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HomeMy WebLinkAboutBUSINESS PLAN ,; .~~ :" : -.1:.-:-.. -.. S J¡¡TE / F AC X L 1: TV ex Ac:¡¡jI.AM , 4..5- _ · FORM ð · Ii1~,? 7 'l I .. I NORTH SCALE: I'f;. lD I BUS I SESS NA.'Œ: DATE: ! / FACILITY ~AHE: (CHECK ONE) SITE DIAGRA~ FLOOR: / or , UNIT .: OF "ì It;2. t7- FACILITY DIAG~~ b t I () 5:' ~-- ~c.1 JL ~~ ø,¡o' £ð" 6:S' , 1'1 '/1/ ~ 1<1 ýo' ~ ~ ~ - ........ ~ 5"""' al\ ~[, !. -4tt- f. b T 1e r ;1- - ~ ~ ~µ- d ¢tJt, £~ .é!/. tv I /!;¿E·· Æ]) k Inspector 'sCo..ents) : -OFFICIAL CSE ONLY- - SA - -- e April 4, 1990 TO: Nina Mayer, Accounts Receivable FROM: ) Ralph E. Huey, Ha2ardous Materials Coordinator SUBJECT: Bakersxield Bit & Tool Nina, account # HM 382501 has a current balance ox $150.00, which they will pay. This business has moved to county so when the account is paid it should be closed. Thanks .. .- 'i"' J ',-<~ ,.0'·... ",.,.-\'<5').,\ /,.J.,. J#I>' ~\ \ it,' ~i~,' ,ç,,',,) ¡,\,,~~!,,;, <""C""": " '/' ¡ ·:'!!!::.-ott'!§:: . ~-' e .. " ./ .. .. t-l ~ \\\,\~~~~ CITY of B, AKERSFIELD' o~l~j:;~,.);i"~~,\~ dIVE C-tRE" c¿3?f ~\ ,~~ )§ :;';''''"-.':'.,;,: I' \\,'.,,1 ~ l¿~J~ííÍ~ 1. S ¡fP \\l:: YÙ -ce O'-{ 't\ U I-Sf'j @ (tYDe or p.rirlL. namei Do hereby co~-'-i.Ç.- that I ha -,-e revieh-ed the .......... l.. __.J.. ...\ '. attached Hazardous Materials business plan RECEIVED JAN 1 1 t989 Ans'd. ........... for ßf1\t...b~Sf GLD ß\1' t -rOOL-- +'VVGI (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for my facility. ©~ ßtt ~ 7> J~ /-:3- t~ sl;!:naT.::::;t I/'I 1)te ·.IÓ'\ "~ / .i,J /\~ J~ ~<tf} ,yv Ÿ ,~t\~~'jt¡Jr-e,\,2\ } IÌ ' ~ ~ V< ðJ V }^'~" ~ ,.f¡~ f ~~ ~¿ :lfY'qI Q ..>Jj' V ~ #-t0~' ,r,v \\~ ~\V (':v ]V ",JJ ~ !,y ct l}f ,,~,I/ ~j\p\¡ . ~;'\Jy ¿J Cv~ ~¡I\ JÚ0 l ~/~1 #-' .. e e BUSINESS NAME BAKERSFIELD BIT & TOOL LOCATION 4106 WIBLE RD ID NUMBER 215-000-000045 HIGH HAZARD RATING 2 RECEIVED JURIS CODE MAP PAGE 123 LAST CHANGE 11/24/87 BY 215-005 JURIS BAKERSFIELD STATION 05 GRID 13C FACILITY UNITS 1 Mt1R ? 1 1969 ESTEffAZ MA . , T. 0 tv. HAZARD RATING 2 1 . OVERVIEW RESPONSE SUMMARY 2A SEC 4) WE HAVE FIRE EXTINGUISHERS IN CASE OF SMALL FIRE ACCIDENT. WE HAVE FIRST AID KIT FOR MINOR CUTS AND BURNS AND IT IS SERVICED MONTHLY. WE ALSO HAVE TELEPHONES IN SHOP. EMERGENCY CONTACTS 2A SEC 2) STEVE HULSEY - OWNER - 833-0478 OR 832-3183 JOHN BLAKE - MANAGER - 833-0478 OR 397-4491 UTILITY SHUTOFFS 2A SEC 3) A) GAS - ON NORTH WALL NEAR THE NW CORNER OUTSIDE SHOP B) ELECTRICAL - ON SOUTH WALL NEAR SW CORNER INSIDE SHOP C) WATER - ON NORTH WALL NEAR NW CORNER OUTSIDE SHOP D) SPECIAL - NONE E) LOCK BOX - NO 2. NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY DOg:;, J\.I \) ì (\ ~9>L '1 < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 12/12/88 15:01 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 .. ~...