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BUSINESS PLAN 7/29/2003
UNIFIED PROGRAM I~'ECTION CHECKLIST .SECTION 1 Business Plan and Inventory Program F~7";: AI C> urz-.J~ s~-ª:'=- -=±~l:Lu_____________ ADDRESS ----------ßÐ-1-~~3 Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 INSP TION pATE ì Z-1l0!> PHO No, u_ INSPECTION TIME -' tp,!~-- No_ of Employees \'1 ~~ FACILlTYCONTACT '^' 1-+ I'T,s L~. ~~ï''l1/S Business 10 Number 15-021- Oot:::>"Z. ~ ---------..-------. ~e~tion1: Businéss Plan and InvêntoryProgram o Joint Agency o Multi-Agency o Complaint ORe-inspection I. ) t c V ( c=comPliance) V=Violation ¿O ApPROPRIATE PERMIT ON HAND -~-~-------~---------,------------_._---- ---.----.-----------------.------------.---..-------------------------.----..--.--.-.-- r!1' 0 BUSINESS PLAN CONTACT-INFORMATION ACCURATE (!( 0 VISIBLE ADDRESS ~ 0 CORRECT OCCUPANCY Q(" 0 VERIFICATION OF INVENTORY MATERIALS ~ 0 VERIFICATION OF QUANTITIES ------------_._--~---~~----------_._---_.--- --------------------------------~-_._.._--_._--------..---.---.-.. r!t' 0 VERIFICATION OF LOCATION r5' 0 PROPER SEGREGATION OF MATERIAL g- 0 VERIFICATION OF MSDS AVAILABILlTYE ~-~- 17" 0 VERIFICATION OF HAT MAT TRAINING OPERATION COMMENTS ._-------------_.---_._------_._~-----~- ----_._-_..~---_.. .--.-----.-.--....--.--------.--------------.--....------- .- .- ------- -~------------_._--_._--- --. - _.._--_.__.~-------_._.__._.__._--_._-------,-_._._---.----.--.-----.-- ",--_.-.------ --.- -~~------~--,-----_._----_._- --~_..-._--_.._-------_._..,--------_.._---------------------.-------------- -.--------------------------- .-.-~---_..,,--..-------.-- ----________.____________________...__..,_ 'n' ---------------..-.----. -------.--------.-------.---.- -------.---------------..------ -_._--------_..-.-------,-_._._------------~------~--._._--,.,_.__._--~- --~-----_.._---- . ----....-- ---~----_.._._~_._- _._~~._--_._-~-----_._-------~.._----_._--~- -'----_.~--_._-- -------_.._-~_._-~_._----_.__._-----_._._----_.._.__.---~_._---------~ gO ~O ~O VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES --_.~-------_.._----- -----_._-_._----_.__._--~._.._..__._-----_.----------~------------.--- EMERGENCY PROCEDURES ADEQUATE ----------_._--~------- _.;-------------_._._._-'-~--_.._-_._----_._--------...---.---.-.------.--.---...-.---- CONTAINERS PROPERLY LABELED ~------------------~------------------_. -----------------------------------.------..------------------------ I!! 0 HOUSEKEEPING ~ ¡;{D~~~- PROTECTION - .. .----- ----------------------------------- J ---.--------------.------- ---------------------.---------------------..--,--------- ~ 0 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: o YES ~ ~ .--------- EXPLAIN: . QUESpONS REGARD.ING THIS¡INSPECTION? PLEASE CALL US. AT (661) 326-3979 _~ ''- k. ~~_ !2:i£\I.€ 1)1 ~ rz Z '-t_~LD3 Inspector Badge No, Whíte - Environmental Services Yellow - Station Copy , JON-- ~"L\- , ~ -~---~-_._-~ qG Business Site Responsible Party Pink· Business Copy e e . CITY OF BAKERSFIEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENT AL,SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3td .'Ioor, Bakersfield, CA 93301 FACILITY NAME KíTEA I D DlZu¡;"..:5ro¡ze ADDRESS &::Co WHITE LN· FACILITY CONTACT I'ÝM£K n9~V)/lI/IO INSPECTION TIME Lo.{'o(''j Do.., 15... ;3.0 rn {fA Section I: Business Plan and Inventory Program INSPECTION»ATE k /¿, ";:: Oð~ PHONE NO,~ 83 7 - 2/15"'" BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES ~O o Routine o Combined o Joint Agency o Multi-Agency o Complaint o Re-inspectiol1 . OPERA TION C V COMMENTS Appropriate permit on hand ¡/ Business plan contact infonnation accurate ¡"....- , Visible address V Correct occupancy v V crification of inventory materials ........ Verification of quantities V Verification of location !¡....- Proper segregation of material vi µ02eð!o. (V'sc~ Verification of MSDS availability v" Verification of Haz Mat training V'" Veri fication of abatement supplies and procedures v , Emergency procedures adequate v Containers properly labeled v Housekeeping v Fire Protection . 5 ~<o.. ("~e.. o;:.\i é \c... (" Site Diagram Adequate & On Hand V C=Compliance V=Violation While - Env, Svcs. Yellow· Station Copy Pink - Business Copy J~~~~y Inspector: 'X ~~ \)Cl'rL.___ Any hazardous waste on site?: 0 Yes Q9 No _ExPlain: Questions regarding this inspection? Please call us at (661) 326-3979 f().thi~ q~ FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ·H· Street Bakersfield. CA 93301 . VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave, Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave, Bakersfield. CA 93306 VOICE (661) 399-4697 FAX (661) 399-5763 - - May 3,2001 Rite-Aid Drug Store 8000 White Lane Bakersfield, CA 93309 Dear Business Owner: I Enclosed, please find the Site and Facility Diagram Instructions packet. Wþen your Hazardous Materials Management Plan and Inventory were submitted it was lacking the diagram portion, Please draw and submit the diagram( s) of your facility by June 8, 2001. The diagram should include the following: 1) 2) 3) 4) 5) 6) 7) 8) name of your business; business address; indicate which direction is North; the cross streets neighboring business addresses (within 300 feet) entrances and exits location of utility shut-offs; location of the nearest fire hydrant; portions of the building protected by automatic sprinkler system; and most importantly the location of the hazardous material(s). 9) If you have any questions, please feel tree to call me at (661) 326-3658. Thank you for your assistance, Sincerely, RALPH E. HUEY, DIRECTOR OFFICE OF ENVIRONMENT AL SERVICES ~j Esther Duran, Accounting Clerk II Office of Environmental Services ED\db Enclosures "" (p' . J/) (7' . U£, //../ u77ld ex:- /. ~, .IN'lN/1?' ÚU} U(WI/,u//l.d'~ .j'O/1! ./{/OOP(} .J'/ta/b ../CJ CJe/ü'I'//r " '. :::/1"~,~~~1 ~:_~!~~}!t:;):'I;':;~-"<~'i6~~ ' iW~if >(.i3~~:~??;;\~'5~{ ~:' \,~, " . : :' ,'~\~:":~';:I, . ~j~::::~\I'::-:"~":'; " :~" ;,~:;0:::~?:;~:;" '~,:::~ .,..-~,. "~' ,;", >ø:fJ.:" ";,,,~:(,~,,;~-;,," " -\p'"' '·e.,'·';'~.." "';;,: ""e- ~"'",:~,;,:',.',:~:,~, , _ ' , < '" " \!::.', '-'-., :' ~, '.': { , :,i :' , 'r.<-- ,', , ..,~" - ~ ~ ' - . ~~ ~ ~, ''''<~' - '. . , ~,.~"'t .', l".,' ,_ . Per ~ ,"."':,." _.~ , '. . .~:~;-. ~".' Hazardous Materials/Hazard'ous'WasteU nified Permit , "0.... CONDITIONS OF ·PERMIT ON REVERSE SIDE This pennit is issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials '. 0 Risk Management Program o Hazardous Waste On.;slte Treatment Permit ID #:: 015-000-000235 RITE AID DRUG STORE #581~ ' . " , '\ \ ' " LOCATION: 8000 WHITE LN, \ \ t Issued by: >-", ":,'.¡ ~\,\'f ¡: ",f' ;,r;'-j, ...... I.','} ~ð ~" '" "i t~.~._ "...'l f; ~ !j,<> ~ ~.r l; '1 ~," t.. -,t ." ~",:',~ ~~, \\;' \..{ \\ \' .\ \\ \ . >, \, ' " '" '" " (,. .....; \..':.. .... .. , Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bàkersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approvoo by: Issue Date Expiration Date: June 30,2003 '\ ';.- '''' -: - "\ ~ ..~- ~ -_ DRUG STORE #5817 / /, " / J~S P6UNDER Mf1/ZK jL{ö NTílfJ í D 8000 WHITE LN BAKERSFIELD t'j3oC¡-7t ~~ tI. SiteID: 215-000-000235 RITE AID Manager : Location: City BusPhone: Map : 123 Grid: 16C (~6t) 837-2195 ComrnHaz : Low FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 09 EPA Numb: SIC Code:6512 DunnBrad: Emergency ,Contact / Title Emergency Contact / Title ~ ~-M 14'~¡,( ¡,{ D/ù ,fj /Ù ì (/ / MANAGER MfCHltEL ett I;}JZ.