Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BUSINESS PLAN 1/19/2006
Praxair Services, Inc. Praxair Services, Inc. 3755 N. Business Center Drive Tucson, AZ 85705 Tei: (800) 394.9929 Fax: (520) 293-1306 IN SERVICE ENHANCED LEAK DETECTION (ISELD) TEST RESULTS Client Date: 1/19!2006 Site Info: Job No: 38717EL Circle Deli Mart 1416 Golden State Ave. Bakersfield,CA 93301 Circle Deli Mart 1416 Golden State Ave. Bakersfield,CA 93301 SYSTE M STATUS - (Pass/ Fail) Product /System Size Tank Product Primary (Primary) Vent Primary) 87 12,000 Pass Pass Pass 91 12,000 Pass Pass Pass 0 - 0 0 0 0 - 0 0 0 0 - 0 0 0 Va orRecove Pass Under Dispenser Containment (UDC) 3 Pass GROUND WATER AND PRODUCT INFO. Product !System IN TANK H2O (In) Product Level (In) Ground Water (in) Tank Bottom (in) Tank Top (in) 87 0 44.239" >10' 140 44 91 0 26.015" >10' 141 45 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 0 0 0 >10' 0 0 SPI LL BUCKET - H2O TEST uc et ass ar apor ecovery uc et ass ar 87 Pass Pass 91 Pass Pass I declare under penalty of perjury that 1 am a licensed tank tester in the State of California and that the information contained in this report is true and correct to the nest of my knowledge Tester: Ricardo Gonzalez Signature: State Lic. #: 04-1695 Date: 1 /18/2006 1 of 2 38717EL Bakersfield Finai.xls ~~ ~~ s • • ~ ~ • Praxa i r Services, Inc. Praxair Services, Inc. 3755 N. Business Center Drive Tucson, AZ 85705 Tel: (800) 3949929 Fax: (520) 293-1306 IN SERVICE ENHANCED LEAK DETECTION (ISELD) TEST RESULTS Client Date: 1/19/2006 Site Info: Job No: 38717EL Circle Deli Mart Circle Deli Mart 1416 Golden State Ave. 1416 Golden State Ave. Bakersfield,CA 93301 Bakersfield,CA 93301 TEST SUMMARY QA Review: Test data and information has been reviewed and conforms to ELD procedure and protocol. The leak detected on the ATG grommet on the 87 tank was repaired and re-tested tight before the end of the testing event. See attached leak log for details. All systems tested pass. Reviewed By: Dew/ Burk 1/30/2006 Signature: 1,~~ 2 of 2 38717EL QA Final DB DARDEN® RESTAURANTS Red Lobster® Olive Garden® Bahama Breeze® Smokey Bones® January 10, 2006 02-~2-0~ n ~ 26 ~-~CVD Joe Canas, Chief EHS Kern Co. Environmental Health 2700 M Street Bakersfield, CA 93301 Re: California Hazardous Materials Business Plans GMRI, INC. d/b/a THE OLIVE GARDEN # 1068 1701 NEW STINE ROAD BAKERSFIELD, CA 93309-3614 Dear Sir or Madam: On behalf of GMRI, Inc., I am submitting an original hazardous material business plan for the above location, pursuant to Health & Safety Code sections 25500-25520. The business plan consists of the enclosed completed Unified Program Consolidated Form, pages 1-10; training manual and Disaster and Emergency Preparedness Manual (rev. March 2005). If you have any questions, please contact me at 407-245-5198. Very truly, `~ ~2.._. 7. Thomas F. Cipollone Director Risk Management Darden Restaurants, Inc. 5900 Lake Ellenor Dr. P.O. Box 593330 Orlando, FL 32859-3330 Direct No. 407-245-5198 TCipollone(~Darden. com Encs.-Hazardous business plan, training manual, Disaster 8v Emergency Preparedness Manual cc: Senior Vice President Restaurant General Manager t UNIFIED PROGRAM.CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 10 I. FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) z. (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA -Doing Business As) s. GMRL Inc. DBA Olive Garden # 1068 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does our facilit .. If Yes, lease com lete these ages of the UPCF... A. HAZARDOUS MATERIALS Have on site (for any purpose} hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases ®YES ^ NO a HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold . _ CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formcfly swRCS Form A> 1. Own or operate underground storage tanks? ^YES ®NO s. UST TANK (one page per tank) (Formerly corm B> 2. Intend to upgrade existing or instal] new USTs? ^YES ®NO 6. UST FACILITY UST TANK (one per tank) UST INSTALLATION -CERTIFICATE OF COMPLIANCE (one page per tank) (formerly Norm C) 3. Need IO report CIOSIng a UST? ^YES ® NO 7. UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ^YES ®NO s. NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ^YES ®NO y. EPA IDNUMBER -provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT (one materials (per H&SC §25143.2)? ^YES ®NO io. perrecycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ^ YES ®NO 1 L TREATMENT -FACILITY (Formerly DTSC Forms 1772j ONSITE HAZARDOUS WASTE TREATMENT -UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D anti L) 4. Treatment subject to financial assurance requirements (for Permit by ^ XES ®NO 12 CERTIFICATION OF FINANCIAL Rule and Conditional Authorization)? . ASSURANCE (Formerly DTSC Form tz3z> 5. Consolidate hazardous waste generated at a remote site'? REMOTE WASTE /CONSOLIDATION ^ YES ®, NO 13. SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ^YES ®NO ta HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? . CERTIFICATION (Formerly DTSC Form lzay> E. LOCAL REQUIREMENTS 15 (You may also be required to provide additional information by your CUPA or local agency.) www.unidocs.org Rev.12/12/05 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Pa e 2 of 10 I. IDENTIFICATION FACILITY ID # ~ BEGINNING DATE 100. ENDING DATE tot. (Agency use only) December 12, 2005 December 12, 2006 BUSINESS NAME (Same as FnCIL[TV NAMH or DBA- Doing Business As) 3. BUSINESS PHONE 102. GMRI, Inc. DBA Olive Garden # 1068 6618321278 BUSINESS SITE ADDRESS w3. T701. New:Stint-Road CITY 404. ZIP.CODE 105. CA Bakersfield 93309=3614 DUN & BRADSTREET 106. SIC CODE (4 digit #) 1oz N/A 5812 COUNTY t0s. Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110. GMRI, Inc. 407-245-4000 II. BUSINESS OWNER OWNER NAME 111. OWNER PHONE nz. Darden Restaurants, Inc. Attention: Risk Management 407-245-4000 OWNER MAILING ADDRESS 113. P.O. Box 593330 CITY 114 STATE 115. ZIP CODE It6. Orlando FL 32859-3330 III. ENVIRONMENTAL CONTACT CONTACT NAME 117. CONTACT PHONE 118 Thomas Cipollone 407-245-5198 CONTACT MAILING ADDRESS 119. P.O. Box 593330 CITY 120 STATE tz1. ZIP CODE 1zz. Orlando FL, 32859-3330 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME tz3. NAME 1zs. Kathy Nahlovsky Thomas Cipollone TITLE tza. TITLE 1z9. Senior Vice President Director Risk Management BUSINESS PHONE 1z5. BUSINESS PHONE Iso. 714-974-2295 407-245-5198 24-HOUR PHONE* 126. 24-HOUR PHONE* 131. 858-583-2277 407-496-8141 PAGER # 127 PAGER # 13z. N/A N/A ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. Property Owner: N/A Phone No.: Billing Address: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally exarnined and am tamiliar with the information submitted and be lieve the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATEll REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. 12/12/06 Thomas Ci ollone NAME O I (pnnt) 136. TITLE OF SIGNER 137. Thomas Cipollone Director Risk Management * See Inswctions on next page. www.unidocs.org Rev.12/12/05 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (onc paec per material er buildine or area) ^ ADD ^ DELETE ^ REVISE 2U0~ -Page 3 of ]0 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3. GMRI, Inc. DBA Olive Garden # 1068 CHEMICAL LOCATION zol. CHEMICAL LOCATION CONFIDENTIAL EPCRA 262. Need to call restaurant ^ YES ®NO FACILITY ID # l MAP # 203. GRID # 2ua. (Agenry Use Only) - - II. CHEMICAL INFORMATION CHEMICAL NAME zus. TRADE SECRET ^ Yes ®No 206. Carbon Dioxide Refrigerated Liquid If Subject to EPCRA, refer to instructions COMMON NAME zo7. 208. EHS* ^ Yes ®No Carbon D1oXlde CAS# zo9. *If EHS is "Yes." all amounts below must be in ]bs. 124-38-9 FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210. HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 2n. RADIOACTIVE ^ Yes ®No 212. CURIES 213. TYPE (Check one item only) PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 27a. LARGEST CONTAINER 215. FED HAZARD CATEGORIES 2t6. (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 2l9 STATE WASTE CODE 220. 200 400 N/A N/A 221. DAYS ON SITE 222. UNITS* ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 days per year (Check one item onl) * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVEGROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ®l. CYLINDER ^ p. TANK WAGON 223. STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a. STORAGE TEMPERATURE ^ a. AMBIENT ^ b. ABOVE AMBIENT ®c. BELOW AMBIENT ^ d. CRYOGENIC 225. % WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # ] . 226. 227. ^ Yes ^ NO 228. 229. 2. 230. 231. ^YCS ^ NO 232. 233. 3 234. 235. ^YCS ^ NO 236. 237. q 238. 239. ^YCS No zao. za1. 