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Home My WebLink AboutBUSINESS PLAN 12/29/2003 Per it Operate to Hazardous MaterialslHazardous Waste Unified Permit ~ CONDITIONSOF",p~IJI_~rrON REVERSE SIDE . -. -.; ',~~: ~f~~{<~:_~:'·~ .:.::.,~~~:\'~' . ",~ !, '. :,: ' , -;"'.. Permit ID #:: 015-000-001814 . , LOCATION: 5209 WÖODMERE DR Issued by: ;~':>:>:,' 'r :.' .-".';.: ..- >. Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: ., ' Issue Date , Expiration Date: June 30, 2003 .. ,::r'." ì.. , I Per it Operate to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: zardous Materials Plan round Storage of Hazardous Materials agement Program Waste 5209 PERMIT ID# 015-021.001814 PERFORMANCE OFF ROAD LOCATION Issued by: WOODME Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 4f~ ph Huey, ffice of ental Servi es June 30, 2000 Approved by: Expiration Date: . SAN JOAQUIN DOOR 5201 GAS/~LECTRIC ¡g"XWÆ lIDf1D~ WlYOODlMlERE Jj)RJ[VE ROLL-UP DOOR ROLL-UP DOOR ROLL-UP DOOR No~\-" 1P~~Œ on ~().&D 5209 'if:!OO~ DlÑ.XVlIJ WATER DOOR . o ~c.V'\ f·~ c..\~ -- .: ,fenced yard D . carbon dioxide argon acetylene . san joaquin door 5201 GAS/ELECTRIC If:u& lIDt~ ROLL-UP DOOR ROLL-UP DOOR DOOR JP~O~Œ OW JR.OJiJD S2()~ íf5'OO~ DJR.:JIW door WOOJDIfÆIm DRIVE WATER I · No~~ / , " - - PERFORMANCE OFF ROAD -I SiteID: 015-021-001814 Manager : Location: 5209 WOODMERE DR City BAKERSFIELD BusPhone: Map : 123 Grid: 22B (661) 834 - 9559 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 EPA Numb: SIC Code:5013 DunnBrad: Emergency Contact / Title Emergency Contact / Title JUAN PRIETO / OWNER ANN PRIETO / OWNER Business Phone: (661) 834-9559x Business Phone: (661) 834-9559x 24-Hour Phone : (661) 831-7192x 24-Hour Phone : ( ) - x Pager Phone ( ) P~, Phone (661) .,.,~ : x : ~-::,-'~ 7" Z 7" . .#:it Hazmat Hazards: Fire Press ImmHlth Contact : JUAN & ANN PRIETO MailAddr: 5209 WOODMERE DR City : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 834-9559x State: CA Zip : 93313 Phone: (661) 834-9559x State: CA Zip : 93313 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Owner Address City JUAN & ANN PRIETO : 5209 WOODMERE DR : BAKERSFIELD Emergency Directives: ~O~ JW"- &W.s I!J)~ h9i"eby e®rti~ ~h$ì~ ~ Mivs (Typs or print naroo) reviewed the attached hazardous materials ~anage- ~~~ ment pian ~~¿'rQ.rnAv-CE: and tM~ i~ @l!ong with (Nsme c.f Bus1nHa) any cOITsdions constitute a c(»mplets and corrrGå maJ,!ø agement plan for my facility. :2~ ~~ Si~'" .ure \~Ç}9-æ> Dare -1- 09/16/2003 -::- . e e F PERFORMANCE OFF ROAD f= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-001814 = By Facility Unit = Fixed Containers at Site = specHazEPA Hazards Frm I DailyMax UnitMCP F P IH G 233.00 FT3 Hi F P IH G 233.00 FT3 Min F P IH G 233.00 FT3 Min Hazmat Common Name... OXYGEN/ACETYLENE TORCH CARBON DIOXIDE ARGON -2- 09/16/2003 ~ e - -3- 09/16/2003 e e F PERFORMANCE OFF ROAD f= Inventory Item 0002 === COMMON NAME / CHEMICAL NAME OXYGEN/ACETYLENE TORCH SiteID: 