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Home My WebLink AboutHAZ-WASTE REP. 3/15/2004~ ; RUSTYS ' 8200 STOCKDAL~;: HWY #M-5 I~ ~ +~~t ,.~~~.. Per . it Operftte to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit Is Issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002151 RUSTYS #12 LOCATION: . Issued by: '. CA 93311 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: MtG 2.0 2M! Issue Date 'June 30, 2003 STATEMENT OF ACCOUNT PAGE i CITY OF BAKERSFIELD POBOX 2057 BAKERSFIELD, CA 93303-2057 U~61) 326-3658 ., . .-. ŒU8T'T~~LZZÅ__~ i 2 8200 STOCKDALE HY M5 6673 M!t'-'G: A\i BAKERSFIELD, CA 93309 CUSTOMER NO: 26182/41072 TYPE: ES - ENVIRONMENTAL SERVICES ---------------------------------------------------------------------------- Cr-lARGE DATE DESCRIPTION REF-NUMBER DVEDATE TOTAL AMOUNT ------ -------- ------------------------- ---------- -------- -------------- HMOOi 3/01/04 BEGINNING BALANCE 3/i5/04 HAZ MAT FEE GROUP 1 STATE MANDATED FEE 3/15/04 HAZ MAT ANNUAL INSPECTION 3/15/04 CA STATE SURCHARGE .00 84. 00 HM017 S8001 C~C~=J ~ /H1E ~QS~ ' 58.00 24.00 ANNUAL HAZ-MAT BILLING FOR FISCAL YEAR 7/01/03 THROUGH 6/30/04-IF RECEIVED IN ERROR CALL 326-3658 -------------- -------------- -------------- -------------- CURRENT OVER 30 OVER 60 OVER 90 ---------.----- -------------- -------------- -------------- 166.00 DUE DATE: 4/14/04 PAYMENT DUE: TOTAL DUE: 166.00 $166.00 DATE: 3/i5/04 DUE DATE: 4/14/04 CUSTOMER NO: 26182/41072 NAME: RUSTY PIZZA #12 TYPE: ES - ENVIRONMENTAL SERV PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE REMIT AND MAKE CHECK PAYABLE TO: CITŸ OF BAKERSFIELD PO BOX 2057 BAKERSFIELD (66i) 326-3658 CA 93303-2057 TOTAL DUE: $166.00 PLEASE DO NOT STAPLE, PAPER CLIP OR TAPE CHECK TO REMITTANCE. - - - UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITYMEtt ~G ------~K ~ ]~ ~-- -.~{_ ~ Z-~_.... ADDRESS .---- ~ ~ ~ ~ INSPECTI(O~N DATE INSPECTION TIME ~~ l 6 ^ U~ l ~ Ott ~ h PHONE No. No of Employees ' SOD ~`~OC Lo~i~e ~ - ~ ~w_ 9 ~ ~35 - 7~/Z ~' ~ - --- --- FACILITYCONTACT ,J ~ _ _ ~ --- O(+~ ~ - -~-- V ---------- Business ID Number 15-021- d all ~ Section 1: Business Plan and Inventory Program Routine ^ Combined O Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection C '~ V ^ \V=V'toatonnce~ OPERATION APPROPRIATE PERMIT ON HAND COMMENTS ;~' ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS ~S ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS A~~Q ~~Z -- --____-- -----_---. - '~ ^ VERIFICATION OF QUANTITIES -_-___---_ -__- ---- _ _--- - ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE - -` ' ^ ~ VERIFICATION OF HAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES - ^ EMERGENCY PROCEDURES ADEQUATE ------- --- ^ ----------- CONTAINERS PROPERLY LABELED _ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES ~ No QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (661 ~ 326-3979 _~ ~~_---- ----------- ~S~ ---~ Inspector Badge No. White • Environmental Services Yellow - Statbn Copy Business Site R ponsible Party Pink • Business Copy I.~ ---.- UNIFIED PROGRAM fNSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 ~~e _¡:~ç --- ~~~,-~~"_H_ { INSPECTION DATE INSPECTION TIME 9-/9-03 I~ "<A.c'r-,. PHONE No, No. of Employees 8"35- 77/2- .L:~..,u...._,_, Business ID Number 15-021- 0'02[0'/ Section 1 : Business Plan~nd Inventory Program ,.;- ~ Routine o Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection c V ( C=Compliance ) V=Violation OPERATION COMMENTS ~ 0 ApPROPRIATE PERMIT ON HAND ----,--.----------..-..--,..".,.------- ..,.,."..,...----"..,..-.,.."-----....---,--....-.---..---."..-..,-,--,...-""..,"..,- JZ't- D BUSINESS PLAN CONTACT INFORMATION ACCURATE Jlf D VISIBLE ADDRESS ~ D CORRECT OCCUPANCY ,---------.----,...-f----...,.-,.--.".-.-,-...,..,---------,.,.,---.."..--..-,-,----.-"..,."."'..--..--.- ~ D VERIFICATION OF INVENTORY MATERIALS 'ffÍ D VERIFICATION OF QUANTITIES ------, -,-----,--_._-------,-,_.,~, ---.--------..--,...,--.--------,.-.-...---....-."-,-,.,,.......,...,._,,-, ~ D VERIFICATION OF LOCATION -,-_.~-_.._-,...__..---------------- -- --.---.----.---- ._--,------_.-~-_.._.._----------,----- .-------_.__..,._-_.~ ..---.,.,. ._-_._----~-- ,-----,-,..._---,-_..,-,.,.. ....-,------,,'...u..-.--·-",--,.--------.-.,-,.·····-..--..__.,..,._,___.___ All (0'7- --------,----,--..-.,-.- ..-----. -..,---..- --------,--,..---.,---...-----...--.----....--. .,...,._-, --------------------------- --------,-_.__.._-,,-,----,-,._._-.._-,---,-,,-,,-'..,- _~ D PROPER SEGREGATION OF ~ATERI~~,_________,_.._,___ Jgr' D VERIFICATION OF MSDS AVAILABILliYE --------,---.-------.-- .".'~--------------- ------_._-_._-~_.~_...._--- -----,----,---,-------,---...-......,--..-.. -,-----.-.-----....--.---..-..-,----..,-,-...-,--,"'-------- D ti VERIFICATION OF HAT MAT TRAINING ,--..---..--".."-,-f---,----,-..-.---.-.,...-------...-..."---"'--'''' --,.....-------.,.- D VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 'Ø 'Ff D EMERGENCY PROCEDURES ADEQUATE rt D CONTAINERS PROPERLY LABELED qg D HOUSEKEEPING -------, ,'P D FIRE PROTECTION -, -------.---.---+--..----- ------.--------.--.------.----..------..----.-.---.-----.-"-------.- ",---------".._,- .......------.....-.-----...-".,----.--"--....,---...,-,..------"'..--- --------.------ "-~.__. .---.----.---.----------.--..-----.-+--.-----.....------.---------..- .-----.,--...- ---.------------,.---.-----,---,..,--,...,--., .------------.---- -----------.--------------.---.-----------.--...-------.- D ". SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: DYES j'ÍNo ~ ~ /,' EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 --b(A.~ ,___,_,__ .ø?90 ,______ s:::1~@,~> U Inspector Badge No. Business Site R,ponSible Party White' Environmental Services Yellow, Station Copy Pink· Business Copy t\ U e - CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd J;'Ioor, Bakersfield, CA 93301 INSPECTION DATE /2 - 7- 0 '2. PHONE NO. 'F 3.S - 771 2- BUSINESS ID NO. 15-210- (YO:Z IF I NUMBER OF EMPLOYEES -j... / . Section 1: Business Plan and Inventory Program 13" Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand Business plan contact infonnation accurate ,/ J j k h,., /./ A ../. L Visible address r/' . Correct occupancy /' Verification of inventory materials / Verification of quantities ,/ Verification of location /1 Proper segregation of material ~ Verification of MSDS availability / d-eel h9 ¿?/Ð/¡tI~ Verification of Haz Mat training / R " Verification of abatement supplies and procedures ..... Emergency procedures adequate ¡/ ¿¡de,,! M ¿1~nt4k Containers properly labeled t/ Housekeeping ,/ Fire Protection 1/ Site Diagram Adequate & On Hand ./ C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes ~o White - Env, Svcs. Yellow - Station Copy Pink· Business Copy -f d\~ CJ.M~ Business ~I~ ~.Site ResoortiliÏ;., ible Party Inspector: ~~ ., '. : ~¡J~t- I( ~ Questions regarding this inspection? Please call us at (661) 326-3979 . . CITY OF BAKERSFIEI_D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST :# 3;)41- 3CP7<f 1715 Chester Ave., 3rd Hoor, Bakersfield, CA 93301 FACILITY NAME !2u5 ADDRESS ?ZacJ FACILITY CONTACT INSPECTION TIME INSPECTION DATE {~)-ð ( PHONE NO. JÞ3r-?7/ z... BUSINESS ID NO. 15-210- 0 'J-( -S- I NUMBER OF EMPLOYEES I:L Section 1: ~outine Business Plan and Inventory Program D Combined D Joint Agency D Multi-Agency o Complaint D Re-inspection OPERA TION C V COMMENTS V v Appropriate penn it on hand Business plan contact infonnation accurate V V- Visible address ~ V ~ Correct occupancy V V /" Verification of inventory materials Verification of quantities V Veri fication of location V / Proper segregation of material " Verification of MSDS availability V Verification of Haz Mat training \I V Verification of abatement supplies and procedures lý Emergency procedures adequate r~S<- C~~-~'L-~t J,Vl$1 Containers properly labeled V....... f-w I?fA 511'lt,-~j P(~ f",....,f-e. . Housekeeping :/ V Fire Protection V 12tph.~b/A,{1:)//I\. ~~ <Q(; {. S"¡~. Site Diagram Adequate & On Hand V c..v, C=Compliance V=Violation DYes ~ Any hazardous waste on site?: Explain: White - Env. Svcs. Yellow - Station Copy Pink - Business Copy J:)Cl.>/{ 1>.-? \ ~ xLt..- Business Site Responsible Party 1/ 1/ *"{t:t( Inspector: NeY'H~ Questions regarding this inspection? Please call us at (661) 326-3979 ;¡ O~20/01 ....~ 14: 19 141001 '8'661 326 0576 . TRANSMISSION OK TX/RX NO. CONNECTION TEL CONNECTION ID START TIME USAGE TBlE PAGES RESULT BFD HAZ MAT DIV *************************** *** ACTIVITY REPORT *** *************************** 9668 8355585 04/20 14:13 05'17 11 OK . J ""'- .-,~.\:; ~ - FAX .ansmittal Cover Sheet .. BAKERSFIELD CALIFORNIA Bakersfield Fire Dept. Office of Environmental Services 1715 Chester Ave. · Bakersfield, CA 93301 FAX No. (66~.) 326-0576 · Bus No. (:661) 326-3979 Today's Date j } '20/6 ) Time 2'. L6 No. of Pages J I S1( b I iÐ"'····,~·"·:·:·:·:·:·:·:,:...,····,·"'· ....... .... .............. ......... ... ................ . "..... '" .. ... ............ TO OC~ c; ~ ,':':':':':':':':' :':':': :.:':. ·f'''· :':.:': :':.:' :.:,:.:.":':':', .... .... ". ... .. ... .... .., .... . ,.;:::::::::. :::::::. :;'. :::' ':.'. ::::::: ::::::: ;::::::' ::::;:;::" . ::1(::~~?r¡i¡¡¡~j:;}if¡t::::.. ::::;:~~:j¡¡¡¡¡¡~::;;;¡jf!trr.::¡¡ ." .......... ........ .. ...... .... .... FAX No·'........ .., ~,QS 7ft 1'- .. ..... ........ .. .... . ~)~1i~~~, 11(», _H"". "s"i<;} ,< iI:;ì~Š' COMME N;rs,·:,:,:::::::::·, t1:::l~ðe ",.\2ll \:,()J7t~", . ft1lk:r.î.::.:.:,:..., .'.:::::::: ~~\;'m~~\~Þ~w4 ··::::~~~1;:::f\:;;:ffm~ . :~~~~t~:.f~[~¡~¡~:.:.¡~¡~~~~..: .!:j:f~~". ;j:\j;f~::::~~[~~::·, - d1t\ ~'J---- ìd- ?"oS~ fØ/ Vie INSPECTION DATE / 1 1'2.--1 Ieo PHONE NO. g'3S" - 77t7- BUSINESS ID NO. 15-210- ¡VC-r..J NUMBER OF EMPLOYEES ~o CITY OF BAKERS}'IELD FIRE DEP NT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~-rY5 ~, "Z- ADDRESS ~'2..B() S ~J)Ll<.G" ~ fI1-S- FACILITY CONTACT INSPECTION TIME Section 1: Business Plan and Inventory Program ~outine o Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection OPERATION C V COMMENTS Appropriate pennit on hand Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials H6uVM. Verification of quantities '2-1 C¡ Gr= Verification of location I¡NSlOG IAJ. oÇ SALGS 0:;J.f"frsJ.. 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 ~o Inspector: lAJl A..Jf55 Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy