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HomeMy WebLinkAboutBUSINESS PLAN 5/22/2007CAL WATER SRVC CO (cBK-s2) 1107 CRANDON PARK ~~~~ . _~OGRAM INSPECTION CHECKLIST; __ _ _._ _ _ li ~., ~ ION 1: Business Plan and Inventory Program << is Prevention Services ___ ~ R_s F , 0 900 Truxtun Ave., Suite 210 F/RE Bakersfield, CA 93301 ~eriu ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NA M E INSPEC ION DA E INSPECTION TIME (` /'~ / ^ C a, \ ~ ^[ °~ /~ r~, , ~ a'l'b ! s,,, V (,,, ~ K - 3 Z. ~ Z-Z-~o~ ADDRESS D PHONE O. ~-~ NO OF EMPLOYEES FACILITY CONTACT ' BUSINESS ID NUMBER 15-021-~2\ l ~ - 'See#on 1..Busin~ss ~P1ar~~ and Inventory Ptagi~aFn t~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V . 'j, (C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSInBSS PLAN CONTACT INFORMATION ACCURATE ~ ^ VISIBLE ADDRESS ` ~li ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~1 ~~ ~{ i,, +^ ~=, l ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ~I ^ VERIFICATION OF HAZ MAT TRAINING , ~ ~~~ ~ ©~~ C~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES Ll~l ^ EMERGENCY PROCEDURES ADEQUATE ~, ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES 'L7"NO rcnr-nui~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # Bu ' ss Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 c~ CALIFORNIA WATER SRV CBK-32 Manager TIM TRELOAR Location: 1107 CRANDON PARK City BAKERSFIELD SiteID: 015-021-002118 BusPhone: (661) 837-7200 Map 102 CommHaz High Grid: 31B FacUnits: 1 AOV: CommCode: KCFD STA 65 EPA Numb: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title BILL TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGR Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: RSs Fire Press ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 837-7200x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK ENT J~ ~ ~ ~ ~~D~ Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~l~) S' ature Date -1- 07/10/2007 F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 07/10/2007 -3- 07/10/2007 A F CALIFORNIA WATER SRV CBK-32 SitelD: 015-021-002118 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 riAGHtCL A~J1,~~1~1tS1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F P IH / / / Hi -4- 07/10/2007 r F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/30/2000 ~ CALL 911. Employee Notif./Evacuation Public Notif./Evacuation 10/05/1992 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan MERCY HOSPITAL, TRUXTUN AVE. 08/04/2006 -5- 07/10/2007 .. F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/27/1994 ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 10/19/2006 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD BE MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS A BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/16/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. V1.11C1 iCGaVU1LG 1'iC~l.l VCl 1.1 V11 -6- 07/10/2007 ;, .: .. F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCC:1d1 ildGdLUS Utility Shut-Offs Fire Protec./Avail. Water 08/04/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. Building Occupancy Level UNMANNED SITE 05/16/2006 -7- 07/10/2007 7> F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/16/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rnya ~ Held for Future Use Held for Future Use -8- 07/10/2007 '~. 4' CALIFORNIA WATER SRV CBK-32 Manager TIM TRELOAR Location: 1107 CRANDON PARK City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: SiteID: 015-021-00211$ BusPhone: (661) 837-7200 Map 102 CommHaz High Grid: 31B FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title BILL TRELOAR / DISTRICT MGR RUDY VALLES ~ / ASST DIST MGR Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: RSs Fire Press ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Address 326--~~3-~~F~S~-8T' 3~Z' Sov~ (.