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HomeMy WebLinkAboutBUSINESS PLAN 5/21/2007ii V II ~~ ~~ ~ MILLS CHIROPRACTIC 0 ~ ~~ 331 S. H STREET_ __ _~~ -- - t ~~ ~ - - - - - -- ------- - --- ~~ UNIFIED PROGRAM INSPECTION CHECKLLST SECTION 1: Business Plan and Inventory Program ~- Prevention Services R e x s F i p 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 v aerM .Tel.: (661)' 326-3979 Fax: (661)- 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ~1~.-~~-5 G1~ ro~~P~gc~Fw ~'JZ o ADDRESS ~t 3 3 I S ~~(-~ s-~ ~JD PHONE NO.. Sys ~~ NO OF EMPLOYEES _s` FACILITY CONTACT , ~ BUSINESS ID NUMBER 15-021- ~~ A ~_~ d~ ~ is ~ Section 1:' Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ' C V (C=Compliarice~ OPERATION V=Violation COMMENTS APPROPRIATE PERMIT ON HAND Y„ ~t ~~/ ^ ~"0 S BUSIrt2SS PLAN CONTACT INFORMATION ACCURATE ~~ ~ ~~ ~ S~ ~„~--~ 1.d 'j 8 ` C~ t ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~ 3 ~ 2007 ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING Steak 1cru~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES -.,~ / ~~ ~ l ((~~ ~~ J ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED •~7 HOUSEKEEPING 't` aa..+~..crvs.. ~M~-@nS1:%-- C vr~ fn Yfq #rS - ^ FIRE PROTECTION ~.~ ~ l ~+'~'~ ¢ ~ Cp~~°`j I~~c.~!'t~ ~ ~5~~' .,,~J ^ SITE DIAGRAM ADEQUATE & ON HAND s .-~ I ANY HAZARDOUS WASTE ON SI E? ~~~] YES ^ NO EXPLAIN: ~~ AS~C ~?~ro.- QUESTIONS REGgqARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Business Site /Responsible Party (Please Prin ) White -Prevention Services Yellow -Station Copy ~ Pink -Business Copy _ ~ FD 2155 (Rev. 09/05 o+~4y`. '~~°~ CITE' ®F BAKERSFIELD FIRE DEPARTMENT c '~~ c~- FACILITY NAME I"+~t LI.S GH 12optw ~-Tt c INSPECTION DATE ~/ ~ 1 ~ ©~ Section 4: Hazardous Waste Generator Program EPA ID # ~,~~ h- 0 .fi ^ Routine ~ Combined ^ Joint Agency ^MultI-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~k t v~,. ~ ~" Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line JJ ~L Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste //l/~. Proper management of lead acid batteries including labels /~' Proper management of used oil filters /~ /a, Transports hazardous waste with completed manifest Sends manifest copies to DTSC K - ~ ~ s ~~ c ~.~- Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years /`V ~ Determines if waste is restricted from land disposal ~,=~,ompuanc/c v = v iotanon Inspector: (.~ ~'~~~ ^-~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. ~ OFFICE OF ENVIRONMENTAL SERVICES • p0 UNIFIED PROGRAM INSPECTION CHECKLIST ~gti 1715 Chester Ave., 3`d Floor, Bakersfield, CA 93301 Pink -Business Copy Business Site esponsible Party . - SELF-CERTlFlCATION CHECKI-1ST ~1%NW'sVW.:..;Y2v:.fY;1r%~h1t.TM:ISAMranmY'A1tKY.~':Mw.w+n~llVFrf..:.., ., .y.}..J w~.:': .:.., ..~'...n ~/: 31'.~T :i:.:ry r. Fire Prevention ., B LrIR.E DEPT. Pr~eat$ou Services ~ 900 Truxtun Ave., Suite 210 ~ifR,R Bakersfield, CA 93301 AiRlr Tel.: (661) 32b-39'79 l~aa;;: (661} $52-2171 FACILITY NAIY~: `,~ , ~ ~ ~ ~ . l F_t.F~Et~FICATtON DATE. 3 ~ D7 ADDRESS: ~o~plete A e city, erro 2~v Code) ,~ ~ HONE Nl1MBER: $35 70 37 FACILITY CANT Cr: ~ 11.5 A% NUMBER: a~s~ /~~ ~ t301110T~DtSSC,+t4#tD -FAILURE TQ t'tETURN iiVlL,.I~, RESULT IN FIRS DEpARtM~NT 1NSt~ECT~t+I xI~TSTRVCI70NS: l'lesse verify and cbeclc each item as appropriate. include comments on each tine or at the bottom as nccessmy. en corrrplatnd, mlalae a second copy for your records and mail the original to the address about. Faiturc to radtuTt wilt result i» inspection. Y N OPERATION COMMENTS ^ Spent fluorescent tubes saved in a stritable