015-021-001814 9 Facility Unit: Fixed Containers at Site 9 Location within this Facility Unit SE SIDE OF THE SHOP Days On Site 365 Map: Grid: CAS # STATE - TYPE Gas Mixture PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 E %Wt. RS CAS # Oxygen, Compressed No 7782447 Acetylene Yes 74862 HAZARDOUS COMPON NTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi f= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Facility Unit: Fixed Containers at Site 9 Location within this Facility Unit SE SIDE OF THE SHOP Days On Site 365 Map: Grid: CAS# 124-38-9 - TYPE Pure PRESSURE Above Ambient TEMPERATURE Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 09/16/2003 '. e e F PERFORMANCE OFF f= Inventory Item == COMMON NAME / ARGON ROAD 0003 CHEMICAL NAME SiteID: 015-021-001814 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit SE SIDE OF SHOP Map: Grid: CAS# 7440-37-1 - TYPE Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 HAZARDOUS COMPONENTS ~ CAS# I 7440371 : I l~~~óoIArgOn HAZARD ASSESSMENT TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min S -5- 09/16/2003 e e F PERFORMANCE OFF ROAD I f= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-001814 9 Fast Format 9 Overall Site 9 07/11/2000 Employee Notif./Evacuation 07/11/2000 LOCAL FIRE DEPT IS NOTIFIED. IN AN EMERGENCY, THE ALARM IS SET AND ALL EMPLOYEES ARE TO EVACUATE THE BLDG IN AN ORDERLY FASHION AND ARE TO MEET ACROSS THE ST. Public Notif./Evacuation 07/11/2000 WITH THE AMOUNTS WE HAVE AT OUR FACILITY, THERE POSES NO THREAT TO THE PUBLIC. WE DO HAVE POSTED AT ALL EXITS EVACUATION ROUTES AND SIGNS. IF THERE WAS A NEED TO EVACUATE NEARBY RESIDENTS, WE WOULD LET THE PROPER AGENCIES HANDLE THAT TASK. Emergency Medical Plan 07/11/2000 IN CASE OF A MEDICAL EMERGENCY, DIAL 9-1-1 OR GO TO MERCY MEDI CENTER SOUTHWEST - 400 OLD RIVER RD - 633-6100. -6- 09/16/2003 I; e e F PERFORMANCE OFF ROAD I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-001814 ì Fast Format ì Overall Site ì 10/10/1997 ALL CONTAINERS (BOTTLES) ARE TO BE SECURED TO THEIR CARTS WITH THE SAFETY CHAINS SECURED AT ALL TIMES. Release Containment 07/11/2000 SHUT OFF LEAK IF WITHOUT RISK. VENTILATE AREA OF LEAK OR MOVE LEAKING CONTAINER TO A WELL VENTILATED AREA. TEST AREA, ESPECIALLY CONFINED AREAS, FOR SUFFICIENT OXYGEN CONTENT PRIOR TO PERMITTING RE ENTRY OF PERSONNEL. Clean Up 10/10/1997 SLOWLY RELEASE INTO ATMOSPHERE OUTDOORS, DISCARD ANY PRODUCT, RESIDUE, DISPOSABLE CONTAINER OR LINER IN AN ENVIRONMENTALLY ACCEPTABLE MANNER, IN FULL COMPLIANCE WITH FEDERAL, STATE AND LOCAL REGULATIONS. Other Resource Activation -7- 09/16/2003 '9 f ¡ .. e e F PERFORMANCE OFF ROAD I f= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 015-021-001814 ì Fast Format ì Overall Site ì I 07/11/2000 A) NATURAL GAS/PROPANE B) ELECTRICAL - NE SIDE C) WATER - NE SIDE D) SPECIAL - NONE E) LOCK BOX - NO - NE SIDE Fire Protec./Avail. Water 07/11/2000 PRIVATE FIRE PROTECTION - FIRE ALARMS. NEAREST FIRE HYDRANT - ?????????????? Building Occupancy Level -8- 09/16/2003 ;f ... (' . ·1It e e F PERFORMANCE OFF ROAD I F Training Employee Training SiteID: 015-021-001814 ì Fast Format ì Overall Site ì 07/11/2000 WE HAVE 4 EMPLOYEES AT THIS FACILITY ALONG WITH THE 2 OWNERS. WE DO HAVE MSDS SHEETS ON FILE NEAR THE FRONT DOOR. BRIEF SUMMARY OF TRAINING PROGRAM: HAZ WOPER AWARENESS, HAZ COM, DHEMICAL HAZARD AWARENESS, CPR, FIRST AID AND MONTHLY TAILGATE MEETINGS. Page 2 r I I Held for Future Use Held for Future Use -9- 09/16/2003 e -, CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENT AI.. SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd F'loor, Bakersfield, CA 9330] FACILITY NAMiPf'('-~r,/Yv.ll'l(,..Q.~QJINSPECTION DATE 5-/0 - 02- ADDRESS "::>dé:f1 l.l '\Ðr¿)/'Y\ {) r~, Dr . PHONE NO. B õLJ - 9559 FACILITYCONTACTT~.JI' ':Vrìe-:tn BUSINESSIDNO. 15-210- lßtl} INSPECTION TIME ~D V"\,' ^J NUMBER OF EMPLOYEES ( ~ Section 1: eI";~:utine Business Plan and Inventory Program o Combined D Joint Agency a Multi-Agency o Complaint D Re-inspection OPERATION C V COMMENTS Appropriate pennit on hand \I Business plan contact infonnation accurate \I Visible address v Correct occupancy \I Verification of inventory materials -..) Verification of quantities 'v Verification of location V Proper segregation of material Iv Verification of MSDS availability IV Verification of Haz Mat training II ('..cJ L-Je ~t ~'t'et:j Dc {e¿ \ \ ()1:\ \ ~ Verification of abatement supplies and procedures " / Emergency procedures adequate V Containers properly labeled IV Housekeeping V Y'\e <>c5t -to. {e. MO \J .Q 5o/Y\e. +'Y<e Fire Protection vi . Site Diagram Adequate & On Hand .,/ Any hazardous waste on site?: Explain: DYes ~~ ~~ mess Site Responsible Party Inspecto~~~~ C=Compliance V=Violation Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs, Yellow - Station Copy Pink - Business Copy ... // - CommCode: BAKERSFIELD EPA Numb:, / JUL 6'7':] ~~~~a~3~ -~;~:rate /By: FacUnits: 1 AOV: STATION 13 ~~SIC Code:5013 DunnBrad: - PRRFORMANCE OFF ROAD SiteID: 215-000-001814 Manager : Location: 5209 WOODMERE DR City BAKERSFIELD Emergency Contact / Title Emergency ~ntact / Title JUAN PRIETO ",/1 OWNER ANN ~IPP ~/é7V ~€St OWNER Business Phone: (~) 834-9559x Business Phone: 834-9559x 24-Hour Phone : ~) 831-7192x 24-Hour Phone : ( ) - x Pager Phone : (W);JjS -f'l?lx Pager Phone : ~~) 335-9999x Hazmat Hazards: Fire Press ImmHlth ,,,, Contact : JUAN PRIETO & ANN ~IPP- hlE.W Phone: (QQa) 834-9559x MailAddr: 5209 WOODMERE DR State: CA City : BAKERSFIELD Zip : 93313 /// Owner JUAN PRIETO & ANN ~Irr ~ fir/E1O Phone: (ãõ5i 834-9559x Address : 5209 WOODMERE DR State: CA City : BAKERSFIELD Zip : 93313 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì p= Hazmat Inventory f== As Designated Order, SpecHaz EPA Hazards Hazmat Common Name. . . DailyMax MCP 233.00 FT3 Min 233.00 FT3 Hi 233.00 FT3 Min CARBON DIOXIDE F P IH G OXYGEN/ACETYLENE 'ZJ..H & F P IH G ARGON F P. H G I, ø ~_ Do