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BUSINESS PLAN 8/6/2007
i~ ~~ (~ FAMILY MOTORS AUTO BODY & PAINT Manager BENEDITTO CAROCCIO Location: 6860 DISTRICT BLVD City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: CAL000188741 SiteID: 015-021-001991 BusPhone: (661) 834-4960 Map 123 CommHaz Moderate Grid: 16D FaCUnits: 1 AOV: SIC Code: DunnBrad:77-034-4799 Emergency Contact / Title Emergency Contact / Title LISETTE CAROCCIO / SECTY/TREASURER BENEDITO CAROCCIO / PRESIDENT Business Phone: (661) 834-4960x Business Phone: (661) 834-4960x 24-Hour Phone (661) 599-6707x 24-Hour Phone (661) 599-6707x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact BENEDITTO CAROCCIO Phone: (661) 834-4960x MailAddr: 6860 DISTRICT BLVD State: CA City BAKERSFIELD Zip 93313 Owner BENEDITTO CAROCCIO Phone: (661) 829-1585x Address 12700 CLAY CREEK CT State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives : EItl~~U ~~7 ~tl ~ ~ ~ ~ ~ PROG A - HAZMAT ~* PROG H - HAZ WASTE GEN PROG S - SPRAY PAINT BOOTH Based on undrnsrbie f~ obf ~nin y of these er g the infarrn dlviduats Penalty ti a o of lavr ~ I certify exasrin~; and a that I have Pe m f rsonally ~ and a,~; ev ae iihe Frith the information =t~ rate d nformati a `' c lete, on is true, Signature"` ~- ~. ~ D ~+~ U O ate -1- 07/11/2007 ~AMILY MOTORS AUTO BODY ~ PAINT 6860 DISTRICT BLVD. ~. I~ ~4 =7 (. F FAMILY MOTORS AUTO BODY & PAINT ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-001991 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PAINT REDUCER F IH DH L 2.00 GAL Hi PAINT REDUCER F IH DH L 2.00 GAL Hi PRIMER F DH L 2.00 GAL Hi LACQUER THINNER F IH DH L 55.00 GAL Mod WASTE THINNER F IH DH L 53.00 GAL Mod PAINT F IH DH L 20.00 GAL Mod PAINT HARDNERS F IH DH L 20.00 GAL Mod PAINT CLEANER F IH DH L 5.00 GAL Mod PAINT CLEAR F IH DH L 4.00 GAL Mod PAINT HARDNERS F IH DH L 2.00 GAL Mod ~ ~~5~ ~~~~G c~~N ~~ 3 0000 ~~ -2- 07/11/2007 } -3- 07/11/2007 ;- , F FAMILY MOTORS AUTO BODY & PAINT SiteTD: 015-021-001991 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT REDUCER Days On Site MID-TEMP REDUCER, 1,2,4 TRIMETHYLBENZENE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 2.00 GAL 1.00 GAL -- t1AGHttLVU~ 1:V1~lYV1V1'S1V15 %wt. Rs cAS# 1,2,4-Trimethylbenzene No 95636 riAGF~KIJ A~~L~~~1~1L~1V'15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT REDUCER Days On Site HIGH-TEMP REDUCER, PROPYLENE GLYCOL METHYL ETHER ACETATE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE -~ PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture I Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 2.00 GAL 1.00 GAL • ri1~iG1-1CCLVU~ 1.V1~lYV1Vt51V 1.7 %Wt. RS CAS# Propylene Glycol Methyl Ether Acetate No 84540578 riHGH.tCL L~5 71; 5 ~1~1JJ1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi -4- 07/11/2007 i S F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0007 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PRIMER Days On Site ZINC PHOSPHATE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE T PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 2.00 GAL 1.00 GAL tiAGAx.LVU~ l.vlYlrvlvL'1V~1~ °sWt. RS CAS# Zinc Phosphate No 7779900 t1AGE1KIJ E'.a a t5J 71~1t41V l J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Hi ~ Inventory Item 0009 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME LACQUER THINNER Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR BLDG CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL illiGHLCLVU~ ~vrlrvlvL~ly 15 $Wt. RS CAS# 42.00 Naphtha Solvent No 8030306 15.00 Toluene No 108883 13.00 Methyl Ethyl Ketone No 78933 t1E~GEitCL 1-~.7,7~~~L~1~1V"1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 07/11/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0010 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE THINNER Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR BLDG CAS# STATE T TYPE T PRESSURE TEMPERATURE CONTAINER TYPE Liquid I Waste I Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 53.00 GAL 53.00 GAL 30.00 GAL t1AGL-1ttLVUJ 1:V1~lYV1VL"1V1J %Wt. RS CAS# 100.00 Thinner No 8030306 r1t~~tv:cL rjJJl;aalnl;lvlJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT Days On Site BASES & COLORS, N-BUTYL ACETATE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 20.00 GAL 1.00 GAL L11iGL-1CCLVlJJ l.Vl°lYV1V ~1V 1.7 %Wt. RS CAS# 25.00 Mineral Spirits No 8030306 15.00 Naphtha No 8030306 5.00 Methyl Ethyl Ketone No 78933 3.00 Ethylene Glycol No 107211 t1EiGHKL 1'~.7.71;.7~J1~1tS1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 07/11/2007 P FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT HARDNERS Days On Site HEXAMETHYLENE DIISOCYANTE POLYISOCYANTE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# 1330-20-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~-Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 0.25 GAL 20.00 GAL 0.25 GAL ruic~ru~LVU~ ~.v-~irviv~lvla ~Wt. RS CAS# 5.00 Ethylbenzene No 100414 45.00 Xylene, Mixed No 1330207 15.00 n-Butyl Acetate No 123864 riAGA1~J~ ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT CLEANER Days On Site PRE PAINT CLEANER - VM&P NAPHTHA 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# Liquid TMixtur~AmbRent~E ~ AmbientT~E METAL CONTAINRTNONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 3.00 GAL ruyuruu~vuo L.V1.1rV1VP~1Vl~J gWt. RS CAS# Naphtha No 8030306 HALAKD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -7- .07/11/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT CLEAR Days On Site XYLENE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1..00 GAL 4.00 GAL 1.00 GAL t1AGHKLVUJ 1.V1~lYV1V1"~1V1D °~wt. Rs cAS# Xylene, Mixed No 1330207 t1HGL-1ttL A~~l;JJ1~11;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0008 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT HARDNERS Days On Site PAINT HARDNER (XTRA FAST), TOLUENE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# 1330-20-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture I Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 2.00 GAL 1.00 GAL t~1t~,c,Htcl~~v~ ~vlYlrvlv~ly 1 %Wt. RS CAS# Toluene No 108883 t11-~GEiKLJ HJJ~J~71~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -8- 07/11/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/08/2006 ~ CONTACT LOCAL EPA AGENCY AND CONTACT LOCAL FIRE DEPARTMENT Employee Notif./Evacuation 05/08/2006 CONTACT WORKING MANAGER AND CONTACT CARE CLINIC Public Notif./Evacuation 05/08/2006 MANAGER WILL NOTIFY CUSTOMERS. CUSTOMERS IN LOBBY ARE TO EXIT THROUGH THE SOUTH DOOR. CUSTOMERS IN GARAGE ARE TO EXIT THROUGH WEST DOOR. CUSTOMERS IN REAR LOBBY ARE TO EXIT THROUGH EITHER WEST OR SOUTH DOOR. Emergency Medical Plan 07/28/2006 CALL 911, NEAREST HOSPITAL OR EMERGENCY CLINIC, PROVIDE BEST CARE POSSIBLE WITH FIRST AID. -9- 07/11/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/08/2006 ~ STORED IN 55-GAL CONTAINER, DAILY OPEN/SHUT-DOWN PROCESS Release Containment 08/29/2003 ONLY SMALL QUANTITIES STORED Clean Up 05/08/2006 SPILL CLEAN-UP BY DRY SWEEP. STORED IN SAFETY CONTAINER. PICKED UP AND DISPOSED OF. v~.11ci 1CCSVULI:C 1'iC.:L1Vdl.1(~il -10- 07/11/2007 I F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~7YCC:1d1 11dGdL U.5' Utility Shut-Offs 11/15/2006 A) GAS - SE CRNR OF FAC B) ELECTRICAL - W SIDE BLDG UTILITY RM C) WATER - SW CRNR OF FAC D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/28/2006 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM AND 6 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ACROSS ST. Building Occupancy Level 10 EMPLOYEES 05/08/2006 -11- 07/11/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/08/2006 ~ MSDS SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: YEARLY TRAINING OF OFFICE STAFF, TECHNCIANS, AND MANAGERS. OVERVIEW OF PREVENTATIVE MAINTENANCE PACKAGE BY VIDEO AND TEST. rayc ~ Held for Future Use nciu iii r u~.uic vac -12- 07/11/2007 ~~~ Prevention Services UNIFIED PROGRAM INSPECTION CHEC~~IST e E R s F , D 900Truxtun Ave., Suite 210 -, _._.