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HomeMy WebLinkAboutPROPAINE APPL. 12/2/2005(PROPANE) ~ FILE #1 _TRACTOR__SUPPL_Y _ _ -- ---_~ __-s~~_-_____._, __ - -, ;;`2749 GALLOWAY-DRIVE ~ -- , . - - - -- - -- - - ~.;~~~ ~~ ~ f~ •'.- r PROPANE EXCHANGE STORAGE TANK(S) APPLICATION FOR INSTALLATION /REMOVAL OF PROPANE EXCHANGE TANK(S) INSTALL ^ REMOVE PERMIT: # PAS- bC~A-3~ a °'~aRSP~~n fiu~,. .~w~~ D~PARTMB111T wy ~'~~ Rz~ v: *~:s `~ ~~ A~ ~~~~~ , ;r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax.: (661) 852-2171 Page 1 of 1 . FACILITY 0 ~ ADDRESS L w~ OPERATO S NAME /~ 3 u (~ ' OWNERS NAME _ ~~ NUMBER OF CAGES TO BE INSTALLED /REMOVED __ ~ ~ ~ ~ ~~ TOTAL NO. OF TANKS VOLUME ~o2k ~.1~=i Fv~~ NAME OF COMPANY INSTALLING & / OR REMOVING TANK(S) l MAILING ADDRESS " ? D (liLl l 0 ZJ G ~ ~ NAME & PHONE NU'MBEnR OF CONTACT PERSON ~W t~ ~ DATE & TIME TO BE INSTALLED OR REMOVED SI E OF APPLIC DATE _ „~ (~`~~ APP OVED BY ~ DATE S ~ /Z r i _ ~•7 .~~ FD2107 (Rev: o2/os) AN"' o«~~ ~., ,~~-, s ~~~ ~h ~~ ~~~ S 7 °~'' C ~9G'C ~y ~jt~~ 1 ~'~ ~~ ~' ~ ~ Rom' S • - -:; ~~ ~i ~~~ _, ~~p"J~ TRACTOR SUPPLY CO ~ ~ SitelD: 015-021-003417 Manager : /~~.~ l~rQ11~~ BusPhoane: (611) 589-1504 Location: 2749 GALLOWAY DR 560 Map 7,02 'ComimHaz Extreme City BAiCERSFIELD Grid: 20C FacUnits: 1 AoV: CammCode: KCFD STA 65 SIC Cade: .~`~~~ EPA Numb: DunnBrad: Emergency Contact ~~BUSiness Phone: 24-Haur Phone Pager Phane ~ T~.tle (G~~ )SSr~ -/~ o~ x (G6~t )LL3 -~3~x (~~r ) $17 -~~~q x Emer ez~.cy Contact ~~ ~~-~~~ ~usineSS Phone: 24-Haur Phone Pager Phone / Tit~e (S?o~ gat- o!?8x { ) - x k~azmat Hazards: Contact : //t~•k ~l~vFrf MailAddr: 2749 GALLOWAY pR 560 City BAKERSFIELD owner ~R~7a~. swPPG~( CevK-~~~ ~( Address ~n m^~ ~"~ btoo PorJ2.u- P(,«.~~ City ~2>~f-ulo-off Period to Preparers Certif~d: ParceiNo: Emergency Directives: FROG A - HAZMAT Fire Press zmmHlth DelHlth Phone: (661} 589-1504x State: CA Zip 93312-2639 Phone: "~g;r nad ~ n n0~ State : ~`~/ Zip t,nn~ ~G~~_3~oa~ TotalASTS: TatalUSTs: _ RSs: No ~oi~ ENT'D M ~Y 2 1 2007 a,~~rkY'rl•„1 riC~ ;u +t +•,r+y,~i~„ ,~,it~ yf~r., ;+:~~."'n~~iGY'• •.ry, n „t ;+r~r+, y.•,r, 'k,r ~rji;~~•:.,~~>i:i« i'; tfllf=, ;'1rl ; I fry 'i :,~,.,~ ~a1 n~•,IF,1,,, Gal Gal -~.- 04/26/2007 F TRACTOR SUPPLY CO -- --- -- SitelD: 015-021-g034I7 ~ ~ Hazmat Inventory - - - -- By Facility Unit ~ ~ MCP~DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz HPA Hazards Frm DailyMax Unit MCP PROFANE E F P IH G 1512.00 FT3 Hi Fes' F IH DH L 300.00 GAL Mod D F bH L 600.00 GAL Low ~'"^'^^''' ^tr- F bH L 200.00 GAL Min '/ (2-Moves- - ~~-~. A.- S fly- n~ d ~s~ s y sin . -2- 04/26/2007 -a- a4/z~/zoos F TRACTOR SUPPLY Co SiteID: 015-021-003417 ~ ~ Inventory Item Op04 -- Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE NW CRNR BLDG CAS# 74-98-6 ~GagATE TPureE -~AbOveSAmbEerit AmbientT~ PORTCOPRES~RCYLINDER AMOUNTS AT THIS LOCATION Lar~est Contain Daily Maximum Daily Aver e q,l(~n~ 2 . 00 FT3 lfg A,~~oN.S],S . 00 FT3 ~~ I~ ~~an~r 1 . 00 FT3 t1KGAKUV U 7 I:VMYVIVL'i1V l 7 ~Wt. RS CAS# 100.00 Propane Yes 749$6 tiE;.4lit~iJ 1~.5"~~."r;~tiAr1~i1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFFA USD4T# MCF No No Na No/ Curies F P IFI / / / Hi ~ Inventory Item 0003 Faca.~.ity Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME '_"~" //~~~" Days On Site /"''vt a v`c' 3 65 Location within this Facility Unit Map: Grid: INSIDE CTR STORE CAS# STATE - TYPE FRESSURE TEMPERATURE ~-~--- CONTAINER TYFE Liquid TMixtur~Ambient ~ Amba~ent METAL CONTAINR-NONDR[7M AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 300.00 GAL 300.00 GAL . _ _.. __. Y!1'~GAt(LVUS C'VMYV1Yr:lV'~',5 ~Dit . RS CAS# 25.00 Mineral Spirits Na 8030306 15.00 Naphtha Na 8030306 5.00 Methyl Ethyl Ketaxze No 78933 3.00 Ethylene Glycol No 107211 tILiGYitNJ 1'., ~~7L" e7~L~1V'1'~ TSecret RS BioHaz Radioactive/Amount EFA Hazards NFFA YJSDOT## MCP No No Na No/ Curies F IH DH / / / MQd -4- !]4/26/2007 ~ TRACTOR SUPPLY CO SitelD: 015-021-003417 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME Days On Site ~Q,N(a v~. 3 6 5 Location within this Facility Unit Map: Gxid: INSIDE CTR STORE CAS# STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture Ambient ~ Ambient ~PLASTZC CONTAINER .~ AMOUNTS ,A,T THZS LOCATION - Largest Container Daily Maximum Daily Average 5.00 GAL 500.00 GAL 600.00 GAL tu~~,K.xyUUS ~~rarvlv~~v~ia ~Wt . RS CAS#~ 100.00 Brake Fluid, Hydraulic (Diethylene Glycol Monob... No 112345 tlAGHxCiJ A5~7r;5,~i~kriV~1-~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Ix~.vex~,tory Item 0002 Facility Unit: Fixed Con.taa.ziers at Site ~ COMMON NAME / CHEMICAL NAME nn M~/~ Days On Site /`C- 365 Location within this Facility Unit Map: Grid: INSIDE CTR STORE CAS# 8020835 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient ~LASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average s.ao GAL 2ao.oo cAL 200.00 GAL ,r~v~~u~uvu5 ~:vr~r~lvx,~v ~ ~ ~Wt. RS CAS# 100.00 Motor Oa,l, Petroleum Based No 8020835 riHGlilU1 K7 ~~~~7M~1~l1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT~ MCP No No No No/ Curies F DH / / / Min -5- 04/25/2007 P TRACTOR SUPPLY CO SiteID: 015-021003417 ~ k'ast Format ~ ~ Notif./Evacuation/Medi Overall S~.te ~. Agex~.cy Notif icati©~rx °Nt ~f ~'~ ~ a(" l~kle ,Sv~~~r-ce 5 l~^~,`" ~b~ - gSL ~7~f~ `~ c~ 6 ~~~~ ~ F r~-c~- Sew j -~ G ~ ~ 4.~-a.,i C~...,,q~~,. J (y~•~-' ! ,U" ~--e~. ~'~ 9! e. ~ L t S' - 3vv a ! _ A-~-~.rR ~ 1 "`.7 0^'.l t C.~-ti~u' q-~~~a 0 u ~ K Z' ~ ~ ~ 8 O Z- C~-l D5(f4 .~ 9~c.-r~.