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Home My WebLink AboutBUSINESS PLAN it to Operftte Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ~~ This pennit is issued for the followina: 1//'-,' //.,,~ It! Hazardous Materials Plan ~~~~~,~~:~-~j o Underground Storage of Hazardous Materials /J I'~~'~' o Risk Management Program ,I .'t( .~'~ ;,,~+Ar,~ "..Ii o Hazardous Waste On-Site Treatment .JL.~"" ":tJ:r ., P fJ."" '. ~. ,.'" ~ ~P':;:; . ,,,..... ' , .. 1 ~,41i;.'t:.,.,,; ,I ':/)" ~ d " r¡ ~ "¡ ii ' -"irL; ·~~~P.t; "'.' \" "~ ,'t::<:Ju\: "V:"'~ ~~' LOCATION 4300 RÐ ~::::J/; .- ' "i ';;, r~ 1li;~;¿.",......,.~~~.__> . "1, . ". rOO ..._;~. :,.:_~ ,./ ~ ¡' -,·-11 ~~~" ,-..:r:J."'" " ,....,..,...,! ,~ ì.:\ , >,., , , , .', Q~~ .... y'¡ \. \b ~ir~ ~'--1\ \ '"I:......'t...J....~ )R~ ~ Issued by: Bakersfield Fire Department JUL 2 3 2001 OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Approved by: _ Issue Date Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: I \ ~ '- ~ -~ "\:. ~ ~ - - ~~... 1~ ~ ~ \~)~~ ~2~; ~~? . I " -,- :!>l .. -.~. '~~,t. ';}. vJ -- c,oOuft¿ - t2P.olf-: 1 - ~\ ~\) ~ :\J ~ D< ,~ .~ ~ '\1\ ~ :i ."'., , ~\~~ ,:I~ - .A ·i,··;;;:;~t_ :¡I ~ Q --:2 sm DIAGRAM t , Business Name: _ ~ Business Address: \....\ FACILITY DIAGRAM t- f e~ " '* ~ (,l a ,-:2 . sm DIAGRAM r t Bulin.. Name: Business Address: ..._~;..~ -",:~,- .- .-.- -;...- .. .. FACILITY DIAGRAM' . "i ',' , ,"" ~-_.~-'~..........' , '.i , , f --~ '~~~1.~ ,,;1 ',' .. 'Î~ _ 'J -'''::.-\1'\; -.....~' i. .~ SiteID: 015-021-002224 NEWMAN AUTOMOTIVE Manager : Location: 4312 WIBLE RD City BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: 't~~) :\ '/.. <?J BusPhone: ~~ Map : 123 Grid: 13C (661) 834-5920 CommHaz : Low FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ROY NEWMAN / OWNER LORETTA NEWMAN / CO OWNER Business Phone: (661) 834-5920x Business phone: (661) 834-5920x 24-Hour Phone : (661) 900-8237x 24-Hour Phone : (661) 900-8249x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 834-5920x MailAddr: 4312 WIBLE RD State: CA City : BAKERSFIELD Zip : 93313 Owner ROY DEAN NEWMAN JR Phone: (661) 834-5273x Address : 4312 WIBLE RD State: CA City : BAKERSFIELD Zip : 93313 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: / One Unified List 9 All Materials at Site 9 f= Hazmat Inventory f== Alphabetical Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP F DH L 55.00 GAL Low F DH L 55.00 GAL Low F DH S 55.00 GAL UnR [' \ "\ , 'II-H S BLÀS í~~'JL) , I I , 0 (S ¡J - möJ~Ç> AN . I A~ ' I ~6 W>rJb~~ IN SïA- ï., · A~~fc ~') '\.~ ~ ~o., ~d~,,~~ -1- ' dCJð c¡~ :5/2003 WASTE ANTIFREEZE WASTE OIL WASTE OIL FILTERS ~//. '~/. HTf!ð ~ ~I ~\~, ~,~~ ~ , " <, ~ i" :~ J .,J .... "'''. .'<!', , - e,..,.. NEWMAN AUTOMOTIVE 4312 WIBLE RD. BAKERSFIELD, CA 93313 OFFICE OF ENVIROMENTAL SERVICES 1715 CHWSTER AVE. 3RD FLOOR ~~. -,-~-- c B:A:KERSFIE.tD-, CA93301--- --- --~--"-~~----~." __ ~_ ___u__.___ RE: CHANGE OF ADDRESS #015-021-002224 EXP. 7/02/03 IN FEBUARY WE WILL BE RELOCATING TO 4312 WIBLE RD. BKRSFLD,CA 93313. I WOULD LIKE INFORMATION AS TO ANY AND ALL PAPERWORK WE MIGHT NEED TO REGISTER OUR NEW LOCATION. Sincerely, ROY NEWMAN JR. OWNER «NEWMAN AUTOMOTIVE» ~/ f'I~ O'\t ,\I\~t~ I Ü- "Iv ~ b~ --- _.------ -. . ---- --------. -." - - ----- --- . . "." '. ~, /.'" ~. . ~..( ~~~''f "...ifÇt ,- .' /~/~-~ CITY OF BAKERSFIELD / OFFICE O/~~E DEPARTMENT I )51 VIRONMENTA / 1715 CHESTER L SERVICES 3' BAKERSFIELD, CALlFO~V~I~U:3301 ~' ;' I j --0' "', ,_"_----- :;>\9 ,'L) /------- ~ . p /' --J Á> D 3 - ~ '"---.. jb :J JfI-ßÞ"... ----- / Jìl~ (j/f'--' j rÞ-: j j;uA'~,) {An!-' ' ~ ~} -- " ~ AUTOMOTIVE BAKERS WIBLE ROAD FIELD CA 93313 ~ NEWM312ý( ~~~~~~N~O ¿~~B~~OðS 1Q03 S1 èA~~R~~~EH~~Te~OTIVE 10/10/ LD CA RETURN T Q330~-b33b " ._ 0 SENDER I '"". 1,IIIIIHlltnÎI""..'I.." . , 111111 ,1'\1111 \111\ "" 11111111,',1,1111,\ "3 ~ ~ 0 i -ñ¡ö.1AI ft i ~3 3 ~~ j --- ~nIl111\Tf919'ftfj - -' --' ~ -~ ~ AIR COND\1l0NING SERVICE & REPAIR . ElEC1RICAL & COOLING SYS1EM SERVICE SUSPENSION & S1EERlNG . ClU1CH & BMKES . ENGINE OVERHAULS 1MNSMISSION'SERVlCE . Oil CHANGES MOS1 01HER AU10M011VE SERVICE & REPAIRS . ROY NEWMAN 4312 Wible Rd. Bakersfield,CA 93313 (661) 834-5920 fax (661) 834-5959 ..--0( ì;.;;~-r ..~~ . S'TA"fEMfNT i~~ ACC~JU~i¡ . :- .'"""'\ '..:.¡::::. ,: T l",,- ::;:. r, ;:. ~-: ::: ;::, :::,:- ,,:::: n ...-.. -' -.....-...-. ---- to:> :"'1 nnv -)/....r.::.,. ~ ,_. ...... '-, '''. :-'_ '_1 ~,..:' .-' ß;~k·...E¡;~5F I:E;_D.· ~_.~{~ c; ~3:3 <) J ._- ;.~: <) ~? '7 (b61; 326-3642 ~'~3t):':: L.JIBLE RC~ A :./ .,;,,,,<2 ~':\ . ( ~-" f' ~ ·r "-~'" ¿./ cu~::.-ror·1ER NO: 3Ó971:/45651; ":/ 'I ,. ''. , -'-~~~ '. '!'-~:':~\ ';:,> ~, : ~~~~~ 1::=_ E!'JY;IRONf1~NTAL SERVICES -=.-_ _.. __ _ _ _.. _ _ _ .J~~ __~\.:..~1.. _ ___ ___ -_ _ __ _ -_ "-~'~ ~. ':~~i~ ì:- .~, . fI t:: '.--\ "~:v-~:; '~~::;~~ ¡ 1 FJ:,,: ,:"""",NtJt~.....R I?¡UJ2;-:'D~-'.!f TOTAL At'1QUf'H ; {l..L..i_.:....'-2,.:..ï...i.w:.::..._ ;;:.;:____1. ~'1 ______________ , ~ ' (.¡~~. . t:j ß 186. 00 i:{ -ft,,' t·¡ .{t .~·::I .'A /7 r-,,"} :~ ;ø"_~ . 't:,~iJ-~"~ ,'" è:<~ ~;.T.I ''".,'~t. ,'" "ì,~.v ~l \ t),~þv) ~ . ;;w~, ~;\. '':ß '~ ,.."'.....r"" . :"':M I c.. .;. /01/03 . -" h~EWMAN AUTOMOTIVE f~Aµ..:ERSF" I ELD~ ,CA ,<7'3~H3 C;iP,f~GE r"'. 1'.. '-r1::' !-' ï: , J- ...--...----- --------- :;:5,/ 0 i ,/ 03 ANNUAL BILL FOR THE FISCAL YR. ïílí2002-6í30í2003_ If RECEIVED IN ERROR PLEASE CALL 326-3642. ..--------~---------.. -------.------..-- -------------- -------------- Ct')RREr~T ~l.'-- ...,~ L:-ýr.:.¡.: ~~.J OIJER 60 OljER 90 -- ,....-- - -.--...-..----- -------------- -------------- ..-------------- 186_00 -. -- . ", $ '- . -... -. lQiOli03 PAYf'iENT DUE: 186_ 00 TOTAL. nUF - $186. f'*\,') - - UNIFIED PROGRAM IN.ECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enuonmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME N"Û,JN\~ ~-nú't£ INSPEC;TlON DfTE INSPECTION TIME 3 (('1-(03 ,'_..