~ _ . ~.,~_-, _~-~__ ---~ -.~:~~.w - _ , _ - - FIRE _ _...._ Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ~ ''Rr"' r Tel.: (661) 326-3979 „ ~ Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE NO. NO OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- np I of el ~ __ Section 1: business Plan-and Inventory Program -' ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMMENTS CIl ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? YES ~ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In / hilt of Site/Station # usiness Site / Re onsible Party (Plea a Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 u~ ;;; FAMILY MOTORS AUTO BODY & PAINT Manager ~~~ ~i~/~~~ Location: 6860 DISTRICT BLVD City BAKERSFIELD SiteID: 015-021-001991 BusPhone: (661) 834-4960 Map 123 CommHaz Moderate Grid: 16D FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: CAL000188741 SIC Code: DunnBrad:77-034-4799 Emergency Contact / Title Emergency Contact / Title LISETTE CAROCCIO / SECTY/TREASURER BEN CAROCCIO / PRESIDENT Business Phone: (661) 834-4960x Business Phone: (661) 834-4960x 24-Hour Phone (661) 599-6707x 24-Hour Phone (661) 599-6707x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth ~ Contact ~~JU ~i~~d~~~~ Phone: (661) 834-4960x MailAddr: 6860 DISTRICT BLVD State: CA City BAKERSFIELD Zip 93313 Owner BENEDITTO CAROCCIO Phone: (661) 829-1585x Address 12700 CLAY CREEK CT State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Prepares: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG S - SPRAY PAINT BOOTH ~N~'p ~'~~ ~ ~ 2007 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, accu , and com te. r ~v !!`~ na Date -1- 01/31/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Hazmat Inventory - By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax _. Unit MCP PAINT REDUCER F IH DH L 2.00 GAL Hi PAINT REDUCER F IH DH L 2.00 GAL Hi PRIMER F DH L 2.00 GAL Hi LACQUER THINNER F IH DH L 55.00 GAL Mod WASTE THINNER F IH DH L 53.00 GAL Mod PAINT F IH DH L 20.00 GAL Mod PAINT HARDNERS F IH DH L 20.00 GAL Mod PAINT CLEANER F IH DH L 5.00 GAL Mod PAINT CLEAR F IH DH L 4.00 GAL Mod - PAINT HARDNERS F IH DH L 2.00 GAL Mod -2- 01/31/2007 -3- 01/31/2007 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT REDUCER ~ Days On Site MID-TEMP REDUCER, 1,2,4 TRIMETHYLBENZENE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE Liquid TYPE PRESSURE Mixture Ambient TEMPERATURE CONTAINER TYPE Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 2.00 GAL 1.00 .GAL t1HG1~KLVUJ 1:V1~lYV1VL'1V15 °~wt . Rs cAS# 1,2,4-Trimethylbenzene No 95636 _ ILEiG1iKL 1~JJL" .7.71~1L" 1V 1_a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT REDUCER Days On Site HIGH-TEMP REDUCER, PROPYLENE GLYCOL METHYL ETHER ACETATE .365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 2.00 GAL I 1.00 GAL ruyc,e-u~.1wvJ COMPONENTS oWt- RS CAS# Propylene Glycol Methyl Ether Acetate No 84540578 r1ti4YiLCL L~i J Jl~J J1~1JJ1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi -4- 01/31/2007 F FAMILY MOTORS AUTO BODY & PAINT ~ Inventory Item 0007 COMMON NAME / CHEMICAL NAME PRIMER ZINC PHOSPHATE Location within this Facility Unit E SIDE SPRAY BOOTH S WALL GARAGE STATE TYPE PRESSURE Liquid TMixture Ambient SiteID: 015-021-001991 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 2.00 GAL 1.00 GAL ri1-~G1~tCLVUa 1:V1~lYV1Vt',1V7J %Wt. ~ RS CAS# Zinc Phosphate No 7779900 t1AGL•itCL A.7~1S5J1~1L"~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Hi ~ Inventory Item 0009 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME LACQUER THINNER Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR BLDG CAS# STATE TYPE PRESSURE TEMPERATURE Liquid TMixture ~ Ambient -Zmbient CONTAINER TYPE METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL .55.00. GAL 55.00 GAL t1t~GtucLVUS lrV1~lrVlvL'ly 15 %Wt. RS CAS# 42.00 Naphtha Solvent No 8030306 15.00 Toluene No 108883 13.00 Methyl .Ethyl Ketone No 78933 1-u~~tixL ti~ 5~~al~ilJly l5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/31/2007 ^~ F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0010 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE THINNER Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR BLDG CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TWaste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 53.00 GAL 53.00 GAL 30.00 GAL tit~~titcLUUa ~:uinrulv~lvl~ %Wt. RS CAS# 100.00 Thinner No 8030306 riAGij.tCL L-~a Jt;~J1~1L'1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT Days On Site BASES & COLORS, N-BUTYL ACETATE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# STATE T TYPE ~~~ PRESSURE TEMPERATURE CONTAINER TYPE ~iquid I Mixture I Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 20.00 GAL 1.00 GAL nr-~~.ytc~uu~ ~vi~iruiv~ivl~ %Wt. RS CAS# 25.00 Mineral Spirits No 8030306 15.00 Naphtha No 8030306 5.00 Methyl Ethyl Ketone No 78933 3.00 Ethylene Glycol No 107211 riHGHKL H.7 ~JtS~J1~1i51v1a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No' No No/ Curies F IH DH / / / Mod -6- 01/31/2007 P F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINT HARDNERS Days On Site HEXAMETHYLENE DIISOCYANTE POLYISOCYANTE 365 Location within this Facility Unit Map: Grid: E SIDE SPRAY BOOTH S WALL GARAGE CAS# 1330-20-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 0.25 GAL 20.00 GAL 0.25 GAL nr~~s-ucLVU~ ~.vi~irulv~lvla gwt. Rs cAS# 5.00 Ethylbenzene No 100414 45.00 Xylene, Mixed No 1330207 15.00 n-Butyl Acetate No 123864 t1E~GHttL HJJt5~51~11"~1V 17 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME PAINT CLEANER PRE PAINT CLEANER - VM&P NAPHTHA Location within this Facility Unit E SIDE SPRAY BOOTH S WALL GARAGE Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE Liquid TMixture ~ Ambient TEMPERATURE CONTAINER TYPE Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 3.00 GAL tys~c~r-uc.uuua 1:V1~lYV1V~1V1a %Wt. RS CAS# Naphtha No 8030306 tiHG1-~KL HJ ~ L" .7 ~l~1~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -7- 01/31/2007 r` F FAMILY MOTORS AUTO BODY & PAINT ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME PAINT CLEAR XYLENE Location within this Facility Unit E SIDE SPRAY BOOTH S WALL GARAGE SiteID: 015-021-001991 ~ Facility Unit: Fixed Containers at Site ~ .Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 4.00 GAL 1.