hereby certify iHat i have (Type Qr Drint mmw) reviewed the attached hazardous materials manage- ment plan for&,~tJ;e ~~at It along with (Name of usiness) .. any corrections constitute a complete and corred man- agement plan ~or my 1acility. -1- 06/13/2000 e - F PERFORMANCE OFF ROAD p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME CARBON DIOXIDE SiteID: 215-000-001814 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit SE SIDE OF THE SHOP Map: Grid: CAS # 124-38-9 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 HAZARD US COMPONENTS %'Wt. RS CAS # 100.00 Carbon Dioxide No 124389 o HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min p= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME OXYGEN/ACETYLENE TORCH Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit SE SIDE OF THE SHOP Map: Grid: CAS # STATE - TYPE Gas Mixture PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS # Oxygen, Compressed No 7782447 Acetylene Yes 74862 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -2- 06/13/2000 e e F PERFORMANCE OFF ROAD p= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME ARGON SiteID: 215-000-001814 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit SE SIDE OF SHOP Map: Grid: CAS # 7440-37-1 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 233.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 233.00 FT3 Daily Average 233.00 FT3 HAZARDOUS COMPONENTS ~ CAS # I 7440371 I l~~~ôoIArgon HAZARD ASSE SMENT TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min S S -3- 06/13/2000 e e F PERFORMANCE OFF ROAD I p= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-001814 ì Fast Format ì Overall Site ì 10/10/1997 DEPARTMENT IS NOTIFIED Employee Notif./Evacuation 10/10/1997 IN AN EMERGENCY, THE ALARM IS SET AND ALL EMPLOYEES ARE TO EVACUATE THE BUILDING IN AN ORDERLY FASHION AND ARE TO MEET ACROSS THE STREET. Public Notif./Evacuation 10/10/1997 WITH THE AMOUNTS WE HAVE AT OUR FACILITY, THERE POSES NO THREAT TO THE PUBLIC. WE DO HAVE POSTED AT ALL EXITS EVACUATION ROUTES AND SIGNS. IF THERE WAS A NEED TO EVACUATE NEARBY RESIDENTS, WE WOULD LET THE PROPER AGENCIES HANDLE THAT TASK. Emergency Medical Plan 10/10/1997 IN CASE OF A MEDICAL EMERGENCY, DIAL 9-1-1. MERCY MEDI CENTER SOUTHWEST 400 OLD RIVER ROAD 633-6100 -4- 06/13/2000 e e SiteID: 215-000-001814 1 Fast Format 1 Overall Site 1 10/10/1997 F PERFORMANCE OFF ROAD I p= Mitigation/Prevent/Abatemt Release Prevention ALL CONTAINERS (BOTTLES) ARE TO BE SECURED TO THEIR CARTS WITH THE SAFETY CHAINS SECURED AT ALL TIMES. Release Containment 10/10/1997 SHUT OFF LEAK IF WITHOUT RISK. VENTILATE AREA OF LEAK OR MOVE LEAKING CONTAINER TO A WELL VENTILATED AREA. TEST AREA, ESPECIALLY CONFINED AREAS, FOR SUFFICIENT OXYGEN CONTENT PRIOR TO PERMITTING RE-ENTRY OF PERSONNEL. Clean Up 10/10/1997 SLOWLY RELEASE INTO ATMOSPHERE OUTDOORS, DISCARD ANY PRODUCT, RESIDUE, DISPOSABLE CONTAINER OR LINER IN AN ENVIRONMENTALLY ACCEPTABLE MANNER, IN FULL COMPLIANCE