIIediate Hea th o Pressure Health COllponent 13 Nalle I C.A.S. NUllber I II b Ph~~ic~l ,~d ~ealth Hajard C.A.S. NUllber COllponent II Nalle I C.A.S. NUllber I ec a t at apply Ii ~àctiYity : ~ . COllponent 12 Nalle I C.A.S. NUllber I o Fire Hazard o De 'Sled o suddf" Re I ease IlIlIIedHlte Hea th o Pressure Health COllponent 13 Nalle I C.A.S. HUllber 00 Phtsical ,nd ~ealth Ha~ard C.A.S. Number COllponent II Nalle & C.A.S. NUlllber L I Q~,ð \ he~~ all at apply '~ctivity ~ ' COllponent 12 Nalle I C.A.S. NUllber o Fire Hazard o Delsled ~ Suddf" Re 1 ease IlImedlste Hea th o Pressure Health COllponent 13 Nalle & C.A,S. NUllber M 'DO Ph~sic~1 ',nd Health Haiard t hec a I that apply . 6"re:,mrd o Reactivity ~led o Suddrn Re I ease o .Colponent 12 Nalle I C.A.S. NUllber IlImedlate ! Hea th o Pressure Hea I th ¡ COllponent 13 Nalle & C.A.S. Mullber , CI1Y at - ~AKt.K~~lt.LU I lr.ns Code 2 Tyae Code ., Pa,ge of -2... EMERGElftv CONTA~TS. !1J;fM ~~"o~'-+ 11m-ï/Y' ~'H~I'~o'!è'ò5 Tt~ tertific!tio" fRerad and $ign afjer cÇJmp7eting. a77. sections) . . - . . 1 certIfy under penartr 0 la)! th~t I have persona Iy eX811lneQ ,"d 811 faalllu( Ylth the info(lIatlon $Ubllltted In thIs end all zttached docUllents. ano t at based on my InQulry~o those IndIY,'D"'S responsIble for obt"n,ng tb. Infornltlon. I belle.e tb~~:be. ..________~. ~ SUbMItted Inforllatlon IS true, accurit~. and cOllplete, __ _______________ ~ :: ~ ..e" 0 C '" ,; p . r . or ..ner pera or S f, ~ r pre en . IV . . ß'!111 re ..f;:::i:, 4Øž' '3Cf ß -o7QS- 7Tl!fTft~ Uã7-st1if ¡C?2- ~--------- -----==-==--====---====-=-~~::=-:.=::-_-_:::.:::-=-:---:-=---:-:-.:_-:--.:===-----===..:..:: -=-=--===-=--=--..::-=-:.:.:=:--=-.:-~~ -- - ---- _...-. - ",-:--::==:. _:.. ::..======.".:-:-.:':''::::-- --::---::.:.::=::::::::=:-=-===-==-=--=-~:~_._. .- . _._ n.._'____ . . __ ____~ I · It " EMPLOYEE TRAINING FOR TIlE WRITTEN HAZARDOUS cœMUNICATION PROGRAM The Hazard Communication "Right to Know" Act was enacted by the Occupational Safety and Health Administration (OSHA) to ensure that employers and employees are aware of possible dangers associated with hazardous mecrials present in their workplace. The Right to Know Act requires employers to: 1. Label all containers containing hazardous materials. 2. Have Material Safety Data Sheets (MSDS) on file for all products containing hazardous materials. 3. Provide a written hazard communication program to be available at each ~ork site. 4. Train employees regarding the Hazard Communication Program, detection and protective measures to use when handling a hazardous material. ] . WHAT IS A HAZARDOUS MATERIAL? A hazardous material is any substance or mixture of substances having properties capable of producing adverse effects on the health or safety of a human being. Materials which are explosive, flammable, unstable or water-reactive are also considered hazardous. 2 . BOW A HAZARDOUS MA TERrAL CAN ENTER TIlE OODY. A hazardous material can enter the body through inhalation, ingestion, injection and absorption (skin contact). 3. PRECAUTIONS TO USE WHEN HANDLING A HAZARDOUS MATERIAL. a. Read labels to familiarize yourself with the properties of the product and any special precautions that should be taken. b. Take caution while opening cases to assure that containers are not damaged. c. - If you smell a strong odor which you suspect may be a hazardous material, vent the area immediately, d. Wash your hands after handling products containing hazardous materials. Do this before eating, smoking, or drinking anything. e· e v Hazard Communication Training Page 2 e. Wear gloves while stacking shelves or prlclng products containing hazardous materials if you have cuts on your hands. f. If you spill a product containing a hazardous material on your skin, immediately wash it off. g. Never mix products containing hazardous materials unless you are certain it is safe to do so. h. Make sure that caps are firmly sealed while stocking or pricing products. i. Use adequate retainer strips to prevent accidental breakage, especially if the products are in glass jars. 4. DETECTION OF A HAZARDOUS MATERIAL. Generally, detection of a hazardous material is by sight or smeil, b~t you also experience the following symptoms: a. Burning of the e~'es, nose, throat or skin. b. It ching of the skin. c. Fatigue and/or drowsiness. d. DizZiness. e. Narcosis (feeling high) or shortness of breath. f. Peculiar taste in mouth. 5. CLEAN-UP PROCEDURES Caution must be taken when cleaning up a spill or a leak of a product containing a hazardous material. Quick action is necessary, so know where your clean-up kit is and always keep it well stocked. The clean-up kit should contain the following: a. Vermiculite or unscented kitty litter (scented kitty litter contains oxidizers that when mixed with certain chemicals can cause an adverse chemical chain reaction). b. Baking soda. c. Broom and dust pan. " - "! .