__..n_'__....._n'_.._'_ _____ ,__, ___ _ =~__ ____ __,_ _ __ _ ____ ..__,___,__,__ PHONE No, No, of Employees ~-~4'lù ,...--,,-----,-,---,--,-,----~------- BUsinesslÕNumbef"- - -, ....._n, , '" -..,"'- 15-021- Nr;iJ ----.__._-_._----~~-------- -------_._--_._----------------~.__.,-.._._-_._-- ADDRESS ________~'Z- FACILlTYCONTACT nvv W, ~~_E-?_____________ N't5-JMAtI) Section 1: Business Plan and Inventory Program o Routine 'ì'ß-.combined o Joint Agency D Multi-Agency o Complaint ORe-inspection c V ( C=Compliance ) V=Violation OPERATION COMMENTS CI ['] ApPROPRIATE PERMIT ON HAND "..__tYJ:E!__ S/7T? ----_._._-~~--------------~-----------_.._------------ ----.--------.---.-..--.--.---.--- ..._____.__u__... _........._.___ _._.n ..... .___.._...__._n.'''· ,___'n__ CI ClBuSINESS PLAN CONTACT INFORMATION ACCURATE __.__~_______~_________ ________._______ __ _.____.__... ____..________n______ ._n.._ _~_._...__.__. ____ . .._..._.._ __.__.._..n.. _ .._...._. .__.. o 0 VISIBLE ADDRESS _,_____"--'--_______________u,_____u_____n___..'__________,_ ___ _.___._._n_n_._____..__ ...m ~~_ _. _",,___, u___.......___ _._ .__._._._... ___ o 0 CORRECT OCCUPANCY ___________,___________,_,____,_,_u__,_.._......_,____u__,_.... - --,-f-- ,-, - -- -- - ,- - - -- ----- - -- r -, -- .. ,- -- -- -- --- - - - _~_=~_~:::::~~:~~:;::~TER=~~-= ·~~~¡i~. -j ()::~;r~ - CI 0 VERIFICATION OF LOCATION , rJÇ,d)([ SW CfZ¡VfL ~ ~#òP --,-------'-'---------------'---------------,,-----,-----__'u_'__ ,.... 1-'_____,__..___...__..____,_____...,_,_,___..________...._ ,- ,- .. ,----..... - o 0 PROPER SEGREGATION OF MATERIAL ~__~._.._______~__..~_______._.______ ..._.__.._____________.__...._....____._._ _ .____..____h__._... "___"._.__... __ .____..n________.____ u__._________ _....___. ._n_ ___... o 0 VERIFICATION OF MSDS AVAILABILlTYE _.__~_.__~_.____._~___.____._.___________.__~_<__. ...____._______...._______ ...____.__ _ _____._....____ .__..___.____.._..___ _ . _ _n.__._.___....._.___.....__..__._ _.. ._._____.._n _._ ..___ ______.._._ o 0 VERIFICATION OF HAT MAT TRAINING -___'__..__,_____,______'_____n'_'_'__ ___ _,____,. ______, c-'__m____u_, _.. ..__.._,__,__..___ .. _ ,'_.._____,_,., ..___ o 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ---~._-___.~______ _________.____.__.__._..._~__________.._ ._..____ __._._._______._ ·~__,,_.___._n_.~ __.._...._.._.__.._.. ._.__. ..__.. _.~____.___.______ ._..___.___._____ o 0 EMERGENCY PROCEDURES ADEQUATE .._'_______...,_________n..___,_.__ _, .._....___,____,..____...._ , , __,,_____..,_,________ _"_..,'~....---m-..-n..- ,,_,,__,_,__,_, CI 0 CONTAINERS PROPERLY LABELED I '-_,____,__~____,_,__ __,m,_,_, _""___,_ ,______..,___.._ .... __" _ __...__,....,__.... ...... _,_+,.._,__,,_,.._____.. __ _, ..u_...._..,__ __.. ·_~_n._" .._____ _ ....."'_ -- - - -. -. . .. -------- -...-..-----. CI 0 HOUSEKEEPING __ ...'___n_'__..'..,_______,____...____,__.._,__....__ ..---- .-.. --. - ----_...--- -.--. ---_.._-_._.__.__.--_...~..__...._--- -- -_._--"~----'-'-'--------'--' - ----- -....- o 0 FIRE PROTECTION ._n__ ______.___n__ __~_.__. ..._____.___ ~_n.___ ___.__..___~__..__________._._..__ __._n_ _.__. _______._._ _.._____~__ n.___ _____ ..._ ___ "__"._..___'__.__... __ ____ ._._ .._. ______..__n___.'___·__ _ ...__u____... o 0 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: r¡á.ES o No EXPLAIN: -- -- - - - - --- ------- ----- --- I~ Badge No, White . Environmenlal Services Yellow . Slalion Copy Pink . Business Copy · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~Af-J AV<ïQ INSPECTION DATE 1/lL0s o Routine Hazardous Waste Generator Program ¡;i Combined EP A ID # CAt.- az> Us-06 ( Section 4: o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste detennination has been made .Ad-<- (~Ç 01!- EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Detennines ¡fwaste is restricted from land disposal /J C=Compliance V=Violation Æ£ Inspector: fA) (/\.J6 Office of Environmental Services 661 326-3979 ~ss Site Res onsible Part ( ) p y White - Env, Svcs. Pink - Business Copy , J\J t" hL ". ~ A#.ð ~\,.. .a 201 CMEMlCALLOCATION - D D IV ,þ'" ,.....,;¡,;; s;.w ,--("nÚ, f..,N""'- ..s~U,,.... , CONFIOENTIAL(EPCRA) - Yes No 202 FACIL~ 10. !TUlllrrLI~~ ·-~_·~-MÃPi(ÖøÏ»naI)-:.~=, __" ~~.~~"=GRiÖ~{oPÏM,~--- . . ',:.:.;';.,/~~..¡fI~:;:/~. ~<. , . "~,,,;,;.{,:}-.j,:. ,~ " ',.' ' :~:A<i:;:t'?~:Ë I 205 : mADE SECRET 0 Ves D No 206 If SuÞjeCt 10 EPCRA. relet 10 insIrucIiaIs .,---- _u'--ær:--- ~ EHS" . CITY OF BAKERSFIELJk o CE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~EW DADO o DELETE D REVISE 200 __.M.. ......____. __....__.__ _.. . .--. ._-.... -.., .~--,_. --.. - _._...------- , . , , . ,: ::.,t '~~~,~~,~:~ I. FACILITY INFORMATION BUSIVVz;:r~·Þ;;j ~~~ãüsm~~~-"'.~,-~_-..~-~ .', CMEMlCAL LOCATION _ ------"-.--- 'L CHEMICAL INFORMATION ----- CHEMICAL NAME u So (-..0 () (L --..----_.. -.--------.. ...- ..." .... -. .. .. COMMON NAME (one tonn per """'ria/ per buittlng or area) Page ~ .':" ::~. :..~i~.~~·~···.:~::t;;~:.'.:· .' '.," 3 204 oVes DNo 208 ' - .------------.- . _.... -_...-- - -- .. -. .. . --- . j CAS' 209 ; "lf~~';:·;~1; ,:~ \:~;;::.,""'..'.;¡., '~::I : .:;I-t~·~·.:..~ _~·.~r~~·.. ~~.:: FIRE cooe HAlAADa.ASSES(CompIeIeifl'lCUlllledbyloc:llllre~-------- - --.-- ,----,--,----,-,- c.,,_._-~'.',. --.., - ..,,' 210 TYPE ~ WAS';': L . It.otOACTIVE Dves DNo -..--. ..-~._- ~-_._. .-----.- ; o p PURe D m MIXTURE --_.~_._--~._-_..._-- --- , PHYSICAL STATE .ø UOUIO ,0 9 GAS 214 ; LARGEST CONTAINER ~s- o . saUD .--.-.-- _..._-~---_._- - ---..---.-. : FED HAZARD CATEGORIES : (Check all 1haI1/y) ¡ ANNUAL WASTE ! AMOUNT ~_FIRE 212 ¡ CURIES 213 215 (/:,ç 217 ¡ ~~NT ,~r 218 ! ~~~UNT , (() --1.. __._~_.___L-._.____.._.__.__..__.__ ______.. UNITS"' 0 va GAL 0 d CU FT D Ib LBS 0 In TONS " If EHS. IIIIOUftt mUll be In Ills. ~ CMRONIC HEALTH 219 ¡ STATE WASTE COOE I ":t... "- t i CAYS ON SITE 221 I :3. 6~ D 2 REACTIVE o 3 PRESSJRE RELEASE o 4 A.::uTE HEALTH -.--.,--- ..,.- - ._.~.__._-~~--_._._.__. --------. STORAGE CONTAINER (Check aU that apply) D i FIBER DRUM OJ BAG D k BOX D I CYlINDER o. ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDe BUILDING ¢,STEEl ORUM o e PLASTICINONMETAlUC DRUM D/CAN 09 CARBOV o h SILO D m GLASS some D n PLASTIC BOme Do TOTE BIN D P TANK WAGON ..-.... .-. '._......- _._--_.._.._--~ STORAGE PRESSURE ~ AMBIENT D .. ABOVE AMBIENT D ba BelOW AMBIENT -.----.---.--------..... -....-.- . ...--- ...... ..-...---.- )!!t: AMBIENT 0 88 ABOVE AMBIENT 0 ba BelOW AMBIENT STORAGE TEMPERATURE , / . },:~j.à.}§~y:~:~~:~~'-~~~~~;~..;~i .....--...-.---....--.-.. _.._-.. 2 2301 I ---...-----.-------.-.-... ..._._-~-_.- I I 3 : , 234 .-.....---. ì 4 238 5 242 . :fi'>:.. ...:..~~>.... ,"'. ._----- -..-...-..- ------- ---.--..- ... --... -... -....-.-..-.....--..---.. --. UPCF (7/99) 216 220. 222 D q RAIL CAR D r OTHER I 223; 224 ! o c CRYOGENIC 2251 I 229 : 233 231 : , i I 241 I I 1 245 ! , j S:\CUPAFORMS\OES2731.TV4.wpd . CITY OF BAKERSFIEL~ o CE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION p4EW DADO D REVISE 200 D DELETE --_.. ...._..____. --...--..-- Þ.. ...... .....__. . .._. .-..,.. -- ...--.-. ._.-. - -~.__._-_..~--- ,:::.,~: ,~~~:t:Y I. FACILITY INFORMATION BUSINESS NAME (s.m. .. FACILITY ~DãA--:0öiñ9-Büsin¡¡¡ïÃŠ)--" ,,'.. -- .. ,-- - -, . N6-,J'f'I/IAN _._,_b!)t).. ,._ ,_,......_, - .-.-----...-'- CHEMICAL LOCATION (0"./0"""., material per buMting 0' BfflB) Page d , . . ,~. ...~~.~. ~" ':i~:;~~~~~'<.' 3 201 CHEMICAL LOCATION ~ 0 0 . CONFIDENTIAl (EPCRA) - Yes No 202 .. - -2õ3"'-T-G:RiöïfêoPÏJiona7--- 204 (AI ~.-&é . ~ W C(¿I'JR.. J: S-4--UP FACILITY ID'[[I]]][rr~-' :-~ ·----1r-MAP lI(oø~--" -...--, --- ¡I: ; , . .., \ i..-._L_:".: .__.__..___......_____._. . . f\. "./F: . . . '..).~:'...;~'~',;-'/. ....-~.~..~...;..;;.:.. r . <,_~~/j'.i~.j(:>' II. CHEMICAL INFORMATION , "c' 'c~:~:",.~::"~- :':;~~:¡j 205 : TRADE SECRET 0 Yes 0 No 206 It SuÞject to EPCRA. reter to Instructions . .... ------ - ._~~_., ~ EHSO I CHEMICAL NAME ~-r:. t ~C"'E~_~_._.. U SC'Ù : COMMONNAfoE - ----..--------.- ._..~. ..........._. -- .... .. ~ -- . CAS. 209! FIRE CODE HAZARD a.ASSES(Comp/eteifrequestedÞy IcICII fInI-~------- - --._- ,---,-, --'- --.-.-- TYPE ~ --'--,.,,------'-'-----'-~ w WAS.: ~~: Ft-.OIOACTIVE 0 Yes , . -- -.!-- _._- - ..- --.....-- - DpPURE o m r.tX1\JRf PHYSICAL STATE ~ LIQUID ,0 9 GAS 214 ; I.ARGfSTCONTAlNER S-~ o . sauD --.-.-- --~..__._--_._- - ._- ----.----. FED HAZARD CATEGORIES (Clledt all I!Iat apply) ¡ ANNUAL WASTE ! AMOUNT o 1 FIRE o 3 PRESSiJRE RELEASE ~ A.:;uTE HEALTH, 0 5 CHRONIC HEALTH 02REAC11VE ...- - ....~--~._-..----_._._-~-------- !6Ç 211 ! ~~NT 16S" 218! ~~NT ' ¡ I () -L __.___.__.."-._.___._______.__.__ ____._.. UNITS" f1I!tø GAL 0 d CU FT 0 Ib LSS 0 In TONS ° " &IS. amount mUll be In l1li. STORAGE CONTAINER (Check al1/ha1 appIy1 o FIBER DRUM OJ BAG Ok BOX OICYUNDER o II Pl.AS11CINONMETALUC DRUM O/CAN o 9 CARBOY Oh SILO 0, ASOVEGROUNDTANK Db UNDERGROUND TANK o ç TANK INSIÓE BUII.OING ~ STEEL DRUM o m GLASS BOTTLE o n PlASTIC BOTTLE 00 TOTE BIN o p TANK WAGON --.....-...-... ..- ...-.--.-..-------- I í STORAGE PRESSURE i _~ AM8IE~___.___.~ aa ~~~~~T_..__,_ .. m~,.ba, e.:L~AMSI~ Dyes DNo 208 ' 210 212 ¡ CURIES 213 21.5 : 216 219 ¡ STATE WASTE CODE I i DAYS ON SITE 221/ 220; 222: o q RAIL CAR o r OTHER 223\ 224 ! STORAGE TEMPERATURE o ba BelOW AMBIENT o c CRYOGENIC 2251 I 6itå AMBIeNT o .. ABOVE AMBIENT ! 1 2 2301 I 3 , , 234 : 4 238 i I 5 242 , ... J ·F'~Y):~~YJ?:;~)i~~~':çp~~~~:\:<~:})~~::·: '," ,,' :,";:¡:;T~i;}:,: -'::j~~~'::~.._ __...._"____..____., _.. .__._ .___~.. ~_~~_O_~~ ,L 231 I 0 Yes 0 No 232 ! --..-.------.-------.---... ...-'-.-.-.. ........ -. ---.-¡--.--.----;---..... -;-- 235 . I ,__ _. __ _ __.. . ,____, _. _ ,----L~- Y: 0 No ~~'l --------------- ~~:-~~: ;: ~ ';.~::?î]f~~'~~~ý~ ,:, .~\~L; " , ' " ", SiGÑÃTuRe '.-,-,-.-- .-.....---. . I I I .-.------ -..-...-. ._. ------- -.....--- ,- .. -.... -... -----.--.---.. -_._- -... ... ! 229 : 233 ¡ 231 ¡ , ~'~ 245 ¡ I , , . ,.;~~:~~'~}~~':,~; UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.Yipd \ .' _ __.. ~!L ~., .. 11 CITY OF BAKERSFIE~--=" OFFICE OF ENVIRONMENT At SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 " HAZARDOUS MATER! AGEMENT PLAN INSTRUCTIONS: /~ rPS 1. 2. 3. 4. 5. To avoid further *tion, retu is fonn within 30 days of receipt. If) if \ ~ C TYPE/PRlNT ANSWER IN ENGLISH. t:7-' Answer the questions below for the business as a whole. -r::,.:~ Be as brief and coµcise as possible. You may also attach Business Owner / Operator Fonn'and Chemical Description Form(s) I to the front ofthisiplan instead of completing SECTION 1. below for initial submission. SECTION I: BUSINESS :IDENTIFICA TION DATA ( BUSINESS NAME: .fj e w f{\~ \\~\-, (Y\o-t\ \J e '. ~d '2ti~\ \~ A LOCATION: L\3DD lv ~ ~\"< MAILING ADDRESS: ßêtm~ CITY:~~e2c~\l.\ e,\tj STATE: eJ\ PRIMARY ACTMTY: '0u'~ ~~Õ~\(' ZIP:~ PHONE: ~O\Q\/?> ~l{ -6<tJo OWNER: ~'-\ \b~.\') eW'~ ~{L PHONE:ldo\ . 93~ 6973 \ ' MAILING ADDRESS: y~ \ 1 ) ~ ~\ ~ \\ EMERGENCY NOTIFICAífION CONTACT 1.'~~ ~ ~0\~ 2; ~./'-f-H\·"~ (\(\0\1\ TITLE BUS. PHONE 24 HR. PHONE ðwl\Ql. 'ð-34 ðì~D CDþu 1(\ IV'- '3ð"-\ (J1dö '1oo·~';}.ó7 <=tDO' 'ðdLA ( 1 ~~-=-..--:<:,-....~~- '- '- . . _ ,_~~~~H^ZARDo.US-MA:¡:ERIALS=lVlANAGEM,EN:¡'~P-bAN ' SECTION II.I: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTfON AND MONITORING PROCEDURES: vi 5utL.A . B. EMPLOYEE AND AGENCY NOTIFICATION: , ;J ,~,----.,-~- '~--?::':-">--'\7"êi'b--- ' )( I _ -~ '_ ,_~-~=z-- ( ~ -' --:--- ---- - -- .