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Home My WebLink AboutBUSINESS PLAN (2) SCIi®~L~ IIV~PECTI®Rl CC~I~CKLI~T Bakersfield Fire Dept. Prevention services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326=3979 "4 n SCHOOL NAME '~" INSPECTION DATE ADDRESS INSPECTION TIME INSPECTION DATE ~ t ~ ~ ~ ~y ~ PHONE NO. " . ~ ~ C ~ = ompiance OPERi4TiON tinn __ __ COMMENTS F C~1 ^ EXIT OBSTRUCTIONS t ® ^ EXIT STAIRS . k _ ~® ^ ILLUMINATE EXIT $r DIRECTIONS SIGNS r y ? ^ NON-COMBUSTABLE WASTE CONTAINERS / '^f ^ ~ HOUSEKEEPING ELECTRICAL ROOM ,4.r ~ Q ^ ELECTRICAL -USE OF EXTENSION CORDS i ~ ~ ~" ~ •~+ i, , ' t. - i . d l. ~ E ~ P i e .n- Z-- l..~/ ,, C ' r ~/ ^ HOUSKEEPING GENERAL n, `,. ^~ ^ HOUSKEEPING BOILER ROOM /CLEARANCES ,~ ~'~, ^ ~ CLEARANCE AROUND ELECTRICAL PANEL BOARD ~ l] ^ y FIRE DRILLS/RECORDS j , ^ ^f FLAME RETARDENT DECORATIVE MATERIAL ^/ ^ ASSEMBLY AREAS OP ^ FIRE ALARM SYSTEM (SERVICED) ^''• ^ SPRINKLER SYSTEM (SERVICED) ~` ^ COMMERCIAL H000 SYSTEMS Oaf ^ FIRE APPARATUS ACCESS / ^! ^ STAGE AREA VIOLATION NOTICE CORRECTION: DUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (8 81) 3 2 8.3 9 7 9 Inspector Badge No./Station White -School Copy Yellow -Station Copy .ti ~ ~ ` School Site Responsible Paity g Pink - PreventiOmServices ~~,,.~ .. .~~ s ,. . ~. rte, ~` ~~ ~'~ FIRE PREVENTION INSPECTION B E R S P I L D ~f BAKERSFIELD FIRE DEPT. ~ ~ ~~ Prevention Services ~~. 900 Truxtun Ave., Ste. 210 L~ Bakersfield, CA 93301 Tel.: 661 326-3979 ^ .Fax: 661 8'SZ- 71 ( ) ( ) // DISTRICT BLOCK NO. DATE ~.... ~~ ~ EE 1 ~ CyV FACILITY ADDRESS ~ ~~ ~ 1 ~r°r"' y CITY, STATE, ZIP ~ ~}~~f~ / / V FACILITY NAME Q Q MA AGER'S NA FAC LITY PHONE NO. ~ cc,r>,o n n n. t~ 1 -~ BUSINESS OWNER'S NAME AND ADDRESS CITY, STATE, ZIP OWNER'S PHONE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO. OCC TYPE'? OCC,L-OAD NO. OF FLOORS D TE HIGH RISE BLDG RIS JF~ ~ ^ YES ~ NO CORRECT ALL VIOLATIONS wo~ariow / ~ REQUIREMENTS A CHECKED BELOW No. COMBUSTIBLE WASTE I DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse boxlfire door (N.E.C.) (U.F.C.) 4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the ` extinguisher not more than 5 feet above the floor. (N.F.P.A. No. 10) 4 EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher to be immediately accessible for use in (area) _ (U.F.C:) ---------------------------- 6 Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to SIGNS fire escape. (U.F.C.) r <. ~"T g Provide and maintain appropriate num ~~~ ti ~ beck~"round and visible from the street to indicate the correct address of the building. (B.M. _ g Repair all (crackslholes/openings) in plasi t~~b ) ______________________________________. Plastering FIRE DOORS/ FIRE SEPARATIONS shall return the surface to its original fire t e Condition. (U.B.C.) 10 Remove/repair (item & location) __________________ _________________________________. Self-closing doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 12 Provide a contrasting colored and permanently installed electric light over or near required exit (location) ______________________________ to clearly indicate it as an exit. (U.F.C.) STORAGE 1g Remove all storage and/or other obstructions from fire escape landings and stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES where needed. (N.E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N. E.C.) (U.F.C.) ouTDOORBURNING 16 Violation of Section 1102 dealin with. recreational fires or o en burnin U.F.C. FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ardin fireworks. OTHER 