HomeMy WebLinkAboutBUSINESS PLAN 8/16/1990
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Bakersfield Fire dlpt.
Hazardous Materials Inspection
Date Completed
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(Top right comer Business Plan)
Shift c... Inspector ~ ¡f4.Je y /°tf
\ ø .~ uate [nad~uate
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Business Name:
Location:
7
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ì VerificatJ
Verification of Quantities
Verification of Location
Proper Segregation of Material
Comments:
Verification ofMSDS Availability
Number of Employees
Verification of Haz Mat Training
Comments:
D
D
D
D
Verification of Abatement Supplies & Procedures
Comments:
D
D
Emergency Procedures Posted
Containers Properly Labeled
Comments:
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Verification of Facility Diagram
Special Hazards Associated with this Facility:
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Violations:
FD 1652 (Rev. 3-89)
,
White-Haz Mat Div. Yellow-Station Copy Pink-Business Office
-
August 16, 1990
TO: Nina Mayer, Accounts Receivable
-
SUBJECT: Tom's Honda Repair
FROM: Valerie Pendergrass, Hazardous Materials Division
Nina, account # HM 414601 should have
Montgomery Honda Service at 4306 Wible Rd.
Ca. 93313.
the name
Sui te A,
changed to
Bakersf'ield,
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REFERRAL TO FINANCE DEPARTMENT FOR COLLECTION
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Referring Department/Section
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Person Making Referral~
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Account Number
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Type of Billing , G
t¡()ðï1TCt~ ~o.- *tc/t~
Name(Busfness Nðme of Commercial Account)
Lj ~IO Co \)j~'¿ ,2j ~~"h p..,
Site Address
Y30CD wJ.rtL eo'.' ~ A
Mailing Address
Pcd~hvt-.. +~ ~~,
cQtoo' 0Jl.~ ~ ' cl CtL q~30\
Owner's Name, Address and Telepho e Number
~31-/78G,
Telephone Number
?)3\- ~83Î
Billing Period:
From '7- 8q
- Month/Year
To
Month/Year
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Amount Due
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List Collection Efforts by Department Prior to Referrål: 'f'l r:r-r-.....L 6fJvJu ~ '
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Comments ~~ l.tw.....</Y\.LV\.J -W \;L\'M/ tJJ1!N..-Uv.-'Y""\(..,( - ~ ~ lfl-J
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tJ-f\.J- ~ (J./nðtr~ - .~ 4~ (Ì'LUct ~~ M9~:t ~º-Q.. Ct~~ ~ ~LL
THIS BILLING HAS BEEN'}VERIFIED AS ACCURATE ~D VALID ~~ to Jìu.i.ç; ~ \..Q.. ~ ~
Authorized Signature
(Original to Cash. Management, copy to Accounts Receivable)
NM 6/8/90
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REFERRAL TO FINANCE DEPARTMENT FOR COLLECTION
MC~ì/ (nee!
Referrin~'Department/Section
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Person Making Referralv
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Account Number
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(tì'ivYlßQ.L/¿'-œJ././n7r
Type of Billing ~
J ó n ~ J-fOí1 ria 1) (JI:JO : r
Name(B~siness Name of Commercial Account)
¡jot/} ÍIJ/hle þ,¡
Site Address
U All<" tJ () uJ N
Mailing Address
Telephone Number
.Jah f'\ L~laf\d
Owner's Name, ddress and Telephone Number
Billing Period: From '1 - g ß
Month/Year
To (¿, -8 '1
Month/Year
Amount Due
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List Collection Efforts by Department Prior to Referrål: ~h.t.4 ~ ':~
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THIS BILLING HAS BEEN v&IFIED AS ACCURArM ANb VALID
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Authorized Signature
(Original to Cash Management, copy to Accounts Receivable) ,
NM 6/8/90
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REFERRAL TO FINANCE DEPARTMENT FOR COLLECTION
I-/A2..A¡e...-DoOs 1^()i2T[~/¡;')cS Ù¡'V
Referring Department/Section
Va/err C- íJf)denìr{ì~S
Person Making Referral ~
;-1m tf/t../ &0/
Account Number
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c;ßJ ~
Type of Billing ,
10m's +-Jon ~t:l-. ~epo.; rt.¡3ô(.. !1..J/hle l:rl.. ~
N~e (Business Name of Corrmercial Account) Si te Address j "", ..:aHA~ p~
I DrY) ~ l£X.nd 'J 34-00 ~ V\.a..Lù wvw~--- ~~_
o -;).17 ~ l{u Au t:-"
~A{(~¡¿~¡:::'IE¿b ,C-A q~30ß ( 8 3r".,-.RÚJ IÎ ) <3'1d-1) ~Cog
Mailing Address - S4mE - ~~ ~~ J\.au...L) Telephone Number'r-""
~'¡f~~ ~~ ~~ :::~U;;;\~~¡'
Owner's Name, Address and Telephone Number
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Billing Period:
From 1 fS7
- Month Year
To ~ /<;&
Month/Year
1
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Amount Due
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List Collection Efforts by Department Prior to Referrål: ...A'U1 ~.': 7;):t:UN¡t
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Comments
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THIS BILLING HAS BEEN VERIFIED AS ACCURATE AND ,VALID
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Authorized Signature
(Original to Cash Manageme~t, copy to Accounts Receivable)
NM 6/8/90
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Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
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RECEIVED
MAY 2 5 1990
Ans'd..