£ / tJ-SST· I4rt;ù - , Business Phone: (tø(P / ) 837-2195x Business Phone: (~~/) g'jï -zflS-x 24-Hour Phone : (~( ) 832-0681x 24-Hour Phone : (~Ç; /) ~ 7:' -[5õj x Pager Phone : ( ) - x Pager Phone : ( ) - ( x Hazmat Hazards: Fire Press React ImrnHlth DelHlth Contact : Phone,: (805) 837-2195x MailAddr: 8000 WHITE LN State: CA City : BAKERSFIELD Zip : 93309 Owner RITE AID CORP Phone: (717) 761-2633x5096 Address : PO BOX 3165 State: PA City : HARRISBURG Zip : 17105 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì p= Hazmat Inventory p== As Designated Order Hazmat Common Name... Hazards DailyMax MCP BLEACH R IH L 240.00 GAL Hi MOTOR OIL F DH L 500.00 GAL Min PROPANE F P IH G 300.00 FT3 Hi PAINTS F IH L 120.00 GAL Mod PAINT THINNER F DH L 90.00 GAL Mod INSECTICIDES F DH L 360.00 GAL UnR HERBICIDES I, PApJC~ t:;.. l411cLI;QQ. Do herelðy certity~hat i haJl.9 280.00 GAL UnR POOL ACIDS ype or print name) R IH L 100.00 GAL Hi POOL CHLORINE LI9éV1~~ed the attached hazardous materiàJs manage- 600.00 GAL Hi POOL CHLORINE SOLIDS S 1200.00 LBS Mod FUEL ADDITIVES ment plan for{(ìi1: flìà CO~ Pi §nd tha~tt along whh 100.00 GAL Hi FUEL (Name 01 Businoss) F IH DH L 200.00 GAL UnR ANTI-FREEZE COOL~y corrections constitute a complete ~1~rrect m~- 300.00 GAL Low FERTILIZER 1000.00 LBS UnR agement plan for my facility. ~!~M ~ 'gootule , T-~-w 05/08/2000 i, e e ..~ r -~ F RITE' AID DRUG STORE #5817 p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME BLEACH SiteID: 215-000-000235 1 Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 7681-52-9 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 240.00 GAL , Daily Average 90.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Sodium Hypochlorite No 7681529 HAZARD,ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME MOTOR OIL Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 8020835 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 500.00 GAL Daily Average 200.00 GAL HAZARD US COMP NEN %Wt. RS CAS # 100.00 Motor Oil, Petroleum Based No 8020835 o o TS HAZ T TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min ARD ASSESSMEN S -2- 05/08/2000 .' e e *' F RITE AID DRUG STORE #5817 p= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME PROPANE SiteID: 215-000-000235 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # .74-98-6 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 300.00 FT3 Daily Average 55.00 FT3 HAZARDOUS COMPONENTS G;] CAS # 749861 I l~~~óolpropane TSecret RS BioHaz Radioactive/Amount E;f>A Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS -3- 05/08/2000 i' e e F RITE AID DRUG STORE #5817 p= Inventory Item 0004 F== COMMON NAME / CHEMICAL NAME PAINTS SiteID: 215-000-000235 l Facility Unit: Fixed Containers on Site l Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 64742-47-8 STATE - TYPE Liquid Mixture PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 120.00 GAL Daily Average 55.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # Mineral Spirits No 8030306 Ethylbenzene No 100414 Toluene No 108883 Xylene, Mixed No 1330207 Methyl Ethyl Ketone No 78933 n-Butyl Acetate No 123864 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mod -4- 05/08/2000 e e F RITE AID DRUG STORE #5817 p= Inventory Item 0005 F= COMMON NAME / CHEMI CAL NAME PAINT THINNER SiteID: 215-000-000235 l Facility Unit: Fixed Containers on Site l Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 64742-88-7 . STATE - TYPE . Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 90.00 GAL Daily Average 55.00 GAL HAZARD US COMPONENT %-Wt. RS CAS # Aromatic Hydrocarbon No 8030306 Toluene No 108883 n-Propanol No 71238 n-Butyl Acetate No 123864 Xylene, Mixed No 1330207 Methanol No 67561 o S HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod , -5- 05/08/2000 e e F RITE AID DRUG STORE #5817 p= Inventory Item 0006 = COMMON NAME / CHEMI CAL NAME INSECTICIDES SiteID: 215-000-000235 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 7757-82-6 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 360.00 GAL Daily Average 120.00 GAL I l~~~óoIInsecticides HAZARDOUS COMPONENTS ~ CAS # 01 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No, No/ Curies F DH / / / UnR p= Inventory Item 0007 F= COMMON NAME / CHEMI CAL NAME HERBICIDES Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # o STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 280.00 GAL Daily Average 100.00 GAL HAZARDOUS COMPONENTS I~ CAS# 01 1 %Wt. I 100.00"He~ici~s HAZARD A T TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR SSESSMEN S -6- 05/08/2000 e e F RITE AID DRUG STORE #5817 f= Inventory Item 0008 F== COMMON NAME / CHEMICAL NAME POOL ACIDS SiteID: 215-000-000235 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 7647010 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 100.00 GAL Daily Average 55.00 GAL HAZARD US MPONENTS %Wt. RS CAS # 100.00 Muriatic Acid Yes 7647010 o CO TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No/ Curies / / / - Hi No No No R IH HAZARD ASSESSMENTS f= Inventory Item 0009 = COMMON NAME / CHEMI CAL NAME POOL CHLORINE LIQUIDS Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 7681-52-9 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 600.00 GAL Daily Average 100.00 GAL %Wt. RS CAS # Sodium Hypochlorite No 7681529 Sodium Hydroxide No 1310732 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi HAZARD ASSESSMENTS -7- 05/08/2000 e e F RITE AID DRUG STORE #5817 p= Inventory Item 0010 = COMMON NAME / CHEMI CAL NAME POOL CHLORINE SOLIDS SiteID: 215-000-000235 l Facility Unit: Fixed Containers on Site l Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 87-90-1 STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container LBS AMOUNTS AT THIS LOCATION Daily Maximum 1200.00 LBS Daily Average 800.00 LBS %Wt. RS CAS # Trichloro-s-triazinetrione No 87901 Dichloroisocyanuric Acid No 2782572 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod p= Inventory Item 0011 F= COMMON NAME / CHEMI CAL NAME FUEL ADDITIVES Facility Unit: Fixed Containers on Site l Days On Site 365 Location within this Facility Unit Map: Grid: CAS#- 11-45-01 STATE - TYPE Liquid Mixture PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 100.00 GAL Daily Average 55.00 GAL U %Wt. RS CAS # Methyl Alcohol No 67561 Methyl Ethyl Ketone No 78933 Ethylene Glycol No 107211 HAZARDO S COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi -8- 05/08/2000 e e F RITE AID DRUG STORE #5817 p= Inventory Item 0012 = COMMON NAME / CHEMI CAL NAME FUEL SiteID: 215-000-000235 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 200.00 GAL Daily Average 60.00 GAL %Wt. I HAZARDOUS COMPONENTS ~ CAS # HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / UnR . p= Inventory Item 0013 = COMMON NAME / CHEMI CAL NAME ANTI-FREEZE COOLANT Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit WAREHOUSE & SALES FLOOR. Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 300.00 GAL Daily Average 30.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # Ethylene Glycol No 107211 Diethylene Glycol No 111466 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Low HAZARD ASSESSMENTS -9- 05/08/2000 e e F RITE AID DRUG STORE #5817 p= Inventory Item 0014 ¡:== COMMON NAME / CHEMI CAL NAME FERTILIZER SiteID: 215-000-000235 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit Map: WAREHOUSE, SALES FLOOR, NURSERY COM- POUND. Grid: CAS # [ STl:\TE I ~YPE ~ P~ESSURE ---r TEM~ERATURE I CONTAINER TYPE =SOlld __Mlxtur~mblent ---1 Amblent ~ BAG AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average LBS 1000.00 LBS 200.00 LBS ~Wt. I HAZARDOUS COMPONENTS G CAS # HAZARD A T TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / UnR SSESSMEN S I' -10- 05/08/2000 e e F RITE AID DRUG STORE #5817 I f= Notif./Evacuation/Medical ~:e:::_:~tification SiteID: 215-000-000235 ~ Fast Format ~ Overall Site ~ 07/24/19921 Employee Notif./Evacuation 07/24/1992 EVACUATION PLAN POSTED ON WALL. SAFETY MEETINGS WEEKLY. Public Notif./Evacuation 05/18/1998 EMPLOYEES TRAINED TO DIRECT CUSTOMERS TO NEAREST EXITS. Emergency Medical Plan 07/24/19921 NEAREST EMERGENCY ROOM. -11- 05/08/2000 e e SiteID: 215-000-000235 ì Fast Format ì Overall Site ì 05/18/1998 F RITE AID DRUG STORE #5817 I p= Mitigation/Prevent/Abatemt Release Prevention MONTHLY SAFETY INSPECTION OF OUR STORE BY THE ASSISTANT MANAGER. PERIODIC INSPECTIONS BY OUR MARKET/DISTRICT OFFICE. Release Containment r I I Clean Up Other Resource Activation -12- 05/08/2000 e F RITE AID DRUG'STORE #5817 I f=. Site Emergency Factors r== Special Hazards Utility Shut-Offs e SiteID: 215-000-000235 ì Fast Format ì Overall Site ì 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. Wate~ 07/24/1992 PRIVATE FIRE PROTECTION - ACE SPRINKLER COMPANY BAKERSFIELD. NEAREST FIRE HYDRANT - FRONT & REAR OF BLDG. Building Occupancy Level -13- 05/08/2000 ,. '':..' e e F RITE AID DRUG STORE #5817 I F ,Training Employee Training SiteID: 215-000-000235 ì Fast Format ì Overall Site ì 05/18/1998 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, HAZ COM, PPE, USE OF FIRE EXTINGUISHERS. SAFETY Page 2 [ I I Held for Future Use Held for Future Use -14- 05/08/2000 ~~~ , e e Section 111: Inventory QWkEX - J H R" P1foTC INVENTORY SUMMARY .:.4.CILlTY NAME: 12.