1g _ ~ _ I ~ C n ~ ~ b // t / ~ A ~ ~ ~ : // CUSTOMER: ~1~ ~: ~ ~ LEGEND: ; , ^ ature) ` " f / Y I (S~'" i` Pl P i t N L ibl Tltl C.F.C. CALIFORNIA FIRE CODE , g i ( ease r n ame eg y, e) U.B.C. UNIFORM BUILDING CODE A INSPECTOR: _ ~,; ~ /\ ~ AP NO.: ~ B.M.C. BAKERSFIELD MUNICIPAL CODE N.F.P.A. NATIONAL FIRE PROTECTION (S19natU~e ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE ~ i ~i ;White -.Customer/Original Y~Ilow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) JAN-7-2007 04:38P FROM: 70:8522171 P:1~3 ~~~ ~, cam' f,.-. f ~ ~.. :~ c ~-~ ,~ r [ice J ~: ~ ~ -~~ ~ ~~~ ~~ ~ --~ . J .~ r ,_ ~ ~. ~, .i f C.. ~.. ~- {' J . _._ _ .~ 'r- ~ G ~y/ ~~ ~~ ~,~ ~- -~ ~»k~U~.ieBo~liy;.tir•'*-4. ~rV~1"'d"~I.xt~.i~3v"~°"q-4,.~+G~%~`y7l`a+~'uwi+kr:(~`*ti~~ht~,r~~K~fiLM~~ ar~"t~''1-~~..,°4%+',. ~„°rr'=o-' 'M1ri,.ti~ ~.: -a'-~ .s'.1.: •',~...r ~W. ., T .._ ~~""^'+~,, .:.,.. :.: yr, s..f.-•:~,.+...~.w:.ia Y'- r~:~ ,P^r~c'ka~-.;a°*ir.~k^w:,.-.A,.,r ~-'•~,,.. +'Y.J°~ d'wS.YW ~b.,, .4':.. ti4as~..v,~x.&:aw-r~`~ f INSPECTION RECORD ,.Bakersfield Fire Dept. ~:.. ;~~~;. ..~;.u :. ..,__. 1715 Chester Ave. ~ THIS IS NOT A BILL Bakersfie]a,CA93301 CUSTOMER I.D. # ENTERED ., .. ~;,, DATE: .~/"` ~ - (~ / FACILITY ADDRESS: ZIP: ~E, t'/\) A. ~ ~~~ ~ ~ ~J ~ FEE: /lf C CITY O COUNTY r FACILITY NAME: ~,'~1 ~Qt"S~- ~' l ~ ~.V ~° ~ / / 'S1 ~~ ~ ~ MANAGER NAME: FACILITY PHONE 6"~.~1-'/s~l~ BUSINESS OWNER NAME, ADDRESS, ZIP CODE BILL TO: (IF DIFFERENT FROM ABOVE)-NAME, ADDRESS, ZIP CODE, PHONE No. -~ OCC TYPE OCC LOAD - No. OF FLOORS -.- HI RISE BLDG. YES O NO EO YES O NO RISER DATE VIOLATION NQTICE CORRECTION: DATE OF REINSPECTION - 1. 2. 3. 4. 5. 6. 7. NOTES C~ ~ ~ a i CUSTO~ R: r INSPECTO AP No. C~ ~`-`~" J FIRE SAFETY CONTROL (805) 326-3951 .WHITE ORIGINAL-OWNER ;YELLOW-INSPECTOR'S COPY PINK-FILE ' .~.>;GS>.. .Y.-... i7 S.r.~...~...~~ s~i_..,_ree: i,aai....i ',y,iJyi~'e- ~ 1..~~.N-..,..Gve. - ,,'•-.~.du.e.,~.a_suss.u_.t:.,,:4~.:i.r,.u:i.>b,EIS:v,:..:.,,~.~,.ae:.~h/,..de..i.~~..<L._.ua'>,.:r.~....w,,,.J,.~~~H...mar...e.a~v...~~...~_aw.~t... .,,e~. ~:~a:'-r.~ED 1953 ,.~..., ,._«.~.,.~. /'''v" P:.~i „w~T, /*~~"a.~a-/s"",n%m i4,.~,i.}'.t.em ~* iR..:~rirA"~Mn... cL~~y~r-i:.r ,~ i. ,~a ?A'.,-s=t~l urv..`v`^~': "s- ~.7+;+r~"Af,~..{~'Yy~: A:~ :~~.-. ~~41,. ywf-k~~,. ,,..Grfi ~":Ht ~~; t 4 -t, ~ :..~e~ 1n~ 1 ,o~M~4 .r5• t` ''~ y'~;.ta x ~- ~; .,~ ;t'L,.°Y, . . ~' INSPECTION RECORD ~ ~ Bakersfield Fire Dept. - ~ 1715 Chester Ave. ,, ~ THIS IS NOT A BILL Bakersfield, CA 93301 CUSTOMER I.D. # ENTERED DATE: c p~ ` I~'`t 6 FACILITY ADDRES ~~ ~i f ~ r~~ ~ ~C ~.' 1 Z?IP: /~,~0~ FE/~,y ~~!"-~. CITY O COUNTY , FACILITY NAME: `~~. M fifV ~ Y1~ I..S~ G'/~PYhN ` B MANAGER NAME: ~ U 1 G ("'1 Q f ~ (.$ BUSINESS OWNER NAME, ADDRESS, ZIP CODE ~~ FA/CILITY PHONE 7 I - ~.Sr? ~) ~ 1/P ~ 1' ~ C~ BILL TO: (IF DIFFERENT FROM ABOVE)-NAME, ADDR ESS, ZIP CODE, PHONE No. ~,~~ ~efh Af~ X330 ~ ~X OCC TYPE ~'~ OCC LOAD No: OF FLOORS HI RISE BLDG. YES O NO C~ EQ YES O NO O RISER DATE ~~ ! '~ VIOLATION NOTICE CORRECTION: 1. DATE OF REINSPECTION z. DU1~~ )~rC' ~G,>'~~ .S e~ ~G~li'11V1 4. J 7. NOTES ~ a~Vt,~,'1h CUSTOMER: FIRE SAFETY CONTROL ~~'' + INSPECTOR: rJ~ ~7rI GI~Ifa/'+fp AP No. '"' (805) 326-3951 ~w WHITE ORIGINAL OWNER- YELLOW WSPECTORS COPY PINK _ ..., : .. r ~ + t ~W~ .M.:~ r~FLLC~ha„~.~.,:a4+~~.~.(.~aa.~si/~~s.~u"'(tg1t~&~~L.. n.~s.~s:.~xs..1Cs acts ,~U~.SL..x'e.u. n.3s,..i...,e...:r} .M. _. i w wi.Y~~{wa' ~ "+k4,,,; ~•-.-Y:Y~,.r`t-a i~.~rB"'t1..~.!"~:I.,rR-.~'mql:r",:w~^cesWxu+rc~,,,s~+"="Y}'(.~"'.~41~°~`N7-r..v4~t}~.:. -.,. ~^Y~F.