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# Xylene, Mixed No 1330207 t1HGa`1tCL I~a .7L" .7.71~1L" 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0008 COMMON NAME / CHEMICAL NAME PAINT HARDNERS PAINT HARDNER (XTRA FAST), TOLUENE Location within this Facility Unit E SIDE SPRAY BOOTH S WALL GARAGE STATE TYPE PRESSURE Liquid TMixture ~mbient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 1330-20-7 TEMPERATURE CONTAINER TYPE Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 2.00 GAL _ 1.00 GAL t1t~L,KKLVUJ ~:c~l~irvlvr;lvl5 %Wt. RS CAS# Toluene No 108883 t1E~G1-1KL Aa~1S751~1L"1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -8- 01/31/2007 1 F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/08/2006 ~ CONTACT LOCAL EPA AGENCY AND CONTACT LOCAL FIRE DEPARTMENT Employee Notif./Evacuation 05/08/2006 CONTACT WORKING MANAGER AND CONTACT CARE CLINIC Public Notif./Evacuation 05/08/2006 MANAGER WILL NOTIFY CUSTOMERS. CUSTOMERS IN LOBBY ARE TO EXIT THROUGH THE SOUTH DOOR. CUSTOMERS IN GARAGE ARE TO EXIT THROUGH WEST DOOR. CUSTOMERS IN REAR LOBBY ARE TO EXIT THROUGH EITHER WEST OR SOUTH DOOR. Emergency Medical Plan 07/28/2006 CALL 911, NEAREST HOSPITAL OR EMERGENCY CLINIC, PROVIDE BEST CARE POSSIBLE WITH FIRST AID. -9- 01/31/2007 F FAMILY MOTORS AUTO BODY & PAINT SitelD: 015-021-001991 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/08/2006 ~ STORED IN 55-GAL CONTAINER, DAILY OPEN/SHUT-DOWN PROCESS Release Containment 08/29/2003 ONLY SMALL QUANTITIES STORED Clean Up 05/08/2006 SPILL CLEAN-UP BY DRY SWEEP. STORED IN SAFETY CONTAINER. PICKED UP AND DISPOSED OF. v~.ilc1 nc~vul~..c t~l~l..lVCil.1V11 -10- 01/31/2007 :, r' F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ o~c~ia.i. nac.aiu5 Utility Shut-Offs 11/15/2006 A) GAS - SE CRNR OF FAC B) ELECTRICAL - W SIDE BLDG UTILITY RM C) WATER - SW CRNR OF FAC D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/28/2006 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM AND 6 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ACROSS ST. Building Occupancy Level 05/08/2006 10 EMPLOYEES -11- 01/31/2007 ~? F FAMILY MOTORS AUTO BODY & PAINT SiteID: 015-021-001991 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/08/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: YEARLY TRAINING OF OFFICE STAFF, TECHNCIANS, AND MANAGERS. OVERVIEW OF PREVENTATIVE MAINTENANCE PACKAGE BY VIDEO AND TEST. rayC ~ nc~.u iii ru~uLC u~c nciu ivt r u~u.~c u~c -12- 01/31/2007 1?208 Page: 1 M A T E R I A L S A F E T Y D A T A S H E E T PRODUCT NAME: COMPLIANT 9~TSRBORNE CLEANING SOLUTION HMIS CODES: H F R P PRODUCT CODE: 1720B 2*1 0 ___________________ SECTION I - MANUFACTIIRSR IDENTIFICATION =___________-_____ MANUFACTURER'S NAME: PACIFIC COAST LACQIIBR ADDRESS 3150 E. PICO BLVD. LOS ANGELES, CA 90023-3683 EMERGENCY PHONE(CHEMTREC) (800) 424-9300 DATE PRINTED 11/08/06 INFORMATION PHONE (800) 672-4900 NAME OF PREPARER N/A SECTION II - HAZARDOUS INGREDIENTS/SARA III INFORMATION VAPOR PRS33IIRE REPORTABLE COMPONENTS CAS NOMBSR mmHG ~TSMP(F) PERCENT ---------------------------------------------------------------------------------- PROPYLENE GLYCOL MONOMETHYL STHSR 107-98-2 B 68 OSHA PEL: 100 PPM, ACGIH TLV: 150 PPM - ISOPROPYL ALCOHOL, 2-PROPANOL 67-63-0 32 68 OSHA PSL: 400 ppm, ACGIH TLV: 400 ppm -Indicates toxic chemical(s) subject to the reporting requirements of section 313 of Title III and of 40 CFR 372. ________________ SECTION III - PHYSICAL/CHEMICAL CHARACTERISTICS =____________ BOILING RANGB (Deg F): 180 - 249 DENSITY: 8.27 lb/gl VAPOR DENSITY: HEAVIER THAN AIR SPECIFIC GRAVITY (H2O=1): 0.99 MATERIAL V.O.C.: 0.20 lb/gl MATERIAL V.O.C.: 24 g/1 SOLUBILITY IN WATER: Soluble EVAPORATION RATE: SLOWER THAN ETHER V.O.C. COMPOSITE VAPOR PRESSURE: 0.162 mmHg 6t 68 Deg F APPEARANCE AND ODOR: Clear liquid with mild odor ____ _____________ SECTION IV - FIRE AND E%PLOSION HAZARD DATA =______________ FLASH POINTtDeg F): >20o METHOD IISED: TCC gr.n~nnLE LIMITS IN AIR BY $ VOLIIME- LOWER: 1.6 UPPER: 13.8 EXTINGIIISHING MEDIA: ALCOHOL FOAM, C02, DRY CHEMICAL, WATER FOG SPECIAL FIREFIGHTING PROCEDURES N/A DNUSIIAL FIRE AND E%PLOSION HAZARDS Fire-exposed containers should be cooled with water to prevent pressure build-up which could result in container rupture. ------------=----- SECTION V - REACTIVITY DATA -------____________ STABILITY: STABLE CONDITIONS TO AVOID Avoid heat, sparks sad open flame INCOMPATIBILITY (MATERIALS TO AVOID) Strong oxidizing agents HAZARDOUS DECOMPOSITION OR BYPRODUCTS Thermal decomposition may yield carbon dioxide and/or carbon monoxide. HAZARDOUS POLYMERIZATION: WILL NOT OCCUR 1720B SECTION VI - 88ALTH ua~nztn DATA Page: 2 INHALATION HEALTH RISRS AND SYMPTOMS OF SBPOSIIRS Inhalation: May cause CNS depression. SKIN AND EYS CONTACT HEALTH RISRS AND SYMPTOMS OF S%POSIIRE Skin and eye contact: May cause irritation to both. SKIN ABSORPTION HEALTH RISRS AND SYMPTOMS OF EBPOSIIRE Skin absorption: May cause irritation. INGESTION HEALTH RISRS AND SYMPTOMS OF ESPOSURE Ingestion: May cause CNS depression. HEALTH HAZARDS (ACUTE AND CHRONIC) Acute: May cause irritation to nose, eyes and skin. May also cause CNS (central nervous system) depression which may be evidenced by giddiness, headache, dizziness and nausea; in extreme cases, unconsciousness and death may occur. Chronic: Prolonged or repeated contact may result fn dermatitis and damage to central nervous system, liver and kidneys. CARCINOGENICITY: NTP CAACINOGSN: No IARC MONOGRAPHS: No OSHA REGULATED: No MEDICAL CONDITIONS GENERALLY AGGRAVATED BY BSPOSURB Pre-existing eye, skin and respiratory disorders may be aggravated. EMERGENCY AND FIRST AID PROCSDURBS INHALATION: REMOVE TO FRESH AIR AND PROVIDE OBYGEN IF BREATHING I3 DIFFICULT. SPLASH (BYES): FLIISH SYSS Il~DIATSLY WITH LARGE AMOUNTS OF WATER FOR AT LEAST 15 MINUTES. SPLASH (SKIN): WASH AFFECTED AREAS WITH SOAP AND WATER. REMOVE CONTAMINATED CLOTHING. INGESTION: DO NOT INDIICS VOMITING. IF VOMITING OCCURS SPONTANSOIISLY, R88P 88AD BELOW SIPS TO PREVENT ASPIRATION OP LIQIIID INTO THS LUNGS. GST MEDICAL ATTENTION IMMEDIATELY. SECTION VII - PRECAUTIONS FOR SAFE HANDLING AND IISE STEPS TO BS TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED REMOVE ALL SOIIRCSS OF IGNITION AND PROVIDE VENTILATION. LARGE SPILLS MAY BE PUKED TO SALVAGE VESSELS. SMALL SPILLS MAY HS PICKED UP WITH AN ABSORBENT MATERIAL. WASTE DISPOSAL METHOD Place in tightly closed containers and dispose of fn accordance with local, state and federal regulations. PRECAUTIONS TO BE TARSN IN HANDLING AND STORING Keep away from heat, sparks and open flames. Keep containers closed when not in use. Use with adequate ventilation. OTHER PRSCAIITIONS Do not take internally. Ground equipment to prevent accumulation of static charge. Do not cut, weld, drill or grind oa or near containers. SECTION VIII - CONTROL MEASURES RESPIRATORY PROTECTION Use self-contained breathing apparatus where vapor concentration may be above TLV limits. Where vapor does not exceed TLV limits, use NIOSH/MSHA approved respirator. -. 17208 Page: 3 VENTILATION Use explosion-proof ventilation as required to control vapor concentrations. PROTECTIVE GLOVES Chemical resistant gloves EYE PROTECTION Safety glasses, splash goggles or face shield Contact lenses should not be worn. OTHER PROTECTIVE CLOTHING OR BQUIPMBNT Safety showers and eyewash stations should be provided. WORR/HYGIENIC PRACTICES Wash hands thoroughly before eating or using the washroom. Smoke in smoking areas oaly. _____________________ SECTION I% - REGULATORY INFORMATION =___________________ CALIFORNIA PROPOSITION 65 None __________________________ SECTION % - DISCLAIMEF22 ------------------------ The information contained herein is based on the data available to us and is believed to be correct. However, Pacific Coast Lacquer Co. makes no warranty expressed or implied regarding the accuracy of these data or the results to be obtained from the use thereof. Pacific Coast Lacquer Co. assumes no responsibility for injury from the use of the product described herein. `~ ~, + FAMILY MOTORS AUTO BODY & PAINT _____________________ SiteID: 015-021-001991 + Manager Location: 6860 DISTRICT BLVD City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: CAL000188741 BusPhone: (661) 834-4960 Map 123 CommHaz Moderate Grid: 16D FacUnits: 1 AOV: SIC Code: DunnBrad:77-034-4799 Emergency Contact / Title Emergency Contact / Title LISETTE CAROCCIO / SECTY/TREASURER BEN CAROCCIO / PRESIDENT(~l(QI Business Phone : (1~4 -°~.;--a~ ~.~,''.~~ (~(p ( g3~{ Q/~us ine s s Phone : ; _ _ _ , _ _ _ _ - _ x ~3 - ` 2 4 -Hour Phone ( ° ^ _ ° ; ~"~ "^ ~ ^ x (~ t~~9 ~ ~ 4 -Hour Phone (~ '~"°~=-~-° ° ~'" f Pager Phone ( ) - x Pager Phone ( ) - x..7 Hazmat Hazards: Fire ImmHlth DelHlth -Contact MailAddr : - ,,,. - - Phone: (-661) 8.34-4960x [p © ~~ S~~ G~ ~( .~~ • State : CA _ _ _ _ .. ____ City . ___ ULO ~~.-~~(2S'~~ E(~~ Zip 93313 ---------------------------------- +- ------------------------~~~~$~=_f~~'=--+ Owner BENEDITTO CAROC~CIO AA ~1.~Phone : , 7~ ~ Address _ -- -- --___ C _-. _.. __ ~a State : CA City ~- Zip ~+3 ~ `~.. Period to Preparers Certif'd: ParcelNo: TotalASTs: = Gal TotalUSTs: = Gal RSs: No Emergency Directives: ~/l~ ~N~ PROG A - HAZMAT I ~ /I/ ~ J~ C PROG H - HAZ' WASTE GEN ~ v C®46' PROG S - SPRAY PAINT BOOTH THIS FACILITY IS A HAZARDOUS WASTE GENERATOR AND REQUIRES A JOINT INSPECTION WITH HOWARD WINES AND THE ENGINE COMPANY. PLEASE GIVE THIS OFFICE 5 DAYS NOTICE PRIOR TO SCHEDULING THE INSPECTION. ~~ i3ased on my inquiry of those individuals ~~ responsible far obtaining the information, I certify to ~ r under penalty of law that 1 have personally ~~`~` Il examined and am familiar with the information f /~ submitted and be i ve the information is true, ~ I-,J(f' accu e, a co te. g atu ~l~~ Date -1- 05/08/2006 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF .PERMIT ON REVERSE SIDE Permit ID#:: 015-000-001991 FAMILY MOTORS AUTO This _m~rmit is Issued for the followin_q; [] Hazardous Mateflals Plan [] Underground Storage of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment LOCATION: 6860 DISTRICT BLVD Issued by: ' Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' ill~ 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 ~ AppmVedby: . Expiration Date: Office of EvimnmentlffS=-vices Issue Date 'June 30. 2003 AUTO BODY AND PAINT Alex Torres 6860 District Blvd. .: ., Bakersfield, CA 93313 (661) 834-4960 Fax (661) 834-0475 J SITE DIAGBAM Business Address: -L CITY OF BAKERSFIi ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN ~ f / Answer the questions below for the business as a whole.' ".o' Be as brief and concise as possible. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing ~ below for initial submission. 2. 3. 4. 5. INSTRUCTIONS; To avoid further action, return this form within 30 days of receipt. TYPF_./PR. INT ANSWERS rN ENGLISH. SECTION I: BUSINESS IDENTIFICATION DATA PHORrE: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZA US MATERIALS MANAGEMENT PLAN SECT[ON. [[, I' D[.,s¢ovERY ^~ NOTrF[¢AT[ONS Ao LEAK DETECTION AND MONITORING PROCEDURES: Be EMPLOYEE AND AGENCY NOTn~ICATION: ENVIRO~AL RESPONSE MANAGEMENT: De EMERGENCY MEDICAL PLAN: H~ARDOI[JS MATERIALS MANA~ [ENT PLAN SECTION IL2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: /. Bo RELEASE CONTAINMENT AND/OR MITIGATION: Co CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHI, Yf-OFFS (LOCATION OF $~0T-OFFS AT YOUR FACILITY) NATURAL OAS/PROPANE: ~/'z~. ~. ELECTRICAL: ~:~,/~ c~ ~Z~ WA~R:' ~ ~ ~~z~ SPEC~: LOCK BOX: ~~ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY HAZAR~US MATERIALS MANAGEMI PLAN SECTION Ilk TRAINING,, NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I, /~l~/ //'~,p .c"~,/-v . CERTIFY THAT ~ ~O~ ~O~TION IS ACC~TE. I ~~ST~ ~T ~S ~O~~ON ~L B~ US~ TO F~F~L ~ F~'S OBLIGA~ONS ~~ ~ "C~O~ ~~ ~ S~E~ CODE" ON ~OUS ~~S ~N. 20 ~~R 6.95 SEC. 25500 ~ ~.) ~ ~T ~A~~O~~QN CONS ~~S PE~Y. TITLE IIAZ MAT MNOMI~T PLAN & INSTRUC 4 CITY OF BAKERSFIE OFFICE OF ENVIRON IENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 FACILITY INFORMATION I. FACILITY IDENTIFICATION 3 II. ACTIVITIES DECLARATION Ooes Your Facility... If Yes, Please Complete... ~. ~AZAROOL.JS '~A'T~i~i~'LS ............... ~'eE'~ '~;1~1"~ .... '-~";'-7 ....... -b'ES' FORM 273'~ (Chem,~ ~e~'0,;o~'F~m! ......... 1. ~ ~nn ~ a-'~'y purpose) hazardous materials at or · · . ¢ CONSOLIDATED COMPLIANCE PLAN above 55 gallons'for liquids, 500 pounds for solids, or 200' i ~ Minimum required planninq elements: Have onsite RS at greater, than the lhreshold planning quantities established by the California Accidental Release Prevention program (CalARP)? C. UNDERGROUND STORAGE TANKS (USTs) Own or operate Underground Storage Tanks? Intend to upgrade existing or install new USTs? cuft/.or compressed.gases (include liquids in ASTs and I USTs)? i 2. Have any amount of an explosive material (other U3an ' OYES ammunition) on site? 5,'"'T',~NK-CLOSURE ! REMOVAI~ I. Need to report closing a UST that held hazardous materials or waste? Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? ~'-~0gE~ 'GROUND PETROLEUM STORAGE TANKS (ASTs) f ' Ovg' ' * Own or operate ASTs above these thresholds: any tank capacity is greater than 660 gallons or the total capacity ; for the facility is greater than 1.320 gallons, j ---.-hAT_.~RObUS WASTE: ' ~"_--_-' ~ ' ~~ous waste? ,J~YES ONO more than 100 kg/mo of recydable materials at ! OYES .(~NO Recycle the same location it was generated? . ,~. -\ 3. Recycle more than 100 kg/mo of recyclable materials at OYES,~N,O an offsite location different/'rom the point of generation? Treat Hazardous Waste on site? OYES.~N.O ~, Subject to Financial Assurance requirements? OYES~'~O ~. Consolidate Hazardous Wasle generaled at a remote OYES'.,~NO · Emergency Response Plan Maps Training · Prevention · Certifications DES FORM 2731 (C~wnic~ Oeso~ouca RISK MANAGEMENT PLAN (m,,~ s~il to USEPA) CONSOLIDATED COMPLIANCE PLAN · Incorporating CalARP Program Elements UST TANK FORM (me ~- ~) UST FACILITY FORM UST TANK FORM UST INSTALLATION FORM (me UST TANK FORM (cSosure sec~oa-o~e per tan~) TANK CLOSURE FORM CONSOLIDATED COMPLIANCE PLAN · Incorporating Federal Spill Prevention Control and Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112 EPA ID number--provide on this page To oblain EPA ID#, please phone (916) 324-1781 RECYCLING FORM RECYCLING FORM TP FACILITY FORM (DTSC Form 1772) TP UNIT FORM (one per unil) CERTIFICATION OF FINANCIAL ASSURANCE REMOTE WASTE I CONSOLIDATION SITE sile? NOTIFICATION FORM PERMIT CON~0~'~-'J:I'0~ 'Z(~I~E: .............................. i '(~'~= la V' CONSOLIDATED COMPLIANCE PLAN Intend to consolidate other Cai/EPA agency permits? · Incorporating all other enviror~mental (It' yes. please complele Section III and al~ach) , permil requirements per 27 CCR 10410 'E: /ou checked YES to any part o! Sections IIA.IIG above, ther~ In addition Io Ihs forms requested above, please Submit DES Form 2730. UPCF ~ ?19~7 S:tCUPAFORMS~AC TlVl'r~ CITY Of BAKERSFIELI) OFFICE OF ENVIRONMENTAL SERVICES 171.5 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 08A/FACILITY NAME I. FACILITY IDENTIFICATION FACILITY INFOI~MATIO/', aus,ness Actlwtie$ Adden~br- Page ~ Gl ~ III. CONSOLIDATED PERMIT ACTIVITIES Is your Facility Compliance Plan subject to review by... H. DEPARTMENT OF TOXIC SUBSTANCES CONTROL '~¢~'S ONO /\ '[' SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT '"J. STATE WATER RESOURCES CONTROL BOARD :'NTF~L V,ALLE,Y REGIONAL WATER qUALITY CONTROL ~OARD K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD L. KERN COUNTY RESOURCE MANAGEMENT AGENCY ~¢~'s ONO OYES ~O OYES~O ~'¢ES ONO OYEs '~o OYES OYES OYES ['~J OYES ~0 OYeS ~1~0 OYES ~0_ OYES ~ OYES~ _~j/0 · OYES ~0 ' OYES ,~ for satisfying the conditions of these permits? STANDARDIZED PERMIT · All Modifications Non-RCRA HAZARDOUS WASTE FACILITY RCRA HAZARDOUS WASTE FACILITY AUTHORITY TO CONSTRUCT PERMIT TO OPERATE WASTE DISCHARGE REQUIREMENT (WDR) GENERAL PERMITS SPECIFIC PERMITS NATIONAL POLLUTION DISCHARGE ELIMINATION SYSTEM (NPDES) REGISTRATION PERMIT ENVIRONMENTAL HEALTH SERVICES PERMITS Domestic Water Well Pen'nit Haz Mat Monitoring Well Permit Seplic System Permit Public Swimming Pool Permit Food Facility Construction Permit Solid Waste Local Enforcement Agency (LEA) Related Pen'nits Medical Waste Related Permits PERMIT NOTE: ,,," If you checked YES to any pail of Sections III-H lo II'I-M above, then please address all applicable permit requiremenls in the Facility Compliance Plan. (, ~. .a O~CE CIT'~' OF BAKERSFIE , ~~ OF ENVIRONMENTAl RVICES ~l rt~_l_ 1715 Chester Ave., CA 93301 (661) 326-3979 - ~ .... ' BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION I. FACILITY IDENTIFICATION P3ge USINESS NAME (Same aa FACILITY NAME or DS.A- [~o,n~.8~siness:8.s) / .... 