\"Œ Pt , D S6-/7 LJ~hTE-- L.I4-N E JMKE¡(çF ì EI,.-1) , ctt , . SITE ADDRESS: fS:Drf) { .jJoý-7¿Rr' Inventory Summary ~em Name of Hazardous Material or Waste Maximum Unit of # Quantity Measure 1 Kodak F1exicolor Developer Repllnlsher LORR 4 gallons 2 Kodak Flexlcolor RA Bleach Repllnlsher NR 1 gallons 3 Kodak Flexicolor RA Fixer & Repllnlsher 4 gallons 4 Kodak Flexlcolor Stabilizer & Repllnlsher LF 8 gallons 5 Kodak Ektacolor RA Developer Replinisher 14 gallons 6 Kodak Ektacolor RA Bleach Fix & Repllnlsher 14 gallons 7 Kodak Ektacolor Prime Stabilizer & Repllnlsher 28 gallons Date Prepared: Summarize the busln... plan Inventory on thl, PlGe. Place In front of Inventory ..ctlon of bulinel8 ptan. Make co~. of thla sheet or (replicate on a computer) .a n'CI..ary. F1f i1 ~ ). : . ~ \ ~ - ~' Physical Hazard: FIRE: FACILITY NAME: Chemical Name: Common Name: Health Hazard: Physical State: Amount and Time at Facility: Storage Location(s): 9Go9ð _% '-5 -" c1 _% <1 _% -" _% NOTES: HAZARDOUS MATERIAL INVENTORY FORM QU. ftLEX - I 11'((. ftfo ì Non-Trld. Secret Page \<.r,e ~ I 0 5g/7 ITEM # Kodak FlexlCCIIor Develoøer Reøllnlaher LORR CAS Ii- FIlm DmIICØIt DOT #- PRESSURE: REACTIVE: - IMMEDIATE HEALTH: DELAYED HEALTH: M A Unit of Measure: T gal8: r&J lb.: IJ E IJ cu ft: R I A L FORM: Solid: Liquid: x Gal: Dust: TYPE: Pure: - Mixture: x - - ., OaysJyear on-altl: 385 MIXlmum Amount: 5 ;alieni Average Amount: 4 gallons Container Type: Plutlc BottI. Storage Prelsure: AmbI.nt Storage Temp: M1òI8nt All chemicalS are ,tared In the pl1c*:llû and/or c:tI8mk:aIlknQe .... Potaulum Carbone1a ~ ""'om SUltlIII 4-(N.EIIyI-N-2~thy\)oZ-metlyl~ IUifIIta DATE PREPARED- MAKE COPIES OF THIS FORM AS NEEDED REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAl IS NOT USTED IN APPENDIX 1. f4{L1~ HAZARDOUS MATERIAL INVENTORY FORM QQAŒX- J tttL P fõJt Non-Trldl Secret Pig. FACILITY NAME: --121'% Pr I D S-K77 ITEM' 2 Chemical Name: Kodak FIuicDIor RA BJeec ft Atøllnlahlr NR CAS II- Fßm Bleach .-- Common Name: DOT II- Physical Hazard: FIRE: PRESSURE: - REACTIVE: - - Health Hazard: IMMEDIATE HEALTH: - DELAYED HEALTH: Physical State: FORM: Solid: _ Liquid: 2- Gal: - DUlt - TYPE: Pure: Mixture: x - - t# Caya/year an-site: 385 Unit of Mealure: Amount and Time at Facility: Maximum Amount: 2 ;donI glls: ŒI Avel'llge Amount: 1 geIIonI Ibl: 0 Container Type: PIutIo Both cu ft: [] Storage Pressure: AmÞIent Storage Temp: Mlblent Storage All chemlœla .,e IIrnd In the photGIab alWMor cNm6caIatarage area Locatlon(s): (Provide ãridCoordiñãtea from camDiãi8d facilItY map.) Percent Concentration & Components eo-6!5 'Nt.. % 10-15 Fento ammonh.., prapyIenedIIninlltraGdo loId % ~10 AmmonIum Ikarride % 8 AmmoniumNlhte % 1-5 AœtIo AØd % 106 1.3.propyIenedlamlMtetrucetlc acid % NOrES: Trade nllml(l) I Iynonym (I) or other amormauon relevant to mltenal{l, I..tn. M A T cE R I A L DATE PREPARED· MAKE COPIES OF THIS FORM AS NEEDED '-_... REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAL JS NOTUSTED IN APPENDIX 1. .. . -, f'1:":~~- ~ o. e e Q U.itL£i- I ff¡(· ~H 0 I HAZARDOUS MATERIAL INVENTORY FORM Non-Trad. Secret Plge 3 FACILITY NAME: ~I íE A I D ,t)k'/7 ITEM' Chemical Name: Kodak FluIacIor RA FIx... , ReøUntaher CAS ,- Common Name: Film FIx DOT #- Physical Hazard: FIRE: PRESSURE: - REACTIVE: - Health Hazard: IMMEDIATE HEALTH: - DELAYED HEALTH: Physical State: FORM: Solid: Liquid: x Gas: DUlt: - - - - TYPE: Pure: Mixture: x - - # Days/year on-site: 386 Unit of Mealure: Amount and Time at Facility: Maximum Amount: 5 ;aIIonJ gila: Œ1 Average Amount: 4 0d0nI lb.: 0 Container Type: PIutIc Bottle cu It: CJ Storage Prellure: Ambient 8te,.;_ Temp: Ambient Storage All chem/cala Ire alOl8d In !tI. photolaò Inciter ci1lm1c11elOf808 ar.. Location( s): (Provide Qiidëooñiiñãte. from corñØiÏild 1lclüiY- map.) Percent Concentration & Components 75-80 Water _% 10.15 AnmonIum Thlccvlna- _% 5-10 Ammonium thIoIuIfa. _% 1-5 SOdIum 8u11. _% <1 Arnn10nlum SUIfItI _% _% NOTES: Trade n......) I .ynonym (I) or other ,.lIv.nt to metenll(lJ I~O. DATE PREPARED' MAKE COPIES OF THIS FORM AS NEEDED REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAL IS NOT LISTED IN APPENDIX 1. M A T E R I A L ~ L/ 0( t- e e HAZARDOUS MATERIAL INVENTORY FORM QUALS~' - J tt"'- p~-! I Non- Trad. S.cret Page 4 FACILITY NAME: ~1"Æ ~O . ')gl7 ITEM # Chemical Name: Kodak Flexlcclor 8labllløt & Re~lItåh.r LF CAS #- Common Name: FIlm Stabilizer DOT #- Physical Hazard: FIRE: PRESSURE: - REACTIVE: - Health Hazard: IMMEDIATE HEALTH: - DELAYED HEALTH: Physical State: FORM: Solid: _ liquid: 2- Gal: DUIt: - - TYPE: Pure: Mixture: x - - # Days/year on-site: 385 Unit of Measure: Amount and TIme at Facility: Maximum Amount: 9 gallona gala: ŒJ Average Amount: 8 gallonl Ibl: a Container Type: Plullc Battle CU ft: 0 Starage Pressure: AmbIent Storage Temp: Ambltnt Storage All c:hen*aI. .re .tend In the photollò .ncllor ch.mlcal ltarage area Location(s): (Provide grid coordinate. "frõñiëompleted facility mao.) Percent concentration & Components 9so1oo water _% <1 HeumethylenetlWlrftne _% <1 Sodium dad~ .won." _% <1 DIprapyIene CI~ _% <1 Nanklnle aurfllct8nt _% <1 SUbaIlIuted th~ -" NOTES: Tracie narM(I)T'1nonym (I) or otner InfOrmatIOn r.levam to nwenal(l) llatad. M A T E R I A L DATE PREPARED' MAKE COPIES OF THIS FORM AS NEEDED REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAL IS NOT USTEO IN APPENDIX 1. ~~1~ ~ e e HAZARDOUS MATERIAL INVENTORY FORM QUi'tlEX- tNt fftúJD Non-Trade Secret PI;' FACILITY NAME: I<.\~ A 10 ~k¡7 ITEM # ð Chemical Name: Kodlk E1ttaoolor RA DeveIoøer Repllnlll'let CAS #- Common Name: Plpar Developer DOT #- ,. Physical Hazard: FIRE: - PRESSURE: - REACTIVE: - Health Hazard: IMMEDIATE HEALTH: DELAYED HEALTH: - - Physical State: FORM: Solid: _ Liquid: -!.. all: _ Dust: _ TYPE: Pure: Mixture: x - - # Days/year on-lite: 386 Unit of Measure: Amount and TIme et Facility: Maximum Amount: 5 gdanI gal8: ŒJ Average Amount: 4 QIIikIna Ibs: 0 Container Type: PIIIIIo Both cu ft: 0 Storage Pressure: AmbIent Storage Temp: AmbIent Storage All chemlc:al1 are ,tortd In thl photoleb and/or cnlmlC8& ltorage .111. locatlon( s): (Provide grid coordiñitel1rom corñõiiiãò faclliiŸ map.) Percent Concentration & Components Q5. 