~Yi iii>.'7MA.,~'-A~tt~V`~"~.T "f"t°r.^VV~ ~ .~a i ~ { t,a~?'r ~sf~.. ... 1 r ~.~ ,..~.r r '~ ° INSPECTION RECOR~ ~ ~ Bakersfield Fire Dept. ` _ ~. 1715 Chester Ave. = ~ THIS IS NOT A BILL Bakersfield, CA 9330.1 CUSTOMER I.D. # ENTERED DATE: ~_~ // FACILITY ADDRESS: ~ ZIP: ~/~ ~i O"`~C~~NTY r FACILITY NAME: ~ MANAGER NAME: ~ BUSINESS OWNER NAME, ADDRESS, ZIP CODE ~-- e~''s FA Y PHONE °~~~ Z-~,.. BILL TO: (IF DIFFERENT FROM ABO~/E) NAME, ADDRESS, ZIP CODE, PHONE No. Q--- ~'.• OG-'(j' TYPE ~° OCC LOAD No. OF FLOORS ~ HI RISE BLDG. YES O NO~..._. EQ YES O NOY~-- .RISER ATE ~ ~~ VIOLATIO NOTIC ORREC ION: ~ ,, ATE OF REINSP C N,..~~°~ c~ 4. ~~ ., 5 .r ,~ . ~ . 6. 7. NOTES `'J CUSTOMER: ~ FIRE SAFETY CONTROL INSPECTOR "`- AP No. (805) 326-3951 WHITE ORIGINAL OWNER YELLOW INSPECTOR S COPY PINK FILE FD1952 . t w..+17.t.~1.:~..r,~..,tW..sca,kae«i.ai..dt +Wra^,c w,Le'.~af~:)y`:.Ytd4lter`®n~ki,.,.f7..{..w.sst.;Fc~a1fcfLt~d~a`1;~$'N1F:efiL~ot?L~YL,rW^si?~N~. ~E2:}, FkxteW,»e,w.:iN,.+vL~a 4~is~is:`&.Sdall.,.:rli-etik• )Gt Y~.a~nA:~:3.k1bPS.ae,.:~.~e~...i~,u~:..a.,.~_~,.ur..__a.vX~.,: _,.....i .., ..n,., ..t„ri .~~....s~l._.. -• :~ B A K E R S F I E L D FIRE DEPARTMENT August 13, 1997 . Linda Fent akersfield Adventist Academy FIRE CHIEF 333 Bernazd St. MICHAEL R. KELLY akersfield, CA 93306 ADMINISTRATIVE SERVICES 2101 •H• sheet ear Ms. Fent: Bakersfield, CA 93301 (805) 326-3941 FAx (eo5> 3es-13x9 ubject: Yearly Fire Mandated Inspection i SUPPRESSION SERVICES Items to be corrected: 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 a 'stration Office FAX (805) 395-1349 Six-pak electrical adaptor must be removed; a receptacle power strip is recommended with circuit PREVENTION SERVICES '""""-"' 1715 Chester Ave. Bakersfield. CA 93301 eachers Work Room (805) 326.3951 FAX (805) 326-0576 )Provide receptacle for printer, or more to different location. Floor receptacles need covers. ENVIRONMENTAL SERVICES )Remove large gas cylinder from this area. Cylinders aze to be secwed properly at all times. 1715 Chester Ave. Bakersfield, CA 93301 ) Provide a drain for hot water heater located In mens restr0om; also, provide metal strap for (805) 326-3979 eCUrity. FAX (805) 326-0576 TRAINING DIVISION - - -`~ "`~"` `" """'" `-'"'""` 5642 victor street )Six-pak electrical adaptor must be removed; provide receptacle power strip. Bakersfield, CA 93308 (805)399-4697 FAX (805) 399-5163 h el Room Provide receptacle cover. Math Room 1) Remove six-pak electrical adaptor. Lab Room 1) Properly secwe floor receptacle junction box. Science Room 1) Remove six-pak electrical adaptor. Dark Room 1) Venting system in this room is not working. Storage Room 1) Electrical panel requires a "dead front cover". ~.~G~rXir~ f/~ ~iyrrirtuia!1~ ~' os~ ~.iG~os~e ~%/~i~ ~ ~G~~c~~ „ • ~ ~ :?'0: - I~ .L ~~ ' rI Crvm Building 1) Repair electrical outlet at Coke machine; exposed electrical wires. 2) Adjust all exiting doors that require maintenance. 3) Kitchen room: electrical conduit needs bracing. 4) Brace overhead conduit in east tunnel. S) Replace broken overhead light cover same location. 6) Repair conduit in PE storage room; exposed electrical wires. 7) All paints should be centrally located in one designated area (storage room, etc.) or Shop Room. Paints must be stored on shelving or in cabinets. Home-Ec Room (second floor) 1) Repair overhead fluorescent light; exposed electrical wires. 2) Secure live exposed electrical on north wall. 3}Provide covers for receptacles and wall switches. Music Room 1) Bare electrical wires in junction box need cover. 