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HomeMy WebLinkAboutBUSINESS PLAN (2) - -,~,- I .,> ,_ i ~ 1~ ~ r LUCKY 7 FOOD STORE #8 2601 S. CHESTER AVENUE ~~- ~~~ ~ ~~~ ~~/ ,~~~~' 1 SEP 1 g 200 m ~~ ~; .~" `~ ` r ~ r~ w ~ ~ ; ~, ~ ~- I~ ~ •~~ - ~©~~~~ °~ ~, o~ u~ Prevention Services UNIFIED PROGRAM INSPECTION CHECKLISTr H E R 5 F r D 900TruxtunAve., Suite 210 -- _. _ ..._.__.. _ _ _..._._ __ FIRE Bakersfield, CA 93301 ' 1; ARTM r Tel.: (661) 326-3979 . SECTION 1 Business Plan and Inventory Program Fax: (661) 872-2171 FACILITY NAME INSPE TION D E INSPECTION TIME C 9 Q~ ADDRESS PHON NO. NO OF EMPLOYEES f 8 :r ~ ~ ~ FACILITY CONTACT BUSINESS ID NUMBER 15-021- ~~ ~ ~ Section 1: Business Platt and lnventary Pragra~n ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance. OPERATION V=Violation COMMENTS _ / L U / ^ APPROPRIATE PERMIT ON HAND , , / L K ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE , , , / 19Y ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~~~. ^ VERIFICATION OF INVENTORY MATERIALS ~\~~~ `__ ~`~ ` ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~ ^ PROPER SEGREGATION OF MATERIAL ,~, LW ^ VERIFICATION OF MSDS AVAILABILITY ^ ^ VERIFICATION OF HAZ MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING Q~^ FIRE PROTECTION ,~ ~~ _ "~• ~ ~ ~/~ YVrQUI. ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES ~ NO K6F-6013 QUES S REGA IN THIS INSPECTION? PLEASE CALL US AT (667) 326-3979 Inspector (Please Print) Fire revention / 1s' In /Shift of Site/Station # mess/; White -Prevention Services Yellow -Station Copy ~ ~ Pink -Business Copy (Please FD 2155 (Rev. 09/05 - `-- .d r. INSPECTIONS B E R S F I L D BUSINESS PLAN & ~RrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: I~t1~C..lc1f~ Section 2: Underground Storage Tanks Program INSPECTION DATE: ~~~ ^ Routine ^ Combined ^ Joint Agency ^ Multi-Agency ^~Complaint ^ Re-Inspection Type of Tank S~tZ~~Lb ~(~ Number of Tanks _ Type of Monitoring ~'jQ Type of Piping Q(y (~'-' N ~[' OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current C Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ~ No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Pink -Business Copy }p , ,~ . BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 Responsible Party KBF-7335 ~ FD n 15V (R6V. ~9/(]rJ) ;, BAKERSFIELD FIRE DEPT ~''- Prevention Services -UNIFIED PROGRAM INSPECTION CHECKLIST =~' r~i~ 90o Truxtun Ave., Sulte 210 i ..,-„ .~ .~.,:..~ ...,,: ..,.: ~, ...,.,.. . ,..... , .R . , ::: ~, .....:. -...,:•. :.:_.::...,: ~RrM t Bakersfield. CA 93301 .SECTION 1: Business Plan and Inventory Program ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY AME NSPEC O DATE INSPECTION TIME ~ r, C / /~ ADDRESS - Y /J ~~~ HONE N '- O OF E OYEES ~ ~ ` ` ~ 3 t 4 Y FACILITY CONTACT USI ESS ID NUM9ER 15-021- ~I Section 1: Business Plan and Inventory Program ri~~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-I ECTION C V ~ C=Compliance OPERATION V=Violation COMMEN APPROPRIATE PERMIT ON HAND ^ BUSIYIQSS 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 /i // ,, ---- --- -- - / V~ -0 -- 2oOC U ^ VERIFICATION OF HAZ MAT TRAINING ^ PROC VERIFICATION OF ABATEMENT SUPPLIES AND URES EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^. FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: - __ INSPECTION? PLEASE CALL U8 AT (881) 328-3979 (Please