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Home My WebLink AboutPERMIT TO OPERATE, HAZ WASTE INVHazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-021001517 D & M MACHINE & REPAIR LOCATION 1019 S H Issued by: This permit is issued for the following: ........................ ,:, -, ~ , ,, ~ ......... ~:":~ ~g=:::¢~ ~:'....'~-~:~ :.~-- _" '.'4~ :~ ~ ' ..~;~i; %'"' % "¢~'. '~ ...... ::% ~: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: June 30, 2000 L¥.L~..L-" DIAGRAM Busine~ NGme: 8usine~ For Office Use Only First tn Stction: lnsaecfion S t~'ion: Area Mca # . of N 0 RTH , /. D & M MACHINE & REPAIR Manager : Location: 1019 S H ST City : BAKERSFIELD CommCode: BAKERSFIELD STATION 06 EPA Numb: SiteID: 215-000-001517 BusPhone: (805) 398-0562 Map : 124 CommHaz : Moderate Grid: 06C FacUnits: 1 AOV: SIC Code:3569 DunnBrad: Emergency Contact / Title OLGA AYALA / OWNER Business Phone: (805) 664-3781x 24-Hour Phone : (805) 665-2664x Pager Phone : (805) 637-6930x Emergency Contact / Title MATEO AYALA / OWNER Business Phone: (805) 398-0562x 24-Hour Phone : (805) 665-2664x Pager Phone : (805) 637-6929x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact : MailAddr: 1019 S H ST City : BAKERSFIELD Owner Addres City Period : Preparer: Certif'd: Phone: ( ) - x State: CA Zip : 93304 ~.. ~.~DONALD ROSSO~MATEO AYALA Phone: (805) 398-0562x 4323 EVE ST~ ~OOF /~$C~9~ State: CA AKERSFIELD ~'~ ~ , ._ ,, to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: -]_- 10/18/1999 F D & M MACHINE & REPAIR ~ Hazmat Inventory --As Designated Order Hazmat Common Name... SiteID: 215-000-001517 By Facility Unit Fixed Containers at Site ISpecHazlEPA HazardsI Frm ALKALINE HOT TANK CLEANER WASTE OIL HOT TANK OIL SLUDGE ACETYLENE OXYGEN ARGON DailyMax IUnit MCP R L F DH L DH L F P IH G F IH DH G F P IH G 55 GAL Mod 55 GAL Low 55 GAL UnR 20 FT3 Hi , 249 FT3 Low! 83 FT3 Min 2 10/18/1999 D & M MACHINE & REPAIR SiteID: 215-000-001517 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME ALKALINE HOT TANK CLEANER ~¢ Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF BUILDING. CAS# F STATE TYPE PRESSURE Liquid Mixture Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. HAZARDOUS COMPONENTS Sodium Hydroxide RSI CAS# No 1310732 TSecret[No N~S BioHazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies R / / / Mod ] Inventory Item 0003 Facility Unit: Fixed Containers at Site ~U~flVlU~ ~Vl~ / ~ ~_,'-.%_~ ~Vl~ WASTE OIL Days On Si~ 365 Location within this Facility Unit Map: Grid: WEST END OF BUILDING CAS# 221 STATE TYPE PRESSURE Ambient Waste I~iquid -- TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS Waste Oil, Petroleum Based CAS# TSecret No oRSlBioHaz N No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F DH NFPA /// USDOT# [ MCP Low 3 10/18/1999 D & M MACHINE & REPAIR ~ Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME HOT TANK OIL SLUDGE Location within this Facility Unit SiteID: 215-000-001517 Facility Unit: Fixed Containers at Site Map: Grid: Days On Site 365 CAS# 221 F STATE ~ TYPE Liquid I Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. HAZARDOUS COMPONENTS IRS CAS# RS [ BioHaz Radioactive/Amount EPA Hazards I No INo I No 'No/ Curies DH NFPA /// USDOT# [ MCP UnR Inventory Item 0005 Facility Unit: Fixed Containers at Site ~lVUVl~ ~Vl~ / ~ 1 ~/*-~1_~ N~Vl~ ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 74-86-2 STATE ~ TYPE Gas ~Pure PRE S SURE TEMPERATURE I Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 20.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 20.00 FT3 Daily Average 20.00 FT3 %Wt. 100.00 Acetylene HAZARDOUS COMPONENTS S CAS# N 74862 HAZARD ASSESSMENTS I Radioactive/Amount I EPA Hazards INo/ Curies F P IH NFPA /// USDOT# MCP Hi -4- 10/18/1999 D & M MACHINE & REPAIR ~ Inventory Item 0006 -- COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit SiteID: 215-000-001517 Facility Unit: Fixed Containers at Site Map: Grid: Days On Site 365 CAS# 7782-44-7 FSTATE = TYPE Gas /Pure PRESSURE , TEMPERATURE Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 249.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 249.00 FT3 Daily Average 249.00 FT3 I%Wt. 100.00 HAZARDOUS COMPONENTS Oxygen, Compressed I HAZARD AiSESSMENTS I TSecret ~S BioHaz Radioactive/Amount EPA Hazards NFPA No N No No/ Curies F IH DH / / / USDOT# MCP Low Inventory Item 0007 Facility Unit: Fixed Containers at Site ~lVUVl~ ~Vl~ / ~± ~fq3~ ~Vl~ ARGON Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 7440-37-1 FSTATE ~ TYPE Gas {Pure PRES SURE TEMPERATURE ] Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 83.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 83.00 FT3 Daily Average 83.00 FT3 I%Wt. { 100.00 Argon HAZARDOUS COMPONENTS TSecret N~S BioHaz No No HAZARD ASSESSMENTS IRadioactive/Amount I EPA Hazards No/ Curies F P IH NFPA /// USDOT# Min -5- 10/18/1999 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format F Notif./Evacuation/Medical Agency Notification Overall Site -- Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan ALL MATERIALS USED AT D&M CAN BE RINSED, WITH REGULAR TAP WATER. 10/10/1994 6 10/18/1999 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site --Release Containment DELETE WITH WATER 10/10/1994 -- Clean Up CLEAN UP WITH SAW DUST AND DELETE WITH WATER. 10/10/1994 Other Resource Activation -7- 10/18/1999 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - SW CORNER OF BLDG B) ELECTRICAL - NW CORNER OF BLDG C) WATER - ALLEY AT ENTRANCE OF REAR GATE D) SPECIAL - NONE E) LOCK BOX - NO 01/07/1998 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ????????????? 01/07/1998 NEAREST FIRE HYDRANT - LOCATED WEST OF D&M Building Occupancy Level -8- 10/18/1999 f D & M MACHINE & REPAIR SiteID: 215-000-001517 Fast Format ~ Trainin9 -- Employee Training WE HAVE ONE OF EMPLOYEE PLUS OWNER OPERATORS. YOU MUST HAVE MATERIAL SAFETY DATA SHEETS ON FILE!!!!!!! GET THEM! BRIEF SUMMARY OF TRAINING PROGRAM: NONE. Overall Site 10/18/1999 -- Page 2 --Held for Future Use Held for Future Use -9- 10/18/1999 Manager: Location: 1019 S'H ST City : BAKERSFIELD SiteID: 215-0-00-001517 BusPhone: (805)~.398-0562 Map : 124 Comm/~'~z : Moderate Grid: 06C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 EPA Numb: SIC Code:3569 DunnBrad: Emergency Contact / Title I Emergency Contact 05) ~43qT~'09~~-~]~1 Business Phone: 24-Hour Phone : (805) ~3~D9~1~-~ 24-Hour Phone : Pager Phone : ( ) - x~7_~Pager Phone : Hazard~ ~,m~f,~ /2~ ~ ~,/ Hazmat-- :g4/~ ~- ~~.~Z-_ ~_~9~7'~ire React Emergency Directives: / Title / OWNER (805) 398-.0562x (805) 665-2664x DelHlth = Hazmat Inventory --MCP+DailyMax Order Hazmat Common Name... ALKALINE HOT TANK CLEANER R WASTE OIL F One Unified List ~ Ail Materials at Site ~ ISpocHazlEPA HazardsI Frm ! DailyMax IUnitIMCP L 55 GAL Mod DH L 55 GAL Low! 1210511997 & M MACHINE & REPAIR SiteID: 215-000-001517 Inventory Item 0002 Facility Unit: Fixed Containers at Site ~lVUVl~ ~Vl~ / ~± ~./.