--- - C. ENVIROm.1ENT AL RESPONSE MANAGEMENT: q f I ./ ". ..". ~~---,.-."--"-,--, ,-,--_.-..--.;;.. ~. --~-:- _._,,""----..~. D~EMERGENCy MEJDICAL PLAN: NeMes-!- iJð¥,¡~ .- -,--.---- . ---- ~ 2 ~~ - '~' ~ - . -..~..,....,-- - --- -~ .-~ ( " ( ~ ~'~., - .;r - e H~RDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: ~ coúp'1'€-ø+ C¿~ -Å-ð .,J{' n reeç \ 14", DO H'JH . 0(\ paJ \cl~ RELEAS~ CONTAINMENT AND/OR MITIGATION:,I, ~ 1"cÞU'P-, G t~ Oft ¿t;bD.b dA +0 soaA:.. vp f , ' B. C. CLEAN-UP ANDRE. COVERYPROCEDURES: , J J odU0+S !l f, -..l L _ ~ J --PO r sex:1 e up ¡:; í ( OflTQ( (l lYlettl {.XU r f. V -10 bp ficÙ,j Uf hy C,a..Yle:s UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ¡Jð-fll2 ELECTRICAL:' :3 ~;èj t . WATER: II' /! SPECIAL: ~e~ LOCK BOX: YES 0 IF YES, LOCATION: PRIVATE FIRE PROTECTION/W A TER A V AILABILITY A. -- r-: J (,,-c;> , / I d ß Ide¡ PRIVATE FIRE PROTECTION: r/re c:;; ý7-. ~-prll7K-!erp J , B. , WATER AVAILABILITY (FIRE HYDRAN1): fèì ~l f- (J ú r--iìo n i, 3 . L.-_,· ___ __~ _~- ~ ~_ __~_ - - . _HAZARDOUS MA TERI.~LS MANAGEMENT PLAN .....,-:~ .,..~ . .-. ~._:':_§~,À.¡~-.-.--__-._-.:.. SECTION III: TRAINING NUMBER OF EMPLOYEES: !5eJJl Ol.ÙIle/' ¡0perccfo("' MATERIAL SAFETY DATA SHEETS ON FILE: '7 () ob!-crr¡(1. .¡h-lYl ACe (~e./fllJ'ec! Sc.Jft )l'-€f~ BRIEF SUMMARY OF TRAINING PROGRAM: . .-----_. - -, - -' - -- . ( CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATIQN CONSTITUTES PERJURY. d__ _ _# - . --~--~~----;..-=---:---~--- ~-~---- '-<-""'~- ----~.---~.. .--.-'~- SIGNATURE TITLE DATE ( IIAl MAT MNOMNT PLAN &: INSTRUC 4 _,.r:~ ' #' :v ~ Â ~~k~~t" , . ...............' ,. " ....~.,~~........ e CITY OF BAKERSFIEL" OFFICE OF ENVIRON~IENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 FACILITY INFORMA TlON Business Activities Page ai I. FACILITY IDENTIFICATION FACILITY 10 ~ IFor office use only, please leave blank) EPA 10 ~ c:~\ OOÖ'~ 58126' 2 DBA/FACILITY NAME f\€.W<Þo-V\ ~~-\\I/'€ ..,'\too, \,0~, ~ " ~\~, \-\_..~\:'ò~~~dù H_,' ,~-'1~.. ~, ~~-~...._.._________, ..~~~_._ qò~\3-,-,--~I. ~~~I~I,!I~_~_~~~~~~~!~~,__.._., _ _,~~.\~,~~_~=ÕCf~____ Does Your Facility... . If Yes, Please Complete... Ã~'HAlARDOÚS 'MATERIÄ"L'Š' - - -.. _._",--- --- --- '--'ÖVE-Š -dÑ()----~-'-;ï------OE-S· FORM 2731 (ëhem'cal D~~~~;;';;'-F';""I---'-- ---- 1. Have on site (for any purpose) hazardous materials at or II' CONSOLIDATED COMPLIANCE PLAN above 55 gallons for liquids, 500 pounds for solids. or 200 Minimum required planninq elements: cu ft for compressed gases (include liquids in ASTs and .. Emergency Response Plan USTs)? _I" Maps Have any amount of an explosive material (other than aYES (~NO 5 .. Training ammunition) on site? . .. Prevention , . Certifications -S:'-R-EGULA TED -SÜSSTANCES(RS)'- ,-- ------- -----OYES-~O--6~--·----6ES' FORM i73-1(ë~';"'ì~~ÖescrìPI;;F;;';'I- -------,-.-,- Have on site RS at greater than the threshold planning II' R.lSK MANAGEMENT PLAN (RMP Submit 10 USEPA) quantities established by the California Accidental II' CONSOLIDATED COMPLIANCE PLAN Release Prevention program (CaIARP)? . Incorporating CatARP Program Elements C.-uÑDERGRoiJN"ò-sTORAGË-TANKS-(ÜsTs)'-------..----'ÖYEŠ'(0"NO ---¡';¡------US'-ÿ-- FACíi..ITYFciR~1 - ,..---,-..- -- -,------ 1 Own or operate Underground Storage Tanks? / II' UST TANK FORM (one per lank) Intend to upgrade existing or install new USTs? aYES GNO 8 II' UST FACILITY FORM II' USTTANKFORM II' UST INSTALLATION FORM (one per tank) D. T ANK-CLOSURËIRÈ"M-ÖVAL -'-----·--------'-aYE~fGNo --9-;.----i]STTÃÑKFÕR-M(d~~~~-s~;;~e P;.~;,,-kr_---- 1. Need to report closing a UST that held hazardous materials or waste? Need to report the closure/ removal of a tank that was classified as hazardous waste and cleaned onsite? ---Ë~ABoijÉGRö-üNõ-pËTRoCËU~;S_roRÄ-GETANKSiÃSTš)---'-ðÿEs-<ÞNõ-'--~-'~--"--ciJNsåuDÄTËDC6M¡iCiAÑCE- PLÃÑ- ---- Own or operate ASTs above these thresholds: any tank . Incorporating Federal Spill Prevention capacity is greater than 660 gallons or the total capacity ! Control and Countermeasure (SPCC) for the facility is greater than 1,320 gallons. ¡ Elements pursuant to 40 CFR Part 112 '-f-HÄzÄ~~~e~:~~""!:~~us wa~~:~-' , ------u--..------~'~~-~uo~~- 12 II' ~:~~~i~u;::-~~t~~~~-f~~~~:(~~~) 3~~~17~:..- , 2. Recycle more than 100 kg/mo of recyclable materials at : aYES 0NO 13 II' RECYCLING FORM the same location it was generated? Recycle more than 100 kg/mo of recyclable materials at an offsite location different from the point of generation? Treat Hazardous Waste on site? 2. 2. QYES QI<IO 10 ! II' TANK CLOSURE FORM 3. aYES ~O aYES c£o 14 II' RECYCLING FORM 4. 15 II' II' II' TP FACILITY FORM (DTSC Form 1772) TP UNIT FORM (one per unit) CERTIFICA nON OF FINANCIAL ASSURANCE 5, Subject to Financial Assurance requirements? ! aYES QNO I ¡ aYES ONO 16 6. Consolidate Hazardous Waste generated at a remote ~~ . 17 II' REMOTE WASTE / CONSOLIDATION SITE NOTIFICATION FORM __ ._. n. ~ ..." ...._... .._...___........_____._.. CONSOLIDATED COMPLIANCE PLAN . Incorporating all other environmental permit requirements per 27 CCR 10410 G. PERMIT cONšoLiDA_rïó¡::[zòÑf---mm....'-.-' --- ...--....-'ÖVËSQ"ÑÕ'- Intend to consolidate other CallEPA agency permits? (If yes. please complete Section III and attach) 18 . ....H _. II' )TE: / If you checked YES to any part of Sections IIA-IIG above. then in addition to the forms rer,uested above, please Submit OES Form 2730. UPCF (7/99) S:ICUPAFORMSIACTlVITY .wpd ~'~~ " 'Ïkif~" -- ,,-' .e __ ÇITY OF BAKE,RSFIELD . OFFICE OF ENVIRONlVlENT AL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORMATION Business Activities Addendum Page of . -'---.'-- I. FACILITY IDENTIFICATION 'F'ÀÒ"ijiY 10 /I (For offièê use (J(!lÿ"-pleasèïëã~e¡;iã~k) ,,' '-"-' .-..--..- .. --.