100 w..... % <1 Potaulum c:ncnalll % <1 TrtethenolemIM % <1 N.N~~J"''''. _% <1 4-(N-e1hylh',álaxyethyl)-2~' % lIIQuMlUlfat8 manctrydrate _% NOTES: Tracie nlme(l) Ilynonym (If orotMr Inform.UOn II m.ten.l(l) Illtea. M A T E R , A L DATE PREPARED' MAKE COPIES OF THIS FORM ÞS NEEDEG REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAl IS NOT USTED IN APPENDIX 1. (2'Jf- fo 1 r · ~' FACILITY NAME: Chemical Name: Common Name: Physical Hazard: Health Hazard: Physical State: Amount and Time at Facility: Storage Location(s): 8O-8S _% ~10 _% 5-10 _% e HAZARDOUS MATERIAL INVENTORY FORM Non·Tr.d' Secr.t Pig. ~rr~ A I 0 . _c:;:k¡7 KoåIk Elda=ìor RA Bleach FbI: & Repllnlener Paøer BlHctI FIx FIRE: PRESSURE: REACTIVE: - - - IMMEDIATE HEALTH: DELAYED HEALTH: - FORM: Solid: _ Liquid: 2- Gal: _ Dust: _ TYPE: Pure: _ Mixture: ~ # Days/year on-8Ite: 385 Meximum Amount 5 a-Iona Average Amount: 4 QIIIanI Container Type: PIuIIa BoUIe Storage Pressure: Ambient Storage Temp: Ambient All chemlcala are elCr8d In !tie photolaÞ and/or chemlcllllØ8Q8 area (Provide grid coordiñãte. from completed fãëiiiiY map.) Percent Concentration & Component. Wtt8r Ammonium thlœulfa18 HnmonIum ferric ethylel'lolodllmlMllltllacetlc acid 1-5 SOdIum bIeuiIIIe _% 1.5 Acallc add _'At <1 AmmonIum .uII1a _% e Q U ~'tl-£X - I rtÞZ· fftDTt ITEM # 8 CAS #- DOT #. Unit of MeBsure: gals: ŒI Ibs: 0 cu 11: 0 NOTES: Tracte namela) laynonym (.) or OUl.' InfOrmation rel.vant to mat.naIra) llaaaa. DATE PREPARED" MAKE COPIES OF THIS FORM AS NEEDED REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAL IS NOT LISTED IN APPENDIX 1. M A T E R I A L ~71r , ¡ e e HAZARDOUS MATERIAL INVENTORY FORM Q LUrL¡;X- tt (· P/t{>TÙ Non-Trade Secret Plge FACILITY NAME: ÇlJ~ A-IO 7 ~f/7 ITEM # Chemical Name: Kodak Ektacclor Prime Stablllat & Repllnlaher CAS ,- Common Name: Plpar StabIIIDI DOT #- Physical Hazard: FIRE: PRESSURE: - REACTIVE: - - Health Hazard: IMMEDIATE HEALTH: DELAYED HEALTH: - Physical State: FORM: Solid: Liquid: X Gal: OUIt: - - - - TYPE: Pure: Mixture: x - - # Days/yelr on-site: 386 Unit of Mealure: Amount and Time at Facility: Maximum Amount: 28 gaiIonI gals: ŒJ Average Amount: 28 oaIlonI lb.: 0 Container Type: PIutIo BoUlt cu ft: 0 Storage Pmaure: AmbIent Storage Temp: AmbIent Storage þ.J d1enicalll,. II.Ottd In the phOICIab Incllor c:nemlcalltcr8ge am Location(s): (Provide ãridëoordiñïte.1rõñ1com;iiiëd fadUty map.) Percent Concentration & Components ~,oo WltIr _% <1 PolyvInylpyrrolidone _% <1 % SodIum aIkyIelher euif8t8 <0.1 SuÞllltuted IhJIzDIIno3.œe _% !5-10 Magnllllum nitrite _% _% NOTES: rr8U8 nlme(l) I Iynonym (I) or 0"'" InYWmlllOn ,..Vlnt 10 ",.ltlW(IJ lII.a. DATE PREPARED: MAKE COPIES OF THIS FORM AS NEEDED REMEMBER TO ATTACH MSDS TO THIS FORM IF THE MATERIAL IS NOT LISTED IN APPENDIX 1. M A T E R I A L ~g-1~ .._w.i;:.;:;;i\¡-~';;; ~¡.,.,..............."",--,-~-"""_.._-'-~---~'_O"~----" .___...h.___..........___ _e .. T .--, e . \'.'..-....... . ,.. ""'-'- "., ". ....."',~, ....,.. CUST .e & NO. ES·- 3i::f:O MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE3-/~ -:tf NEW ACCOUNT 1 ADDRESS CHANGE CLOSE ACCT I : FINANCE CHARGE , OTHER ADJ I CUSTOMER NAME L~ ~ -E..- [à., ( cl S 1-0 f e. '5<6 \ I MAILING ADDRESS <6O,(X:) W~ ~ ~.~. ~ ' CITY ßo:l~S~{ dd STATE (JA. ZIP CODE 9~s~ SITE ADDRESS PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT I I R~~S:b~: ~b :5ùrc-bP~~ sloJd'vp~ . APPROVED BY 4~~ ~>.~ ¡J.·tù. State of California - California EnVironm~.otection Agency - Department of Toxic Substances Control Page 1 of 1 ONSITE HAZARDOUS W ASTE TREATMENT NOTIFICATION FORM ~ Initial o Amended FACILITY SPECIFIC NOTIFICA nON For Use by Hazardous Waste Generators Performing Treatment Under Conditional Exemption and Conditional Authorization, and by Permit By Rule Facilities Please refer to the attached Instructions before completing this form, You may notify for more than one permitting tier by using this notification form, DTSC 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit specific notification forms for five of the categories and an additional notification form for transportable treatment units (TTU's). You only have to submit forms for thetier(s)/category(ies) that cover your unit(s). Discard or recycle the other unused forms. Number each page of your 'completed notification package and indicate the total number of pages at the top of each page at the 'Page of _'. Put your EPA ID Number on each page. Please provide all of the information requested, a~lfields must be completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any attachments, The notification fees are assessed on the basis of the highest tier the notifier will operate under and will be collected by the State Board of Equalization. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOTIFICATION FORM. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you must attach. Conditionally Exempt Small Quantity Treatment operators may not operate units under any other tier. Number of units and attached unit specific notifications for each tier reported. A. B. -1.. C. Conditionally Exempt-Small Quantity Treatment (CESQT) D. Conditionally Exempt-Specified Wastestream (CESW) E. Conditionally Authorized (CA) F. Permit by Rule (PBR) CE--Commercial Laundry (CE-CL) Conditionally Exempt-Limited (CEL) II. GENERA TOR IDENTIFICATION EP A ID NUMBER CA Pending BOE NUMBER (if available) H _HQ_ _ _ _ _ _ _ _ FACILITY NAME (DBA--Doing Business As) PHYSICAL LOCA nON Rite Aid # 5817 8000 White Lane CITY Bakersfield CA ZIP 93309 COUNTY . ßal<ersfield / J< >fL (YL ()... ". "7îf. , ~ CONTACT PERSON Sherry Kinsey PHONE NUMBER C2.!.2-J~-2633 Store Number: 805-837-2195 (First Name) (Last Name) Manager: Jim Ponder MAILING ADDRESS, IF DIFFERENT: COMPANY NAME Qualex Inc. STREET 4020 Stirrup Creek Drive, Suite 211 CITY Durham STATE NC ZIP 27703 . COUNTRY CONTACT PERSON (only complete if not USA) Russ (First Name) Roeller (Last Name) PHONE NUMBER (~ 484 . 3631 DTSC 1772 (1/96) Page 1 f;1~~~'[.~¿~'V¿D '-..", , '''I ,1 ~ 'jI:rHl ",.I ..,~~ ~ ì '1U _.-. ~ ~ ~: It fI ;-\oJ ¡,' 'i':l T EPA ID NUMBER Pen dine - Page 2 of 1 III. RADIOACTIVE MATERIALS OR WASTE YES NO D ŒJ Does the facility use, store or treat radioactive materials or radioactive waste? IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes (a/our digit number) that best describe your company's products, services, or industrial activity. Example: 7384 Ph ototinish in!! lab V. YES D D D D D 7218 Industrial/aunderers First: 5912 Retail Store Second: 7384 Photoprocessinq Lab PRIOR PERMIT STATUS: Check yes or no to each question: NO ŒJ l. ŒJ 2. ŒJ 3. ŒJ 4. 0 5. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim status for any of these treatment units? Do you now have or have you ever held a state or federal full permit or interim' status for any other hazardous waste activities at this location? Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you are now notifying for at this location? Has this location ever been inspected by the state or any local agency as a hazardous waste generator? VI. PRIOR ENFORCEMENT HISTORY: Not requiredfrom conditionally exempt generators or commercial laundries. YES D NO o Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders- resulting from an action by any local, state, or federal environmental, hazardous waste, or public health enforcement agency? (For the purposes of this fonn, a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a final order.) D If you answered Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) VII. ATTACHMENTS: Attachments are not required from commercial laundries. ŒJ ŒJ l. 2. A plot plan/map detailing the location(s) of the covered unites) in relation to the facility boundaries. A unit specific notification form for each unit to be covered at this location. DTSC 1772 (1/96) Page 2 }.). 'i EPA ID NUMBER Pendin~ e Page 30f Z VIII. CERTIFICA TIONS: This form must be signed by an authorized corporate officer or any other person in tire company who has operational control and performs decision-making functions that govern operation of the facility (per Title 22, California Code of Regulations (CCR) Section 66270.11). All three copies must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. TieredPermittin2: Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also provide the required fmancial assurance for closure of the treatment unit by October I, 1996. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fmes and imprisonment for knowing violations. Signature Corporate Safety Manager Title Sherry Kinsey· Name (Print or Type) OCT 2 9 1998 Date Signed IX. REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DTSC may shorten the time period between notification and authorization when the owner or operator establishes good cause. Jfyou need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be automatically effective on the date your completed notification form is received by DTSC. (Use additional sheets, if necessary.) YES D Reason: OPERA TING REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are setforth in the statutes and regulations, some of which are referenced in the Tier-Specific Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION· PROCEDURES: All three forms must have ori!!inal signatures, not photocopies. You must submit two copies of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section, HQ-IO Attn: TP Notifications - Form 1772 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806 You must also submit one copy of the notification and attachments to the local regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. PLEASE, DO NOT SEND YOUR FEE PAYMENT WITH THIS FORM. DTSC 1772 (1/96) Page 3 r.. ... EPA ID NUMBER Pending e - Page 1. of1 CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c» The Tier-Specific Fact Sheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. UNIT ID NUMBER CMX 5C UNIT NAME Academy Silver Recovery Unit ~ Container(s)/Container Treatment Area(s) NUMBER OF TREATMENT DEVICES: _ Tank(s) Each unit must be clearly identified and labeled on the plot plan attached to Form 1772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations, I. W ASTESTREAMS AND TREATMENT PROCESSES: YES NO D Œ] D Œ] D Œ] D 1. D 2. D 3. D 4. NOTE 5. ŒI NOTE Estimated Monthly Total Volume Treated: _ pounds and/or <425 gallons Is the waste treated in this unit radioactive? Is the waste treated in this unit a bio-hazardous/infectious/medical waste? Is remotely generated hazardous waste (HSC 25110.10) treated in this unit? Thefollowing are the eligible wastestreams and treatment processes. Please check all applicable boxes: Treating resins mixed or cured in accordance with the manufacturer's instructions (including one-part and pre-impregnated materials). Treating containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (To be eligible for this exemption, this waste cannot contain more than 10 percent acid or base by weight.) (Effective January 1, 1995). 6. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the food processing industry. (Effective January 1, 1996),. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 7. Silver recovery fromphotofinishing is completely exempt from authorization requirements if the quantity treated is 10 gallons or less in any calendar month. Do not complete this form if you qualify for this exemption. (Retain documentation verifying your eligibility for this exemption, such as developer invoices.) DTSC 1772B (1/96) Page 10 1',/ ... D D D D D D EPA ID NUMBER pendinge 8. 9. 10. 11. 12. e Page .2. of 1 CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c» Gravity separation of the following, including the use of tlocculants and demulsifiers if: a, The settling of solids from the waste where the resulting aqueous/liquid stream is not hazardous. b. The separation of oiVwater mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). (NOTE: AB 483 (Ch 625, 1995) allows certain used oil/water separation under new the CEL category. See Form 1772L and CEL Fact Sheet.) Neutralizing acidic or alkaline (basic) material by a state certified laboratory, a laboratory operated by an educational institution, or a laboratory which treats less than one gallon of onsite generated hazardous waste in any single batch. (To be eligiblç for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) Hazardous waste treatment is carried out in quality control or quality assurance laboratory at a facility that is not an offsite hazardous waste facility. A wastestream and treatment technology combination certified by the Department pursuant to Section 25200.1.5 of the Health and Safety Code as appropriate for authorization under CESW. Please enter certification number: (See Appendix 5) The treatment of formaldehyde or glutaraldehyde by a health care facility using a technology com bination certified by the Department pursuant to section 25200.1.5 of the Health and Safety Code. Please enter certification number: II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used, . III. YES ŒJ D ŒJ o D 1. SPECIFIC WASTE TYPES TREATED: Silver-bearing waste solutions generated by a one-hour photoprocessing lab. 2. TREATMENT PROCESS(ES) USED: Silver recovery unit utilizing two metallic replacement RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit. NO D ŒJ D ŒJ ŒJ cartridges in series. 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler? If you do, where is the waste sent? Check all that apply. ŒJ a. Offsite recycling D D o b. Thermal treatment c, Disposal to land d. Further treatment 4. Do you dispose of non-hazardous solid waste residues at an offsite location? 5. Other method of disposal. Specify: DTSC 1772B (1/96) Page 11 ~ JO¡ EPA ID NUMBER pendinge e Page Q of 1 CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c» IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (Title 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: D Œ] D D D D Œ] D D 1. The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous waste under California state law. 2. The waste is treated in wastewater treatment units (tanks), as defmed in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES pennit. 40 CFR 264. 1 (g)(6) and 40 CFR 270.2. 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES pennit. 40 CFR 264. 1 (g)(6) and 40 CFR 270.2. 4. The waste is treated in a totally enclosed treatment facility as defmed in 40 CFR Part 260.10; 40 CFR 264.1(g)(5). 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible asa federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. 6. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators oflOO to 1000 kg/month. 40 CFR 262.34, 40CFR 270. 1 (c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. 1 (g)(2), and 40 CFR 266.70. 8. Empty container rinsing and/or treatment. 40 CFR 261.7. 9 Other: Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO D Œ] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. DTSC 1772B (1/96) . Page 12 '- .þ."'!:" ...., (]) c= ro ... ...J C (]) ( ) E ~ .c ~ ( ) to) C nI 0 nI = 0 ..J < 0 ( ) to :!:: c ~ .c D. ;: ... 0 U) D. U) ( ) r... 'C 'C < f'-.. T""" to 1.0 ¡,: ( ) .c E ::1 Z ~ o ... en "'0 « (]) +-' ë2 ~ o ... en e e ~---------------------------- --------- --------- w; II (:2l ~j ¡m -- --------- ,--------- --------- --------- I I I I I I I I I I ---------i---------1---------1---------t--------- I I I I I I I I I I I I I I I I I I I I I I I I . , , I I I I I I I I I I I I I I I I I I I I I I I-----_---~---------~---------~---------~--------- I I I I I I I I I I I I I I , I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I ---------J---------J_________l_________L_________ I I I I I I I I I I I --------- --------- --------- -------------------. Page 7 of ï 'it>' 'Í pO ~tate of California - California EnVironme.otection Agency e Department of Toxic Substances Control Page 1 of 1 ONSITE HAZARDOUSF~~I~~P:C~~~~:~~~o~OY~:;~~~~;al For Use by Hazardous Waste Generators Performmg Treatment --~~t,W,E£] Amended Under Conditional Exemptio~ and Conditio~~l. Authoriz¿..t....I..pnl' '-" . J';JL 1 and by Permit By Rule FacIlities.;, fJ: ... '" VJ !.()98 Ple~se refer to the attached Instructions before completing this/orm. 'you mer notifY fo m!~!t1i'dìnlJl~./¡ß7¡:mi!~$Jier by ing this notificatIOn form, DTSC 1772. You must attach a separate umt specific notificatIOn f-orm unttV4,t1TiSA.liiß;¡gt~n: ¡here are different unit specific notification forms for five of the categories and an additional notification form for tra e treat ent units (TTU's). You only have to submit forms for the tier(s)/category(ies) that cover your unit(s), Discard or recycle the 0 ßr unused forms. Number each page of your completed notification package and indicate the total number of pages at the top of each page at the 'Page of _'. Put your EPA ID Number on each page. Please provide all of the information requested, allfields must be completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any attachments, The notification fees are assessed on the basis of the highest tier the notifier will operate under and will be collected by the State Board of Equalization. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOTIFICATION FORM. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you must attach. Conditionally Exempt Small Quantity Treatment operators may not operate units under any other tier. Number of units and attached unit specific notifications for each tier reported. A. B. --1- C. Conditionally Exempt-Small Quantity Treatment (CESQT) D. Conditionally Exempt-Specified Wastestream (CESW) E. Conditionally Authorized (CA) F. Permit by Rule (PBR) CE--Commercial Laundry (CE-CL) Conditionally Exempt-Limited (CEL) II. GENERA TOR IDENTIFICATION EP A ID NUMBER CA Pending BOE NUMBER (if available) H_HQ_ ___ ____ FACILITY NAME (DBA--Doing Business As) PHYSICAL LOCA nON Rite Aid # 5817 8000 White Lane CITY Bakersfield CA ZIP 93309 COUNTY Bakersfield CONTACT PERSON Sherry Kinsey PHONE NUMBER <2!2....J~-2633 Store Number: 805-837-2195 (First Name) (Last Name) Manager: Jim Ponder MAILING ADDRESS, IF DIFFERENT: COMPANY NAME Qualex Inc. STREET 4020 Stirrup Creek Drive, Suite 211 CITY Durham STATE NC ZIP 27703 . COUNTRY CONTACT PERSON (only complete if not USA) Russ (First Name) Roeller (Last Name) PHONE NUMBER C_~.!~J 484 . 3631 DTSC 1772 (1/96) Page I ¡-:~ ¡j EPA IDNUMBER~ e Page 2 of 1 III. RADIOACTIVE MATERIALS OR WASTE YES NO D [K] Does the facility use, store or treat radioactive materials or radioactive waste? IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes (a four digit number) that best describe your company's products, services, or industrial activity. Example: 7384 Phototinishinl! lab 7218. Industrial launderers First: 5912 Retail Store Second: 7384 Photoprocessina Lab V. PRIOR PERMIT STATUS: Check yes or no to each question: YES D D NO ŒJ I. ŒJ 2. ŒJ 3. ŒJ 4. ŒJ 5. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim status for any of these treatment units? Do you now have or have you ever held a state or federal full permit or interim status for any other hazardous waste activities at this location? Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you are now notifying for at this location? Has this location ever been inspected by the state or any local agency as a hazardous waste generator? D D D VI. PRIOR ENFORCEMENT HISTORY: Not required from conditionally exempt generators or commercial laundries. YES NO D ŒJ Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders- resulting from an action by any local, state, or federal environmental, hazardous waste, or public health enforcement agency? (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a fmal order.) D If you answered Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) VII. ATTACHMENTS: Attachments are not required/rom commercial laundries. ŒJ ŒJ A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. A unit specific notification form for each unit to be covered at this location. I. 2. DTSC 1772 (1/96) Page 2 þ .. EPA lD NUMBER Pen dine e Page 3 of1 VIII. CERTIFICA TIONS: This form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per Title 22, Califomia Code of Regulations (CCR) Section 66270.11). All three copies must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permitting: Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also provide the required fmancial assurance for closure of the treatment unit by October 1, 1996. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility offmes and imprisonment for knowing violations. . Sherry Kinsey NameUTinto~ Corporate Safety Manager Title Signature OCT 2 ® 19'.1 Date Signed IX. REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DTSC may shorten the time period between notification and authorization when the owner or operator establishes good cause. If you need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be automatically effective on the date your completed notification form is received by DTSC. (Use additional sheets, if necessary.) YES D Reason: OPERA TING REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the Tier-Specific Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION PROCEDURES: All three forms must have orif!inal signatures, not photocopies. You must submit two copies of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section, HQ-I0 Attn: TP Notifications - Form 1772 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806 You must also submit one COpy of the notification and attachments to the local regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. PLEASE, DO NOT SEND YOUR FEE PAYMENT WITH THIS FORM. DTSC 1772 (1196) Page 3 ~ r¡' EP A ID NUMBER Pending e e Page 1 of1 CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 2520 1.5 (c)) The Tier-Specific Fact Sheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. UNIT NAME Academy Silver Recovery Unit UNIT ID NUMBER CMX 5C NUMBER OF TREATMENT DEVICES: _ Tank(s) ~ Container(s)/Container Treatment Area(s) Each unit must be clearly identified and labeled on the plot plan attached to Form 1772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. . W ASTESTREAMS AND TREATMENT PROCESSES: YES NO D Œ] D Œ] D Œ] D 1. D 2. D 3. D 4. NOTE 5. Œ] NOTE Estimated Monthly Total Volume Treated: _ pounds and/or <425 gallons Is the waste treated in this unit radioactive? Is the waste treated in this unit a bio-hazardous/infectious/medical waste? Is remotely generated hazardous waste (HSC 25110.10) treated in this unit? The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: Treating resins mixed or cured in accordance with the manufacturer's instructions (including one-part and pre-impregnated materials). Treating containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (To be eligible for this exemption, this waste cannot contain more than 10 percent acid or base by weight.) (Effective January 1, 1995). 6. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the food processing industry. (Effective January 1, 1996),. Recovery of silver from photo finishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 7. Silver recovery from photofinishing is completely exempt from authorization requirements if the quantity treated is 10 gallons or less in any calendar month. Do not complete this form if you qualify for this exemption. (Retain documentation verifying your eligibility for this exemption, such as developer invoices.) DISC 1772B (1196) Page 10 f, ',:' D D D D D D r. EPA ID NUMBER pendin_ e Page ~ of 1 8. 9. 10. 11. 12. CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c» Gravity separation of the following, including the use of flocculants and demulsifiers if: a. The settling of solids from the waste where the resulting aqueous/liquid stream is not hazardous. b. The separation of oiVwater mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). (NOTE:AB 483 (Ch 625, 1995) allows certain used oil/water separation under new the CEL category. See Form 1772£ and CEL Fact Sheet.) Neutralizing acidic or alkaline (basic) material by a state certified laboratory, a laboratory operated by an educational institution, or a laboratory which treats less than one gallon of onsite generated hazardous waste in any single batch. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) Hazardous waste treatment is carried out in quality control or quality assurance laboratory at a facility that is not an offsite hazardous waste facility. A wastestream and treatment technology combination certified by the Department pursuant to Section 25200.1.5 of the Health and Safety Code as appropriate for authorization under CESW. Please enter certification number: (See Appendix 5) The treatment of formaldehyde or glutaraldehyde by a health care facility using a technology combination certified by the Department pursuant to section 25200.1.5 of the Health and Safety Code. Please enter certification number: II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used. ·111. YES Œ] D Œ] o D 1 . SPECIFIC WASTE TYPES TREATED: Silver-bearing waste solutions generated by a one-hour photoprocessing lab. 2. TREATMENT PROCESS(ES) USED: Silver recovery unit utilizing two metallic replacement RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit, NO D Œ] D cartridges in series. I. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler? If you do, where is the waste sent? Check all that apply. Œ] a. Offsite recycling D o D b. Thermal treatment c, Disposal to land d. Further treatment ŒJ Œ] 4. Do you dispose ofnon-ha.zardous solid waste residues at an offsite location? 5. Other method of disposal.$pecify: DTSC 1772B (1/96) Page 11 ^- ~ EPA ID NUMBER pendin~ - Page §. of 1 CONDITIONALL Y EXEMPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (Title 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: o I. Œ] 2. 0 3. 0 4. 0 5. 0 6. Œ] o o The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous waste under California state law. The waste is treated in wastewater treatment units (tanks), as defmed in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264. I (g)(6) and 40 CFR 270.2. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES permit. 40 CFR 264. 1 (g)(6) and 40 CFR 270.2. The waste is treated in a totally enclosed treatment facility as defmed in 40 CFR Part 260.10; 40 CFR 264.1(g)(5). The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34,40 CFR 270. 1 (c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. 1 (g)(2), and 40 CFR 266.70. 8. Empty container rinsing and/or treatment. 40 CFR 261.7. 9 Other: Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO o Œ] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. DTSC 1772B (1/96) , Page 12 Store: Rite Aid Store Number: 5817 Address: ~ Plot Plan Attachment ..' 8000 White Lane White Lane ¡- - - -- - - - -- -¡ - ----- - --- ¡--- - - - -- - - j ------i~~~~f~ti I I I I I I I I I . I I I I I I I I I I I I I I______-----~----------~----------~----------~--------___, I I I I I I I I I I I I I I I II I I I I I . I I I I I I I I I I I . I I I I I I I I I I I I I I I I I I I I___________~__________L__________~___________~__________I I I I I I I I I I I . I I I I I I I , I I I I I I I I I I I I I I I I . I I I I I I I I I I I I I I I I I I I-----------~----------~----------~-----------~-------___I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I , I I I I I I I . I I I I I I I I I I I I-----------~----------p----------~-----------~----------I I I I I I I I I I , I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I e e .-------------------------------------------------------- "'d I» (JQ (II ...¡ o ...., -I -~--- .-..- --~ " ~;,~'~\K ~58. 'P.~'7\~YLEC£ DRUG STORE::R'" I Manager : JAMESCreJ5TREr::'POl ~FElVED Location: ,8000 WHITE LN MAY 1 8 1998 City BAKERSFIELD ...¿/ ~i /1::SY: CommCode: BAKERSFIELD STATI'~ll.'J'u:::J EPA Numb: e SiteID: 215-000-000235 BusPhone: Map : 123 Grid: 16C (805) 837-2195 CommHaz : Low FacUnits: 1 AOV: SIC Code. 6S12 .sqrd-.. DunnBrad: Emergency Contact / Title E~ergency Contact / Title JAMES CR..M:. 'f~EE-POLJ\..J1>Eff MANAGER / Business Phone: (805) 837-2195x Business Phone: ( ) - x 24-Hour Phone : (805) iJJ 16JJx 24-Hour Phone : ( ) - x Pager Phone : ( ) ~:- o<o8\x Pager Phone : ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Emergency Directives: Hazmat Common Name... SpecHaz EPA Hazards One Unified List l All Materials at Site l 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 f= Hazmat Inventory p== MCP+DailyMax Order POOL CHLORINE LIQUIDS PROPANE BLEACH POOL ACIDS FUEL ADDITIVES POOL CHLORINE SOLIDS PAINTS PAINT THINNER ANTI-FREEZE COOLANT MOTOR OIL FERTILIZER INSECTICIDES F HERBICIDES F IH FUEL ,), ~ F IH DH i, ~~~ L. -t'\1 \Sev_ ..)@ hereDiy c@rtify ~ha~ ~ hav~ ·~r¡;¡~'iI!Jmi;;¡Y r~vil8wOO Qoo ®iNSl©~OO h®Æai'dô)tJJ$ WMi1~~uV.a~$ manag®o m~nQ ~nJ ~©fi'~~~~<l~4"7~ft©1 Q~~ i~ ~~@ü'8g w¡~h BIn}! OOW~Ó@~$ ©'Qm$ßIWß~ ® tompls~e ~n©J oow®~ m®lf10 RECEWED F P IH IH R IH R IH IH MAY 1 5 t998 F r,:Ì'nn,~m\1 ~!:~,'V!(';~S <0:07111\111. l:n'oL-"..! ; .........::.;J v~___· F F IH DH R IH F DH R IH DH BJ@em~ryQ 19>~U'D ~fi' M1? ~r¡;mi!1f. 5-'f-9B l)ate -1- 0,3/11/1998 ~~~] u~ jT e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 j íë Inventory Item 0009 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o POOL CHLORINE LIQUIDS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 7681-52-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 600.00 GAL 0 100.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %'Wt. 0 0 RSo CAS # 0 o 0Sodium Hypochlorite 0No 0 76815290 o 0Sodium Hydroxide 0No 0 13107320 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ °TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 IH 0 / / / 0 0 Hi 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj ¡, e e ., íë Inventory Item íëë COMMON NAME / o PROPANE O' 0003 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site i CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 74-98-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 METAL CONTAINR-NONDRUM 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 300.00 FT3 0 55.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.00oPropane 0No 0 749860 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -2- 03/11/1998 " e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o BLEACH 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 7681-52-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure ° Ambient ° Ambient 0 PLASTIC CONTAINER ° åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container ° Daily Maximum 0 Daily Average 0 o GAL 0 240.00 GAL 0 90.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Sodium Hypochlorite 0No 0 76815290 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount ° EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No ° No/ Curies ° R IH 0 / / / 0 0 Hi ° åëëëëëëëüëëëüëëëëêëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0008 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o POOL ACIDS ° Days On Site ° o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o ° CAS # ° o 0 7647010 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure ° Ambient ° Ambient 0 PLASTIC CONTAINER ° åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container ° Daily Maximum ° Daily Average 0 ° GAL ° 100.00 GAL ° 55.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # ° o 100.000Muriatic Acid °No ° 76470100 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount ° EPA Hazards ° NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies ° R IH ° / / / 0 ° Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -3- 03/11/1998 ~ e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 ¡ íë Inventory Item 0011 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FUEL ADDITIVES 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 11-45-01 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Above Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 . Daily Maximum 0 Daily Average 0 o GAL 0 100.00 GAL 0 55.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Methyl Alcohol 0No 0 675610 o 0Methyl Ethyl Ketone 0No 0 789330 o 0Ethylene Glycol 0No 0 1072110 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0010 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o POOL CHLORINE SOLIDS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 87-90-1 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Solid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o LBS 0 1200.00 LBS 0 800.00 LBS 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Trichloro-s-triazinetrione 0No 0 879010 o 0Dichloroisocyanuric Acid 0No 0 27825720 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ °TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -4- 03/11/1998 e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 ¡ íë Inventory Item 0004 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o PAINTS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 64742-47-8 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëf íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Above Ambient 0 Ambient 0 METAL CONTAINR-NONDRUM 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 120.00 GAL 0 55.