2) Repair overhead broken light fixture. Wei t Room 1) Provide cover to open electrical box. 2) Plug all fire hose cabinet valves. - - - 3) Overhead electrical wires need to be installed injunction box and terminated properly; live wires. Outside Area 1) Northwest exit door location has electrical conduit protruding from building above door. This needs to be secured properly; exposed wires. Shop Building 1) This building is in need of housekeeping. 2) Provide two 2AlOBC fire extinguishers, and mount at a maximum height of 60 inches. 3) Overhead electrical wiring should be terminated at control panel if system is not going to be used. 4) A gang switch box cover at exit door needs to replaced; broken. 5) Large gas cylinder must be secured properly. NOTE: just as a reminder, there should be easy access throughout this building for safety reasons. Yours truly, ~~ r H.E. Anger, ire Inspector ~ - Fire Safety Control HEA/d S:~L.etters (Anger)~3333 Bernard -2- "~-~~~~ CORRECTION NOT~~~E ~-~~""._ BAKERSFIELD FIRE DEPARTMENT ~~~~ 0 ~ ~ 9 $ J ,~ '~, Location.~~~` ~ ~~ ~ ~iti ~ .G/~G/r:'~r~ ~; ~;. 1 Sub Div~~2~~ k, .Lot You are hereby rec}uired to make the following corrections at the above location: co:. r~o / / / ~ `~ Completion Dai.e for Corrections ~ ~1~,~-~~~ Date ~ - ~~ °' 1~ ./_-'~ ,~ ~ Inspector ~~ i~ 326-3951 \ ~•ti.. _y-~ -. .. ,. ~r =} ka.~y.:.i`'v f .7M..,~,,~A-, ~tt4yl~~~n_wr ~.r.Yl~'"~F .f. .r,'. .; k~@?-<. .: .sn•~nn.~..n~,.,.-, ~ \' w ,---`~; - ,~~; - ~1 ~ 1 ;~ ~- - tom...-~: INSPECTION RECOR~~ ~ ~ ~ ' ~ ~-~~ Bakersfield Fire Dept. :. . ~ .:i - 1715 Chester Ave. TINS IS~ NOT A BILL _ Bakersfield, CA 93301 ~~' ,1 ~~ C CUSTOMER LD. # ENTERED ~~ - ~~~`~`~" ~ ~ v DATE: ~$ v ~ / ~ FACILITYp~ADDRESS: '_~~j/j i/ 1 ~~ / 9 /Y ~ M ZIP/:p /~ ~~~(Y/ 17 7FEE:~ t/V ~ O COUNTY B '~ /~~~`~!'~ G ~£..~ FACILITY NAME: ~ /~/~ ' MANAGER NAME: ~~ G ~~~ac.~/a~ra~ BUSINESS OWNER NAME, ADDRESS, ZIP CODE FACILITY PHONE ~~~`~~~~ BILL TO: (IF DIFFERENT FROM ABOVE)-NAME, ADDRESS, ZIP CODE, PHONE No. C E OCC LOAD No. OF FLOORS HI RISE BLDG. YES O NO O EQ YES O NO O RISER DATE VIO ~TION NOTICE CORRECTION: 1. DATE OF REINSPECTION )) 3. 4. 5. 6. 7. NOTES t CUSTOMER:. FIRE SAFETY CONTROL INSPECTOR: .. AP No. ~'}~~~ (805) 326-3951 ~,. WHITE ORIGINAL-OWNER YELLOW-INSPECTOR'S COPY PINK-FILE FD1952 _..'%J.+:5 is ~3 -- s.:il,~tek~%,G=v:;rw~.~~:i..a~;a.x•x7..u'2u.M3sw_.~a,Fyn:~siah~,,:..,r~a~u~,r~,.f.:m,.-,..r~.,slti-:fie ~cvc~.azd~~aa~«:~csxbi.~s~. -- wt~:u.:tau.~u:sL,a,':~D:.c~.ndi:.,+-.._.w:;c~ee+,..~..._.:.c E. ....o-.,~i_. v..,., ..,,.,~..,., ;s w,, .,..._ .u.....,.. ,.,.. ~- ~,._ . DAT,~ ADDRESS ,ZIP CODE ~~} ~,p / FEE BLOCK NO. W i~USiNESS LICENSE NO. PERMIT REQUIRED PERMIT NO. `~' ~ a~J ~ ~ YES ^ NO ^ Z O ~ BUILD ING CLASS/TYPE OF OCCUPANCY ~~ ~ BUSINESS NAME ~ d G-/~~ Y N BUST ESS OWNER BUSINESS MGR./RESPONSIBLE Z BUSINESS PHONE ~-~ "-,~ HOME PHONE d -;OF;,6LOORS~ yJ ' SQUARE FOOTAGE ~ ~ CFO ~AI.NOTICE ISSUED? ~ ~^^ `; OCCUPANT LOAD W DATE OF REINSPEC ON / 1) ~ (2)-°""~~ '13) OT ER / /-T- 'n /~ t___ ~} iy ! L° N~ INSPECT /' STr ION/SHIFT/STATION PHONE if Q,,,,~m ,~ ~` W ~!"~ - - , _ ~ ~ _ a BAK,ERSFIELD FIRE DES ARTMENT ~~~~'' 0 ~ ~ 9 ~ ' 3 LOCatlOn ~~" ~ ~/~ e ' Sub 'Div. . Blk. .Lot You are hereby required to make the following corrections ~. at the above location: Cor. No ~ - ~ ' i j _ 4 ~{~ ~' I ~- - -- - J~ j \ -.. ~~~.. y3 - -~ r} t y ' M'^k` ~ ~ ~ _ _ ~~7 4, q - ._--.-... , V ' ' I ~, ^ . / ~ I A ~ ~'QnN~ (~ ' I `} ' Completion Date for Corre.. '" ~~/ ~~ Date ~` ~`'1 !ra ° U/` ~ !'!1. .