HomeMy WebLinkAboutBUSINESS PLAN 10/16/2003
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CALIFORNIA WATER SERVtlt
157-01
.~ Si¿s-2:::2
Manager : MEINHJ ·BYfU~
Location: 4521 WILSON RD
City BAKERSFIELD
OC' '2. ~ --
BusPhone:
Map : 123
Grid: 11C
(661) 396-2400
CommHa z :
FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 07
EPA Numb:
SIC Code:4941
DunnBrad:
Emergency Contact ~ Title Emergency Contact / Title
_~ß""T .7T-.T .....u........, ..~..... ""T~'" 'I 7\"'''''''' 1"'\ T C'T' Mr.!'D
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Business Phone, : (661) 396-2400x Business Phone: (661) 396-2400x
24-Hour Phone : (661) 396-2400x 24-Hour Phone : (661 ) 396-2400x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards:
React ImmHlth
Owner
Address
City
CALIFORNIA WATER SERVICE COMPANY
: 3725 S H ST
: BAKERSFIELD
Phone: (661) 396 -2400x
State: CA
Zip : 93304
Phone: (661) 396-2400x
State: CA
Zip : 93304
Contact : 19IELVIN ߥRD
MailAddr: 3725 S H ST
City : BAKERSFIELD
Period : to
Preparer:
Certif1d:
ParcelNo:
TotalASTs: =
TotalUSTs: =
RSs: No
(D' .
l~ lstnct Manager-Tim Treloar
Asst. Dist Manager-Bill Harper
Contact Person-Tamara Johnson
Same Phone Numbers
- ------
Gal
Gal
Emergency Directives:
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IlAmA£A J~N~rJDO hereby r:ertify that I have
. .
(Type or print name)
mviewed the attached hazardous materials manage-
ment plan ¡or CAL{ ç. (DATE£.. and th~;t it along with
{Name of BusiM8S\
any corrections constitute a complete and correct man-
agement plan for my facility.
~~~~
Signa
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10/10/2003
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CITY OF BAKERSFIELD
OFFICE' OF ENVIRONMENT.AL.SERVICES
1715 ChesterAve.~ Bakerstield,CA (661) 326-3979
ÇS~d~?3 '
HAZARDOUS 1\1ATERlALS: MANAGElV1ENT'PLAN
f¡{",'
INSTR UCTIONS:
/23~//~
~1
1.
2.
3,
4. '
5.
To avoid further action, return this form within 30 days of receipt.
TYPEJPRINT ANSWERS-- IN ENGLISH. '
, Answer the questiOns below for the business as a whole.
Be as brief and 'concise as possible.
You may also attach BusineSs OWnerl Operator FOlIn and Çhemical Descriptiçm F011fr1(s) ,
to the'n-ont of this plan instead of completfug SECTION"I. below fói initial submission.
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SECTION I: BUSINESS IDENTIFICATION DATA
BUSINESS NAME:' C;I/ L / Eð Æ'A//A, Iv'A-¡Z..eS E¡(// ICE' ¿:tJ/1,:?A/lY- S7/l7JIJA/ /,f'7, () (,
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LqCATION:
45":<1 M¿fo/l /foA/./
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MAILING ADDRESS: ,31 ß 5óuí/l 1-1 5"í.(EEí
CITY: &&/I.f//cLO
'STATE:¿'JA ZIP: 95..!ð/ PHONE:¿Ú-.5ft-..1~
/tÆVéYÕ.e ð¡:-¡)()¡t{ES7/c MrE',.f' ,
PRIMARY ACTIVITY: "
OWNER:
CAL/ßtJIfAl/A WÁJï:.t 5E£I/IC'é ¿*tJ¡tf,P//,4/Y
PHONE: 6¿1- ,E't¡( ......1;/a;?
MAILING ADDRESS:
.ð7:1.5 .JðVTN 1//1 QST£EE-r
EMERGENCY NOTIFICATION
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CONTACT
#eLv/d ¿Y,<o'
1.
TITLE BUS. PHONE 24 HR PHONE
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LJJJí¡(léí ÆIfIAúé£ b"6I,,;.5f'/~:17'd¿J : S'/I/f./E
2. 7/Þ! WL..1A£'
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~ARDOUS MATElUALSMÄNAGEMENT P~'f
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SËCTION fr.l : DISCOVERY AND NOTÌFICA TrONS
A. LEAK DE1':ECTION AND- MONIT®RFNG PR.OCEDURES: ' '.,
CHLo£/If/E J~ 5hl(Eb 14 S-EA1£A-7É ~EA/éE.o E/T/l'Lt.2f't/¿~ A/1/0
II/lJ )/0.% SEL'ONOA,(jI erJ/V/A/I'IIII4ENT.
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B. EMPLOYEE AND AGENCY NOTmICATIQN: .
, ?Ji if IS /Î IV u# #AiVA/E l? -.5/íf
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C~ ENVIRONMENTÄL RES¡>ONSE MANAGEMENT:
£E¿EAJ'é /li3A7E/t1EA/í' /VaULO 6~ /E£h:J£fi.lEO ¿f.f/ .4/V /A/æ-.4'E/V.oE#7"
&/!IE.aJAJ/òN t:'ðNS{.ILïÃAlÎ .45 /YéEOE..o #A/iJ 'ß ÍflE ,f/17iJßlel1ð/V ð/
#lE£E:5/Þ/VSIßLE £E6¿rL/lï2J£~ /lbE'A/CY. .
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D. EMERGENCY MEDICAL PLAN:',
#ELJICAL &flf/?l///¿?E WtJl/L/.:/ ðE h'ðL//,ðELJ ðr JYLA'eY A£-~i:m ¿
Z1úX7l-w ,4YE. .dÁÆ'E/tfr/ELLJ, L!,¿/¿¡/t1£A//Å J
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HAZARDOUS ~IA TERIALS ~fANAGEMENT PLAN
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-
SECTIONII.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASPRES:, ", '
Ll?/LVf/7I 1//£1/5 -ÆY ~w..5 /lÉ£.fCJ/!/¡VE'L 74/1//1/£1/ /AI
/lAz- #/1/ ~EfJtJR7//ýG -
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'B. RELEASE CONTAlNMENT AND/OR MITIGATION:
¿ltOt/ILl L'/--!L/J¿/ItJE - SEt*'tJA/¿}A£V åJAl/A/AIIIE'1J/7
C. CLEAN-UP AND RECOVERY PROCEDURES:
,(é/L£ 7ð- SEt.'77ol/7£ - Iff¡t( ~
/
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UTILITY SHUT -ÒFFS (LOCATION OF sHuT -OFFS AT YOUR FACILITY>
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NATURAL GASIPROP ANE: I'I~
ELECTRICAL: "'#41A1 A£EAd¡{--/A/5ìl.J£ ¿guiLD/Nfl tJ/V ELEOR'ICAL ¡t'.4¡11EL
WATER: - 71I/f 15 ANA ïT£ hiE L¿
SPECIAL:
LOCK BOX: YE~' IF YES, LOGATION:
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PRlV ATE FIRE PROTECTION/W ATER A V AlLABILITY'"
A. PRIVATE FIRE PROTECTION: FJLE E%TJ/I/&tJ/fHtf'.e'ðNJlrE
B. WATER A V AlLABILlTY (FIRE HYDRANT): #¿-¿¿ ¿;/J~#Æ£6£
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HAZARDOUS ~IATERIALS ~fANAGEMENT PLAN
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SECTION III: TRAINING
NULvŒER OF ENŒLOYEES: ,., l//V¡<£/.//)t/A/EO .lITE
K.
MATERlAL SAFETY DATA SHEETS ON FILE: IAlFILL¿} ð.6~(CE 1/1P.fIOE .fì)f71tJAlLh/Lb//1/G
BRIEF ST.fM1.fAR.Y OF TRAINING PROGRAM: .s/V f/J'/lY ",,¢,.f£ /11/1LJE.o.4/L.f ðY
¡:?¿/¡fI,ð ¿J¡!Jé£ATI£.f hPAIIY¿LJ IAI ~/A2-ÞIA7 £t'/¿1R1?/l/ú /-'£LJt!Ebt/£E. ßlð/f./í'JILÝ
CdN.P'AAlý 5/1Æri/ ~£tlt5R4/!1/- AL.5CJ /!f}O;(IESfEJ /I/lZ4ÆO¿j(/J '#4r&/A'¿ '7æ/l//V//ð-.
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, CERTIFICATION
I, '~4E. 8&é# CERTIFY THAT THE ABOVE INFORMATION
IS ACCURATE. I UNDERSTAND THAT THIS INFORlVfATION WILL 'BE USED TO
FULFILL MY FIRM'S ,OBLIGATIONS UNDER THE "CALIFORNIA. HEALTH AND S~TY
CODE" ON' ~OUS MATERIALS (DIV. 20,CHAPTER 6.95 SEC. 25500 ETAL.} AND
THAT INACCURATE INFORMATION CONSTITUTES PERJURY.
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/11,4 JA(fffi'AIV~ .Y.I'ER/IVI2'-/lØéAl/
TITLE
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DATE
SIGNA
IfAZ MAT Ml\ OMNT PLAN 41NSTRUC
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CITY OF BAKERSFIELD
OFFICE OF ENVIROm1ENTAL SERVICES
1715 Chester Ave.; CA93301 (661) 3~(i-3979' ,
FAClLJTY INFORMATION
Business Activities
.-... .-.-----,------.---- .-- -.
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iFÃCIUTŸ 10 'i#(ï:o.: ';¡¡¡èa~õñ~' :':-piëäš;ïëãVë öiàñkj-- -:- ---
¡ .
I. FACILITY IDENTIFICATION
Page of
---- -. . -- ..