WITH FEDERAL, STATE AND LOCAL REGULATIONS. Other Resource Activation -5- 06/13/2000 e e SiteID: 215-000-001814 ì Fast Format ì Overall Site ì I F PERFORMANCE OFF ROAD I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs 10/10/1997 NATURAL GAS/PROPANE: NORTH EASTSIDE ELECTRICAL: NORTH EASTSIDE WATER: NORTH EASTSIDE SPECIAL: LOCK BOX: NO Fire protec./Avail. Water 10/10/19971 I FIRE ALARMS Building Occupancy Level -6- 06/13/2000 ~ e e F PBRFORMANCE OFF ROAD I F Training Employee Training SiteID: 215-000-001814 ì Fast Format ì· Overall Site ì 03/18/1999 HOW MANY EMPLOYEES DO YOU HAVE ON SITE????????????? 1/ £11111/;1££5 ž' ()~~ J DO YOU HAVE MSDS SHEETS ON FILE??????????? Yô ) Nt£( ~tk" \:roQ.. GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: C) n ..Ja.\;aow Page 2 [ I I Held for Future Use Held for Future Use ~LWDftl cbá)tsS ~-ÛJM ÚUMlC!L ~ ~ cJ \l- ~~~ ~1) 'MD¡'\~l ~ -<lG/JiE. Vvt~/Ilit.s:: -7- 06/13/2000 ~~ \,II I'- ,j .~ <u ~1~ :?\ .,. \) 'j ~ I- ... u..~ t~~~:;ro ~ Gosford Road A,he Road NewSt:ine Road Wible Road Whitr: Lane Pacheco Road ¡ AUTO Woodmcrc Drive IotAll <§) 5209WO!L.,..~. Harris Road Panama Lane A,he Road NewSt:ine Road Wible Road N ~ \ J~ s ~. J" [ÕYñ'~o 0 é, ifii<. ,¿, .¡,.., ,,0. '. lí~ 'Vi~;'\- \~n 0 .. ~f ..I, o . '.'---- -,---..-. , ...~,. ,- - --h..f p~ý~ oq ',1 i -~. CITY OF BAKERSFIELD f-t 2Z ~~. 3 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 [jB] St£Q ~~"- t\Ttr , ~ ~ -':).':tß \~~ r-1ð, '- INSTRUC'Ç:ONS: 1. 2. 3. 4. To av~~ further action, return this form within 30 days of receipt. ~~ Iq9) TYPE/PRINT ANSWERS IN ENGLISH. <:j O~ \ - r-:;- Answer the questions below for the business as a whole. b" ( e:; 7 Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: PERFORMANCE OFF ROAD LOCATION: 5209 WOODMERE DRIVE BAKERSFIELD, CA ~3313 e MAILING ADDRESS: SAME AS ABOVE CITY: BAKERSFIELD STATE: CALIFZIP:93313 PHONE:834-9559 DUN & BRADSTREET NUMBER: SIC CODE: 5531, PRIMARY ACTIVITY: INSTALLATION OF AUTOMOTIVE ACCESSORIES O~R: JUAN PRIETO & ANN TRIPP MAILING ADDRESS: 270 HUDSON DRIVE BAKERSFIELD, CA 93313 SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. JUAN PRIETO OWNER 834-9559 831-7192 2. ANN TRIPP OWNER 834-9559 pager 335-9999 'e I ,- I "),.,... ..,. - e HAZARDOUS MATEWALS MANAGEMENT PLAN .. , ,! SECTION 3: TRAINING .- NUMBER OF EMPLOYEES: THREE MATERIAL SAFETY DATA SHEETS ON FILE: YES BRIEF SillAMARY OF TRAINING PROGRAM: ,~ WE'VE GONE THROUGH THE FOLLOWING PROGRAMS: . .1" !. CHEMICAL HAZARD AWARNESS 2. HAZARD COMMUNICATION 3. HAZWOPER AWARNESS LEVEL 4. EMERGENCY EVACUATION PROCEDURES SECTION 4: EXEMPTION REOUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH a & SAFETY CODE" FOR THE FOLLOWING REASONS: ,., i I ' WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, DARRELL MILLER CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TIllS INFORMATION WILL BE USED TO FULFILL MY FIRM'S 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. ~~ SIG ATUÍŒ '- TITLE OCT. 4, 1 99 7 DATE SAFETY CONSULTANT e· 2 "r .