3 BUSINESS PHONE ~/~.. c¢~..~y.'~,p~b ,o2 JN & ~ ~ SIC COOE ~DSTREET ~ (n Digit ~ ER.A, TOR NAME ,0~ OPERATOR PHONE II, OWNER INFORMATION ,VNER MAILING OWNER PHONE '~'~ STATE III, ENVIRONMENTAL CONTACT zip 9',,~, 3 o 116 DNTACT NAME CONTACT PHONE ~ ~8 )NTACT MAILING ' ~g DDRESS STATE ,2, ZIP ,2~ -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- 'LE /_.;~,_. ,25 [ TITLE .~..~.~ ~.$.... ,30 SJNESS PHONE /~'_/'..... al~,.~/.~/-- ~,/'~'~ ~7 ~2e! BUSINESS PHONE ...... ~./,,~.../~....~..~_~ ................. 13~ ................. ~',..~? / ......... ~ z' ....................... . ..........i ....................... 'HOUR PH0~_. __~.~/~..---~__~. ,~'---?..." ~ S"" 3 ,27 24-HOUR PHONE .... 3ER # ~.~/,~2 _ ~ .~../,~,~2~"-~3.. ,28 ' PAGER # .,,,,/'~,~'/"l~ 133 V. CERTIFICATION fification: Based on my inquiry of those individuals responsible for oblaining the Informalion, I cediS/under penalty of law that I have personally examined am ~amiliar with the info~D3aBoxn submitted in this invenlory and believe the inrormaUon Is true, accurate, and complete. /J/._/~?. _~:.~.,~'I_. ................................. I ~ ....................................................... .'ES OP~"OVV"~F~7(!~P...ERAi"OR (pdnt) ,3S i TITLE OF OWNER/OPE.F~TOR/ ....... .......... : (7/9g) S:~CUPAFORMS~OES2730.TI~.wPa B Owner/Operator Identifical lolease su0,mt ~r~e ::]~,~mess -~¢t~,mes :~age. Ir~e ~us~s ~ner/~e~(or fdenQ~On ~age (DES Fo~ 2730). 3~d Ha~3rdo~s ~{~1~ · Ch~i~l 'qole; ~e numoermq ,~1 '.,he ,ns~ct~ons follows ~he dala element numbem ~al are ~ ~e UPCF ~g~. ~e da~ ~emen~ numO~ are ~ ~ ;~ ~romc ~bOm~ss~on ~nd Jre ~e ~me 3s ~e num~enng uS~ ,n 27 CCR. Appendix C. ~e Business S~fion of ~e Um~ P~m Oa~ O~ona =~ease nbmD~ jII DJ~S OI '/O~r ~uom~al. Th,S helps /our CUPA or .~ iden~ w~e~ ~e subtotal ,s ~mplele 3nd ~ ~ny pa~es am separal~. I ~AC:Li T¥ I0 NUMGE~ - Th~5 numDer ~S ~sS~g~ Oy ~he CUPA or ~. Th~s ~S ~e umque numOer whi~ ~den~es your fac~l~. 3. 5US;NESS NAME - Emer ~e ~ll ~al name of :he ousme~. f00. BEGINNING OAFE. Enler :he o~mnmng year 3nd dale of the repod. (Y~MMOO) ~01 ENDING OATE· Enler :~e ending y~r and date o¢ ~e r~d. (Y~MMOO) 102. BUSINESS PHONE - Enl~ ~e p~ne number, area ~e tirol and any ~ten~on. 103. BUSINESS SITE AOORESS- Enter ~e s~eet addre~ ~ere ~e ~cili~ is Io~t~. NO ~st office box numbem are allowS. ~is in~a~on mus~ provue a means :o g~mphi~lly Io~e ~e ~ali~. 104. CI~ -'Enter ~e ~ or unin~rat~ area in ~ busin~ site is Io~. 105. ZIP COOE- Enl~ the ap c~e of buslne~ site. ~e ex~ 4 digit zip may al~ ~ add~. 106. DUN & B~DSTREET - Enter ~e Dun & Brads~t number ~r ~e faali~. ~e Dun & Bmds~eet number may be ob~ain~ by ~lling (610) 882-7748 or Dy IntemeL 107. SIC COOE- Enter ~e pnma~ Sla~ard Indus~al Cla~ifl~on C~e number for pfima~ busine~ acfi~. NOTE: If ~e is more ~an 4 dig~. r~ only ~e flint four. 108. COUN~ - Enter ~e ~un~ in ~i~ ~e busine~ site is Io~t~. 109. BUSINESS OPE~TOR ~ME - Enter ~e ~me of ~e b~in~ operator. 110. BUSINESS OPE~TOR PHONE - En/~ ~n~ o~tor p~ne n~. ~ dlff~t ~ ~sin~ p~e, ar~ ~e ~t. ~ any ~. ' 111. O~ER ~ME. Enter ~me of ~sin~ ~. ~ diff~ent ~m b~n~ ~. 112. O~ER PHONE. Ent~ ~e bu~ne~ ~s p~e num~ if differ ~ ~ ~, ar~ ~e tirol a~ any ~n. 113. O~ER ~ILING ADDRESS - Enter ~e ~s maili~ addr~s if different ~m ~n~ site addr~. 114. O~ER CI~ - Enl~ ~e name of ~e d~ ~ ~e ~s ~ili~ addr~. 115. O~ER STATE - Ent~ ~e 2 ~mct~ s~le abbre~a~n for ~e ~s maa~ ~r~. 116. O~ER ZIP CODE - Enter ~e zip ~de for ~e o~er~ addr~. ~e ~ 4 d~it ~ may al~ ~ ~d~. 117. ENVIRONMENTAL CO~ACT ~E - Enter ~e ~me of ~e ~r~n. if differ~t ~om ~e Bu~ ~er or Operator, ~o r~ all en~mnm~l ~~~ a~ ~11 r~ D ~m~t a~. 118. CONTACT PHONE - Enter ~e ~ne numbs, if d~er~t ~m ~er or Opera,r. at ~ ~e ~mnm~l ~n~ ~n be ~n~, ~ ~e tirol a~ any ~t~. 119. CO~ACT ~ILING A~RESS - Ent~ ~e ma~i~ addr~ ~e all en~m~ffil ~ ~en~ s~uld be ~L ~ ~t ~ ~ ~te addr~. ~ ~ ~. CI~ - Ent~ ~e rome of ~e d~ ~r ~ ~mnm~ mnm~ ma~ a~r~. 121. STATE - Ent~ ~e 2 ~am~er s~te abbre~n ~ ~ ~~1 ~ ma~ a~r~. 1~. ZIP CODE - Ent~ ~e ~p ~e for ~e ~~1 ~n~c~ ~ili~ ~dr~. ~e ~ 4 d~ ~p may al~ be add~. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency invoMng hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for [he business regarding incident miliga~n. C 124. TITLE - Enter the lJlJe or' the pdmary emergency contacL 125. BUSINESS PHONE - Enter the business number for the primary emergency contacL area code lirsL 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. I1' it is not the contact's home phone numbe~', Ihen the sen, ice answer Ute phone must be able to immediately contact the individual stated aboYs. 127. PAGER NUMBER - Enter the pager number for the iximary emergency contact, if ava~ble. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary re~xesental~ve Utat can be contacted in Ute even/that the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to-m~ke decisions for the business regarding incident mitigation. 129., TITLE - Enter the title or' the secondary emergency contact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contacL area code firsL and any extensio~i 131. 24-HOUR PHONE - Enter a 24-hour phone number for [he secondary emergency contact. The 24 hour phone number musl be one which is answered 24 hours a day. If it is not [he contact's home phone number, then the service answering the phone must be able to immediately contact the individual slated above. 132. PAGER NUMBER - Enter [he pager number for [he secondary emergency contact, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUPAs or AAs to collect any additional int'ormalion necessary to meet [he requirements or' their individual programs. Contact your local agency for guidance. 134. DATE - Enter the date that the document was signed. (YYYYMMDO) 135. NAME OF DOCUMENT PREPARER - Enter Ihe ~JII name of the person who prepared the inventory submittal information. 136. NAME OF SIGNER - EnLer the full printed name of th person signing the page. The signer certffles to a familiarity with thc in/=ormalion submitted and that based on the signer=.~ inquiry of IJ~ose individuals responsible for obtaining the infon'nation, all the information submitted is true. accurate and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE. The Business Owner/Operalor. or officially designated representalive of the Owner/Operator. shall sign in [he space provided. This signature certifies Utal Ute signer is familiar with the int'ormatlon submitted and that based on tho signer=s inquiry o~ [hose individuals responsible for obtaining the Information it is the signer=-s belief that the submitted in/ormation is b"ue, accurate and comploto. 