. _ _ _ . ---
--l~AI~#~_-.. - ~__~-_-~~_.u·,_
ôBÄiFAÒÙTŸ NAMÈ -- - - '
-'-- ----.-...-
2
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!.'.4L//'IJ£A!/4 111/1 íZ£. ..fÉA't/leE LbN/'/I~¡/' fr/f1/()/V /ð7~¿;J1
II. ACTIVITIES DECLARATiON
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Does,Your Facility",
/'
HAZARDOUS MATERIALS ! ØVES ONO
Have on site (for'any purpose-) hazardous materiaJsat or , .
above 55 gallonsfèir!iquids. 5qOpounds,for solids. or 200 ¡
cu ft for compressedgasesc(incfude liquids in ASTs and I
USTs)? . ' ' I - /
Have any amount: otan explosive material (other than I OYES 0NO
ammunition) on site?, , , "
1 /
j OVES 0NO '
2.
L-_
B. REGUIß.TED SUBSTANCES (RS)
Have onsite RS at-greater than the threshold planning ,
quantities established by the California Accidental
Rejease Preventiön'.pro~ram (CaIARP)?
C, UNDERGROUND STORAGE TANKS (USTs)
Qwn or,operata Underground' Storage-.Tanks?
Intend to upgrade existing or instaU new USTs?
-I
I
OVES ØNO
OyES ¿9
,
¡
---.
¡ OVES NO
I
I
!
¡ OVES ØNO
!
OVES 0NO
D. TANK CLOSURE / REMOVAL
1. Need to reportcfo~ing,aUST that held hazardous
materials or waste?' . '
2.'
, Need to report thë closurel removal of a tank that was
classified as hazardous waste and cJeaned onsite?
E, ABOVEGROUND. PETROLEUMST0RAGE TANKS (ASTs)
OINlJ or operate ASTs above these thresholds: any tank
capacJty is great~r than 660 gallons (Jr the total capacity
for the facility is greater than 1.320'gallons.
F. HAZARDOUS WASTE: I _/
1. Generate hazardous waste? lOVES (!)NO
RecycJe more than 1 GO kg/mo of recyclable materials at I QYES -0NO
the same locath~n it was generated? I
RecycJe more than 100 k9/mò of recycJable materials at :,' OYES <ØNO
an offsite location, different from the point of generation? I - , ..,
4. Treat Hazardous Waste on site-? ,/ OVES ~O
I 5. Subject to Financial Assurance requirements?OVËS ~O
I 6. Consolidate Hazardous Waste generated at a remote OVES Ø'NO
I site? , ' k
~ï:)ERMïTëõNSOLJDATlON ZONE: ¡ OŸËs ~
i Intend to consolidate other Cal/EPA agency permits? "
(If yes, please complete Section III and attach)
2.
3.
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If Yes, Please Complete...
OE,S FORM 273,1 (Chemica Description F.orm)
C'CN50LJ[)A TED' COMPtJANCE Pu\N
Minimum reauired pjanninq elements:
· ' , Emergenèÿ Response Plan
· Maps
, . TrainIng
· Prevention
· Certifications
OES FORM 2731 (Chemical Description Form)
, RISK ,M;MjAGEMeNT PIß.N (RMP Submit to USEPA)
CONSOLJDATED COMPUANCEPIJ,N
· InCorporating CalARP Program Elements
UST FAÇILJTYFORM
,U~T ~ A:NK FORM~ (ane,perWk)
UST FACILJTY FORM
UST TANK FORM
UST INST ALLA. TlON FORM (one per tank)
UST TANK fORM (dosu18sedion-onepertank)
----.
TANK. CLastJRE FORM'
CONSOUOATED. COMPLJANCE PLAN
. Incorporating Federal Spill Prevention
Control and Countenneasure (SPCC)
Elements pursuant to 40 CFR Part 112
EPA 10 number-provide on this page
To obtain EPA 10#, please phone.(916) 324-1781
- RECVCUNG FORM
RECVCLlNG FORM
TP FACILITY FORM (DTSC Form.1772)
TP'UNIT FORM (one per unit)
CERTIFICATION OF FINANCIAL ASSURANCE
REMOTE WASTE I. CONSOLJDATION SITE
NQTlFtCA TION FORM
CONSOUDA TED COMPLJANCE PIJ.N
. Incorporating all ather environmental
permit requirements per 27 CCR1041 0
JTE; .
/ If you checked VES to any part of Sections "A-JIG above. then in addition to the fonns r8( uestedabove. please Submit OES Fonn 2730.
UPCF (7/99\
S:\CUPAFORMS\ACTlVllY.wpd
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CITY OF BAKERSFIELD
OFFICE OF ENVIR01\H\1ENTAL SERVICES
1715 CIiester A ve.,Bakersfield, CA 93301 (661) 326-3979
r-~--:d_- ~- '
, I FACIUTY Ie 1# (For otfIce us~ OnlY - ~ léave bJank)
i
i. ,
'---=-c,__ ..____.
i DBAlFACIUTY NAME
¡
I. FACILITY' IDENTIFICATION
..,
FACJUTY INFORMATION
Business Activities Addendum
if.