container and recyding* ( You retY on an outside ayeexy 1br the re~yding, Please intlkats 111e Dame, address: and Bone nurnger of the agency that mmrn~ your tubes.) me: ha No= ttdreas: ~ O Waste batteries saved in Suitable container for ratycling" ^ Discarded eledrortic devices saved for necyding` ^ Dise~tdt3d items containing Mercury saved for t~ecyding' ~ ^ Discarded non-empty aerosol spray cans slatted for recyding* ^ Current annually serviced `ABC Type" fire extirtguistxrr every i5 feet of travel S~ ^ Extension cords not used in place of what should be permanent wiring 7~ © All exits indicated by etdt signs, net more than 100 fa9t apart, if oocupan# load is 1t~0 or mote ~, ^ Minimtmr of 30 irxites of dearance in front of electrical panels ~, ^ 'Cover pltates lnstgNed on all electrical outlets, switches, and junction boxes {no eacposed wrong) jib ^ Flammable and Combustible material stored property and not adjacent to a source of ignition {Check hot water heater 8nd fumaoe area) DO you use or Store arty hazardous materials on site? ~ -~.o .a r o c.~. s S i v+~ ,a ~ ~ S ^ Does your building have a monitored fife alarm system? ^ does your building have 8 fire suppression (sprinkler) system? 'Recycle et the Kern County t3peclal VY85tp FaGillty, 4951 Standard Street, ~ak@rsfletd, CA 93309. Phone: ~(8~81y)~88'2-8922 COMMENTS: ..... ~ ~ ~ ,_. ~~~~~ ~ _ ~~ ~-5--~!P~ CJiHkr~ T ~----.~14r~_._. ~.~S,L~L1.__. R QUESTIONS RK(aAItDINCi THIS CHECKLIST? P~Ea9e GALL US AT (fifity x26.3879 ~ ~ ~ ~J t3ltsrrtess 3Me 1 Ftesponsl PeRy (Please Print) FD 2755b (RBY. 09!08) ~o 0 D ' (HMMP) H~iZAR~US MATERIAL MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM) _ _ APPLICATION BUSINESS OWNER/OPERATOiZ IDENTIFICATION FORM (HAZARDOUS MATERIAL FACILITY INFORMATION BAKERSFIELD FIRE DEPT. " Prevention Services ' 1600 Truxtun Avenue, Suite 401 s s x s p I n Bakersfield, CA 93301 PI~6 OFFICE: 661-326-3979 - A~ r FAX: 661-852-2171 Page i of 2 I. "FACILITY IDENTIFICATION FACILITY ID N0. 1 YEAR BEGINNING 100 YEAR ENDING 101 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 BUSINESS PHONE 102 SITE ADDRESS 103 3 i Sp, , cm ~3 k~.rS ~'~ 2 c~ loa CA ZIP °~ 33© ~~ los DUNN & BRADSTREET NO. 106 SIC CODE 30J 9' 5- 5 - 22 ~3 COUNTY ~ 4._ ~ ~ - 108 ~~~ OPERATOR NAME ~ 109 OPERATOR PHONE 110 II. OWNER INFORMATION OWNER NAME ~ L.,. YV~~~ ~ 111 S OWNER PHONE _ 35 _ 0 3. 112 OWNER MAILING ADDRESS 113 sa. s I m C-Q V~~~ 114 STA~0. 115 21P ~ 330 - 116 - III. ENVIRONMENTAL CONTACT .CONTACT NAME _ _ _ _ 117 CONTACT PHONE ~ 3~~ _ 11B r L. ~ ^ . C 35- 03 CONTACT MAILING ADDRESS - ' ~ Q , 1 \ ~ ~ ' ~`\\_ 119 CITY 120 STATE 121 ZIP 122 IV. ;EMERGENCY CONTACTS PRIMARY SECONDARY NAME ~! v ~ 123 NAME 128 TntE ~ 12a TITLE 129 C-7 ~ Y ,~ a BUSINESS PHONE S P 125 gU NESS PHONE 130 24-HOUR PHONE 126 3~~_ 55 ~ 24-HOUR PHONE ~ tobl- 3~. --035-1 131 CELL PHONE 127 ~ CELL PHONE - 132 \ ~ -~ L t s 8 b 6 - ~ ~ S - 2 133 V. CERTIFICATION ertification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personal) xamined and am familiar with the Information submitted in this inventory and believe the information is true, accurate, and complete. SIGNATU DOCUM NT S NER 136 DATE 134 NAME OF DOCUMENT PREPARER ~• 135 :~,~ o v NAME OF OWNER/OPERAT•OR (SIGN & ) 137 TifLE OF DOCUMENT SIGNE 138 ~ L ~ 1N~', ~ ~ Q HAZARDOUS MATERIAL FACILITY INFORMATION (HMMP) BUSINESS OWNER/OPERATOR IDENTIFICATION i Please submit the Business Activities page;' the Hazardous Material Facility Information (HMMP) Business Owner/ \ Operator Identification Form, and Hazardous Material Inventory Chemical Description Form for all hazardous material inventory submissions. For the inventory to be considered, please complete this page; it must be signed by the appropriate individual. NOTE: The numbering of the instructions follows the data element numbers that are on the Business Owner/Operator Form page. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, Business Section of the Unified Program Data Dictionary. Please number all pages of your submittal. This helps our CUPA or AA identify whether the submittal is complete and if any pages are separated. 1 FACILITY I.D. NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3 BUSINESS NAME -Enter the full legal name of the business. 100 BEGINNING DATE -Enter the beginning year and date of the report: 101 ENDING DATE -Enter the ending year and date of the report. 102 BUSINESS PHONE -Enter the phone number, area code first, and any extension. 103 BUSINESS SITE ADDRESS -Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104 CITY -Enter the city or unincorporated area in which business site is located. -. 105 ZIP CODE -Enter the zip code of business site. The extra 4-digit zip may also be added. 106 DUNN & BRADSTREET NUMBER -Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be obtained by calling 610-882-7748 or by Internet. - -- •• - - ` 107 SIC CODE - Enter.the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more than 4 digits, report only the first four. 108 COUNTY -Enter the county in which the business site is located. 109 BUSINESS OPERATOR NAME -Enter the name of the business operator. - ,.-• -. 110 BUSINESS OPERATOR PHONE -Enter business operator phone number, area code first, and any extension.• 111 OWNER NAME -Enter name of business owner.' 112 . OWNER PHONE -Enter the business owner'phone number, area code first, and a.ny extension. 113 OWNER MAILING ADDRESS -Enter the owner mailing address. _ 114 OWNER CITY -Enter the city for owner mailing address. 115 OWNER STATE -Enter the 2 character state abbreviation for the owner•mailing address. ` • 116 OWNER ZIP CODE -Enter the zip code for the owner address; extra 4-digit zip may also be added. 117 ENVIRONMENTAL CONTACT NAME -Enter the name of the person who receives all environmental correspondence and will respond to enforcement activity. 118 CONTACT PHONE =Enter the phone number at which the environmental contact can be contacted, area code ;first, and "any extension. ~ ' _ • 119 CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact correspondence should be sent. 120 CITY -Enter the name of the city for the environmental contact mailing address. 121 STATE -Enter the 2 character state abbreviation for the environmental contact mailing address. _ 122 ZIP CODE -Enter the zip code of the environmental contact mailing address; extra 4-digit zip may also be added. ~ - 123 PRIMARY EMERGENCY CONTACT NAME -Enter the name of a representative that can be contacted iri case of an emergency, involving hazardous material, at the business site. The contact shall have FULL facility access, site familiarity, and authority to. make decisions for the business regarding incident mitigation. '~ 124 TITLE -Enter the title of the primary emergency contact. 125 BUSINESS PHONE -Enter the business number for the primary emergency contact, area code first, and any,extensions.r x-- 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. If it is not the contact home phone number, then the service answering the phone must be able to immediately contact the individual. 127 CELL NUMBER -Enter the cell number for the primary emergency contact. 