137. TITLE OF SIGNER - Enter [he IJlJe of the person signing Ute page. CITY OF BAKERSFIE] 2E OF ENVIRON3,1ENTA ,R¥'ICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION . '~F.'.v ' i"J ADD I"10ELETE ~'~ REVISE ' I. FACILITY INFORMATION .... . . .. . CONFIDENT~L (E~) ~,~,~,~.] ~ .................. ~' ~T~ ......................... ~'" ~o~,o.~.~.~ ........ II. CHEMICAL INFORMATION .................................................................................................. ~o~- --~'.xo~-c'~ .... o~;, ~;o-~;" CODE'~6~{'~e ,' reque~ ~/k~ca eo ~ -- lbs. 210 ~=: ........ [] p PURE [] m ~,aXTURE ,~ WASTE 211 . RADIOACTIVE [-]Yes [:::]No 212 CURIES 21.1 LARGEST CONTAINER 21S ~SICAL STATE ["1 S SOUO I~;~L~UID ~ g GA~ 214 ~ HAZ_.A.'~D CATEGORIES '~ FIRE 02 REACTIVE [:::] 3 PRESSURE REI.F. ASE 1"14 ACUTE HEALTH 05 CHRONICHEALm 2~6 .WASTE 217 i MAXIMUM 218 ~ AVERAGE · 219 STATE WASTE CODE 220 I : uNrra- Et"~ m~. [] u cu~ O ~, L~s O ~. m.s ~,, RAGE PRESSURE [ri · AMSIEKI' f--J ts ABOVE ANSIENT % BELOWAM81ENT 224 RAGE TEMI:~RATURE [] IAMSIENT .f-J ao ABOV~AMBIENF '=~-.~.~ELOW~IENT I--J c CRYOGENIC 225 HAZARDOUS COMPONENT EHS t CAS # %WT .......... L ..................................................~ .................. L ............ ~ .................... 234 I 235 , []yesEl.o 23e j 242 243 . []yes []No 244 I 2~'5 __ IlL SIGNATUI~ / ,/ :26' (7~99) S:\CUPAFORMS~OES273 1 .T'V4.wpd Ha:'ardous Materials Inventory - Chemical Description ~A~L: ~Y 0 ~8~ * ~,~ .~u~DO~ ~ J~ ~Y :~e '~UPA Or ~. ~ ~$ ~ un~u~ numar ~nic~ ,denh~e$ /our ~USJN~ >~ME - En(e~ the full ~al na~e o~ :ne Z~. AOO/CEL~TE/R~IS~ - in~(e ,( (~e ~aler,al .s ~,~ 3dd~ to ~be ,nvenlo~. dole(~ ~rom ~e ,nvenlow. or ,( t~e ,nfo~a~)on prev,ous~ subm,~ed Z0f. CHEMICAL LOCATION - Enlor (~e 0u~lO~ng or ouIs~el JOlacent 3rea wflere ~e hazardous mate~(al ,s ~anOl~. A ~em~l ~a{ i~ ~ 3t ~he same 202. CHEMICAL LOCATION CONF~ENTIAL. EPC~ - All 3usmesses which ara suOlec~ {0 [ha Ema~ge~y Planmng and Commum~ R~nl ~o Know Act c~ec~ 'Yes' ~o ~ee0 c~em~l ~3{~on ,nto~a~ ~n6dential. I~ Ihe bus,ness ~s no~ wis~ ~o keeO c~ems~l I~l~n ~n~ocmalion ~n~ential c~eck "No'. 205. C~EMICAL NAME. Eh[er c~e ~roOer c~em~cal name J~a(~ ~(h the Cheracol A~slracl Se~e (C~S) numDef of ~he hazardous malarial. Th~s snouM be lnlemai~nal Umon o~ Pure and Appli~ Chem~s~ (IUPAC) Mrna ~ound ~ ~e Material Sa(eW 0ale Sheer (MSOS). NOTE; If the ~em~l is a mixture, ~molele chis ~eM; ~pMle the 'COMMON ~ME' ~M instMd. 2~. T~OE SECRET - ChecX ~es' E the ,n~o(mal~ ,n ~ ~ i$ ~ a t~e $e~e~ ~ ~o' d it is n~ S~te r~u~remen~ It yes. a~ b~ess is no( sub~ ~ ~C~ di~e of ~e ~s~t~ ~e s~et ~fo~n ~ ~und by HSC {2551 F~I requ~ement: If ~s, and busings ~s ~ub~ ~ ~C~. d~m o( ~ d~M(~ T~ ~el in(~a~ ~ ~und by 40 CFR ~ musl subm~ a 'Su~n~n Io A~y C~ M T~e ~ f~ (40 CFR ~.27) ~ 207. COMMON ~E - Enle( ~e ~ name or ~de n~e ~ ~e h~ ~le~al ~ ~um ~i~ a ~a~ mal~. 208. EHS · Ch~ ~' it ~e h~s real.al ~ an ~6~ H~ Suba~e (EHS). aa ~an~ ~ 40 CF~ P~ ~. ~ ~ If t~ mate~ ~ a m~um ~n~n~g an EHS. leave th~ sec~ b~nk a~ ~pM~e ~e s~n ~ ~s ~nts be~w. 209. CAS d · En(e~ ~he Chem~al ~st~ Se~i~ (C~) numar ~ ~e h~ar~s ~led~. F~ ~lu/es. enier ~e ~ numar of ~ m~ute if it ~s ~n aM~ a numar d~tin~ from i~ ~m~en~. I( Ihe mixture has ~ ~S num~. ~ve ~is ~n b~nk and re~ t~ ~S num~ of [~ ~1 ~m~nen~ in ~e ap~opdale s~n be~. 210. FIRE COOE H~RO C~SSES - Fire ~e H~d C~es de~d~ to ~mt res~ers t~ ~ and ~vel o~ h~ar~ materials whi~ a ~si~ ~S. Th~ ~n(o~a(~n s~ll on~ ~ p(o~ded d the I~l ~(e c~Ml dee~ ~t MM~a~ a~ requests ~e CUPA ~ ~ ~o ~ ~1. A list o( the haza~ ~ses on h~ to dateline whi~ ~ss a matedal ~aqs u~ ate i~l~ in ~e ap~s of ~te ~ o[ the UnEo~ F~e ~e. If a mal~l ~s aOGl~e hazard c~. ~de all. ~n~ CUPA ~ ~ f~ ~anM. 21 ~.'H~DOUS MATERI~ ~PE · Ch~ the ~e ~ ~at ~st ~d~ ~e ~ ~ ~a~ mateda~ ~re. m~um or ~ste. If ~ste ma(~l. ~ If m~mre ~ ~sle. ~pMle h~ard~s ~en~ s~n. 212. ~DIOACTIVE - ~k 'Yes' R ~e ~za~s ~t~ W ~d~e ~ 'No' if it is ~ 213. CURIES - I( ~e h~u/mate~l is ~e. ~ ~b ~ to re~ ~ a~ ~ ~. Y~ may use up ~ ~ ~ ~ a ~a~ d~al ~ 214. PHYSI~ STATE - C~ ~ ~e ~x ~at ~l d~ ~ s~ ~ ~ ~ ~s ~le~l is ~: ~, ~u~ ~ 215. ~GEST CONT~NER - EM~ ~ total ~pK~ o( t~ ~ ~M~r in ~ ~ mat~ b ~. . 216. FEDE~ H~D ~TEGORIES - Ch~ aD ~t~ ~ d~ ~e p~l a~ h~ ~Ms a~t~ m~ ~ ~s PHYSICAL ~RDS f H~L~ Pressure Relemse: ~xg~s~es. ~m~re~ed Gmses. B~sl~ Agenl~ '" CHrOnic Hem~ (DelJyed): G~. o~t ~-~ ~ ~ve~e e~l ~ ~ le~ ex,sure . 21 ~. AVENGE gAILY AMOUNT - ~m~le ~e ~ve~e ~ ~unl o~ ~e ~m~ ~lenml or m~lure ~mg m h~mt~s ~le~l. m ~ ~*~ ~m~e rares. Om~ulm~s ~11 be bms~ on ~e ~us ~m~s ~ven~ of ~le~l re~ ~ ~ pmge. To~l mil dmBy m~un~ m~ ~e ~ ~ num~ o~ dm~ ~e ~m~l wiB ~ ~ ~ile. II lh~ ~ m msle~l ~ml ~m ~! ~ been presenl mi ~s I~. ~e mm~nl shrub ~ ~e m~ ~ m~t dai~ am~nL 218. M~IMUM DALLY ~OU~ - Enter ~e maximin ~n( o[ e~ h~a~ ~e~ ~ ~ ~ a ~a~s ~tw~J, w~ b ~ ~ ~ ad~cenE~e area at any ~e time ~er ~e ~me ~ ~ ~ar. ~ a~nl must ~ al a min~um ~st ye~s ~v~ ~ ~e ~le~ r~ 219. ANNUAL WASTE ~OUNT * If t~ ~ mal~l ~ i~en~ is a ~e. ~e ~ es~le o[ ~e annual a~l 2~. STATE W~TE COOE - If the ~rd~s mat~l is a ~s{e. ~ler ~e apOStle California 3~R ~8~ wasle ~e as asl~ ~ ~e ~ of ~e H~a~s Wasle Man~esl. · 221. UNITS - Chex the unit o[ measure that is most apOStle for l~ ~te~al ~i~ re~ on t~ p~e: gal~ns, ~unds, ~b~ [~l ~ ~n3. NOTE; If ~e ~leMI [ederaW darned Extremely Hazard.s Subs~nce (EHS), all a~un[s mug[ ~ re~ ~n ~nds. I~ male~aJ ~s a m~ure ~nlai~ng an EHS, re~ ~ um~ ~t the malarial is stor~ in (gallons. ~unds. ~bc [~L ~ long). 222. DAYS ON SiTE · List l~e colal number of days dun~ Ihe ~at ~al l~e malarial ~s on 223. STOOGE CQNTAINER - Ch~k all ~xes Ihat des~ the lype o[ slomge ~ntainers in which ~e hazardous material is stored. NOTE: If a~gropdale, ~u may 224. STO~GE PRESSURE - Check [he one box thai best desk.s the pressure al wh~h ~e hazardous material is slored. 225. STOOGE TEMPE~TURE - C~eck ~e one box [hat ~sl dead.s the lempetatu~e al which the haza~ous material is s~red. 226. H~OOUSCOMPONENTS f.5 (% SY WEIGHT} . Enlet lhe ~ntage ~h( o( ~e haza~s ~mp~enl ~n a m~lu(e, tl a range o[ percenlages ~ ava~ab~, re~ the h~hesl percentage in that ra~e. (Re~ [~ com~nen[g 2 ~[~gh 5 in 230, 2~. 2~, a~ 242.) 227. H~ROOUS COMPONENTS 1-5 N~E - When fep~i~ a hazardous male~el ~al is a mmlure. Iisi up to ~ve chem~al ~mes of hazardous ~nenls mixture by pe(~nt Weight (re,er to MSOS or. in Ihe ~se of ~ade secret, re[er to manufacturer). All hazard, s c~enls in the mixture present al greeter Ihan 1% by ~hl ~l no,~carcin~en~, ~ 0. t% b~ ~ht i[ carcin~en~. $~u~ ~ re~. If more than rwe h~ar~$ ~mponen~ are presenl a~ve pnrcentages.~umayatlachanaddit~nalsheelo[~rlocaplurolher~uir~n[ormat~n. ~en (opodlng wasle mixlures, mineral a~ chemi~l ~$i~ Sh~ld be lisled. (Rein [~ componenls 2 I~ough 5 in 231, 235, 239. a~ 243.) 228. H~0OUS COMPONENTS I-5 EHS · Check 'Yes' ~(the ~mponen( ot the mixlu(e ~ c~s~e/~ an E~lremely Haza~us Subsla~e as de~m~ ~ 40 CFR, Ps~ 355. or 'No' ~L~I ~l nOl~ (Reoo~ (Or com~nenls 2 Ihrough 5 in 232. 236, 240. and 244.) 229. H~RDOUS CO~IPONENTS 1-5 C~S - L~sI lbo Chemical Absl[acl Sempe (CAS) numbe/s ~s (elaled to the hazardous ~m~nenls in Ihe mixture. (Repeat Cot 2.5.) 246, LOCALLY COLLECTED ~NFORMATION - Th~s space may be useO by the CUPA or ~ (o colloc[ 3ny addilionsl in[o(malion necessa~ 1o moo( [he t~u~emen~ o( Iheir ind~w~ual pr~rams. ConlaCl t~e CUPA o[ ~ (or gu~danM. UPCF (I/00) 7 OES Form 2731 PERMIT No. Bakemfleld Fire Dept. PREVENTION SERVICES. 1715 Chester Ave. Bakersfield, CA 93301 I'1 ALARM SYSTEMS CARNIVALS& FAIRS(w/attachment) COMMERCIAL HOOD SUPPRESSION SYSTEM I"1 HIGH-PII I=~ COMBUSTABLE STORAGE MOTION PICTURE RLMING(w/attachment) In conformity with provisions of pertinent ordinances, codes and/or regulations application is made by: to display, store, i~tall, ~e, operate, sell or ~le ~te~a~ or proc~s~ involving or Crying co~itio~ dee~ h~ard~ to l~e or pm~ ~ follows: ~ V~IC~ ~SP~Y (w/a~m~t) THIS PERMIT MUST BE POSTED APERMITwas [] Issued on By Autho~zed Representative Date Inspecting ~r CORRECTION NC iCE 0~882 BAKERSFIELD FIRE DEPARTMENT Location ~ q~GO ~t.~"~,c-r I~cv'~ Name You are hereby required to make the [olJowing corrections at the above location: Completion Date f(r. Corrections FD 1950 Inspector 326-3951 COllECTION N ICE 0&882 BAKERSFIELD FIRE DEPARTMENT Location Name F'.,~.,,.,,,,..v ~4o~-.~ k~J,ro ~,doV' ~ P4.,rv-r' You are hereby requ/red ,to make the fo/loving correctYons at the above Jocation: Cor. No. FO 1950 Inspector 326-3951 FACILITY NAME ADDRESS ~'~60 FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~ Floor, Bakersfield, CA 93301 INSPECTION DATE ~'~ PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [21 Routine [~LCombined [21 Joint Agency [21 Multi-Agency [21 Complaint [221 Re-inspection / - OPERATION C,~V .-....... MENTS ~ Appropriate permit on hand ( ':~LC~-SE- . ~'~~ ~ ~cp~O ~ B~iness plan contact info~ation actuate Visible ad,ess Co,eot oecup~cy Verification of invento~ materials ~ Q~//~_6~ o~ ~ ~s Verification of quantities Verification of location Proper se~gation of material Verification of MSDS availabili~ Verification of H~ Mat mining Verification of abatement supplies ~d procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Dia~am Adequate & On H~d C=Compliance V=Violation Any hazardous waste on site?: ~Yes 1~ No Explain: bov~ ~c,,~tC~z- Questions regarding this inspection? Please call us at (805) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Business Site Responsible Party Inspector: FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakerstield, CA 93301 ~ ~O~g4 P.'~,-'"C' INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID #~_AZ.-~Z9 t°o$ 74[ [] Routine ~J.~ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous xvaste determination has been made (/ EPA ID Number (Phone: 916-324-1781to obtain EPA ID / Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurance or maintains a contingency plan and training Estahlished Hazardous waste accumulation time fi'ames Containers in good condition and not leaking Containers are compatible xvith the hazardous waste Containers are kept closed ;vhen not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 fket from propeny line Seconda~ containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters / Transpons hazardous waste with completed manilkst Sends manilkst copies to DTSC Retains manffbsts tbr 3 years Retains hazardous xvaste analysis fbr 3 years Retains copies of used oil receipts tbr 3 years Determines if waste is restricted fi-om land disposal C=Compliance V=Violation Inspector: Office of Environmental Scrvices (805) 326-3979 Business Site sponsible Party \Vhite - Env. Svcs. Pink - Business Copy CITY OF BAKERS. FIEI OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL. DESCRIPTION (one fo~rn per material per building or ama) ' BUSINESS ~ (~e ~ FACIL~ ~ ~ D~ - ~ B~ ~) .. 3 / CHEMIC, ALLOCATION ~/'~,~S' t'~_,. ~,_~ ~.~{-~ ~ ~.~ 2011 CHEIvlICALLOCATION DYes I-]No 202 CONFIDENTIAL (EPCRA) 205 ! TRADE SECRET r-I Yes [] No 206 CHEMICAL NAME ; L ,'~._~ C~ ~"~/,",J,A~ j If Subjec~ to EPCRA, tefra' to instructions 207 COMMON NAME FIRE CODE HAZARD CLASSES (Complete if requested I~/local fire ctd~) TYPE [] m IvlXTURE Zli RADIOACTIVE [] Yes [] No 212 CURmES 213 PHYSICAL STATE I'-) $ SOUD [~ I.JQUID E] g GAS 214I"AR~T cONTAINER ~T~ ~ 215 FED HAZARD CATEGORIES [~1 FIRE · D 2 REACTIVE [] $ PRESSURE RELEASE [] 4 ACUTE HEALTH ~5 CHRONIC HEALTH 216 (Chec~ aa mat ANNUAL. WASTE 217 I MAX~ 218 [ AVERAGE 219 AIvlOUNT DAILY ANIC~NT DAILY AMOUNT UNITS* ~/1~ ga GAL [::] d CU FT /' if EHS. amount mu~ be In lbs. [] lb lis r"] In TONS 221 STATE WASTE COOE 220 DAYS ON S/TE 222 STORAGE CONTAINER [] a ABOVE~UND TANK [] · PtASTIC/NONMETALUC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK; [] f CAN [] j BAG [] n Pt. As'nc BOTTt. E [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN ,1~ STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE a AMBIENT [] == ABOVE AMBIENT [] ba BELOW AMBIENT 224 i STORAGE TEMPERATURE AIvlBIEI~ [] al ABOVEA~IENT [] be SELOWAMBIENT [] c CRYOGENIC 225 i 1 22a $ $ PRINT NAME & TITLE OF ,~ []yes [:]No 220 231 ~-I yes [] NO 232 233 235 I-1yes[]No 23e 237 239 [] Yel [] No 240 241 243 245 J'rHORIZED COMPANY REPRESENTATNE UPCF (7199) S:~CUPAFORMS~.OES2731.TV4.wpd OI~FICE OF ENVIRO~NTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326 3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION 0 NEW BUSINESS ~E (~e ~ FACIL~ ~ ~ O~ - ~ B~ ~) 3 ~1 ~E~L LO~TION T~E SE~ ~E~L ~ Su~ to EP~ ~ to i~ COIVlMON NAME 2O7 CAS # FIRE CODE HAZARD CLASSES (CompM~e if requested by IocM tim ct~ EHS' I--I Yes ~ No 208 PHYSICAL. STATE [] $ SOLID r']l LIQUID [] g GAS 214 LARGEST CONTAINER "~::) . 215 ~ CHRONIC HEALTH 216 FED HAZARD CATEGORIES - ~ (Olec~...all.~;~:~g~ ~--,L! FIRE ' D 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH DALLY AMOUNT DALLY AMOUNT ',,,,, --" / STO~ABOVEGROUND TANK [] · P;.ASTIC/NONMETALLIC DRUM [] t FIBER DRUM 219 ~I'ATE WASTE CODE 220 221 DAYS ON SITE 222 'Check all that apply) [] m ~BOTTLE []q RAILCAR 223 [] b UNDE~UND TANK ri f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUll. DING [] g CARBOY [] k BOX [] o TOTE BIN ,~ STEEL DRUM [] h SILO [] I CYUNDER [] p TANK WAGON STORAGE PRESSURE '~o AMBIENT [] a~ ABOVE AMBIENT [] be 8ELOWAMBIENT 224 22~ 227 []Yes •No 228 23O 23~ EYes I--I NO 232 234 235 E]YesONo 2~ 242 243 [] Yes [] NO 244 246 ~- / ~ / / · UPCF (7199) S:\CUPAFORMS\OES2731 .TV4.v~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ayg.. ~B.~kersfield, CA (805) 326-3979 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 1' BUSINESS IDENTIFICATION DATA LOCATION: I_0 8 b ~) ~ i (~'4-(' i 0..54' ~)~ 1) ~ · MAH.ING ADDRESS: DUN & BRADSTREET NUMBER: OWNEa.: -.~'OSa. M.A--.ING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR, PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER 0F EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIKEMENTS OF CHAPTER 6.95 OF TI-tE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION INFOKMATION 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 PERJUKY. ~TIT~LE DATE It~ZARDOUS MATERIALS MANAGEMENT PLAN SECTION ?: MITIOATION. PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: ~ ~ ~.