~ , i. ' -" - t~,~, Inspector - - - 326-3951 i Bakersfield `'ire Dept. Hazardous Mat~~ials Division 2130 "G" street `~ , akersfield, A. 93301 I~ ~ ~ ~I~ ~~ v! HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS• l i . To avoid further action, return this form wifhln 30 days of receipt. 2. TYPE/PRINT ANSWERS 1N ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION l: BUSINESS IDENTIFICATION DADA BUSINESS NAME: ^BAKERSFIErD ADVFNmT~m rnnFMv LOCATION: 3333 Bernard St. MAILING ADDRESS: same CITY: Bakersfield STATE: CA. ZIP: 93306 PHONE: t, RECEIVED ~~AN 1 7 19y2 ~taz_ near. oiv. 871-1591 DUN & BRADSTREET NUMBER: ...` SIC CODE: PRIMARY ACTIVITY: x - 12 school OWNER: MAILING ADDRESS: ~ EN~~~ ~~`~ ~ 5 206 SECTION 2: EMERGENCY NOTIFICATION; CONTACT TITLE BUS. PHONE 24 HR. PHONE ~, David Ferch Maint. ~ 871-1591 872-9138 Samir Berbawy Principal 871-1591 872-8534 2. r Fo~sq -., _r .. Bakersfield F~~ Dept. _ ~~ Hazardous Materi~~s Division - ~ - ~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION RE62UEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING RE6~UIREMENTS OF CHAPTER 6.9v OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS IW~ATERIALS, BUT THE 9UANTITIES AT NO - - - -- - - -- - - -- TIM~EExGEED THE MFNiMU~M-REPC~Ri1NG-QUANTIT-I°ES. - ~ - OTHER (SPECIFY REASON) ce^T~~~~ e. ^esrie~i•wr~~u. I, samir Berbawy .- .. CERTIFY THAT THE ABOVE INFOR- MATION iS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CAL[FORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PEI'~JURY. ~ - SIGNATU Pr DATE 7. ~"ITLE ~. _ CITY of BA.K`JRSFIELI? ` "WE CAFE" .~ ,~~ 0 January 7, 1992 FIRE DEPARTMENT S. D. JOHNSON FIRE CHIEF Bakersfield Adventist Academy 3333 Bernard .Ave. Bakersfield, CA 93306 Dear Sir: 2101 H STREET BAKERSFIELD, 93301 3263911 Your Underground Storage Tank for gasoline was removed on 1-3-92. Our records show that storage of gasoline in that tank was the only Hazardous Material in reportable quantity stored at your facility at 3333 Bernard Ave. If you wish to file exempt frrom the~Hazardous Materials Management Plan and Inventory Reporting Requirements you must complete and exemption request. I have enclosed a set of blank forms for your convenience. Completion of the Hazardous Materials Management Plan sections (1) Business Identification Data, (4) Exemption Request and {5) Certification must be completed and returned to this office in order to become exempt from these state reporting requirements. We have also included a cover letter to business owners briefly summarizing the filing requirements. If we can be of any further assistance please do not hesitate to call. Sincerely yours, ~~ alph E. Huey azardous Materials Coordinator REH/ed Encl. ,, ~ ~~ ~ 0,. ~e ~~ Business Bakersfield F"i~re Dept. ~,, / HAZARDOUS MATERIALS DIVISION `" ~fl~tZ~ F7 ~9 ,4,DUc~11S ~ A~C~ e~~ Date Completed I Z- 3o-~i n: 3 3 3 3 (~nMaeD ~ErvE'v s Identfication No. 215-000 - oolo/ ~ ~"I'"op of Business Plan) ~!~ ~+ 0 3 1992; No. ~ Shift B Inspector N~~ ~~`' HA7_. MAT. DIV. Adequate Inadequate Verification of Inventory Materials ~ ~ ~ ~ ~ ~ Verification of Quantities Verrfication of Location Proper Seg-egation of Materiz~l Comments: UND 6~rv~ ~A-sov~C-' TR.~V,. ~~S ~Pr~+cPc~ Verification of MSDS Availablity Number of Employees Verification of Haz Mat Training Comments: ..... O Verification of Abatement Supplies & Procedures Comments: --- Emergency Procedures Posted Containers Properly Labeled Comments: ... Verification of Facility Diagram Special Hazards Associated with this Facility: -- Violations: ~~ usiness 0 ner/Man ger All Items O.K~ Correction Needed FD 1652 (Rev. 1-90) WFii1e-Haz Mat Div. Y~low-Statkm Copy Pik-Business Copy .