The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLANi ~~ n i~„ JIM HARRTC w~.T ING CJ ~~ ~ 829 ESPEE STREET - o -- r~ ~~ ~' ~, ~~ !j Hazardous Materials/Hazardous Waste Unified 'Permit CONDITIONS OF..PERMITON :REVERSE SIDE Permit ID #:: 015-000-000276 JIM HARRIS WELDING ~' ~ i · This hermit is issued for the following: [] Hazardous Materials Plan · El.Underground 'Storage of Hazardous Materials · 13 Risk Management Program El Hazardous Waste On-.Site Treatment LOCATION: 829 ESPEE ST Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Office of Evimnmml~Services ~ Expiration Date: June 30.. 2003 Issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-0214)00276 JIM HARRIS WELDING LOCATION 829 ESPEE ........ i~;~,;~,:i~,=?~7,~,~i~:~:~;,!~?!!~,~:.~,:~,~,~ ....... This permit is issued for the following: ~., ~ ....~ .. ~ ~ =~ ~.. ,?~. ..... ~ ~-~ ~.. ,. ~=.. ....~ ~, ".-. ~ . ~,-~ ,~" ~ .... ~:~ ' ', ~ ~.G~· ~ ~.=' F ~ ..,' ~,~, ~,~..' .' ,' ¢]~ r j ~-. ".C~ ~ ...... ~ ~.~ ~, ....,.....'., ,~,- ,,~/ ..~.'" ',,, ',~ '~"~% ~: ~ ~',: '~]-%:;',, , c..~ ~>" /!' '," ~g ~ .... ~ ~. i,,~ ,~ ~.~. ~., .,. ~..~ ~ J '~ ~'r"~ -" --~: '~m ~'~ ~, ~' '"~:.j- .~' .,.' ..-, ,:--..., ,., ...' ,,' / ¢ g ¢ ~?~' Issued by: Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: June 30, 2000 BAKERSFIELD CITY FIRE DEPARTMENT I{AZARDOUS MATERIALS SITE/FACILITY DIAORAMS FORM 5 INSTRUCTIONS GENERAL INSTRUCTIONS Use these instructions and the attached form to complete a SITE DIAGRAM'of the property and immediate surrounding area, and a FACILITY DIAGRAM of each facility unit or building. If the entire business can be shown in adequate detail on the Site Plan, individual Facility Plans may not be necessary. The. Inspector can assist you in making this determination if there is a question. Complete the information at the top of the diagram form. The box at the bottom of the form should be left blank. SITE DIAGRAM The SITE DIAGR~ should include the business and at least 300 feet from the property line. Identify the items listed on the SITE DIAGR~ using the symbols provided on the back. Include all items that apply. See the attached example. FACILITY DIAGRA~ Develop a FACILITY DIAGR~%~ that will show the building interior and the immediate exterior area. Complete a separate FACILITY DIAGRAM for each floor of a multi-story building. Identify on FACILITY DIAGR~ items listed under both "SITE DIAGRAM" and "FACILITY DIAGRam" on the back of this page. Use the symbols provided. Include all items that apply. See the attached example. - $ - UNIFIED PROGRAM INSPECTION CHECKLIST Bakersfield Fire Dept.. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661)-326-3979 ____ __ SECTION 1 Business .Plan and Inventory Program ~~ • FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE No. No. of Employees -----~2~ ---_E'~~~-_~'~~---.----- ---------, _ - --------- 323-19 FACILITYCONTACT Business ID Number ~s-o2i-v27~ Section 1: Business Plan and Inventory Pn~gram ~&! Routine ^ Combined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection C V ~ V=vo ationn~) OPERATION COMMENTS ^ ^ APPROPRIATE PERMIT ON HAND --- ^ --- ^ - BUSINESS PLAN CONTACT INFORMATION ACCURATE (~ ~,/~~ ~~~ ~lJ " ~0~~~~w' r Y ~ ^ ^ VISIBLE ADDRESS _- _ ~ - _ . _. - ~ ~' ~ > ^ ^ CORRECT OCCUPANCY f ~ f! .(., \ ^ - --- ^ ~ - --- VERIFICATION OF INVENTORY MATERIALS - ---- ---- ..._.------------ ------ -- ------- .._... .-..-...-.. ~ r~S Qn 5i ~(~ y -._..___ . 1 ^ ^ VERIFICATION OF QUANTITIES ^~~ ^ ^ .VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE ^ ^ VERIFICATION OF FIAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES ANO PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ~ -- ^ ---- ^ {{ --..._....-----------------...--....____.._...-------------- -..... CONTAINERS PROPERLY LABELED I ---- --.. ---__. __ ^ ^ HOUSEKEEPING ^ ^. FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE: OYES ^ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~sC)'I ~ 3Z6-3979 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site While - Enwonmental Services Yellow -Station Copy Business Site Responsible Party (Please Print) ~ Pink -Business Copy CUST ~&NO. MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE /-"7/- i ~ - ~ NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT FINANCE CHARGE OTHER ADJ CUSTOMER NAME MAILING ADDRESS CITY SITE ADDRESS PARCEL NUMBER (IF APPLICABLE) ADJUSTMENT ; CHG DATE CHARGE CODE A.~JUSTMENT AMOUNT cuS'I'~PE & NO. MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT ' FINANCE CHARGE I / ! OTHER ADJ I )~ CUSTOMER NAME MAILING ADDRESS SITE ADDRESS PARCEL NUMBER (IF APPUCABI,,E) ADJUSTMENT I CHG DATE CHARGE CODE t ADJUSTMENT AMOUNT STATEMENT OF ACCOUNT CITY OF BAKERSFIELD P 0 BOX 2057 TO: JIMMY HARRIS WELDINg 829 ESPEE ST BAKERSFIELD, CA 93301 PAgE DATE: 12/01/'01 CUSTOMER NO: 2880 CUSTOMER TYPE: ES/ 2880 CHARGE DATE DESCRIPTION HMO01 HMO01 HMO01 A A A REF-NUMBER DUE DATE 11/0!/01 BEgINNINg BALANCE 6/01/98 HAZ MAT HANDLINg FEE STATE MANDATED. FEE 1/10/99 HAZ MAT HANDLINg FEE STATE MANDATED FEE 6/01/00 HAZ MAT HANDLINg FEE STATE MANDATED FEE 9/21/00 PAYMENT 1/01/01HAZ MAT HANDL!NQ FEE STATE MANDATED FEE 11/?,0/01 Charge adJustment- HAZ MAT HANDLINg FEE 11/30/01 Charge adjustment HAZ MAT HANDLINg FEE 1i/30/0i Charge adjustment HAZ MAT HANDLINg FEE il/30/01 Charge adjustment HAZ MAT HANDLINg FEE HMO01 A HMOIO 12/31/01 HMOIO 1~/?,1/01 HMO10 12/31/01 HMOIO 12/31/01 TOTAL AMOUNT 887.00 73.00 73.00 73.00 252.50- 77.00 295.00- 292.00- 292.00- 307.00- STATEMENT OF ACCOUNT PAOE 2 TO: CITY OF BAKERSFIELD P 0 BOX 2057 BAKERSFIELD, CA ~3303-2057 JIMMY HARRIS WELD'.iNQ ~AKERSFiELD, CA 93~01 CUSTOMER NO: 2880 DATE: CUSTOMER TYPE: ES/ 12/01/01 2880 CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT FOR QUESTIONS OR CHANQES TO YOUR~ACCOUNT PLEASE CALL THE NUMBER AT THE_TOP OF THiS STATEMENT. CURRENT 63.00- DUE DATE: 12/31/01 OVER 30 OVER 60 OVER 63.00 PAYMENT DUE: TOTAL DUE: 547.50- $547. 