~ - z~°~ c, -Nye-- voo Employee Notif./Evacuation I v~ ~~V~iI7 ~' I 1/v H"/~N(NG~~ Q1N s"3 -6- 04/26/2007 F z~.AC~raR SC7PPLY CO - Site2D: 015-021-003417 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ --- Release Pre'velaC].on / ~~ S-f~ l~-'r(v~ /~-t~"Se,i.t" ~,.~ ~~<hr.,c+,~ o...~/ (/~.ol.., -fi ~,(oCn.tt ,/~o/c ~~J !~'~ ~ A.~QhS.f ~./-~ ! N-~.~ceF 'f~ (~ . !^~ ~ NR ~/C ~,e...~~'~v~e~ fr ~ i~ `'~ ~~~f~~-~ -~ s,~< <~ nay-~ . = Rel/ease/ Containment ~cn7 ~ Gf .1 r~~r,~FL ~ ~GO -~3 r-'S35 J 1 ~r f{'SJ.sf ~Frc..4 ~.v ~.~~~~.~ ~ 1 ~~,~~. w~~~r A~c~,J4 oN wG~.~ ,~ ~i,z~ ~~ L N ~/ (/~/W S~C C~-~~~ G'~Ci-~ 'fa'g ~<'c'!~-~ `~/v ~ ~ ~'~c~o~CS~` clean up / -~ ~~~ Q Lf ~ r~-~i~c..~ goo -$"~J'-~S'~~~i,~ ~r-.~oe. Gle~tN ~,fo ~.-e c,e~'' /'` J p~.-o'~ ~nP ~r L~-- f~ ~ ~c I~ o s Ft- ~ . c~r.ner xesaurce t~cLiva,~1vn -7-~ 04/26/2007 r F TRACTOR SUPPLY CO SiteID: 015-021-003417 ~ Fast Format ~ ~ site Ernerger~cy Factors - overall Site ~ Special Hazards Utility Shut-Offs lre Protec . /A,vaz1 . wager S~r~~ ~~a. S y S~ ~M Building Qccupancy Level -8~ D4/26/2007 F TRAGTQR SUPPLY Cd Sa.telD: 415-021-043417 ~ Fast Format ~ ~ Training Overall Site ~ Emrployee Training 1(!_ , .~//y~ // / e ~~,. ens ~~ s ~ // 7 /~(f fF ~ r Ar ~ k. r~-b(tio (~T ~ LA-ro^ l.dM~n~~,«9.7~ d^. l ~/~aC.e~O JJ /L N r N t ti \/1 Page 2 Held for Future Use tte.~a =or rueure use -g- o~/z~/zoo? ;•~ r~. 4JNIFIED PROGRAM INSPECTION CHECKLIST ... . -. k::. ~ 1J1Y311F2'~OlP'A'Iaf ~XA91Ne SECTION 1 Business .Plan and Inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 I _~b Tel: X661) 326-3979 _ _ ,FACILITY NAME WSPE TION ATE INSPECTION TIME -- ADDRESS PHONE of Employees FACILITYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program ~2outine ^ Combined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection C V (y=voatilonn~/ OPERATION COMMENTS ~~ ~~ ~ ^ ^ APPROPRIATE PERMIT ON HAND ~~ S f ~ ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ~ ~'~ ^ ^ VISIBLE ADDRESS ~' O I' ^ ^ CORRECT OCCUPANCY _- .__... ^ ------ ^ ~ ----- VERIFICATION OF INVENTORY MATERIALS -- -------- --- - --- --- - -------- ._ ..-..._. j P~/~^1 i 1`-~~~ ~tcsg,2 orL (,S~ ®~ C. ^ ^ VERIFICATION OF QUANTITIES 6 x 7c,~L 300 ~ ~~ Cn~ ^ - ^ --- .VERIFICATION OF LOCATION --- . - -- - -- -._...- -- --- -. wtS.nC niw Gt2RKL ~5~nC C^%r2- _ ....S~LG ..-- - ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE ^ ^ VERIFICATION OF FIAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ENT b. SAY ._~, ~_2-~-06_ .._..__- - -..._ ^ ^ CONTAINERS PROPERLY LABELED ----- ^ ^ HOUSEKEEPING -- - - __ . 5~ ~~ -I~_~j_ ^ ^. FIRE PROTECTION ~ - --___ __ _ - - ,__ --__ _ ___-- -...__-----. - -1~1- --+_--- ^ ^ SITE DIAGRAM ADEQUATE St ON HAND ~ ~~ r-'CII ~' ~ l _ m I ANY HAZARDOUS WASTE ON SITE?: ^ YES '~ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~ss'I ~ 326-3979 t ~~~ - C~~ Inspector (Please Pnnt) Fire Prevention 1st-In/Shik of Site ~' sr Site Responsible Party (Please Print) 8 White • Environmental Services Yelk>w -Station Copy Pink - Business lApy BAKERSFIELD FIRE DEPT. ;~ (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN ~ Prevention Services UNIFIED PROGRAM CONSOLIDATED FORMS n °- R-S--1'-T. n 900 Truxtun Ave., Ste. 210 --~ F/Rri Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM "'~'"' T Tel.: (661) 326-3979 HAZARDOUS MATERIALS INVENTORY ~ Fax: (661) 852-2171 NEW ^ ADD ^ DELETE ^ REVISE 200 i0ne form per matenaf. per building. or area.) o,....~ ..s n 1. FACILITY NF RMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Ooing Business A5) ~~e~Tr,~. ,~ ~ f'PZ~ c_o . CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 ~ ~ S r ~ ~ ~,~~~ ~~ S~ n ~. ,v+w CONFIDENTIAL (EPCRA) ^ Yes ^ N FACILITY ID No. 1 MAP No. (optional) 203 GRID N0. (oprionap 20 IL CHEMI AL INFORMATION CHEMICAL NAME ~ ~ 205 2 r~1 n/~ A~.~ -~ TRADE SECRET C Yes ^ No COMMON NAME 207 EHS' C Yes ^ No 20 CAS No. 209 '!f EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE 211 RADIOACTIVE: ^ Yes ^ No 212 CURIES 21 '~yy~URE C m MIXTURE C w WASTE LARGEST CONTAINER 21 PHYSICAL STATE ^ s SOLID BQLLQUID ^ g GAS 214 21 FED HAZARD CATEGORIES l¢~7' .EIRE ^ 2 REACTIVE ^ 3 PRESSURE RELEASE ^ 4 ACUTE H EALTH ^ 5 CHRONIC HEALTH (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 22 AMOUNT DAILY AMOUNT / ' `e ~ (QCl DAILY AMOUNT CODE ^ UNITS GAL 221 DAYS ON SITE 222 "ff EHS, amount must be in Ids. ^ cf CU FT ^ Ib LBS ^ to TONS 22 STORAGE CONTAINER ^ k BOX ^ p TANK WAGON /check au rner epvey) ^ a ABOVEGROUND TANK ^ f CAN ^ b UNDERGROUND TANK ^ g CARBOY ^ 1 CYLINDER ^ q RAI L CAR ~ ~, ^ c TANK INSIDE BUILDING ^ h SILO ^ d STEEL DRUM ^ i FIBER DRUM n PLASTIC BOTTLE ^ e PLASTIC/NONMETALLIC DRUM C j BAG ^ o TOTE BIN ,,,,,,___/// 22 STORAGE PRESSURE t~Q a AMBIENT C as ABOVE AMBIENT ^ ba BELOW AMBIENT STORAGE TEMPERATURE ~a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 22 %WT HAZARDOUS COMPONENT EHS -CAS # 1 226 227 ^ Yes ^ No 228 22 2 230 231 ^ Yes ^ No 232 23 3 234 235 ^ Yes 7 No 236 23 4 238 239 ^ Yes ~- No 240 241 5 242 243 ^ Yes ^ No 244 2q III. SIGNATURE PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2 rr ~Jy~~~ - FD 2144 (Rev. 09/05) EN'TpD MAYO 1 2006 (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIALS INVENTORY NEW r ADD ^ DELETE c REVISE 200 a n. R.,s-.n...~. n iUi<I All TAl T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 rOne form per material, per building. or area ) o., ..e~ ".i n I. FACILITY INF RMATION BUSINESS NAME (Same as FACILITY NAME or DBA • Doing Business As) `-~-2a~c-te~• S~pPc.~ CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 ,, G ~~S t ~~ C~7~`!Z cK S (~ZC CONFIDENTIAL (EPCRA) ^ Yes G N FACILITY ID No. 1 MAP No. (optiona!) 