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Mineral Spirits 0No 0 80303060 o 0Ethylbenzene 0No 0 1004140 o 0Toluene 0No 0 1088830 o 0Xylene, Mixed 0No 0 13302070 o 0Methyl Ethyl Ketone 0No 0 789330 o On-Butyl Acetate 0No 0 1238640 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëf íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëf '-5- 03/11/1998 e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 ¡ íë Inventory Item 0005 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o PAINT THINNER 0 Days On Site 0, o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 64742-88-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 METAL CONTAINR-NONDRUM 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 90.00 GAL 0 55.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Aromatic Hydrocarbon °No 0 80303060 o 0Toluene 0No 0 1088830 o on-Propanol °No 0712380 o on-Butyl Acetate °No 0 1238640 o 0Xylene, Mixed 0No 0 13302070 o 0Methanol 0No 0 675610 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F DH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj . -6- 03/11/1998 e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 i íë Inventory Item 0013 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o ANTI-FREEZE COOLANT 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o WAREHOUSE & SALES FLOOR. Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëÜëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 'Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 300.00 GAL 0 30.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Ethylene Glycol 0No 0 1072110 o 0Diethylene Glycol 0No 0 1114660 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/A~ount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 R IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0002 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site i íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o MOTOR OIL 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 8020835 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 500.00 GAL 0 200.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS. ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS# 0 o 100.000Motor Oil, Petroleum Based °No 0 80208350 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F DH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -7- 03/11/1998 e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 ¡ íë Inventory Item 0014 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FERTILIZER 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o WAREHOUSE, SALES FLOOR, NURSERY COM- POUND. 0 CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Solid 0 Mixture 0 Ambient 0 Ambient 0 BAG 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o LBS 0 1000.00 LBS 0 200.00 LBS 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 R IH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o 0006 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 íë Inventory Item íëë COMMON NAME / o INSECTICIDES o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 7757-82-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average' 0 o GAL 0 360.00 GAL 0 120.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSO CAS # 0 o 100.000Insecticides 0No 0 00 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëË!ëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F DH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -8- 03/11/1998 e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë' SiteID: 215-000-000235 ¡ íë Inventory Item 0007 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HERBICIDES 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o 0 CAS # 0 o 0 0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 280·.00 GAL 0 100.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS# 0 o 100.00oHerbicides 0No 0 00 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o Location within this Facility Unit 0012 ëëëëëëëëëëëëëëë Facility Unit: Fixed Containers on Site ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: íë Inventory Item íëë COMMON NAME / o FUEL o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER ' 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 200.00 GAL 0 60.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH DH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -9- 03/11/1998 " '. e e í PAYLESS DRUG STORE ë~ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Notif./Evacuation/Medical ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Agency Notification ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 i o 0 o CALL 9-1-1. o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Employee Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 i o 0 o EVACUATION PLAN POSTED ON WALL. SAFETY MEETINGS WEEKLY. o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Public Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 i o 0 o EMPLOYEES TRAINED TO DIRECT CUSTOMERS TO NEAREST EXITS. CFR ~RÅIPJED o ErIPl.6J'":EE3 9n --<¡:!-=µp.¡¡¡,.. o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Emergency Medical Plan ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 i o 0 o NEAREST EMERGENCY ROOM.. o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -10- 03/11/1998 -¡ ~ "- e e í PAYLESS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Mitigation/Prevent/Abatemt ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Release Prevention ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 09/25/1997 ¡ o . '81' -+hsL As5¡'s~t tv\C\"QCj~ 'V~:a&'c.. 0 o MONTHLY SAFETY INSPECTION OF OUR STORE.ID:' §lJK ~!\.IrET.l :g-'DE:I:I~ INSPECTIONS BY 0 ;.. ~~~!~&~~.ì,S*..................................................................................................................: aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeef íëëë Release Containment ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Clean Up ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Other Resource Activation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf I I I I I -11- 03/11/1998 ~ ~ ~ ~ e ~ e í PAYLÉSS DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 i íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format ¡ íë Site Emergency Factors ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site ¡ íë~'Special Hazards ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Utility Shut-Offs ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 ¡ o 0 o A) GAS - REAR OF BLDG o B) ELECTRICAL - NE CORNER OF STORE BY BREAKROOM o C) WATER - REAR OF BLDG o D) SPECIAL - NONE o E) LOCK BOX - NO o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Fire Protec./Avail. Water ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 ¡ o 0 o PRIVATE FIRE PROTECTION - ACE SPRINKLER COMPANY BAKERSFIELD. o o o o o o o o o o NEAREST FIRE HYDRANT - FRONT & REAR OF BLDG. o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Building Occupancy Level ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -12- 03/11/1998 ----- ,c ~ .' ~,ç ...,~ / e e í PAYBES~ DRUG STORE ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000235 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format ¡ íë ~/aining ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site ¡ í~~Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 07/24/1992 ¡ 0/ 0 o WE HAVE 28 EMPLOYEES AT THIS FACILITY. o o o o WE DO HAVE MSDS SHETTS ON FILE AT THE MAIN OFFICE. o o o o BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES TRAINED IN PROPER USE OF 0 o CHEMICAL SPILL KIT. SAFETY 'f:ALIGJ 8IVEJU Þ1~ILï. ¡.Ae&T I.)GS. Moùí\-\ L Y 0 o !-JA-z..QON\/l>ÞE, L\sE O+.ç';tùL1?f-.. ..'f¥j<4.:S~. 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Page 2 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj