HomeMy WebLinkAboutBUSINESS PLANI E2C R~sMEDIATION T,I,C
~I 5300 WOODMERE DR. ~~105
I
6
=1
+ BLACKS CONSTRUCTION _________________________________ SiteID: 015-021-000216 +
Manager
Location: 5300 WOODMERE DR 103
City BAKERSFIELD
BusPhone: (661) 396-0261
Map 123 CommHaz Low
Grid: 15D FacUnits: 1 AOV:
CommCode: BFD STA 13
EPA Numb:
SIC Code:
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
JIM BLACK / OWNER GARY KAUK / FOREMAN
Business Phone: (661) 396-0261x Business Phone: (661) 396-0261x
24-Hour Phone (661) 588-2517x 24-Hour Phone (661) 632-4882x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: Fire DelHlth
Contact Phone: (661) 396-0261x
MailAddr: 5300 WOODMERE DR 103 State: CA
City BAKERSFIELD Zip 93313
Owner JIM BLACK Phone: (661) 5~4--~
Address -~-~~ ~~ a~~0~ ~~~ Q~~+- G~~B~ ~~e State • CA ~ ~' ~ - ~~~
City BAKERSFIELD Zip 933~'~~,3
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
Based on my inquiry of those individuals
onsibte for obtaining the infiormation, I certify
resp malty of law that 1 have personally
under P familiar with the information
examined and am ,
submitted and bel lete, the information is iru ,
accurate, and comp ~~~
~zO~d(o
~' ~ Date
~~~ A PR ~ 4 2006
-1- 03/15/2006
ç __ _ cj
. .'
+ E 2 C REMEDIATION, LLC============================== SiteID: 015-021-002035 +
Manager :
Location: 5300 WOODMERE DR 105
City BAKERSFIELD
BusPhone:
Map : 123
Grid: 16D
(661) 831-6906
CommHaz : UnRated
FacUnits: 1 AOV:
CommCode: OUT OF:BUSINESS/HAZ-MATL'S SIC Code:8071
EPA Numb: DunnBrad:77-0241949
+==============================================================================+
+=======================================+======================================+
Emergency Contact / Title Emergency Contact / Title
PHIL~IP GOALWIN / OWNER ·MIKE RIVERA PI-t,\ P.c-05+A / LAB DIRECTOR
Business Phone: (661) 831-6906x Business Phone: (661) 831-6906x
24-Hour Phone: (661) 587-0585x 24-Hour Phone: (661) JJ4 1011x
Pager Phone () x Pager Phone () 83(0: ,q Ii X
+---------------------------------------+--------------------------------------+
I Hazmat Hazards: I
+------------------------------------------------------------------------------+
Contact : Phone: (661) 831-6906x
MailAddr: 5300 WOODMERE DR 105 State: CA
City : BAKERSFIELD Zip : 93313
+------------------------------------------------------------------------------+
Owner PHILLIP GOALWIN Phone: (661) 831-6906x
Address : 5300 WOODMERE DR 105 State: CA
City : BAKERSFIELD Zip : 93313
+------------------------------------------------------------------------------+
Period to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
+------------------------------------------------------------------------------+
Emergency Directives:
+==============================================================================+
+= Hazmat Inventory ========================================= One Unified List +
+== Alphabetical Order ================================= All Materials at Site +
+--------------------------------+-------+-----------+-----+----------+----+---+
I Hazmat Common Name... ISpecHazlEPA Hazards Frm I DailyMax IUnit MCpl
+--------------------------------+-------+-----------+-----+----------+----+---+
I, PH I uP G> tt-W /µ Do hereby csrtify that I hays
(Typa or print n~m&)
reviewed the attached hazardou~ materials manags-
ment plan for r7.c, ~r.tIIOII.l1t..and that it along with
(Nama 0 !ness)
any corrections constitute a complete and correct man-
+========================
-1-
~~~...................+
03/04/2002
.
¡
. .
+ E 2 C REMEDIATION, LLC ============================== SiteID: 015-021-002035 +
+================================================================= Fast Format +
+- Notl'f /Evacuatl'on/Medl'cal ------------------------------------ Overall Sl'te +
-. ------------------------------------
+== Agency Notification =========================================== 07/14/2000 +
GCMS 1'5 PRLSsuR.f.Sw~,¡nvé'.~"'T win SHift ~w.J'd.Ui. To p,u.~,,~~ \o~s.
NO A.UTOMATED LEA.K DETECTION DEVICED INCTALLED, NEEDED. ONE (1) GAL WATER
WASTE IN GLASS CONTAINER IS ALL ON LOCATION.
+==============================================================================+
+--- Employee Notl'f /Evacuatl'on ----------------------------------- 03/04/2002 +
--- -----------------------------------
OFFICE OF EMERGENCY SERVICES 1-800-852-7550 OR 911 IF EMERGENCY SITUATIONS
WOULD ARISE.
+==============================================================================+
+---- Publl'C Notl'f /Evacuatl'on ------------------------------------ 03/04/2002 +
---- . ------------------------------------
PHILLIP GOALWIN, OWNER, ASSIGNED PERSONNEL TO MAKE SURE ANY RESPONSE OR
EMERGENCY ACTIVITIES ARE CARRIED OUT.
+==============================================================================+
+----- Emergency Medl'cal Plan ---------,---------------------------- 03/04/2002 +
----- -------------------------------------
CALL 911 IF NEEDED FOR EMERGENCIES. NOTIFY OWNER. TEND TO EMERGENCY AS
NEEDED. NEAREST HOSPITAL - MERCY SOUTHWEST, 400 OLD RIVER RD.
+==============================================================================+
\
-2-
03/04/2002
( t
. .
+ E 2 C REMEDIATION, LLC ============================== SiteID: 015-021-002035 +
+================================================================= Fast Format +
+= Mitigation/Prevent/Abatemt =================================== Overall Site +
+==Release Prevention ============================================ 03/04/2002 +
HEALTH AND SAFETY PLAN AVAILABLE TO ALL EMPLOYEES. MSDS SHEETS AVAILABLE TO
ALL EMPLOYEES.
+==============================================================================+
+--- Release Conta1.'nment ------------------------------------------ 03/04/2002 +
--- ------------------------------------------
EVACUATE AREA OF RELEASE OF UNNECESSARY PERSONNEL. WEAR SUITABLE PERSONAL
PROTECTION EQUIPMENT (PPE). CONTAIN THE RELEASE AND ELIMINATE SOURCE.
+==============================================================================+
+---- Clean Up ---, ------------------------------------------------- 03/04/2002 +
---- ----------------------------------------------------
EVACUATE AREA OF RELEASE OF UNNECESSARY PERSONNEL. WEAR SUITABLE PPE.
CONTAIN THE RELEASE AND ELIMINATE SOURCE. TAKE UP AND CONTAINERIZE AS
DESCRIBED UNDER FEDERAL, STATE AND LOCAL REGULATIONS.
+==============================================================================+
+===== Other Resource Activation =======~======================================+
I I
+===========================~==================================================+
-3-
03/04/2002
¡ ~
. .
+ E 2 C REMEDIATION, LLC ============================== SiteID: 015-021-002035 +
+================================================================= Fast Format +
+= Site Emergency Factors ======================================= Overall Site +
+== Special Hazards ===========================================================+
I I
+==============================================================================+
+--- Utl'll'ty Shut-Offs -------------------------------------------- 03/04/2002 +
--- --------------------------------------------
A)
B)
C)
D)
E) LOCK BOX - NO
FIRE EXTINGUISHER IN LABORATORY
WATER AVAILABILITY ACROSS WOODMERE
GAS - OUTSIDE ON EAST WALL
ELECTRICAL - PANEL LOCATED
WATER - OUTSIDE SOUHT WALL
SPECIAL - NONE
OB
IN
OF
BUILDING/TOWARS SOUTHS IDE
SE CORNER (PHILLI GOADWIN OFFICE)
BUILDING/CENTER OF SOUTHSIDE
DRIVE
+==============================================================================+
+---- Fl're Protec /Aval'l Water ----------------------------------- 07/14/2000 +
---- .. -----------------------------------
PRIVATE FIRE PROTECTION - FIRE SPRINKLER SYSTEM INSTALLED.
NEAREST FIRE HYDRANT - FRONT N OF OFFICE.
+==============================================================================+
+===== BUlldlng Occupancy Level ===============================================+
¡ , \
+==============================================================================+
-4-
03/04/2002
~ ~
+
E
2
C
REMEDIATION,
. .
LLC ==============================
SiteID: 015-021-002035
+================================================================= Fast Format
Overall Site
03/04/2002
+= Training
+== Employee
Training
---------------------------------------------
---------------------------------------------
+
+
+
+
-----------------------------------------------------
-----------------------------------------------------
WE HAVE 10 EMPLOYEES AT THIS FACILITY.
WE DO HAVE MSDS SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM:
EMPLOYEES.
40 HR HAZWOPER, CPR AND H2S TRAINED
+==============================================================================+
+=== Page 2 ===================================================================+
I I
+==============================================================================+
+==== Held for Future Use =====================================================+
I I
+==============================================================================+
+===== Held for Future Use ====================================================+
I I
+==============================================================================+
-5-
03/04/2002
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
SUPPRESSION SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (805) 326-3951
FAX (805) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (805) 326-3979
FAX (805) 326-0576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (805) 399-4697
FAX (805) 399-5763
e
.
1)cJr;6M ;;;2Cr dcð /
Dear Business Owner: rd ç;JIJúJ~
This notice is meant to act as a reminder that the California Health
and Safety Code, Chapter 6.95, requires any handler of hazardous materials
to revise their hazardous materials business plan within 30 days of anyone
of the following events: ~ 100-./ :::Lq(::LOO I
(1)
A 100 per cent or more increase in the quantity of a
previously-disclosed material.
ø
(2) Any handling of a previously-undisclosed hazardous
material, subject to the inventory requirements of Chapter
6.95.