~ '~ . :u ~ :/ /~ ~~ ~ ~,~~ I. FACILITY/SITE Bakersfield ''ire Dept. ~ ~ HAZARDOUS MAT~IALS DIVISION ~ 2130 G Street, Bak~~~field, CA 93301 (805) 32~I~3970 ~ ~ RE~E~ ~~D UNDERGROUND TANK QUESTIONNAIREp~~; ~ 1591 .,,._, .e No. OF TANKS _ % '~ ~ -~ DBA OR FACILITY NAME NAME OF OPERATOR ADDRESS ~ . LEST CROgg STREET PARCEL No.(OPTIONAta N A~ lEQNA / ~ C CRY NAME S~`A'f~ ZIP CODE K ~~ ~/90XTOINDICATE CORPORATION QINDNIDUAL ^PARTNERSHIP QLOCALAGENCYpiSfRiCTS ^COUNTYAGENCY ^STATEAGENCY ^FEDERALAGENCY TYPE Of BUSINESS ^ }GAS STATION ^ 2 DISTRIBUTOR . KE~H COUNTY PERMR /~ ^ 9 fARM ^ b PROCESSOR b OTHER ~/ /~f~ TCJ tlPERATE No. ~ oO~ ~~ / ~ v II. .PROPERTY OWNER INFORMATION (MUST BE COM~L~TED) NAME CAkE OF ADDRESS INFORMATION ~4~v -r~s .. MAILING OR STREET ADDRESS /~ liOX Q INDIVIDUAL ^ LOCAL AGENCY ^ STATE AGENCY TY`31 3 ~2Ni42~ NDICATE ^PARTNERSHIP QCOUNTY AGENCY QfEDERAL AGENCY CIN NAME STATE ZIPCODE PHONE No. WRH AREA CODE ~~. ~KEcZ-sG','r ct~ ~i°~ 30~ i~c~- f37/~/~~ / -~ EMERGENCY CONTACT PERSON PRIMA ' , .... EMERGENCY CONTACT PERSON SECONDA Clonal DAYS: NAME (LASE FIRST) PHONE No. WRH AREA CODE BAYS: NAME (LAST, fIRST) PHONE No. WITH AREA CODE ' v - - 9 r, ~ ~ ~~c3~w D -87 ~ - IS / NIGHTS: NAME (LAST. FIRST) PHONE No. WITH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE No. WRH AREA CODE TANKOWNER INFORMATION (MUST BE COMPLETEC~) NAME CARE OF ADDRESS INFORMATION K~KS' ~ >~L 14 ~a+t7 "-1 ~ MAIIING OR STREET ADDRESS ./ SOX Q INDIVIDUAI Q LOCAL AGENCY Q STATE AGENCY ~~ ~ql ~ ( TCI IHDICATE QPARTNERSHIP QCOUNTY AGENCY QFEDERAL AGENCY CRY NAME /~~ 9fkfill ZIP CODE PHONE No. WITH AREA CODE ~A~~.sFf ~ c.3~ ~.~- S ~30~ dos- ~'~ /- /S~ OWNER'S DATE VOLUIId~ PRODUCT IN TANK No. lNSTAELED STORED ~ SERVICE Y/N Y/N .. Y1PI Y! N .... Y / N DO YOU HAVE FINANCIAL RESPONSIBILITY? t~~ TYPE s~ ELF ~ Nsu~- ~ ~ r `,~~ _-nom Fill one segment ~ for each tank, finless all~nks and piping are - constructed of th ame materials, style and e, then only fill one segment out. please identify ~~tnks by owner ID #. • I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF I UIIrA101M.1 A. OWNER'S TANK 1. D. v ~ .............. A: MANUFACTURED BY• C. DATE INSTALLED (MO/DAYIYEAR} (S; LANK CAPACITY IN GALLONS: tJ~O III. TANK CONSTRUCTION MARK rnuF ri>=u ow Y IN IiOXFS A R- AND C-AND ALL tWATAPPLIES IN BOX D A. TYPE OF ^ ~ DOUBLE WALL ^ 3 SINGLE WALL WITH EXTEWIIC~R LINER , ~ 95 UNKNOWN SYSTEM ^ 2 SINGLE WALL ^ 4 SECONDARY CONTAINMENt (VAULTED TANK) ^ 99 OTHER 8. TANK 1 BARE STEEL- ^ 2 STAINLESS 8TEEL ~ 9 FIBERGLASS ^ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL 5 CONCRETE ^ 6 POLYVINYL CHLORIDE ~ 7 ALUMINUM ^ 8 10094 METHANOL COMPATIBLE W/FRP (Primary Tank) ^ 9 BRON7F ^ t0 GALVANIZED STE0. ~ 98 UNKNOWN ^ g9 OTHER ^ 1 AIJBBER LINED ^ 2 ALKYD LNING ~ 3 EPOXY UNWG ^ 4 PHENOLIC LINING ri. INTERIOR LINING ^ 5 GLASS LINING ^ 8 UNLINED ~ 96 UNIWOWN "~~"" ^ 99 OTHER - IS LUV{NG MATERUIL COMPATIBLE WITH 100% METHANOL 7 00 ll Yf~l ~ NO_ _.... D. CORROSION ^ t POLYETHYLENE WRAP ^ 2 coATMp : •~ ~ '~ vwYL WRAP • • ^ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ^ S CATHODIC PROTECTKNI ^ 91 NONE p5 1pJ10~lOWN -• ^ 99 OTHER IV. PIPING INFORMATION CIRCLE A IFA80VEGROUNOOR U IFUNDERGROUN~:BOTHIFAPPLICABLE A. SYSTEM TYPE A U 7 SUCTION A U 2 PRESSURE .. A~ -. 