P-a~8 ~
of
--.--
11~AIDI# ,____ ,.___ ____
2'
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¿9,4LI/ðItIV/A W'A¡z-¡g fE£///tC L1JNJ?A4fr- J/47/¿J# /57-ð/
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Is your Fª,cility Compliance, Plan ,Subject to review by..;
I H. DEPARTMENT'OFT0XICSUBSTANCES'CONTROL ! OYES
! '
III. CONSOLIDATED PERMIT ACTIVITIES
for satisfying, the conditions of thesE! permits?
, STANDARDI2EÐiPERMElL
. 'AI/>Modiffèations.- ,
: OYES <ØNO
: OYES @'NO
I
I
¡
;
I
¡ I. SAN JOAQUIN VALLEY UNIFIEзAIR POLLUTION
_ ¡ CONTROL DISTRICT
I
!
I J: STATE WATER RESOURCES CONTROL BOARD
( ':NTRAL VALLEY REGIONAL WATER QUALlTf CONTROL
h::!OARD '
I~
I'
i ¡ OYES ~O
, I .
¡ K. CALIFORNIA INTEGRATED WASTE MANAGEMENT ~OARD i OYES 0Ño'
i . '
/, L. KERN COUNTY RESOURCE MANAGEMENT AGENCY i_/
¡ , ®YES ONO
I !'
I' ! OYES ~O
I, ! OYES ~O
, ! OYES ~O
I "
I ' ¡' OYES @No
I '
i ¡ OYES ~O
/
: OYES 0NO'
: OYES 010
¡ OYES 0NO '
: OYES gNo
¡ ,OYES Ø'NO' '
¡
I
¡ OYES ~O
M. CITY OF BAKERSFJELD WASTEWATER DIVISION
¡
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! OYES
NO
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Non-RCRA HAZARDOUS. wASTE FACIUTY
RCRA HAZARDOUS WASTE FACIUTY
. AUTHORITY TO CONSTRUCT '
PERMIT TO OPI;RATE
WASTE DISCHARGE REQUIREMENT (WDR) ,
GENERAL PERMITS
SPECIF'C PERMITS
NÞ..T10NAL PÇ)tLUT10", DISCHARGE
etJMfNA TlON SYSTEM (NPDES)'
. , .'
REGISTRA TlON PERMIT
.,
,ENVIRONMENTAL HEALTH SERVICES PERMITS~ i
'DÐmestic' Water Well P.ermit, ' i
!
, ¡
Haz Mat Monitoring, WellPennit i
Septic System Permit
v
Public Swimming Pool I?ermit
v
Food Facility Construction Permit
Solid Waste Local'Enforcement Agency
(LEA) Related Permits '
Medical Waste Related Permits
IN,Dl.;J:STRJAL WASTE WATER DISCHARGE
PERMIT ' " ,
I
I NOTE:',' ,
I v If you checked YES to'any part of Sections III-H to III-M above, then please address all applicable permit requirem~ts in the Facilily Compliance Plan.
I' ' " ,
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S;ICUPAFORMS\I\i:IMty adencWm.W Id
Ju y 1, 1998 '
".,~
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. CITY OF BAKERSFIEL'
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661) 32,6-3979
"
BUSINESS OWNER I OPERATOR ID,ENTJFJCA TJON
FACIL1TY INFQRMATION
F'age _ Of,
I. FACILfTY IDENTIFICATION
: FACIUTY 'P ~ ,¡ , ... , Ii; : i 11 Year Beginning 2ðO I
~ __..___ _.:1, ; -L-L_, , ' . .L_______
: BUSINESS NAME (Same as FACIUTY NAMe or DBA- Doing Business As)
, ,~_tlL~!I1J£Alt.f.LN//7E~.5C:,f!(t..ç C##/&!IJ!::. S1ÆPðAl , ff:1-l:J/ '
I SITE ADDRESS 162/ MLfðN /bP?O
.---"--.-
; CITY ~¡(EÆfr/fLO
ii,
100 : Year Ending
¡ .
101
3. : BUSiÑESSPH"ÕNE ----.---.., ____.n --1"õ2-
__ :._..~#- ff'l~>:tfco '
""7""-------- .--..-. -- ---___
103
1Ó4 I CA . ZIP
I 93-::taf
¥rt/I
105
COUNTY
OPERATOR NAME
¿)O"'6ë¡1-~5/ß
i<ÉÆ'N
CAL/rolÚ1l/-4 l1!//íT;¿ .sé.<ÞíCt!· ('tJl'/"P/lA!.Ý
IJ. OWNER INFORMATION
, '
106 j SIC CODE
. ¡ (4 Digit #)
107
: DUN&
, BRADSTREET
108
109 ¡ OPERATOR PHONE ~¿I-.51t -~¡C(J .