(3) Change in business ownership. 9~JL ~oS) \.0 ~
'~ (>
(4) Change in business address. ~"ß"5 t ((\c....c)~~ ~'~ D
~ C;~OO Lù()Od.í'\Q.¡~ :+\lO~
(5) Change of business name. 4 \-LQ~O.b~ ~
'7 E:LC g£fl1Ø5i RfiDIJ
Any questions regarding these required revisions, please call the ï
Hazardous Materials Division at (805) 326-3979.
Sincerely yours,
~.
"7~de W~ ~.A~.r~ A W~"
~.
. CITY OF BAKERSFIELe
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
...
HAZARDOUS MATEIDALS MANAGEMENT PLAN
INSTRUCTIONS
SECTION I. - BUSINESS IDENTIFICATION DATA:
The Business Owner I Operator Fonn, Chemical Description Fonn(s) and other Fonns
(e,g,: underground storage tank infonnation, hazardous waste treatment, etc., as needed)
may be submitted as the first section of the Hazardous Materials Management Plan in
order to avoid duplication of infonnation for initial submissions.
HAZARDOUSMATEmALS~AGEMENTPLAN
SECTION II. I - DISCOVERY AND NOTIFICATIONS
A.
LEAK DETECTION AND MONITORING PROCEDURES:
c
Describe the procedures and equipment used to detect any release or threatened release of a
hazardous material ITom any storage container, tank, or vessel at your business. Please
provide a written explanation that also includes the make and model number of any
automated or electronic leak detection equipment in use at your facility.
B.
EMPLOYEE AND AGENCY NOTIFICATION:
What agencies and or corporate officials are notified in case of a hazardous materials spill
or emergency - What procedures are used to notify these parties? At a minimum, you
must call 9-1-1 and the Office of Emergency Services at 1-800- 852-7550 to report any
spills that are a threat to life, safety or the environment, or for other non-emergency
spill reporting, please call our office at (661) 326-3979.
c. ENVIRONMENTAL RESPONSE MANAGEMENT:
Please describe who will be responsible for what activities (notifying authorities, clean-up
companies, ~tc.), and what the chain-of-command is at your facility for making sure these
1.ctivities are carried out.
D.
EMERGENCY MEDICAL PLAN:
,_.c
Summarize your plan for handling medical emergencies occurring at your business. List
the local medical facility capable of handling an accidenti, :0lving Hazardous Materials
used at your business.
-"'!
HAADOUS MATERIALS MANAGEAT PLAN
...., '.
,¡/
SECTION n.2 . RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
Explain the procedures that you have developed and implemented to help prevent an
incident from occurring. These steps could include, but are not limited to, storage methods,
container types, segregation, safety equipment, and/or procedures used.
B. RELEASE CONTAINMENT AND/OR MITIGATION:
Explain the procedures that you have developed and implemented to assist in keeping a
hazardous materials incident at your business as small or confined as possible.
C. CLEAN-UP AND RECOVERY PROCEDURES:
Explain what clean up procedures will be implemented in case of a release at your business.
This should address small spills, as well as a major release of material once the material is
contained.
Hazardous Waste: Please provide the name of the hazardous waste company that
regularly removes the wastes from your business, and how often that waste is removed.
Please keep all disposal receipts for the last three years availabl~ on site for inspection.
UTILITY SHUT -OFFS
List locations of shut off's using compass points and known or obvious landmarks. If you
have a lock box containing keys and maps of the facility for the Fire Department to use,
please list its location also.
PRIVATE FIRE PROTECTION/W A TER AVAILABILITY
A. Private Fire Protection: Describe on-site fire protection for your business or
facility unit, including sprinklers, fire extinguishers, alarm systems and private
response teams.
B. Water Availability (Fire Hydrant): Give the location of the closest water supply
or fire hydrant to be used by the Fire Department in case of an emergency.
2
,O¡
J'
''-
SECTION ([[ - TRAIN.
e
"
'"
List the number of employees that are working in the area of the hazardous materials, use
or storage. [nclude all employees who have any occasion to be in those areas.
Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS
must be readily available on site in a place where employees can access them.
Give a brief summary of your Hazardous Materials Training Program.
Employees are required by State law to have a program which provides employees with initial and
refresher training in the following areas:
1) Methods for safe handling of the hazardous materials used by your business.
2) The Ca1 OSHA Hazard Communication Standard.
3) Correct use of emergency response equipment and supplies available at your business.
4) The prevention, minimizing and clean up procedures you have developed for your business.
(
5) The emergency evacuation plans you have developed, as well as, your notification
procedure and medical plan.
6) Procedure to coordinate with and assist the local emergency personnel that may respond to
your business .
7) Who and how to call for immediate assistance in the event of an accident involving
hazardous materials.
CERTIFICATION
Please fill in your name, title, and sign and date on the signature line.
IMPORTANT
You must return this plan, inventory forms, and map within 30 days of receipt.
If yap '-1ave any questions _
please call us at (661) 326-3979 -
Thank you/or helping to keep our All America City cleaner and safer.
3
/
. CITY OF BAKERSFIELA
FFlCE OF ENVIRONMENTAL ~VICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
~
'.
HAZARDOUSMATEmALS~AGEMENTPLAN
INSTRUCTIONS:
1. To avoid further action, return this fonn within 30 days of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH.
3, Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
5. You may also attach Business Owner / Operator Fonn and Chemical Description Fonn(s)
to the front of this plan instead of completing SECTION I. below for initial submission.
SECTION I: BUSINESS IDENTIFICATION DATA
(
BUSINESS NAME: ["-. L Re.VYHd ;~+iD v1, LLL
LOCATION: 5300 Wood VYlere. Dnvc- J S;¡te \05
MAILING ADDRESS: 5300 Wood I/'t^ere .Dfl·ve) 2Yv\te. \ 05
CITY: fulée(s.TIðd STATECA ZIPJ33l3 PHONE:0bII~t-{ç¡Ob
PRIMARY ACTIVITY: EnJfýDVH'}1efffal Cv~SJ ~al1k
OWNER: Th~ l (('p Gv(Ãlwf~ .
MAILING ADDRESS: '?!;oO WQpMf ~ DR! v(E Sun=E
~{cE~) ,CA: 15313
)
EMERGENCY NOTIFICATION
PHONe! /fP.>/-b'lDb
I os-
I
!(
CONTACT
1. ?~lI \ t'r ~lwl~
2.J1L~e Rlvert;1
TITLE BUS. PHONE
. YoI-~ I-1f1Dfo
MaV\~\t\jMtM~
Lab Dlrec-br t;hl-~~(-C1!Ob
24 HR. PHONE
bh 1- 5ß-:¡-tJ5!5
bÚ 1- 3~t-lo t I
1
HAtþ.oOUS MATERIALS MANAGE.T PLAN
'\~ ...¡ -, -.
-" !.
, .",
\ .
11- it i
SECTION ILl : DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORlNG PROCEDURES:
îhere tJcœ 1'\0 auþY'l\'" fJ detec.,~DY\ devIce! ; YlsP-lI e .Q aJtk
~ II~ a. VI J 1'1 D t'I€ a V'e t1 ec eSSCt 2J
B.
EMPLOYEE AND AGENCY NOTIFICATION:
I. otf,c~ "f£m~c^c:,; Sz~V(~V @.. r(8cv- t>'5L- 'fS'iD
2. P',tI"/ q -91/ OVl .f;.c; li~ phtrne~ ,f e~H'~je^c.,/ SttvtÆ-h~
afl s..e-s' , ,
Ie
I .,.'
C.
ENVIRONMENTAL RESPONSE MANAGEMENT:
I, lìt;!(;p &a;..lw:" LMt(A~;"J 1'1eVM!,r;>r/OUVle,)
2. ¿WV!er-as)0I1e~ pe~VlV!el-lv kMJle !Æ"'j rCSfYl~
Of' e Wle!je>'\CJ ~~o:hO'^S'.' .
D. EMERGENCY MEDICAL PLAN:
I. Ca II q -q II lit a>'l Ô'l'le 0e 1\ /.' s bu U Ge(J.()'
2· Noi-;h¡. OWl1er/MM'èJ'ð tYleMIæí.
:3 . It' po;sMe ) ~\f\J -4v ô'Y\V"JeAC7 .
I( 4. ~æst +Þ>r;f,..1 - ~e'o/ ::buf~w~
4D oU-~verRœ-d
2 ~kvstl~(J ,CA <133( I
0"1- 063-0006 .
/
!J . '~' . , /
.
.- .¡,
HA.DOUS MATERIALS MANAGE.T PLAN
""
/,-;-..
j,~,;-~
1,,//
SECTION n.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
1. q~lfl(Á^J ~h~ Pk" is av&:'tla:~I'C: -löttUf'WlfIt)de~.
2- MSD5 5keek ¿¡r~ av¿d",W-e iöall eWlflojqeÇ. ".
Cla:ol7oVl 0.( it \ ? -42 ,I ¡., kbo-r~, of(¡ce )
B. RELEASE CONTAINMENT AND/OR MITIGATIOÑ:""'Û '
1, fÝ(Ácvð..k ð\V~ of rdeMe ofWllr1fC(',ro..j persùYll1e(.,
2-.1)ðVl (Ãf.fro~ý,,,,ié' Persarta.,/ føfeëh~ ~ vlfVl1C'/d œ(~:),
:5 · CoV\ttÅl~ rel&~ tti'\tl s~ut-oif !e{\I"v1~"'^te §oUlf[.e,
(
C. CLEAN-UP AND RECOVERY PROCEDURES:
1-3. tVlÞG..) stef ß Jtt~O~ ,.' " '
L{. Covl-þ,""IN¡2-e "",,,,1cI1.Ja-s descV"11od uI\jer fJ&>.. I~p..+(" ~ I.a:",/
rCju~~ ", '
'5" 1)1'. -Cø....-fu M'M,h' ) fD v 'f \W' "i ¡lÂÆ<- ,e-k. as M ee ~~.P .
UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
f
IF YES, LOCATION:
PRIVATE FlREPROTECTIONIW A TER AVAILABILITY
A.
'J
( B.