..........
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
1. To avoid further action, return this form within 30 days of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH,
3, Answer the questions below for the business as a whole,
4, Be brief and concise as possible,
SECTION 1: BUSINESS IDENTIFICATION DATA
.
BUSINESS NAME: ..Jv\.~~ =<-V-j:;
LOCATION: H-;,ÒCc, ¿,..J" J., A ), l :J .. ~ ~k Lu-.J
MAILING ADDRESS: ~ ~;-r;LoI
~TATE:Ct, ZIP: Q3313PHONE: X'~("lì'?lc:'
~~ ~(~
.~~~u:-~ ~
f
q~ 3ß )
Æ1:.. f3> I'))f '37
BUS~ONE 241=?R. PHONE
µ.-À 3 Ce Ce -- '-f 'fCC ~t- )
#- ~3 \ - t 7 ~ 10
CITY:
DUN & BRADSTREET NUMBER:
PRIMARY A~ITY:
OWNER: ~
MAILING ADDRESS:
SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION:
TITLE
1 .
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2. ~}w\.
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1 .
FD1590
Bakersfield Fire Dept. e
e Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
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SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: Z
MATERIAL SAFETY DATA SHEETS ON FILE: (5 J,<-~ f'c-~'~ \
BRIEF SUMMARY OF TRAINING PROGRAM:~ ~ v0,,;-~e- ~ J
\~ \."'-) ~ ~ -Z- ~ fl-7'-F'~ ~..~ .
~ ~ù~-~~/~~ <>-J- \.l~
~~ ù~JJd,(~~~L¡
~~.)
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE
REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH &
SAFETY CODE" FOR THE FOLLOWING REASONS:
WE DO NOT HANDLE HAZARDOUS MATERIALS.
'^'
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
,/
//'
(SPECIFY REASON)
I~ICATI~ 1
I, U/¡.. CERTIFY THAT THE ABOVE INFOR-
M ION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM' OBLlGA TlONS,UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE"
ON HAZARDOUS TERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 E~. AND THAT
INACCURATE IN MATION CONSTITUTES PERJURY.
~
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TITLE DATE
2,
FD1590
e
Bakersfield Fire Dept. e
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
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Facility Unit Name: 'K. ~~ ~
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
~0-~ -{ <L-~~. \ I
L '" L~
C--~ ~~ J
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C. PUBLIC EVACUATION:
t.f -ºf ~ h
2. çr-~ '2 r~
D. EMERGENCY MEDICAL PLAN:
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(j'J.S.r0
3.
FÐl~
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a Bakersfield Fire Dept. tit
... Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A, RELEASE PREVENTION STEPS:
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
~.
,L'0~k ~\ ~ ~
C. CLEAN-UP PROCEDURES:
C-~\-- ~~.... - ~ - ~~ ù--~ .
SECTION 8: UTILITY SHUT-OFFS (LOCA nON OF SHUT-OFFS AT YOUR FAC 1dfY):---=::::----
tX.t-~ ~~ s~~,
NATURAL GAS/PROPANE:
ELECTRICAL: S '--'-' ~ .
WATER: v~ J-~ ~ ~ I Ç' w
~-, ~ -;. Cor-~
SPECIAL:
LOCK BOX: YEé) IF YES. LOCATION:
SECTION 9: PRIV ATE FIRE PROTECTION/WATER A V AILABILITY:
A.
B.
