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HomeMy WebLinkAboutBUSINESS PLAN 7/17/2007__ _ :. LJ~_ -~. - ----- --~ Ideal.. Cleaners. --- - ;~ -~~ __ -- ~ 3070 Brundage Ln _ ..~ IDEAL CLE Manager Location: City CommCode: EPA Numb: ANERS CRISTOBAL CEJA 3070 BRUNDAGE LN BAKERSFIELD BFD STA 03 SiteID: 015-021-001380 BusPhone: (661) 322-8152 Map 123 CommHaz Moderate Grid: OlA FacUnits: 1 AOV: SIC Code:7216 DunnBrad: Emergency Contact / Title Emergency Contact / Title DANIEL CE JA / OWNERS SON MAYRA E GONZALEZ / OWNERS DAUGHTER Business Phone: (661) 322-8152x Business Phone: (661) 322-8152x 24-Hour Phone (661) 472-1156x 24-Hour Phone (661) 832-8572x Pager Phone (661) 472-1156x Pager Phone (661) 717-5736x Hazmat Hazards: Fire React ImmHlth DelHlth Contact CRISTOBAL CEJA Phone: (661) 832-8572x MailAddr: 2233 ELLIOTT ST State: CA City BAKERSFIELD Zip 93307 Owner CRISTOBAL CEJA Phone: (661) 832-8572x Address 2233 ELLIOTT ST State: CA City BAKERSFIELD Zip 93307 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK ~ ~ ~~~t~ ~~~ ~ ~ g ~~~/ Eased on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of lav. that I have personally examined and am famil'sar with the information submitted and believe the information is true, accurate, and complete. S{gna u~T r~ Date -1- 07/12/2007 1 '1 F IDEAL CLEANERS ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-001380 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PERCHLORETHYLENE F IH DH L 70.00 GAL Low WASTE PERCHLOROETHYLENE R L 20.00 GAL Low -2- 07/12/2007 -3- 07/12/2007 F IDEAL CLEANERS ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME PERCHLORETHYLENE Location within this Facility Unit DRY CLEANING MACHINE & STORAGE TABLE STATE TYPE r- PRESSURE Liquid Mixture 1 Ambient SiteID: 015-021-001380 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 70.00 GAL 70.00 GAL 70.00 GAL t1HGF~KLVU~ 1:V1~lYV1VI;1V1J %Wt. RS CAS# 100.00 Perchloroethylene No 127184 ti1~G1-~tCll 1j55L" ~7w71~1L' 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME WASTE PERCHLOROETHYLENE Location within this Facility Unit STATE TYPE PRESSURE Liquid ~aste ~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 127-18-4 TEMPERATURE CONTAINER TYPE Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 20.00 GAL 20.00 GAL 20.00 GAL riHGHttL V U 5 l: V1~lY V1V 1;1V 15 %Wt. RS CAS# 100.00 Perchloroethylene No 127184 ti1~L,1~KlJ 1j.7.7L" ~~1~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Low -4- 07/12/2007 r. F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/30/2000 ~ NOTIFY FIRE DEPT. Employee Notif./Evacuation EMPLOYEES LEAVE TO MEET IN PARKING LOT. 10/30/2000 Public Notif./Evacuation Emergency Medical Plan MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. 10/30/2000 -5- 07/12/2007 ~. F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/30/2000 ~ MAINTAIN EQUIPMENT. Release Containment 10/30/2000 PLACE WASTE IN DRUMS FOR HAZARDOUS WASTE HAULING BY SAFETY KLEEN. Clean Up MOP SPILLS AND RECLAIM. 10/30/2000 v~.ucl 1CCbVUiI.:C HC:l.1Vdl,1V11 -6- 07/12/2007 ~: ~S F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~Nc~ial. nuc~aiu~ Utility Shut-Offs 04/13/2007 GAS - SW CRNR OF BLDG ELECTRICAL - REAR OF BLDG WATER - FRONT OF LOT ON BRUNDAGE LN Fire Protec./Avail. Water 05/10/2007 FIRE EXTINGUISHERS FIRE HYDRANT - S END OF SITE ACROSS BRUNDAGE LN. Building Occupancy Level 03/01/2006 2 EMPLOYEES -7- 07/12/2007 F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/10/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE IN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: KEEPING HAZARDOUS MATERIALS ON EXACT LOCATION, HAZARDOUS WASTE HAULING BY SAFETY KLEEN, MAINTAIN EQUIPMENT, FIRE DEPARTMENT, AND ROTHU KEO, INDUSTRIAL WASTE INSPECTOR. Ydy C G Held for Future Use Held for Future Use -8- 07/12/2007 HMMP W~I~DOUS MATERIAL MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM) APPLICATION BUSINESS OWNER/OPERATOR IDENTIFICATION FORM (HAZARDOUS MATERIAL FACILITY INFORMATION 8 B R S F I D F/R,$ r ~a 5 ~ BAKERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Avenue, Suite 401 Bakersfield, CA 93301 OFFICE: 661-326-3979 FAX: 661-852-2171 Page 1 of 2 ~~ ~!