128 SECONDARY EMERGENCY CONTACT NAME - Enter•the name of a secondary representative that can be contacted in.the,eyent that the primary emergency contact is not available. -The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 129 TITLE -Enter the title of the secondary emergency contact. ~ 130 BUSINESS PHONE -Enter the business telephone number for the secondary emergency contact, area code first, and any extension. 131 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24-hour phone number must be one which is answered 24-hours a day. If it is not the contact home phone number, then the service answering the phone must be able to immediately contact the individual., 132 CELL NUMBER -Enter the cell number for the secondary emergency contact. ~ - ' 133 ADDITIONAL LOCALLY-COLLECTED INFORMATION -This space may be used for CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs. Contact your local agency for guidance. 134 DATE -Enter the date that the document was signed. 135 NAME OF DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. 136 STGNATURE OF DOCUMENT SIGNER (FULL SIGNATURE) -Enter the full signature of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer inquiry of those individuals responsible for obtaining the information, all the information submitted is true, accurate, and complete. 137 SIGNATURE OF OWNER/OPERATOR/DESIGNATED REPRESENTATIVE -The Business Owner/Operator, or officially-designated representative of the Owner/Operator, shall sign and print in the space provided. This signature•certifies that the signer is familiar with the signer belief that the submitted information is true, accurate, and complete. ~ ~ - - - 138 TITLE OF DOCUMENT STGNER -Enter the title of the person signing the page. _ Page 2 of 2 FD2142 (Rev. 03/07) _ \ -_ .. ~ rl .... ' (HMMP) ~ ~ BAKERSFIELD FIRE DEPT. HAZARDAUS MATERIAL MANAGEMENT PLAN ~ Prevention Services ~ ' ` ~ " ~ '` ~- 1600 Truxtun Avenue, Suite 401 APPLICATION H B R~ P I n .Bakersfield, CA 93301 FOR SECTION DISCOVERY & NOTIFICATION . , pIR~ OFFICE: b61-326-3979 (FORMS) ARIA/ i1'~' ~ FAX: 661-852-2171 ' _ .. 1 Page 1 of 2 ~ - . INSTRUCTIONS - - .. ~ r _ ._ . .. 1. To avoid further action, return this form within 30 days of receipt. 2. Typejprint answers in ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. • SECTION I: FACILITY IDENTIFICATION .. BUSINESS NAME (FACILITY NAME or DBA) 11 1 .- , _ _ _ ~t \ l 1, ~ C~~ V' Y' OTC ~ L ~ ~ ~ 1!~ _ ADDRESS (for local use only) " ~3 ~ 4-~. ~ ~ ~~s ~ ~~ C 3 0 FACILrfY ID NO. I SECTION II:1: i?ISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: ,~'~ - C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: 1 --~ -~_ - - -- ---- SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: FD2169 (Rev. 03/07) Page 2 of 2=-~ - - - - ,. _ -, SECTI,ON,II.2:. RELEASE RESPONSE PLAN (CONY) i` __ _ - UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) . i - , ~C1(y,\ ~d1 In C Jl NATURAL PROPANE: i1~ Q-S ~ ~1^O ~ d~ (tJa-5'C' ELECTRICAL: ~ O ~ ~ y ~ 1/''S ~cL Y WATER: ~ a ~ C.~° ~` ' SPECIAL: PRIVATE FIRE PROTECTION/WATERAVAILABILlTY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): to ~ ~~ ~ ~ ~ ~ b~ i ~d 1 ~~ n h -1~.~ ~ so ~-~~ ~6YY~Q-V (~~ ~O. R qY~ ~~--Y'VCLCC~ ~0.`~Q_ -- - _ - _ _ SECTION III: TRAIN°ING - - - - -- NUMBER OF EMPLOYEES: c'~ - G4-- - - - __ - MATERL4L SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTI~FICATI.ON Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that~I have personal) examined and ain familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER~OPERATOR OR~DESIGNATED REPRESENTATIVE DATE an ~ ~\ a' o AME OF SIGNE (print) a78 TITLE OF SIG R 479 ~~ ~ i-..