203 GRID N0. (optional) 2 ll. CHEMI AL INF ORMATION CHEMICAL NAME ~ ~ __ 205 2 Y~6'TO 2 O t C..'r' " TRADE SECRET C Yes ^ No COMMON NAME Z07 EHS' C Yes ^ No 20 CAS No. 209 'g EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE 211 RADIOACTIVE: ^ Yes G No 212 CURIES 21 ~.pURE C m MIXTURE C w WASTE LARGEST CONTAINER 21 PHYSICAL STATE ^ s SOLID I LIQUID ^ g GAS 214 ~s-- J FED HAZARD CATEGORIES 1 FIRE ^ 2 REACTIVE ^ 3 PRESSURE RELEASE ^ 4 ACUTE HEALTH ^ 5 CHRONIC HEALTH 21 (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 22 AMOUNT DAILY AMOUNT 2 +~ DAILY AMOUNT ~ CODE 221 222 ^ UNITS ~a GAL • ^ cf CU FT ^ Ib LBS ^ to TONS GAYS ON SITE K EHS, am unl must be in lbs. 22 STORAGE CONTAINER (Check ali that apply) ^ a ABOVEGROUND TANK ^ f CAN ^ k BOX p p TANK WAGON ^ b UNDERGROUND TANK G g CARBOY ^ I CYLINDER ^ q RAI L CAR • , ^ c TANK INSIDE BUILDING ^ h SILO ^ d STEEL DRUM ^ i FIBER DRUM PLASTIC 80TTLE C e PLASTICINONMETALLIC DRUM C j BAG C o TOTE BIN 22 STORAGE PRESSURE ~ a AMBIENT C as ABOVE AMBIENT D ba BELOW AMBIENT 22 STORAGE TEMPERATURE~a AMBIENT C as ABOVE AMBIENT ^ ba BELOW AMBIENT 11 c CRYOGENIC %WT HAZARDOUS COMPONENT EHS -CAS # 1 226 227 ^ Yes ^ No 228 22 2 230 231 G Yes u No 232 23 3 234 235 G Yes :~ No 236 23 4 238 239 ^ Yes ~= No 240 241 5 242 243 G Yes ^ No 24a 24 z III. SIGNATURE PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SI GNATURE DATE 2 FD 2144 (Rev. 09105) ENS ~ A~ Q ~. ~~0~ ~' _ .. (HMMPj HAZARDOUS MATERIALS MANAGEMENT PLAN UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIALS INVENTORY `~•NEW ^ ADD ^ DELETE ^ REVISE 200 FIA/ AI~TA/ T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: {661) 852-2171 i0ne rorm per material. per building. or area.) I. FACILITY INF RMATION BUSINESS NAME (Same es FACILITY NAME or DBA -Doing Business As) _ CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 r~s~ ~~ ~, ~ti,~ p~,~ ~~ ~~~ ~~ ~ ~ ~ CONFIDENTIAL. (EPCRA) ^ Yes ^ N FACILITY ID No. 1 MAP No. (oprionaq 203 GRID N0. (oprlona0 20 ORMATION II CHEMICAL INF CHEMICALNAME ~- _ 205 2 ^ ~.. = TRADE SECRET C Yes ^ No COMMON NAME Z07 EHS' ^ Yes ^ No 20 CAS No. 209 •lf EHS is "Yes; all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete ii requested by local fire chiei) 2l TYPE 211 RADIOACTIVE: ^ Yes G No 212 CURIES 21 ^ p PURE ,~ MIXTURE C w WASTE ~/'~~ PHYSICAL STATE ^ SOLID 1 L IQUID ^ GAS 21A LARGEST CONTAINER 21 s yTt ~ L g 21 FED HAZARD CATEGORIES FIRE ^ 2 REACTIVE ^ 3 PRESSURE RELEASE ^ 4 ACUTE H EALTH 0 5 CHRONIC HEALTH (Check all that apply) ANNUAL WASTE AMOUNT 217 MAXIMUM DAILY AMOUNT '3~ ~ 216 AVERAGE DAILY AMOUNT ?) ~~ 219 STATE WASTE CODE 22 221 222 ^ UNITS !