- - "-- .'.'.-.,...' -....--...+--.-..-.... ----.--.....,.-..---. 'ÈPA 10 /I .. ..- -- .--.------. 2 DBA/FACILITY NAME ---" .._._-~_.- --,..".,.--- ---------.-.----.-.--..-------- . .... ---------.------------...--.--..---- ----- --..- ._. ..".---.- - .---.--..- - .--.-.,---- III. CONSOLIDATED PERMIT ACTIVITIES --------.--.-.- · Is your Facility Compliance Plan subject to review by... " for satisfying the conditions of these permits? ¡--H."DËPARTMENT öF'T"oxicšUBSTANCES COÑTROL-----OVES OÑÕ- --:-~--_.. "STANÕAR-ÕÎiËDPERMIT- ,.-- ---,--,------ · ,I , . . All Modifications OVES QNO OVES ONO ·v Non-RCRA HAZARDOUS WASTE FACILITY _.-...~ -- - v RCRA HAZARDOUS WASTE FACILITY 'I~' SAN JoÃ-öuiN\ÏÄLCËY"lJÑÌFlEõ-ÄïR-poï.:WT¡o¡;J -------- OYESÖNO---¡';-- -'--ÃUTHÖRrrVTO-CõNSTRUëT'----- CONTROL DISTRICT OYES ONO ~v PERMIT TO OPERATE .... .--------------------..-- OYES-- ONO-¡~--WASTEDTSC-HÃRGE-R'ÊQUIREMENT (WDR) OYES ONO i V GENERAL PERMITS J. STATE WATER RESOURCES CONTROL BOARD ':NTRAL VALLEY REGIONAL WATER QUALITY CONTROL öOARD OYES ONO ! ;v SPECIFIC PERMITS OYES ONO ¡ V NATIONAL POLLUTION DISCHARGE ; ELIMINATION SYSTEM (NPDES) '"'ï<:-CÄlIFOR"Ñ-,ÄINTÊGRATÈDWÃSTEMÄNÃGEMENTSÕARD ÖVES· OÑO-'---'~--REGISTRATION PERMIT ! L. KERN COUNTY RESOURCE MANAGEMENT AGENCY .----- ...-.'.--. ---.-.-. -.--------.-----..-.---.-..-----. · ;-------'-~---<-----. "-õ.'- -- .-- ENVIRONMENTAL HEALTH SERVICES PERMITS OYES ONO V Domestic Water Well Permit i OYES ONO V Haz Mat Monitoring Well Permit OYES ONO V Septic System Permit OYES ONO V Public Swimming Pool Permit OYES ONO V Food Facility Construction Permit I Iv I OYES ONO I v I ,_,__"'___ ,",__" __,_..,._,........._..__n.._'_'_..__.._..___.. _,......,._,.... _,__.__.~,_ ,-..,_..__ ----..-....--..--...---1.- _..---"..,_..,---,..'-' ,..","' ,..,.. -,.,-------..- ..----..-,-,--------. M. CITY OF BAKERSFIELD WASTE WATER DIVISION OYES ONO 'I' v INDUSTRIAL '-YASTE WATER DISCHARGE I PERMIT OYES ONO Solid Waste Local Enforcement Agency (LEA) Related Permits Medical Waste Related Permits NOTE: v If you checked YES to any part of Sections III-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan_ S;\CUPAFORMS\ActMlyadondum,wpd July t. 1'J08 , ,~f~ &"t:li~ - ............... ~ ,,' ~..-- CITY OF BAKERSFIELQ. OF-=E OF ENVIRONl\lENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION Page Of ... . - '. --... . .. . . '_'..n __.' ..' ..._ _... .. -.. --.. .. . .. _n __.h_ . I. FACILITY IDENTIFICATION --FACIUTY 10 # , ~,.I. , . .~, . ,_. '" I, Year Beginning BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) \\Jö.0 f'\"H..(\, G\u. \0 rno-\\'-J~, SITE ADDRESS ~ ~,l() ~~, ~. ~_ \\,...__ .n...__.._ ,. " ____,....,,_.. , ..". _____' _" '. CITY\ò~~Ø2B~\ø.Ò_.. ,. ..(~_... , nu_.____.._____.,___~~_,'__~~,_,.ZI~..~~~l~ .'..___..'..'___n_m'_,__ .___~ DUN & 106 SIC CODE 107 B~~~!~,~ET J.=%L \f\J..~.~·j\~)\..q,I:.~lí(o~~- ____h__'_____~(~ _~i~it_~!__:l53.1L_ COUNTY 100 Year Ending 101 3 BUSINESS PHONE ' ~\Q,\' <63'-\ -ð~90 102 103 ... 04" ... _ . 108 .,.- ..- --.,.-. -.------.----------------------------------.---.-.....------.---.----- ,()!E~TORNAME \2Ð\.-( (\~ 109 : OPERATOR PHONE \fu\-~~'i '~1~dI0 II. OWNER INFORMATION - -- , O~~,E~_~_~~_~.___~__~_~_Ûi),.ù~O~\2:--'----m-----~~-~~~-~~ ,~_H.?,NE _~4:\:_"ð-D~.:õd ì 3 112 , OWNER MAIUNG ~D~~~~,~___rJ.l9\~_~:\6~ ~) ...__.~~-_/~~-,,- --~=~ -~---- III. ENVIRONMENTAL CONTACT · "C:?N!~~i:~A~,:_r ~~~-Q~-M-..,"'~~==~===-----,-n----,I,~7---~?N~~~-~~?~~~~~\.~~~L~ ~~_~,5~ð CONTACT MAILING' 11g I.'~~_~~_:~~______ Y2D..Q_, W\b\..c>__Qó___~ (\ _____'______'__-,____u_ ------ -,-----,----------.. ; " C_I~:____~~~v\ __._-"______,_______.____________~~~~T~.:_f:6_._121__._ 'um~'~~__~~\~_,_,___~__ -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY· _._..________._____._._._._.____...._____.__._...._._.____..__._.._____.. _____0__....------...--.. ...____.___________ I·" NA~~_fu+ù..-Q.u)'(i"G,f\-----~~-!~~ME J:t>.Q£.UA-___ß~~"~ut\~,n,.m__..___,_u___.._.____~ , . TITL~,_____('2\..iLÜ..DA.. _u,_,____ __..__..__,_____'n.._____u__~~~L T~~~,~_,_,0£~________, nn___n' _ "u.n'n__ ' ,_____,___ .____.._____... ,~~, BUSI~E~S.~~,?~,r:.....,~~.eA:~~~..,~~B..___-__--.., __u", 12~n:S.USINE~S.PHO~,~,~ß,l1 :q<j9Q ,,_ _" _. "..., ____1:.'_ 24~~OURP~()~~,.__qCx::t~~~~]---~-..._,-_--,-~~~-L~~~~<?-~,~.~~-()-~.:n...-_~GE>-'-~d~I'" ,___.., __.., _ ... ., ,,_,1~~_ PAGER # i 128 . PAGER # 133 V. CERTIFICATION -.-...------------------------ 1'3 ~____' ______nm_._.._____ 114 ; STATEC;{~ 115, ZIP (l~è>\ ~ 116 ... .--....-..-.-...-...--.---..------------ --------------- -------- ------ I Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined . and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. . _u.. .. .._..~.._. _. .__..____....__._..,._. _ _ _ _. ...__... . ._... ,_ .... .__.._______. ~...._ ..h __u.. .._ _ _.... _ ._... .__...... _._._ _....~.... n._.. .___. .. u _ .. ".. ...~_..__._.__u. ._n .___.. _.._u__ ----. SIGNATURE OF OWNER/OPERATOR ûATE 134 . NAill',": OF DOCUMENT PREPARER 135 .~ __... _.____...4.. __'..., .". ..... ____..__ _ .. ._._ ,__._._'____...... ' h.Q~ \1.f\\\~~_0, 136 . TITLE OF OWNER/OPERATOR .. . -... -----.. --- NAMES OF OWNER/OPERATOR (print) Ro~ U~_..ß~\":?~sn 137 -s~ ! i , DW'{\-er UPCF (7/99) S:\CUPAFORMS\OES2730. TV4. wpd .ness Owner/Operator Identific4Þ" 7"-....;; Please submit the Business Aêtivlties page, the Business Owner/Operator Identification page (OES Form 2730), and Hazardous Materials - Chemical Oescnption pages (OES Form 2731) for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual, \jote: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used Jr electronic submission and are the same as the numbering used in 27 CCR, Appendix C. the Business Section of the Unified Program Data Dictionary,) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1, FACILITY 10 NUMBER· This number is assigned by the CUPA or AA. This is the unique number which identifies your facility, 3. BUSINESS NAME - Enter the full legal name of the business, 100, BEGINNING DATE - Enter the beginning year and date of the report. (YYYYMMDD) 101, ENDING DATE - Enter the ending year and date of the report. (YYYYMMDD) 102. BUSINESS PHONE - Enter the phone number, area code first. and any extension. 