~ ~°~ s o e , ~-~~~v FD2169 (Rev. 03/07) K. (HMMP) HAZARDOUS MATERIAL MANAGEMENT PLAN~'~~ UNIFIED PROGRAM CONSOLIDATED FORMS -. ~. s B S R S A I D FIRE CHEMICAL DESCRIPTION .FORM r HAZARDOUS MATERIAL INVENTORY Q NEW ^ ADD ^ DELETE ^ REVISE zoo I. FACILITY INFORMATION BAKERSFIELD FIRE DEPT. Prevention Services ' 1600 Truxtun Avenue, Suite 401 Bakersfield, CA 93301 OFFICE: 661-326-3979 ' FAX: 661-852-2171 Page 1 of 2 !toe form n~r_ material eer buildino. 4r areal _ BUSINESS NAME (FACILITY NAME or DBA) 3 CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 ' CONFIDENTIAL (EPCRA) ^ Yes ^ No FACILrrY ID NO. ~ 1 MAP No. (optional) _ V 203- GRID N0. (optional) 204 ~ II. CHEMICAL INFORMATION, CHEMICAL NAME ~ - _ - -- - - - 205 206 - TRADE SECRET ^ Yes ^ No If subject to EPCRA, refer to instructions COMMON NAME 207 - EHS* ^ Yes ^ No e ~~ 208 CAS NO. 209 *If EHS is yes, all amounts below must be In pounds. FIRE CODE HAZARD CLASSES (complete if requested by local fire chief) z1o TYPE ~ 211 RADIOACTIVE: ^ Yes~No 212 CURIES ~ 213 ^ PURE ^ MIXTURE ^ WASTE LARGEST CONTAINER 215 PHYSICAL STATE ^ SOLID ~ LIQUID ^ GAS 214 S' ~~ 216 FED HAZARD CATEGORIES ^ FIRE ^ REACTIVE ^ PRESSURE RELEASE ^ ACUTE HEALTH ^ CHRONIC HEALTH (Check all that apply) ~ ~ . ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE-. 220 AMOUNT DAILY AMOUNT DAILY AMOUNT CODE 221 DAYS ON SITE 222 ^ UNITS` ^ GAL ^ CU FT ^ LBS ^ TONS ~If EHS, amount must be in lbs. STORAGE CONTAINER 223 ^ ABOVEGROUND TANK ^ CAN ^ BOX ^ TANK WAGON . ^ UNDERGROUND TANK ^ CARBOY ^ CYLINDER ^ _ RAIL CAR ^ TANK INSIDE BUILDING ^ SILO ^ GLASS BOTTLE ^ OTHER ^ STEEL DRUM ^ FIBER DRUM ~I PLASTIC BOTTLE ^ TOTE BIN ^ PLASTIC/NONMETALLIC DRUM ^ BAG 224 STORAGE PRESSURE ^ AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT ' 225 STORAGE TEMPERATURE 0 AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT ^ CRYOGENIC %WT HAZARDOUS COMPONE NT EHS CAS # 1 226 227 ^ Yes ^ NO 228 ~ 229 2 230 231 ^ YES ^ NO 232 233 3 234 235 ^ Yes ^ NO 236 237 4 238 239 ^ Yes ^ No 240 241 S 242 ~ - ~ ~ 243 ^ YES ^ No 244 - 2a5 III.' SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ ~ SIGNATURE I~ . . ~_ _ n ~ . ., _ ~ / ~ /J DATE 246 CALIFORNIA WASTE CODES Code Descri tp ion Inorganics 111 Acid solution 2 < pH < 7 with metals (antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, silver, thallium, vanadium, and zinc) 112 Acid solution without metals 113 Unspecified acid solution 121 Alkaline solution pH >12.5 with metals (see 111) 122 Alkaline solution without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12.5) containing reactive Anions. (azide, bromate, chlorate, cyanide, fluoride, hypochlorite, nitrite, perchlorate and sulfide anions) 132 Aqueous solution with metals (see ill) 133 Aqueous solution with total organic residues 100% or more 134 Aqueous solution with total organic residues < 10% 135 Unspecified aqueous solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 161 FCC Waste 162 Other spent catalyst 171 Metal sludge (see 111) 172 Metal dust and machining waste (see 111) 181 Other inorganic solid waste ~, Code Description ~ '' Organics (cont) 261 PCB and material containing PCB 271 Organic monomer waste (includes unreacted resins) 272 Polymeric resin waste 281 Adhesives 291 Latex waste 311 Pharmaceutical waste 321 Sewage sludge 322 Biological waste other than sewage sludge 331. Off-spec, aged or surplus organics 341 Organic liquids (non-solvents) with halogens 343 Unspecified organic liquid mixture 351 Organic solids with halogens Sludge 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 ; , Sulfur sludge ,J 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 Tetraethyl lead sludge 491 Unspecified sludge waste Organics . 