Print) Fire Pr~ion / 1" In / ShiN of Site/Station q While -Prevention Services Yellow - 3tetion Copy Bus Slie/School Site es nsib a Party (Please Print) Pink - Business Copy FD2049 (Rev.02J05) ~~ ~~ ~ ~ M~ rj1 y 1 ~~ ~ • • ~~ ~k-E.::Rf~~ FACILITY NAME_C~ G~ CITY OF BAKERSFIELD PIKE DEPARTMENT OFFICE OF ENVIRONNIE:N'I'AI~ SERVICES UNIFIED PROGRAIVI INSPECTION CHF,CKLIST 1715 Chester Ave., 3'~`' Floor, Bakersfield, CA 93301 INSPECTION DATE ~ - t ~ ~ Section 2: tinderground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mulb-Agency Complaint ^ Re-inspection Type of Tank ~1.. C4) .~ ~ /~~ Number of Tanks Type of Monitoring _ Q.fi'~ Type of Piping OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes NO Section 3: Aboveground Storage Tanks Program TANK SIZE(S) _ Type of Tank AGGREGATE CAPACITI~' Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (661) 326-3979 white -Env. sues. ,,,,~-. Bustness Site Resp nsible Party Pinl< -Business Cory ~~~ i,-. ~~ <. UNIFIED- PROGRAM INSPECTION CHECKLIST ~' SECTION 1: Business Plan and Inventory Program BAHERSFIELD FIRE DEPT Prevention Services „ ~~~s 900 Trtixtun Ave., Suite 210 ~R>rlr Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 ~ FACILITY NAME / A / V / NSPECTION DATE INSP ECTION TIME Y ~ ~~ ~ -~ L ( _ ~ I /i ~ S~ ADDRESS HONE NO. O OF EMPLOYEES 7 ~3~ x'74 FACILITY CONTACT USINESS ID NUMB 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliances OPERATION V=Violation __ _ COMMENTS ^ APPROPRIATE PERMIT ON HAND ~. ^ Business 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 R CEDURES ^ EMERGENCY PROCEDURES ADEQUATE lQ' ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION .~ ^ SITE DIAGRAM ADEQUATE & ON HAND ` ANY HAZARDOUS WASTE ON SITE? ^ YE$ ~-~NO EXPLAIN: - _ _ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 /Nlr9A1 ~ Inspector (Please Print) ' Fire Prevention / 1" In / Shift of Site/Station 4 ~~~ ~t~ •~ite Re i e Party (Please Print) White -Prevention Services Yalfow - Station Copy Pink - Buainesa Copy FD2049 (Rw. 02M51 w .t .ate '.'a.LI) ~; ~T~i CITY OF BAKERSFIELD FIRE DEPARTMENT ro~ OFFICE OF ENVIRONR~IF.NTAL SERVICES . ~~` UNIFIED PROGRAM INSPECTION CHECKLIST ~F'' AR`~,~!~ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 FACILITY NAME `t~fL~u ~ INSPECTION DATE ~-~~'d~o Section 2: Underground Storage Tanks Program ^ Routine ombined ^ Joint Agency ^MuIti-Agency ^ Complaint ^ Re-inspection Type o Tank X~?~u~,f~. cv~~t Number of Tanks ~ Type of Monitoring ~c9U71yu~:s ~IV_ Type of Piping /~iet~l~- t-y.~lL OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current % ~ Failure to correct prior UST violations Has there been an unauthorized release? Yes _~/~i .. No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks v~",Cy~ OPERATION Y N COMMENTS SPCC available SPCC on the with OF,S Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: ~~ ill ~,42Z,~- Office of Environmencal Services (661) 326-3979 ~'hitc - inv. Svcs. Pink -Business Cody `" Bu, iness Site Resp nsible Party '~~F~ i 'G~'~~ !7HL !v'_! Nijr r, a, r, Ij~~ !!iH'ti:: !„I~~L J 1 '~!.~ 'NHL i i _ r~~ '!• _. _.«_r_ ~ ~ _~~ i • 1 _'a~~ --? L `7 ~' is ~ ~~ ? I t r.,'.~ - . h. ~i -_ _, :~i- `I f I , - 9~~ _ ..~`1' ~=1F~1r~ ,.~. ~_`~a. _ ,NHL X11 _;y !fir _: F~_~F.. ^nL + LUCKY 7 FOODSTORE 8 _________________________________ SiteID: 015-021-000611 + Manager Location: 2601 S CHESTER AVE City BAKERSFIELD BusPhone: (661) 836-1794 Map 124 CommHaz Moderate Grid: 07C FacUnits: 1 AOV: CommCode: BFD STA 05 SIC Code:5541 EPA Numb: DunnBrad:77-019--0797 Emergency.Contact / Title Emergency Contact / Title SALEH ALNAJAR / OWNER NAZEM ALNAJAR /.MANAGER Business Phone: (661) 835-1794x Business Phone: (661) 836-1794x 2 4 -Hour Phone ( 6 61') 8~-8~r`tr8 x 2 4 -Hour Phone ( 6 61) .-.8-3-~'~'~`/'>~X Pager Phone ( ) 3~~ ~ ~~~,tx Pager Phone ( ) ~(~; y -~~,~~x - - - - - Hazmat Hazards: Fire 'ImmHlth DelHlth,l Contact Phone: (661) 836-1794x MailAddr: 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Owner SALEH,ALNAJAR Phone: (661) 836-8678x Address 2601 S CHESTER-AVE State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ENro ~~R ~ 8 ZD06 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~ ~~ ign re Date -1- 03/30/2006 e LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 Manager NAZEM ALNAJAR Location: 2601 S CHESTER AVE City BAKERSFIELD BusPhone: (661) 836-1794 Map 124 CommHaz Moderate Grid: 07C FacUnits: 1 AOV: CommCode: BFD STA 05 EPA Numb: SIC Code:5541 DunnBrad:77-019-0797 Emergency Contact / Title Emergency Contact / Title SALEH ALNAJAR / OWNER NAZEM ALNAJAR / MANAGER Business Phone: (661) 836-1794x Business Phone: (661) 836-1794x 24-Hour Phone (661) 364-9864x 24-Hour Phone (661) 364-9864x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact NAZEM ALNAJAR Phone: (661) 836-1794x MailAddr: 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Owner SALEH ALNAJAR Phone: (661) 836-8678x Address 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ENT, J ~~ ~e i3a^2d on my inquire of those individuals respcnsii,le fE~r ob°~ning the information, I certify under penalty of ia~; that I have personally examined and am familiar with the information su~amitted and heiieve the information is true, accurate, and complete. ~? Signa~ - Date -1- 07/12/2007 C ~ F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: LUCKY 7 FOODSTORE 8 Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper BRUCE HINSLEY ICC Nbr: 1064437-UC PROPERTY OWNER INFORMATION Name NAZEM ALNAJAR Phone: (661) 836-1794x Address: City Type INDIVIDUAL Name NAZEM ALNAJAR Address: City Type BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name: State UST # State: Zip: TANK OWNER INFORMATION Phone: (661) 836-1794x State: Zip: Phone: Ttl: 1998 Upg Cert#: - x -2- 07/12/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED PLUS F DH L 10000.00 GAL Mod PREMIUM UNLEADED F IH DH L 10000.00 GAL Mod REGULAR UNLEADED F IH DH L 6000.00 GAL Mod -3- 07/12/2007 -4- 07/12/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED PLUS Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 Liquid TMixtur~ Ambient~E ~ A~PeRATURE ~EROGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GAL 8000.00 GAL tiAGAttLV V ~ ~:Vl~lrvly ~lv 1 %Wt. RS CAS# Gasoline No 8006619 tlE~GHiCL 1-~J ~~551~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixture ~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 8000.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 ril-~G1-~tCL H~J.7r,~~1~1~1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 07/12/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 6000.00 GAL 5000.00 GAL nr~c~ruu~vua ~.vrirvlvr,lvlJ owt. Rs cAS# 100.00 Gasoline No 8006619 i7t~GtiRL H. 7 JP~A J1"1P~lY l.> TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 07/12/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 11/21/2000 ~ CALL 911 TO NOTIFY EMERGANCY SERVICES. Employee Notif./Evacuation 10/21/1992 ALL WORKERS ON SITE SHALL BE INFORMED IN THE EVENT OF A HAZARDOUS MATERIALS SPILL. Public Notif./Evacuation 10/21/1992 THE PUBLIC SHALL BE NOTIFIED TO LEAVE AND STAY AWAY FROM THE PREMISES IN THE EVENT OF A SPILL. Emergency Medical Plan 11/21/2000 CALL 911. -7- 07/12/2007 i F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/21/1992 ~ ALL EQUIPMENT IS UP TO SPILL PREVENTION STANDARDS. Release Containment 10/21/1992 CAT LITTER SHALL BE USED TO CONTAIN SPILLS. Clean Up 04/28/2006 THE APPROPRIATE CLEAN-UP COMPANY SHALL BE CALLED. V1.11CL iCC.7"VULUC HC:l.1VdL1Vi1 -8- 07/12/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~~C:1c11 rid'Gd.GU~ Utility Shut-Offs 11/21/2000 A) GAS - W REAR WALL OF BLDG B) ELECTRICAL - W INSIDE WALL OF BLDG C) WATER - W REAR WALL OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - S CHESTER AVE. 04/28/2006 Building Occupancy Level 03/30/2006 NO EMPLOYEES -9- 07/12/2007 ,_ . F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/02/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE ARE TRAINED TO: PROPERLY USE FIRE EXTINGUISHER; TO SHUT OFF EMERGENCY SWITCHES; NOTIFY THE PUBLIC TO LEAVE THE PREMISES; TO CALL EMERGENCY SERVICES; TO DIKE SMALL SPILLS WITH CAT LITTER; TO PROTECT OURSELVES FROM INJURY; AND TO AVOID CONTACT AND INHALATION AND STAY UPWIND. rays a nciu ivi. r u~.utc vac Held for Future Use -10- 07/12/2007 T: ~ / LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 Manager NAZEM ALNAJAR Location: 2601 S CHESTER AVE City BAKERSFIELD BusPhone: (661) 836-1794 Map 124 CommHaz Moderate Grid: 07C FacUnits: 1 AOV: CommCode: BFD STA 05 EPA Numb: SIC Code:5541 DunnBrad:77-019-0797 Emergency Contact / Title Emergency Contact / Title SALEH ALNAJAR / OWNER NAZEM ALNAJAR / MANAGER Business Phone: (661) 836-1794x Business Phone: (661) 836-1794x 24-Hour Phone (661) 364-9864x 24-Hour Phone (661) 364-9864x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact NAZEM ALNAJAR Phone: (661) 836-1794x MailAddr: 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Owner SALEH ALNAJAR Phone: (661) 836-8678x Address 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT EN1'D o~T l l 20 PROG U - UST ' . -;.~ir:~ i.li ~ ri"':,~~Jii, } . .'. ~' v rte`. ~~; . . ;.:^r n; t~-~ta:;' pcn~!:y n, I<~rl trial I "=,vc ;a:,rc,;`!'ii~/ examinee anu am f.~.rr.iliGr with the intcrmsticn SUJP~1i'ieG vrd bclie•;~ the in°crmation is tru:., accurate, anc complete. Signature Date -1- 10/08/2007 ,, s F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION ~ Business Name: LUCKY 7 FOODSTORE 8 Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper BRUCE HINSLEY ICC Nbr: 1064437-UC PROPERTY OWNER INFORMATION Name NAZEM ALNAJAR Phone: (661) 836-1794x Address: City State: Zip: Type INDIVIDUAL Name NAZEM ALNAJAR Address: City Type BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name: State UST # TANK OWNER INFORMATION Phone: (661) 836-1794x State: Zip: Phone: ( ) - Ttl: 1998 Upg Cert#: x -2- 10/08/2007 F LUCKY 7 FOODSTORE 8 ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-000611 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED PLUS F DH L 10000.00 GAL Mod PREMIUM UNLEADED F IH DH L 10000.00 GAL Mod REGULAR UNLEADED F IH DH