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Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This permit is issued for the following:
:::Hazardous Materials Plan
round Storage of Hazardous Materials
agement Program
Waste
3601
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PERMIT ID#015-02H)01726
·WILSON XPRESS LUBE
LOCATION
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Issued by:
WILSON
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Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SER VICES
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (805) 326-3979
FAX (805) 326-0576
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ffice of ental Servi es ,
June 30, 2000
Approved by:
Expiration Date:
;'~~Et~R~,:PAYMENTS'TBA~:;;'~:,;~,i;:\;,:;,;:;:;7!!.i),(¡~;'i;':':'" ," ",: :;) ,,':-,,; ..'
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MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE ~- \D~Cf6
NEW ACCOUNT i
ADDRESS CHANGE
CLOSE ACCT i
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CUSTOMER NAME c..), \'X>Cì x'~re~s lü'be
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CITY ~teí<;:,~ìcl9 STATE C=Ä; ZIP CODE 9~
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ADJUSTMENT
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BAKE_FIELD· CITY FIRE DElARTMENT
HAZARDOUS MATERIALS DIVISION'
1715 ·CHESTERA.V£~
BAKERSFIELD, CA. 93301
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I1AZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
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To avoid further action. rerum ,his ferm within 30 days of receipt.
TYPE/PRINT ANSWERS IN ENGLISH.
Answer the Questions below fer the business as a whole. ' , Œf), r
3e brief and concise as Dessible. ,\) \,ð::1 . Q V
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SECTION 1: BUSINESS IDENTIFICATION DATA
3.
3USiNESS NAME:
f-....) I (. <;. c.> N
X. PR.GÇ$. Luge::
L~C,';7¡ON: 36 Q I
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SEC¡¡ON 2: =MERGENCY NCT¡F1C~T¡ON:
CCNïAC¡
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BUS. PHONE
24 HR. PHONE
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HAZARDOUS M~TERIALS MANAGEMENT PLAN
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SECTION 3: TRAINING:
NUMBER OF, EMPLOYEES:
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4 PGŠON S /L'lPS'/L. v' 3. c;U 'S ¿'T"'G.:
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MATERIAL SAFETY DATA SHEETS ON Fll~: YES
BRIEF SUMMARY OF TRAINING PROGRAM:
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SECTrON 4: EXEMPTION REQUEST:
: CE~TiFY UNDE~ PENALTY OF PERJURY THAT\W BUSiNESS IS EXEMPT FROM THE
;~E?ORTfNG I~E;:U¡RE;'v1ENTS OF CHAPTER 6.95 OF THE "CALlFORNIA HE.A.LTH &
SAF::TY CODE" :=CR THE ~CLLOWING RE.'·\SONS:
WE SO 0JOT HANDLE :-':A¿.;ROCUS MATëRIALS.
WE DC HANDLE H.A,ZJ.,RCCUS ìv1A TERIA.LS, SUT THE QUANï!TiES A ï NO
-¡ìv1E=:<CEEJ THE ¡v!lNIMUM R::?CRTiNG QUANTfTiES.
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SECTION 5: C::RTIFICÂTION:
i, CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNDERSTAND TMAT THIS INFORMATiON WILL BE USED TO
FULFILL MY FiRM'S OBLIGATIONS UNDER ir£ "C.';UFORNIA HEALTH AND SAFETY CCDE"
ON HAZARDOUS MATERIALS (DIV. 20 C:-LA.PTER ó.95 SEC. 25500 ET AL.) AND THAi
INACCURATE INFORMATrON CONSTITUTES PERJURY.
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SIGNATURE '
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TITLE
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DATE
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Hazaràous Materials Divisio~
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HAZARDOUS. MATERIALS MANAGEMENT PLAN
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Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:-
A. AGENCY NOTIFICATION PROCEDURES:
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Av^ßI\- A6LE 710 C)f=-r=¡ ~ ¿= i: SMJP
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3. =MPlOYE= NOTIFICATION AND =',/ACUAilON:
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Hazardous Materials Division .
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HAZARDO'U5 MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A. RELEASE PREVENTION STEPS:
c:> ,<- . IS D 150 ÆAJ<;L:...-(J
~ '(ANI<:S "",;(7:> 01'-
GU IV 5. ON <RoS é Re6:... S
3. RELEASE'CONTAINMENT AND/OR MINIMIZATION:
I1BS:J-r¿OÄ-^i'i (~ AvAd....AI)<...6: I~-V LugE ß^-Ys
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CL=.::'.N-UP ?~CCEJURES:
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SECTION 8: UTIUTY SHUT-OFFS (LeCATION CF SHUT-OFFS AT YOUR FACILITY):
NA TU RA,L~,':"S¡?RO P,Jl.NE:
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SECTION 9:, PRIVATE FIRE PROTECTION/WATER A V AILABIUTY:
A.
PRIVATE ¡:!RE PROTECTrCN:
F.,zé @T'I'ßvI~~l.s. ¡ ^-.J ~J:J¡)P k 1~4Y..s
B. WATER AVAILABIUTY (FiRE HYDRANT):
f\/ ê C()'f2.AJE n... CJP' Pæ..o-P'C-'¿ r-y
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BAKERSFIELD CITY FIRE DEPARTM:ENT
H.DOUS MATERIALS INVEeORY
Page_of_ '
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Business Name tA.N.../Sc.>rJ ~,fn.Gs,::> Lu ße
Address >60 (
c-.>, L Sc.N-.J . c<..o
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CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New ( ) Addition ( ) Revision ( ) Deletion ( ) Check if chemical is . NON TRADE SECRET [ . J' \ TRADE SECRET [ )
2) Common Name: ~ .ðlL- 3) 'DOT # (opâoMl),
Chemical Name: AHM ( ) CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire I I Reactive( ) Sudden Release 01 Pressure I ) Immedl8te Health (Acute) I ) Delayed Health (Chronic) [ )
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid I I üquid Bi::f Gas [ ) Pure ~ Mixture I ) Wes. I ] RItdioec::tMI [ )
CUEOUU. ÐlAr APPl'
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES '"'t.....