211 Halogenated solvents (methylene chloride, chloroform, . TCE, TCA) 212 Oxygenated solvents (acetone, butanol, MEK) 213 Hydrocarbon solvents (Stoddard solvent, xylene) 214 Unspecified solvent mixture 221 Waste oil and mixed oil 222 Oil/water separation sludge 223 Unspecified oil -containing waste 231 Pesticide rinse water 232 Pesticide and other waste associated with pesticide production 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste Miscellaneous Empty pesticide containers 30 gal or more Other empty container 30 gal or more Empty containers less than 30 gal Drilling mud Chemical toilet waste Photo chemical/photo processing waste Laboratory waste chemicals Detergent and soap Fly ash, bottom ash, and retort ash . , Gas scrubber waste Bag house waste Contaminated soil from site clean-ups Household wastes 511 512 513 521 531 541 551 561 571 581 591 611 612 Page 3 of 3 ~ Pouaaa (Rev. 03-07) . ; .. . ~ (HMMP) BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIAL MANAGEMENT PLAN 5 ,~ Prevention Services _ ._._._ w.__._ __ ..___ r ~._ __ .___. _ _ ,_ _ .____ + S B R S P I n 1600 Truxtun Avenue, Suite 401 SITE & FACILITY DIAGRAM ,; i ~M T Bakersfield, CA 93301 t OFFICE: 661-326-3979 '` FAX: 661-852-2171 ' `"` Page 2 of 2 SITE DIAGRAM FACILITY DIAGRAM Business Name: M 1 `~ S C~nj vs2 vac--~~ ~yv~~ ~~_ ~.~______~__ Business Address: r,~ ~oY~ ~ ,' 4 v z Y-- ___._._._ ~~~~ ~ ~- ~~ .. 3 ~ ~~~ r, ~~`"`~.. X14-~-~v :~ ca \.L '~'~' ti v' oar ~ ~'1 ?C +~.~®" 4i~ '~ ~~ ~ ~t ~~ !~ ~ ~ ~~~ ~~~~`~ NORTH Please indicate direction of North r. ' ° ' ~ (HMMP) ~ ~- i HAZARDOUS MATERIAL MANAGEMENT PLAN INSTRUCTIONS SITE & FACILITY DIAGRAM - 8 H R S F I D P/R@ ~Rrr r ~. ~BAKERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Avenue, Suite 401 Bakersfield, CA 93301 OFFICE: 661-326-3979 FAX: 661-852-2171 Page 1 of 2 These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium- size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing an additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a remote location. All diagrams must be on 8~/2x11-inch paper and drawn using a straight edge tool. SITE DIAGRAM INSTRUCTIONS - The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you wilt not be submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top left corner of the form provided that indicated "Site Diagram." 2. Print the name of your;business, as shown in your HMMP, on the top of the diagram. 3. Label the location of the hazardous material and identify them by name and type of hazard (flammable liquid, corrosive solid).` 4. Label the location of utility shut-off points for gas, electric, and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow.) 8. All labeling and identification on the diagram must be legible and easily understandable at the scale submitted. Diagrams 'must be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. a FACILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. - ~ 1. Check the box in the upper right hand corner of the form provided that indicated "Facility Diagram." 2. Print the name of your business as shown on your HMMP. Print the ,name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instructions (3-8)* for site diagrams regarding the specific details to be included on each facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: If you operate an Underground Storage Tank (UST) facility, the facility diagram shall also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring will be performed. FD2170 (Rev. 03/07)