PRIV~EFIR~ON'6 . ~.+~~_~___
WATER A V AILABILlTfJ(FIRE ::::T): ~ _~_ø-~-~,,--~I=)
,Ç í~ ~ ~~ --- ""~
1 r:s ð. J-t ~ +-k s~" iJ t..,^-",,'\
"- ~Ð\. /
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12/12/8':3
. ~~otiQ~~it ecr¡1 ~ H c¡
Site as a Whc.le
Page 001
General InforMation
r
I Location: 4306 Wible Rd
Ident NUMber: 215-000-000657
Map: 123 Hazard: Moderate
Grid:13C Area of Vul:
AdMinistrative Data
Mail Addrs: 4306 WIBLE RD
City: BAKERSFIELD
GeoSubdiv: BAKERSFIELD STATION 07
D&B NUMbe'r~:
State: CA Zip: 93309-
SIC C.:,de:
Owner: TOM LAYLAND
Addrs: 3400 MOUNTAIN VIEW APT 234
City: BAKERSFIELD
C,:.rlt act
TOM LAYLAND
JOHN LAYLAND
Title
Phorle: (805)
State: CA
Zip: 93309-
8-USiness Phone
( ) 831-1786 x
( ) 831-1786 x 836
831-1786
I SUMma'r~Y :
~~
50lá
r--..J " ~ -::Jo "-..J S
-\-ð b \'O~
Ho ~CL Qpcü r
~¡¿jLol5 N~~
24 Hour Phon~
) 836-8617
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A-~~~~
RECEIVED
DEC 1 9 1989
H,i.\.? MAT. DIV.
I-JÎ- ~ ¿(µJ:i1 ~ __~)
w&- ~ ~ ~ ffL ç077\-"-/
()v11£L qjX' /fIP»J i&1/YfL!J·
05/08/'30
~v~
¡r\~ ~R 215-000-00<A7
~ Overall Site with 1 Fac. Un~
Page
1
General InforMation
Location: 4306 WIBLE RD
Ident NUMber: 215-000-000657
M
G¡-
.
ap: 123 Haza¡-~d : Mc.de¡-~ate
~id : 13C A¡-~ea clf Vul: 0.0
ss PhclY'le - 24 HClur Phc'Y',e,
-1786 x (805) 836=8617 V
-1786 x ( )
-
D&B NUMbe¡-~ :
ate: CA Zip: '3330'3-
SIC Cc,de:
Ph':'Y',e: (805) 831.-1786
State: CA
Zip: '3330'3-
II
C':'Y'lt act NaMe
TOM LAYLAND
JOHN LAYLAND
Title
Bus i Y'le
(805) 831
(805) 831
OWNER
AdMinistrative Data
Mail Addrs: 4306 WIBLE RD
City: BAKERSFIELD St
COMM Code: 215-007 BAKERSFIELD STATION 07
I I Owner: JON LAYLAND
I I Address: 3400 MOUNTAIN VIEW APT 234
I City: BAKERSFIELD
Sl\MMa¡-~y
"
eby certify that I have
reviewed the att..':.;;~"3rJ hazardous materials mé1nage-
ment plan fo,___.., __ and th~t n [:dong with
(I:.ilma gl~JI:::~.)j)
any correct¡on~ ~';!~li!~!!.., a complete 3fid cQrreci man-
agement P~'f;~.
L--- ft- j. / /. J
CI ~
05/08/'30 JONS HONDA REPAIR 215-000-000657 Page 2
Hazrnat I y,veYlt C1t'Y List i YI Reference Nurnbet~ Ord et~
02 - Fixed CC'Ylt a i Ylers CIY, Site
P 1 y,-Ref Narne/Hazat~ds F Clt'W QuaYlt it Y MCP
02-001 MOTOR OIL ? c.-I:" Minirnal
..J..J
GAL
02-002 WASTE OIL ? 70 LCiw
GAL
02-003 SOLVENT ? I:' I:" MCldet~at e
..J..J
GAL
02-004 ANTIFREEZE ? 55 LClw
GAL
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II 05/08/'30
JO. HO~~A REPA I R . 215-()()0-0~)tA7
O¿ - Flxed Contalners on Sl~
Page
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HazMat Inventory Detail in Reference NUMber Order
02-001 MOTOR OIL
?
55 Mi Ylimal
GAL
CAS #:
Tt~ade Sect~et:, Nc.
ForM: Unknown Type: Pure
Days:
Use: LUBRICANT
- Dai ly Max GAL -T Dai ly Avet~age G(~L --r- AYIYlual AMc.l.mt GAL
55 0 - '3'3 I 400
I
Stc't~age r Pt~ess T Temp ll\lE CORNER OF LB'U:'CI LatD 11' ·N:'YG'
DRUM/BARREL-METALLIC
- COYIC _I
100.01- Motor Oil
C':.mpC'YleYlt s
I~ MCP ~ist
Mirlimal I
02-002 WASTE OIL
?
70 L.:.w
GAL
CAS #:
Tt~ade Sect~et: Nc.
Form: Unknown Type: Waste
Days:
Use: WASTE
- Dai ly Max GAL -r- Dai ly Avet~age GAL -,- AYIYlual AmclI.mt GAL
70 \ 0 - '3'3 \ 200
St ot~age
DRUM/BARREL-METALLIC
r Press T Temp 1
NE CORNER
Locat icq"l
- CC'YIC _I
100.01- Waste Oil
C,:,mp':'YleYlt s
r.- MCP -,-L i s t
\ Lc.w I
02-003 SOLVENT
?