L 6000.00 GAL Mod -3- 10/08/2007 -4- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED PLUS Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 Liquid TMixtur~ Ambient~E ~ AmbientT~E ~ER GROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 8000.00 GAL t1AG1~KLVU~ w1~1rV1v~1v1J %Wt. RS CAS# Gasoline No 8006619 tiHGAKL L-1551"~~Jl~ll"~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixtur~mbient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 8000.00 GAL riliGKKLVU.7 1.,V1~lYV1VL"1V 15 %Wt. RS CAS# 100.00 Gasoline No 8006619 riHGEiKL L-1~.71;~~1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~ Ambient ~ Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 6000.00 GAL 5000.00 GAL tit~Gi-1ttLVU~ w1~1r~1vL'1V~1~ oWt. RS CAS# 100.00 Gasoline No 8006619 nt~~tucL ti~ ~~~ai~i~ly l a TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 11/21/2000 ~ CALL 911 TO NOTIFY EMERGANCY SERVICES. Employee Notif./Evacuation 10/21/1992 ALL WORKERS ON SITE SHALL BE INFORMED IN THE EVENT OF A HAZARDOUS MATERIALS SPILL. Public Notif./Evacuation 10/21/1992 THE PUBLIC SHALL BE NOTIFIED TO LEAVE AND STAY AWAY FROM THE PREMISES IN THE EVENT OF A SPILL. Emergency Medical Plan 11/21/2000 CALL 911. -7- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/21/1992 ~ ALL EQUIPMENT IS UP TO SPILL PREVENTION STANDARDS. Release Containment 07/26/2007 CAT LITTER WILL BE USED TO CONTAIN SPILLS. Clean Up THE APPROPRIATE CLEAN-UP COMPANY SHALL BE CALLED. 04/28/2006 V1.11C1 ACw7VU1 ~:C til.: l.1VQl.1 V11 -8- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~peciai nazarus Utility Shut-Offs GAS - W REAR WALL OF BLDG ELECTRICAL - W INSIDE WALL OF BLDG WATER - W REAR WALL OF BLDG 07/26/2007 Fire Protec./Avail. Water 04/28/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - S CHESTER AVE. Building Occupancy Level 03/30/2006 NO EMPLOYEES -9- 10/08/2007 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/02/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE ARE TRAINED TO: PROPERLY USE FIRE EXTINGUISHER; TO SHUT OFF EMERGENCY SWITCHES; NOTIFY THE PUBLIC TO LEAVE THE PREMISES; TO CALL EMERGENCY SERVICES; TO DIKE SMALL SPILLS WITH CAT LITTER; TO PROTECT OURSELVES FROM INJURY; AND TO AVOID CONTACT AND INHALATION AND STAY UPWIND. rayc c. L1C 1C.1 1VL PUI.ULC USA LIC 1l.L 1VI t'UI..UIC USC'' -10- 10/08/2007 ~~~ ~ ~J. ,/ LUCKY 7 FOODSTORE 8 Manager :. _.~~~ ~~- ~' LN`A-~,~'L~- Location: 260 S CHESTER AVE City BAKERSFIELD CommCode: BFD STA 05 EPA Numb: SiteID: 015-021-000611 BusPhone: (661) 836-1794 Map 124 CommHaz Moderate Grid: 07C FacUnits: 1 AOV: SIC Code:5541 DunnBrad:77-019-0797 Emergency Contact / Title Emergency Contact / Title SALEH ALNAJAR / OWNER NAZEM ALNAJAR / MANAGER Business Phone: (661) 836-1794x Business Phone: (661) 836-1794x 24-Hour Phone (661) 364-9864x 24-Hour Phone (661) 364-9864x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact N.