50- M~430I%7 Customer ID . . . : Last statement . : Last invoice : Current balance . : Pending ..... : CITY OF BAKERSFIELD~ scellaneous Receivables ~uiry 9/20/01 11:23:09 288O 9/01/01 o/00/0o 1,182.00 .00 Name: JIMMY HARRIS WELDING Addr: 829 ESPEE ST BAKERSFIELD, CA 93301 A ACTIVE ENVIRONMENTAL SERVICES T~pe options, press Enter. Combined Detail 5=Display Opt Trans Date Code Description 1/Ol/Ol - 1/01/01 - 1/01/01 - 1/01/01 - 12/01/00 - 11/01/00 - 10/01/00 - 9/21/00 stmrn Statements Processed SS001 CA STATE SURCHARGE HM017 HAZ MAT ANNUAL INSPE HM010 HAZ MAT HANDLING FEE stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed PAYMENT Amount .00 10.00 1182 53.00 1172 307.00 1119 .00 812 .00 812 .00 812 252.50- 812 Chg Bnk G Balance Typ Cd L 1182 00 N 00 A 00 00 A 00 00 A 00 00 N 00 N 00 N 00 00 More... F3=Exit F12=Cancel * = Pending MR430107 CITY OF BAKERSFIELD ~ scellaneous Receivables I~uiry 9/20/01 11:23:09 Customer ID . . . : Last statement . : Last invoice . . : Current balance : Pending ..... : 2880 9/01/01 0/00/00 1,182.00 .00 Name: JIMMY HARRIS WELDING Addr: 829 ESPEE ST BAKERSFIELD, CA '93301 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail 5=Display Opt Trans Date Code Description 9/01/00 - 8/01/00 6/01/00 -- 6/01/00 -- 6/01/00 -- 6/01/00 - 5/01/00 - 4/01/00 stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed SS001 CA STATE SURCHARGE HM017 HAZ MAT ANNUAL INSPE HM010 HAZ MAT HANDLING FEE stmrn Statements Processed stmrn Statements Processed Amount .00 .00 .00 10.00 50.00 292.00 .00 .00 Chg Bnk G Balance Typ Cd 1064 50 1064 50 1064 50 1064 50 1054 50 1004 50 712.50 712.50 L N N N A 00 A 00 A 00 N N More... F3=Exit F12=Cancel * = Pending MR430107 CITY OF Bi~KERSFIELD~ scellaneous Receivables I~uiry 9/20/01 11:23:09 Customer ID . . . : Last statement : Last invoice : Current balance : Pending ..... : 2880 9/01/01 0/00/00 1,182.00 .00 Name: JIMMY HARRIS WELDING Addr: 829 ESPEE ST BAKERSFIELD, CA 93301 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail 5=Display Opt Trans Date Code Description 1/15/99 - 1/15/99 - 1/15/99 - 1/01/99 - 12/01/98 - 11/01/98 - 10/01/98 - 9/01/98 SS001 CA STATE SURCHARGE HM017 HAZ MAT ANNUAL INSPE HM010 HAZ MAT HANDLING FEE stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed Chg Bnk G Amount Balance Typ Cd L 18.50 721.00 A 00 50.00 702.50 A 00 292.00 652.50 A 00 .00 360.50 N .00 360.50 N .00 360.50 N .00 360.50 N .00 360.50 N More... F3=Exit F12=Cancel * = Pending MR430107 CITY OF BAKERSFIELD~ .scellaneous Receivables iry 9/20/01 11:23:09 Customer ID . . . : Last statement : Last invoice . : Current balance : Pending ..... : 2880 9/01/01 0/00/00 1,182.00 .00 Name: JIMMY HARRIS WELDING Addr: 829 ESPEE ST BAKERSFIELD, CA 93301 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail 5=Display Opt Trans Date Code Description 8/01/98 - 6/30/98 - 6/11/98' - 6/01/98 - 6/01/98 - 6/01/98 - 6/01/98 - 5/01/98 stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed stmrn Statements Processed SS001 CA 'STATE SURCHARGE HM017 HAZ MAT ANNUAL INSPE HM010 HAZ MAT HANDLING FEE stmrn Statements Processed Chg Bnk G Amount Balance Typ Cd L .00 360.50 N .00 360.50 N .00 360.50 N .00 360.50 N 18.50 360.50 A 00 50.00 342.00 A 00 292.00 292.00 A 00 .00 .00 N More... F3=Exit F12=Cancel * = Pending JIM HARRIS WELDING Manager : Location: 829 ESPEE ST City : BAKERSFIELD CommCode: BAKERSFIELD STATION 04 EPA Numb: SiteID: 015-021-000276 BusPhone: Map : 103 Grid: 19D (805) 323-1985 CommHaz : Moderate FacUnits: 1 AOV: SIC Code:7692 DunnBrad: Emergency Contact JIM HARRIS Business Phone: 24-Hour Phone : Pager Phone : / Title / OWNER (805) 323-1985x (805) 871-5180x ( ) - x Emergency Contact Business Phone: ( 24-Hour Phone : ( Pager Phone : ( / / ) ) ) Title x x x Hazmat Hazards: Fire Press ImmHlth Contact : MailAddr: 829 ESPEE ST City : BAKERSFIELD Phone: ( ) State: CA Zip : 93301 x Owner JIM HARRIS Address : 3612 HARMONY DR City : BAKERSFIELD Period Preparer Certif ' d Emergency Directives: Phone: (805) 323-1985x State: CA 93306 = Gal = Gal No = Hazmat Inventory --As Designated Order Hazmat Common Name... OXYGEN ACETYLENE ARGON One Unified List All Materials at Site ISpooHazlEPA HazardsI Frm I ~DailyMax IUnitlMcP F P IH G 400.00 FT3 Low F P IH G / ~9_.C .T~ F P IH G --~-'~'0~.'00 FT3 Min F P IH G 330.00 FT3 Low I. ~ ') Il'V/ ~ Do hereby certify that I have v, (Type or print rmn~) - reviewed the at~ached hazardous materials manage- ment plan for~/,~/'/~ ~ E,/~.~nd ~hm it along with ' (Nam~ of tiosi.ess) ~ ' any corrections constitute a complete and correct man- agement plan for my facility. 11/30/200C JIM HARRIS WELDING Sit_~eID: 015-021-000276 Inventory Item 0001 Facility Unit:~ Containers on Site OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: FRONT LEFT CAS# 7782-44-7 FSTATE -- TYPE Gas TPure PRESSURE TEMPERATURE I Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest ContainerFT3 AMOUNTS AT THIS LOCATION Daily Maximum 400.00 FT3 Daily Average 400.00 FT3 %Wt. 100.00 HAZARDOUS COMPONENTS Oxygen, Compressed HAZARD ASSESSMENTS Radi°active/Am°unt I EPA HazardsINo/ Curies F P IH / / / LOW J Inventory Item 0002 Facility Unit: Fixed Containers on Site ~U~I~ ~vl~ / ~£~Z%/~ ~vl~ ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: FRONT LEFT CAS# 74-86-2 FSTATE ~'TYPE Gas /Pure PRESSURE TEMPERATURE ] Above Ambient ~ Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 200.00 FT3 Daily Average 200.00 FT3 %Wt. I 100.00 Acetylene HAZARDOUS COMPONENTS Yes 748 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F P IH NFPA 1.1.1 USDOT# I MCPHi -2- 11/30/200£ JIM HARRIS WELDING SiteID: -021-000276 Inventory ~m 0003 Facility Unit: Fixed on Site ARGON ~/ Days On Site \ 365 Location within~this Facility Unit Map: Gr FRONT LEFT ~ / CAS# 7440-37-1 FSTATE ~ TYPE Gas /Pure 10 0.0 0 Argon Largest Container PRESSURE TEMPERATURE Ambient I Ambient CONTAINER TYPE AMOUNTS AT THIS LO~ Daily FT3 600.0 FT3 PORT. PRESS. CYLINDER Daily Average 600.00 FT3 Radioactive EPA Hazards No/ C~ F P IH NFPA /// USDOT# MCP Min -- Inventory Item 0004 y Unit: Fixed Containers on Site ~GON/~ON DIOXIDE /~ Days On Site 365 Location within this F~ility Unit ap: Grid: FRO~ LEFT . 7440-37-1 FSTATE ~ TYPE PRESSURE I CONTAINER TYPE Gas I Mixture Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS ON Largest Conta~ I Daily Maximum Daily Average FT3 I 330.00 FT3 330.00 FT3 " ~UU~ ~U~F~N~'£'~ ~ %Wt. RS CAS# 90.00 Argo~ No 7440371 7.50 Car~on Dioxide No 124389 2.50 Ox~en, Compressed No 7782447 / HAZARD ASSESSMENTS ITSecret I RS lBiOHaz EPA Hazards F P IH / / USDOT# MCP Low -3- 11/30/2000 F JIM HARRIS WELDING SiteID: 015-021-000276 Fast Format = Notif./Evacuation/Medical --Agency Notification CALL 911 Overall Site 11/14/1991 Employee Notif./Evacuation VERBAL AND CALL 911. 11/14'/1991 -- Public Notif./Evacuation N/A NO EMPLOYEES 11/14/1991 Emergency Medical Plan NEAREST HOSPITAL. 11/14/1991 -4- 11/30/200£ F JIM HARRIS WELDING SiteID: 015-021-000276 9 Fast Format 9 =Mitigation/Prevent/Abatemt --Release Prevention Overall Site 9 11/14/1991 PROPERLY STORED AND CHAINED WITH PROPER FITTINGS. WE HAVE 4 FIRE EXTINGUISHERS ON PROPERTY. Release Containment COMPRESSED GASSES ONLY 11/14/1991 -- Clean Up N/A 11/14/1991 Other ResoUrce Activation -5- 11/30/200C F JIM HARRIS wELDING SiteID: 015-021-000276 Fast Format F Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - FRONT OF SHOP OUTSIDE B) ELECTRICAL - FRONT OF SHOP C) WATER - FRONT OF SHOP LEFT SIDE D) SPECIAL - NONE E) LOCK BOX - NO 11/14/1991 -- Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS 11/14/1991 : FIRE HYDRANT - RIGHT, FRONT OF SHOP Building Occupancy Level -6- 11/30/200( JIM HARRIS WELDING SiteID: 015-021-000276 Fast Format = Training --Employee Training WE HAVE NO EMPLOYEES AT THIS FACILITY WE DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BREIF SUMMARY OF TRAINING: ??????? Overall Site 11/14/1991 -- Page 2 Held for Future Use Held for Future Use -7- 11/30/200( MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE NEWACCOUNT ; ADDRE88CHANGE CLOSEACCT j · RNANCECHARGEJ. / · OTHER ADJ l:y i CUSTOMER NAME MAILING ADDRESS CITY ZIP CODE SITE ADDRESS PARCEL NUMBER (~F APPUOABLE) ADJUSTMENT I CHG DATE CHARGE CODE I ADJUSTMENT AMOUNT I i APPROVED BY HM392701 Account Number ACCOUNTS RECEIVABLE ADJUSTMENT July 20~ 1995 Date Esther Duran From Fire Department- Hazardous Materials Division Department/Division JIMMY HARRIS WELDING New Account New Address Close Account Service Chan.qe Other Adjustments X Billing Name 829 ESPEE STREET Billing Address Site Address Parcel # (if Applicable) ~andlord Name & Address (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effective Date of Billing Change < 1.15> 07-01-95 Remarks: WE WILL ADJUST OFF THESE FINANCE CHARGES. PAYMENT WAS POSTED ON THE 3RD AFTER FINANCE CHARGES HAD ACCRUED. )109/90 JIM ~RRIS WELDING 215-000-000~ Overall Site with 1 Fac. Unit General Ir~format i Looatior,: 829 ESPEE ST Map: 103 Hazard: Moderate Ident Number: 215-000-000276 Grid: 19D Area of Vul: 0.0 Adrnir~istrative Data Mail Addrs: 829 ESPEE ST D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comrn Code: 215-06)4 BAKERSFIELD STATION (i)4 SIC Code: Owner: JIM HARRIS Phone: (805) 323-1985 Address: 3612 HARMONY DR State: CA City: BAKERSFIELD Zip: 93306- S *~ nl nl a r y i, Do hereby c®r~i~ that ~ h~v~ reviewed the attached ' ..... ' Bent plan for any corrections cons¢~ute ~ complete and corrs¢~ man- a~ement plan for my facility. / Bate/ ~ 10/09/90 Page 2 Pln-Ref Name/Hazards JIM HARRIS WELDING 215-000-000276 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Form Quantity MCP 02-002 ACETYLENE Fire, Pressure, Immed Hlth Gas 200 FT3 High 02-001 OXYGEN Fire, Pressure, Immed Hlth Gas 400: FT3 Low 02-004 ARGON MIX Fire, Pressure, Immed Hlth Gas 330 FT3 Low 02-003 ARGON Fire, Pressure, Immed Hlth Gas 600 FT3 Minimal /0/09/90 / O0 - Overall Site <D> Not if./Evacuat ion/Medical Page 3 <1> Agency Notificatior~ CALL 911 <2> Employee Notif. /Evacuation VERBAL AND CALL 911. <3> Public Notif. /Evacuation <4> Er~erger~cy Medical Plat, NEAREST HOSPITAL. 10/09/90 JIM HARRIS WELDING 215-000-000276 O0 - Overall Site <E> Mit i gat ior,/Prevent/Abat erst 4 <1> Release Prever, tior, PROPERLY STORED AND CHAINED WITH PROPER FITTINGS. EXTINGUISHERS ON PROPERTY. WE HAVE 4 FIRE <2> Release Cor, tainmer, t Clear, Up <4> Other Resource Activation 10/09/90 JIM~RRIS WELDING 215-000-000~6 00 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Utility Shut-Offs A) GAS - FRONT OF SHOP' OUTSIDE B) ELECTRICAL - FRONT OF SHOP )~WA]'ER - FRONT OF SHOP LEFT SIDE SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS F IR,E HYDRAN'r - ~ <4> Held for Future use 0/09/90 JIM HARRIS WELDING P15-000-000276 O0 - Overall Site Page 6 <G> Trair~ing Page 1 WE HAVE EMPLOYEES AT '[HIS FACILITY O~ DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BREIF SUMMARY OF TRAINING: Page ~ as needed <3> Held for Future Use <4> Held for Future Use Fare and Agriculture BUS[NESS NAME LOCATION; CITY. ZIP: PHONE #: j CII'Y Of BAKERSFIELD ' HAZARDOUS MATERIALS INVENTORY standard 8us(ness [] NON--TRADE SECRETS -OWNER NAME: NAME OF T~IS FACILITY: ' STANDARD IND. CLASS CODE~ ' ADDRESS; ~ ~IP:_ DUN AND "B~STR~! NUMBER ..... REFER ~O'-~NSTRUCTZONS FUN PROPER CODES I 2 3! 4 ~ 5 6 1 8 9 10 II 12 CodeTrans coae!Yl~e Am!;I~ax Av.erpgeAec ; ;~ AnnualEst HeasUreun~ts onl~[e ContType COnLPress COntTemp .USco~e Location.Mhe(e. Stored In ~aClllCy Physical and Health;Hazard (Check all that apply} ~ire Hazard Reactivity~ ~ Health. of Pressure Health Componen~ Physical Iod Health~Hazard C,A,S. Number Componen~ II Name ICheck all that applyl ~ Fire Hazard ~ Reactivity , Health of Pressure Component 13 Name I C.A.S. Number Physical and Healt~ Hazard tCheck all that '?PLY) ~ Fire Hazard['~ Reactivity' . Hem/Ch of Pressure Health Component 13 Name Physical'l~ Health Ualard {Check al/ that app/yl ~ Fire Hazard ~ Reactivity · Health of Pressure . I , Name - {erti[i{;atioq i.(Rej~d a..n.d.~'ign af~pr cornpl~tipg,al l .,sC. ct.i,ons.) '~ l certify under @enaltX .of!aw tnqt l navepersonal~y, examlnq~Qqolm ~ami~la(.~/itO the Imormatlon Su~mitt.e~l in this and all i . ¢ '~,ktached d~cueents, an; tpat oaseo on.my ~nquiry <~t.tnose inDiviDuals responsible for obtain(n9 the ~nrormacton. ! believe that,'the~ ~ / / ~tted ~n~rmat? IS true., accurate, and complete. . . ,:~, f ~ ~~ ~,~~ ~ner/o,erator's authorized re,resen:attve ~4 ~ ~~~ BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 tUS INESS NAME 0FFIC[AL USE ONLY ID~ HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: L B. LOCATION / STREET ADDRESS: ~LC[" CITY: 323.- SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-915-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by EMPLoyeE IN CASE OF EMERGENCY: . NA~ME/A~D'T,I-TLE DURING BUS. HRS. AFTER BUS. HRS. A Ph~ B. Ph~ Ph= SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE D. SPEC'IAL: I 1 E. LOCK BOX: YES / ~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / N0 YES / N0 MSDSS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TE~ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTanCE FOR YOUR BUSINESS AS A WHOLE REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO' INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS ~TERIALS:...' .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C, PROPER USE 0F SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO ,YES NO E. DO Y0U ~5%INTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: ~AZARDOUS ~ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN $00 POUNDS OF A ~ ~//~ ~~0LI~' 55 ~ ' ,~//GALL~NS 0F,~ LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I7~v~j ,~,~7~~~ , certify that the above information is accurate. I understa~ that this information will be used to fulfill my firm's obligations under the new Ca/ifornia Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 28800 Et Al.) and that inaccurate information constitutes perjury. S I GNATUR~~'~ '~ (.. DATE BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFICIAL USE ONLY ID# BUSINESS pLAN SINGLE FACILITY UNIT FORM. 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as .possible. FACILITY UNIT# FACILITY b~IT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES. SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS b'~JIT ONLY' · - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... YES N0 If YES, see B. If NO, continue with SECTION 4. B. Are any 0f the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E,~ERGENCY RESPON~ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES,'~OCATION: IF YES, SITE PLANS? FLOOR PLANS? YES / NO MSDSs? YES / NO YES / NO KEYS? YES / NO - 3B - .U. HAZARDOUS BUSINESS.NAME:C. m -CS ADDRESS :~q_ 6~ ' ~.~-~ ~- O BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON--TRADE SECRETS ~IATERI ALS I NVENTORY OWNER NAME: l ~c[/i 'l~r~ t~C.~ ADDRESS: ~'"~1"~,~ -~no--~., ~. FACILITY UNIT CITY,Z~P:~E~t~.. ¢.a ~~ Page.~ ,,of FACILITY UNIT #: NAME: OFFICIAL USE CFIRS COOE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL COST USE LOCATION IN THIS · BY HAZARD D.0.T CODE AMOUNT AMOUNT uNIT CODE CODE FACILITY UNIT ' WT. CHEMICAL OR COMMON NAME CODE GUIDE / . . ~gidt ~ TITLE: EMERHENCY C NTACT: TITLE: ?T?~.,(PHONE # BUS HOURS: ~/ ' AFTER BUS HRS: EMERHENC¥ CONTACT: TITLE: PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: AFTER BUS BBS: - 4A-1 - I TE/FAC ILI TY FORM DIAGRAM 'INORT~ H SCALE: ? BUSINESS NAME:j//~ ~/~/_~ ~-L~/~4/~FLOO~: / O5 / I DATE: / / FACILITY NA~ME: UNIT (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM /00 r i I I I I I 5.yop ~ I I i I I l(Inspector's Comments): -OFFICIAL USE ONLY- - SA -