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HomeMy WebLinkAboutBUSINESS PLAN SITE DIAGRAM ~< BUSiness Name: A" T. S, it 4- ," '. / , / '" I, FACIUTY 'AGRAM ÀvrOIk h- TI c. .,-R.A¡U SM. ,-;.'>-,.>-0 s¡:S/ó/,c.c:; 3usiness ACOress: {j ¡J ((,),J ÞcJ ror Offiee Use Only r:irST In Sterion: Area Meo ;; ~t NORTH 0 Insoecjon Stcjon: (: .J , , I I t I I ¡ -< :J \!> ! "i. ") ~ .... '-J , ;j i ~ i ~ ( ¡ 0 , I -. i -'J >( ... -~ 'x: 11 r I~ I 'f- V Ad..-L.cs..Y ~p A,. ~ SToJG --- i t4 UN IO,J c,J~1£ 0'..... .. I or.-"t ! êwz.. Ac£~ \ "ù~T" \ fl::~~{Ð \1 ATF I . \. ¡ i ~' : ~ I ' i (;.) ),s~ Y." ,¡>I\¡2.TS ~! at.... ! i . I i ~ I I A ' ï. S. 5 f-{.oP - ~,æl ;JS",i> ßY >¡)~ ',)11<>1"> I ¡IO () ¡o,J i\),j c,C,VTQ. Y "s R.v ¡<:Co ÇJ A . f\- i J I <L "t ¡ £ (' 1.0 ~ c t c::,J(~ 6.<£.- . ~ v) , \0 ,. cl /. r KV ~Tc-'¥'-.A&C I: © r I j I I i .¡...-. I ,... ,<. y- , }' .L' '" A. ~ ~" .~ , ifl(,(..Ä ¡"NN M'OTG£.. ./ Per... it , . Ii: to Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: rdous Materials Plan ~;[9round Storage of Hazardous Materials "mqagement Program "",'"", Waste 114 PERMIT ID# 015-021.Q01731 A T 5 AUTOMOTIVE TRANSMI ' LOCATION Issued by: UNION Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rdFloor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 ' *~- ph Huey, ffiee of ental Servi es Approved by: Expiration Date: June 30, 2000 1--- ..'" " ~~.,. . It ~c.t .;X CITY OF BAKERSFIELD FIRE DEPARTMENT JDl\ n ~ A.···~Q'~· ~' OFFICE OF ENVIRONMENTAL SERVICES (' ~ UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ? INSPECTIONDAA-"3tJ-1i PHONE NO. BUSINESS ID NO. 15-210- 2--1, ðtJO 00/73 I NUMBER OF EMPLOYEES e Section 1: ~outine Business Plan and Inventory Program D Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy ~Il~ Iyç f?J1/'~ (tJfÇ~) Verification of inventory materials /)~ / l (J\ I If) I \1 (AJ, ~ % 'S Verification of quantities v'V' I"v v v ...","/1,1 ' '\ Verification of location I ¡{)CA11 D~ 1\.__ / Proper segregation of material ~ Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes DNo White - Env, Svcs. Yellow - Station Copy Pink - Business Copy Questions regarding this irispection? Please call us at (805) 326-3979 ,a-· ~~ - ,L Manager : Location: City 114 UNION AVENUE BAKERSFIELD - ~I~(C~ÜW~ e TRANSMISSION ' nl SiteID: 215-000-001731 JUN 23 1997 III) ... '/"', I.:ii lsPhone: ( 805) 322 -8 06 0 13 // M lp : 103 CommHaz : Low ~y G~id: 32C FacUnits: 1 AOV: ~/ ' A T S AUTOMOTIVE CommCode: BAKERSFIELD STATION 06 EPA Numb: SIC Code:7537 DunnBrad: Emergency Contact / Title Emergency Contact / Title VERN HAMM / OWNER JACK GENTRY / CO-TENNANT Business Phone: (805) 322-8060x Business Phone: (805) 323-9456x 24-Hour Phone : (805) 366-0590x 24-Hour Phone : (80~) 832-1920x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Agency-Defined Topic Title :1 p= Hazmat Inventory f== MCP+DailyMax Order One Unified List i All Materials at Site i SpecHaz EPA Hazards DailyMax MCP F P IH G 250 FT3 Hi F IH DH G 249 FT3 Low F DH L 110 GAL Low F DH L 60 GAL Low Hazmat Common Name... PROPANE OXYGEN WASTE TRANSMISSION FLUID TRANSMISSION FLUID I. J~ Q NO vJ ~l'l M""- Do hereby csi1i~ tha~ I !have (Type or print nama) reviewed the attached hazardous materials manage- mentplan for-ß ~.. and that it along with ~SineSS) any corrections constitute a compls~e and corred man- agement plan ~or my iacility. , . l\ ~ 0.-- Signature '-~-97 \!1s1t::> -1- 06/02/1997 -.- e -- FAT S AUTOMOTIVE TRANSMISSION p= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME PROPANE SiteID: 215-000-001731 l Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit PROPANE SPACE HEATER INSIDE WORK AREA CAS# 74-98-6 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS STORED AND IN Lrgst Cant. this Lac FT3 DailyMax this Lac FT3 DailyAvg this Lac FT3 250.00 250.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 USE HAZARDOUS COMPONENTS ~ CAS# 749861 [ l~~~öo[propane -2- 06/02/1997 ".- e e FAT S AUTOMOTIVE TRANSMISSION F Inventory Item 0003 == COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-001731 ~ Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit WELDING CART INSIDE CORNER OF WORK AREA. CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 249.00 249.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 " -3- 06/02/1997 e e FAT S AUTOMOTIVE TRANSMISSION f= Inventory Item 0002 == COMMON NAME / CHEMICAL NAME WASTE TRANSMISSION FLUID SiteID: 215-000-001731 , Facility Unit: Fixed Containers at Site l Days On Site 365 Location within this Facility Unit OUTSIDE NE END OF BUILDING. CAS# 221 STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK AMOUNTS STOR D AND US Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 110.00 55.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL E IN E HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Transmission Fluid (Petroleum-Based) No 0 100 115 ir0 ~ q ßdv(l.... G D-r;Nk ('()lJ"'" On . ~ _ - í \\ . rJ'JiiUlP- J~ '-Ò-~ (Y\~J .~ CULO ~~ &~~ T~L, -4- 06/02/1997 e e FAT S AUTOMOTIVE TRANSMISSION f= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME TRANSMISSION FLUID SiteID: 215-000-001731 ~ Facility Unit:· Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit CAS# o STATE'- TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 60.00 55.