~ ~. ·e e 1- e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUSMATEmALS~ENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESSN~ PERFORMANCE OFF ROAD & AUTOMOTIVE ACCESSORIES F ACILITY N~ SAME AS ABOVE SITE ADDRESS 5209 WOODMERE DRIVE CITY BAKERSFIELD ZIP 93313 STATE CALIF NATURE OF BUSINESS INSTALLATION OF AOTOMOTIVE ACCESSORIES SIC CODE5531, 7533, 7538 DUN & BRADSTREET NUMBER NONE O~RlOPERATOR ANN TRIPP/JUAN PRIETO PHONE 834-9559 MAILING ADDRESS 270: iHUDSON DRIVE ' CITY BAKERSFIELD STATE CA ZIP 93307 NAME JUAN PRIETO EMERGENCY CONTACTS TITLE OWNER BUSINESS PHONE 834 - 9 5 5 9 N~ ANN TRIPP 24 HOURPH0NE831-7192 TITLE OWNER BUSINESS PHONE 834-9559 ..... 24 HOUR PHONE PAGER 335-9999 " 1 ARDOUS MATERIALS INVENTOI "'" Business Name PERFORMANCE OFF ROAD Ad~s 5209 WOODMERE DRIVE Page~of~ 'r CHEMICAL DESCRIPTION I) INVENTORY STATIlS: New [x] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret[ ] Trade Secret[ ] 2) Common Name: ACETYLENE Chemical Name: ACETYLENE 3) OOT # (optional) 1 001 AHM [ ] CAS # 74-86-2 4) Physical & Health PHYSICAL REALm Hazard Categories Fire [X ] Reactive [ ] Sudden Release of Pressure f ] hnmediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code fi"om DHS Fonn 8022) USE CODE 1 6 6) PHYSICAL STATE Solid [ Liquid [ ] Gas ~ ] Pure [X ] Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILITY Maximwn Daily AmOWlt 2 Bot t 1 e 5 Average Daily AmOWlt 2 Annual AmOWlt 2 Largest Size Container 233 cubic feet # Days on Site 3 6 5 - Circle Which Months: UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 fX ] Curies [ ] 8) STORAGEOC,pDES a) Container: b) Pressure: 1 c) Temperature 4 CAll Year)J, F, M, A, M, J, J, A, S, 0, N, D 9)~Tln{E: Li~ the three most hazardous I) chemical components or 2) any AHM components 3) COMPONENT CAS# %Wf AHM [ ] [ ] [ ] lO)LOCATIONSOUTH EAST SIDE OF THE SHOP I) INVENTORY STATUS: New [X] Addition [ ] Revision [ ] Deletion [ Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: ARGON 3) OOT # (optional) 1 006 Chemical Name: ARGON AHM[ ] CAS# 7440-37-1 4) Physical & Health Hazard Categories PHYSICAL REALm Fire [ ] Reactive [X] Sudden Release of Pressure [x] hnmediate Health (Acute) [ ] Delayed Health (Chronic) [ USE CODE 1 6 (3-digit code from DHS Fonn 8022) 5) WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [ Liquid [ Gas [x ] Pure [ J Mixture [X] Waste [ ] Radioactive [ 7) AMOUNT AND TIME A T FACILITY Maximwn Daily AmoWlt 1 Bot t] p- Average Daily AmOWlt !': rl m A Annual AmOWlt Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [X] Curies [ ] 8) STORAGE 8~DES a) Container: b) Pressure: 1 c) Temperature 4 same ?~~ l"'llhic feet ~ h t; n rl Y s Circle Which Months: (All Year)J, F, M, A, M, J, J, A, S, 0, N, D ~ 9) MIXTURE: List the three most hazardous chemical components or any AHM components COMPONENT I) CARBON DIOXIDE 2) 3) CAS# 124-38-9 %Wf 75 ARM [ ] [ ] [ ] DARRELL MILLER/CAL WEST SAFETY PRINT Name & Title of Authorized Company Representative IO)LOCATION SOUTH EAST SIDE OF THE SHOP I certi.fY under penalty of law, that I have personally examined and am familiar with the infonnation on this and all attached docwnents. I believe the submitted infonnation is true, accurate and complete. .