~ I. FACILITY IDENTIFICATION FACILIN IDNO. 1 1 0 ~ 1 1 YEAR BEGINNING 100 YEAR ENDING 101 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 BUSINESS PHONE 102 SITE ADDRESS ~o~~ ~~c~.ge Lai e 1D3 cm n ~~O ~~J~ D , ~ loa Lr CA zIP ~~ ` J~~ !~.~ los DUNN & BRADSTREET No. ® e~©© lp6 [v SIC CODE - 107 COUNTY ~) ~\ ~ 1 ^ ~~ A ~ ~~ ~.. 108 ` ~~~~ 109 OPERATOR NAME~~~~~a OP~T~PHONE ~ ~~~~ 110 II. OWNER INFORMATION OWNER NAME ~ ~ 111 ` OWNER PHONE 112 ~~ G - OWNER~~ADDR~ ~ \ ©~~ ~~ 33 113 CITY 114 STATE ~~e~s~ ~e ~ c~ lls ZIP ~ A~ 4~~~~ 116 - III. `ENVIRONMENTAL CONTACT ~ - - - - - /~ \ - ~1 ~ .~ 117 CONTACT NAME (`.J1(-"~\ `GJ 4, Teti CONTACT PHONE{ - - ~ ~~---~ - 1 1 8 CONTACT MAILING AD ESS C ~/ \ ` ^ ~ V~ 119 CITY ~ ~ ~ ~ 120 STATE 121 ZIP ~~~^ 122 IV. EMERGENCY CONTACTS PRIMARY S..ECON DARY NAME ~~/~q\ 123 1` NAME ~ ~A\ 1V ~ ~~ 128 TIRE ~~ 124 TITLE ~ 129 BUSINESS PH NE ~ ~ 125 BUSINESS PHONE I /~ ~ I ~ 1 ~ (~/• 130 24-HOUR PH N ~ ~ ~ - ~ ~~ ~ 126 24-HOUR PHONE ~ - ^ ~~ ~J 131 CELL PHONE \ ~~ _~~ ~ 127 ~~~ J CELL PHONE ( '~ ~ 132 133 V. CERTIFICATION ertification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personall xamined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. SIGNATURE OF DOCUMENT SIGNER 136 DATE ~v~ 134 ~'~ ~G~ NAME OF DOCUMENT PREPARER 135 NAME OF OW OR (S NT) 137 TITLE OF DOCUMENT SIGNER 138 ,~ // V tUL14L (KEV. U3/U/) HAZARDOUS MATERIAL FACILITY INFORMATION (HMMP) , BUSINESS OWNER/OPERATOR IDENTIFICATION ,ry ~ `' , Please submit the Business Activities page, the Hazardous Material Facility Information (HMMP) Business Owner/ Operator Identification Form, and Hazardous Material Inventory Chemical Description Form for all hazardous material inventory submissions. For the inventory to be considered, please complete this page; it must be signed by the appropriate individual. ~ NOTE: The numbering of the instructions follows the data element numbers that are on the Business Owner/Operator Form page. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, Business Section of the Unified Program Data Dictionary. Please number all pages of your submittal. This helps our CUPA or AA identify whether the submittal is complete and if any pages are separated. i FACILITY I.D. 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. • 101 ENDING DATE -Enter the ending year and date of the report. 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 DUNN & BRAD5TREET NUMBER -Enter the Dunn & Bradstreet number for the facility. The Dunn & 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 which the business site is located. 109 BUSINESS OPERATOR NAME -Enter the name of the business operator. 110 BUSINESS OPERATOR PHONE -Enter business operator phone number, area code first, and any extension. 111 OWNER NAME -Enter name of business owner. 112 OWNER PHONE -Enter the business owner phone number, area code first, and any extension. 113 OWNER MAILING ADDRESS -Enter the owner mailing address. 114 OWNER CITY -Enter the city for owner mailing address. . 115 OWNER STATE -Enter the 2 character state abbreviation for the owner mailing address. 116 OWNER ZIP CODE -Enter the zip code for the owner address; extra 4-digit zip may also be added. 117 ENVIRONMENTAL CONTACT NAME -Enter the name of the person who receives all environmental correspondence and will respond to enforcement activity. 118 CONTACT PHONE -Enter the phone number at which the environmental contact can be contacted, area code first, and any extension. 119 CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact correspondence should be sent. 120 CITY -Enter the name of the city for the environmental contact mailing address. 