~ e e BUSINESS NAME BAKERSFIELD BIT & TOOL LOCATION 4106 WIBLE RD ID NUMBER 215-000-000045 HIGH HAZARD RATING 2 3. HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY \. 3 ) EJ11¡?)O/EE'S < NO INFORMATION RECORDED FOR THIS SECTION > UJ-e.. 0~"L \-~~ \ ~~'f" t(\"I.G\.. \, '~"" ç,o N'. \- \.. -e- , rr-, ~ \-c...~ ~ ~ \ ~~k \'\ d. (w~ CA. we:.." t.., ~h~ 't.-~ ~ _~v-. ~ __ ~ \~ ~~1- ___~ 'C.-t.. ~,_:s ~ O~t.t... 4. LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 11/24/87 BY ESTER 2A SEC 4) WHITE LANE MEDICAL CENTER 5401 WHITE LN 832-2000 o PAGE 2 12/12/88 15:01 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 ---" .,.... e e BUSINESS NAME BAKERSFIELD BIT & TOOL LOCATION 4106 WIBLE RD FACILITY UNIT 01 ID NUMBER 215-000-000045 HIGH HAZARD RATING 2 A. OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 11/24/87 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE KEROSENE 55 GAL MODERATE NW CORNER OUTSIDE DRUMS OR BARRELS MET.. CLEANING ID PERCENT COMPONENTS HAZARD LISTS 1178.01 100.0 KEROSENE MODERATE ö B. FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 11/24/87 BY ESTER 3A SEC 4) WE HAVE FIRE EXTINGUISHERS IN EVERY BUILDING FOR FIRE PROTECTION. 3A SEC 5) FIRE HYDRANT IS 50 FEET NORTH ON WIBLE RD IN FRONT OF SLEEP & AIRE MATTRESS. PAGE 3 12/12/88 15:01 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 -,: "," e e ID NUMBER 215-000-000045 HIGH HAZARD RATING 2 BUSINESS NAME BAKERSFIELD BIT & TOOL LOCATION 4106 WIBLE RD D. EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 11/24/87 BY ESTER 3A SEC 2) EXIT BUILDING AND PROCEED WEST TO WIBLE RD IF BLOCKED PROCEED EAST OUT THE BACK GATE. VERBAL NOTIFICATION ON SITE. E. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 11/24/87 BY ESTER 3A SEC 1) KEEP ALL LIDS SECURE AND PUT ALL PAINT AND THINNER IN CABINET. KEEP KEROSINE IN RACK WHERE IT CAN BE KEPT AWAY FROM FORKLIFT PATH OR ANY VEHICLES. KEEP OXYGEN AND ACETYLENE BOTTLE CHAINED TO THE WALL WITH CAPS AND KEEP THEM TIGHT. PAGE 4 12/12/88 15:01 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 ." .\ of BAKERSFIELD MATERXALS XNVENTORY TRADE SECRETS CITY == H~~ZARDOUS NON- ,~ '--' _¿ of NAME OF TR1s FACILITY: STANDARD IND. -CLÄSS CODE V DUN AND BRAD~~REET NUMBER AJ~- L't-lbJ-_A 5~76 L P", "¡.I'\)(... OWNER NAME: S T ¡: P It/: T\J M ~ ADDRESS: S"<.oo <:-\1"11 e€ S' CITY. ZIP: ßiLì""O ~I... G¡33c PHONE ,,: ,!?O$ 832. - 31 8..3 IUfl'IØt ro IIISr7fUcrIOItS rolt PltOl''' CODa -/1.;L.se'f iOOL.. St.nd.rd 8u~¡nn~ ~ '\ tur, Ir. Ind Aqrlcu 11 __ of ...tt.....lc-t. . IlIIt.-t I... \4112. 0 ~~6" __ 1] ,'" lit -- /oq_: --- ; --.-- ,I. JÁ ~ Ov'!3.!.f}~__ c...anent II .... C. a.5. ....... c:a...-t 12 .... c.a .5. .... c...anent IJ ... ........ 12 leat 1l1li ...... 5tor.d In Facility I l1li . 5 , a_. annu. ....u... AIIt Est Units sa ~~._ /(;)0 _~1~~ U.5 J III. AIIt _t_L?