55 M':ldet~ate
GAL
CAS #:
Trade Secret: No
Form: Unknown Type: Mixture Days:
Use: CLEANING
- Daily Max GAL
55
Daily Average GAL
o - '39
Annual Amount GAL
55
Stc.rage
DRUM/BARREL-METALLIC
r Pt~ess T Temp _I
NE CORNER
Lc.cat iC'YI
- CC'YIC
100.01- NaPhtha
CCIMpC'YleYlts
. MCP --.-List
Mc.det~ate
05/08/'30
JONS HONDA REPAIR 215-000-000657
02 - Fixed COntainers on Site
Page
4
Hazmat Inventory Detail in Reference Number Order
02-004 ANTIFREEZE
?
55 Lc,w
GAL
CAS #:
Tt~ade Sect~et: Nc,
,I
I!
Form: Unknown Type: Pure
Days:
Use: COOLANT/ANTIFREEZE
---- Daily Max GAL Daily Average GAL --y-- Annual Amount GAL
55 ----r-- 0 - '3'3 I 55
St c't~age
DRUM/BARREL-METALLIC
r Press T Temp l
NE CORNER
LI:,cat iCln
- CCIY'IC -r::-:--
100.01- ¡Ethylene Glycol
C':'mpC'Y'leY'lt s
T MCP -¡-L i st
I Lc,w I .
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, 05/08/'30
J4 HONDA REPA I R 215-000-00e7
00 - Overall Site
Page
5
<D} Notif./Evacuation/Medical
<I} Agency Notification
CALL '311
<2> Employee Notif./Evacuation
DOORS ARE LOCATED AT EACH END OF THE BUILDING. I WOULD EVACUATE AND CALL
911. KERN SECURITY SYSTEM.
<3} Public Notif./Evacuation
NONE LISTED
<4} Emergency Medical Plan
MERCY CENTER - 2301 ASHE RD - 832-8300
WHITE LANE MEDICAL CLINIC - 5401 WHITE LN - 832-2000
/~
05/08/90
JONS HONDA REPAIR 215-000-000657
00 - Overall Site
Page
6
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention ,
OIL SPILLS ARE TAKEN CARE OF WITH CAT LITTER AND MOP. SOLVENTS ARE KEPT
IN AN AREA THAT CAN BE CLEANED EASILY - MOP.
<2> Release Containment
<3> Clean Up
<4> Other Resource Activation
e
e
05/08/90
J4 HONDA REPA I R 215-000-00"&:7
00 - Overall Site ,.,
Page
7
<P> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - REAR OF BUILDING (SOUTHWEST CORNER)
B) ELECTRIAL- REAR OF BUILDING (SOUTHWEST CORNER)
C) WATER - REAR OF BUILDING (SOUTHWEST CORNER)
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM - ROOF MOUNTED
FIRE HYDRANT - REAR OF BUILDING
<4> Held for Future use
05/08/90
JONS HONDA REPAIR 215-000-000657
00 - Overall Site
Page
8
(G) T)'~a i \'"IÌ \'",g
(1) Page 1
WE HAVE?? EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING:
(2) Page 2 as needed
(3) Held for Future Use
(4) Held for Future Use
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
CJt~Td£~
RECEn!£D
OCT 1 1 1988
Ans'd.
...........
OFFICIAL USE ONLY
ßpA I Q..
ID#
UO~
HAZARDOUS MATERIALS ~. A ~5
BUSINESS PLAN AS A WHOLE ¿j!J ~
FORM 2A ',é /:'/~
t12f2 CJY ~
INSTRUCTIONS:
1. To avoid further action, return this form by 9 -:2,c¿ -ß7,
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NAME: To~ \-\~A.)CA 6PR,e
B. LOCATION / STREET ADDRESS:~?>O(,., W i ßLL- e..O
CITY: 1SA\C.tt:..n= I ~LD
ZIP: C\3""3óCJ
BUS. PHONE: (<6öS) X- '3 I - 17>< (n
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
NAME AND TITLE
A. \{)I'--\ Lr-><:....¡ L ~¡.j n
B. '3 Q 1:-\ 0 L/~.. 'f LÞ,)'J 0
OF EMERGENCY:
DURING BUS. HRS.
Ph# 8 31 - \ 7 'R '=-
Ph# ~ ?:>I ..,\ ì 9. {,-,
AFTER BUS. HRS.