5, zaz. za3. No zaa. ^ Yes zas. If more hazardous components are present at greater than 1 % he weight ifnun-carcinogenic, or 0.1 ~o by weight if carcinogenic, attach additional sheets of paper capturing [he required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zab. DOT Hazard Class: If EPCRA, Please Sign Here. www.unidocs.org Rev.12/12/05 acility Site Plan/Storage Map (Hazardous Materials Business Plan Module) Site Address: 1701 New Stine Road Bakersfield. CA 93309 Date Map Drawn: ~ ~ ~-~ ~ ~ ~ ~ ~ , ~ ~ ~ Map Scale:. ' ~ s ~ ~ ~ Page 4 of 10 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Instructions are printed on the following page. www.unidocs.org Rev.12/12/05 acility Site Plan/Storage Map (Hazardous Materials Business Plan Module) Site Address: 1701 New Stine Road Bakersfield, CA 93309 Date Map Drawn: ~ ~ Map :Scale: Page 5 of 10 1 2 3 4 5 6 7 S 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z `'~ .~ i-- ' kti"+ ~y.Ea ~- - ~ i _._ _~ ._ _... i _ ~~ ,, ~.:. , ~ i , 4 ~ ~ i , ~- i ,_.. ., _ , i ~ ~ . _.___ www.unidocs.org Rev.12/12/05 Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Authority Cited: HSC, Section 25504(b); Title 22, Div. 4.5, Ch. 12, Art. 3 CCR Page 6 of 10 All facilities that handle hazardous materials in specified quantities must have a written emergency response plan. In addition, facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a contingency plan. Because the requirements are similar, they have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is a Ere, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. Within Santa Clara County, hospitals and police agencies have delegated receipt of these plans to the local agencies administering Hazardous Materials Business Plans, so additional copies need not be submitted. However, a copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom special (i.e. contractual) emergency services arrangements have been made (see section 3, below). 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ^ Bells; ^ Horns/Sirens; ®Verbal (i. e. shouting); ^ Other (specify) b. ®Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it will be visible to employees and visitors. 2. a. Emergency Contacts*: Fire/Police/Ambulance ......................................... State Office of Emergency Services b. Post-Incident Contacts'x: Fire Department Hazardous Materials Program .................. . Local HazNlat Regulatory Agency California EPA Department of Toxic Substances Control .... '... , ... . Phone No. 911 Phone No. (800) 852-7550 Phone No.: (661) 868-3670 Phone No. (661)326-3751 Phone No. (415) 972-3188 Cal-OSHA Division of Occupational Safety and Health :. ,..:. ;....... -Phone-No. (661) 868=3801 Air°Quality:Management`District ` ~ ...' _, 4 Phone No:-(661) 326=6900 Regional Water:Quality"ControlBoaril . ....: ~~.~. ~.: ~.. ~. ~. . ~:.:: Phone~No:=(661) 334-2755 * These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may be required to be notified. c. Emergency Resources: Poison Control Center ....................................... Phone No. (800) 876-4766 Nearest Hospital: Name: Mercy'Southwest Phone No.:.(661)-663-6000 .~ Address: 400 Old river Road City: 'Bakersfield 3. Arrangements With Emergency Responders: If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements below: www.unidocs.org Rev.12/12/05 Emergency Response/Contingency Plan (HMBP Module) Page 7 of l0 4. Emergency Procedures: Emergency Coordinator Responsibilities: a. Whenever there is an imminent or actual emergency situation such as a explosion, fire, or release, the emergency coordinator (or his/her designee when the emergency coordinator is on call) shall: i. Identify the character, exact source, amount, and areal extent of any released hazardous materials. ii. Assess possible hazards to human health or the environment that may result from the explosion, fire, ~ or release. This assessment must consider both direct and indirect effects (e.g. the effects of amp toxic, irritating, or asphyxiating gases that nre generated, the effects of any hazardous surface water run-off from water or chemical agents used to control fire, etc.). iii. Activate internal facility alarms or communications systems, where applicable, to notify all facility personnel. iv. Notify appropriate local authorities (i. e. ca11911). v. Notify the State Office of Emergency Services at 1-800-852-7550. vi. Monitor for leaks, pressure build-up, gas generation, or ruptures in valves, pipes, or other equipment shut down in response to the incident. vii. Take all reasonable measures necessary to ensure that fires, explosions, and releases do not occur, recur, or spread to other hazardous materials at the facility. Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall: i. Provide for proper storage and disposal of recovered waste, contaminated soil or surface water, or any other material that results from a explosion, fire, or release at the facility. ii. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas of the facility affected by the incident until cleanup procedures are completed. iii. Ensure that all emergency equipment is cleaned, fit for its intended use, and available for use. iv. Notify the California Environmental Protection Agency's Department of Toxic Substances Control, the County of Santa Clara's Hazardous Materials Compliance Division, and the local fire department's hazardous materials program that the facility is in compliance with requirements b-i and b-ii, above. Responsibilities of Other Personnel: On a separate page, list any emergency response functions not covered in the "Emergency Coordinator Responsibilities" section, above. Next to each function, list the job title or name of each person responsible for performing the function. Number the page(s) appropriately. 5. Post-Incident Reporting/Recording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility's operating record. Within 15 days of any hazardous materials emergency incident or threatened hazardous materials emergency incident that triggers implementation of this plan, a written Emergency Incident Report, including, but not limited to a description of the incident and the facility's response to the incident, must be submitted to the California Environmental Protection Agency's Department of Toxic Substances Control, the County of Santa Clara's Hazardous Materials Compliance Division, and the local fire department's hazardous materials program. The report shall include: a. Name, address, and telephone number of the facility's owner/operator; b. Name, address, and telephone number of the facility; c. Date, time, and type of incident (e.g. fire, explosion, etc.); d. Name and quantity of material(s) involved; e. The extent of injuries, if any; f. An assessment of actual or potential hazards to human health or the environment, where this is applicable; g. Estimated quantity and disposition of recovered material that resulted from the incident; h. Cause(es) of the incident; i. Actions taken in response to the incident; j. Administrative or engineering controls designed to prevent such incidents in the future. 6. Earthquake Vulnerability: (t9 CCR §z731(e)1 Identify any areas of the facility and mechanical or other systems that require immediate inspection or isolation because of their vulnerability to earthquake-related ground motion: www.unidocs.org Rev.12/12/05 Emergency Response/Contingency Plan 7. Emergency Equipment: Page 8 of 10 22 CCR §66265.52(e) [as referenced by 22 CCR §66262.34(a)(4)] and the Hazardous Materials Storage Ordinance require that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. Equipment Category 2. Equipment T e 3. Locations * 4. Description** Personal ^ Cartridge Respirators Protective ^ Chemical Monitoring Equipment (describe) Equipment, ^ Chemical Protective Aprons/Coats Safety ^ Chemical Protective Boots Equipment, ^ Chemical Protective Gloves and ^ Chemical Protective Suits (describe) First Aid ^ Face Shields Equipment ®First Aid Kits/Stations (describe) Cash Stand ^ Hard Hats ^ Plumbed Eye Wash Stations ^ Portable Eye Wash Kits (i. e. bottle type) ^ Respirator Cartridges (describe) ^ Safety Glasses/Splash Goggles ^ Safety Showers ^ Self-Contained Breathing A aratuses (SCBA) ^ Other (describe) Fire ^-.Automatic Rir•e_Sprinkler Systems Extinguishing ^~'Fire Alarm Bozes/Stations Systems ^ Fire`~Extiriguisher:~Systems (desazbe) ^ Other (describe) Spill ^ Absorbents (describe) Control ^ Berms/Dikes (describe) Equipment ^ Decontamination E uipment (describe) and ^ Emergency Tanks (describe) Decontamination ^ Exhaust Hoods Equipment ^ Gas Cylinder Leak Repair Kits (describe) ^ Neutralizers (describe) ^ Overpack Drums ^ Sumps (describe) ^ Other (describe) Communications ^ Chemical Alarms (describe) and ^ Intercoms/ PA Systems Alarm ^ Portable Radios Systems ®.Telephones 4 locations