110
OWNER NAME
êAL/rtJ£A//A WAiF£' Sc£r//éZ' â;J#;7AAlf/
37.25 5(;tl7# "/I 4' fJ:téEí
, ¿/¡t<VI5FIELiJ
111 ; OWNER PHONE
~¿'/-~9C -~¥ðt>
112
OWNER MAIUNG
ADDRESS .
113
I
1141 STATE L'A
115 : ZIP
,
~330f
116
, III. ENVIRONMENTAL CONTACT '
CONTACT NAME
5é~ ðELdtJ,
.5AME'
117 , CONTACT PHONE f/lNE
118
CONTACT MAILING
ADDRESS
119
Cln'
fA ¡VJE
, -PRIMARY-
I '
120 i STATE LA
121· ;
ZIP ?.ßtJ¥
-SECONDARY-
122
: 24-HOUR PHONE
I PAGER #
NAME NELJ///Ý ¿Y£,O
TITLE .()IJ7ie/~T hI/lVI/eEl<
BUSINESS PHoNE a/- 39t -:2.~ð
S,lJME
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IV. EMERGENCY CONTACTS
123 ¡NAME 1//14 í.i:éLò.l!L
!
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125 I TITLE //SfT ô/5r£ICí #.4A1AúE£
1,26 ¡, BUSINESS PHONE It I -3ft ·-.zlæ)
~__ -J---¡---___ _ ______..__.___ _..--
127 ! 24-HOUR PHONE ' fA HE
! ' "
.128 i PAGER# .} /VIA
.. . .
1:29
130
'131
132
...-------.
133
V. CER"IFICA TION
Certification: Based on my inquiry of those individuals responsible for obtaining the infonnation, I certify under. penalty of law that I have personally examined
and am familiar with the infonnation submitted in this inventory and believe the infonnation is true, accu~te, andicomplete_ :
SlGNATÜ- O~NER/OP~TOR, I DATE 134 ¡ NAME OF DOCUMENTPREPARER
ç: ...&vA- I q/¡gtl : dMEtf£EEN
\JAMES OF R/OPERATOR (print) 136 r-TITLE OF OWNER/OPERATOR --------.--
_.._. ÇAL!~)Uvl,4 J.//J7r1t .Q-~J//tE atl'l;7A¡t/y' ~_ ~A/~1?~AAI(~~~!1'/~..v0~_.. ___,,__"_"_
135
137
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Business Owner/Operator Identification
Please submit the Business Activiöes page. the Business Owner/Operator Idenöficaöon page (OESForm 2730). aÌÍd Hazardous Matenals . O1~ical'
Descripöon pages (OES Form 2731) for all hazardous materials inventory submissions. For the inventory to be œnsidered complete' '
this page must be signed by the appropriate individual. ' ,
\fate: the numbering of the instructions follows the data element numb~ that are on, the, UPCF pages., These dati element numbers are used:, "
Jr electronic submiSsion and are the same as the numbering used in 27 CCR. Appendix C. the Business SediCA' of the Unified Program Oata-Oidfcnary.)
Please number all pages of your submittaJ. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated.
1. FACIUTY ID NUMBER - This number is assigned by the CUPA or AA This is the unique number which idenöfies your facility.,
3. 'BUSINESS NAME· Enter the fiJ J legal name of the business.
100. BEGINNING DATE· Enter the begiImirig year and date of the report. (YYVYMMDD)
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 facJüty is located. No post offica box numbers are aIJowed. This infurmatiori
must provide a means to geographically locate the facility.
10:4. CITY - Enter the city or unincorporated area in which business site is located.
105. ZIP CODE - Enter the Zip code of business site. The extra 4 digit Zip may also be added. ,
106. DUN & BRADSTREET - ErÍter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling
, (610) 882-7748 or by Intamet.
107. SIC CODE - Enter the primary Standard IndustJiai 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 OPERA TOR NAME - Enter the name of the business operator. ,
110. BUSINESS OPERA TOR PHONE - Enter businëss operator phone number. if different from business phone, area code first, and any extension.
111, OWNER NAME· EI1ter name of business owner. if different from business operalDr.
112 OWNER PHONE - Enter the businesS owner's phone number if different from business phone. area cede first, and any e::ctension.
,113. OWNER MAIUNG ADDRESS - Enter the owner's mailing addreSs if different from business site address.
114. OWNER CITY - Enter the name of the city for the owner's mailing address.
115. OWNER STATE· Enter the 2 character stlte abbreviation for the owner's maillng'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 fI:om'the Business Owner or Operator, who receives all
, . eI1vironmentl ,colTespondence and WIll respond to enforœment adivity. '.
118. CONTACT PHONE - Enter the phone number, if different fróm Owner or Operator, at which the envircnmen/al contlet can be contlcted.
code first, and any extension.