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Í"lt. EHS CAS# 100.00 Transmission Fluid (petroleum-Based) No 0 -5- 06/02/1997 e e FAT S AUTOMOTIVE TRANSMISSION I f= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-001731 1 Fast Format 1 Overall Site 1 02/28/1996 TELEPHONES IN OFFICE CAN BE USED TO CALL 9-1-1. Employee Notif./Evacuation 02/28/1996 VERBAL NOTIFICATION SUFFICIENT TO INDICATE EVACUATION. Public Notif./Evacuation 02/28/1996 NEIGHBORING BUSINESSES WOULD BE NOTIFIED TO EVACUATE THE COMMON YARD THROUGH THE SW GATE. Emergency Medical Plan 02/28/1996 FIRST AID KIT IN BATHROOM PREFERRED HOSPITAL: MEMORIAL -6- 06/02/1997 e e FAT S .AUTOMOTIVE TRANSMISSION I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-001731 ì· Fast Format =t Overall Site 1 02/28/1996 RELEASE PREVENTION STEPS: WASTE FLUID DRAINED FROM FUNNEL STAND INTO WASTE OIL CONTAINER. Release Containment 02/28/1996 ABSORBANT MATERIAL AVAILABLE TO SOAK UP SPILLS. WASTE OIL DRUMS HAVE SECONDARY CONTAINMENT PAN. Clean Up Other Resource Activation -7- 06/02/1997 ~ . e e FAT S AUTOMOTIVE TRANSMISSION I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 215-000-001731 1 Fast Format l Overall Site 1 I 02/28/1996 NATURAL GAS/PROPANE: N/A ELECTRICAL: BEHIND E WALL OF BUILDING IN CARPORT. WATER: METER VALVE IN GROUND NEAR UNION AVE. Fire Protec./Avail. Water 02/28/1996 FIRE EXTINGUISHER IN SHOP. Building Occupancy Level -8- 06/02/1997 . .;; , ,. . e FAT S AUTOMOTIVE TRANSMISSION I F Training Employee Training SiteID: 215-000-001731 ì Fast Format ì Overall Site ì 02/28/1996 NUMBER OF EMPLOYEES: 0 MATERIAL SAFETY DATA SHEETS ON FILE: YES BRIEF SUMMARY OF TRAINING PROGRAM: N/A Page 2 r I I Held for Future Use Held for Future Use -9- 06/02/1997 ,. . e - __ BAKERSFIELD CITY FIRE DEPJ{RTMENT HAZARDOUS MATERIALS DIVISION 1715 ·CHESTERA.V£~ BAKERSFIELD, CA. 93301 . \ 'Ì 7' , I. To avoid further action. reTurn ¡his form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLiSH. ~ Answer the auesTions below for the business cs a whole. JI~( Se brief and concise cs Dossible. HAZARDOUS MATERIALS MANAGEMENT PLAN (!f2 L TØ2& 6- 111 LO INSTRUCTIONS: 2. 3. ~ -. SECTION 1: BUSINESS IDENTIFICATION DATA 3USiN~SS NAME: A~ T. S, AUTOMATIc.. -rQA-NStt-TISS/o--V S8t.vI<:E LC::C';7¡ON: ) 14- UN (0.....) ,ÅV ;'v1 A; L)¡'J G ACe RES S: s~€ I' <:¡:-'{: 57 A Té: Z¡P: ~ ~3D7PHONE: :5 z<.- ~ObÒ '=:'¡r' '--'t")o;:,7S-3>7 ...... '-' --~ _. =U:~ &. =R,~2S¡KE:=7 NUM6E~: ,= ~ ¡;viA¡~Y ,Ä, C~;V\T'(: 2WN::R: V Ea...f\J l-fAIVIM .""1,:',, ~: ,\; G:., =: =: ~ ::: s : ( D I Z. <6R-C-$"k....X~D Q3.SÔ6 Sr:C7!CN 2: ~MERGENCY NCT¡F1CAT10N: CONTACT -'-1 - BUS. PHONE 24 HR. PHONE ¡ il...= ì. vGr¿/v f.-./4YVl tv? ð u..)A.)éfL :1'2.. 2 -<:6QÇO s'=>6 - òç-C;o 2. J Ä<..K. c;.ci\JiR.. <.¡ Co- TGtv/\Jl.1rJT 3. 23,-44.Ç6 ~-3 '- - 1<12.ð 1. . - ............. .......I;;;.