{ s~ City S~-d~SE '~a(/„~ _ f ~~ Period to Preparers Certif' d: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Phone : ( ~€-6-~~ 45~~-max State: CA ~ x'37,7200 Zip ~~ 933ny ............... TotalASTs: = Gal TotalUSTs: _ dal RSs: Yes ENS ~~~ ~~ ~ ~~~ Based on my inquiry et ti~~~~ iNdividuals responsible for obtaining tl'~e intarwn~tion, I certify under penalty of law that I t-av© personally examined and am famlllar with tFie information submitted and believe the inf~rr~ation is true, accurate, and complete. . 2 ~ ~2_____- ature ~~ Da e -1- 0l/29/~007 'f F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-00211$ ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit ~~P SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 01/29/2007 -3- 01/29/2007 ~~ F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-002118 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 STATE TYPE PRESSURE Liquid TMixture ~-Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL riAY,KKLVU~ 1:V1~lYV1V1!;1V 15 °sWt . RS CAS# 12.50 Sodium Hypochlorite No 7681529 riAGF~t~CL A~ a Y55 ~1~1L"~1V "15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA? No Yes No No/ Curies F P IH / / / Hi -4- O1/29/2b07 :~ F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-00211$ ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/30/20170 ~ CALL 911. Employee Notif./Evacuation Public Notif./Evacuation 10/05/1992 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan MERCY HOSPITAL, TRUXTUN AVE. 08/04/201)6 -5- 01/29/2007 :~, `~ F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-00211$ ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Sits ~ ~ Release Prevention 09/27/19g~ ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 10/19/2006 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD $E MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/16/2005 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULAT01 AGENCY. V1.11C 1. iCC~V Ul. C:C HC: l.1Vdl.1 V11 -6- Ol/29/~007 F ~ F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-00211$ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ special nazaras Utility Shut-Offs Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. 08/04/20176 Building Occupancy Level 05/16/20176 UNMANNED SITE -7- O1/29/2b07 F CALIFORNIA WATER SRV CBK-32 SiteID: 015-021-00211 ~ Fast Format ~ ~ Training Overall Sita ~ ~ Employee Training 05/16/20x5 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rage neiu =car ruzure use neiu iur ru~ure use -8- Ol/29/2d07 i`" ~~ __ r_ _ _~ .V\. ,-~e ~ .. f. + CALIFORNIA WATER SRV CBK-32 _________________________ SiteID: 015-021-002118 + ' c~37, 7 Z.oa Manager BusPhone: (661) '^` ^^^^ Location: 1107 CRANDON PARK Map 102 CommHaz High ~ City BAKERSFIELD Grid: 31B FacUnits: 1 AOV: CommCode: KCFD STA 65 SIC Code:4941 ~~ EPA Numb: DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title BILL TRELOAR / DISTRICT MGR ~ud•) VdIIr~ / ASST DIST MGR Business Phone: (661) _ _ _ _ _ _ ___x,37-7zc Business Phone: (661) ~3-9fr--`2~-O~x~37-7~- j 24 -Hour Phone ( 6 61) ' ° ~ ''. ^_ ^ ^~ fu7 -)zo 24 -Hour Phone ( 6 61)~~ ~ o Ox X37 ~7L- ~ Pager Phone ( ) - x Pager Phone ( ) - x i Hazmat Hazards: RSs Fire Press ImmHlth Contact ~; j ~ ~ I~cSfTcA Phone : ( 661) 3~~-4-6~x MailAddr: 3725 S H ST State: CA ~37-7'27~ City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (408) 451-8200x Address 1720 N FIRST ST State: CA City SAN JOSE Zip 95112 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK CONTACT PERSON: 832-2141 rased nn my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. 