-~_~ ~vl~ ALKALINE HOT TANK CLEANER Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF BUILDING. CAS# STATE ~ TYPE Liquid I Mixture PRESSURE Ambient TEMPERATURE Ambient Largest ContainerGAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 55.00 GAL %Wt. _ HAZARDOUS COMPONENTS ISodium Hydroxide CAS# 1310732 TSecret No HAZARD ASSESSMENTS EHS BioHazI Radioactive/Amount EPA Hazards No NoI No/ Curies R NFPA /// USDOT# Mod Inventory Item 0003 Facility Unit: Fixed Containers at Site ~lVUVl~ ~Vl~ / ~£ ~/-~1~ ~vl~ WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF BUILDING CAS# 221 STATE ~ TYPE Liquid I Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I 55.00 GAL Daily Average 55.00 GAL HAZARDOUS COMPONENTS %Wt. I 100.00 Waste Oil, Petroleum Based EHS CAS# No ~* ITSecret EHS BioHaz No No No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F DH NFPA /// IUSDOT# I MCP ~-. Low 12/05/1997 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format ~Notif./Evacuation/Medical Agency Notification Overall Site Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan ALL MATERIALS u~E~-~-D~M-CAN~BE RINSED, WITH REGULAR TAP WATER. 10/10/1994 -3- 12/05/1997 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site -- Release Containment DELETE WITH WATER 10/10/1994 -- Clean Up CLEAN UP WITH SAW DUST AND DELETE WITH WATER. 10/10/1994 Other ReSour~e-~Activat ion -4- 12/05/1997 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format = Site Emergency Factors -- Special Hazards NATURAL GAS/PROPANE: SOUTHWEST CORNER OF BUILDING. ELECTRICAL: NORTHWEST CORNER OF BUILDING. WATER: ALLEY AT ENTRANCE OF REAR GATE. LOCKBOX: NO. Overall Site 10/10/1994 Utility Shut-Offs Fire Protec./Avail. Water FIRE HYDRANT LOCATED IN THE NEIGHBORHOOD WEST OF D&M. 10/10/1994 Building Occupancy Level -5- 12/05/1997 MACHINE & REPAIR SiteID: 215-000-001517 Fast Format Training -- Employee Training NUMBER OF EMPLOYEES: NONE. OWNER OPERATORS. MATERIAL SAFETY DATA SHEETS ON FILE: NONE. BRIEF SUMMARY OF TRAINING PROGRAM: NONE. Overall Site 10/10/1994 -- Page 2 -- Held for Future Use Held for Future Use -6- 12/05/1997 Owner 3 Angle Valve Jobs · Boring · Rotor & Drum Service Fly Wheel Surface · Bearing Press · Complete Overhauls (Foreign & Domestic) 15 Years Experience 1019 So. H Street · Bakersfield, CA 93304 · (805) 398-0562 10/15/96 D & M MACHINE & REPAIR 215-000-001517 Overall Site with 1 Fac. Unit Page General Information Location: 1019 S H ST Map:124 Haz:3 Type: 3 City : BAKERSFIELD Grid: 06C F/U: 1 AOV: 0.0 Contact Name Title DONALD ROSSON / OWNER Business Phone: (805) 398-0562x 24-Hour Phone : (805) 834-6891x Pager Phone : ( ) - x Contact Name Title MATEO AYALA / OWNER Business Phone: (805) 398-0562x 24-Hour Phone , !8~05) Pager Phone : Administrative Data Mail Addrs: 1019 S H ST City: BAKERSFIELD Corm Code: 215-006 BAKERSFIELD STATION 06 D&B Number: State: CA Zip: 93304- SIC Code: 3569 Owner: DONALD ROSSON/MATEO AYALA Address: 4323 EVE ST City: BAKERSFIELD Phone: (805) 398-0562 State: CA Zip: 93307- Summary , . ached hazardous materials ~anage.