¡,\.4. ...:.u. C;; J...II::: U ¡.. . Itzaràous Materials Division ,.. HAZARDOÙŠ M~TERIALS MANAGEMENT PLAN I ,\ " . '- SECTION 3: TRAINING: NUMBER OF· EMPLOYEES: ð MATERIAL SAFETY DATA SHEETS ON FIL~: YEs BRIEF SUMMARY OF TRAINING PROGRAM: fJ/4 R.V.'s_ ..7 wèiéomé ~ AUTOMATIC TRANSMISSION SERVICE Growing , Available Vem Hamm Owner (805) 322-8060 \ 114 Union Avenue \ Bakersfield. CA 93307 J SECTTON 4: EXEMPTION REQUEST: · CE~ïíFY UNOE~ PENALTY OF PERJURY THAiMY BUSiNESS IS EXEMPT FROM THE ~::?ORnNG R::';:UIREMENTS OF CHAPTER ó.95 OF THE "CAUFORNIA HE.A.LTH & 3AF:::Y CODE'! ~CR THE FOLLOWING RE.A.SCNS: WE SO ,\JOT :-iANDLE ~Al';RDCUS MAï=~IALS. 'NE SO HANDLE HAZ.A,ROCUS ìv1A iERIA.LS, 3UT THE QUANïliíES AT NO ~¡ìviE=:<CE=c) THE MINIMUM RE?CRìlNG QUANTITIES. ~-:.....:=:-: /~= ¡:;-''='I cc ~ ~ r"\ 'N' -- J I . _." \....... I _ _ H I 1'< 1.... \...... \...... I ) SECTION 5: CERTIF¡C,\TION: ;, \JGd-N AA-Y"l1'V1 CERT1FY THAT THE ABOVE INFOR- ;\1AT!ON IS ACCURATE. I UNDERSTANO THAT THIS INFORMATiON WILL BE USED TO FULFILL MY FiRM'S OBLIGATIONS UNDER THE "c';UFORNIA HEALTH AND SAFETY CCDE" CN HAZARDCUS MATERIALS (OIV, 20 CHAPiER 6.95 SEC. 25500 E7 AL.) AND THAT INACCURATE INFORMAnONCONSTlTUTES P~RJURY. cl~- v~ SIGNA TURE TITLE z I g /96 DATE Öl.ù¡VE:.R. ,.., t q ! - r . '-', '. .. ..- - -- - ~ -- .azaràous Materials Division. ' HAZARDOUS. MATERIALS MANAGEMENT PLAN Facility Unit Name: A - T" $ ~ SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: -r.ELéP~~S. (/'J oF¡::·c€. C.4;J ßE U'SEO (b CAlL q -(-I 3. E:MPLOYE= NOTIFICATION AND ="/ACUAï!ON: U E'?-'3A L- rJ O'll r=l C.A Ie.."""'; <;:,u J;FI C,J{~t\J r to l AJ I '( I ð ...-E l;;;V4<..<.J .A" c).,./ C. ?U6L~C =\1 ACUA T¡ON: NE::e&14t?on,'\l& ß()S(lvESs~s ~o 1~6 I\JO'n t="1(9) Ì""Ò E\JA:<..ùA-TE "'f)-{C;: COt~f'I1.6..j ÇJAA~ ~c..J6-i-l '114G SvJ GATE_ ...... =~¡1E~G¡:NC,( MEDiCAL i=~,':'.N: F,f¿Sc Alo Kit ,,.J 'f.A-~ Pi<C-P~Q..&D c:pI.,e>'5Þ, Î AL-·. /"'lC-vVlCJ(ttLJ..L ,1. :V1~ · Bakersfield Fire Dept. . Hazardous Materials Division .....-... 1 r HAZARDO'US MATERIALS MANAGEMENT PLAN SECTtON 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: (,,)JA<; TË FLU: C> 'D.eA<^-'EO ~ r::-UI\INf;t..; STAN 0 (NTh W.A"'T~ 01<- CcrJTLl1l'\/G'L 3. REl=ASE·CCNTAINMENT AND/OR MINIMIZATION: þ...ß5o<l13.A¡J'í IYIIlTCItI/.t(.. Av'A/c...AßLf: 4'"D Sc>A/< uP sP'us .. WAÇTE 01<'" D(l.ù/V1s l...(þU¿ SEc:<>!\JI)A~y CðN-rÄ.NI'Lt(;,./'l fA,..) ......... '-' . CLE..l,¡\j-UP ?ROC:=:JURES: I W P. '> <íG C)I L,. f<()CêD () P ß. ~ 8J~z.GC-A.J oIL W(.,t 7 SECTION 8: UTILITY SHUT-OFFS (LCCAïION OF SHUT-OFFS AT YOUR FAC!lITY): :\1 AT U R A L3 ,-\ S ¡ PRe P ,A, N E : ¡J/Á =~=~~~R ¡C,;~: IS E'1-+' N D E uJ.6. l,.(... of:- ß<..O &- ¡..J CA«.. Pò/l..-r ';V A ïE~: Mé:'q:E/L VALVE IN 6/ùNf'Jð ,vC-AIL V"tV,ùN ¡....J S?~í~:AL: LCC:< 3CX: '(r::S/NO ¡:: yr:;s, ~OC,;ï!ON: I. SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABILlTY: A. PRIVATE :=¡RE PROTECTrCN: Ç.R.-G G-X:-Tl~/.J.)I~rJBL 11\3 :>+60P B. WATER AVA¡LABIUTY (FíRE HYDRANT): " BAKERSãlELD CITY FIRE DEPARTMENT HAZØDouSMATERIALS INVE~RY Page_of_ . 1,- ~l . q 3usiness Name A,TÍ'-~ Address i ; CHEMICAL DESCRIPTION 1) INVENTORY STATUS: N_t;4 Addition ( ] Revision ( ] Deletion ( J Check if chemical is . NON TRADE SECRET [ J'" TRADE SECRET [ ] 2) Common Name: .A.:JT() /VI þ..:¡ I G.- -rR.Ar-J ,,:>,..,., ( ~ s' òrJ ÇLOI fJ 3) DOT II (optionel)- , Chemical Name: AHM [ ] CAS II 4) PHYSiCAl & HEAlTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ~ Reactive ( J Sudden Release of Pressure [ J Immediate Health (Acute) ( ] Detay.d Health (Chronic) ( ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE zk:. 6) PHYSICAL STATE Solid ( J Liquid ~ Gas ( J Pure {.SJ Mixture ( ] Waste ( ] R8dioa:tMt ( ] 04EC/lAI.L )jAr Al'RY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: GD Ibs ( ] gal ~ !t3 ( ] a) Container: Average Dally Amount: 5'"<;.- curies ( ] b) Pressure: Annual Amount: ¡be> c) Tempel1ltUre: Largest SizeContainer: # Days On Site Circle Which Months: All Year, J, F, M, A. M, J. J. A. S, 0, N, D 9) MIXTURE: List COMPONENT CAS II %WT AHM the three most hazardous 1) ( ] chemical components or any AHM components 2) ( ] 3) ( ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ["! Addition [ ] Revision [ ] Deletion [ J Check if chemical is a NON TRADE SECRET ( ] TRADE SECRET ( ] 2) Common Name: t..0A'STt T A~1A115'5> ~ ¡¡:::-L U I C> 3) DOT II (optional) Chemical Name: AHM ( ] CAS II 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire (Ø" Reactive [ ] Sudden Release of Pressure ( ] Immediate Health (Acute) ( ] Delayed Health (Chronic) fà 5) WASTE CLASSIFICATION 2 '2...1 (3-digit code from DHS Form 8022) USE CODE 4ð 6) PHYSICAL STATE Solid [ J Liquid ~ Gas [ ] Pure [ ] Mixture ( ] Waste ii+ Radioactive [ ] C>iECI< ALL THAT APA.., 7) AMOUNT AND TIME AT FACIUTY 1/6 UNITS OF MEASURE 8) STORAGE CODES 6 Maximum Daily Amount: ibs [ ] gal +-t 113 [ I a) Container: Average Daily Amount: S!;' curies [ ] b) Pressure: ( Annual Amount: "(;>0 c) Temperature: 4 Largest Size Container: S-S' # Days On Site 3bS- Circle Which Months: All Year, J, F. M, A, M, J, J, A. S, 0, N. D 9) MIXTURE: List COMPONENT ~(..Ù'Ç> CAS II %WT AHM the three most hazardous 1) W'A<=.:>T¿ 1'<.twVS,t.. ( Sç. (~ [ ] chemical components or any AHM components 2) ( ] 3) [ ] 1 0) Location C>v"tS\ DE NE e·-0 D o-ç: ~l) G- I certi1y under penaJty of law, that I have personiilTy examlliiiiT and am tam/llar WIth the mfomatJon submItted on this and aJI atlaclled Clocuments. rIiiilíeve tfje submitted information is true. accurate,and complete. \/82.AJ J-lAm M . OvtJAiet<.... PRINT Name & Title of Authorized Company ~epresentative -1' L --j a- ~gnature À -<f- c¡£ Date ..........3D. ,., NGIØIY LEPCITIlfirllQMDRRI BAKERSFlfiLD CITY FIRE DEPA"eNT··' HAZAR!bUS MATERIALS INVENTORY . ) ,. ¡ Page_of_ t CIsiness Name A - T, 5 ~ Address ( l4- ÙNt~ CHEMICAL DESCRIPTION ., 1) INVENTORY STATUS: N_ ~ Addition ( ) 'Revision ( ) Deletion ( ) Check if chemiceI is. NON TRADE SECRET { ) ',TRADE SECRET ( ] 2) Common Name: ð'i.