~__~ Al:_ end ....It h "'"I'd ,11 thlt 'IIP Iy) ..-., L_" 1 lyøe Cod, 1 Irø", (0<1. V ..-., L_" ~v" ~ -, ~.. Deltyed L_" ....lth '"V'iC' tr.twoc k ~~ Fi.. H."rd · C.I.S. 1....I.t. ....Ith Sudden hl_, of P...._~ hac:tlvtty -----..->- ... . C.I.S. ....... ... . c.a. S. ........ ... . C.a.S. .... ~t'l c...anentn ~tlJ 1....I.t. ....Ith a____.... U.S. ....,_ ..-., L_" Sudden hl_ of Pra_ ..-., Del"" L_" ....Ith ..-., L_" ------ Phys ic.1 end ....lth H."I'd (Chtck .11 thlt '1/IIIy) ,..-, ~-, , - J F I.. "'lIrd L -.. hlc:t Ivtty --, ....... ....... ....... - ....... ....... ....... to.panInt It c...anentn to.panIntlJ ____JL______L____________l.-____________JL___________J______l______l_____J_~JL_______L__________ Physlul end ....ltlt IIIlm c,a,s. ...... _____. to.panInt 11 (Chtck .11 thlt ..,1,) r - , .. - ., r - , Co.ponent 12 , - J FIr, Hllard L -.. lltet Ivlty L - .. to.panIntlJ --..- Physlul and ....ltlt "'rm! (C*k .11 thlt 'lIPly) ,..-, r--' , - J L -.. RNCtivtty · C.I.S, · C.a.s ... ... ....... - r-" L_" c.a.S r-' L_" ,.-., L_" · C.a.S · C.a.5. · c.a.s ... ... .... .....i.t. ....Ith Suddtn lit I..,. of P/'IIIUM' Del.v-d 11M Ith ,.-, L_" r-, L_" Fir, HII.I'd ~~M ~_______~____ n~~_?3b- · C.A,S 12 IL.t: /'\.) 0 V'\ D 1'1 M L.- 1Iii---------------------------------- ... 7~~?p~-~~-- I....i.t. 11M Ith ~~~~J?tfl:2J[----------- Sudden lit I.." of Pr",ur~ "II~~-~-~--J~-lc-~-~-i--------------- .. , Of 1.v-d H..lth thol. Indlvldua 11 /'ll1IIIII.ib 1. 1 - LI - ~ 1 _______ o¡ti-Si9ñ~L------------------ of MId thlt bllld l1li .., inquiry .ttlChed cIoc_u .11 and sign 3ftcr co.plp-ting all s~ctiansJ I hly, Dtr~on.lly ,...inld end .. fHt1i.r with the Infor..tillll su.lttld In thll ¡IY' thlt thf ~u.ltttd inlo....t ion ¡~ true. .c;cur.t.. end c;o.øl.te. S--~( - -' '9"' Urt C,*UCTS Ctr ic.tton (R~.d and I Clrt Ify und,r /1M Ity of 1.. thlt for ~;nin9 the infOl'llltlon. I bt 3,oJ -, fh )\ ePli TV 0 I.-s, -..../;; \ ê II - n.--"Ç---l-r'¡ l~--~' ___t-\u ----ßDR--- -7--2-rP..-&1 c=---=~----·----(-(--- .... c~,nu 0 'c'. in, ° own.¡:ToDtr.tor own.. O:H'rI,or sïütn"ruru r.orntn . 'Y' tic", --~ X !If RGENCY .~/ Jtr e C2J2- BAKERSFIELD CITY FIRE DEPAR~NT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 7.@ l.z 3 - 1$ tJ. I JtfJ5P ~7 ~-~~-<67 '~ >\..- T 0, ?, / OFFICIAL USE ONLY ID# 000045 BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and conci~e as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: ~A-~íS \..,~€\ d ~ -: \- q- B. LOCATION / STREET ADDRESS: t.¡ lOCo W, 10 I G CITY: ßAk-e.r~:J·\~~.1d ZIP:~331·~ " /- Tool I2.J BUS.PHONE: (90'S') f?33 - o~ 7 (? SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. S\-e..u~ \\ù\ ~ e..'t - OLùn-e-r Ph# ~33- OLf7;? Ph# 332-<J cf3 B. :ç; ~'" '" 6 \f\-'¥:---e - ()ì A'~ c; t.: æ.. Ph# 833- (Yi 79 PhI ~ 97- Lf L( 9 I SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE <; NAT. GAS/PROPANE: Of\) T~c.... Nöf'th vJ£A\\ r\e..o....r \-I.