103. BUSINESS SITE ADDRESS· Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104, CITY - Enter the city or unincorporated area in which business site is located. 105, ZIP CODE - Enter the z.ip code of business site. The extra 4 digit zip may also be added. 106. DUN & BRADSTREET - Enter the Dun & Bradstreet number for the fadlity. The Dun & Bradstreet number may be obtained by calling (610) 882-7748 or by Intemet. 107, SIC CODE - Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more than 4 digits, report only the first four. 108. COUNTY - Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business operator. , 110. BUSINESS OPERATOR PHONE - Enter businèss operator phone number, if different from business phone, area code first. ånd any extension. 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's mailing address if different from business site address. 114. OWÑER êlTY': Enter the name of the city for !he owner's mailing address. 115, OWNER STATE - Enter the 2 character state abbreviation for the owner's mailing address. 116, OWNER ZIP CODE - Enter the zip code for the owner=s address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACT NAME - Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE· Enter the phone number, if different from Owner or Operator, at which the environmental contact can be Contacted, area code first, and any extension. 119, CO' IT . ~T ~;'AILlNG ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent, if different from the site address. 20. CITY - Enter the name of the dty for the environmental contact=S mailing address. 121. STATE - Enter the 2 character state abbreviation for the environmental contact=s mailing address. 122, ZIP CODE - Enter the zip code for the environmental contact=S mailing address. The extra 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency invoMng hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding inddent mitigation. 124. TITLE - Enter the title of the primary emergency contact 125. BUSINESS PHONE - Enter the business number for the primary emergency contact, area code first, and any extensions. 126. 24·HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the indMdual stated above. 127. PAGER NUMBER;. Enter the pager number for the primary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access, site familianty, and authority to make decisions for !he business regarding incident mitigation. 129. TITLE -Enter the title of the seconda'iy eniergencÿ eontact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact. area code first, and any extension. 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24 hour phone number must b'e,one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the seCondary emergency contact, if available. 133. ADDITIONAL LOCALL v COLLECTED INFORMATION - This space may be used for CUPAs or AAs to collect any additional information , necess<JI Y 10 meet the requirements of their indMdual programs. Contact your local agency for guidance. 134. DATE - Enter the date that the document was signed. (YYYYMMDD) 135. NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal information. 136, NAME OF SIGNER - En~r the full printed name of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer=s inquiry of those individuals responsible for obtaining the information, all the information submitted is true, accurate and complete. SIGNA TURE OF OWNERJ OPERA TOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and that based on the signer=3 inquiry of those individuals responsib!o for obtaining the information it is the signer=s belief that the submitted information is true, accurate and complete. 137. TITLE OFSIGNER - Enter the title of the person signing the page. ';. " HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION . CITY OF BAKERSFIEIa OPnCE OF ENVIRONl\'IENTAL ~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 ONE'N DADO D DELETE o REVISE 200 {one form po, malef/al De, bUJJdmg or 3reò> Page of J. FACILITY INFORMATION BUSINESS' NAME (Sáme äs'F·ÀCILITŸÎÌlAMËõ;ÓBA. Qõ¡iig-äüSY,ieSs Ásj---" '-..-'-.---.,. -----'--'---" - .. --.. u_. (\{¿v) ('<\ç...t') Ç\u, -\(;> (òy),~' ,,~, ". - .,. . _.- ----..,--.. . '·--'-3 . . . . ""---"-. . U__ ....____._._._.n. _,~~~iL,I~ 10 #~~ J~~___~I_=_=~_~,~~__~ ~~i(õPthná~- ,..,---- . 4"'_""'_ 4. ., __, .- 201, CHEMICAL LOCATION CONFIDENTIAL (EPCRA) " 203 'GRj[)# (opiiöiiaï) '" o Yes JaNO 202 ..'..- '''--'-'---:fu.¡- CHEMICAL LOCATION ..-----...---...---------.-----.-- II. CHEMICAL INFORMATION ......--.-... ....-. "'."-' ..-...--.--....---. . ---.. .-. ---.------..----.--------..-.....'. - . .."" .... - --- 205- TRADeSECRET ' o ~~ RJ~o- 206- CHEMICAL NAME If Subject to EPCRA. refer 10 inslructions ___.._ ,__.... ,_____.._,_____ ..,......__m _________,_..._____________._____ ____un,__ ,----, --2~'--n---.' - - -.,-.---. ,_n COMMON NAME EHS' o Yes 'Ø No 208 --.------.--------. --.-.------- CAS # 209 °If EHS is-Yes, - all amounts below muSI be in Ibs. --..----... 'Fii=ŒcODEHAzAR6-é[AsSES(ëOOiplete if requested by loCal fire ci\iet¡ 210 " --'-'.--'''- ,-- ------..--... ._-,-_..' '--'------'--~---,..- TYPE 0 P PURE 0 m MIXTURE JIll, W WASTE 211 ; ~-;;IOACT;V~----O~.._jQ-~--·-·-;;;-· ëÜRies.... --- "--~;y . ---------...--.--------.... ....-----.------------------ .-..--------.--.-...----.....---.--- .--..