- . f\ , Hazard Communication Training Page 3 d. At least two chemical respirators. A dust mask is not adequate protection and should not be used. You may order a respirator through the Safety Department. e. Liquid repellent gloves - vinyl or rubber. NO LEATHER GLOVES. f. Two pair of safety goggles (not glasses). These can be found in the hardware section of most of our stores, however if your store does not carry them, they can be ordered through the Safety Department. g. One box of heavy duty plastic garbage bags. h. Tvw "Caution, \\':'t Floor" signs. The above materials should be placed in a large, plastic garbage container. The lid should be taped shut and labeled "Chemical Clean-up Kit". This kit should be placed in a readily accessible locati0~, and all employees should be instructed On its use. Although the immediate concern is getting the spill cleaned up, we should not forget about customer and employee safety. ~0ver leave a spill unguarded. Either call anotheT employee to guard it or ask a customer to stand by while you retrieve the chemical clean-up kit. To clean a spill or leak, the following steps are to be taken: a. Get the clean-up kit. b. Have someone vent the area by opening the doors and or using large fans to exhaust the fumes. c. Put on the respirator. Make sure it is tightly fitted to the face, and clear the respirator by holding your hands over the expulsion valve and blowing out. Test the fit of the respirator by holding your hand over the front of the cartridge and breathing in. (Note: If the person using the respirator has facial hair; i.e., a beard, it may be impossible to obtain a tight seal.) d. Put on the goggles, making sure that they fit snugly to the face. e. Put on the gloves. · e , , Hazard Commu~jcation Training Page 4 f. Take the vermiculite or unscented kitty litter and pour a containment ring around the spill. Then pour absorbent on the spill itself. Give it adequate time to absorb the liquid. g. Sweep the absorbent material along with the broken container into the dust pan and place it in a large plastic bag. h. ~ipe the floor with clean paper towels and deposit the contaminated towels into the plastic bag. i. ~et mop the floor with warm water and baking soda. Place two tablespoons of baking soda for every gallon of water in the mop bucket. Dry the entire area with paper towels. Deposit all towels into the plastic bag. j. Seal the sack and dispose of it properly. If you need to store the sack prior to proper disposal put it in a container with a tight-fitting lid. If instructions are needed, the Department of Environmental Quality, Agricultural Department, Fire Department, or the chemical manufacturers may be contacted. k. Throughly wash and rinse the dust pan and broom and allow the0 to dry. Perform this procedure with gloves on. 1. Disinfect the respirator with alcohol before putting it a\,ay. m. ~ash your hands throughly with soap and water. n. Fill out an incident report. 6. roPING WITH LARGE SPIlLS Because our company handles products which are packaged for the customer, it is unlikely you will need to deal with a large spill. However, if one does occur, immediately evacuate the area and seal it off. Have someone call the fire department and request their assistance. Be sure to give the fire department the NAME OF THE HAZARDOUS MATERIAL so they will know how to respond. 7. FIRST AID PROCEDURES a. If an employee or customer is overcome with the effects of a hazardous material, IMMEDIATELY get them to fresh air. # '. . ~ Hazard Communication Training Page 5 b. If they are sprayed with a product containing a hazardous material rinse the area of contact with plenty of clear, cold water for at least 15 minutes. Then wash the area with soap and rinse again. c. If a hazardous chemical has been splashed into the eye, hold the eye open and rinse with plenty of cool. clear water. Be sure the affected eye is "downstream", so that the chemicals being rinsed out ~o not get into the other eye. d. If a hazardous chemical is accidentally ingested, give one glass of water and immediately contact the poison control center. 8. LABELS All containers must be labeled with the following information: a. Identity of the hazardous material. b. Appropriate hazard warning; i.e., flammable, combustible, taxlc, carcinogenic, etc. c. ~ame and address of the hazardous material manufacturer, importer, or other responsible party. d. All labels must be in English and predominantly displayed. 