PRIVATE FIRE PROTECTION:i1n:~~~lSh~ l" lala,vo-~
WATER A V AILABILITY (FIRE HYDRANT): o.cvvss. Jvœx1~ Þ~ve..
3
HA.OUS MATERIALS MANAGE.T PLAN
,.~
~- ~ í':
,-' "
,.."
.--
.'
SECTION III: TRAINING
NU~BER OF El\1PLOYEES: I D
MATERIAL SAFETY DATA SHEETS ON FILE: '/ð
BRIEF SU11MARY OF TRAINING PROGRAM:
- t{d,r ~Z-W~ I i ,04+ Uplitc
- cPR. Tva~Y\e~ eMr1ofts. .
- rt~ S I VZtI V\~~ t'/1l''f\b¡ee~ .
(
CERTIFICATION
I,~lC~k~ ~lVE((j\ 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 MATERIÀLS (D1V. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND
THAT INACCURATE INFORMATION CONSTITUTES PERJURY.
!~l~
La ~ 1) YLCtor
TITLE
!llz/ol
DATE
( "^Z M^ T MNOMNT PLAN &: INSTRUC
4
')',.e
o.J
"
. CITY OF BAKERSFIEL.
'WFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
, ,
SITE AND FACILITY DIAGRAM INSTRUCTIONS
FOR
HAZARDOUS MATERIALS MANAGEMENT PLANS
These instructions explain the use of the site diagram and the fàcility diagram. Nonnally, sma11
and medium size businesses will only have to submit a site diagram. If you have subdivided your
business into smaller areas because of the complexity or size, then you will be completing and
additional detail map, tàcility diagram, for each of these areas. Include instructions that show the
route to your business it it is in a remote location.
SITE DIAGRAM INSTRUcnONS
The site diagram is used to show your busineš; and to indïcat~the businesses that immediately ,
surround your property, usually within 300 feet. If you will be showing specific area detail on~:,>.
tàcility diagrams, use the site diagram to show an overall layout of the plant. If you will not .,e::~'
submitting fàcility diagrams, the site map must include all of dië following information: .~,
1. Check the box on the top left comer of the form provided that Í11dicated "Site
Diagram".
2. Print the name of your business, as shown in your HMMP, on the top of the -,
diagram. '_.
3. Label the location of the hazardous materials and identify them by name and ~"
of hazard (ie. Flammable liquid, corrosive solid).
4. Label the location of utility shutoff points for gas, electric and water serv1ces.~
S. Label the location of fire hydrants.
6. Label portions of the building protected by automatic sprinkler systems.
7. Label the direction representing north on the diagram. (The diagram fonn
provided includes a north arrow).
J
/
.~ . ì
~
sm: DIÃGRAM~ . . FAd DIAGRAM t
BuaIneu Name: b.. C Re h\ e J I ^ -h ~.., J LLC..
Buliness Address: 5"300 WøoolVle ('e br1ire SUitt::... IDS
-
~kít r')f¡é ¡eI) CA- 933/3 'ßt..d~ ft,,'kl~~
Lot
f
I
~I
QI'
()
."2
~r-'" ~ ~ c 1\
~re.. e. D~ c-
I J
Off-l c. e ,
/
~J
;
Lu'tl\d:.
«0<):;'
Wom-e-^~
Met'l~.s
. I
6ø~"
~ ~c)C)~-'1
I, ßI,^,,~; eo~~tN"t;~
ofLt-\(.e
~. "do,""
. off'c..e
,l~J.Þ~,
(
Su\ie.. I at;" n .
-E. -:l-t. (( e .." tc:;;( , q" t,O'" ,
~
00'-0 -¡ .
~1.0 tfv..k"f
"-,
(J~r~;;j
C/
~'
Wood"YI~re. DY'lve
~1
" ·Á
g,~è.~.s
Co VI stt'\l(.1¡o:"
s~""
~
3
v
~
C-r~ ~ s
Ar(!.~
So~~
.ð
fife Hyd'rOl^-I- I
r;þ:
. CITY OF BAKERSFIELD.
OFFICE OF ENVIRONMENTAL SERVICES
1115 Chester Ave., Bake,rsfield,CA (661) 326-3979
~,
HAZARDOUS ì\'IATERIALS FACILITY INFORl\'IATION
INSTRUCTIONS
BUSINESS OWNER / ()PERA TOR FORlVI
.~ .~ '
I. FACILITY IDENTIFICA nON:
Enter the reporting period (year beginning and ending) for the facility information.
Enter the business name and site address and phone number of your business. Do not use
P.O. box nwnbers.
, ,
Enter the Dun & Bradstreet or federal tax identification number for your business.
Enter the Standard Industrial Classification (SIC) number for your business. Each type of
business has a Standard Industrial Classification code number. Some common SIC codes
are listed on the back of this page. Other SIC codes may be obtained from your worker's
compensation insurance forms, the State of California Employment Development'
Department, or by calling our office at (661) 326-3979.
Enter the name and phone number of the person responsible for operating the business. '
II. OWNER INFORMATION:
List the legal business owner or corporation name and provide the headquarter address or
residential address if owned by an individual and phone number.
III. ENVIRONMENT At CONTACT:
Identify the person who is primarily responsible for environmental compliance at the
.. ~ _ .... ..,busin..ess. j'hi~ person may be either the business owner, one of the emergency contacts,
an environmental manager, or consultänt. . - - ,..' ,
IV. EMERGENCY CONTACTS:
List the name, title, and phone numbers of two people at the business who can respond if
the Bakersfield Fire Department requires additional information or other assistance.
These contact persons must have keys or access to all areas of the facility, be available for
emergency call-outs, and have decision-making a1!thority to call on other resources (such
as hazardous waste clean-up companies) as necessary.
V. CERTIFICATION:
The business owner or operator must sign, date, and also identify the document preparer.
',,'
.1/' .
Olll,Wheat production
o ItS Com production
,e
013 I Cotton production
"
0139 Field crops, except cash
grains
o 161 Vegetables & melons
0172 Grapes
0173 Tree nuts
0174 Citrus fruits
0175 Deciduous tree fruits
>
0179 Other tree fruits & nuts
0192 General farms, primarily
, ,crop
I"
..::. "
I
0241 Dairy farms
. ,
0252 Chicken eggs
0253 Turkey eggs
ARD INDUSTRIAL CLASSIFICA
"
0724 Cotton ginning
0541 Grocery store
1541 Dry cleaners
2911 Oil refineries
3441 Welding/fabrication-
structural
3443 Welding/fabrication-
boiler
3569 Machine shop
4222 Cold Storage
·4925 Compressed gas supplier
5093 Automobile salvage
5169 Chemical supply
5511 Motor vehicle dealers
(new & used)
5521 Motor vehièle (used only)
- -- -------~- -- -. -----~
-- ~------------ --- -- --
- ---.' --------~~_._--_.- -.._--- ~ ..- - .- - . ..---
2851 Paint manufactUre ..
- ..- - -~._..
0291 General farm, primarily
livestock & animal
specialties
5531'Auto & home supply
stores
5541 Gasoline service stations
2
.
. .... ....¡.;'"
.."
. ;,..
5821 Eating places
5813 Drinking places
(Alcohol service)
5983 Fuel oil dealers
5984 LPG dealers
7342 Pest control
7532 Auto top, body,
upholstery repair
Auto paint shops
7533 Auto exhaust repair
7536 Auto glass
replacement
7537 Auto transmission
repair
7538 General auto repair
7542 Car washes
8071 Chemical laboratory
-"- .-----.-.--,.--- --.-- --- --.-< ---."-...
- -- .~- ----,--
·~7 '.1It.
ST:-\ rE WASTE CODE . . .,
" "f' .,.. j' .. 2_0
rf the: haz:mJolls material is iî wasle:enler the appro'priale California 3-digit hazardous wasle code ~L'¡ listed
01\ the: back of the Uniform Hazardous Waste Manife~t. A list of common State Waste Codes are included
on page oJ of these instructions. .
UNITS 22 I
Check the unil of measure that is most appropriate for the material being reported on this page: gallons.
pounds, cubic feet or tons. NOTE: [f the material is a federally defined Extremely Hazardous Subs lance
(EHS). all amounts must be reported in pounds. [f material is a mixture containing an EHS. report the units
. that the material is stored in (gallons. pounds. cubic feet. or tons).
DA YS ON SHE 222
List the total number of days during the year that Ihe material is on site.
STORAGE CONTAlNER 223
Check all boxes that describe the type of storage containers in which the hazardous material is stored.
NOTE: [f appropriate, you may choose more than one.
STORAGE PRESSURE 224
Check the one box that best deséribes the pressure at which the hazardous material is stored.
STORAGE TEMPERATURE 225
Check the one box that best describes the temperature at ~hich the hazardous material is stored.
HAZARDOUS COMPONENT 1 - 5 (% by weight) 226, 230, 234, 238, 242
Ifa range of percentages is available, report the highest percentage in that range.
HAZARDOUS COMPONENT 1- 5 Name 227,231.235.239.243
When reporting a hazardous material that 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 than 1 % by weight if non-
carcinogenic, or 0.1 % by weight if carcinogenic, should be reported. If more than five hazardous
components are present above these percentages, you may attach an additional sþeet of paper to capture the
required information. When reporting waste mixtures, mineral and chemical composition should be listed.
HAZARDOUS COMPONENT 1 - 5 EHS 228, 232, 236, 240, 244
Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as
defined iñ 40 CFR, Part 355;'or"N" for no~ if it is not'
HAZARDOUS COMPONENT 1- 5 CAS 229,233.237,241,245
List the Chemical Abstract SelVice (CAS) numbers as related to the hazardous components in the mixture.
m. S[GNA TURE:
Please print name. title, sign and date each chemical description form.
246
If you have any questions
please call us at (661) 326-3979
3
,
~ALlFORN[A W AS1:.E COD"
, .'
Codt: _
Description
.'
I n¡)rgan ics
III Acid solution 2 < pH < 7 with metals
(antimony. arsenic. barium. beryllium,
cadmium. chromium, cobalt, copper, lead.
mercury, molybdenum. nickel, selenium, silver,
thallium. vanadium and zinc)
112 Acid solution without metals
113 Unspecified acid solution
121 Alkaline solution pH >12.5 with metals (see
III)
122 Alkaline solution without metals
123 Unspecified alkaline solution
131 Aqueous solution (2 < pH < 12.5) containing
reactive anoins (azide, bromate, chlorate,
cyanide, fluoride, hypochlorite, nitrite,
perchlorate and sulfide anions)
132 Aqueous solution with metals (see Ill)
133 Aqueous solution with total organic residues
10% or more
134 . Aqueous solution with total organic residues
less than 10%
135 Unspecified aqueous solution
141 Off-spec, aged, or surplus inorganics
151 Asbestos containing waste
161 FÇ;C Waste,
162 Other spent catalyst
171 Metal sludge (see Ill)
172 Metal dust and machining waste (see Ill)
181 Other inorganic solid waste
Organics
211 Halogenated solvents (methylene chloride,
chlorofonn, TCE, TCA)
212 Oxygenated solvents (acetone, butanol, MEK)
213 '" Hydrocarbon solvents (stoddard solvent,
xylene)
214 Unspecified solvent mixture
221 Waste oil and mixed oil
222 Oil/water separation sludge
223 Unspecified oil - containing waste
231 Pesticide rinse water
232 Pesticide and other waste associated with
pesticide production
S;\ClJP^FORMSIIIA7.M^T F^CfLITY INFO INST,
Code
Descriotio"
241 Tank bottom waste
251 Still bottoms with halogenated organics
" 252 Other still bottom waste
261 PCB's and material containing PCB's
271 Organic monomer waste (includes unreacted
resins)
272 Polymeric resin waste
281 Adhesives
291 Latex waste
311 Pharmaceutical waste
321 Sewage sludge
322 Biological waste other than sewage sludge
331 Off-spec, aged or surplus organics
341 Organic liquids (nonsolvents) with halogens
343 Unspecified organic liquid mixture
351 Organic solids with halogens
SIud2es
411 Alum and gypsum sludge
421 Lime sludge
431 Phosphate sludge
441 Sulfur sludge
451 Degreasing sludge
461 . Paint sludge
471 '.' Paper sludge/pulp
4,81 Tetraethyllead sludge ,
491 Unspecified sludge waste
Miscellaneous
511 Empty pesticide containers 30 gal or more
512 Other empty container 30 gal or more
513 Empty containers less than 30 gal
521 Drilling mud
531 Chemical toilet waste
541 Photo chemical/photo processing waste
5S I Laboratory waste chemicals
S61 Detergent and soap
571 Fly ash, bottom ash, and retort ash
581 Gas scrubber waste
591 Baghouse waste
611 Contaminated soil from site clean-ups
612 Household wastes
4
. -r
,>II',
..~~
t ,
, ,.;
,,,. '~ '. e Â
o-~lkii~
.,.... ~ ,"..-.'.
.' CITY OF BAKERSFIEL"
OFFrl:E OF ENVIRON~IENTAL S"l'"RVICES
1715 Chester Ave., CÁ 93301 (661) 326-3979
FACILITY INFORMA TlON
Business Activities
Page 01
I. FACILITY IDENTIFICATION
FACILITY 10 # ¡For office use only· please leave bla"k)
EPA fD #
z
DBA/FACILITY NAME . .
t2.tfevneJ,~-I-/~r'\ LlL 5)00 WùtJdW1-er€ Dr/V'( I SlIlfe It>')
, .' , -..,..., . ), ,....,...-... .--, _ .,_.. ..- , . "'-'-----'- --- , ,..,--
II. ACTIVITIES DECLARATION
. 3
l)Ct~"ç'fcld ){]f'1?3L3
.. ... ....... --- -----...-..........-.-----.
"-- ..'.-_...... .. ..--..--.............
.... __...___.__.. ..4.._.._ _._......_._._. ___ -. ..-----.-- ..-.-.. .-..
....-.... ,- ..... ....... ..-----...-----.-.
Does Your Facility...
If Yes, Please Complete...
Ã:'Ï1ÄZARDOÙS 'MÄTè~IALS' - "- - ,." ..-.- .-.- ·_-·----.-ŸË"š 'ÖÑo ---·~·'-'-~--'··"OE-S- FORM 2731 (Chemical D~;~¡;~;F~ --- -. .,--
1. Have on site (for any purpose) hazardous materials at or ..... CONSOLIDATED COMPLIANCE PLAN
above 55 gallons for liquids. 500 pounds for solids. or 200 : Minimum reauired planninQ elements;
cu ft for 'compressed gases (include liquids in ASTs and : . Emergency Response Plan
USTs)? . Maps
2. Have any amount of an explosive material (other than : QVES þO 5 . Training
ammunition) on site? . Prevention
. Certifications
'"ii'" RË~GULA TED -SÜëSTÄN'CES1R'šf- ---.,--.-- ---'OYES .NO'-6~----Ö·ES 'FORM i73-f(ëh~ic:..-¡;escriPt;on F;;,;,'----·-,·,·--' ,.
Have onsite RS at greater than the threshold planning ..... RISK MANAGEMENT PLAN (RMP 5ubmillO USEPA)
quantities established by the California Accidental ..... CONSOLIDATED COMPLIANCE PLAN
Release Prevention program (CaIARP)? . Incorporating CalARP Program Elements
c.-üÑi)ï::"i~GRÖÜÑffsTÕRÄGË-TANKŠ·1Ü_šTš)----'-·'ÕVEŠ·'.NO--¡V--'-"-üšY FACillTŸ"'FÓR~1 - .. ------.,- -- -.,----.-
1 , Own or operate Underground Storage Tanks? ..... UST TANK FORM (one per Ult1k)
Intend to upgrade existing or install new USTs? ' QVES eNO 8 : ..... UST FACILlTV FORM
, ..... UST TANK FORM
'I : ..... UST INSTALLATION FORM (one per lank)
·D.-·TÃNK-CLÕ-ŠüRE7RëMõvÃL ,------.----- : QVES-.NO - -T~--UŠ'f ·TÃÑK'FÕRM(d~·~-~on~-;;.~;;;kr_·--..'
1. Need to report closing a UST that held hazardous
.materials or waste?
2. Need to report the closure! removal of a tank that was QVES .NO 10!..... TANK CLOSURE FORM
classified as hazardous waste and cleaned onsite?
n'Ë-:-AãövË··GROüNõPËTRÕLËÜM-ŠföRÄGËTAÑKŠ-iÄSTš)-QŸ~s .NO--;;-·~-"'--COÑSÕ-ÜDkfËD CÕMPÜÃÑCË PLÃN" --,.-
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. i ' Elements pursuant to 40 CFR Part 112
, -F:HÄzÄRCÕÜS"WÄSTë;'---'-' --'---'-.---;--.----.--. : ..... EPAïõ;;ùnibër::pfcjŸidë-õn this pãge- ------
1. Generate hazardous waste? i QVES .NO 12' To obtain EPA ID#. please phone (916) 324-1781
2. Recycle more than 100 kg/mo of recyclable materials at : QVE'S eNO 13'..... RECVCLlNG FORM
the same location it was generated?
Recycle more than 100 kg/mo of recyclable materials at QVES eNO
an offsite location different from the point of generation?
Treat Hazardous Waste on site?
3.
14
.....
RECVCLlNG FORM
4.
: QVES eNO
15
.....
.....
.....
TP FACILlTV FORM (DTSC Form 1772)
TP UNIT FORM (one per unit)
CERTIFICATION OF FINANCIAL ASSURANCE
! QVES .NO
I .
Consolidate Hazardous Waste generated at a remote ¡ QVES .NO
site? i
G. PERMIT CÒNsöÜöÃii6Ñ 'ZOÑË:·'--··..'..····..·- ,--- ------¡ öŸeS".NO·'
Intend to consolidate other Cal/EPA agency permits? !
(If yes. please complete Section III and attach)
5.
Subject to Financial Assurance requiremenls?
16
6.
,
111.....
..' ..I... _.
1e .....
REMOTE WASTE I CONSOLIDATION SITE
NOTIFICATION FORM
ëONSÖÜOÄTED'COMPÚÄNCË'PLAN' -. ..-.---"'-
. Incorporating all other enviror'rT1ental
permit requirements per 27 CCR 10410
~: .
./ If you checked VES to any part of Sections IIA·IIG above. then in addition to the forms requested above, please Submit OES Form 2730.
UPCF (7/99)
S:\CUPAFORMS\ACTtvlTY ,wpd
1._>~ ~~~{,;
,{"¡ "".;, , '
, All'." ,
~ --oOIIIIÂo. ,....~t_
-, :.:-:,
,....' ,'-.".
-~'I'~-~--
ÙF!E g:l~~fR~~~:~~~~L~VICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
.~
~
'.
FACILITY INFORMATION
Business Activities Addendum
Page 01
I. FACILITY IDENTIFICATION
........- -. ..-.. .. .....----..--
4'· ._. . ._.
...._-...-._--
2
OBÞJË~IŒNA~~W1~j,'~ t:'~l Lid ., 530;- Wù~plvn~;~ f)r;~e Çv:1~ -'Os ßpJ:{'r~ß(" ¡d IC4-'
___..___._.. ,_.._,_,_______.__.___..,_______"____..__._____--.!...,.!...__.._____..._ _,_'..__ __q3_~,D-..
III. CONSOLIDATED PERMIT ACTIVITIES
------'---¡s your Facility Compliance Plan subject to review by... ,for satisfying the ëõñdit¡óns of these permits?
:-~DËPAR;_MËÑTOFroXiëSüäsTÃNëëSCÕÑTRõL---OYEš-ÑO - --"-~----. '-STANDAR-óiZËÖ--PERMIT- -,- -- ------------,
, , ' ' ¡. All Modifications '
'FÁëiLlï:v 10 /I (For Offlëë use onlÿ-· -pieasëiëå~biå,;k)
.. ......_..__._......... ..__._ .. .__.._.._.....,.__..._.__._~..4_.__._._.._..·
, "
aYES .NO
aYES .NO
'v
:v
ï 'E"PÄïó ¡,
3
Non-RCRA HAZARDOUS WASTE FACILITY
, RCRA HAZARDOUS WASTE FACILITY
, --I:·SAÑ']ÖÃÕÜÏÑVALLËY"ÜÑiFiËDÃiR-põiIUTiON----- OYËS ONO -¡;..----ÃUTHÕRITYÏ'õ-ëoNSTRUCT
CONTROL DISTRICT '
QYES ONO : V' PERMIT TO OPERATE
i
.,",
:V'
;
aYES .NO
, aYES .NO
-.. ._-
I:
1
, J. STATE WATER RESOURCES CONTROL BOARD
:NTRAL VALLEY REGIONAL WATER QUALITY CONTROL
dOARD
jV'
~v
ay~~ .NO
1v
WASTE DISCHARGE REQUIREMENT (WDR)
GENERAL PERMITS
SPECIFIC PERMITS
aYES .NO
NATIONAL POLLUTION DISCHARGE
ELIMINATION SYSTEM (NPDES)
: ï<:-cÃÜFõR"ÑiÄïNiËGRA"TëowÃsrËMÄNÃGEMEÑrSõARi) aŸÊŠ' eÑõ-----'--V--REGISTRATIOÑ PERMIT
¡·L. KERÑ'COUNTY RËSOURCE MÃNAGEMENT AGENC'y--'--
ENVIRONMENTAL HEALTH SERVICES PERMITS
Domestic Water Well Permit
aYES .NO v
i
, aYES .NO :v
, , ,
I
aVES .NO ,
:v
I
aYES .NO !v
I
aVES .NO :v
I
OYES .NO iV'
!
Haz Mat Monitoring Well Permit
Septic System Permit
Public Swimming Pool Permit
Food Facility Construction Permit
Solid Waste Local Enforcement Agency
(LEA) Related Permits
i
aYES .NO I v Medical Waste Related Permits
i
, I
¡ ~CëiTy'o-FBÃKËRSFÎËLDviiÄsT=-': ,:-=:=fFfói\iiš'IÓ;;¡' ------·ÖVES- -.ÑÖ---"·T-.ï··---'·-'iÑDUSTRiÄLwÄSTËïNÃTËifõïsë¡::¡ÃRGE'
I PERMIT
NOTE:
V' If you checked YC::S to any part of Sections III-H to III·M above, then please address all applicable permit requirements in the Facility Compliance Plan.
S:ICUPAI'ORMS\ActNty _um.wpd
J<it I, IGOt
~."........, ..;;::~..."~~':":~I..I...",,,.\!,,: ... _n. '. .
. CITY OF BAKERSFIELD. '
OFFICE OF ENVIRONi\tIENT AL SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER I OPERATOR IDENTIFICATION
FACILITY INFORMATION
.~.~
''''tjk~i~
.."~ ,..--."
~
- .' _. .. ..-. .--- .. ..-.
......... .. .-..... -....
- -... -... .., ....
.,.. p~e _ . -:-: ' ~~.. ,.:-:-:-
I. FACILITY IDENTIFICATION
10'
'FACILITY 10 #, ' j ._ ,_: " Yea< Beg;M'''.~ Z ,,__'''' Yea' E""'" :ZO<>:3
BUSINESS NAME (Same as FACILITY NA~E ï DBA- Doing Business As) 3 BUSINESS PHONE .
f 1- t RelM e.~.( tÆ ì/ ~ 01:)1 LLC.-. .
S'TE ADDRESS 53°9 Wt:k,lw:'fC"': J)_CI~~,J-stJ-dc JiJ.C .' - .... . .' ..., . - . '"
CiTy.... J2t..}:::'e r "fl d J .. _ _,_... ,_ .___ _,__~c-c:A-ZIP!J.~13 ' -- ;¡,
-. .-..---.....- ....-...----.....--- --...-.--
,02
107
DUN & 106 SIC CODE c;.
'BRADSTREET "1:;_ ¿y;gOO~ ' (40~¡I#) 007 /
~~~~;~~~~f;/~~~-¡¿¡~~=~===- -~~~;~;;.~ l-b~O~
I
II. OWNER INFORMATION
O~~ER ~~E fI.., 1/; ;(;"", I¡,J, ~ '" OWNER PHON; U ¡):,m -690(.
_,..-...-..-'-.. --·..-----·----1'--·--- --------,--,---.-------.--..--------'...:---...- -". ., ---- -------
OWNER MAILING 1) d .D S . -1- ' -
ADDRESS )'300 ¡.v vð IYt ere. ("I ve, V I I e. {OS
-~---fId.~-;rJ- _-- '" ; STAT~(4- ",_-~-;-q3~Ô
\II. ENVIRONMENTAL CONTACT
¿;;-N2'A~ ~~~J'J,~ll'f,-~kl.L.b-~-':'---'-. - ,,--,-~."- C9NT':,?! ~¿~~-~~ f /rJ:¡ .þ?y"L_'"
CONTACT MAILING I ' . 11S
ADDRESS Il/OS fYl S ~
¿,~:=_ _ f5:. 'H ~~¡I ~7 [---'-----=--===--==_~ : STAT~~=:;:.:~~,,~~-'Jl~ /2. -~~:- ,;
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY.
~~~:iJ,"II'~¡~:=~- -,~~~M~k~ f1;¡-;-=-~-='=~~-===- "
:'~~~;.-S~:.~,~f1"';tr~<¡~~~~~ __,_,~~.L :~~~~~~~~~fi~fº~3i -~¿ 9~(; ----' ,,----"-" ~;
24:~OU~;~~~~ -~¿ -, ~i8i--b-¿Ÿi' ,- ,-- -- ';':;4:"~~~ ;H~~~_¡'61133 Y -/ b /1- - ... ...." ---;, I
PAGE~ . c¿ïr-(;¡--5---=ï~'v------;;.'-~~G;;; --~';r-----"-"-' f t _"¡' ~u ,- - ..- ;
108
110
·112
113
116
.....---...-.- ....._._-----_....~-------
V. CERTIFICATION
~erlification: Based on ~inqUiry of those individuals responsible for obt;¡ining the information. I certify under penalty of law that I have personally examined
3 d a amiliar with the I ration submitted in this inventory and believe the information is true. acc-.:rat", and complete.
-IGNA'r ¡¡:;)F' OwNE -, 'ERA T U -. -, - «,- ,,,,,-'-'-"- T ÕATC - - ,- ,,-- ;" :"ÄMEÖF OOCUMENT PREPMER ---" ---,
"^ E ~Rï6 ERÄ TOR' (prinl) -..--' ,'" -' ,,--' -" ';;, ¡ nTLE OF' OWNERiOPEriA J::!' f:e.. Ri ve '0., ' '" -' ' --
fU [, f gOiÁ I '1i' ~.. .. ¡ Dw"" e r- /III "'.., V ; , M e hi lo~f'
s:\CUP AFORMS\OES2730.TV4
, .
CITY OF BAKERSFIEL~
O.E OF ENVIRONl\'IENTAL IIRtVICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY-
CHEMICAL DESCRIPTION
o NEW 0 ADO
o DELETE
èf ReviSE
200
(one form øer mDlenal øer Þudatng or amd!
Page 01"
I. FACILITY INFORMATION
BUSiN~SS·[~~Ce~í~;::r~~f~ng::".tt~--'~~-~·~~-=-~·-~-"~-·.~__.~-~'-.-... .-.. ,. ..'------'.'.
_~,::~;~J~~:t --,--~4-~:'~!~f~,:1l---,-.
II. CHEMICAL INFORMATION
'--'--'-'~T' "ï' .. -, .-. ..., . .. ..--.. .--- c ..f..··---,· u, .-- -.----..----.--...,.. - - ... -"-20s-fRÄóë-ŠëëRËi ' - --- O~- ~~ - 206-
-:~:':L'=-_'-.-iktj.~ lIn~..v1I\,_ _ __~1-___ ¿ (I '\ J e L-____________,,~..~-. ':"CRA,,~,:~ ....~.:..
COMMON NAME. íJ I ' EHS' 0
________,__ e... 111m l:)--ú..8 ~ Il!.der : Yes No 208
CAS /I 1- ~/Uo -~c, - 7- 'r
'FiRE c'õõë~-éœséSfCc:mlÌløl. if requestecl by loi:aIlite chiet)
,... ,-.-.... . ----3
..- . .............--....
201 CHEMICAL LOCATION
CONFIDENTIAL (EPCRA)
2Ò3 "GRió ii (op(¡ö¡;iij -,-,
o Yes .èS1 No 202
--'-""'-';zõ.ï
__ø....________
209
·If EHS is"Yes." alllIIIOUIIIS below mull be iJI /bs.
210
l'YþË---'----·--:----- -&1-;-~;;--'D m Mlxn:;~~O:-;¡ŠTE 211 RADIOA~--'O~--~-----2;;--· cüRÎês.... --- "-~;y
.,:~~SI~~~!~-'---~--..~-~-~UD- O~.lIQU~ -&r9_GAS 214' lARGEST CONTAINER ;l;Lt/ (!k~_i.~~t?1-&;};~__~~,
r~..o~ ~p~GORIES 0 1 FIRE 02 REACTIVE è1; PRESSURE RElEASE 04 ACUTE HEAlTH 0 5 CHRONIC HEAlTH 216
----
UNITS"
217 i MAXIMUM t I
! DAILY AMOUNT ;"'2, Út It-
o ga GAl ð cf CUFT
. It EHS. amount must be In Ibs.
218 ¡AVERAGE
! DAILY AMOUNT
~~v C,,/ 1-
o In TONS
Al WASTE
A...vUNT
,¡¡:¿
219 STATE WASTE COOE 220
221 CAYS O~E 222
...2f.?£:¡. Ý'
o q RAil CAR 223
Or OTHER
o IÞ lBS
STORAGE CONTAINER
(Check aU that apply)
o a ABOVEGROUND TANK
Db UNDERGROUND TANK
o c TANK INSIDE BUILDING
o d STEel DRUM
O. PlASTICINONMETAllIC DRUM
Of CAN
09 CARBOY
o h SILO
o I FIBER DRUM
Oj8AG
Ok BOX
~I CYliNDER
Om GlAsS BOTTlE
o n PlASTIC BOTTlE
00 TOTE BIN
o p TANK WAGON
-.---....- .-.....--------.-
.----.------þ------.--
STORAGE PRESSURE
o a AMBIENT
ø aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
-.-.-- .--.-..--
STORAGE TEMPERATURE ~a~1ENT 0 aa ABOVE AMBIENT 0 ba BElOW AMBIENT 0 c CRYOGENI~
___ _n%W!__._,-_______~~~~~~~~M:.?~:NT ___, _____._.,___-+__.:.~,~_+..------. CAS #
1 __..WQL _ ~28J.J1.i 1ti JJe {IV ~_ Q~l!.1\ J ~~__~.___,...__,___J_c:_~es~NO 228.,LY-NJ£. ~Î ~_1:~_
I -11. T I',
2 230 ': 231 : 0 Yes 0 No 232 , 233
,.,.'",._., ......._.,_..L._,.___...._, _.,_..,J _,. .'__.,_ _....___..,...,..
, .......--,.,.., .,..------.. -., -.-,. .-----.,-...---.....-.---....., , ; I 237
234 : 235 I 0 Yes 0 No 236 I
..,._ ,_ ,., _. _.., , , ,..1,.. ....___.. .' _....._,. ,_..,.. ,..,_..,.,... _... ..--___..,._ ---., .-_ .- -_____,.., ...,.' . ,'-..-- ._-...¡,---...,-..-,---,---,. -..... ' --, . . ,. ,-.'-,------'
>, .- -:-/-,-----,,,--------------------- -,,,-;,-~~~:-~ :;:1 -,--- --~-= ::: ..
,______._..,.__ _J.__ _ __.__,________________., ,_..___.___.__,__.___...._ --_______________,____...._,..____
225
3
pø.;""f NAME & iirì.Ë Õj:;ÃÜTHÕRizeö ëòMÞÃ;';YRËi>REšËÑTATIVË-'
ß(ke RtverPJ
III. SIGNATURE
--- ,- -)jJJ §L-'---u ,.
... ....... .... ... ..
'---"--OATE 246-
II~/?,.J
JPCF (7/99)
S:\CUPAFORMS\OES2731.TV4.wpd
<'. ~;" ..'
Hazardous Materials Inventory. Chemical DescrIption
~{
"
.. r
.1. '
"
; J.
"
I
I
I
I
Y~.~~SI ::ompIIlIO ,I ·;"p,.,,111I H.I.:,]rdous ""alllrral, 'nvenlor, , ChemICal Description page for "ach halardous maloflal (/laZardOus subslances .Jnd haurdous welle) 11181
you handl., 'JI .,our 'ólClllly ,n , ( groq.lle '1UoInlltles tlQualrO fJr ')tealer t/lan SOO pounds. '55 .gellons. ,200cuboc feel 01 gas '(calCulated oIlSlandard remperalu,. and ør..aure)
or 'he 'fI<IlIf.1' Ihr'llno'" plann.nq .Iuolnloty for Exlremely Halamoul SubS/allCes. whlc/lever 's less, Also complele a page for eac/l radioactive malenal handled over
quanlo"el lor Nnlch ,In "mtlrl)0nev plan 's reqUIted 10 oe ·1doPled pursuanllo 10 CFR Par1s 30. -10. or 10. The complelo<l,nvenlory Ihould reneel all repOt1able quantllles
01 n.uardoul ,".lIorrall ,]1 your faclllly, 'epOr1ed 18parl181y tor each bUilding or oulslde adjacenl area. Wllh '8paral8 pages for un.que occurrences of physical stale. Slorage
remper,]lurll InL1 ,lor:lge prllssur". ,Note: Ihe numberrnq of Ihe ,nslructions follows Ihe dal3 elemenl numbers I/lal are on I/le UPCF pages. These dala elemenl numbers
3re used for "Ioc'ro",c submisSIon .Jnd are t/le lame as ~he numbeflng used ,n 27 CCR. Appendix C, Ihe BusIness SectIOn 01 I/le Unified Program Data Dictionary.) Please
number 311 Pa<)tlS of your submlllal, rhls hOlps your CUPA or AA Idenllfy w/lether thO submillal,s complele and ,I any pages are separated.
.t, FACILITY 10 NUMBER· T/lls number is assigned oy the CUPA or AA. T/liS is t/le unique number 'HhlCII odenlifies your lacllity.
3. BUSINESS NAME - Encer 1/10 lull legal name 01 the business.
200. ADD/DELETE! REVISE - Indicale ir I/le material is b~ ng added 10 tl10 invenlOry. deleted Irom the inventory. or ir the inlormation previously submItted is being revised.
NOTE: Vou may c/loose 10 leave t/lis blank ,I you resubmIt your enlire invenlory annually, "
201. CHEMICAL LOCATION - Enler I/le building or outside' adjacenl area wllere the /lazardous material is handled. A chemical thaI is stored at t/le same pressure and
lemporalure. in mulliple Iocalions WIthin a building. can be repor1edon a single page. NOTE: This inlormaCion is nol subjecllo public disclosure pursuanl to HSC
§25506, '. ,
'202. CHEMICAL LOCA TlON CONFIDENTIAL· EPCRA - All businesses w/lic/l are sub ecllo tile Emergency Planning and Community RighI to Know Act (EPCRA) must
check "Ves" to keep c/lemicallocalion information confldenlial. "I/le business does nol wish to keep c/lemicallocation inrormation confidenlial check "No'.
'--203. MAP NUMBER - II a map is included. enler Ihe number 01 t/le map on w/lic/lt/le location 01 tile hazardous material is s/lown.
204. GRID NUMBER - II grid coordinates are used, ~nler Ihe grid coordinales or t/le map Ihal correspond 10 Ihe location 01 t/le /lazardous material. If applicable. multiple grid
coordinates can be lisled,
205, CHEMICAL NAME - Enter I/le proper cllemical name associaled wil/lthe Cllemical Abstract Service (CAS) number or the /lazardous material. This should be the
Intemational Union of Pure and Applied Chemistry (IUPAC) name lound on the Malerial Salety Dala Sheet (MSDS). NOTE: If the CIIemical is a mixlure. do not
complele this field; complele the 'COMMON NAME" ftold inslead.
206. TRADE SECRET, C/lock "Yes' if the informalion in this section is declared a trade secrel. or "No' if il is nol
State requirement If yes, and business is IlOl subject to EPCRA. disclosure of the designaled trade secret infonnalion is bound by HSC §25511.
Federal requirement: If yes, and business is ~uÞject to EPCRA. dlsdosure or lIIe desigrialed Trade Secret inrormation is bound by 40 CFR and tho business
must submit a 'Subslantlalion to Accompany Claims or Trade Sec:tec:y" form (40 CFR 350.27) to USEPA.
207. COMMON NAME - Enler. lIIe common name or trade name or lIIe hazardous material « mixture containing a hazardous material.
208. EHS . Check "Yes· if the hazardous material is an Extremely Hazardous Subslatlc:e (EHS), as defined in 40 CFR. Part 355, Appendix A. If the malerial is a mixture
containing an EHS, leave I/Iis section blank and complele the section on hazardous components below.
209. CAS /I - Enter the Chemical Abstrad Service (CAS) number lor the hazardous malerial. For mixtures. enter the CAS number of the mixture ir il has boon assigned a
number distind from its components. If 1/10 mixlure has no CAS number, leave this column blank and report the CAS numbers of lho individual hazardous
components in the appt'opriate section below.
210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe 10 lirsl responders 1/10 typo and level of hazardous materials w/lich a business handles. This
, information s/lall onty be provided il the local fire CI1iel doèms it necessary and requests the CUPA or AA 10 conecl iL A lisl of I/le lIazard classes and instrudions
on how to delermine which dass a material lalls under are included in the appendices 01 Ar1k:Ie 80 01 the Uniform Fire Code. If a malerialhas more than one
, applicable hazard class, include all. Conlad CUPA or AA for guidance.
211. HAZARDOUS MATERiAl TYPE - Check the one box thai besl describes the type of /lazardous material: pure, mixture or waste. If wesle malerial. CIIec:k only that box.
" mixlure or. waslè. complete /lazardous components seçtJon.
212. RADIOACTIVE - ChecJc "Yes· if the hazardous malerial is radloactlve« ·No· if it is noL
213. CURIES ·If the /lazardous malerial is radioactive. use this area to report the activity In Curies. You may use up to ninè d'ogits with a Roallng decimal polnllo report
..' ãétMìY'n'curies. ',. - ,
214. PHY~ICAL STATE· Chec:I< the one box thai best describes the slate In which the hazardous material is handled: solid. liquid or gas.
2 f 5. LARGESr CONT AINE.R - Enler the 10181 capacity of tho IaIgOsI container in whic/I the material is stored. .
216. FEDERAL HAZARD CATEGORIES - C/Iock an cal ories thai døŠcribe the I and health hazards associated with the hazardous malerial.
PHYSICAL HAZARDS HEALTH HAZARDS
Fire: Flammable . uids and Solids. Combustible . ids. ro horic:s. Oxidizers ,Acute Health (immediate): Highly Toxic, Toxic, Irritanls. Sensitizers, Corrosives,
Reactive: Unstable Reactive. anic Peroxides. Waler Reactive, Radioactive other /lazardous chemicals with an adverso effed wil/l sllor1lerm ex ure
Pressure Release: Explosives, Compressed Gases, BIaSling Agents Chronic Health (Delayed): Carcinogens. other /lazardous c:homicals willi an
adverse effeel wilh lenn ex sure
217. AVERAGE DAIL V AMOUNT - Calculale lIIe average daily amount of the hazardous malerial or mixture containing a hazardous malerial, in each building« edjaœnl1
outside area. Caleu/allons s/lall 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 the chemical will be on site. If this is a malerial that lias not pt'oviouSIy been present al this location. the amount s/lall be the average daily amount you
ptOjeelto tie On /land during Ihe course 01 the year. This amount should be consistent willi the units reported in box 221 and should not exceed that of maximum
daily amounL
218. MAXIMUM DAILY AMOUNT - Enler lIIe maximum amount or each hazardous material or mixture conlaining a hazardous material, which is handled in a building or
adjacenVoutside area al any one time over the course of the veer. This amounl must contain al a minimum last year's invenlory 01 the malerial reported on this
page. with the reßedion of addlllons. delol/ons, or revisions projected for the current year. This amount should be consislent with lIIe units reported in box 221.
