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SITE DIAGRAM I FACILITY DIAGRAM
Business Name: h ~~\J \e. --( \ ~:> Q... 0
Business Address: l\ ~ \ ~ \}...) \. \:>~, Q.j
For Office Use Only
First In Station:
Inspection Station:
Area Map # of
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HM723301
Account Number
ACCOUNTS RECENABLE ADJUSTMENT
January 13. 1995
Date
x
Esther Duran
From
Fire Department· Hazardous Materials Division
Department/Division
LEISURE TIMES RV
BIlling Name
4318 WIBLE RD
BIlling Address
Site Address
Parcel # (If Applicable)
Landlord Name & Address (If Applicable)
ADJUSTMENT
Last Billed Correct Billing Adjustment to Effective Date of
Billing Change
110.00 0 <110.00> 1·11·95
AP;Z ((ðii----
Remarks: THIS BUSINESS CLOSED THIS FACIUTY IN MARCH OF 1994. THEY ARE NOW lOCATED
IN THE COUNTY.
, .,~ETURN. PAYMENTS. TO: ','
CITY OF BAKERSFIELD
P.O~ BOX2057
BAKERSFIELD, CA93303-2057'
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PLEASE MAKE CHECKS PAYABLE TO:
MAZ,ARboUSK~T~RI ALSf}!,VIS lOW \
CITY OF BAKERSFiElD
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ACCOuNT NO. HH 12J30t<
J:f~ .zaÌ"d()u$t~..,te rial$!13"'dlingfee$ .
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:jNQUIRIES' t::ÖÑGERNiNGiTHÎS,;ÈlìL¡;;i;PtÊÁse}¡' o'i~;::', ::>~~:áf<i~~lh :~~~.C,:~¡ji~;~1i¡;:,;' ::'Hi~
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L.E ¡SURE " T ,
·4318'1161.£ RD ,
'8A~fRSF tELi), . CA 93'31:S'
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RETURN PAYMENTS TO:
CITY OF BAKERSFIELD
P.O. BOX 2057
BAKERSFIELD, CA 93303-2057
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INQUIRIES CONCERNING THIS BILL, PLEASE PHONE: '~"
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PLEASE MAKE CHECKS PAYABLE TO:
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CITV'OF BAKERSFIELD
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,.INVOICE NUMBER
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RECË1VED
SfP Q 1991
Aos'd,
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Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street
Bakersfield, CA. 93301
r'\d-~'?O \ ~ 2-
HAZARDO~LS MANAGEMENT PLAN
INSTRUCTIONS: ~ ~Cr 6-
o(
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l.
2.
3.
4.
To avoid further action, return this form within 30 days of receipt. '?.,/~
TYPE/PRINT ANSWERS IN ENGLISH, .. 11\2>- ( v'-'
Answer the questions below for the business as a whole. oJ..
Be brtef and concise as possible. 1- 1 (
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: ~e...\~u '\~ ,\ r-e......,,:>
LOCATION: L\1>\'ß LJ--)\~\n.... '0-0\
;
MAILING ADDRESS:
CffY: ~~~Å
STATE: C", ZIP: g~~l;PHONE: '2l11-Ql1L
SIC CODE: 4\ f") .2>
DUN & BRADSTREET NUMBER:
PRIMARY ACTIVITY: ~\ '('--:::>
OWNER: lr, ~ d Co Q -\.--\-hY\... S-j
MAILING ADDRESS: ~.nJL..-
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT
TITLE
24 HR. PHONE
BUS. PHONE
1.Lo~c\ CoOL~~j OUJ~ 3G{1"C{1\ \
2. \l\c1L\' 0Qµ'.J2.i1'~) 'S~~
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FD1590
e Bakersfield Fire Dept. .
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
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SECTION 3: TRAINING:
NUMBER OF EMPLOYEES: ~ 'L
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
'Nt\-~ S 't0~ cl't..~ b k*" ~ { ~ ,~~ f\.e
,
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 Ql,JANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, lo,..y:\ CoCl.\-~ ~.:) CERTIFY THAT THE ABOVE INFOR-
MA TION IS ACCURATE. I UNDERSTAND THAT THIS INFORMA liON WILL BE USED TO
FULFilL MY FIRM1S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE"
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL), AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
'.,
DATE
2,
,
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Bakersfield Flre Dept. -
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION ~ND ABATEMENT PLAN:
A. RELEASE PREVENTION STEPS:
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
1.-~e\{ u'-~v\ ":>0 !+l.¿5> S')'t,~ - ~D)~\'7'
~-e.<..A.:>' ~ "b ~~ ~ ~c...\. \.~(l5
C. CLEAN-UP PROCEDURES:
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SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE: ~~~ \":)~ (\(Li; \- cloo{ ~O"-'" b~ Qù~(' \.\-t.-.;ue.