~ 'reviewed the att r~~ ~ ~ ~ '~ ment .... p~an ,u,~~J~ ~ ~ ~o~~ that 'it along any corrections constitute a complete and ~e~ m~- agement plan ~°r mY fa~ili~l ~ RECEIVED HAZ. MAT. DIV. 10/15/96 D & M MACHINE & REPAIR 215-000-001517 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers at Site Pln-Ref 02-001 02-002 02-003 Name/Hazards Form Max Qt¥ MCP HYDROCARBON SOLVENT h~~ §5 Moderate ALKALINE HOT TANK CLEANER Liquid 55 Moderate · Reactive GAL THERMO· SPREX ~~~ Unrated 10/15/~6 D & M MACHINE & REPAIR 215-000-001517 02 - Fixed Containers at Site Hazmat Inventory Detail in MCP Order Page 3 02-001 HYDROCARBON SOLVENT ~ ~ Immed Hlth, Delay Hlth CAS #: 01330-20-7 Trade Secret: No Liquid 55 GAL Moderate Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL55 I Daily Average30.00GAL Annual Amount GAL 500.00 Storage Press T Temp Location METAL CONTAINR-NONDRUMIADove IAmbientlWEST END OF BUILDING. -- Conc 75.0% 11,2-Xylene 25.0% INaphtha Components iMCP ---~uide ModerateI 27 ModerateI 27 02-002 ALKALINE HOT TANK CLEANER ~ Reactive Liquid 55 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL55 I Daily Average55.00GAL Annual Amount GAL -- 55.0O Storage DRUM/BARREL-METALLIC Press T Temp Location AmbientlAmbientlWEST END OF BUILDING. -- Conc 0.0% ISodium Hydroxide Components IMCP__TGuide ModerateI 60 02-003 THERMO SPREX /~ // _/~ ? 0 Unrated CAS #: Form: Unknown --Daily Max Storage -- Conc ~ Trade Secret: No Type: Unknown Days: Use: Daily Average0.00 Press T Temp ~ Annual Amount Location 0.00 Components , MCP ---TGuide 10/15/96 D & M MACHINE & REPAIR 215-000-001517 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification <2> Employee Notif./Evacuation <3> Public Notif./Evacuation <4> Emergency Medical Plan ALL MATERIALS USED AT D&M CAN BE RINSED, WITH REGULAR TAP WATER. 10/15/96 D & M MACHINE & REPAIR 215-000-001517 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention <2> Release Containment DELETE WITH WATER <3> Clean Up CLEAN UP WITH SAW DUST AND DELETE WITH WATER. <4> Other Resource Activation 10/15/96 D & M MACHINE & REPAIR 215-000-001517 00 - Overall Site <F> Site Emergency Factors Page 6 <1> Special Hazards NATURAL GAS/PROPANE: SOUTHWEST CORNER OF BUILDING. ELECTRICAL: NORTHWEST CORNER OF BUILDING. WATER: ALLEY AT ENTRANCE OF REAR GATE. LOCKBOX: NO. <2> Utility Shut-Offs <3> Fire Protec./Avail. Water FIRE HYDRANT LOCATED IN THE NEIGHBORHOOD WEST OF D&M. <4> Building Occupancy Level 10/15/96 D & M MACHINE & REPAIR 215-000-001517 00 - Overall Site <G> Training Page 7 <1> Employee Training NUMBER OF EMPLOYEES: NONE. OWNER OPERATORS. MATERIAL SAFETY DATA SHEETS ON FILE: NONE. BRIEF SUMMARY OF TRAINING PROGRAM: NONE. <2> Page 2 <3> Held for Future Use <4> Held for Future Use BAKERSFI'ELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 1715 ~CHESTER-. A~V£.'. BAKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: To avoid further action, return this form within 30 days o eipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whoJe. Be brief and concise' as possible.\ ~t~u'~['\'C RECEIVED /'/,4Z &t4T' DIll. SECTION 1' BUSINESS IDENTIFICATION DATA DUN & BRADSTREET NUMBER: STATE: ("-/~--- ZIP: ~q PHONE: PRIMARY ACTIVITY: OWNER: ~:~,,~,'~-'~ MAILING ADDRESS' SECTION 2: EMERGENCY NOTIFICATION: 'CONTACT '1. iakers~eld Fire Dept. ardous l~aterials Di~sion HAZARDOUS MATERIALS MANAGEMENT PLAN NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CAUFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WEOO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEEO 'THE MINIMUM REPORTING QUANTIFIES. OTHER (SPECIFY REASON) SECTION 5' CERTIFICATION: ,. MATiON IS ACCURATE. I UNDERSTANO THAT THIS INFORMATION WILL.BE