-tJ6-0J 3) DOT # (optional) -. Chemical Name: AHM ( ) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ( ) RelCtive ta Sudden Release of Pressure of'] Immediate Health (Acute) ( ) Delayed Health (Chronic) ( ) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 4"L 6) PHYSICAL STATE Solid ( ) Uquid ( ) GasWt Pure (téJt Mixture [ ] Waste ( ] RadioCMI ( J. OlEO( AU. 'THAT APPt., 7) AMOUNT AND TIME AT FACIUTY ''2...4 q UNITS OF MEASURE 8) STORAGE CODES 4 Maximum Daily Amount: Ibs ( ) gal [ ) ft3 ~ a) Container: Average Daily Amount: 'Z.. 4- 't curies [ ) b) Pressure: z.. Annual Amount: ~., c) Temperature: 4- Largest Size Container: Z ~ # Days On Site --:S6S- Circle Which Months: All Yeer. J. F. M. A. M. J. J. A. S. O. N. D 9) MIXTURE: Ust c> xY(';;,-C--N COMPONENT CAS # l~ AHM the three most hazardous 1 ) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 1 0) Location We0)/~'G CAe.-ï /V SIDE ¡..J6 c/l-AJ t?- z::+ 0->~K M-EA CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New~) Addition [ ] Revision [ ) Deletion [ ] Check if chemicel is a NON TRADE SECRET [ ) TRADE SECRET [ ) 2) Common Name: t'RoPAN'E 3) DOT # (optional) Chemical Name: AHM I) CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ~ Reactive [ J Sudden Release of Pressure f4+ Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE ~T'.-JCr 6) PHYSICAL STATE Solid [ ] Uquid [ ) Gas I"f Pure [4t- Mixture [ ) Waste [ ) Radioactive ( ] CHfCJ< AU. T}lAr APPLY 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES 4- Maximum Daily Amount: '2 S-ö Ibs [ ] gal [ ] ft3 ~ a) Container: Average Daily Amount: ~ curies ( ) b) Pressure: 2- Annuai Amount: c) Temperature: 4- Largest Size Container: '2.~ # Days On Site 3bÇ" Circle Which Months: All Yeer. J, F, M, A. M. J. J. A, S. O. N. D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazerdous 1 ) PæoPAA..JC [ ) chemical components or any AHM components 2) [ ) 3) [ ) 10) Location ~pþ<ß..)¿ SPikE µi5A'fG?_ IN~ 10e t..ùDltK AR.EA certify under penaJty of law. that I have personally examined and am TaniìTìar with the InfomaDOn submitted on flus and aJI attllcllect ctocuments. I believe the '.Ibmitted informatÍon is true, accunrte, and complete. ¡)A~M o W J'J c:...==rt. J RINT Name & Title of Authorized Company RepresentatÍve Signature Z/~(9~ Date vß?~ ~......æ '.. ..... ¥ \..EPCSI'NCW'I)FC:IW