~.g~GAL ^ of CU FT ^ Ib LBS ^ tnTONS DAYS ON SRE If EHS, amount must be in lbs. 22 STORAGE CONTAINER (Check all that apply) . ^ a ABOVEGROUND TANK "~f CAN ^ k BOX p p TANK WAGON ^ b UNDERGROUND TANK G g CARBOY ^ I CYLINDER ^ q RAIL CAR ~ ±~,, ^ c TANK INSIDE BUILDING ^ h SILO ~ ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE ^ e PI.ASTIClNONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 22 STORAGE PRESSUR£ ~ AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT 22 STORAGE TEMPERATURE AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT G c CRYOGENIC °IoWT HAZARDOUS COMPONENT EHS CAS # 1 226 ~ 227 ^ Yes ^ No 226 22 2 230 231 G Yes ^ No 232 23 3 234 ~ 235 ^ Yes Ci No 236 23 4 23B 239 ^ Yes ^ No 240 241 5 242 243 ^ Yes ~~ No 244 24 °' III. SIGNATURE PRINT NAME S TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2 1 S pE, ENT ~qy n runL144 (ttev. oaru5) v ~ ~U~U HAZARDOUS MATERIALS MANAGEMENT PLAN UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIALS INVENTORY NEW ^ ADD ^ DELETE C REVISE 200 n ~.x.s.-P...i. n PIR< AR TAI T BAKERSFIELD FIRE DEPT. Pr@V@1it1OII Servic@S 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 lone form per malenal, per building. or area.) I. FACT ITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 OUTS r ~ ~ ~ /~ C, 2~2 ~~ Y' ~11~ (`~ u ~ CONFIDENTIAL (EPCRA) ^ Yes G N . \ FACILITY ID No. 1 MAP No. (optional) 203 GRID N0. (optional) 20 - II. CHEM C L NF ORM TION CHEMICAL NAME ~ __ 205 2 _`,~~~ ~,.. _ '( !~ TRADE SECRET C Yes ^ No COMMON NAME ZD7 EHS• C Yes ^ No 20 CAS No. 209 'If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete ii requested by local fire chief) 2t TYPE 211 212 RADIOACTIVE: ^ Yes G No CURIES 21 ~.~PURE ^ m MIXTURE C w WASTE LARGEST CONTAINER 21 PHYSICAL STATE p s SOLID ^ I LIQUID i' g GAS 214 2~Z FED HAZARD CATEGORIES FIRE ^ 2 REACTIVE PRESSURE RELEASE ^ 4 ACUTE HEALTH ^ 5 CHRONIC HEALTH 21 (Check all that apply) ANNUAL WASTE AMOUNT 217 MAXIMUM DAILY AMOUNT ' ~, ~ 218 AVERAGE 219 DAILY AMOUNT / ~~ Z STATE WASTE CODE 22 ( ~ 221 222 ^ UNITS ^ ga GAL . ~ CU FT ^ Ib LBS ^ to TONS DAYS ON SITE K EHS, amount must be in lbs. 22 STORAGE CONTAINER (cneck ell that eppry) ^ a ABOVEGROUND TANK ^ f CAN 0 k BOX ^ p TANK WAGON 0 b UNDERGROUND TANK G g CARBOY I CYLINDER ^ q RAIL CAR • - - :+,,, ^ c TANK INSIDE BUILDING ^ h SILO ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE ^ e PLASTIC/NONMETALLIC DRUM C j BAG ^ o TOTE BIN STORAGE PRESSURE 0 a AMBIENT ~aa ABOVE AMBIENT ^ ba BELOW AMBIENT [AO~~ M A [.'v 22 STORAGE TEMPERATURE ~a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT G c CRYOGENIC 22 %WT HAZARDOUS COMPONENT EHS CAS # 1 226 227 ^ Yes G No 228 22 2 230 231 C Yes ^ No 232 23 3 234 235 G Yes ^ No 236 237 4 238 239 ^ Yes G No 240 241 5 242 243 G Yes ^ No 244 2q ar III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2 2 ~~~~ FD 2144 (Rev. 09/05)