Office, Podium, Back door Cash stand ^ Underground Tank Leak Detection Monitors ^ Other (describe) Additional ^ Equipment ^ (Use Additional ^ Pages if Needed.) ^ * Use the map and grid numbers from the Storage Map prepared earlier. for your HMBP. ** Describe the equipment and its capabilities. If applicable, specify any testing/maintenance procedures/intervals. Attach additional pages, numbered appropriately, if needed. www.unidocs.org Rev.12/12/05 ,. Employee Training Plan (Hazardous Materials Business Plan Module) '•`' Authoring Cited: HSC, Section 25504(c); Title 22, Div. 4.5, Ch. 12, Art. 3 CCR Page 9 of 10 All facilities that handle hazardous materials must have a written employee training plan. This plan is a required module of the Hazardous Materials Business Plan (HMBP). A blank plan has been provided below for you to complete and submit if you do not already have such a plan. If you already have a brief written description of your training program that addresses all subjects covered below, you are not required to complete the blank plan, below, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. [Note: Items marked with an asterisk (*) are required.]: 1. Personnel"are trained In the`following procedures: ® Internat:alarm/notification`* ~`Eyacuation/re-ent rocedures &~assembly-~ ointaocations* Emergency incident re ortin External emer ency res onse-organization notification ® Location(s) and contents of=Emergenc' Res onse/Contin eac Plan ^~ Facility evacuation dtills;thai are-conducted af3east_(~specify) ~ ~ (e,=g. ""Quarterly", etc.) 2. Chemical Handlers are additionally-trained>in the following: ®. Safe •methods for handling and storage of hazardous~materials * ~_~9l.ocation(s) and proper-use of'fireand'`s ill control~equipment 'Spih~procedures/emergency ~procedares ® Proper.use of persona] protective equipment Specific ;;°hazard(s) _of each ;chemical to which they~may °be exposed,. including routes of ~ exposure (a ~e,,: inhalation, .,ingestion, absorption)' ® -`Hazardous .Waste Handlers/Managers are trained is all aspects' ~of hazardous waste management=spedfic ~'to their job duties (e. g. ~corttainer_:accumulation ;.lime requirements;- labeli~tg requirements, storage area inspection requirements, manifesting 're uixe~nents, etc.) _. 3. 'Emergency Response ~Team;lVlembers ark capable of and engaged. in <the following:. Personnel rescue procedures ^ Shutdown of o erations ^ ~,Liaison with~~responding~agencies ^ -Use, maintenance, andxe lacement of emergencyres ~ onse e ~ ui uient ^ ~ --Refresher training, which is ,provided at leasGannually~ ^ `Eniargency responsedrills; which`are.condacfed at least (Specify) ~ ' " ~ ~~~. -' ~~(e:,~~g.. "Quarterly", etc.) www.unidocs.org Rev.12/12/05 Record Keeping (Hazardous Materials Business Plan Module) Page 10 of 10 All facilities that handle hazardous materials must maintain records associated with their management. A summary of your recordkeeping procedures is a required module of the Hazardous Materials Business Plan (HMBP). A blank summary has been provided below for you to complete and submit if you do not already have such a document. If you already have a brief written description of your hazardous materials recordkeeping systems that addresses all subjects covered below, you are not required to complete this page, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. The following records are maintained at the facility. (Note: Items marked with an asterisk (*) are required.]: -'Current em loyees''..train~n records (to be ~i-etained until closure ~of the facili ~) ® ~ -Former employees''"training-records (to be retained at-least three years afterterrriination-- o_ f eniptoyment) ® Training=Program(s) (i:e: written description of c'ntroducto -and continuin training) Current copy ofthis Emergency Response/Contingency Plan.* Record:ofrecordable/re ortable;hazardous material/waste releases * ^ Record'of hazardous.material/waste storage area inspections;*. ® Record of hazardous` waste tank daily inspections ^ Description and documentation of facility,emergency response-drills Note: The above list of records does not necessarily identify every type of record required to be maintained by the facility. A copy of the Inspection Check Sheet(s) or Log(s) used in conjunction with required routine self- inspections of your facility must be submitted with your HMBP. (Exception: Available from your local agency is a Hazardous Materials/Waste Storage Area Inspection Form that you may use if you do not already have your own form. If you use the example provided, you do not need to attach a copy.) (-:heck the appropriate box: ^ We will~~use the Uriidocs'"Hazardous~Materia'ls/Waste Storage~~~Area'Inspection Form"ao document inspections. ^ We~will -use our own documents to record inspections: (A blank copy of'each document-used must be attached to .this HMBP.) www.unidocs.org Rev.12/12/05 ~. ~~ TRAINING The purpose of training is to ensure the employees, outside contractors, and other affected individuals are adequately educated about potential chemical risks and how to respond to such hazards. It is important that all questions are answered - we don't want to minimize a hazard, however, we also don't want to exaggerate risks. Although employee training has always been a part of most programs, it is not necessary to establish very formal, documented programs. It is recommended that we continue the on-the-job explanation of specific health and safety hazards with any particular job (especially those tasks done very infrequently or for the first time), but supplement this with -generic chemical safety training. Since explaining the health and safety risks is part of a job indoctrination, we need to be sure that this is always done. Any training program given to employees must be formally documented. Each employee should signify his/her attendance by signing in on the Chemical Safety Training Log. These forms should be filed permanently in this manual in the Employee Training section. TRAINING MUST CONSIST OF: • Information on the requirements of OSHA Hazard Communication standard and applicable state/ local chemical safety laws and regulations; • Information on operating procedures in their work area where hazardous chemicals are present; • Information on where the Material Safety Data Sheets (MSDS), the written program (this. Manual}; and the list of hazardous chemicals are kept; • Review and explanation of the appropriate Material Safety Data Sheet (MSDS); • Methods employees can use to protect themselves, such as: work practices and the use of personal protective equipment; • How to read and interpret information on labels; • How employees can obtain and use the available hazard information; • Information on the established procedures in the safe handling, storage, and disposal of chemicals; • Information on the hazards of non routine tasks such as area and/ or equipment cleaning, maintenance, or repair as well as hazards associated with chemicals contained in unlabeled pipes in the work area; • How to clean up and respond to medical concerns as a result of exposure to a chemical spill. CONTRACTED SERVICES (Preventative Maintenance, Hood Cleaner, Refrigeration, etc.) As part of OSHA's Hazard Communication Standard, contractors must be informed of any chemical hazards their employees may be exposed to during the time they work in your restaurant. Although the contractor is responsible for training his personnel, contractors and all other outside vendors must follow our safety rules. Contractors' employees should also be confined to their specific job area. All contractors should be informed of hazardous materials in the areas in which their employees will be working. The restaurant's Chemical Safety Program should also be explained and any related questions answered. Additionally, contractors must be in compliance with federal OSHA and state/local Laws and regulations regarding chemical safety and must supply us with Material Safety Data Sheets (MSDS) for any hazardous chemicals they bring into the workplace. EMPL 01~EE MEETING ~ L~TLINE SUBJECT: CHEMICAL SAFETY PROGRAM PARTICIPANTS: ALL RESTAURANT EMPLOYEES (Only 1 work area in attendance per meeting.) PREPARATION: 1. Obtain a container of each hazardous chemical used by the work. 2. Have a copy of the MSDS for each chemical in that work area. 3. Have the meeting attendance sheet from the Chemical Safety Program Manual; each employee needs to verify his or her attendance. MEETING: 1. Begin the meeting by mentioning the word "chemicals". Ask the employees for examples of different chemicals that are found at home (hair spray, fertilizers, fly spray, etc.) and at work (dish machine detergents, bleach, window cleaner, etc.). 