~ ~ ~ RELEASE CONTENT AND/OR MINIIV~ZATION: C. CLEAN-UP PROCEDURES: SECTION lit: UTnJTY SHUT-OFFS _(LOCATION OF SHUT-OFFS AT YOUR :FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YE~ IF Y~S, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAII.ABILITY Ao WATER AVAIl.ABILITY (FIRE HYDRANT): .. - 4 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVA(~UATIQN PROCEDURES Ao Bo AGENCY NOTIFICATION PROCEDURES: EMPLOYEE NOTIFICATION AND EVACUATION: EMERGENCY MEDICAL PLAN/~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME FACILITY NAME SlTEADDRESS ( a ~a~ ' "~),&-~-C'~0_.Jf' NAU, O BUSI SS ZIP SIC CODE DUN & BKADSTREET NUMBER OWNEPJOPEKATOR ~/~CL. L._.A f-c,~_~./~ffz~o PHONE(/Oto[ h ~c~c~- 5~D CITY ,'~ ~t~£~',~(~ STATE ~_~_ ZIP q -)'O 3/5 EMERGENCY CONTACTS 1 24 HOUR PHONE (_8(~) &ot-l%ff 24 HOUK PHONE r'"O~aO_ (- ~ bb,I) ¢38 - "~ Ii Business Name I~ARDOUS MATERIALS INVENTS. Y ~c')-~r"'5 Addr~ [~_~(_OO ~,%3rC~ ~lodP.age '~C-°f~ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [f~] Addition [ ] l~vision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ 4) Physical & Health PHYSICAL Hazard Categories Fir~ [ ] Reactive [ 5) WASTE CLASSIFICATION 3) DOT # (optional) ,~-[M[ ] CAS# ] Trade Secr~ [ ] ]SuddenReleaseofPmssure[ ] Immedia~Health(Acut~)[ ]DelayedHealth(Clmmic)[ ] (3-digit cede ~ DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] C~ [ ] 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount _5 ~o,I Average Daily Amount ~/Z ~-f'. L~e~t Siz~ Container ~- # Days on Site Lbs[ ]Gal[~ft3[. ] c~e~ [ ]. Ci~le Which Months: ] Mtxtu~[ ] Wa.~[ ] l~Uoactiv¢[ ] 8) STORAGE CODES a) Contatuer. b) Pressure: c) Temperature AIl Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT the three most hazardous 1) chemical components or 2) · any AHM components 3) 1) INVENTORY STATUS: New [~Addition [ ] Revision [ ] Deletion [ ] 2) Common Name: ~ ~ ~ 4) Physical & Health PHYSICAL Hazard Categories Fire [ ] Reactive [ ] Sudden Release ofPressu~ [ [ ] [ ] CAS# % WT Ch~ck ffchemical is a NON Trade Secret [ ] Trad~ Se~e~ [ 3) DOT # (optional) Am, i[ ] CAS# ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE SoUd [ ] Liquid [ ] Gas [ ] Pure[] Mixture[ ] Wa.~[ ] lmuoa~ve[ ] 7) ~aMOUNT AND TIME AT FACILITY Maximum Daily Amount .~,: Average Daily Amount ---r-~_~ Annual Amount I Largest Siz~ Conufia~r \ # Days on Sit~ o UNITS OF MEASURE 8) STORAGE CODES Lbs[ ]Gal[ ]ti3[ ] a) Container:. · b) Pressuxe: c) Ciml¢ Which Months: AIl Year, ~, F, M, A, M, ~, $, A, S, O, N, D 9) MIXTURE: List COMPON]~ CAS# %WT ARM the three most hazardous 1) [ ] chemical components or 2) [ ] auy ~d-{M components 3) [ ]. I certify under p~ty of law, that I have personally ex{m~ned as~d am familiar with the intbrmation on this and aH a_n_~h._~ document. I believe ~e ~bmRt~ infection is lrue, accux'a~ ~ compleu~. PRINT Name & Title of Authorized Company RePrer'en~ativ¢/ Signatu~ Da~ Busm~ N~¢ HA OUS MATERIALS INVENTOt CI~P.~C~ DESCRIPTION I ) INVENTORY STATUS: New [h~ Addition[ ]Revision[ ]Deletion[ ] CheckifchemicalisaNONTmd~Secret[ ]Trad~Secret[ /__ 2) Common Name: 3C~C'C~.,A~ ~,..~" 3) DOT # (optional) 4) Physical & Health PHYSICAL HEALTH I-r~rd eat~ories Fire [ ] Reactive [ ] Sudd~ ReI~ ~fPressum [ ] ~edi~ Health (^~m~) [ ] Del~y~l I-Ie~lth (Chrome) [ USE CODE (3-digit code from DHS Form 8022) Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [ ] Liquid [ ] C~ [ ] UNITS OF MEASURE 8) STORAGE CODES Lbs[ ]Gall Iff3[ ] a)Contain~:.. Curies [ ] b) Pressure: c) Tempe~tum Ali Year, ~, F, M, A, M, $, $, A, S, O, N, D 7) AMOUNT AND TIME AT FACILrk'Y Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Si~ Circle Which Months: [ ] [ ] [ ] ~ - ' 6)- Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Sec~t [ '] 9) M/XTURE: List COMt~NENT CAS# % WT the thr~ most lmzardons 1) chemical componon~s or 2) .ny AHM components 3) INVENTORY STATUS: N~ [ ] Addition [ 3) DOT # (optional) cas# PHYSICAL HEALTH Fir~[ ]Renctive[ ]S~44_~ReleaseofPre~ure[ ] lmmediat~Health(Acute)[ ]DelnyedHealth(Clmmi¢)[ ] USE CODE $) WASTE CLASSIFICATION O-digit code from DHS Form 8022) 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pm[ ] ] wm [ ] mmion ive[ ] UNITS OF MEASURE S) STORAGE CODES Lbs [ ] Gal ~7~ f~3 [ ] a) Conmiu~. Cun'~ [ ] b) Pr~anz: c) TeantmmUm: AIl Year, J, F, M, A, M, $, J, A, S, O, N, D 7) AMOUNT AND TIME AT FACILI~ Maximum Daily Amount' q Average Daily Amount Annual Amount Largest Size Contuinn' # Days on Site Circle Which Months: 9) MIXIlJRE: List COMPONENT CAS# %.WT AHM me ~ most h~-rdous 1) [ ] ch~nical compon~t~ or 2) [ ] any AHM comlxalonts 3) [ ]. 10)LOCATIO ' ' I certify undet~nalt37of mw, that I have personally examined ami am familiar with the/-tbrmati~ on this and all~.hed dogutfi~nts. I believeth, e submitted information is tme, accurate and complet~. /~/ ~ d / ~>/ _/ -- PRINT Nnme & Title of Authorized Company Representative-" Sil~(~e Dat~ ] ] Busings Name ~U'Y%'% H2~'~OUS MATERIALS INVENT~Y CHEMICAL DESCRIFrlON I)INVENTORYSTATUS:Nmv[faJAddition[ ]Revision[. ]Del~ti~[ ] 2) Common ~ Cl~mi~ N~: 4) Physical & F,~lm Cheek if chemical is a NON Trade Se~ret [ ]Trad~Seemt[ ] Fir~ [ $) WASTE CLASSIFICATION ] Reamive [ ] S,_,~ Release ofPr=.sum [ ] tr.m_~!.te Health (Acute) [ ] Delayed Health (Chronic) [ (3.digit eod~ fia~m DI-~ Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] 7) AMOUNT AND TIME AT FACILIT~ Maxim-,- Daily Am~mt ~c ¢c~(Z Annual Amount # Days on Site 9) MIXTU~: List ~a~ thr~ most hazardom 1) dmnical c,~mImnmta or 2) any AHM compun~ts 3) COMPONENT CAS# % WI' [ ] [ ] [ ] 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check ifchemieal is a NON Trade Secret [ 4) Physical & I-I~lth Hazard Camm= F~ [ ] ]{e'a~iv¢ [ i ~, qo./'o, qe. ] rr~~[ ]' AHM[ ] CAS# PHYSICAL HEALTH ]S~4_~P. el~ofPr~m~[ ] Immedi~H=lth(Acut~)[ ]DelayedH~lth(Clmmic)[ $) WASTE CLASSIFICATION O-digit co& from DHS Form ~022) USE CODE 6) PHYSicAL ST^T~ So~m [ ] Uquid [ ] Cas [ ] n~-~[ ] Miami ] Wadi ] Re~o~/v~[ ] 7) AMOUNT AND ~ AT FACILr~ Maxim,-- Dally Amount Average Daily Amount Annual Amount L~ Siz~ Contain= # Days ~ Si~ UNITS OF MEASURE 8) STORAGE CODES Lbs[ ]Cml[~fl3 [ ] a) Contains. cm=[ ] ¢) Temperature Circle Which Munro,: Ail Y~r. $, F. M. A. M, $, L A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# %:WT AHM the three most bazm'dous 1) [ ] chemical compommts or 2) [ ] my AHM comlxmonu 3) [ ]. I ~ un4= l~al~ of law, tim I have p~sonally _e~mi-_-a dd m ~ with the im'ornmtion on this and all attak~ d~ammn6/. I PRINT Name & Title of Authorize! Company Representative.:::" q-'/ Signatu~ Date Name CI~~ DESCRIPTION I)~ORYSTATUS:New~,Addition[ II'vision[ ]Del~ion[ l 2) Common Na~: r~C'~ ~~ 4) Phys/cal ~ Health PHYSICAL HazardCa~-gori~ Fir~[ ]~ve[ ]SL,&~__Re. less~ofPressur~[ $) WASTE CLASSIFICATION Cl~kffd~micalisaNONTrad~S~r~[ ]Trad~{ J 3) DOT # (optional) Amd[ ] c~s# ] Imm~lia~I-Ie~th(Acute)[ ]Delay~dI-I~lth(Chronic)[ ] (3-digit ced~ from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas { ] · Pm-c[] ~[ixuze[ I waste[ ] Remonc~vc[ ] UNITS OF MF..AS~. 8) STORAGE CODES Lbs[ ]C. ral[,~fl3[ ] a)C~ ~m[ ] b)~: "- c) T~~ Citr2e Which Mon~: AIl Y~ar, J, F, M, A, lyf, $, $, A, S, O, N, D 9) MIXTUR~ List COMPONENT .CAS# % WI' AHM ii~ thr~ mos~ haza~ 1) [ ] ~ ~u or 2) [ ] my ~ ~~ 3) " [ ] I)I~VENTORYSTA'U4.S:New[ ]Addition[ ]Revision[ ]Deletion[ ] Ch~kifchcmicalisaNONTra~Sccrct[ ]Trad~[ ]' 2) Common Name: t tk.~ c4, , Ch~ N~:' T' ~ I t z~e~rxe~ AH~ { I CAS # ~ ~ ~ L PHYSICAL HEALTH Hazard Cat~ories Fire [ ] ReaCtive [ ] S~4a_~ Rcless~ ofPressu~ [ ] lmm~i.te It~alth (Acute) ( ] Dclayai Health (Chronic) [ ] $) WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [ ] Liquid [ 7) AMOUNT AND ~ AT FACILIT~ Maximum Daily Amouat Average Daffy Amount Annml Amount # Days on Sit~ O-digit cod~ from DHS Form 8022) USE CODE I c-~[ ] p~[ ] ~[ 1' was~[ ] UNITS OF MEASURE S) STORAGE CODES Lbs [ ] Gal [ ~ ft3 .[ ] a) Contain= Curies [ ] b) Pressure: c) Radioa~ve [ Circle Which Month-s: AIl Year, I, F, M, A, M, $, $, A, S, O, N, D 9) MIX21/RE: List COMPONENT CAS# %WT AHM ~c thrcc mo~ han~us 1) [ ] chemical ~omponmu or 2) [ ] anyAHM ~ompononts :3) [ ].