9. MATERIAL SAFETY DATA SHEETS (MSDS) MalTJiufacturers, importers and distributors are required to provide Material Safety Data Sheets on all products containing a hazardous material. Material Safety Data Sheets are to contain the name of the hazardous material, the name of the manufacturer and emergency telephone numbers, as well as information concerning the physical data, fire and explosive data, health hazard data, reactivity, spill or leak procedures, and special protection and precautions to use when handling this material. Material Safety Data Sheets will be available from the Safety Department upon request. · e , Hazard Commuf.,icéJtion Training Page 6 I 10. WRITI'EN HAZARD COMMUNICATION PROGRAM The "Right to Know" la,,' covers any chemical which may pose a physical and/or health hazard. Physical hazards include combustible liquids, compressed gases, organic peroxides, oxydizers and chemicals which are pyrophoric, explosive, flammable, unstable, or water reactive. Health hazards include carcinogens, toxic age~ts, irritants, corrosives and sensitizers. ] 1 . PURPOSE AND SCOPE The purpose of the hazardous communication program is to insure that all employees are train~d in the hazards associated with hazardous materials they may be exposed to in the work place. This program explains training and labeling requirements, methods of documentation and how to access information. 12. EVALUATION AND INVENTORY OF HAZARDOUS MATERIALS a. The first step in the control of hazardous materials is to identify them. 1. Their location by room or work area. ') .;. . Quantity. 3. In what operations they are used. b. List the complete name of the product including the f ollo,,'ing: 1. Complete chemical name. 2. Trade name. 3. Complete address and phone number of manufacturer and/or supplier. 4. Quantity that is stored or used. 5. Purpose for which the chemical is present. c. DO Nar ASSUME THAT A MATERIAL IS HARMLESS .ruST BECAUSE THERE IS NO WARNING LABEL. ,4 '. . .\\ 1 Hazard Communication Training Page 7 d. Once the hazardous chemicals are identified, Material Safety Data Sheets need to be obtained and kept on file and be readily accessible to employees as needed. 1. Because we are a retail outlet, many of the substances we sell fall into the hazardous category, however, because most of these Hems are packaged for the commercial consumer market it is not necessary to file an MSDS in each store. 2. If a MSDS is needed contact the Safety Department at (503) 685-6011. e. Evaluate the storage area of hazardous chemicals to make sure that if there is a Jeak of incompatible materials it does not constitute a health hazard. In other ~ords, pool chlorine and pool acid or chlorine and ammonia when combined produce highly toxic fumes. Special consideration should be given to the amount stored in anyone location depending on: 1. Type of storage container. ') .:.. . Distance bet~ee~ substances. 3. Effectiveness of controls provided; i.e., ventilation, fire extinguishing systems, drains, etc. 4. Accessibility in case of an emergency. 13. LABELS AND OTIIER FORMS OF WARNING a. All containers of hazardous substances for store use must be labeled. b. Check these labels periodically to make sure they are in good condition and clearly legible. c. If a label becomes damaged, either apply a new label containing all the information that was on the original or dispose of the product accordingly. . e' ..", A. }, .' . I , I Hazard Comnunication Training PageS" 14. MATERIAL SAFETY DATA SHEETS (MSDS) a. The Wilsonville Office Safety Department will be responsibile for obtaining the MSDS from suppliers as needed. b. The Safety Department will be responsible for reviewing the MSDS for accuracy and completeness. c. The Safety Department will maintain a central file of MSDS for products containing hazardous materials packaged for consumer use. MSDS on products will be available to any employee upon request. d. Employees who use products on a daily basis that contain hazardous substances should have a MSDS at their work site. 15. EMPLOYEE INFORMATION AND TRAINING A. The manager at each store is responsible for training the employees on the Hazardous Communication Program. After reading this information and watching the "Ri ght to 1\no",-" video each employee will sign a form to verify the same. 16. CONTRACTORS a. It will be the responsibility of the management team to infor~ outside contractors of this program and where it is located at each store. b. If an outside contractor; i.e., janitorial crew, store hazardous chemicals on location they will be required to provide MSDS that are easily accessible to all personnel.