2. Remind them that some chemicals are not hazardous, however many have some degree of hazard. 3. Ask them two questions: • "How do you know the difference?" • "How can you protect yourself?" 4. To help you answer these questions, the Occupational Safety and Health Administration (OSHA) .has issued a standard called "Hazard Communication -Your Right to Know". Explain that this standard is intended to ensure chemical manufacturers evaluate their products for safety and this information is passed on to alI users. Since you use many chemicals in the restaurant, it is important to know which products are hazardous and proper procedures to handle and use these products. 5. Always remember your safety is very important to many people: a. To OSHA b. To the Chemical Suppliers c. To your employer d. To you 6. Labels are important, they tell (show the label from one of your demonstration chemicals you have in the room): a. Product name b. Product's intended use c. Using directions d. Any special instructions i.e., Keep out of reach of children e. Signal words i.e.: Danger, Warning, Caution f. Hazardous ingredients that may be in the product g. Precautionary measures i.e. physical/ health hazards, protective gear and first aid instructions h. Safe handling and storage instructions i. Name and address of the manufacturer 7. Material Safety Data Sheets (MSDS's) (Pass around some sample MSDS sheets for viewing) The Material Safety Data Sheets (MSDS) provides us with information for using a chemical safely. 7t identifies the substance(s) of concern in the chemical and potential hazards. The sheets describe precautions for use, handling, storage and also, gives procedures for emergency situations. Each MSDS will be divided into sections, each section will tell different information about the product. For example, typical sections on an MSDS will tell the following: • Identify the product • Hazardous chemicals in the product • Physical and chemical characteristics of product (appearance and odor) • Physical hazards of the product • Health hazards -(first aid procedures) • Special precautions (how to store, what to do in case of leaks, how to dispose of product) 8. We have obtained information regarding the hazardous chemicals in the restaurant. This information includes: • MSDS Sheets on every chemical • A guide on how to read an MSDS sheet • A guide on how to read a product label • A list of the hazardous chemicals in each work area This information is on file in the Manager's office. Additionally, this information is available on wall charts that will be posted so you may refer to it easily. We also have an inventory of chemical products in the restaurant. . (Tell employees where they are stored.) We will be giving new employees this training and everyone will receive information regarding any new hazardous chemicals in the restaurant. 9. So far we have talked about the government's (OSHA's) role, the chemical supplier's role, and our role in chemical safety. The last and most important person in the chain is you. We need you to help protect yourself. Do this by: • Using the proper chemical for the job • Following correct procedures • Reading labels • Knowing where to find information about the chemicals • Knowing how to handle and use the chemicals you work with • Wearing and taking care of protective gear • Following warnings and instructions • Learning emergency procedures • Becoming familiar with how the products look and smell • Asking the manager on duty when in doubt 10. REMEMBER TO TREAT ALL CHEMICALS WITH RESPECT AND NEVER MIX CHEMICAL PRODUCTS TOGETHER. 11. Ask if there are any questions. Answer any. 12. Have employees sign attendance sheets. Place signed attendance sheets in your Chemical Safety Program Manual. CHE~VII CAL SAFETY TRAINING L O G SUBJECT: TRAINER`S NAME: TRAINER'S TITLE: RESTAURANT #: EMPLOYEE NAME OB TITLE DATE SIGNATURE CHEMICAL SAFETY TRAINING L D G SUBJECT: RESTAURANT #: TRAINER'S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATt3RE CHEMICAL SAFETY TRAINING L O G SUBJECT: RESTAURANT #: TRAINER'S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATURE ~; CHEMICAL SAFETY TRAINING L O G SUBJECT: TRAINER'S NAME: TRAINER'S TITLE: RESTAURANT #: EMPLOYEE NAME OB TITLE DATE SIGNATURE ~~~~ Disaster and Emergency Preparedness Manual ~~. ,~ Revised March 2005 .~. DISASTER MANUAL HOW TO USE THIS MANUAL • • Disaster and Emergency Preparedness Manual • Table of Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. How this manual should be used a. Being Prepared b. Emergency Numbers Fires Hurricanes Tornadoes or Severe Storms Floods Blizzard Earthquake Bomb Threats Drain and Sewage Backup Power outage Water supply Boil Water order Food Product Handling Procedures Community Involvement Computer Systems Restaurant version Page 2 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ,~ How to use this Manual We have created this guide to provide you with a summary of what to do before, during and after a disaster or emergency. This advice will help you plan and survive a disaster or emergency and prevent or at least minimize injuries, property damage and overall disruption of business. Familiarity with what to do during a disaster or emergency is not only comforting, but will give you confidence in addressing the situation. Remember there is no better time than now to check your supplies and make sure that you are prepared for any disaster or emergency that may come your way. Unlike natural disasters, there are disasters caused by accidents such as the accidental release of poisonous chemicals into the area or radiation leaks. Because these disasters vary depending upon the agent involved and generally require specialized technical evaluation, they will not be discussed in this manual. If one of these occurs, immediately contact the Total Quality Department at the Restaurant Support Center. In any disaster you should contact your Director of Operations first. They will provide advice on closing and scheduling. When you get directions to close, evacuate the restaurant and close it. Immediately begin to make the necessary preparations. Review this manual annually as part of your safety committee meeting as well as in your regular scheduled manager meetings. Each year Operations will schedule a month on their Operations calendar to remind all General Managers to review this manual with all managers ensuring they know how to shut off water supply, gas valves, etc. as outlined. This is a good time to review the evacuation plan with their employees ensuring this evacuation plan(s) is posted in a clear location. This is also a good time to complete your Emergency Numbers listed on page 8. r~ U Restaurant version Page 3 of 58 C:\Documents and Settings\GGSDADi\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ Being Prepared Being prepared is your first responsibility during a disaster or emergency. Preparation and good planning are essential to handling any disaster and emergency effectively with minimal impact to your guests, team, and restaurant. Knowing what to anticipate and the proper alternatives to pursue will give you a comforting command of the situation. It is essential that you make sure you have the following items on hand in case of a disaster or emergency: Emergency Response (ER) Kit also known as Y2K Be sure it contains..... ^ Manual credit card imprinter that is not part of the kit ^ 3 Packs of Manual Guest Checks ^ 3 Packs of AMEX Credit Card Slips ^ 5 Quick Reference Guides for Emergencies ^ 2 Darden Emergency Response Guides First Aid Kit ^ Using your First Aid sticker to ensure your Kit contains all items listed. • Flashlights ^ Your restaurant should have two or three D cell battery flashlights. ^ Use alkaline batteries in the flashlights because they last longer. ^ Check the flashlight quarterly for brightness. ^ Change batteries every six months regardless of previous use or brightness. Battery-powered Radio ^ During a disaster or power outage, it is important to stay informed of current situations, so stay tuned to your local radio stations. ^ Use alkaline batteries in your radio, check them regularly and replace them every six months. ^ Do not play the radio in guest areas. ^ Monitor local weather reports on the radio in the kitchen -the line or production areas are the best places. ^ Make kitchen employees responsible for keeping you informed of any updates. Pen and Paper (use your checklist found on first page of each section) ^ Keep checklist or pen and paper handy as you will need to keep track of telephone numbers, product temperatures, contact names, times, destroyed product, etc. • Evacuation Plan ^ Need to review the evacuation plan with your staff -Evacuate the building in a safe and orderly fashion Restaurant version