119. CONTACT MAIUNG ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent if different
' site address. <,
,120: CITY - Enter the name of the city for the environmental contacÞs maißng address. , ,
121. STATE· Enter the 2 character state abbreviation for the environmental contad=s mailing address.
122. ZIP CODE - Enter the zip code for the environmental contld=s mailing addréss: The extra 4 digit zip may also be added,
123; PRIMARY EMeRGENCY CONTACT NAME - Enter the name of a representltive that can be contacted in case of an emergency invoMng
hazardous materials at the business site. The con/act shailhave FULL faciûty access; site familiarity, and authority to make decisioAS
for the business regarding incident mitigation.
124. TITLE - Enter the title of the primary emergency contlct. ,
125. BUSINESS PHONE "EI1ter the business number for the primary emergency contlet. area code first, and any extEÍi1siQns.
126. 24-HOUR PHONE - eoter a 24-hour phone number for the primary emergency contact. The 24-hcur 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 individual stated above.
127. PAGER NUMBER - Enter the pager number for the primary emergency contlct; if available.
128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contleted in the event that the primary
, emergency con/act is not available. The contlct shall have FULL facility access. site familiarity, and authority to make decisions for the busiriess
regarding incident mitigation.
129.' TITLE . Enter the tiUe of the secondary emergency contlCt.
130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contld,' area cede first, and any extension:
131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact.Thi! 24 hour Phone number must be'one which is
answered 24 hours a day. If it is not the Contlct's home phone number. th~, the service answering the phone must be able to
immediately contlct the indMdual stlted above.
132 PAGER NUMBER - Enter the pager number for the secondary emergency ccntlet. if available.
133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUPAs or AAs to collect any additional infonnation
necessary to meet the requirements of their indMdua/ programs. Contlet your locat ~gency.for'guidanœ.
134, DATE· Enter the date that the document was signed, (YYYYMMDD) ': ' .." '
135, NAME OF DOCUMENT PREPARER - Enter the fuil name of the person who prepared the inventory submittaJ information.
136. NAME OF SIGNER - Ent?r the fun printed name of the person signing the page. The signer ceröfies- to a familiarity with the information
submitted and that based on the sigl'ler=s inquiry of these individuals responsible fer obtaining the infcnnation. all the information
submitted is true, accurate and complete.
SIGNATURE OF OWNER! OPERATOR OR DESIGNATED REPRESENTATIVE· The Business Owner/Operator, orofflcially designated
representative of the Owner/Operator. shall sign in the space provided. This signature ceröfies that the signer is famüiar with the
infonnatlon submitted and that based on the signer=s inquiry of those illdividuais responsible for obtaining the infunnaticn it is the
sign8l=S belief that the submitted information is true, accurate and complete.
137. TITLE OF SIGNER - Enter the title of the person signing the page.
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
DADO
D DELETE
o REVISE
200
(ana form par material oar building or ama)
Paga of
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I. FACIUTY INFORMA nON
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BUSINESS NAME (Sama as FACIUN NAME or DBA c Doing Business As)
CA¿Ih;£A!I,4 WAíE¿ SE£I/ICE CON,t7I'1Ã1Ý.- 57J:11íðN /67-01
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FACIUTYID#I ~ 11 MAP # (optional) 203 GRID#(õptionalj --
202 ,
204
II. CHEMICAL INFORMATION
205 ; TRADE SECRET D Yes rø'No 206
! It Subjact to EPCRA, refer to instructions
CHEMICAL NAME
'".foOltJHIIY/'tJt:IILtJR I ïE-
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207 t~
COMMON NAME
EHS·
Dyes ~ 208
, CAS#
, 209 "If EHS is- Y.... . all amounlS below IIIIIst be in !lis.
FIRE CODE HAZARD ClASSES (ëOmplete it requested by oèai fire chiel)
210
¡Ø'.... m MIXTURE
o W ,WASTE
211 ,j RADIOACTIVE
I
DYes ~NO
212
, CURIES
213
TYPE
o p PURE
PHYSICAL STATE
o s SOUD
I]{¡ LIQUID
OgGAS
214 LARGEST CONTAI~ER 020 '0
215
FED HAZARD CATEGORIES
(.....'>dc aJI that appjy)
AL WASTE
Ao.oJUNT
o 1 FIRE
o 2 REACTlVE
o 3 PRESSURE RELEASE
04 ACUTE HEALTH ; æ{ CHRONIC HEALTH Cð£,(tJfII/E
216
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AI/II
MAXIMUM
DAIL AMOUNT
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218 i AVERAGE --L.
i DAILY AMOUNT .~
o Ib LBS D tn TONS
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219
STATE W~STE CODE Z20
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DAYS ON $ITE "' 222
UN~
93 GAL 0 ct CU FT
. If EHS. amount must be in Ibs.
221,
STORAGE CONTAINER
(Check aU that apply)
J ,t7t1£ r
IIlJ a ABOVEGROUND T~NK
Db UNDERGROUND TANK
DC TANK INSIDE BUILDING
D d STEELDRUM
De P!.AS1icmONMETAWC DRUM
Of CAN
o 9 CARBOY
o h SILO
o i FIBER DRUM.