121 STATE -Enter the 2 character state abbreviation for the environmental contact mailing address. 122 ZIP CODE -Enter the zip code of the environmental contact mailing address; 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 material, at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 124 TITLE -Enter the 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 PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24-hours a day. If it is not the contact home phone number, then the service answering the phone must be able to immediately contact the individual. 127 CELL NUMBER -Enter the cell number for the primary emergency contact. 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 available. The contact shall have FULL facility 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 not the contact home phone number, then the service answering the phone must be able to immediately contact the individual. . 132 CELL NUMBER -Enter the cell number for the secondary emergency contact. 133 ADDITIONAL LOCALLY-COLLECTED INFORMATION -This space may be used for CUPA or AA 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. 135 NAME OF DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. 136 SIGNATURE OF DOCUMENT SIGNER (FULL SIGNATURE) -Enter the full signature of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer inquiry of those individuals responsible for obtaining the information, all the information submitted is true, accurate, and complete. 137 SIGNATURE OF OWNER/OPERATOR/DESIGNATED REPRESENTATIVE -The Business Owner/Operator, or officially-designated representative of the Owner/Operator, shall sign and print in the space provided. This signature certifies that the signer is familiar with the signer belief that the submitted information is true, accurate, and complete. _ 138 TITLE OF DOCUMENT SIGNER -Enter the title of the person signing the page. Page 2 of 2 Fo21a2 (Rev. 03/07) (HMMP) HAZARDOUS MATERIAL MANAGEMENT PLAN APPLICATION '' FOR SECTION DISCOVERY & NOTIFICATION (FORMS) BAKERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Avenue, Suite 401 Ii I3 a 8 P I D Bakersfield, CA 93301 /~lR! OFFICE: 661-326-3979 A y FAX: 661-852-2171 ~ Page 1 of 2 INSTRUCTIONS "~ 1. To avoid further action, return this form 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. SECTION-I. FACILITY IDENTIFICATION - _- BUSINESS NAME (FACILITY NAME or DBA) ADDRESS (for local use only) -~ ~ ~~a ~ ~ ~ e ~5~ e-~d ~ ~ ~~~aLl .FACILITY ID NO. 1 SECTION II.1: DISC01/ERY AND NOTIFICATIONS -- A. LEAK DETECTION AND MONITORING PROCEDURES: ~'CC> t~s~o~~'<oC QL l,eC~~ VJ2 ~(`a.~ d. . v~`dJC~.\ Cm ~~~-~. O, cc~o~.~~t;C S~O.~'C~-~1o^C1 SvJ~;t~~c'C~„ B. EMPLOYEE AND AGENCY NOTIFICATION: ~ 1 l ~-~ ~ C~ ate- E~~ r~~c ~ S ~c'~1 t C. 2 ~ 0~-~' 1-~6 C~ ~ -- X65 ~ `r7 5~ ~ C. ENVIRONMENTAL RESPONSE MANAGEMENT: n . ~.1 D. EMERGENCY MEDICAL PLAN: oJa ~ sec P`~ ~.~~'+~-«~ '~C',revJ '~-~ ~~ ~.\ ~ a~5 }C"C'vx k~~ Pcve X2-1 ~ ~ la ess 1eo-vC ~ - 33-1.1 ,~ ~ `~ SECTIUN IL2: RELEASE RESPONSE PLAIN A. HAZARD AaSSEISMENT AND PREVENTION MEASURES: M G ~ ~~ ~Q t ~ 2GQL~ ~ ~ ~`~l B. RELEASE CONTAINMENT AND/OR MITIGATION: Q lac e ~~t er ~ n ~ ~~r~, s ~ q ~ l~ v~c~ bL~ ~-F~e;-~ C. CLEAN-UP AND RECOVERY PROCEDURES: ~l.~~n. M-o~ °~,~ ; X15 ~ d '~E'_ C~CJ, l YYl FD2169 (Rev. 03/07) Page 2 of 2 t:4 ~ SECTION I~L2: RELEASE RESPONSE PLAN (CON'T.) __ UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL AS PR PANE: ~~ v©`~ ` `~~~ ~~ ~\~v ELECTRICAL: ~ e ~^ ~~ ~ ~ <.J~ ~/ v~ WATER: ~ \ ~~'T (~ ~ ~~ ~ ~ ` ~1 ~`~ ~~ ~1 .' 'CJ V SPECIAL: \VO~ v PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: ~ G~coss ~c~~ ~ Lti , _ ~' ~e ~ x ~ ~ c.~U~ s~~' B. WATER AVAILABILITY (FIRE HYDRANT): ice ~v~~o.~-~ ~s ~~n ~o~-~~, ~~~ p~oc~~ ;~C'C1'1V1~1_111P 1"KN1`IR"lltll7 NUMBER OF EMPLOYEES: - - - -_ - - - - ~s.