Page 4 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual Note: The prediction or forecast of a disaster may prove to be inaccurate. However, the cost incurred for taking action will be minimal in relation to possible losses if the forecast was accurate and no action was taken. "Closed" Sign Posting ^ Post a "closed" sign on the front door if you suspend operations. This will minimize the chance for liability claims by keeping guests out. (see CLOSED sign provided in the front section of this manual) ^ Wherever possible or necessary, post an employee at the door to give information and offer directions to the closest Darden restaurant, if applicable. Garbage Removal During periods when you are closed for business due to disaster, please remember the following: ^ Remove all garbage from the building as soon as possible. This will minimize the chance of off odors and vermin infestation. Equipment and Utensils Prior to resuming operation after any disaster: ^ Wash and sanitize all food contact surfaces and utensils to prevent contaminating the food supply (a sanitizing solution can be made by mixing one capful of chlorine bleach to every gallon of water) Reporting Damage to Building or Site After the disaster or emergency is over, return to the restaurant as soon as it is safe to do so to assess any damages and to make emergency repairs. If the building structure or equipment is damaged, contact your Director first, then the Facilities Department at the Restaurant Support Center (407-245-4200) as soon as possible. Restaurant version Page 5 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • m m m z z c W m N • Disaster and Emergency Preparedness Manual ~ Emergency Numbers -Company Numbers -Call Director of Operations first then notify Total Quality, . Facilities and Corporate Securit Division Vice-President Director of Operations 407-245-5330 Total Qualit Department 407-245-4200 Facilities De artment Su plier/distributor (Marriott (MBM), etc. Local -record our local phone- numbers below. Contact suppliers to stop deliveries. Police Fire Health De artment Red Cross Civil Defense Libert Mutuallnsurance Electric Utilit Gas Utilit Water De artment Sewer De artment Electrician Plumber D Ice Su tier Bottled Water Su tier 1-800-345-9282 Refrigeration Truck Rental -Ryder -provide them with your restaurant # as Purchase Order number -see instructions on last pa e Produce Supplier Bread Su tier Other #s , General Mana er home or cell phone number Director of O erations cell hone number Facilit Manager cell phone number Total Qualit Manager cell phone number Restaurant version Page 6 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • C7 m m N • Disaster and Emergency Preparedness Manual r~ u FIRES • Restaurant version Page 7 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~~~ '~ r ~i ~_y ;~ ,. --~ r=-~ - MAJaR FIRE FIRE Determine the type and extent ofthe fire. Be prepared to close the restaurant if necessary. Evacuate guests & employees immediately. Motify Fire Department. Arrange for medical attention, if necessary. Close the restaurant and past someone atfront doorto direct guests to closest Darden restaurant. hJotifythis location to expect additional guests due to fire. • i Call Director of Operations, Facilities Manager, Total QualityMartager, and Liberty Mutual for additional help and recommendations. Once the fire is out, review damage with Fire Departmer-~t. If restaurant is closed, mast local Health Departments require you to discard food affected by fire and+,von't letyou reopen until Health officials have inspected the restaurant, Your QA Manager must be involved arith food disposal. inventory all food ar-~d equipment. Recharge Ansul system before reopening. Take pictures, if possible. Restaurant version C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc MINI~R FIRE Use AEC type fire extinguisher to put out small fires. Put out grease fires by covering fryerwith a sheet pan if safe to do so. ff you can't cantral a line fire, activate the ansul system. Steps under MA.JGrR FIRE. Afterthe fire is under control, attend to guests and clean up any debris. Discard any exposed food or grease. VUash all exposed plate ware and equipment. Contact D0, Facility Mgr, Total Quality Mgr, and Liberty+ Mutual Page 8 of 58 Disaster and Emergency Preparedness Manual • Disaster Checklist Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Qualit Manager and Facilit Manager for assistance • • Post our evacuation plan where all emplo ees can see it Do ou have a flashli ht with fresh batteries? Pen and aper -keep this checklist available A 10" to 12" pipe wrench to turn off main valve as su pl Battery-powered radio to monitor weather conditions First aid su lies - is our first aid kit stocked with ade uate su plies Emer enc tele hone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during power outages . - Shut off electricit at main breaker Shut off individual equi ment or un lu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping tape. Call our Director, Total Qualit Department and Facilit Mana er for other directions. Have car filled with gasoline Secure han in signs and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outage situations. See Page 44 for instructions on handling d ice. Check and record refrigeration/freezer temperatures, compare actual interior tem- perature with exterior gau a and record differences. Restaurant version Page 9 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ FIRES In case of an unexpected disaster such as fire or explosion, do the following keeping in mind that your guests' and employees' safety is always your first priority: ^ Do not panic. ^. Turn off main power switch to keep fire from spreading through electrical wiring or prevent shock from melted conduit if possible ^ Evacuate the building as quickly and orderly as possible. ^ Have employees assist guests out of building, leading them by hand if necessary. ^ If smoke is extremely dense, advise everyone to crawl on their hands and knees for best visibility. ^ Contact your Director of Operations and advise of fire and status report of situation once everyone is safely out of the restaurant: ^ Building has been evacuated ^ Fire. Department and law enforcement officials contacted ^ Employee and guest safety • ^ Who has been contacted, i.e., Facilities Mgr., Liberty Mutual, Total Quality Mgr. ^ Damage to the building ^ Restaurant is closed for business ^ All food products must be examined by your Total Quality Manager for smoke or water damage prior to reopening the restaurant and use of the products. Refer to the following sections: ^ Power Failure Restaurant version Page 10 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc x c n a z m N • • Disaster and Emergency Preparedness Manual ~~ HURRICANES TROPICAL STORMS • Restaurant version Page 11 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual Disaster Checklist Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facility Manager for assistance •• Post our evacuation plan where all emplo ees can see it - Do ou have a flashli ht with fresh batteries? Pen and a er - kee this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is your first aid kit stocked with adequate supplies Emergenc telephone numbers -See List below A 10" to 12" pipe wrench to turn off main valve as su I Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during power outages Shut off electricit at main breaker. Shut off individual equipment or unplu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping tape. Call our Director, Total Qualit De artment and Facilit Mana er for other directions. Have car filled with gasoline Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, ans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outage situations. See Page 44 for instructions on handling d ice. Check and record refrigeration/freezer temperatures, compare actual interior tem- erature with exterior au a and record differences. Restaurant version Page 12 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • HURRICANES -BEFORE THE STORM HURRICANES -STOP, LOOK AND LISTEN! Hurricane Season is from June 1St through November 30tH' Hurricane watch: means possible danger within 24 hours. If the danger materializes, a hurricane warning will be issued. Meanwhile, keep alert and ignore rumors. Continue normal activities but stay tuned to radio or television for all weather bureau advisories. Hurricane warning: means that a hurricane is expected to strike an area within 24 hours. Plan your time carefully to avoid last-minute preparation which may leave you unprotected or unprepared. Preparing for a Hurricane In preparing for a hurricane, you should take the same steps as you would for a severe storm. Hurricane paths