--- _:~~~ICA~~T~~E_______~~_ SOLl~__ ~ I_,~~~~____~~_ GAS 214' LARGEST CONTAINER 215 ---------------.---.. ..---._--- ---.----- FED HAZARD CATEGORIES ¡r''"Ck alllhal apply) AL WASTE A.",-,UNT 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE o 4 ACUTE HEALTH o 5 CHRONIC HEALTH 216 -----.-------------- --~---._------_.__._._--- 218 i AVERAGE ! DAILY AMOUNT 219 STATE WASTE CODE 220 217 ! MAXIMUM DAILY AMOUNT ----- UNITS' OgaGAL OdCUFT . If EHS. amount must be In Ibs. o Ib LBS o In TONS 221 DAYS ON SITE 222 ---.-.---------.--------- ------ --------- ._------------- STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK ~ c TANK INSIDE BUilDING Ii&1 d STEEL DRUM o e PLASTIClNONMETAlLlC DRUM OrGAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN o p TANK WAGON o q RAIL CAR o r OTHER 223 -,.--'---'-'-~ .-....------.--------- .-----....--------...---.-----------..-.---. -_._-----------~------ STORAGE PRESSURE o a AMBIENT o as ABOVE AMBIENT o ba BELOW AMBIENT ' 224 ......-.--.--. ------_. ______0__-- STORAGE TEMPERATURE 0 a AMBIENT 0 aa ABOVE AMBIENT 0 ba BELOW AMBIENT 0 C CRYOGENIC 225 __._ _u%~,__,_"--,-,.---.---~~~~.~U.~-??M~?~~~ ____ ____._.._,_.____L__,~~~__..J..I __'H_..'___... CAS # . I 1 226 ¡ 227 r 0 Yes 0 No 228 ¡. 229 _'n___'__'_..__._..:_-1-.._____~_,____,_"____,____________..___".,"__H_____~------~,.,.L, --,~~.. -------,---'- I ' ' 2 230 231 : 0 Yes 0 No 232 : 233 ,.. ,c,.., _ _, ,_........ ,___....., ...______._,.. _, _, _" ,_,__.._, ,_... ___ ........_____,..' ' ....-..-..-..!..- ,- on ,..,~. _""'. + -'. H'_"_· -..-,----. -... ,.... 2,34 : 235 I 0 Yes 0 No 236 I 237 ...1,__ '..,....... .._'u,'_..,_...._, ".._'.._..H _,.' ....__...,._._,_ ___.. ..... ..__.__.._..., ....._.._....+___..,__,._,_._,_u,..,....,_..__" ..,-..-,-..-----, : '- ,~:+-d----"---_---------W_------ :~}-~~:~:~:i--- ------- ::: - ,._....:.....,.._____..... __J.____ _"'._.'__ ,________________ ____'_"_ __.___.,_ __,_ _,_.__.___~_______n_______.._..__....._..___.___,___ III. SIGNATURE pØ'';¡YNAMÈ 80 rïrLË ÔFÄUTHQR-,ZeÔëOMPÃ¡"¡Ÿ'RËf5RëšËNTATlviC -..-....---..---·-'-'SIGÑÃTURE-- ,..- ..'", .. ... ....__._.___._..___..._.. -0_"-_'·-,.,-,-' ..--- n-D~246'" UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd · -- ~:-i--; ~.:o \:,.. Hazardous Materials Inventory· Chemical Description You !"'uSI ,;ompl.,IO ,""p,lr,lI" H,I~.Jrdous ,"'alo"aIS !nvenlOrl ' ChemIcal Desc"pllon page lor tlach hazardous 11'1.110".11 (hazardous subsrances and ~azardous wa5le) thai you haMlo al',our '~CII,ty ,n "<)9"'qale qUdnl,lI.,s Ilquallo ,)r ~realor Ihan 500 pounds. 559allons, 200 cubic feet 01 <¡as (calculaled at standard temperature and pressure) or 'he leder.¡llhresho!l1 plan''''''l ,¡udnllly (or E,<lremely Hazardous Substances, whichever IS less, Also complete a page (or each radioacllve matenal handled over '~uanlllles :orNn'ch "n ..merr¡on,;y plan ,sreqUlred 10 oe ,ldopled pursuant to 10 CFR Parts 30, 40. or iO, The completed ,nventory should reflect all reportable quanUlies 01 hazardous "',lto"als .It your laclllly, reported separately lor "ach OUllding or outs,de adjacent area, "",Ih ..parate pages (or unIque occurrences o( physical state. storage temperJlure .lnd '¡IOrage prllSSuro, ¡Note: Ihe numoe"ng 01 !he Instructions (allows the data ,,'emonl numbers thai are on the UPCF pages. These data element number! aro used (or "leclrOOlc suom,ss'on and aro'the same as tho numoe"ng used ,n 27 CCR. Appendix C, the Business Section 01 the Un,fied Program Data Dictionary,) Pleàso numoer all paqos o( your suomlttal. Th,s hOlps your CUPA or AA 'denllly whether the submittal,s romplete and II any pages are separaled, f, , I, FACllI TY 10 NUMBER, This number 's assigned by the CUPA or AA. This is the unique' numoor which ,dentifies your (acllity, ! ,'.' 3, BUSINESS NAME· Enter the (ulllogal name of the ousiness, " 200, ADO/DELETE! REVISE· Indicate il the material is ooing added to the ,nventory, deleted (rom the inventory, or il the in(ormation previously submitted is ooing revised, NOTE: You may choose to leave this blank II you resubm,t your entire invenlory annually, 201, CHEMICAL LOCA TlON - Enter the building or outsidel adjacent area where the hazardous material is handled. A chemicallhat is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This inlormalion is not subject to public disclosure pursuant to HSC §25506, 202, CHEMICAL LOCA TlON CONFIDENTIAL· EPCRA . All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check -Yes' to Keep chemical location in(onnation confidential. 1/ the business does not wish to keep chemical location information confidential check ·No·. 203, MAP NUMBER· 1/ a map is included. enter the numoor 01 the map on which the location 01 Ihe hazardous material is shown. 204, GRID NUMBER· II grid coordinates are used, enter the gricl coordinates 01 the map that correspond to the location o( the hazardous material. If applicable, multiple grid coordinates can be listed, 205, CHEMICAL NAME - Enter the proper, chemical name associated with Ihe Chemical Abstract Service (CAS) number 01 Ihe hazardous material. This should be the Intemational Union 01 Pure and Applied Chemistry (IUPAC) name lound on the Material Salety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not romplete this field: complete the ·COMMON NAME" neld instead. ' 206. TRADE SECRET· Check "Ves" if the inlormation in this section is declared a trade secret. 