Ph# ? '3 ~ - K' b 1 '7
Ph# 8";, b - ~ b. (I
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROP,4NE, ~"~ç~~~~~"~-,,,,,t"~
~: :~~i~~I~ ~ ~~ti-, ~ ,~V;~ \ '" .::,'¿' <=~" ')
D. SPECIAL: ~
E. LOCK BOX: YES ~ F YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES I NO
FLOOR PLANS? YES / NO KEYS? YES / NO
- 2A -
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, ~
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SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
H- t..-1Le- '-I C L. ~ N ~c.--
W l-t \T~ l.A- N ~
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS,
CIRCLErYËSJnR NO INITIAL
A. MET~FOR SAFE HANDLING OF HAZARDOUS
MATERIALS:..........................,........,... {§)NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES:......................... .~' NO
C. PROPER USE OF SAFETY EQUIPMENT:......."......... ' NO
D. EMERGENCY EVACUATION PROCEDURES:.. ..........,.,.. ~
E, DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:....... YES ~
REFRESHER
@NO
YES~
YES >iã2
YES I ;¡{6)
~NO
I
SECTION 7: HAZARDOUS MATERIAL
.-~'--
CIRCLE~ES R NO
DOES YOU BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS ,OF A'-
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:...,.. YES NO
I'~Ã~¡~~ ~ l~ , certify that the above information is accurate.
I understand that this 'nformation 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.
SIGNATURE7~ 7#TLE a~~
DATE I (f r/O<~§rri'
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BAKERSFIELD CITY FIRE DEPARTIIEXT
2130 "G" STREET
BAKERSFIELD. CA 93301
"
O??TCTAL USE OXLY
BUSINESS ~AY¡E: -r;;f'.0 ~~.0 OA {iPA\{G
ID#
------
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS
1. To avoid further action. this form must be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as »ossible.
FACILITY UNIT#:
FACILI~ 'UNIT N~~: ~''''Ù> ~~4' (JpRrlfL
SECTION 1: MITIGATION, PREVENTION, ABATEME~jL PROCEDL~ES
o \ \... d P ~ L.U' ~ C\ A-\'--!.10 CJ+-Æ..t... 6 (j=- L-J L T 1.4
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SECTION 2: NOTIFICATION A~"D EVACUATIONPROCEDCRES AT THIS L"XIT OXLY
~ Ð ÇL S (:;J (l..-~
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SECTIO~ 3: HA7.AROOGS !fAT~RTALS FOR THIS ¡,XIT O~LY
A. Does this Facility Unit contain Haz~rdous ~ate~i~l~?.
If YES, see B.
If NO, continu~ with SECTIOX 4.
B. Are any of the hazardous materials a bona flde Trade Secret \"Ese!)
If No, complete a separate hazardous materials inventory
form marked: XOX-TRADE SECRETS OXLY (white form ~4A-l)
If Yes, complete a hazardous materials inventory form mark~d:
TRADE SECRETS O~LY (yellow form #4A-2) in addition to the non-trade
secrpt form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTTO~ .i
5ft-~"-\(..~ $G~~ -~-+ ,~~
+.----- .
SECTION 5: LOCATION OF WATER Sù~PLY FOR USE BY ~RGENCY RESPO~ERS
~·V~~"'~ .c.£,~ ~~)
SECTIO~ 6: LOCATIOX OF LïILITY SHLï-OFFS AT THIS UXIT ONLY.
A. XAT. GAS!?ROPANE~
~~ <r-f 'o~~ C :>_~, u::>¡-~J
"-~
B. ELECTRICAL:
C~.c.--J ' 'SLiD~).
, '
,~~~~
C. ~'IA TER : L~ \...L.c--'
.
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D, SPr.:CAL: L~
~~ ~~ C~W=~,->-»
E, LOn( B(1'\, Y:::S ~? YES, LOC\TIOX:
If YES, srTE P~A~S~
~~,OOR pr.\~S0
?ES / ~,.()
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ONLY
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FOR~I "A-I
NON-THADE SECHETS
AZAHDOUS MATEHI ALS' I NVEN
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OWNER NAME
AUURESS I~
CITV,ZIP
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ONE , nus IIOURS
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RECEIVED
JUl1 7 1987
Ans' d............
TOM'S HONDA REPAIR
5333 WHITE LANE
BAKERSFIELD, CA 93309
Pf:; # «105) 831-1786
BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3\~~Û
<.9.J::rN5
OFFICIAL USE ONLY
ID#
13Y07
HAZARDOUS MATERIALS
PLAN AS A WHOLE
FORM 2A
INSTRUCTIONS:
, 000657
1, To avoid further act~on, return this form by
, \
2. TYPE/PR INT ANSWERS IN\ENGL I SH,
3. Answer the questions be~ow for the business
4. Be as brief and concise as possible.
\
SECTION 1: BUSINESS IDENTIFICATION DATA
as a whole,
B. LOCATION / STREET ADDRESS:
CITY: BCL ke~ .ç ì e ld
ZIP:
BUS.PHONE:
A. BUSINESS NAME:
SECTION 2: EMERGENCY NOTIFICATIONS
\
'.