are often unpredictable but it is always better to assume that your restaurant is in the path of a hurricane and initiate preparation. ^ Start preparation when the possibility of a hurricane becomes apparent. • ^ Do not leave all preparation for hurricane until 24 hours before the hurricane is due to pass your area. ^ Although a true determination of a hurricane's path cannot be predicted very far in advance (usually 24 hours for a more definite prediction), your area will almost certainly experience some severe weather, at least heavy rain even if the eye of the hurricane bypasses your area. ^ Contact your Director of Operations to advise him/her of the situation and your course of action ^ Continue to keep them updated as the path of the hurricane becomes more predictable Before Leaving the Restaurant If a disaster or emergency should occur that significantly affects the restaurant, such as high winds, water, etc., you should initiate the following actions immediately as listed in Before the Storm section found on next page. Restaurant version Page 13 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual HURRICANES -BEFORE THE STORM Preparing for High Winds If high winds are predicted, please remember the following: You may wish to board up windows to avoid breakage -your Facility Manager will assist you with making this decision. Keep the following in mind: ^ Small windows are generally broken bywind-driven debris ^ Large windows may be broken by wind pressure ^ Draw curtains, shades or blinds to protect from breaking glass Preparing for Hurricane or Tropical Storms In addition, take the following measures to secure the building during a hurricane or tropical storm: ^ Secure any outdoor objects that might be blown away or uprooted. Anchor any • objects that are outside or bring them inside building. Ensure that roof top unit panels are secure and dumpster gates are locked down. ^ Put all prepared foods in the walk-ins; put ice cream in freezer ^ Cancel all food deliveries ^ Bag up ice and place in freezer for use when reopening or if you have power failure. ^ Take your employee roster home (including management) for telephone numbers; divide this task among your managers to call everyone and advise them of working conditions and needs. ^ Call the Local Health Agency for local health exceptions to reopening ^ Unplug your P.O.S. and B.O.S. ^ Turn off the gas supply - ^ You may also need to shut off electrical power at main breaker if there is a danger of flooding inside the restaurant ^ Test the flashlights and portable radio for working status • Restaurant version Page 14 of 58 C:\Documents and Settings\GGSDADi\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • After the Hurricane When you are ready to reopen the restaurant, please follow security guidelines before entering the restaurant and perform the following: ^ Survey the damages and advise upper management of equipment, roof, and weather status ^ Telephone those employees needed to operate the restaurant ^ If you can, check with your director and if approved, advise a local television or radio station you are open to assist the community ^ If the cooler and freezer temperatures are approaching the danger zone (40°) contact your Total Quality Manager immediately to discuss possible options and recommendations for discarding product. ^ Discard the day's first production of ice after reopening ^ Advise your Director of Operations, Total Quality Department and Facilities Department of the open or close status and restaurant building condition • ^ Anticipate a call or visit from the local health agency ^ Contact your Director of Operations and Facilities Department as soon as possible to advise them of any damage and of the local situation 0 Make whatever temporary repairs are necessary to protect your restaurant from further damage by wind and rain (i.e. board up windows or cover them with canvas; cover the holes in the roof or siding with temporary materials) Check for damages on the following at your restaurant:: ^ The roof ^ .Roof-mounted equipment ^ All related utilities (water, gas and electricity) For assistance, contact your utility company or HVAC vendor. Refer to the following sections for more details: ^ Power Failure ^ Water Supply ^ Boil Water Order 0 Sewage and Drain Backup Restaurant version Page 15 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc TORNADOES OR SEVERE STORMS • • • J Disaster and Emergency Preparedness Manual i. J -' ~~ TORNADOES SEVERE STORMS • Restaurant version Page 16 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • r~ LJ Disaster Checklist .. Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facility Manager for assistance .• Post our evacuation plan where all emplo ees can see it - Do ou .have a flashli ht with fresh batteries? Pen and pa er -keep this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is our first aid kit stocked with adequate supplies Emer enc tele hone numbers -See List below A 10" to 12" ipe wrench to turn off main valve as sup I Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during power outa es Shut off electricit at main breaker. Shut off individual equi ment or un lu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping to e. Secure hangin si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outage situations. See Page 44 for instructions on handlin d ice. Call our Director, Total Qualit De artment and Facilit Manager for other directions. Have car filled with gasoline Check and record refrigeration/freezer temperatures, compare actual interior tem- erature with exterior gau a and record differences. Restaurant version Page 17 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual BEFORE THE TORNADO AND SEVERE STORMS Tornado watch: when conditions are ideal for a tornado to develop or for a chance of dangerous weather with damaging winds Tornado warning: a tornado has been sighted nearby. Danger signs: ^ severe thunderstorms ^ hail ^ roaring noise ^ funnel cloud Tornadoes have 2 seasons: May through August -when most tornadoes occur December through April -when the most devastating tornadoes occur Tornado Facts: ^ Tornadoes are more unpredictable than hurricanes because we don't have ample warning to take action before they hit • ^ A tornado watch can cover an area of 140 miles wide by 200 miles long and even then, severe weather can occur outside the watch area ^ Pinpointing tornadoes, which is desired by everyone, is not possible. ^ During a tornado watch, keep abattery-operated radio nearby and listen for weather advisories If a Tornado Hits ^ Check to make sure you have switched off electric power and/or gas supply without putting yourself in danger. Restaurant version Page 18 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual DURING A TORNADO OR SEVERE STORM If the restaurant is occupied when a tornado is approaching: ^ All occupants should seek protection along the inside walls of the building (server alley, galley/dining room wall) or freezers. ^ Tornadoes create a rapid change in atmospheric pressure. To accommodate this, try to let exterior doors open, ideally on the side of the building opposite the tornado's approach. ^ Notify the police or sheriff's department and the fire department, if possible. ^ Do not physically move anyone who may be injured or in shock until examined by a paramedic or technician from the rescue squad, nurse, or others from the medical profession. ^ Assign a staff member to keep record of identification of persons moved from the building (due to injuries) and their destinations. ^ Uninjured persons should be gathered together in a safe area of the building to await transportation to another designated area or to their homes. Refer to the following sections: ^ Power Failure ^ Water Supply ^ Boil Water Order ^ Sewage and Drain Backup Restaurant version Page 19 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • r O O v Disaster and Emergency Preparedness Manual C~ • FLOODS Restaurant version Page 20 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Disaster Checklist Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facilit Manager for assistance •. Post our evacuation plan where all emplo ees can see it - Do ou have a flashli ht with fresh batteries? Pen and pa er - kee this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is your first aid kit stocked with adequate supplies Emer enc telephone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during ower outages A 10" to 12" ipe wrench to turn off main valve gas su pl Shut off electricit at main breaker. Shut off individual a ui ment or un lu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping to e. Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for ower outa a situations. See Page 44 for instructions on handlin d ice. Call our Director, Total Qualit Department and Facilit Mana er for other directions. Have car filled with gasoline Check and record refrigeration/freezer temperatures, compare actual interior tem- erature with exterior au a and record differences. Restaurant version Page 21 of 58 C:\Documents and Settings\GGSDADI\My Documents\Oisaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ FLOODS (cont'd) If your area is threatened by a flood: Continue normal activities but stay alert and listen to radio or television for all weather bureau advisories -ignore rumors and hearsay. If severe weather is expected to strike within 24 hours, begin making preparations with the assistance of your Facility Manager. ^ Avoid last-minute preparation that may leave you unprotected or unprepared. Consider lining up the following items: ^ bottled water supplier or a water tank truck with potab/e (fit to drink) water (at least 3,000 gallons) ^ refrigeration and/or freezer truck ^ carpet cleaners (in case of flooding) ^ dry ice if refrigeration and ! or freezer truck is not available ^ Keep your personal car fueled (service stations may be inoperable for several days after the storm) ^ If you close the restaurant: ^ Turn off the gas supply ^ You may also need to shut off electrical power at main breaker if there is a danger of flooding inside the restaurant. ^ If your restaurant is going to be closed, contact the following about your plans to close. o Contact at OG is Betty Jones at 6821 o Contact at for RL o Contact at for SB Deena Armstrong at 5744 o Contact at for BB Paul Fox at 4512 ^ It is important for you to carefully evaluate the impending weather conditions and base decisions on previous experience, the predicted severity of the storm, the restaurant's location, its susceptibility to damage, etc. ^ Contact other restaurants in your area to determine what they are doing. ^ If you think you should close the restaurant, make sure your SVP and Director of Operations approve it first ^ If you think you should stay open, make sure your SVP and Director approve that. ^ Be prepared to reverse the decision and close. ^ If you stay open, keep in mind your guest count will probably be low and there may be a problem getting supplies Restaurant version Page 22 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ FLOODS (cont'd) Before Leaving the Restaurant If it is decided to close the restaurant, take the following steps to prepare your restaurant: ^ Put all prepared foods in the walk-in refrigerators; ice cream in freezer ^ Cancel all food deliveries ^ Bag up ice and place in freezer for use when reopening or if you have power failure. ^ Discard the day's first production of ice after reopening ^ Take your employee roster home (including management) for telephone numbers; divide this task among your managers to call everyone and advise them of working conditions and needs. ^ Call the Local Health Agency for local health exceptions to reopening • ^ Power down, turn off and unplug the P.O.S. and B.O.S. systems Turn off power and gas supply if you can safely do so. See Power Outage for instructions. ^ Test your flashlights and portable radio for working status After the Flood You should return to the restaurant as soon as it is safe to do so to determine the extent of any damages. Do not make plans to reopen the restaurant if more severe weather is forecast. Please remember to do the following: ^ Survey any damages and advise the Facilities Department at the Restaurant Support Center of equipment, roof, and weather status ^ Telephone those employees needed to operate the restaurant ^ If you can and director has approved, let a local television or radio station know you are open to assist the community i Restaurant version Page 23 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ FLOODS (cont'd) ^ Advise your Director of Operations of the amount and age of food to coordinate inter-restaurant transfers and deliveries if needed ^ If the cooler and freezer temperatures are approaching the danger zone (40°) contact your Total Quality Manager immediately to discuss possible options and recommendations for discarding product. ^ Anticipate a call or visit from the local health agency ^ Avoid downed power lines and any objects that may be touching them; notify the police or utility company about them ^ Listen to your radio for instructions from local authorities ^ If you are put under a boil water order, refer to the "Boil Water Order" flow chart for easy reference. Refer to the following sections: ^ Power Failure ^ Water Supply ^ Boil Water Order ^ Sewage and Drain Backup ^ Food Product Handling Procedures Restaurant version Page 24 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • ao r_ v N Disaster and Emergency Preparedness Manual C7 SNOW STORMS AND BLIZZARDS Restaurant version Page 25 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual Disaster Checklist Keep all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facility Mana er for assistance •• Post our evacuation plan where all emplo ees can see it - Do ou have a flashli ht with fresh batteries? Pen and paper -keep this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is your first aid kit stocked with adequate supplies Emergenc tele hone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during ower outa es A 10" to 12" pipe wrench to turn off main valve gas sup I Shut off electricit at main breaker. Shut off individual a ui ment or unplu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping tape. Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outa a situations. See Pa a 44 for instructions on handlin d ice. Call our Director, Total Qualit Department and Facilit Mana er for other directions. Have car filled with gasoline Check and record refrigeration/freezer temperatures, compare actual interior tem- perature with exterior au a and record differences. Restaurant version Page 26 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ SNOW STORM OR BLIZZARDS If your area is threatened by a blizzard: ^ Continue normal activities but stay alert and listen to radio or television for all weather bureau advisories (ignore rumors and hearsay) ^ If severe weather is expected to strike within 24 hours, begin making preparations with the assistance of your Facility Manager. Avoid last-minute preparation that may leave you unprotected or unprepared. Consider lining up the following: ^ bottled water supplier or a water tank truck with potable (fit to drink) water (at least 3,000 gallons) ^ refrigeration and/or freezer truck ^ carpet cleaners (in case of flooding) ^ dry ice if refrigeration and/or freezer truck is unavailable ^ Keep your personal car fueled (service stations may be inoperable for several days after the storm) ^ Advise the Facilities Department and Director of Operations about your plans, status and weather conditions. It is important to carefully evaluate the impending weather conditions and base decisions on previous experience, the predicted severity of the storm, the restaurant's location, its susceptibility to damage, etc. ^ If you think you should close the restaurant, make sure your SVP and Director of Operations approve it first ^ If you think you should stay open, make sure your SVP and Director are in agreement. Be prepared to reverse the decision and close. ^ If you stay open, keep in mind your guest count will probably be low and there may be a problem getting supplies Restaurant version Page 27 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ SNOW STORM OR BLIZZARDS (cont'd) Before Leaving the Restaurant If it is decided to close the restaurant, take the following steps to prepare your restaurant: ^ Put all prepared foods in the walk-ins; ice cream in freezer ^ Cancel all food deliveries ^ Bag-up the ice and place in freezer for use when reopening or if you have power failure. ^ Take your employee roster home (including management) for telephone numbers; divide this task among your managers to call everyone and advise them of working conditions and needs. ^ Call the Local Health Agency for local health exceptions to reopening ^ Power down, turn off and unplug the P.O.S. and B.O.S. systems • ^ Test your flashlights and portable radio for working status After the Blizzard You should return to the restaurant as soon as it is safe to do so, at least to determine the extent of any damages. Do not make plans to reopen the restaurant if more severe weather is forecast. Please remember to do the following: ^ Survey any damages and advise the Facilities Department at the Restaurant Support Center. ^ Telephone those employees needed to operate the restaurant ^ If you can, let a local television or radio station know you are open