IJSED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY ~OOE!' ON HAZARDOUS MATERIALS (OIV. 213 CHAPTER 6.95 SEC. 255013 ET AL.) AND THAT SIGNATURE TITLE - DATE BAKEF FIELD CITY FIRE DEEARTMENT H/ F_.ARDOUS MATERIALS INVLmlqTORY Page_of_ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ~ ] Addition [ ] Revision [ ] Deletion [ ] ChecR if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] PHYSICAL & HEALTH _ PHYSICAL HAZARD CATEGORIES Fire i~Reactive I ] Sudden Release of Pressure HEALTH Immediate HeaJth (Acute),J,~layect HeaJth (Chronic) [ ] . 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ J Uquid~ Gas [ ] Pure,~-~Mixture { ] Waste { ] Radioactive 7) AMOUNT AND TIME AT FAClUTY Maxim~um OaJly Amount: Average Dally Amount: Annual Amount: Largest Size'Container: # Days On Site 9) MIXTURE: L/st ~t3e three most.h_ .az:~g~us chemica~ comoonent~ or .... UNITS CF MEASURE 8) STORAGE CODES (bS [ ] ga~ ( ]' tt3. [ ] a) ContaUner: t~' curies [ ] b) Pressure: Circle Which Months: All Ye , J, A, S, O, N, D CHEMICAL DESCRIPTION 1) tNVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Chect< if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optionaJ) ,' Chem~ca~ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive( ] Sudden'Release of Pressure [ ] Immediate HeeJth (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-¢figit code fi.om DHS Form 80221 USE CODE 6) PHYSICAL STATE Solid ( ] Liquid ( ] Gas { ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT'AND TIME AT FACtUTY Maximum Oalty Amount: Average DaJty Amount: Annua~ Amount: Largest Size Container: # Days On Site UNITS CF U~ASURE curies [] 8) STORAGE_COOES a) Contmner: b) Pressure: c) Temperature: Circle Which Months: All Year, J, F, M. A. M, J, J, A, S, O, N, O MIXTURE: {fist :he three most i3aza~clous ctlemm_.~ comDonents or my AHM components COMPONENT CAS # % WT AHM Il [ l [ ] ~:0) Loca:aon Ce~Ely Under 13erlafll~/ or taw. ~13at I nave personally examined and am iarn~iaJ' wlrll gle mromaDon suDrn~ea on mis eno a~/ ar~acnea document. I believe m,; suDmitteo informaoon rs ~rue. accurate, ano coml31ete. PRINT Name & Title of Au~onzea Company t~epresenm~ive Signature Date' BAKERSFI i[.D CITY FIRE DEPAPI MENT HAZAR[ OUS MATERIALS INVENTOIIW 3usiness Name ,' Address Page_of_ CHEMICAL DESCRIPTION 1 ) INVENTORY rSTATUS: New [ ] Addition [ ] Revision [' 1 Deletion [ I Checx if chemicaJ is a NON TRADE SECRET SECRET 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire { ] Reactive( ] Sudcien Release of Pressure [ ] Immediate HeeJtl~ (Acutel ~ Oeteyea Health (Chronicl 5) WASTE CLASSIFICATION (3-digit coae from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid~L liquid [ ] Gas [ ] Pure [ ] Mixture~...~este [ ] Radioactive [ I 7) AMOUNT AND TIME AT FACIUTY Maximum Omiy Amount: Average omly Amount: Annum Amount: La. rgest Size'Container: ~ Days On Site UNITS OF MEASURE 8) STOP, AGE CODES Ibs~gaJ [ ] ~3 [ ] a) Contmner: '- cunes( ] c) Temper~ure: CHEMICAL DESCRIPTION 1) INVE~ITORY STATUS: New ( ] Addition [ ] Revision { ] Deletion [ ] Check( if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ ] 3) DOT # (optionaJ) · .k '4i PHYSICAL & HEALTH PHYS'CAL HEAL/TH/ [i::.i HAZARD CATEGORIES Fire ( ] Reactive { ] Sudden Release of Pressure [ ] Immediate HeaJth (Acutei~layed Health (ChroniciC:F~'~ .'5) WASTE CLASSIFICATION (3-digit coae from OHS Form 80221 USE CODE 6) PHYSICAL STATE Solid ~'"'-Liquid ~ ] Gas [ ] Pure { ] Mixture,~'~'Waste [ ] Radioactive ( ] .... UN,TS 0,~,4_ ,~UR. 8) STORAGE CODES T) AMOUNT AND TiME AT FACF'_ITY ' = ~ c,*e , = Maximum Oady Amount: f~s~ [ ] ~3 [ J - - - a) C0-n[mner: '- '~::~ Average ~aiy Amount: curies [ ] b) Pressure: Annum Amount: c) Temperature: !_a. rges[ Size ContaJner: ~& , ~,~~ # Days On Site Circle Which Months: All Ye F,_M, A, M, J, J, A, S,~O COMPONENT 9) MIXTURE: Ust the tlqree most hazardous 1 ) cnem~caJ comDonents or any AHM components 2) [] 3) [ ] BAKER i iELD CITY FIRE DEP iRTMENT HAZARDOUS MATERIALS INVEI I'ORY Page_of__ ~usiness Name Address CHEMICAL DESCRIPTION 1 ) INvEN¥oRY STATUS: New { ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] Common Name: 3) DOT # (~ptional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive( ] Sudden Release of Pressure [ ] lmmediate Health (Acute) [ ] Delayed HeaJth (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) '" USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture { ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY Maximum Dally Amount: Average Dally Amount: Annual Amount: Largest Size Container: # Days On Site UNITS OF MEASURE ~bs [] ga [] ~3 [] cunes[ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List the three most hazarclous chemical components or any Ai-iM' cbml::~nehts COMPONENT -~ CAS # % WT AHM ~) [] 2), [ ] 3) [] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) ChemicaJ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] WaSte [ ] Radioactive 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average OaJiy Amount: Annual Amount: Largest Size Container: # Days On Site UNITS OF M~,SURE ~bs [ ] gal [ ] ft3 [ ] cur~es { ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: Circle Which Months: All Year. J, F. M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List the three most haza;oous chemicaJ components or ~ny AHM components COMPONENT CAS # % WT AHM 1) [] 2) [ ] 3) [ 1 1 O) Location cer~fy unaer pen~U~/ or law, fl~at i have personally examined anc~ am tamiiiar wi~h the inroma~on suPmirteo on this and alt a~tacheO documents. I believe the ;uDmitted informaSon is ~ue. accurate, ancf complete. 3RINT Name & Title of Authorized Company F~epresentat~ve Signature Date BAKER:~!~:IELD 'CITY FIRE DEP~FITMENT HAZARDOUS MATERIALS DIVISION 1715 CHESTER AVE. BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY CHECK 1F BUSINESS ISA FARM [ FACIUiFY NAME FACILITY DESCRIPTION ] SITE ADDRESS NATURE CF BUSINESS T~X ~,¢. DUN & BRAOSTREET NUMBER 77- O..~',~Z'.~'I '"7....~ OWN E,=,/'C P ERATO R MAILING AP. DRESS - EM-ERGENCY CONTACTS BUSINESS ~HONE .~¢"~ 6::2.1'-6 ~-- 24-HOUR PHONE ~.<.L'_ ~"c:~// NAME /~2. ¢~-,,~d::? BUSINESS PHONE 24-HOUR PHONE Bakersff~eid: Pire Dept. Hazardous Materials Divisio,a-- HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SEC*'CN 6: NOTIFICATION AND EVACUATION PROCEDURES' AGENCY NOTIFICATION PROCEDURES' EMPLOYEE NOTIFICATION AND EVACUATION' C. PUBLIC EVACUATION: EMERGENCY MEDICAL PLAN' B~kersfietd Fize Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: '- C"" A. REL,_zA~c PREVENTION STEPS: RELEASE. CONTAINMENT AND/OR MINIMIZATION: CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ~¢, I~¢",¢'~''~,, , .~t~--,~ OCr' 1~'~l~/~ . ELECTRICAL: L/~/'O, /,.,,,UES¢~'''''- ('f/~,,,..,G..,,('(.._ O¢- ~2~.tL'l~lU~' S, rCIAL -- BOX: YES~ iF YES, LOCATION' SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): '