~b ~ ~ _ MATERIAL SAFETY DATA SHEETS ON FILE: ~ ... " ~9.~ ~~~~~ p~~ C~ ~\E 6 BRIEF SUMMARY OF TRAINING PROGRAM: ~e p~~y \~ a-zc~- c cbus ~c`c`C~.~a.~~ d~ ~cc~-'~- 1 ~ cc~.-~ot~ , ~~ce ~~tk~~e~- - . ~~~1~ ~e© - S~c~,Y~kC ~c~.\ w(9.5~2 ~~eC{-pt- . CERTIFICATION ._ . I Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personal) examined and.am familiar with the information submitted. and believe the information is true, accurate, and complete. SIGNATURE OF OW OPERATOR OR DESIGN D REPRESENTATIVE DATE 477 V NAME~O^F GlNE,R (Mprint) a78 C` ~ "~`C V~~ ~ ~ a79 TITLE OF S'IG,N^E~R ~W~~~ ' FD2169 (Rev. 03/07) _ „ (HMMP) i BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIAL MANAGEMENT PLAN Prevention Services ` , UNIFIED PROGRAM CONSOLIDATED FORMS B 8 R 8 P I n 1600 Truxtun Avenue, Suite 401 F/RB Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM ~ f OFFICE: 661-326-3979 HAZARDOUS MATERIAL INVENTORY FAX: 661-852-2171 ,..._... Page 1 of 2 ^ NEW ^ ADD ^ DELETE ^ REVISE zoo fQae form_oer material. Oer b0iidino, 0[~rea,) ___ I: FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 ~'O~(~L CL~ 4'cN~c'~ S CHEMICAL LOCATION L~«~p~ ~ Z01 CHEMICAL LOCATION 202 • ~Ut~ ~~~ k ~~~C~'Glht'(~ CONFIDENTIAL (EPCRA) ^ Yes~No ~c~~•. a~a ~-ec~. ~e ~-ube.~ FACILITY ID N0. 1 MAP No. (optional) 203 GRID NO. (optional) 204 ~ ~oa~>oo~ ago ~~-~ ~~~ II. CHEMICAL INFORMATION CHEMICAL Ngggg~~~~1111E 205 206 ~~~~b .~-~1.p., ~ ~ ~ ^ ~ ~ ` ~ l ~ e ~ TRADE SECRET ^ Yes ^ No - If subject to EPCRA, refer to instr uctlons COMMON NAME P 207 EHS* ^ Yes ^ No erC 208 CAS N0. I 't ~ ~ \Cd ); 209 *If EHS is yes, all amounts below pounds. must be in \ 1 ~ / ~ FIRE CODE HAZAR D CLASSES ( c o m plete if requested by local fire chief) 210 TYPE PURE ^ MIXTURE ^ WASTE 211 RADIOACTIVE: ^ Yes ^®100 212 CURIES 213 4 LARGEST CONTAINER 215 PHYSICAL STATE ^ SOLID Jf /LIQUID ^ GAS 214 ~' ~1~~ 216 FED HAZARD CATEGORIES ^ FIRE ^ REACTIVE ^ PRESSURE RELEASE ^ ACUTE HEALTH ^ CHRONIC HEALTH (Check all that aDDIY) . n- ANNUAL WASTE ~L11 ~~^ 217 AMOUNT ~ MAXIMUM DAILY AMOUNT ~ ' 218 AVERAGE 219 ` DAILY AMOUNT 2O h STATE WASTE CODE 220 ~ ~ `~ ^ UNITS` ~ GAL ^ CU FT ^ LBS ^ TONS 221 DAYS ON STIE i~1 ~(~, 222 ~If EHS, amount must be in lbs. t~ lJ v STORAGE CONTAINER 223 ABOVEGROUND TANK ^ CAN ^ BOX ^ TANK WAGON ^ UNDERGROUND TANK ^ CARBOY ^ CYLINDER ^ RAILCAR ^ TANK INSIDE BUILDING ^ SILO ^ GLASS BOTTLE ^ OTHER ^ STEEL DRUM ^ FIBER DRUM ^ PLASTIC BOTTLE ^ TOTE BIN ^ PLASTIC/NONMETALLIC DRUM ^ BAG STORAGE PRESSURE AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT 224 STORAGE TEMPERATURE~AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT ^ CRYOGENIC 225 %WT HAZARDOUS COMPONENT EHS CAS # 1 226 227 ^ Yes ^ No 228 ~t //~~ ~~-- { ~~-p ~ 229 2 230 231 ^ Yes ^ No 232 233 3 234 235 ^ Yes ^ NO 236 237 4 238 239 ^ Y25 ^ NO 240 241 5 242 243 ^ Yes ^ No 244 za5 IIL SIGNATURE` PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATUR ~ DATE 246 E ,D "' FD2144 (Rev. 03/07) - CALIFORNIA WASTE CODES "' ~' Code Descri t~ ion Inorganics 111 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 111) 122 Alkaline solution .without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12.5) containing reactive Anions. (azide, bromate, chlorate, cyanide, fluoride, hypochlorite, nitrite, Perchlorate and sulfide anions) 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues 100% or more 134 Aqueous solution with total organic residues < 10% 135 Unspecified aqueous solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 161 FCC Waste _ 162 Other spent catalyst 171 Metal sludge (see 111) 172 Metal dust and machining waste (see 111) 181 Other inorganic solid waste Organics Code Descri tion Organics (con't.) 261 PCB and material containing PCB 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 (non-solvents) with halogens 343 Unspecified orgahic liquid mixture 351 Organic solids. with halogens Sludge ; 411 Alum and gypsum sludge 421 ,Lime sludge 431 Phosphate sludge 441 Sulfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 - Tetraethyl lead sludge ~ . 491 Unspecified sludge waste 211 Halogenated solvents (methylene chloride, chloroform, 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 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste ~' Miscellaneous 511 Empry 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 551 Laboratory waste chemicals 561 Detergent and soap 571 Fly ash, bottom ash, and retort ash 581 Gas scrubber waste 591 Bag house waste 611 Contaminated soil from site clean-ups 612 Household wastes Page 3 of 3 ~ Fo2144a (Rev. 03-07) (HMMP) ~ ~ BAKERSFIELD FIRE DEPT. i •HAZARDOUS MATERIAL MANAGEMENT PLAN j ~ Prevention Services ~'' (UNIFIED PROGRAM CONSOLIDATED FORM) B B R S F I n 1600 TrUxtun Avenue, Suite 401. . _ _ _ ___ fIRB Bakersfield, CA 93301 BUSINESS ACTIVITIES PAGEu r OFFICE: 661-326-3979 (HAZARDOUS MATERIAL FACILITY INFORMATION) ~- FAX: 661-852-2171 Page 1 of 1 I. FACILITY IDENTIFICATION FACILITY ID # (for office use only) 3 ~ EPA ID # BUSINESS NAME (FACILITY NAME or DBA) 103 2L ACTIVITIES DECLARATION DOES Your Facility... If Yes, Please Complete... lz9 A. HAZARDOUS MATERIAL s No • CHEMICAL DESCRIPTION FORM 130 1. Have on sib (for any purpose) hazardous material • HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 gallons for liquids, 500 pounds for Minimum required planning elements: solids, or 200 cu. ft. for compressed gases (include • Emergency Response Plan liquids in AST and UST)? • Maps • Training • Prevention • Certification • B. REGULATED SUBSTANCES (RS) es ^ No •. CHEMICAL DESCRIPTION FORM 131 1. Have on site RS at greater than the threshold • RISK MANAGEMENT PLAN (RMP Submit to USEPA) planning quantities established by the California • CONSOLIDATED COMPLIANCE PLAN Accidental Release Prevention program (CaIARP)? • Incorporating CaIARP Program Elements C. UNDERGROUND STORAGE TANKS (UST) es O No • UST FACILITY FORM 13z 1. Own or operate Underground Storage Tanks? • UST TANK FORM (one per tank) Yes O No • UST FACILITY FORM 133 2. Intend to upgrade existing or install new UST? • UST TANK FORM (one per tank) • UST INSTALLATION FORM (one per tank) D. TANK CLOSURE/REMOVAL ^ Yes o • UST TANK FORM (Closure section -one per tank) 1. Need to report closing an UST that held hazardous material or waste? 2. Need to report the closure/removal of a tank that ^ Yes Flo • UST TANK CLOSURE FORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS ^ Yes o • HAZARDOUS MATERIAL MANAGEMENT PLAN (ASTI • Incorporating Federal Spill Prevention Control and Countermeasure 1. Own or operate AST above these thresholds; any (SPCC) Elements pursuant to 40 CFR Part 112. tank capacity is greater than 660 gallons or the total capacity for the facility is greater than 1,320 gallons? F. HAZARDOUS WASTE ~ EPA ID NUMBER -provide on this page 1. Generate hazardous waste? es ^ No • To obtain EPA ID Number, please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable ,pfyes ^ No • RECYCLING FORM material at the same location it was generated? ~ 3. Recycle more than 100 kg/mo of recyclable ^ Yes [ No • RECYCLING FORM material at an off-site location different from the point of generation? 4. Treat Hazardous Waste on site? ^ Yes r~No • TP FACILITY FORM • TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? yes ^ No .CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a Yes ^ No • REMOTE WASTE/CONSOLIDATION SITE NOTIFICATION remote Site? FORM NOTE: if you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested above, please submit BUSINESS OWNER/OPERATOR IDENTIFICATION FORM. FD2143 (Rev. 03/07) Hazardous Material Inventory - Chemical'Description `~ r ~ ~± UNIFIED PROGRAM CONSOLIDATED FORMS You must complete a separate Hazardous Material Inventory -Chemical Description page for each hazardous material (hazardous substances and Hazardous waste) that you handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the Federal threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which _an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous material at your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure. (NOTE: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, and 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. i 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. 