'Z 2 C7 ature Date ~~ ENT ®q ~~ ~ ~ zoos -1- 05/16/2006. Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This Dermit is issued for the following: [] Hazardous Materials Plan [3 Underground Storage of Hazardous Materials [3 Risk Management Program PERMIT ID # 015-021-002118 [] Hazardous Waste On-Site Treatment CALIFORNIA WATER LOCATION: 1107 CRANDON CA 93312 ~-.i Issued by: Bakersfield Fire Department  OFFICE OFENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Approved by: (.. ~ Bakersfield, CA 93301 OfficeorEv~Services Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: JMr~e 30,. 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This perrrlit is issued for the followinQ: [] Hazardous Materials plan i-I Underground Storage of HazardOus Materials " [3 Risk Management Program .- El Hazardous Waste On-Site Treatment. ...... PERMIT ID # 015-021-002118 CALIFORNIA WATER LOCATION Issuedby: Bakersfield Fire Department' " " ':'~"~ "?: "' /O .'" ,~q -~....... ' - · . NOV ::i Z000"  OFFICE OF ENVIRONMENTAL SER VICES"' '1 " ' ' 1715 Chester Ave., 3rd Floor Approved by: a~/~ _~~j~.~'~- Bakersfield, CA 93301 . {~ta~p~Ho~EeYv~ ssue'Date Voice (661)326-3979 "'June30:2003 FAX (661) 326-0576 Expiration Date: .! SITE DIAGRAM ~ ! ! Business Address: c~.- ,~-~.. '"' '~' ='~ ~, ~ ,r-r'.~ BRIMHALL ROAD ' I - ...... ~ ..... ....................... ~- .......... ~.~ lB~ PVc F'LD. 379 8" P.V.¢. 'R, FED. 379 20 '.' ~"~ 64 .... : ~..J --T'---f 50 .J 57 o ~ (/3 Z 8'! PVC FLD 413 48 · b "~ ............... . 61 58 I 14 47 i. O_ O DRIVE ',3 FLD. ;~79 IZ: 0 3B 39 44 r,' .... PVC FiD 413 8' PVC. FLD 379 37 40 ' 0 36 41 RUN '~ X 19 - I0' PV¢ FLD 4t3 I0' PV¢ FLO 446 8'PVC 77 MEMORANDUM CALIFORNIA WATER SERVICE COMPANY BAKERSFIELD TO:. Karen FROM: Tammy Johnson DATE: 10:21-03 ':SUBJECT: Missing Facility &'Site Diagram Your department notified us that we weremissing a diagram for permit 015-021-002118. I have attached a new'drawing for this property. If there is anything else that we can do, let us know.. ......... Thank you, '(atomy Johnson '"AZARDOUS MATERIAL NAGEMENT PLAN Enmronmental Services SITE & FACILI~ DIAG~M 1715 Chester Ave B~ersfield, CA 93301 ~ tofl Tel: (661)326-3979 ~ALIFORNIA WATER SERV CBKSTA32 SiteID: 015-021-~002118 =~ ~7~ (661) 3 ~-7-1~z~ Manager : M ...... DYRD BusPhone: Locationi 1107 CRANDON PARK DR // Map : 102 Com~az : Minimal BAKERSFIELD ~ ~ ~ ~ Grid: 30 FacUnits: 1 AOV: City : ~ ~CommCode: CO~TY STATION 6~ 0~ SIC Code:4941 EPA Nu~: ~ DunnBrad: 00 - 691 - 3578 +__ ~=== Emergency Contact / Title ~ Emergency Contact / Title MELVI~I ~YRD / mTgTRICT ~~TKELOAR ' / GEN SUPER - Business Phone: (661) 396-2400x ~ Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x ~ 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x ~ Pager Phone : ( ) - x ....................................... +- -~ .................................. Hazmat Hazards: RSs ~~ire Press Im~lth Contact : . ~ Phone; (408) 451 ~00x MailAddr: PO BOA iiS~~~ S~C: CA~ City : S~ Zip : 95!08~ ....................... ....................................................... Owner CALIFO~IA WATER SERVICE COMPLY Phone: (408) 451-8200x Address : 1720 N FIRST ST State: CA City : S~ JOSE Zip : 95112 .............................................................................. Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: ~ ~s~ ~ ParcelNo: + .................................................. Dis~ic~ ~ag~-Tim Trelo~ - Emergency Direct ives: Assr Di~ic~ ~ag~-Bill Ha~er Conmc~ Person-Tampa 3o~son CONTACT PERSON K~K 832-2141. S~ePh~neN~rs ~a~l~g Ad.ess Change: -~ ~ I, /~~ ~ ~ .h~m~ e,~ ~ake~s~e~, C~ 93304 mvi,w~ ~he a~ach~ h~ardous m~ ........ ~ ~ m~ plan ;or~/~ ~~ and ~h~ ~ ~ ~i~h + 1 07/30/2003 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 -HAZARDOUS MATERIALS MANAGEMENT PLAN · INSTRUCTIONS: · 1. To avoid further action, return tNs 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. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~KL,...,..,,',~ ,o,.a~..l~,~." <o~.-,.,,,-~ LOCATION: MAILING ADDRESS: 3n~.~ $o. ~ ~+. CITY: ~v..~,-~g,'~.~d STATE: tax. ZIP:q~$oq-PHONE: PRIMARY ACTIVITY: '~,., ,- ,e e ,./ o ,' or- elo,~,~.,,~e._ OWNER: ~,e~ ~ PHONE: MAILING ADDRESS: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE ' 24 HR. PHONE HAZARDOus MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: CD. r_~ t I g~t~ ~, ~, 'g. o~-~,~.~- o~- ~...~ '~'~-I S C. ENVIRONMENTAL RESPONSE MANAGEMENT: 2 I~ARDous MATERIALS MANAG~ENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: ~ B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDUREs: UTILITY SHUT-OFFS (LOCATION OF' SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: N/~ ELECTRICAL: WATER: ~/~, SPECIAL: LOCK BOX: YES./~ IF YES, LOCATION: ----- PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: ----- B. WATER AVAILABILITY (FIRE HYDRANT):. ~."e - k,~,t~-o.,-.4 ,, ~- ,...,,-~t - HAzAq~DOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING MATE~AL SAFETY DATA SHEETS ON FILE: B~EF SUGARY OF T~~G PROG~: CERTIFICATION L' I, ~3-.,_ [.- L- ~ 6.,- , ,,, CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PE1LJURY. SIGNATURE TITLE ~ DATE 4 .715 Chester Ave., CA 93301 (661) 326-3979 FACILI~ INFORMATION Page Of ..... ': ::.)~: FACILI~ IDENTIFICATION BUSINESS NA E Sameas AC IIYNAM o .- oin B in s~) 3 BUSINESS PHONE SITE ADDRESS ~o3 DUN & ~o6 SIC CODE 108 OWNER MAILING  CONTACT PHONE ~8 CONTACT NAME CONTACT ~ILING ~9 ADDRESS CITY ~ ~20 STATE ~ ZIP ~ ~22 129 - 130 132 24-HOUR PHONE 5 ~& ~2z 24-HOUR PHONE ~ &~ ~ PAGER ~ ~ ~28 PAGER ~ ~ CeHification: Based on my inqul~ of thoso individuals rosponsiblo for obtaining tho information, I ~ai~ under penal~ of law ~at I have personally examined and am familiar ~th tho info. Etlon submitted in this Invonto~ and believe the information is tree, accurate, and ~mplete. ~6hhWDRE OFFWNEmOEE~TO~~j DATE ~a~ NAME o~C5MENT PREPARER NAMES OF OW~~TOR ~rint) 136. TITLE OF O~E~OPE~TOR UPCF (7~99) S:\CUPAFORMS\OES2730.TV4.wpd /~ CITY OF BAKERSFII~ n ,~"E ~-s ~' ,~ o OFFICE OF ENVIRONMENTAL SERVICES -~a~r~r. 1715 Chester Ave., CA 93301 (661) 326-3979 ,. "'--~~~'~' . H~RDOUS MATERIALS INVENTORY - '- CHEMICAL DESCRIPTION '-': ' .. (one fo~ per matedal per budding or ama). ol CIfEMI~L LOCATION :~ ' ' . ~._~ONFIDENTIAL(EPC~) ......................... ~ Y~ ~ No 202 ~ ' T~DE SECRET ~ Y~ ~ No 206 CHEMI~L ~ME . . ~ If Subj~ to EPC~, ref~ to insulins I t 207 f. EHS* ~ Y~ ~No 208 ~' COM~N ~" CAS ~ ~PE ~ p PURE ~ m MITRE ~w WASTE 211 ~DIOACTIVE ~ Y~ ~ NO ' 212 I CURIES~ PHYSICAL sTATE ~ s SOLID ~1 LIQUID ~ g ~S 214 ~RGESTCO~AINER 215 FED H~RD ~TE~RIES ~ 1 FIRE ~ 2 REACT~ . ~ 3 PRESSURE REL~SE ~4 ACU~ H~L~ ' ~ 5 CHRONIC H~LTH 216 ~ (Ch~ all that app.) ' DAYS ON SITE ' 222 ., UNffS', ~ ga ~L D d CU ~ ~ lb LBS ~ tn TONS 221 STOOGE CO~AINER ~ a A~VEGROUND T~K ~ e P~STI~ONM~ALLIC DRUM D I FIBER DRUM D m G~SS BO~LE ~ q ~IL ~ 223 that app.) ~ b UNDERGROUND TANK ~ f '~N ~ j 'BAG ~ n P~STIC BO~LE ~ r OTHER ~ c T~K INSIDE BUILDING ~ g ~R~Y ' ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM D h SILO ~ I CYLINDER ~ p TANK WAGON { STOOGE PRES'SURE ~ a A~IE~ ~ ~ ,A~VEA~IE~ Dba BELOWA~IEN~ 224 STOOGE TEMPE~TURE ~ a A~IE~ ~ ~ A~VE A~IE~' ~ ba BELOW A~IE~ ~ c CRYOGENIC 225 233 ~ 231 ' ~Y~ ~No 232 2 ~ 230 / 234 · 241 ~8 ' ~9 ~ Y~ ~ NO 240 242 ' . . ~ . 243 ~Y~ ~ No 244 245 T~TLE OF AUT~o'.ED ~OMPANY REPRESE'ATIVE. .- . ". , SIG'TURE ~ '. ' ' A '~'~ . .'"~-O ~'