OJ BAG '
Ok BOX
D I CYÚNDER
o ~LASS BOT11..E ,
Iï!rn PlJ\STIC BOT11..E
o 0 TOTE BIN
o p TANKWAG9N
o q RI\IL CAR
Dr OTHER
223 .
, ~a AMBIENT
~ AMBIENT
o as ABOVE AMBIENT
D be BE1.0W AMBIENT
224
STORAGE PRESSURE
STORAGE TEMPERATURE
o as ABOVE AMBIENT
D ba BE1.0W AMBIENT
D c CRYOGENIC
Z25
%WT
HAZARDOUS COMPONENT
CAS #
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230 I
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231 i 0 Yes 0 No 232
235 i 0 Yes 0 No 236
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239 I 0 Yes 0 No 240 ,
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241
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245
III. SIGNATURE
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DATE 246
P"""IP NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE
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H~rdous Materials Inventory" Chemical Description
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You musl complete a separate HazaÌ'dous Malerials Invenlory - Chemical Description page (or'each hazardous malerial (hazardous substances and hazardous waste) thSt
you handle ¡It your facility in aggregate, quaniities equal to or greater than 500 pounds. 55 ,gallons. 200 cubic leet of gas (calcuJated at sìandard temperature anct pressure)
or tI1e lederal threshold planning quantity (or Extremely Hazardous Substances, whIchever IS less. Also complete a page lor each radioactive material handled OV8l"
quantities (or which an emergency plan is required to be adopted pursuant to 1 0 CFR Parts 3D, 40, or 70. The completed inventory should reRect all raporlaele quantities
of hazardous materiaJs at your lacility, reported separately lor each building or outside adjacent area, with separate pages lor unique occurrences of physical state, storage"
temperature and storage pressure. (Note: the numbering of tne instructions lollows the data element numbers that are on the UPCF pages. These data element number.r
are used lor electronic submission and are tile same as the numbering used in 27 CCR. Appendix C. tne 8usiness Section of the Uniñed Program Data Dictionary.) 1"1_
number aU pages 01 your submittal. This helps ~our CUP A or AA identify whether the submittal is complete and if any pages are sepatated.
1. FACIUTY ID NUMBER - This number is assigned by the CUPA or AA This is tne unique number which identifies your (acility. it: ,
~. 8USINESS NAME - Enter the lull legal name of tne business.
200. ADD/CE!.ETEI REVISE - Indicate if tn,e material is being added to the inventory, deleted (rem the inventory, or if the infonnation previously submitted is being revised.
'NOTE; You may choose to leave this blank if you reSubmit your entire inventory annually. ' , .
201. CHEMICAL LOCATION - Enter the building or outside! adjacent area where thEi hazardous material is handled, A chemical tIIat is stored at tne saine pressure and '
temperatur~, in multiple locations within a building, can be reported on a single' page. NOTE: This infonnation is not subject to public dlsdosure pursuant to HSC
§25506.' ,
202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA . All businesses which are subject to tne Emergency Planning and Community Right to Know Act (EPCRA) must
check "Yas" to keep chemicaJ location ¡nfonnation confidential. If tne business does not wiSh to keep chemical location information confidential check, "No",
203. MAP NUMBER - If a rnàp is induded. enter the number of tne map on which the location of the hazardous material is shown.
204. GRID NUMBER· If grid coordinates are used, enter the grid coordinates of the map tnat COITeSpond to tne,location of tile hazardous material. If applicable, multiple grid
' coordinates can be listed. " ' ,
205. CHEMICAL NAME· Enter, tile proper chemical name associated witll the ChemicaJ Abstract Service (CAS) number of the hazardous materia'.' This should be the
Intemational Union at Pure and Applied Chemistry (IUPAC) name found on tne Material Safety Data Sheet (MSDS). NOTE: If the chemicaJ is a mixture, do not
complete tnis field; complete tne "COMMON NAME" field instead.' ,
206. TRADe SECRET - Check "Yes" if the information in tnis sadion is dedared a trade seaet, or "No" if it is'nol , ,
State requirement If yes, and business is not subject to EPCAA, disdosure òf tile designated trade smt information is bound by HSC §25511.
Federal requirement If yes, and business is ~ubject to EPCAA, dfsc10sure of the designated Trade Seaet information is bound by 40 CFR and tne business
must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40' CFR 350.27) to USEPA. , '
207. COMMON NAME - Enter the common name or trade ,name of tile hazardous materiaJ or mixlure containing a hazardous material.
208. EHS . Check ,"Yas" if the hazardous materiaJ is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355. Appendix A If tI1e materiaJ is a mixture
, containing an EHS, leave this secüori blank and comptete the section on hazardous components beJow. . , '
209. CAS # - Enter the Chemical Abstract Service (CAS) number for tne hazardous material For mixtures, enter the CAS number of the mixture if it' has "been assigned a
number distinct lram its components. If the mixture has no CAS number. leave this column blank and report the CAS numbers of tile individual hazardous
" , components in the appropriate section beJow.' , ' \ '
210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materiaJs which a buSiness handles. This
' infonnation shail only be provided if the local fire chief deems it necessary and requests the CUP A or AA to collect it, A list of the hazard classes and instructions
on hew to detennine which class a material falls under are incJuded in the appendices of ArtIc:le 80 of the Unifonn F"tre Code, If a material' has more than one ' '
, applicable haiard class, include all. Contact CUPA or AA lor guidance. '
211, HAZARCOUS MATERIAL ll'PE - Check the one box, that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box.