200 ADD/DELETE/REVISE -Indicate if the material is being added to the inventory, deleted from the inventory, or if the Information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201 CHEMICAL LOCATION -Enter the building or outside/adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information Is not subject to public disclosure pursuant to HSC §25506. 202 CHEMICAL LOCATION CONFIDENTIAL - EPCRA -All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check yes to keep chemical location information confidential. If the business does not wish to keep chemical location information confidential check no. 203 MAP NUMBER - If a map is included, enter the number of the map on which the location of the hazardous material is shown. 204 GRID NUMBER - If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed. 205 CHEMICAL NAME -Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not complete this field; complete the "COMMON NAME" field instead. 206 TRADE SECRET -Check yes if the information in this section is declared a trade secret or no if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by HSC §25511. Federal requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a Substantiation to Accompany Claims of Trade Secrecy form (40 CFR 350.27) to USEPA. 207 COMMON NAME -Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208 ENS -Check yes if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209 CAS # -Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture'if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210 FIRE CODE HAZARD CLASSES -Describes to first responders the type and level of hazardous material which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class, include all. Contact CUPA or AA for guidance. 211 HAZARDOUS MATERIAL TYPE -Check the one box that best describes the type of hazardous material: pure, mixture, or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. 212 RADIOACTIVE -Check yes if the hazardous material is radioactive or no if it is not. 213 CURIES - If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214 PHYSICAL STATE -Check the one box that best describes the state in which the hazardous material is handled: solid, liquid, or gas. 215 LARGEST CONTAINER -Enter the total capacity of the largest container in which the material is stored. 216 FEDERAL HAZARD CATEGORIES -Check all categories that describe the physical and health hazards associated with the hazardous material. 217 AVERAGE DAILY AMOUNT -Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/outside area. Calculations shall be based on the previous year 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 material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in Box 221 and should not exceed that of maximum daily amount. 218 MAXIMUM DAILY AMOUNT -Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain et a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in Box 221. 219 ANNUAL WASTE AMOUNT - If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220 STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221 UNITS -Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet, or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). 222 DAYS ON SITE -List the total number of days during the year that the material is on site. 223 STORAGE CONTAINER -Check the one box that best describes the type of storage container in which the hazardous material is stored. 