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HomeMy WebLinkAboutHAZ-BUSINESS PLAN 4/17/1997 - -I - lJ 0 ~ 2]- . II I o'~ . ,0--;-- 0 >.tfr-1-r7:-'fc?'" ~ l.-.S~ECIMTY HONDA' C~ ~PAIR o_~o l ~~_ _ ___ I! II (6) 'fa> ~ j ",t (fu I', ,,, .-;: ".... ''''./" i ~: f . ,"" ,\ "..~~~.~....~ ". 'MAP cP HUMp ." . ..L.'.1tþ T .L PLMi. SITE DIAGRAM Business Name: FACILITY D(AGRA ~ £¡o..O ~ U '\J'~~. j-ilcry Business Address: For Office Use Only if First In Station: Area Map 1# of NORTH -{} Inspection Station: oJ:t~ -"~ ,~ -------- --- ---------- Nóen+ I S,· R'lufY\ ~ , ~1 (pO ~~v(i\..\,\ SiDE wf\i-\( t_ 1 \---- - .~ .Ç) )!~ ~~ t - ~ rJ:<Y ~()- .~~ ~~ ¿y . Cj ~6V' ~~ \-- -- ~ ~ Jd 3 0 ~í\ ~lt? ,~'5 t'i ~~f? ~} ~ . 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MoB IU= AUDI() S«óf' , "/1-,éPt:'.:NDCvr i)éïA 11.-/ ~,sc....J"'l /' 1.0 TIR6' ¡vtOßI<.E .,A.c..Jl)tQ SA<..ES KAiNßð~ ~ vJAS-U o ~ W .....J ~ 1 - ~ . ~1I BAKEtlFIELD CITY FIRE DE'ARTMENT HAZARDOUS MATERIALS DIVISION 1715 'CHESTER,AVL BAKERSFIELD, CA. 93301 W '1 f? HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: Vl;ìß ~ Or- 0- ~ i. 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. 8e brief and concise as possible. (POl ( SECTION 1: BUSINESS IDENTIFICATION DATA f'/ 3USINESS NAME: 5'fE:..¡A~ rY +h-voA. CAe<. ~6PA/(Z LCCATION: ~c,o / WlfÇ¿£ ~ ì ìv1AIL!NG ADDRESS: S~¡:; . Cry: STATE: _ ZIP: q3."3.0'7 PHONE: 551) - 6~L6 DUN & BRADSTRE::T NUMBER: SIC CODE: ?R!:-lIARY,A.CTIV\TY: OWNER: ~¿ r.,J <.....>µ 'ITA K<:Sz ;vl~\!~jNG ADDRESS: ~ A.vtc SECTION 2: EMERGENCY NOTIFIC:"'TION: CONTACT, TiTlE BUS. PHONE l. C;¿æ~Y WI.{ I rrl.ll-<..::<... ~, ~~1 - b~Zb 2. bcJ.rlLE P6JtJ ~ ~G'<. - I -'oJ - £.A¡....) 11 24 HR. PHONE ~ C,b ~~6S- 3"L.Ç" cr S-/-6 3'11- 81 lc;;. 1 . .öaKersneld ~'ire Dept. .rdous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN ,. '. - ,; SECTION 3: TRAINING: NUMBER OF EMPLOYEES: ..J. MATERIAL SAFETY DATA SHEETS ON FILE: ?GS j BRIEF SUMMARY OF TRAINING PROGRAM: C' ^ c::;...oO¡-{ J 1//'<:''-::'''1 .III ' ò-' ~ =- 'r" "c...cç-v 1V-\c:. f?(2ÐJIDéD k:tb -z.. - (PM -raAiAvJ I ,vc--/ " " SECTrON'::~1: EXEMPTION REQUEST: ! C~RTIFY UNDER PENALTY OF PERJURY THArMY BUSINESS IS EXEMPT FROM THE REPORTING f~EQUIREMENTS OF CHAPTER ó.95 OF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REA,SONS: WE DO NOT HANDLE HAZARDOUS MA ïERIALS. WE DO HANDLE HAZJ\ROOUS MATERIALS, BUT THE QUANTITIES AT NO TiÌYIEEXC~ED THE MINIMUM f~E?ORïlNG QUANTITIES. ,,"" 'r-- (s"c:rrr-y Rc:,\ ~"N) 'vlï:t::~ r,-,-,ir., ....'"\::iu SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATfON WILL BE USED TO FULFILL MY F!RM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFE:ÌÝ CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER ó.95 SEC. 25500 ET AL.) AND THAT INACG~RATE INFORMATION CONSTITUTES PERJURY. ~. . ~>df . " ~~~ SI I ATURE TITLE DATE ,., - .uc:u::...~l~.I.:1.~.l.U. £ li~ l.JëlJl". .; '!~ _ Hazaràous Materials DiviS10W HAZARDOUS. MATERIALS MANAGEMENT PLAN Facility Unit Name: S(/&v1..L TV FloY\1I)A- CAL. R:CS-OAIIL SECTION 6: . NOTIFICATION AND EV ACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: (j)i:J:.