~~~l ~~N~r~'~~ Phone: {661) 836-1794x MailAddr: 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Owner SALEH ALNAJAR Phone: (661) 836-8678x Address 2601 S CHESTER AVE State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST EN~'°D ~ ~. ~ ~ ~ 2QO7 Oased on my inquiry of those individuais resp,:;nsible for obtaining the information, 9 certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- _ 02/02/2007 ~j; F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: LUCKY 7 FOODSTORE 8 Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Open BRUCE HINSLEY ICC Nbr: 1064437-UC PROPERTY OWNER INFORMATION Name NAZEM ALNAJAR Phone: (661) 836-1794x Address: City State: Zip: Type INDIVIDUAL Name NAZEM ALNAJAR Address: City Type BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name: State UST ## TANK OWNER INFORMATION Phone State: Zip: (661) 836-1794x Phone: ( ) - Ttl: 1998 Upg Cert#: x -2- 02/02/2007 .r F LUCKY 7 FOODSTORE 8 ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-000611 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED PLUS F DH L 10000.00 GAL Mod PREMIUM UNLEADED F IH DH L 10000.00 GAL Mod REGULAR UNLEADED F IH DH L 6000.00 GAL Mod -3- 02/02/2007 -4- 02/02/2007 ~ 1 F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED PLUS Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 8000.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# Gasoline No 8006619 ruyc,tucL ra ar,a~rir,lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# ' 8006-61-9 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL ~ 8000.00 GAL raraurucivva ~.v1.1rv1vrly t S %Wt• RS CAS# 100.00 Gasoline No 8006619 I1tiG1'iRL L•'1 J .~L' Jw71~1L" 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 02/02/2007 F LUCKY 7 FOODSTORE 8 ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME REGULAR UNLEADED Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixtur~Ambient SiteID: 015-021-000611 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 6000.00 GAL 5000.00 GAL t1AGAttLVUS ~~inr~lv~ivl5 ~Wt. RS CAS# 100.00 Gasoline No 8006619 riA;GE~iKL AS~L'~551~it~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 02/02/2007 1 ~ F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 11/21/2000 ~ CALL 911 TO NOTIFY EMERGANCY SERVICES. Employee Notif./Evacuation 10/21/1992 ALL WORKERS ON SITE SHALL BE INFORMED IN THE EVENT OF A HAZARDOUS MATERIALS SPILL. Public Notif./Evacuation 10/21/1992 THE PUBLIC SHALL BE NOTIFIED TO LEAVE AND STAY AWAY FROM THE PREMISES. IN THE EVENT OF A SPILL. Emergency Medical Plan 11/21/2000 CALL 911. -7- 02/02/2007 F LUCKY 7 FOODSTORE 8 SiteID:,015-021-000611 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/21/1992 ~ ALL EQUIPMENT IS UP TO SPILL PREVENTION STANDARDS. Release Containment 10/21/1992 CAT LITTER SHALL BE USED TO CONTAIN SPILLS. Clean Up 04/28/2006 THE APPROPRIATE CLEAN-UP COMPANY SHALL BE CALLED. v~.i1CL 1SCAUU1l:C tiC:l.lVdl.1U11 -8- 02/02/2007 ~ ~~ F LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ o~a~iai na~a.LU~ Utility Shut-Offs 11/21/2000 A) GAS - W REAR WALL ~OF BLDG B) ELECTRICAL - W INSIDE WALL OF BLDG C) WATER - W REAR WALL OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 04/28/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - S CHESTER AVE. Building Occupancy Level 03/30/2006 NO EMPLOYEES -9- 02/02/2007 i1 r~• P LUCKY 7 FOODSTORE 8 SiteID: 015-021-000611 ~ Fast Format ~ ~ Training Overall~Site ~ ~ Employee Training 02/02/2`007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: WE ARE TRAINED~TO: PROPERLY USE FIRE EXTINGUISHER; TO SHUT OFF EMERGENCY SWITCHES; NOTIFY THE PUBLIC TO LEAVE TH PREMISES; TO CALL EMERGENCY SERVICES; TO DIKE SMALL SPILLS WITH CAT LITTER; TO PROTECT OURSELVES FROM INJURY; AND TO AVOID CONTACT AND INHALATION AND STAY UPWIND. rc~yC G i1C1U LVL t'UI.ULC Vw7-C L1CLU LVL t'UI.ULC VSC -10- 02/02/2007