224 STORAGE PRESSURE -Check the one box that best describes the pressure at which the hazardous material is stored. 225 STORAGE TEMPERATURE -Check the one box that best describes the temperature at which the hazardous material is stored. 226 HAZARDOUS COMPONENTS i-5 (% BY WEIGHT) -Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227 HAZARDOUS COMPONENTS i-5 NAME -When reporting a hazardous material that is a mixture, fist 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 sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228 HAZARDOUS COMPONENTS 1-5 EHS -Check yes if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or no if it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229 HAZARDOUS COMPONENTS i-5 CAS -List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246 LOCALLY COLLECTED INFORMATION -This space may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs. Contact the CUPA or AA for guidance. Page 2 of 2 FD2144 (Rev. 03/07) 1 :,r, ~~~~ IDEAL CLEANERS SiteID: 015-021-001380 Manager L'~,~~i J~~ fc=~Q y ~ Bus Phone : ( 6 61) 3 2 2 - 815 2 Location: 3070 BRUNDAGE LN Map 123 CommHaz Moderate City BAKERSFIELD Grid: OlA FacUnits: 1 AOV: CommCode: BFD STA 03 EPA Numb: SIC Code:7216 DunnBrad: Emergency Contact / Title CLAYTON O KENNEDY / ~ ~~~I~/~ ~ r ency Cont ct .L/ Ti _r GARY ~~~e ~/~- ~ Business Phone: (661 )322-8152x Business Phone 1) 322-8152x 24-Hour Phone (661) 589-8921x 9325x 24-Hour e (661 Pager Phone (661) 330-1438x _ Pag hone ( ) Hazmat Hazards: Fire React ImmHlth DelHlth Contact DIANA NAJERA Phone: (661) 322-8152x MailAddr: 3070 BRUNDAGE LN State: CA City BAKERSFIELD Zip 93304 Owner CLAYTON O KENNEDY Phone: (661) 589-2921x Address 10339 CHEYENNE DR State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK qq fig, (~(~ ~ ~ ~ x+ ~"~"~~ ~N~`~ h~ ~ Based on my inquiry of those individuals I certify the information btainin ibl f D O , g or o e respons under penalty of law that I have pers,anally examined and am familiar with the information submitted and believe the information is true, accur te, and complete. c~ _ ~ Q~ S' nature ate . -1- 02/01/2007 F IDEAL CLEANERS SiteID: 015-021-001380 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PERCHLORETHYLENE F IH DH L 70.00 GAL Low WASTE PERCHLOROETHYLENE R L 20.00 GAL Low -2- 02/01/2007 -3- 02/01/2007 ~ ~, F IDEAL CLEANERS SiteID: 015-021-001380 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PERCHLORETHYLENE Days On Site 365 Location within this Facility Unit Map: Grid: DRY CLEANING MACHINE & STORAGE TABLE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid ~Mixtur~mbient ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container ~ Daily Maximum Daily Average 70.00 GAL 70.00 GAL 70.00 GAL t1ti~.ytcLUU~ ~ulnr~lvl;lv~t5 %Wt. RS CAS# 100.00 Perchloroethylene No 127184 t1E~GH.KL A~5~5~1~1tS1V 1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low r ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE PERCHLOROETHYLENE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 127-18-4 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Twaste Ambient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Con20100rGAL Daily M~x0im0u0m GAL I Daily A20r00e GAL ntiat~tcLUU~ wlnrulvr~lvt~ oWt. RS CAS# 100.00 Perchloroethylene No 127184 ri1~GKtCL HJ.7~5~1~1L'1V1J TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Low -4- 02/01/2007 F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/30/2000 ~ NOTIFY FIRE DEPT. Employee Notif./Evacuation 10/30/2000 EMPLOYEES LEAVE TO MEET IN PARKING LOT. ru.r~iic 1voLir . ~ r;vacuazion Emergency Medical Plan 10/30/2000 MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. -5- 02/01/2007 F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/30/2000 ~ MAINTAIN EQUIPMENT. Release Containment PLACE WASTE IN DRUMS FOR HAZARDOUS WASTE HAULING BY SAFETY KLEEN. 