--e..... '(\o~+~wt..c;.t- c..c'Ï'I'\t,f" Dù\-S\O\."" S\"'of , B: ELECTRICAL: () f\) l'\"\e... ~Où T\-\ V-:)'A II f\-("C.....' *~c ~Où+-\o\(.<.J 'C...c;,+ (" O'f'fle("" \~~\('\€ ~<;,l+oP C. WATER: 01'\ ïh<.... v\()r-t-" w G..!\ ~éêA"" \--"-<- 'C'\(').-\-h v.JY c,+ <"'0 rr'\iLr OÙ t-sid.-<. "ho.l> D. SPECIAL: . E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - e e þ '~'. ~ SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE W~ y\Ç>.,v- ç,(-~ ')'!rI'\~~\~"'e.""''5 ~:r.. C-(''''-~<- oJ- Srnr'J-L1 -Ç,rè- c...c.c..;cI-e.l'\f. /).J<.. h~v'(... FIr;·~t- c..-~cI K.d for f"r-'(\Or C-vl-s ;-- 6"JI"r'\J~.c...V'\c.l,'/, ~s .s-c.."'VI;'~ (; d.' MO~\h.) 'f. uJ c- cd sv J., þ(J-1/ '- l-c.Je..fh on e...:> I;"" 5 A Ð r? 0 ,.. "'¡... v.J SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTkVCE FOR YOUR BUSINESS AS A WHOLE ~Ù-~ .r ~ ~S ç,Y'C.-.. ~ ct I I. (Va \ \¿ ~ 0 ("" S \-.-e... ~ Ç-t Cn l \-\- lS'" WfA.'-1 ~~Ù \ q l \ {\YV\ laù\ Cv"r' c.. ~ 1; ((~G>.-~ e.J ~<:..S q \ \ ~O\. S ÛV" c.0V\ ~ co \ C1 \ \ i¡\)e..G . \ - 800- J-( 2.-4 - "680'- /).J ~ : /-<. 'SLiDI LftTv(., ýJ1't.~A¿~ I G~Ær- wh~ï..e I n. if 32. - GOOO SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. \ CIRCLE YES OR NO A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:...................... .... C. PROPER USE OF SAFETY EQUIPMENT::................. D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . . . E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:....... INITIAL ~:\~Ò, !E NO" ES NO, NO YES @ REFRESHER YES NO YES NO YES NO YES NO YES NO . ~-..:-..-~...-..:o-~ ------=--~ -__..__ ---.0 - ~ -~- - ..:.. -~-'""-- -~-,<-"---~------~-~ SECTION 7: HAZARDOUS MATERIAL CIRCLE. YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUN~OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:... .., YES NO , \ ,,'- .' , I, ~~v~ \-\",\5<' t ' certify that the above information is accurate. I understand that t is information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et AI.) and that inaccurate information constitutes perjury. / SIGNATURE A4 TITLE 1fJ....~ DAT~ <-/é(-f7 - - 2B - i' ~" e e .' BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL GSE ONLY BUSINESS NAi'<rE:BAKrRSFIFilJ BIT & TOOL ID#7.z --91.3 Z 22?.. BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS , 1. To avoid further action, this form must be returned by~_ 2. TYPOÞRli~f' YOUR-ÃÑSWËR-Š iÑ ENGî::.i:3H. - _r - , 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY ù~IT N~~: SECTION 1: MITIGATION, PREVENTION, ABATEME~! PROCEDURES i~ \L~t:. -p Q..\\ \ \'d~ o...(\~ P v\-- C-.\ \ " i h l>"IfI~f" ~ c:...~ \)f'~ pfrlV'\ ~ ~ \('\ c..~\~~+ . :1, \L~e.. p ~'*.V\ c:. . «'~\c.. W~-e..f"~ ì' J/.:'t..(J J,. \f\ c.~rV ~ e-WVT1 ~ Fo t" t... " :{. \- fo...~ ~f' ftflV'1 /:log. A,'¿-/,~ . 