3 GRAVITY A U 99 OTHER ~~_ B. CONSTRUCTION A U t SNGLE WALL A U 2 DOABLE WALL A~ - 3 LINED TRENCH A U 95 UNl(NOWN A U 99 OTHER C. MATERIAL AND A U T BARE STEEL A U 2 STAWLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PEE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U T STEEL W/ COATING A U 8 100% METHANOL COMPA LE W/FAP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTKIA) A U ~ UN~OWN A U ~ 99 OTHER D. LEAK DETECTION Q t AUTOMATK: LINE LEAK DETECTOR ^ 2 LINE TGHTNE6`S TESTING ^ ~ M~ONrtORU1G ^ ~ OTHER /~ V. TANK LEAK DETECTION ^ 1 VISUAL CHECK ^ 2 INVENTORY RECONC~IATION ^ 3 VAPOR MON11bRING ^ 4 AUTOMATIC TANK GAUGING ^ 5 GROUND WATER MONRORING ^ 8 TANK TESTING ^ 7 INTERSTITIAL MONITORING ~ 91 NONE ^ 95 UNKNOWN ^ 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF uNKNOwN A. OWNER'S TANK I. D. s E~. MANUFACTURED BY: C. DATE INSTALLED (MO/DAYdEARI 1'1: YANK CAPACITY IN GALLONS: 111. TON K CdNSTRl1CT10N MARK ONF ITEM ONLY IN ROXES A. BAND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF ^ I DOUBLE WALL ^ 3 SINGLE WALL WITH EXTERIOR LINER ^ g5 UNKNOWN SYSTEM O 2 SINGLE WALL ^ 4 SECONDARY CONTAINMENT (VAULTED TANK) ^ 99 OTHER TANK B ^ ~ HARE STEEL ^ 2 STAINLESS STEEL ~ 3 FIBERGLASS ^ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC . MATERIAL ^ 5 CONCRETE ^ 6 POLWINYL CHLORIDE ^ 7 ALUMINUM ^ 8 ItX7X. METHANOL COMPATIBLE W/FRP (PrimaryTank) ^ g ggpN~ ^ 10 GALVANIZED STEEL ~ 95 UNKNOWN ............... ^ 99 OTHER ^ t RUBBER LINED Q 2 ALKYD LNING ~ 3 EPOXY LINING ^ 4 PHENOLIC LINING C. INTERIOR ^ s CLASS LINING ^ 8 ,UNLINED ^ 95 LpJKNOWN ^ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WFTH 10096 METHANOL T Yf$_ NO_ ~ • D. CORROSION I POLYETHYLENE WRAP ^ 2 COATING 3 VINYL WRAP ~ ^ 4 FlBERGLASS REINFORCED PLASTIC PROTECTION ^ 5 CATHODIC PROTECTION a 9T NONE ^ $S UNKNOWN ^ 99 OTHER 1V. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUNO,BOTHIFAPPLICABLE A. SYSTEM TYPE A u ~ SUCTION A u 2 PRESSURE a 1) 3 GRAVITY A U 99 OTHER __ 8. CONSTRUCTK)N A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER ........... C. MATERIAL AND CORROSION PROTECTION A U t BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC}A U 4 FIBERGLASS PIPE A U S ALUMINUM p U a CONCRETE A U 7 STEEL W/ COATING A U 8 70094 METHANOL COMPATIBLE WIFRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION p U 95 UNKNOWN A U 89 OTHER D. LEAK DETECTION ^ t AUTOMATK: LINE LEAK DETECTOR ^ 2 LINE TIGHtNESS TESTING ^ ~ u~T UL 99 OTHER MDNRORWG ^ V. TANK LEAK DETECTION . t VISUAL CHECK 6 TANK TESTING ^ 2 INVENTORY RECONCILIATION ^ 3 VAPOR MONI1°ORlNG ^ 4 AUTOMATIC TANK GAUGING ^ 5 GROUND WATER MONITORING ~~ 7 lNTERSTI7IAL MONITORING a 91 NONE ~ 95 UNKNOWN a 99 OTHER J5 ~_ ` BARERSFIELD CITY SIRE DEPARTIKENT ~,~ ~ " 1 t~ ~ U ' 2130 "G" STREET _ ~ BARERSFIELD~ CA 93301 s~~ ~ ~ ~~~~ (805) 3~E3=3979 J D3ra~ ~ ~h~ ~: _..._....: OFFICIAL USE ONLY iNESS NAME ID# oaYO~~ HAZARD0L7S 1~+IATERI ALS BiJS I NESS PLA1"~` AS A WHOLE FORD 2A INSTRIICTIONS: 1. To avoid further action, return this ~t~rm by 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. SECTION 1: $USINESS IDENTIFICATION DATA nn ~~~~~ A. BUSINESS NAME: ~Y'~~S-~('P~~X ll~'l_ -~ C'~-~ ~.Qa G~- ~ 8. LOCATION / STREET ADDRESS: ~.~ ~' Ci TY : ~L~ ~Y'•~~ l p~~ ~ Z I P : eJ; ~b~ BUS .PHONE : (gos~ .~'7l 't Sal SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a ha2ardous material, call 911 and 1-800-852-7~~0 ar 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY. IN CASE OF EMERGENCY: NAME AND TITLE m~w~~~~ ~ D~J~t ING $US . HRS . AFTER BUS .' ~ HRS . A . c~~ a~' ~~E ~9 f Sw~._ [~SY•,sea~h# '~+ ~ / b`y/ Ph#~ Z- 6 z.I~6 8 . ~u m l r ~y'(~wa Plr i rte+' c~~ ,.Ph# ~ l -1 S'tl Ph# ~Z.