10/30/2000 Clean Up MOP SPILLS AND RECLAIM. 10/30/2000 v~.uci itcavui~.c 1-al.l.1V0.~.1V11 -6- 02/01/2007 .+ F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l:1 G11 21dGCLL Ua Utility Shut-Offs A) GAS - SW CRNR OF BLDG B) ELECTRICAL - REAR OF BLDG C) WATER - FRONT OF LOT ON BRUNDAGE LN D) SPECIAL - NONE E) LOCK BOX - NO 04/13/2006 Fire Protec./Avail. Water 12/01/2006 FIRE HYDRANT - S END OF PROP ACROSS BRUNDAGE LN. Building Occupancy Level 2 EMPLOYEES 03/01/2006 -7- 02/01/2007 ~, F IDEAL CLEANERS SiteID: 015-021-001380 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/01/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rayc c. Held for Future Use nciu iui ru~uic uaC -8- 02/01/2007 r~ L~ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program B E R_S F I D -- -F/RE - - ARTM T Prevention Services 900 Truxtun.Ave., Suite 210 Bakersfield, CA 93301 Tel.: " (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME 11DEos1.. L~ rc~ 'RS INSPECTION DATE n 2 6 INSPECTION TIME - ADDRESS PHONE NO. NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- (3D ~ 38rp - Section 1: Business Plan and inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS G]/ ^ APPROPRIATE PERMIT ON HAND ^ BUSIt1eSS PLAN CONTACT INFORMATION ACCURATE (]~ ^ VISIBLE ADDRESS a •~ ^ CORRECT OCCUPANCY '^ ~ ~~ ~ ~ >" CEY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION C~/b PROPER SEGREGATION OF MATERIAL C~ ^ VERIFICATION OF MSDS AVAILABILITY ^~^ VERIFICATION OF HAZ MAT TRAINING C~~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED L y ' ^ HOUSEKEEPING , _ , / L4~ ^ FIRE PROTECTION ~i. ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? AYES ^ NO QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/Station # Business Site /Responsible Party (Pleas rint) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 -J C ~~ + IDEAL CLEANERS ______________________________________ SiteID: 015-021-001380 + Manager Location: 3070 BRUNDAGE I,N City BAKERSFIELD BusPhone: (661) 322-8152 Map 123 CommHaz Low Grid: OlA FacUnits: 1 AOV: CommCode: BFD STA 03 EPA Numb: SIC Code:7216 DunnBrad: Emergency Contact / Title Emergency Cont t / ~ Title CLAYTON KENNEDY / ~~ -- ~ w z ~'"4 Business Phone: (661) 32'2'-8152x 61) Business Phone: ( 322-8152x 24-Hour Phone (661) 589-8921x 24-Hour Phone (661) 323-9325x Pager Phone (661) 330-1438x Pager Phone ( ) - x Hazmat Hazards: Fire React ImmHlth DelHlth Contact Phone: (661) 322-8152x MailAddr: 3070 BRUNDAGE LN State: CA City BAKERSFIELD Zip 93304 Owner CLAYTON 0 KENNE]D'Y Phone: (661) 589-2921x Address 10339 CHEYENNE DR State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT P T - R O G GROUND ABOV E S TOR AGE TANK ` ~ ~ ( , I r1YK ~ / / J ~ ~/ .. / ~~~ t-~/ /e li~~~ ENT A PR ~ 3 2006 ,...,,~F.,;, on my inquiry of those individuals ;4;spr;,rsihie for obtaining the information, I certify ,,,~,,j~, ocnalty of law that I have personally ~,;-,,,-,,,red and am familiar with the information ~;::r,~,;rted and believe the information is true, ;~~c~;ra;e, and complete. ___~_~ ~,.---~ oat-~-~~ ;;~~natur -1- 03/02/2006 uNI~1ED Pi20CR~411A INSPECTION CHIECKLIST Bakersfield Fire Dept. ' Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 SECTION 1 Business Plan and Inventory Program • FACILITY NAME INSPECTION DATE INSPECTION TIME /a- -es /S' h. --- ADDRESS PHONE No. No. of Employees ~ ~,W/Y12~ .32-2 - ~I.S`Z 1 FACILITYCONTACT ~ Business ID Number LL ~ ~ v 15-021- 13 ~ Section 1: Business Plan and Inventory Program Routine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection • ANY HAZARDOi1S WASTE ON SITE?: ^ YES ^ NO EXPtA1N: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661 ~ 32G-3979 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site White -Environmental Services Yellow -Station Copy l.~-t"~ 'E 40d..I ~ r~ Pink -Business Copy Print) m