219. ANNUAL WASTE AMOUNT· If tile hazardous malerial being inventoried Is a waste. provide an estimale 01 the aMual amount handled.
220. STATE WASTE CODE .If the hazardous malerial is a waste. enter lIIe appropriate Califomia J.<Iigil hazardous waste code as Osled on the back 01 the Uniform
Hazardous Wasle Manifesl.
221. UNITS· C/leck t/le unil of measure thaI is mosl appropriale lor Ihe material being reported on Ihis page: gallons. pounds. cubic reel or tons. NOTE: If the material is a
federally defined Extremely Hazardous Substance (EHS), all amounts musl be, repor1ed in pounds. If malerial is a mixture containing an EHS. repor1 tho units that
the material is sl«oo in (gallons. pounds. cubic feel or tons).
222. DA VS ON SITE - LisllllO lotal number or days during the year that the malerial is on sile.
223. STORAGE CONTAINER - C/leck all boxes thaI describe I/Ie type or storage conlainers in whiCII the hazardous malerial is slored. NOTE;" appropriale. you may
Clloose more than one. '
224. STORAGE PRESSURE· Check t/le one box Ihal besl describes tile pressure at w/lic/lthe hazardous material is slored,
225. STORAGE TEMPERATURE - C/leck the one box t/lal besl describes l/Ie lemperalure al which the hazardous material is stored.
226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) . Enler Ihe percentage weig/lt of the hazardou· -"mponenl in a mixture. If a range 01 percenlages is available,
repor1 the highest percenlage in thai range. (Repor1 lor components 2 throug/l 5 in 230. 234.. 0 and 242.)
227, HAZARDOUS COMPONENTS 1-5 NAME - W/Ion repor1ing a hazardous malerialthat is a mixture. list up 10 five CIIemical names 01 hazardous components in that
mixlure by percent welghl (reler to MSDS or. in the case or trade secrets. reler to manuracturer). All hazardous components in I/le mixlure present al grealer
Ihan 1 % by welg/ll il non-carcinogenic. or 0.1% by welghl ir carcinogenic. should be repor1od, II more than fIVe /lazardous components are present above Ihese
percenlages. you may allac/l an additional sheet of paper to caplure I/le required inlormalion. When repor1ing waste mixlures. mineral and ChM1ic.~' c.nmoosilion
should be IIsled. (Report lor components 2 through 5 in 231. 235. 239. and 243.)
228. HAZARDOUS COMPONENTS 1-5 EHS - Check "Yes" il the component 01 the mixlure is considered an EXlremely HazardOus Substance as defined in 40 CFR,
Par1 355. or "No' itit is not. (Repor1 (or components 2 through 5 in 232. 236, 240. and 24-1,)
229, HAZARDOUS COMPONENTS 1,5 CAS· Lisl the Chemical Abstract Service (CAS) numbers as ,elaled 10 Ihehazardous componenls in the mixture, (Repeat for 2-5.)
246. LOCALL V COLLECTED INFORMA nON· This space may be used by I/le CUPA or AA 10 coUeel any additional inlormation necessary 10 meel tho requirements 01 their
indivIdual programs. Conlact lho CUPA or AA for ~uidance,
UPCF (1/99)
7
OES Foml 2731
a CITY OF BAKERSFIEL.
OFWtE OF ENVIRONMENTAL ~VICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
DNEW
200
DADD
o DELETE
. :·)~?~i;tI~~~:::~··'.;;~'~:~i::::i;~;:F~tr;3·~~::r~~;~('~7;~~-c '.
::. : ':~' ,: .~ ': ? ".;.T, <," .
(one fa,," per material per building or arr
Page or
;:;<",:-'.
:~;.._: - ".; .' ~:';t:.
,.> ;""-,'
_.' ":;":'.,-r.',.,:,'<.-
Bð.G/é ~~ I )
201i CHEMICAllOCATION
! CONFIDENTIAL (EPCRA)
203 I GRID # (opoonal)
i~(/Ir{:;;=!t{:;(",~·~H~~,£~)~~"ç~M.~~,O~,,:f¡;~e;;;,~:.;::~",.:)'::.;'., "
DYes ki No 2
DYes LðNO 2
If Subject to EPCRA. reler to instructions
&1'
(;&J
! ~JLrw
205
207
I
I
I
209 I
i
r"
COMMON NAME fI J
y rdJe-^
(
I) 10'- "7 3-.<
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
EHS·
CASt
"",: .,' . '.,.. ,"','" ,., -."
"- "-.. .' -. -,', ""-"- . ..,'. .'
O[fEHS is·Ves. . 'all ~ ¡'c¡';;"mwt bCm n"
oyes)2'No 2
TYPE P PURE o m MIXTURE
PHYSICAL STATE o s SOLID o I liQUID
FED HAZARD CATEGORIES 01 FIRE o 2 REACTIVE
(Check all that apply)
ANNUAL WASTE ð 217 MAXIMUM
AMOUNT ~ DAilY AMOUNT
UNITS·
o w WASTE 211 RADIOACTIVE 0 Yes
)rg GAS 214 LARGEST CONTAINER ~ -:20 L1. h I ~.
&r3 PRESSURE RELEASE 04 ACUTE HEALTH 05 CHRONIC HEALTH
~~L,c..fr 219
AVERAGE
DAilY AMOUNT
o In TONS
STORAGE CONTAINER
(Check all that apply)
De PLASTIC/NONMETAlliC DRUM
Of CAN
o 9 CARBOY
o h SilO
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
DC TANK INSIDE BUilDING
o d STEEL DRUM
o i FIBER DRUM
OJ BAG
Ok BOX
P CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTlE
o 0 TOTE BIN
o P TANK WAGON
2
CURIES
STATE WASTE CODE
221
o q RAil CAR
o r OTHER
STORAGE PRESSURE
~ aa ABOVE AMBIENT
o ba BELOW AMBIENT
o a AMBIENT
~~~~~~H§:Æ~:~'~f;'
o c CRYOGENIC
o Yes ~o 228
2
3 I 234
, i
~
,
4 238
: 5 242
231
o Yes 0 No 232
235 OYesONo 236
239 DYes 0 No 240
243 DYes ONo 244
UPCF (7/99)
S:\CUPAFORMS\OES2731.TV4
_ CITY OF BAKERSFIEL.
OFWtE OF ENVIRONMENTAL ~VICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
a ADD a DELETE )sf REVISE 200
·.-.,...;,¡~ff~;;~;,;;t~:;iJ:s~:;;2f?;\:,::'·::\::;:.,<,·::;{J;:~~)n..1.::~':¡;Å~iÛ-ff,1'~~H~~~t¡t;~' ':i:-:'?,)2,;j::'\ '.
, BU~e; CME ( ; ;;~ll,:1~·:B~ DOnrr£:As)
CHEMICAL LOCATION ~ I D 17 /... U 201: CHEMICAL LOCATION
.? /II 0 /II ÞtÁc. f- 4'1 t ' ! CONFIDENTIAL (EPCRA)
FACILITY 10 # I I I 1 MAP # (optional) 203 I GRID # (optional)
. "':f;·i.S:·;~X,~;:{f.:\;i,··qH~µi£~:t~F.9~,..~rI,Ò~:~U#:;é;t··):;;'::, ..',,'
aNEW
TRADE SECRET D :sw
Yes ~No 2
If Subject to EPCRA. refer to instructions
205
CHEMICAL NAME
207
COMMON NAME
EHS"
(one form per material per buUding or an
Page of
D Yes ~ No 2'
2'
Dyes B1 No 2
CAS #
::;':7 :2r - 3'1--{
:::¡'=¡82... -,/L/-:y.
209
. .- c. ,.".. ....
°ltEHS is·Ves." all ~IS bC~ IÌIust bC &i Ib'
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
TYPE
Dyes
D m MIXTURE
D w WASTE
@,g GAS
RADIOACTIVE
NO
211
p PURE
214
LARGEST CONTAINER '1.., Il/'l I'
q<..,L. '1 l.M.f? ~ n
PHYSICAL STATE
D I LIQUID
D s SOLID
FED HAZARD CATEGORIES
! (Check all that apply)
ANNUAL WASTE
AMOUNT
¿ç 3 PRESSURE RELEASE
o 4 ACUTE HEALTH
o 5 CHRONIC HEALTH
01 FIRE
o 2 REACTIVE
217
MAXIMUM
DAILY AMOUNT
~~L~f~UNT J-:¿ V ~ L l(. !'J
o Ib LBS 0 In TONS
-£7.
UNITS"
STORAGE CONTAINER
(Check all that apply)
D a ABOVEGROUND TANK
o b UNDERGROUND TANK
Dc TANK INSIDE BUILDING
o d STEEL DRUM
De PLASTIC/NONMETALLIC DRUM
Of CAN
o 9 CARBOY
o h SILO
o i FIBER DRUM
OJ BAG
o k BOX
&,1 CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTLE
D 0 TOTE BIN
o p TANK WAGON
',.'::
212
CURIES
219
STATE WASTE CODE
221
DAYSONS
1'"rë . r
o q RAIL CAR
o r OTHER
STORAGE PRESSURE
'sa ABOVE AMBIENT
o ba BELOW AMBIENT
227 o Yes~ No 228 1'1--3'1-
231 o YesÅNO 232 t2 -l/y -
235 oYesDNo 236
239 DYes 0 No 240
243 DYes oNo 244
o a AMBIENT
o ba BELOW AMBIENT
<~~~~\~i~~~~~ j~~~~~~H])~Jr¿·iYT
2
3 I
:... i
,
4 238
,
--
: 5 242
o C CRYOGENIC
UPCF (7/99)
S:\CUPAFORMS\OES2731.TV4
. ..r...tL....;.;....:;..;~"",:'1I;Jõ~..u.·.w :·~I_": .,'.. . ..
..~ ..,'
~ . i·
:" ": 1
CITY OF BAKERSFIELD' ,
OFeE OF ENVIRONiVlENTAL .VICES
,1.715 Chester Ave., CA,93301 (661) 326-3979
BUSINESS OWNER I OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page _ or _
,. ... ..... . - .. _. .. .._~ .--- - .-_.
......-......-...--.... _.. ..... -.'. .~._..
.'·P'· ....... ...
. . ..-.. ..- "P
I. FACILITY IDENTIFICATION
FACILI.~ 10,# , ' ~,j.. "._ ,. ..... ,~ 1 ¡ Y~ar Begi~ni~~~ Z
BUSINESS NAME (Same as FACILITY NA~E 'f DBA· Doing Business As)
f?- t ?e,.VVI e~',(Ã 11; ~I LLC... .
SITE ADDRESS~3 ~q. Y)òð_d _~,f.,C~.._!2C,,~~uJ-'u.?v._d~
CITY.. _,. ....I.?,~, Ke r~f) ëJ J . _ .._ m" , ___,_ ...._.. ,___.:
100 Year Ending .., ~
^Dct::>
, -,.,. ._, :, -. BUSINESS PHONE .
101
102
loÇ-
103
. -.--....-- p..
- ... .-. .-. - .
..... -.-.- ...
104
CA
ZIP q33 ).3
105
. -...-------.---.---..... _. ..-.-,----- .-. .-.------..- ...--..----.-.--- .--.-.--
DUN&
B~~~!RE_ET _oJ "1 ~_.Q~QQ..rr__.__,.,_,_..__..____ _._..___
I COUNTY, '[Se rVl
~~;¿;~;'~AME Ph; /.J i IJ 'G-ða./-;:;-;-;;----------·
I
106 , SIC CODE
, (4 Digit #) &t) 7 I
107
.... -- -.--.-.-------.
108
109 : ~;;~~OR·PH;_NE ~b7/i3'-bC¡o'
110
I --.-------.------
114 ¡ STA~_~_ ZIP 93~(3)
III. ENVIRONMENTAL CONTACT
c:?~!~?i:.~~.:.J1~.ll,!~.._~60k.L~X~-.H-~-"-.-""-: - ___ ~.._~.~7_ ??NT~~!.~~?~-~~.~_~ tlrY:¡ ;£&.~_,__~1~
CONTACT MAILING f I 119
ADDRESS J!iE.ç YI S ~
~~!~=~=._ I?c.!;g ~'~I-I~-ïJ -.- ·-------==~=~___~j.:TAT~.0 .,=,~;~__~.~·_~..~~_2~3(2-__=:~~-· 1;;~.
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
~;~~-'-=rh I' { JI;f-~¡:;;~~-'~-· ";'~~i~;;-M*~~ K1 v~~;;~~~~~-=~~=-===- 129-
:J~;~;;;~:o':.~~:i~;3r~1'í:-2c-"'&!'" --,;;~ :;;;~~~;~~~~f~f9~i'~ 9~~ -----,----,--p~: .
.' ,'.,., ."....... .,_..._._, __ ....._,. ,.' .__, ..'__, ._. _ .._...', __.... .. '.... ... " .." _,. '.' ... _,_,. __ J. ,_, ."H' " .. ,. ..., .-.. ..,... ... ..,.. '. .,..--.-
24-HOUR PHONE ,(pC:, ( - 587 -6~~ 127 : 24-HOUR PHONE bb / - 53 c¡ ~I ó I J
PAGE~# c¿ïr-'-(,-,-T----5-~q·=·--¡Lf7D-..-..--·--~;~·--;~G;;';·--~;t7"---~~-ï"·-~f(p -'ï'!i:'~~-· n. .'.. .. --- ;;;-
II. OWNER INFORMATION
-i~~.~~_~~~_~.__._/1t J1'~r" G~l t.J'~~_.__'-'_" ____._.._____:~_~~e..~ ~~~.~~. Gf!..tl.~~ 1 -690~
OWNER MAILING' J j) S . J- . 0 -
ADDRESS 5""300 kJ òù Ýi'I ere. . YOl ve ) VI I e. f S
. -~--'.f[~L< rs-';-;[d
112
113
116
132
V. CERTIFICATION
-.....-....þ.- ---..-------.-.----
c.:ertification: Based on m inquiry of those individuals responsible for obl;:¡ining the information, I certify under penalty of law that I have personally examined
a d a amiliar with the I ~ alion submitted in this inventory and believe the information is true. acc:.:rat€:, and complete.
IGNArË1:>Þ'ÓWÑE -. ï~RÄT" -' --, - -.... ··'·..·'·-·----'·-·-TÕÄTË··..-- .-" ··-'-"1-34-~-NAMË·ÖFDOCUMËNT"PREPÃRËR·"---·_··_-;-:is-·
, ,......·-,·,-···I:i'¡ TiTLE or:·OWNER1åPEAAt:!.I/<e..- Rtver?:j, . .... ...N' 137
. 6-o~ /~!.t ~ '. ... . i Ów"" e r~M a..., tJ ;, IV1 e m lo~" ..
PCF (7/99)
S:\CUPAFORMS\OES2730. TV4. wpd
· > ':~: ~ :~
.';'~:: ,i.iness qw!,erìbpe~a'or Ide~\If)_n ,~':"" 'f'4i
Plea~'5~~mlt the Business Activities page. thjJ, Business Owner/Operator,ldentillcallon page (OES F~73O). and Hazardous Materials, Chemical",
Descñøl{ò:n pages (OES Form 2731) for aJlhazardous materials inventory submissions. For the inventory to be considered complete
this pag¡, must be signed by the appropriate individual.'
'oîè;:;.rh.è,numbenng of the instnJctions follows the data element numbers. that are on the UPCF pages, These data element numbers are used
.Jr eìèclÍ'onic submission and are the same as the numbering usØd 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 ID 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. (YYVYMMDD)
101. ENDING DATE· Enter the ending year and date of the report. (YVYYMMDD)
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 zip code of business site. The extra 4 digit zip may also be added.
106. DUN & BRADSTREET - Enter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling
(610) 882-7748 or by Internet.
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 whid;1 the business site is located.
109. BUSINESS OPERATOR NAME . Enter the name of the business operator,
"0, BUSINESS OPERATOR PHONE .- ~ter businëss operator phone number. if different from business phone. afea code first. and any extension.
",. OWNER NAME· Enter name of business owner. if different from business operator. - ,
112. OINNER PHONE· Enter the busineSs owner's phone number if different from business phone. area code first. and any extension.
113, OINNER MAILING ADDRESS - Enter the owner's mailing address if different from business site address,
114. OINNER CITY· Enter the name of the city for the owner's mailing address. '
115, OINNER 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 ptione number. if different from Owner or Operator. at which the environmental contact can be contacted. area
, code first. and any extension. .'
119. CONTACT MAILING ADDRESS· Enter the mailing address VrtIere all environmental contact correspondence should be sent. if different from the
", site address.,
20. CITY - Enter the name of the city for the environmental con~_cÞs maiDng address. ' ',,'" --
121: STATE· Enter the 2 character state abbreviation for the environmental œntacÞs mailing addresS.
122. ZIP CODE· Enter the zip code for the environmental contacÞs 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 involving
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 /he 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, PHO~E ~ Enter a 24-hour phone number for the primary emergenëy contact. ,The 24-hour phone number must be one which Is
answered 24 hours a day. If it is not /he contact's home phone rn.mber. then the service answering the phone must be able to
immediatelý contact the individùal stated above.
127. PAGER NUMBER· Enter the pager number for the primary emergency còotact,1f 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 avaUable. The contact shall have FULL faality access. site familiarity. and authority to make decisions for the business
regarding incident mitigation.
129. TITLE - Enter the title of the secondary emergency contact. '
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 be one which is
answered 24 hours a day. If it is no! the contact's home phone number. then /he 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 LOCALLY COLLECTED INFORMATION· This space may be used for CUPAs or AAs to collect any additional information
necessary to meet the requirements of their individual programs. Contact your local agency for guidance.
134. DATE - Enter the date that the document was signed. (VYYYMMDD)
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 OWNER! OPERA TOR OR DESIGNA TED REPRESENTATIVE· The Business Owner/Operator. or officially designated
representative of the Owner/Operator. st>:,1I sign in the space provided, This signature certifies that the signer is familiar with the
information submitted and that based on the signer=s inquiry of those individuals responsible for obtaining the informadon it is the
signer=s belief that the submitted information is true, accurate and complete.
137. TITLE OF SIGNER - Enter the tiUe of the person signing the page.
550 (j /¡}07Jdn<-ß/vL Û.~/ dic~~r
.
, ÌÀM t~ IfL.
tkre ~d'~ ~ I '1wV\t\ ~t-""" YD IÆ l~~ f'1 ~ t J) ,
J~ yo" ~\~\r€- 7 1 ~*~s )fl~ Cß-Ll r¥\Q. rt
<?>1-blOb '~Ñvkç
"
HIke ~v~Ú\
E2C REMEDIATION, LLC
ENVIRONMENTAL I ENGINEERING CONSULTANTS
Since 1970
. 1 Tel· 661 831 6906 Fax: 661.831.6234 Toll Free: 800.339.4952
5300 Woodmere Drive" SUIte 105, Bakersfield, CA 933 3 . 5 ~O ~ . 408 327 5707 Email: E2C.Remediation.LLC@sbcglobal.net
Corporate Office: 382 Martin Avenue, Santa Clara, CA 95050 Tel: 408.327. 7 ax. , .