Maximum Daily Amount: t 5"0 Ibs I I gal ~ 1t3 I I a) Container:
Average Oaily Amount: l6ù curies I I b) Pressure: 1
Annual Amount: tW c) Temperature: 4-
Largest Size·Container:
# Days On Site '3.~ S- Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D
9) MIXTURE: üst COMPONENT CAS # %WT AHM
the three most hazardous 1) fUò TOIL 01 <-- I)
chemical components or
any AHM components 2) I)
3) I)
1 0) Location , A.JS I 0 é e c.,..N;;},. '- (... o?- $1J..ü.p
,
CHEMICAL DESCRIPTION
, 1) INVENTORY STATUS: New ( ] Addition I ] Revision I ] Deletion ( ] Check if chemical is a NON TRADE SECRET I ] TRADE SECRET I ]
, ¿..J'Ú<;Tc::::.
2) Common Name: Oft...... 3) DOT, # (optional)
Chemical Name: AHM I] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire ~ Reactive ( ] Sudden Release of Pressure ( ] Immediate Health (Acute) ( ] Delayed Health (Chronic) !a-
S) WASTE CLASSIFICATION -z. 7- t (3-digit code from DHS Form 8022) USE CODE 46
6) PHYSICAL STATE Solid ( ] Uquid ~ Gas ( ] Pure ( ] Mixture I] Waste I1-t' Radioactive ( I
ÇHfC1(ALL mAr APPlY
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES CJ(
Maximum Daily Amount: 300 Ibs [ ] gal ~ 1t3 I ] a) Container:
Average Daily Amount: lÇO curies ( ] b) Pressure: t'
Annual Amount: ( OCX) c) Temperature: 4-
Largest Size Container: ~DO
# Days On Site r:> rcÇ' Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D
9) MIXTURE: üst COMPONENT CAS # %Wf AHM
the three most hazardous 1) l.JV>.. s '\ f=- OIL I I
chemical components or
any AHM components 2) ( I
3) [ ]
10) Location 00 'í'<;' , c>E .s Evf> oe: ßLD6
I cerrìfy under penally at law, tf1at I /'lave personally examined and am tamlliar WIth the IntomaClon submitted on thIS ana all attacned aocuments. I believe tf1e
submitted informaøon is true. accurate. and complete.
C-~ fà ,...le 5 W"; lip¡ /11 ~ II\\~ ~
PRINT Name & Title of Authorized Company Representaøve
o w/h~(
" 1:"'1 ~,
~J1lw- W; ,LtJ~
Signature
Date
·-:eø....,.,3QI_
!IIIEGIOIv LEPCI'TIiINOIIN)FCJIIM
BAKERSFIQLD CITY FIR En DEPARiMENT~
HAZARð!US MATERIALS I NVENTOJ!llt,
.'
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Page_of_ :.
'Jsìness Name
Address
i
I CHEMICAL DESCRIPTION '.,
I
I 1) INVENTORY STA1\JS: N_I ) Addition I ) Revision I ) Deletion I ) Check if chetÌIicaI is. NON TRADE. SECRET [ ) :11WJE SECRET [ ]
2) Common Name: 3) DOT # (oplioMl)
. Chemical Name: AHM I) CAS #
4) PHYSICAL & HEALTIi PHYSICAL HEALTIi
HAZARD CATEGORIES Fire [ ] Reactive [ ) Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] [)eay.d Health (Chronic) [ )
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid I) Uquid [ ] Gas [ ) Pure [ ) Mixture I ] Waste [ ] RacIio8ctMt [ ],
OIEOULl. THAT APPlY
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount: Ibs ( ) gal [ ) ft3 I ) II) 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
9) MIXTURE: Ust COMPONENT CAS # %WT AHM
the three most hazardous 1 ) [ )
chemical components or
any AHM components 2) [ ]
3) [ )
1 0) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New ( ) Addition ( ) Revision [ ) Deletion I ] Check if chemical is a NON TRADE SECRET ( ) TRADE SECRET I )
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM I) CAS #
4) PHYSICAL & HEALTIi PHYSICAL HEAL TIi
HAZARD CATEGORIES Fire [ I Reactive I J Sudden Release of Pressure I] Immediate Health (Acute) [ ) Delayed Health (Chronic) I)
5) WASTE CLASSIFICATION (3·digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ J Uquid [ I Gas [ ] Pure [ ) Mixture [ ) Waste I] Radioactive I ]
CHfCJ( AU. THAr.4PPt.Y
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ ) a) Container:
Average Daily Amount: curies [ ] b) Pressure:
Annual Amount: c) Temperature:
Largest Size Container:
# Days On Site Circle Which Months: All Year. J. F, M. A. M. J. J. A. S. O. N. D
9) MIXTURE: Ust COMPONENT CAS # %WT AHM
the three most hazardous 1) ( ]
chemical components or
any AHM components 2) [ )
3) [ )
10) Location
:;ert1~ un~e' penalty ~f law, that I have personally examined and am familiar WIth the Intomatlon siiDmntiid on this and all attached documents. I believe the
Jbmitteci informatIon IS true, accurate, and complete.
I
i RINT Name & . Title of Autho;;zed Company Representative
Signature
Date
1I.....æ ,_
NGICJII V LEPC S1'1INQIiINJ FabII