- 9-~~ Signature OCT. 4 , 1 9 9 7 Date ..;¡ ...",~ e e e- e e HAZARDOUSMATE~SMANAGEMENTPLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: LOCAL FIRE DEPARTMENT IS NOTIFIED B. EMPLOYEE NOTIFICATION AND EVACUATION: IN AN EMERGENCY THE ALARM IS SET AND ALL EMPLOYEES ARE TO EVACUATE THE BUILDING IN AN ORDERLY FASHION AND ARE TO MEET ACROSS THE STREET. C. PUBLIC EVACUATION: WITH THE AMOUNTS WE HAVE AT OUR FACILITY THERE POSES NO THREAT TO THE PUBLIC. WE DO HAVE POSTED AT ALL EXITS EVACUATION ROUTES AND SIGNS. IF THERE WAS A NEED TO EVACUATE NEAR BY RESIDENTS WE WOULD LET THE PROPER AGENCIES HANDLE THAT TASK. D. EMERGENCY MEDICAL PLAN: INCASE OF AN MEDICAL EMERGENCY DIAL 911 MERCY MEDI CENTER SOUTHWEST 400 OLD RIVER RD. 633-6100 3 e e ~....~ HAZARDOUS MATEmALS MANAGEMENT PLAN - SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: . ALL CONTAINERS (BOTTLES) ARE TO BE SECURED TO THERE CARTS WITH THE SAFETY CHAINS ,SECURED AT ALL TIMES B. RELEASE CONTAINMENT AND/OR MINIMIZATION: SHUT OFF LEAK IF WITHOUT RISK. VENTILATE AREA OF LEAK OR MOVE LEAKING CONTAINER TO WELL_VENTILATED AREA. TEST AREA, ESPECIALLY CONFINED AREAS, FOR SUFFICIENT OXYGEN CONTENT PRIOR TO PERMITTING RE ENTRY OF PERSONNEL. C. CLEAN-UP PROCEDURES: SLOWLY RELEASE INTO ATMOSPHERE OUTDOORS, DISCARD ANY PRODUCT, RESIDUE, DISPOSABLE CONTAINER OR LINER IN AN ENVIRONMENTALLY ACCEPTABLE MANNER, IN FULL COMPLIANCE WITH FEDERAL, STATE AND LOCAL REGULATIONS. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROP ANE: NORTH EAST SIDE -e ELECTRICAL: NORTH EAST SIDE WATER: NORTH EAST SIDE SPECIAL: LOCK BOX: YESINQ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/W ATER AVAILABILITY A. PRIVATE FIRE PROTECTION: FIRE ALARMS B. WATER AVAILABILITY (FIRE HYDRANT): --) 4 -" ~'...; '- LARDOUS MATERIALS INVK~)RY B~inessNæmePERFORMANCE OFF ROAD A~5209 woodmere drive Page~of~ " CHEMICAL DESCRIPTION 2) Common Name: CARBON DIOXIDE I) INVENfORY STATUS: New [X] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret[ ] Trade Secret [ ] Chemical Name: CARBON DIOXIDE 3) OOT # (optional) AHM[ ] CAS# 124-38-9 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [x ] Sudden Release of Pressure r ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code from DHS Fonn 8022) USE CODE 1 6 6) PHYSICAL STATE Gas [x ] Pure [ Mixture [X] Waste [ ] Radioactive [ Solid [ Liquid [ 7) AMOUNT AND TIME AT FACll.ITY MaximwnDailyAmount 1 bottle, Average Daily Amount same Annual Amount same Largest Size Container ? 