0( "No· if it is not. State requirement: II yes, and business is not subject to EPCRA, disclosure of the designated trade secret infonnation is bound by HSC §25511, Federal requirement: If yes, and business is ~ubject to EPCRA, disclosure of the designated Trade Secret inlormation is'bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" fO(m (40 CFR 350.27) to USEPA. ' 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS - Check "Yes" if the hazárclous material is an Extremely Hazardous Substance (EHS), as denned in 40 CFR, Part 355, Appendix A. If the malerial is a mixture rontaining ,!n EHS, leave this section blank and complete the section on hazardous romponentS below, 209: CAS II ' Enter the Chemical Abstract Service (CAS) numoor lor the hazardous material. For mixtures, enter the CAS number 01 the mixture il it has been assigned a number distinct lrom its components, I/Ihe mixture has no CAS number, leave this rolumn blank and report the CAS numbers of the individual hazardous romponents in the appropriate section below. 210, FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles, This , in(ormation shall only be provided il the local fire chie( deems it necessary and requests the CUPA or AA to rollect it. A list 01 the hazard classes and instructions on how to determine which class a materiallalls under are included in the appendices 01 Article 80 of,the Uniform Fire Code. If a material has more than one applicable hazard class, include all, Contact CUPA or AA for guidance. " .." . ': ( 211. HAZARDOUS MATERIAL TYPE - Check the one box that best describes the type of hazardous material: pure: mixture 'or waste. If waste material, check only that box. " mixture or waste, complete hazardous components section. ' 212. RADIOACTIVE· Check "Ves" if the hazardous material is radioactive or "No" if it is not. ' , " 213. CURIES -If the hazardous material is radioactive. use this area to report the activity in curies. You may use up to nine' digitS with a floating decimal point to report activity in curies. 214. PHVSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid, 0( gas. 215. lARGEST CONTAINER, Enter the total capacity 01 the largest container in which the material is stored, 216. FEDERAL HAZARD CATEGORIES - Check all cateoories that describe the phvsical and health hazards associated with the hazardous material, PHVSICAL HAZARDS HEAL TH'HAZARDS Fire: Flammable Liouids and Solids. Combustible Liouids, Pvroohorics, Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, Reactive: Unstable Reactive, Oraanic Peroxides. Water Reactive, Radioactive other hazardous chemicals with an adverse effect with short term exoosure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect w~h Iono tenn exoosure , , 217. AVERAGE DAILY AMOUNT - Calculate the average daily amount 01 the hazardous material or mIXture containing a hazardous material, in each bUilding 0( ad¡acentl outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days Ihe chemical will be on site. 1/ this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course 01 the year, This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218, MAXIMUM DAILY AMOUNT - Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building 0( adjacenVoutside area at anyone time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the refle'ction ol,additions, deletions, 0( revisions projected fO( the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT - If the hazardous material ooing inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE - If the hazardous material is a waste. enter the appropriate Califomia 3-digit hazardous waste code as listed on the back 01 the Uniform Hazardous Waste Manifest. 221. UNITS· Check the unit 01 measure that is most appropriate (or the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a _' _, _ federally defin,ed Extremely Hazardous Substance (EHS), all amounts must be reported in pounds, If material is a mixture rontaining an EHS, report the units that - - e , the mateiiã(¡s storeCl ¡"n (gaîíorís: Pounds, éubic léet, or tons), " .. '. 222, DAYS ON SITE - List the total number 01 days during the year that the material is on site. 223. STORAGE CONTAINER - Check all boxes that descrioo the type 01 storage rontainers in which the hazardous material is stored. NOTE: If appropriate, you may , choose more than one, I , 224, STORAGE PRESSURE - Check the one box that best describes the pressure at which the hazardous material is stored. 225, STORAGE TEMPERATURE - Check the one box that best describes the temperature at which the hazardous material is stored. 226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - Enter the percentage weight of the hazardous romponent in a mixture. 1/ a range 01 percentages is available, report the highest percentage in that range, (Report ',)'-components 2 through 5 in 230, 234, 238, and 242,) 227. HAZARDOUS COMPONENTS 1-5 NAME - When reporting a hazardous material that is a mixture, list up 10 nve chemical names 01 hazardous components in that mixture by percent weight (refer to MSDS or, in Ihe case 01 trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight il non-carcinogenic, or 0.1% by weight if carcino~,,"ic, should be reported. " more than five hazardous romponents are present above these percentages, you may attach ,"n odditional sheet 01 paper to capture the required inlormation. When reporting waste mixtures, mineral and chemical composition should be listed. (Report 101 ~úlllponents 2 through 5 in 231,235,239. and 243,) 228, HAZARDOUS COMPONENTS 1·5 EHS . Check ·Ves· if Ihe romponent of the mixture is considered an Extremely Hazaroous Substance as defined in 40 CFR, Part 355, or "No" i~it is not. (Report (or components 2 through 5 in 232, 236, 240. and 244,) 229. HAZARDOUS COMPONENTS 1-5 CAS· List the Chemical Abstract Service (CAS) numbers as related to the hazardous romponents in the mixture. (Repeat (or 2-5.) 246, LOCALL Y COLLECTED INFORMATION - This space may be used by the CUPA or AA 10 collect any additional inlormation necessary to meet the requirements 01 Iheir individual programs, Conlact the CUPA or AA (or guidance, UPCF (1/99) 7 ...' .~- OES Fom1 2731