In case of an emergency involving the reíease or threatened release of a
hazardous material, call 911 and 1-800-852-7550~r 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 YV\e<:-~OSY\tDuRING BUS\HRS. AFTER BUS, HRS.
A. ""\ n VY\ LC\... \/ \ Cl ~ - 0\..0 K.e f' Ph# ~ 3l- 17 <¡( ~ Ph#:1 c¡ a -Da bJ?,
0- "I \ ~ ~, _1 DOO~~ \.., ~
B. \1 \ f'q I. \'\\Q L~ I(A!'NY\ O~h# ~q :;).-O;;¿6 ~ Ph# 3<=[;;L -0;:) ~()
~
:~CTION 3: LOCATION OF UTILITY SHUT-OFFS,FOR BUSINESS AS A WHOL~
NAT. GAS/PROPANE: ~
B. ELECTRtGAL: 0
C. WATER: t 1\
D. SPECIAL:
E. LOCK BOX:
...----
I
r-
IF YES, LOCATION:
"
I~ YES, DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
MSDSS? YES /~N~
KEYS? YES / NQ\
- 2A -
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
-(kNL cq'e lÀSú.ecLly., ~ \.00 f.er-8C)""-6 ìV\. S fLop Ct t ct L {
i-\VV\es, ~UV' 'Pt~V\.e~ are CU)Cll£a.JJ(e, -rk-ere ctre .3
blÀ-S\ t\.,esseß lit\. II Ll \I 2:> tw.ped ~,ayÿ\'p ~ 'i w '1-¿'q' þ~ DC[ ('6 k~:;J
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
E V\'\- ~ '9 e~~~ CL VV\ fDu lOJY\e.Q Cl 0 ct; [a...kJl e. lDy d ct i ¡ ¡' YL9 q t I,
ߺ-ìV\O 00i(i'{kft)': ~~tDcd r bU$/'f\QS,S --tra.. V\.ßpóriccj-'I'ðV\. f~
CLL\)j&YS Cl\)Q'1 la,ble, ~Q"C'..ð' ~0P'¡fc<-( ,Ì-s ct
-{ e u.:J "rvI.~ ¡'H-L -1-es Q wa V ' r \ ts i ct I cI k tf 1 S Ó VI,.,
llJCl ~\ '-Vt ea \f' 6 +ct l r'S ,
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
REFRESHER
® NO
INO
S NO
E NO
YES ,@)
@NO
'Is ' NO
Y S NO
'Y~S ~
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF~
SOLI ,55 G~LL2NS 0 ~ Ll~UlI~:~~200 CUBIC FEET OF A COMPRESSED GAS:...... YES ~
l r-q t it ~ ,lß¡-l-{ ~,r '-Y' '
I, o.s i , certify that the above information is accurate.
I understand that this 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~ W[j~. ~lJ~TLE (') \.ú 1'\ ec
OATE~IC¡'ii 7
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BAKERSFIELD CITY FIRE DEPARTMENl
2130 "G" STREET
BAKERSFIELD, CA 93301
TOM'S HONDA REPAIR
5333 WHITE LANE
BAKERSFIELD, CA 93309
?14, # (805) 831-1786
OFFICIAL USE ONLY
ID#'
BUSINESS NAME:
------
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoid further action, this form must be returned by:
2, TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT#
FACILITY ù~IT NAME:
SECTION 1: MITIGATION, PREVENTION, ABATEMENl PROCEDURES \'
'lIt~Lú Ö~ I ls Þ-p+- '\ V\ '-YY'ekJ1 <:) ì I~a-Io{~~+ (C~Jlecf
ItOl '¡ Y' ,bo ~ II, cvY\. cl RCÅJ.JYY\.P e c/ ð U+ -éö pO, U.S e £t c: I~I
~ l V\ ~~d (') II oLr:~ UJY\..~ ~e-+et r s, t\.k
60 I é)QY\.;'1- l ~ C-lD~€d 0 {I dr-urn. c1Jrd I V\ dee p
yY\Q*~\ s\~k, Oìl ¡,s 0~t'-.~Q¡i\ed /11\ ~S~- C;Cl!(()1A-
~o ~ {cumer'S Q..~ ~s IAct ttLy 't ~~ ØJ\J. J1.öi {' lA-1{ ,a t:Jwnd CUY\~
c-f RClop (Ã.re ,C\.oculcckJ/eO. S~~~e 0s Ct{V\ \ Jo-e, us-ed +0
bLOOP U-f 0 t Ilk +0 [;lsad 0 I [ Qòb\ ia l V1 t?iI',
Wcc\--e" ~ kö~ ðL-l:i-&t'ci.<L ~e {~I c;.t()ð ff" () /I\. ..Q a,sf 'St~ I
SECTION 2: NOTIFICATION A~~ EVACUATION PROCEDURES AT THIS UNIT ONLY ,
F~0e. <Sf\'\~k\,º-\S ìh (e~),\~.wì~~ Q.Ja..NIY'-þLlQ,
Tk\e. ~('<2- d ~K ~-+s \ V\ lrndc<J ctbor C(+
-E \'0 Y\ -\- <5f ¿) ~ P I
\~ Q>--Q. 4 -bJJ¿.p~ CLGQ~ lCL~ ì V\.
S~~\ o~ ls lO~CLie. cf ~ ~~--+ cLoer,
L OJ\.O¡- ~~{a..Q O\}-€J\ ~~ cL OD r Q cuy\ kJ.e ~a. S t t /
(') pe Y\ød. -GSt. b"] P. LL-Ill' Nj 0 ~ Q.D reI. T'i ¡ S /pe V\
~Do;o ô-{- -iìyY\Q clLtfi~ 1Dl.t~ì1\.ess kðll I0s ,
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this Facility Unit contain Hazardous Materials?. . . ., ~ 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-1)
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
F ì r-e s p r- \ Y\- k../ Q ('-s ì K C. Q ¡ l ~ n.~ .
F ì f<::- ~..Q.. 'X:i t Þ"-jlt \ Q A- e f" bA.JV\. dJ Ol-t be) iiÖP7\.
e> --{ oS +ct,J (' S
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
,t--kö~er 8f'03
~oM~ SìdQ QJ-Ç-
CLU~ð+ ì1 ºl\Cjl~o~)
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT, GAS/PROPAN~~
AlIÆ
Cl u.. ~W\.ð f 0 fJe
I'
B. ELECTRICAL: ,"-öQ.CLi-e..aÁ fJl\. \.CLle.c:frtcCl./ R.O~:>YV\ CLt
\~ kef' ßros, Ad'DI1'\(')'f~'lJe, C we~ i Y1 e/~lt hðu)
C. WATER:
LO~Cl+-eot ì V\ ~ rò ~ '\-
dvt\- D~'Í ,\)Ç> ~ f'Lðr-i-~
oi- H-oö kef' ßros_
6f'J. e (Wé'6i ,-¡/¡01"1kloòf\)
D, SPECIAL:
f1JfÀ.
E. LOCK BOX: YES /~ IF YES, LOCATION:
IF YES, SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
MSDSs? YES / NO
KEYS? YES í NO
- 38 -
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Page
TOM'S HONDA REPAIR BAKERSFIELD CITY FIRE
5333 .wl1'TE LANE ' FORM 4 A-1
~ER$,.,tlP, CA,93309 NO N- TRAD ESE eRE T S
m: # ~g05) 831-1786
HAZARDOUS MATERIALS INVENTORY
DEPARTMENT
#
D
I
:~~~:~~~ ::AME:'\t~~?~\~fX'r OWNER NAME: \ ðYY\ I "1 A I ClJY\oI FACILITY UNIT #:
ADDRESS: (,,;:J , ì ~ ð.:>D )! A rJ ,U( FACILITY UNIT NAME:
CITY, ZIP: ~ ", ~ 3Cf'1 CITY, ZIP: gr, ho 1\.J"'\c! .~ kD ro¡Q
PHONE #: 3q2 -O.:r lc-'< <' IOFFICIAL USE CFIRS CODE
PHONE #: 3 - Co
ONLY
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.. O. T
""CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT, WT. CHEMICAL OR COMMON NAME CODE GUIDE
\)? <g() 1{;¡5 'fcd DC:> ¿;Zfo a. q ct , \A. ß 1- ,\j.)Cl CI ·(00 t ao- s-0u:) '-yY1 01-0f' ð~íl1 ð" FLLQ
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I/O' ct00 qa..{ 00 '-/0 l \ II '5 í "'-t. , J51Y' tf£,Ç~
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NAME :'1\ IIYI hA ~CI. cr'1 1"1 J. '''' ,.......111 T I TL E : u^ , - ~ 'P€ D€J\ .s I GN~ TURE :\ " 'r-A I\A. t i".I., <t"(~,LQ.1A IIN,JY'C/ DA TE: Cj,u I A {.5 Jt/fiV
EMERGENCŸ CONTACT:\~MI'D~ 10/ rl.11lr-..,'Yv-JTI'tLE:'"'W\('='clldm«(\ -OÖ)Ì'd.:'l. PHONE # BÓ'S HOURS:£~I-/7ffb '
, \ ,f ' , AFTER BUS HRS: 3C¡:;;z. -0=;.. h'X '
\I\::ivloti'o-f~~ nTLE:~~\- ÖU\M"-PHORE . BUS HOURS: 3'i:7-a~~Ö'
ACT I I TY: Q{:-1- ", ì\..lî:J. ~ S\ AFTER BUS, HRS : "3 ì ;;;L -()~ ''(5)
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SITE/FACILITY
FORM 5
SCALE:
(CHECK ONE) SITE DIAGRAM
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DIAGRAM
TOM'S HONDA REPAIR
5333 WHITE LANE
B.\I<£RS~ELD, CA 93309
I'll # (8Ð5~ 831-1786
FLOOR:
OF
UNIT::: OF
FACILITY DIAGRAl'vI ~
ó~e
q-ti-LÀ- -{Q ned
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(Inspector's Comments):
-OFFICIAL USE ONLY-
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MATERIAL SAFETY DATA -SH,eIET/.
. . omplies with 2~èf:R 19iO,120Ò?
ÇQ9E ~U~IJE.R: He:) 1
. T~ADE NAME: "I NERAL SPI RI T S
¿ÇHEMICAL FAMILY: PÈTROlEUII
, DA:rE><'''::=--
.' '~ 860m
SUPERC~D~fì "~' ~'
'.. 85.1221
, , . Ç;A.S; NO.: 1IIXTURF~
TSCA I"'FORMATION: lOT cœEm.Y LISTED
~i~i~~f~}i~;~;ÎIÎ~;',QN';i(,
C~A.S.
NOS.: '
'TLV/PEL
PPM mg/ma
PERCENT BY' I
WEIGHTIVO!-UME
COMPONENTS
""2:88'-' ,lòO
100
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}tl;;'¡··,,·,·,·'·';:;lf~I~~~U;,}~:;,~(;,
HAZARDÒUS THERMAL DECOMPOSITION
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'FL~SH POINT: ASTII D56<TCt)
... 0 C (10..0 f)
..~T INf'0RM~TION: 173.115
10, N. . .
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r:1Ç¡'HTING PROCEDURES: 00 lOT EITEJt.., EICI..~"OR ~11iO
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HÁZARDOUSÖECOM~ê>S;111~N;P~Ç~µ,CTS:
, CMIBtI..x,I8L:-" II". ASPII'iXIAI01:
, HAZARDOUS'POLYMERlzATI9N "ötáïPAtIONAL EXPOSURE LI "IT '
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AREA. APPlY MTIFlCI..
RESPIRATlOI IF UIICOIICIOUS
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'STEP.S TO BETAKEN INCASE ,
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WASrE, DISPOS~LMETHC)D:
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I' ~ 11TH UJCAL STATE .. FEŒRAl REGUUtTlOlS REGtlllDIIC HEM.TH PRECAUTU.
.. _II ,.. IM'ÌERPll.WfIGl,
TRANSPORTAT!Ç,NI.,FORMATION: COIIIUSTIBLE LIQUID PER " CFR P3.W
~ TO sml" In OfTHJS IIS8S FCIt _In.. REcanIID\TlOIS COfICERI(IIC PLACARDIIC.
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CIIIIICtü.Y RESISTIVIT _TS .. ~ RECCOIIIE&O.
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PREÇAUTIONS TO .BE TAKEN WHEN HANDLING OR STORING:
_IDSTfItAIiE .. IIEII FLAIE œ OTIER stUtES OF IGlITIOI.
. ~~IUE !lISTIIC MY CAUSE SlIPPERY Fl_. PROPER FOOTIÐR REQUIRED.
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PERSQNAL HYGIENE: IIASII _ IUTH SOAP AlII !lATER BEFORE EATIIIG, DRI.IIIG~ OR SlllCIIIi.
'OTHER PRECAUT.IONS:_ œ TME SIØER IF GŒRAl CClTACT 0CCIItS. REIIOUE Oll-
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handling directions
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''/~f;-'' ;'i'>ì. . -;,~;;<i) "-";~:. ,'_.;-, '<.>
Nåtional Fire Protection Association
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Thrøshold Lil11.tt. Yªtu~t~ r~.ç9:mmenct~d;,,~pþ·er:·li,rp,it¡Rr;rW~:
c()ncentratlol1"åf'ã;sµÞštaJÌce"'towh¡ch' mô~f worké'rs'Cån ,"":;
be e~pq~egW,it~outa~vø¡'!?e ~ffeçt.,
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Time Weighted Ave.ra,ge
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8015 Paramount Blv(J. ¡
Pico Riv¡3ra, CA 90660A8~8
Telephone (213) 928-3311
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