11 r.1J hie fee t # Days on Site 3 6 5 Circle Which Months: UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [x ] Curies [ ] 8) STORAGE C8~ES a) Container: b) Pressure: 1 c) Temperature 4 ®I Yearß, F, M, A. M, J, J, A. S, 0, N, D 9)~: Lim the three most hazardous 1 ) chemical components or 2) any AHM components 3) COMPONENT ARGON CAS# 7440-37-1 %WT 25 IO)LOCATION SOUTH EAST SIDE OF THE SHOP AHM [ ] [ ] [ ] 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ Check ifchemical is a NON Trade Secret[ ] Trade Secret [ ] 2) Common Name: 3) OOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health Hazard Categories PHYSICAL HEALTH Fire [ ] Reactive [ ] Sudden Release ofPressw'e [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code 1ÌOm DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solid [ Liquid [ Gas [ ] Pure [ Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature 7) AMOUNT AND TIME AT F ACll.ITY Maximwn Daily Amount Average Daily Amount Annual AmoWlt Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [ Curies [ ] Circle Which Months: All Year, J, F, M, A. M, J, J, A. S, 0, N, D 9)~: Lim the three most hazardous 1 ) chemical components or 2) any AHM components 3) COMPONENT CAS# %WT IO)LOCATION AHM [ ] [ ] [ ] I certify Wlder penalty of law, that I have personally examined and am familiar with the information on this and all attached documents. I believe the submitted information is true, accurate and complete. /7 .i' /.1 ¿ ~ DARRELL MILLER! CAL WEST SAFETY ~f~ \ OCT. 4, 1997 PRINT Name & Title of Authorized Company Representative Signature - Date a&RDOUS MATERIALS INVENT" ~ .i"· Business Name Address CHEMICAL DESCRIPTION Page ~ of --:: j 1) INVENTORY STA1lJS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASlE CLASSIFICATION (3-digit code from DHS Form 8022) 6) PHYSICAL STAlE Solid [ Gas [ ] Pure [ Liquid [ 7) AMOUNT AND TIME AT F ACllJIY Maximwn Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs[ ]Gal[ ]ft3[ Curies [ ] Circle Which Months: 9)~: List the three most hazardous 1 ) chemical components or 2) any ARM components 3) COMPONENT lO)LOCATION USE CODE Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature All Year, J, F, M, A, M, I, I, A, S, 0, N, D CAS# %Wf ARM [ ] [ ] [ ] 1) INVENTORY STA1lJS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check ifchemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASlE CLASSIFICATION (3-digit code from DHS Form 8022) 6) PHYSICAL STAlE Solid [ Liquid [ Gas [ ] Pure [ 7) AMOUNT AND TIME AT FACILITY Maximwn Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Site UNITS OF MEASURE Lbs [ ] Gal [ ] ft3 [ Curies [ ] Circle Which Months: 9)~: List the three most hazardous 1 ) chemical components or 2) any ARM components 3) COMPONENT 10)LOCATION USE CODE Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature All Year, J, F, M, A, M, I, I, A, S, 0, N, D CAS# %Wf ARM [ ] [ ] [ ] I certify under penalty of law, that I have personally examined and am familiar with the information on this and all attached documents. I believe the submitted information is true, accurate ~d complete. .... ;\ PRINT Name & Title of Authorized Company Representative Signature Date