If mixture or waste, complete hazardoUs components section, '
212. RAOIOACïlVE . Check "Yes" if the hazardous materialjs radioactive or 'No' if it is nol
213. CURIES -If tile hazardous material is radioactive, use thiS area to report the activity in curies, You may use up to nine digitS with a,ßoating decimal point to report
~~~ - -
214. PHYSICAL STATE- Check tile one box that best describes tne state in which tile hazardous materiá is handled: solid, Dquid or gas.
215. LARGEST CONTAINER· Enter tile total capacity of the largest container in which the material is stored.
216. FEDERAL HAZARD CATEGORIES - Check all cat ories that describe the sic31 and health hazards associated with tne hazardous materiàl.
PHYSICAl: HAZARDS HEALTH HAZARDS
Fire: Fiammable U uids and Solids. Combustible U Ids. hories. Oxidizers Acute Health (Immediate): HJghly Toxic, Toxic, Irritants, Sensitizers, CòtroSives.; ,
Reactive: Unstable Reactive. 0 nic Peroxides. Water Reactive. Radioactive other hazardous chemicals with an adverse effeCt with short term osure
Pressure Release: Explosives, Compressed Gases, 8lasting Agents C.hronlc Health (Delayed): Carcinogens, otl1er hazardous chemiè:aJs with an
adverse effect witl1lon tenn re
217. AVERAGE DAILY AMOUNT - Calcuiate tne average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent!
outside area. Calculations shall be based on the previous yea"s inventory of material reported on this page. Total all daily amountS and divide by tile number of
days tne chemical will be on site, If tnis is a material that has not previousty been present at this location, the amount shall be the average daily amount you
project to be on hand during the course of the year. This amount should be cónsistentwitl1 tne units reported in box 221 and should not exceed that of maximum
daily amount, ,
218. MAXIMUM CAlLY AMOUNT - Enter the maximum amount of each hazardous'materiaJ or mixture containing a hazardoUs material, which is handled in a buDding or.
adjacent/outside area at anyone time over the course of tile year. This amount must contain at a minimum last years inventory of the material reported on this
page. witn the reRection of additions, deJetions, or revisions projected for tI1e current year. This amount should be consistent with tile units reported in box 221,
219, ANNUAL WASTE AMOUNT· If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled.
220. STATE WASTE CODe -If the hazardous material is a waste, enter tile appropriate California 3-digit hazardous waste code as listed on tile back of the Unifonn
Hazardous Waste Manifesl '
221. UNITS . Check the unit of'measure that is most appropriate for tI1e material being reported on this page: gallons, pounds, cubic feet or tons. NOTE.: If the material is a
federally defined Extremely Hazardous Substance (EHS), all amol!nts must be reported in pounds. If material is a mixture containing an EHS, report the units that
the material is stored in (gallons. pounds, cubic leet, or tons).,
222. DAYS ON SITE - List tile total number of days during the year that tne material is on site.
223. STORAGE CONTAINER - Check all boxes that describe tne type of storage containen; in which the hazardous material is stored. NOTE.: If appropriate, you may
choose more than one.
224. STORAGE PRESSURE - Check the one box tI1at best describes tne pressure at which the hazardous nj8terial is stored.
225. STORAGE TEMPERATURE - Check tne one box that best describes tne temperature at which the hazardous material is stored.
226. HAZARDOUS COMPONENTS 1·5 (% 8Y WEIGHT) - Enter the percentage weight 01 the hazardous component in a mixture. 'If a range of percentages is available,
report the highest percentage in that range. (Report lor components 2 througl1 5 in 2:30, 234, 238; and 242.)
227. HAZARDOUS COMPONENTS 1·5 NAME - When reporting a hazardous material tI1at is a mixture. list up to five chemical names of hazardous components in that
mixture by percent weight (refer'to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater
tnan 1 % by weight if non~rcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than flVe'hazardous compcinents are present above these
percentages, you may attach an additional sheet of paper to capture the required infonnation. When reporting waste mixtures. mineral and cl1emical composition
should be listed. (Report lor components 2 tnrough 5 in 231. 235, 239, and 243.)
228. HAZARCOUS COMPONENTS 1·5 EHS . Check -Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR,
Part 355, or 'No" ilit is nol. (Report lor components 2 through 5 in Z32. 236, 240, and 244.)
229. HAZARDOUS COMPONENTS 1-5 CAS - List tne Chemic31 Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2-5.)
246. LOCALLY COlLECTED INFORMATION· This space'may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of tneir
individual programs, Contact the CUP A or AA lor guidance.
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