3· ~t.f .. ~' +---~ ~J1~ DJC1St.h r A-u..e..l-1-Jyt1c- b oN -I (., c..J.. ,., I Þ'\ e.J .. \-l~~.rl w~ r\.. c...~p~ It-c.p+- SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - ----;. 0.__-_---- __ .' - -- - - ------- ---- ----- ---- ~ £ )(.~t b~ ~ 'c\\'r~ ~ \ \ oc:.. e.cA l.c.>e.~ ~ \-0 w '~b\'(, ~\ I.'~ b \ c:;¡ ~ p..-o '- 'Uè- J L.-c....." \- 00 .\- ~l---__ b G....<:...k.. S y.y ""C. . \Jc..r bv-,\ IÙc\-"Q.~~G.. \--:~...... ~ 5 '\ \'- ~ -- 3A - -- e . f.' ..... "'-. '. SECTION 3: HAZARDOUS MATERIALS FOR THIS ú~IT ONLY A. Does this Faci 1 ity Unit contain Hazardous 'Materia.ls? . . . .. @ NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION Wi:- 'hc...v-c.' <:s.1.; ~ G-)(. ~ V'S~\ ~ l.o f' ~ .. \\('\ f:...1J '<0-( "'1 ~~ \O\,~S SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SO .(:\ NO("~~ 0" w\Ia\~ ~ , \n ~....\ o~ S\-c.cp Ò-, Fh<' {"\ ~t\~SS SECTION 6: LOCATION OF UTILITY A. NAT. GAS/PROPANE: (k \d\., e, ~ c... S \.- \I \- e:Áç '\ ç Pt o...J\-s~at.. ~'i....o....--d \c,u't..\ SHUT-OFFS AT THIS u~IT ONLY. \oc.cJ.e.d O~ \-\-c.. £'ou-\-\.. ~~J.(, -1JU~~ c...or-ou', of ß~\\J.\~S B. ELECTRICAL: ~~\\J.^'\ ß ;.. ~~\)J '''S c. - ~. Ù, Go ¡-"<.-or- <J r\ wo-\\ ,'", ~\Jt 5 \,.", P Sooth ~\ -wc..~\ (.c('<,\e,('" 0"," w¡,..\\. ~~!!.~- s'" 0 ('" C. WATER: e.;,,\J."S ß - l\Jo....~ \Þo'...1\ ~\,)\-S\d.-<.. \:).;\\d,'nç ~ ~~ \ch n \ <:.. - rv oM-" ùo->c.-\\ - 0-> ~~ '-Q ('^ e>-<' \'~ +~-c... Ç-.o....\- o~ \-\.-.a... Ff<r\ 'j o Vt'50I~c... f"'t.At' h·c- ~ t"O\U,,-o(. D. SPECIAL: 'I E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLA0iS? YES / NO YES / ;'¡O MSDSs? KEYS? YES ¡ NO YES / NO ¡ - 38 - ,'" .. , - j~ f' of - Page I,D CITY FIRE FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY DEPARTMENT BAKERSFIE # 77-0137232 D I FACILITY UNIT # FACILITY UNIT NAME OWNER NAME: ~ U~ IAJ ADDRESS: \ LOo c.,,1~"'-' CITY. ZIP ð~FD. c...V'1 d= /0(;, BUSINESS ADDRESS :, CITY, ZIP e .__ 't'--, I_ I.... ,J.~, ~ , - ~ :3 ~- c> '-( 7 "'8 PHONE #: g33-OV7¥ IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T tODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIr.AL OR COMMON NAME CODE GUIDE \ \? .~ 11-(fSh ~pjL. O~ O~ N· W. c...onv C,.(" OC;> 'T ~ I rfiP' / oC) ~ e., o.s,. \ V\e., / / 7~· 0 / FL'-G \ I J" I ~ S Ç,AL ID ~\ CoA\ \'5 711 S.lA.) '-t¡f~.f' I A ~Qi) 100 (h I r¡~~('" ~ Pr'-'\\~\- ¡ÉLI-Q ¡V) \. : . - ~ - . , - , " ... a .._ S 1-c..v-<... t-\ù\ ~"-'::j. TITLE: OwMJ ~fL S'IGNATURE: A -!17: J L t7~ D~,!E: S -.~I(-:Y7 PHONE #::::::-B'US HOURS AFTER BUS HRS: PHONE # BUS HOURS AFTER BUS HRS: TIn. E ('ì u..J 111 ~ IL TIT L E : vYÌt-"H ì a f-e r=- -, J. ..I A- t' ð r... II'" \ 1'\ (' e.\ f' ì II, V\ I' -, (') () I .so. i -¡--- J 4A-1 ~'"()~ \"'\1)\ <."¡¿'-f I :So ~ \1'\ ~ \ 'f\ k.. ACT IV I TY: __~,h:....\ d\<" CONTACT CONTACT: BUSINESS EMERGENCY EMERGENCY PRINCIPAL