.
ELECTRICAL: \ '(\ ~ul", \ö..>\.\.~I.'A.~
WATER: 'V;)0 ç {"b f\-r- ð-t:?b'
SPECIAL:
LOCK BOX: YES/NO
IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABILlTY:
A. PRIVATE FIRE PROTECTION:
-s ~ '(' \ (\ ~ W ~ .,Ç \. f'-O- .s:L -( l.. \. "'- \ \..) ~ \...-.r-..:>
B. WATER AVAILABILITY (FIRE HYDRANT):
4,
FD1590
e 'A,
Bakersfield Fire Dept. .,
Hazardous Materials Division
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HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name: \-.12...\;)~ ,( ~\, ~ \<..,J
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
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B. EMPLOYEE NOTIFICATION AND EVACUATION:
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C. PUBLIC EVACUATION:
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Y\.JLA, '{..r¿.;> .\" ~ '" l -t-
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D, EMERGENCY MEDICAL PLAN:
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3,
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CITY OF BAKERSFIELD
HAZARDOUS MATERIALS INVENTORY
NON - TRADE SECRET
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Page "of
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[] Farm and. Agriculture o Standard Business
BUSINESS NAME: ~\.;)\){"'- ,,\~&
LOCATION: '-\ ~ \ 'ð '--' ~4 ~ ~
CITY, ZIP: ~~~~;~
PHONE #: ~ q -' \
~~
OWNER NAME: L,=,~ d (e~++...Q..-n.. ~
ADDRESS: 'ŸIf èH ~ f?q" '
CITY, ZIP: \~",bo'f~~d
PHONE #: ~ b \ -0 , ?> I
NAME OF THIS FACILITY:
STANDARD IND. CLASS CODE:
DUN AND BRADSTREET NUMBER/FEDERAL ID #
- - --
1
Trans
Code
\\)
CODES
12
Location Where
Stored in Facilit
13
, by
wt
14
Names of Mixture/Components
See Instructions
\:J Fire Hazard (J
o Reactivity 0
Delayed
Health
Component , 1 Name & C.A.S. Number
Component , 2 Name & C.A.S. Number
Component , 3 Name & C.A.S. Number
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Component , 1 Name & C.A.S. Number
component , 2 Name & C.A.S. Number
Component , 3 Name & C.A.S. Number
C.A.S. Number
Physical and Health Hazard
(Ch~ll that apply)
B Fire Hazard 0 Sudden Release
of Pressure
C.A.S. Number
o !~CtiVity~'Q Immediate 0 Delayed
Health Health
Physical and Health Hazard C.A.S. Number Component , 1 Name & C.A.S. Number
(Check all that apply)
component It 2 Name & C.A.S. Number
0 Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 Delayed
of Pressure Health Health Component , 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number
(Check all that apply)
o Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 Delayed
ot Pressure Health Health
component' 1 Name & C.A.S. Number
Component , 2 Name & C.A.S. Number
Component , 3 Name , C.A.8. Number.
EMERGENCY CONTACTS
u
2
Name
Title
24 Hr. Phone
Name
Title
24 Hr Phone
Certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS)
I certify under peanlty of law that I haver personally examined and am familiar with the intormation submitted in this and all attached documents and that based on my inquiry ot those
individuals responsible for obtaining the information. I believe that the submitted information is true, accurate, and complete.
NAME AND OFFICIAL TITLE OF arlNERjOPERATOR OR OWNER/OPERATOR' S AUTHORIZED REPRESENTATIVE
SIGNA!rURE
DATE SIGNED
FIRE DEPARTMENT
S D, JOHNSON
FIRE CHIEF
e e
CITY of BAKERSFIELD
"WE CARE"
M~ ur O~ '¥ttG
9-lb,Q ( ~ ~
AUGUST 15, 1991
2101 H STREET
BAKERSFIELD, 93301
326-3911
MR. GATTENBY:
NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE
-----------------------------------------------
-----------------------------------------------
IN'THE INSPECTION OF YOUR BUSINESS LEISURE TIMES RV,
LOCATED AT 4318 WIBLE ROAD, BAKERSFIELD, CA 93313 ON
AUGUST 7, 1991 THE FOLLOWING HAZARDOUS MATERIALS REGULATION
VIOLATIONS WERE IDENTIFIED:
1. A hazardous materials business plan has not been filed
for this location. Propane in RV storage tanks exceeds
the reporting requirements for a compressed gas.
VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND
SAFETY CODE SEC.25503.5
(a) Any business, except as provided in subdivision
(b), which handles a hazardous material or mixture
containing a hazardous material which has a quantity at
anyone time during the reporting year equal to, or
greater than, a total weight of 500 pounds, or a total
volume of 55 gallons, or 200 cubic feet at standard
temperature and pressure for a compressed gas, shall
establish and implement a business plan for emergency
response to a release or threatened release of a
hazardous material in accordance with the standards in
the regulations adopted pursuant to Section 25503.
The above violations must be corrected by
Complete the packet of forms attached and
Bakersfield Fire Department 2130 G Street
93301
0:
The department will schedule a re-inspection of your facility
to verify compliance. If you have any questions regarding
this notice, please contact Barbara Brenner at 326-3979.
Sincerely,
,~~/'~OU-Q-' ~r',-,~(
Barbara Brenner
Hazardous Materials Planning Technician
cc: Ralph Huey
e e
CITY of BAKERSFIELD
"WE CARE"
FIRE DEPARTMENT
S D JOHNSON
FIRE CHIEF
AUGUST 15, 1991
2101 H STREET
BAKERSFIELD, 93301
326-3911
MR. GATTENBY:
NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE
-----------------------------------------------
-----------------------------------------------
IN THE INSPECTION OF YOUR BUSINESS LEISURE TIMES RV,
LOCATED AT 4318 WIBLE ROAD, BAKERSFIELD, CA 93313 ON
AUGUST 7, 1991 THE FOLLOWING HAZARDOUS MATERIALS REGULATION
VIOLATIONS WERE IDENTIFIED:
1. A hazardous materials business plan has not been filed
for this location. Propane in RV storage tanks exceeds
the reporting requirements for a compressed gas.
VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND
SAFETY CODE SEC.25503.5
(a) Any business, except as provided in subdivision
(b), which handles a hazardous material or mixture
containing a hazardous material which has a quantity at
anyone time during the reporting year equal to, or
greater than, a total weight of 500 pounds, or a total
volume of 55 gallons, or 200 cubic feet at standard
temperature and pressure for a compressed gas, shall
estabiish and implement a business plan for emergency
response to a release or threatened release of a
hazardous material in accordance with the standards in
the règulations adopted pursuant to Section 25503.
The above violations must be corrected by september 16, 1991.
Complete the packet of forms attached and return it to:
Bakersfield Fire Department 2130 G Street Bakersfield, CA
93301
The department will schedule a re-inspection of your facility
to verify compliance. If you have any questions regarding
this notice, please contact Barbara Brenner at 326-3979.
Sincerely,
,~r:.'/ClY-rQ-' ~ç-P,-,~,r
Barbara Brenner
Hazardous Materials Planriing Technician
cc: Ralph Huey
-----
o'~
. H(N~ '.
BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
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RECEIVED
JUN 1 1987
Ans'd........... .
OFFICIAL USE ONLY
ID#
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IBUSINESS NAME
OU0202
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A I S ¡,-. /.
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J}. 5c¡fh, ~ epors :;00gItL
3ro. 3'1 £ê x lÓ061\V .: a,oo--?
6Al... t"f
Need ~ ~
INSTRUCTIONS:
1, To avoid further action, return this form by
2. TYPE/PRINT ANSWERS IN ENGLISH,
3. Answer the questions below for the business
4. Be as brief and concise as possible,
as a whole.
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NAME: \...., P.À 5ùf.1L '\ '\ V'f\J! S
B, LOCATION / STREET ADDRESS: l\. ~ l ~ w \.~\ p
CITY: ~~ß\~~L('~ ZIP: ÚÀ1,{-
~\J
~\
BUS. PHONE: ('ßû.ç )
3>Ql-cn \ ,-
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
y~ur local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAME AND TITLE
A. Lb-..¡. d <OC~ ~'-~
DURING BUS. HRS.
Ph# ?, ct ) - &( '"' l \
B,
Ph#
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE:
B. ELECTRICAL:
C. WATER:
D. SPECIAL:
E. LOCK BOX: YES / NO IF YES, LOCATION:
AFTER BUS. HRS,
Ph# ~:> \ - \,) \ 3 I
Ph#
IF YES. DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
- 2A -
MSDSS? YES / NO
KEYS? YES / NO
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SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
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SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRk~ 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
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR 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;,...., ~ NO
.,' <5YV1I1/( 't>f..<,<JII.I-J"+ff.,5 't lA-Iliff
I, 'VlLY \. (oa.~~l ' certify that the above information is accurate.
I understand that this nformation will be used to fulfill my firm's ohligations 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-¿"'~A~ ·x'/o'dPAlifITLE. ~
DATE ,.('"'- I '1- J'7
,
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