- ~5 3Z1 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR......~IJSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~ ~ ..... B. ELECTRICAL: Pi`to ,' ~ sbw ~t~+e.~ .,,,...... C . WATER : O~'Ca ~' S y--ell ~_L-e~,~-~e ..... D. SPECIAL: E. LOCK BOX: YES / '0 IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PL7S? YES / NO MSDSS? YES / NO FLOOR PLt~TS? YES / NO KEYS? YES / NO _ nN _ • '~~ . ': 1 SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINES~,,,.AS A WHOLE .'' t ~tn~y ~ ~i~ ~vl~gv~~l2Pir`~' nh ~v Y1~C3y~~ -~ t.e9P. ~- rk c did Y' Yc~•~*'9 1 • 'f 11cd'^ hµ-v-l~i~e,5 /~a~a~dov5 'rrl.aa~2Y% a (S. .,~ . ~ . SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCh FOR YOUR BUSINESS AS A WHOLE ;fie u1evl ~. Ca lI ~ !t SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:......... YES YES `. a( B. PROCEDURES FOR COORDINATING ACTIVITIES V ~/ WITH RESPONSE AGENCIES :.. . . .......:.......:...... YES . YES N C. . PROPER USE OF SAFETY EQUIPMENT :...........:...... 0 AYES D. E EMERGENCY EVACUATION PROCEDURES :..........:...... DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS : CYO ~ YES ~ YES YES . ...... SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR N0 DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IiV QUANTITIES LESS THAN 500 POUNDS OF SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC P`~~T OF A COMPRESSED GAS:...... .YES NO I , _ ~,-~' ~~~~,Q~_ certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations ,under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et A1.) and that inaccurate information constitutes perjury. SIGNATURE J ~ /~Lft~dCL•~._.~ TITLE l~i0li1~nc~F G/"Ur.~ DATE l'" O '-'~~ -2'B- "• • BAKERSFIELD CITY FIRE DEPART~IEIT 2130 "G'" STREET BAKERSFIELD, CA 93301 .......... OrcICiA~ i;SE OILY ID# _____ BGSINESS \A~IE : _ BUS I NE ~ ~ PLAN SI ~TGLE FACT LI'TY UNI T • F ORI-~ 3 A INSTRGCTIOAS 1. To avoid further action, this fdlrrn must be returned by: 2. TYPE.!PFI~T YOCR A\SWERS I\ ENGLIS~I. 3. Answer the questions below for I'VE FACILITY CHIT LISTER BELOW 4. Be as BRIEF and CO\CISF as possi~5le. FACILITY Wi IT3Y~'~" ~ FACILITY L'~i'I'~ :VA~'IE: 1'j'1Qlh~t~ai~ue S/~cq~p. SECTION 1: ~fiTIGATION, PREVEITTIO~T, ABA'~~,~?IE~1'+T PROCEDGRES ~~ ~u~ Ve P~ SYha~j G~vaKJ~yS OT ~p.°yitr(~o~S r1~~..3 . C I~c,v, ~~ ~,t1ov~ ~io vef j SC~S~r~ JC~G'! tUtt "L ~~r~ ~~~ ?~'D EVACLATIO\ ..F', OCEDL'RES AT Tl ~'O~ ~(h~s5+~ hesl~~ (~~aY. T 0\L _ 3 A ~~ SECTIO\ 3: FiA?aRDOLS ZIATE'RI4LS FnR THIS L'~"1`.T OILY A. Does this Faczlity Lnit COtlt1111 :ia~~irc;ous Lsa}e~•i.a'::?...... `c. ~0 If YES, s~P B. If \0, continue with SECTIO': 4. B. Are any of the hazardous materials ~ bona fic':e Tr,~de Secret YES \0 I: No, complete a sep?rate hazardott~ materials inventory f~~rm marked: \Ot-TRADE SECRETS O~F.Y (white form =-4a-1) If Yes, C01Rp1Pt@ a hazardous mater~:~.'_s inc-ento_•y F~rt:t ntar'ced: TRADE SECRETS O~T..Y (y?110N' form ~~!A~2) in adclitinn to tl~~e non-t~•:~rlP secret for;n. List o.^.ly ihP trade s~cr•ats nn fort! ~a-2. SECTIO'N' 4: PRIVATE FIRE PROTECTIC\ ~~ ~~ ~ lY1c~' fJ~`Sh,e r5 . SECTION' 5: LOCATIOiy OF WATER SUPPLY r01 ~'ptrhe~' ~ Sar~,y 1.pr~ ~ .~iO-7 ~-vG. c> ~ cY s SPCTION 6: LOGATIO\ OF UTILITY SiiI;T-OFFS,....,E~T THIS 1;\IT C\LY. hv~~. vsedZ H. ELECTRICAL: J•~f~ ~s~ hey~~- ~anr u~- w~ ~ ~h~ ~~~ s~c~~ E-pc~~riC 6h~+ t9~~' for (was ~~~ o~f~p wit ~ovr f, . itiATFR D. SPcCTA;..: F. LOG1; ;?O\: l'i_'.; \0 r- 1'FS, l.~('~TIO\: .i < t'EG . S TTr Pf ASS? YES ! .`~'0 ~iSDS>>? 4'~. ~ \('. FLOOR PF.,-1\5? YES ;Tj \i`~ ~:r~'S? `:'FS ~ \0 - J17 -