ðJf3$ i,.J tf-+-iC€ ~ .ç: ~,p <P Cß¿(, <=1-1- I í\L~6- IS AL, Afè..i\A. 1'(" ~ U =>I.J ,..) I SECJfU:; Cd. a. EMPLOYE~ NOTIFICATION AND EVACUAi!ON: W'L<- 6x , \' 'f"'D w, ður !hAY DðVf2..<; C. PUBliC EY ACUA ïION: ~I u_ . e::'X' T TO S ,our bJìfl.b.~..iC6 µ~ c. ë:v1E~GENC,( MEDICAL PL.':"N: .. , " .. '- .. :ì, ;:VI!>' € It Bakersfield Fire Dept. _ Hazardous Materials Division .....-... ,- 0'0 " HAZARDO'US MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: 'þ!bJM 5 ß!t.~ (pc'+Tt;.O .fJ.ù::>",J(J;r ¿Jôi...J- ()¿J'( c>r:: c..U1J.~ c»: VE,tc{IC U:;s 8. RELEASE'CONTAINMENT AND/OR MINIMIZATION: W;L~ Js~ Mð(=J ~ í3ue,l(r:5~ ,.... ',-, . ClE,~.N-UP PROCEDURES: WA'c:..T~ C;>-1L- !?'(jL(5p up ß~ c..f2ANé IS SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ELECTR !C,';L: WAïE~: 5. Ç, Dé- of ')?:Li'>('s' fV1 A ( AJ ~ l::. z;¡-.Jo cJJ=. ðS L f)G SPECiAL: LOC:< SOX: YESíNO iF YES. LOC,; TION: SECTIO N 9: PRIV ATE FIRE PROTECTION/WATER A V AlLABlllTY: A. PR!V A TE FIRE PROTECTION: ~ ~\ ,..JI'<: (c:.--ttÐ R L\:>6- vJ! ,... - I...·~.: C;c:: T. ^"G..~ I S ~Eíe ) B. WATER AVAILABILlTY (FIRE HYDRANT): ,. :.¡ BAKERSFIELD CITY FIRE DEP~RTMENT H.RDOUS MATERIALS INV~ORY . Page_of_ . Business Name <;;P§:.£. AL-rT' ~N'OA Address 3c" 0 I W'!3<..¡¿ -z:r7 CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New It! Addition L J Revision I J Deletion I J Check if chemical is a NON TRADE SECRET' IJ' TRADE SEèRET I J 2) Common Name: ¿,JÓSTG 01(...... 3) DOT # (optional)", Chemical Name: AHM I J CAS # 4) PHYSICAL & HEALTH PHYSICAL ' HEALTH HAZARD CATEGORIES Fire f.ff Reactive I J Sudden Release of Pressure [ J Immediate Health (Acute) I J Delayed Health (Chronic) f p]' 5) WASTE CLASSIFICATION :27-( (3-digit code from DHS Form 8022) USE CODE 40 6) PHYSICAL STATE Solid I J Uquid ~ Gas I J Pure I J Mixture I J Waste . Radioactive I J CHEClC.AU. THAT APPLY 7) AMOUNT AND TIME AT FACIU1Y I 05" UNITS OF MEASURE 8) STORAGE CODES \ì>lA<; t,,- Maximum Daily Amount: Ibs I J gal I"'J 113 [ J a) Container: í)1WJN) Average Daily Amount: 1 (.>Ù curies I J b) Pressure: 1 Annual Amount: "500 c) Temperature: 4- Largest Size 'Container: ~S- # Days On Site '?, '" t;" Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D 9) MIXTURE: .Ust '~ COMPONENT CAS # %WT AHM the three most hazardous 1) ~JV\ 01 <... , LJA·c; 1'"6 I J chemical components or , any AHM components 2) I J , 3) I J 10) Location f0c...J C{2AJR Oç' -:;./(oP CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [~ Addition I J Revision I ] Deletion [ ] Check if chemical is a NON TRADE SECRET I J TRADE SECRET I J 2) Common Name: A:fJT ¡ ~eE'"Z.c 3) DOT # (optional) Chemical Name: AHM I J CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive I J Sudden Release of Pressure I ] Immediate Health (Acute) fj¡ . Delayed Health (Chronic) I] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE ~ C.CVt.AW , 6) PHYSICAL STATE Solid [ ] Liquid [~ Gas [ ] Pure [fit Mixture [ J Waste ~ Radioactive I J CHECK Ail THA.T APPlY 7) AMOUNT AND TIME AT FACIU1Y ~ç UNITS OF MEASURE 8) STORAGE CODES f't...)\'<;''T' ( f)(l(,;1A, Maximum Daily Amount: Ibs [ ] gal (!¡jf 113 [ J a) Container: Average Daily Amount: SS- curies [ ] b) Pressure: 1 Annual Amount: ~S- c) Temperature: Largest Size Container: ç~ # Days On Site '3>"~ Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D 9) MIXTURE: Ust COMPONENT CAS # ~lJb AHM the three most hazardous 1 ) e--n-t YL("7\J Ë G-t.KOc..- I J chemical components or any AHM components 2) I J 3) [ ] 10) Location µ0 CR&\JR.. 6F ::5J.1oP c","1y en<l., penelly of low, ..." h"". p.""nelly ",",,",ned end em IemiIIM wi/h ... m/omaliOn '".j~ on 1M """l')-¡ .ocum."" I believe the submitted information is true, accurate, and complete. 'ß /; / ~ A - , . :~, L f//µ /y~ PRINT Name & Title of Authorized Company Representative SignatuØ " Date $«II~3QIS11n AE~ Y L£PC STNICNID FCFtM BAKERSFIfi..D CITY FIRE DEPAR»1ÊNT HAZARðl5US MATERIALS INVENTO~ .' .- Page_ot_ '"' .' 3usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New (1) Addition [ ) Revision [ ) Deletion [ ) Check if chemical is a NON TRADE SECRET' [ ) TRADE SECRET [ ) 2) Common Name: Mt à 0«- Dlv 3) DOT # (optional) - ' , Chemical Name: ,/ AHM [ ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [~active [ ) Sudden Release of Pressure [ ] Immediate Health (Acute) ( J. Delayed Health (Chronic) [ ) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ) Uquid [~Gas [ ) Pure [ ) Mixture [.~waste " [ ) Radioactive [ f CHEOC AU. THAT N'Pty , 7) AMOUNT AND TIME AT FACIUTY _ UNITS OF MEASURE 8) STORAGE CODES , c; """'m,m Dol, Am,."" ~ Ibs [ ) gal H43 [ ) a) Container:. Average Daily Amount: , curies [ ) b) Pressure: f· I c) Temperature: i Annual Amount: i largest Size Container: .¿:¡- LJ Circle Which Months:~ear. J. ! # Days On Site F. M. A. M. J. J. A. S. O. N. D ¡ "- 9) MIXTURE: Ust COMPONENT 0 CAS # %WT AHM the three most hazardous 1 ) H.~ éJe , [ ) chemical components or any AHM components 2) [ ] 3) [ ) I 10) location Ale;; CRrv R- c>l=" S~p I ! CHEMICAL DESCRIPTION \ 1) INVENTORY STATUS: New [ ) Addition [ ) Revision [ ) Deletion [ ) Check if chemical is a NON TRADE SECRET [ ) TRADE SECRET [ ) 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ) Reactive [ ] Sudden Release of Pressure [ ) Immediate Health (Acute) [ ) Delayed H,ealth (Chronic) [ ) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE , 6) PHYSICAL STATE Solid [ ) Liquid [ ) Gas [ ) Pure [ ) Mixture [ ) Waste [ ) Radioactive [ ) , , CHECK ALl. THAT M¥'t.Y ; I 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ) gal [ ] 11:3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: largest Size Container: ! # Days On Site Circle Which Months: All Year. J. F, M. A. M. J. J. A. S. O. N. D ; , I 9) MIXTURE: Ust COMPONENT CAS # %WT AHM I I the three most hazardous 1 ) [ ) chemical components or any AHM components 2) [ ) 3) [ ) 10) location I certify under penalty of law, that I have personally exammed and am familiar With the mfomation submitted on -tfjls aiier all attacned documents. I Del/eVe me submitted information is true, accurate; and-complete. PRINT Name & Title of Authorized Company Representative Signature " Date 'Ò«II_þw3Q,t~ RE~III..EPCST~FCJUot