to assist the community -See Community Involvement Section - ^ Contact names o Steve Coe for OG Media Relations ext. 4823 o Wendy Spirduso for RL Public Relations ext. 6546 o Mike Bernstein for SB or BB Public Relations ext. 5270 Restaurant version Page 28 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ ^ SNOW STORM OR BLIZZARDS (cont'd) ^ Advise your Director of Operations of the amount of food to coordinate to restaurant, as well as the amount of food to discard. ^ If the cooler and freezer temperatures are approaching the danger zone (40°) contact your Total Quality Manager immediately to discuss possible options and recommendations for discarding product. ^ Anticipate a call or visit from the local health agency ^ Do not touch downed power lines and any objects that may be touching them; notify the police or utility company about them ^ Listen to your radio for instructions from local authorities Roof ^ Contact your snow removal company to assist with removal of excessive snow from your roof to prevent collapse. ^ Insure contractor has liability insurance to protect Darden property. Refer to the following sections: ^ Power Failure ^ Water Supply ^ Boil Water Order ^ Sewage and Drain Backup Restaurant version Page 29 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • m a -~ x v c a m • Disaster and Emergency Preparedness Manual EARTHC~UAKES Restaurant version Page 30 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Disaster Checklist Keep all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facilit Manager for assistance •• Post your evacuation plan where all employees can see it - Do ou have a flashli ht with fresh batteries? Pen and a er -keep this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is your first aid kit stocked with adequate supplies Emer enc tele hone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during power outa es A 10" to 12" ipe wrench to turn off main valve as suppl Shut off electricit at main breaker. Shut off individual equipment or unplu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping to e. Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we -have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for ower outage situations. See Page 44 for instructions on handlin d ice. Call our Director, Total Qualit Department and Facilit Mana er for other directions. Have car filled with asoline Check and record refrigeration/freezer temperatures, compare actual interior tem- . erature with exterior auge and record differences. Restaurant version Page 31 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ EARTHQUAKES Here are some important tips to remember during and after an earthquake: During the earthquake: ^ Do not evacuate the building during an earthquake 0 Be aware of "where you are". Earthquakes come on fast and sometimes hard. The tendency when a quake hits is to freeze. With an average duration of less than 20 seconds, the awareness of where, or what you area in the proximity of i.e., windows, items that could fall on you (buildings, tower signs, etc) needs to be instinctive/second nature, to get out of harms way. ^ Seek shelter -the safest places would be in the walk-in's, door frames, under table tops and away from windows After the earthquake: ^ Get out of the building -find an open space ^ Know where the gas, electrical and water shut-offs are in the event that you need to . operate them (only if it is safe to do so) ^ Contact local officials and applicable RSC personnel (SVP, DO, FM, another restaurant, etc) to let them know that you and your crew are safe Emergency Lighting ^ Your emergency lighting system normally lasts for 1 to 2 hours ^ A flashlight or portable battery-operated lighting unit should be in place for periods after the emergency system is extinguished ^ Do not use candles during a power outage. You may have a gas leak due to broken lines which will cause an explosion. ^ Power down, turn off and unplug the P.O.S. and B.O.S. systems ^ Turn off power and gas supply if you can safely do so. See Power Outage for instructions. Restaurant version Page 32 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • After the Earthquake When it is safe to return to and you are ready to reopen the restaurant, please follow security guidelines before entering the restaurant and perform the following: ^ Survey the restaurant and advise upper management of equipment and building damage ^ Telephone those employees needed to operate the restaurant ^ If you can, check with your director and if approved, advise a local television or radio station you are open to assist the community ^ If the cooler and freezer temperatures are approaching the danger zone (40°) contact your Total Quality Manager immediately to discuss possible options and recommendations for discarding product. ^ Discard the day's first production of ice after reopening ^ Advise your Director of Operations, Total Quality Department and Facilities Department of the open or close status and restaurant building condition • ^ Anticipate a call or visit from the local health agency ^ Contact your Director of Operations and Facilities Department as soon as possible to advise them of any damage and of the local situation ^ Make whatever temporary repairs are necessary to protect your restaurant from further damage by earthquake (i.e. board up windows or cover them with canvas; cover the holes in the roof or siding with temporary materials) Check for damages on the following at your restaurant:: ^ The roof ^ Roof-mounted equipment ^ All related utilities (water, gas and electricity) For assistance, contact your utility company and local vendors for electrical or plumbing repairs. Refer to the following sections: ^ Power Failure ^ Water Supply ^ Boil Water Order ^ Sewage and Drain Backup Restaurant version Page 33 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • m O 00 x m • • Disaster and Emergency Preparedness Manual i. • BOMB THREATS Restaurant version Page 34 of 58 C:\Documents and Settings\GGSDADi\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual u • Disaster Checklist . .. Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facilit Manager for assistance • • Post your evacuation plan where all emplo ees can see it Do ou have a flashlight with fresh batteries? Pen and a er - kee this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is our first aid kit stocked with adequate supplies Emer enc telephone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during ower outa es A 10" to 12" pipe wrench to turn off main valve gas suppl Shut off electricit at main breaker. Shut off individual a ui ment or un lu Turn off all water faucets/outlets Shut off gas supply at main valve - To turn off, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage Secure all compressed air cylinders in an upright position. Use chains or strapping to e. Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a corporate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outa a situations. See Page 44 for instructions on handlin d ice. Call our Director, Total Qualit De artment and Facilit Mana er for other directions. Have car filled with gasoline Check and record refrigeration/freezer temperatures, compare actual interior tem- erature with exterior au a and record differences. Restaurant version Page 35 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ BOMB THREATS Bombs are the most destructive weapons used by people with a grievance against an organization. Most bomb threats against restaurants or retail operations are not real. When the bomb threat is real, the caller is concerned about the safety and well-being of the people inside. In a true warning call, the caller will describe the bomb, identify the type of mechanism and exactly what time the bomb is to go off. The bomber usually wants to make,a point and not injure innocent people, however all bomb threats must be taken seriously. Managers should use all available information to evaluate the threat and make a sound decision. Guidelines ^ When a call is received, the person taking the call should remain calm and follow the guidelines for filling out the Bomb Threat form-include in package. ^ Stay on line as long as possible by asking the caller to repeat the message ^ Request that the caller give you the location of the bomb and the time it is supposed to detonate (these are the most vital pieces of information) ^ Listen carefully to the caller's voice and note any special characteristics (accent, • dialect, speech patterns) ^ Note the conversation and whether the caller seems calm, tense, nervous, drunk, etc. ^ Note any background noise or sounds that identify the location of the call (phone booth, traffic, machinery, trains, aircraft, etc.) ^ Record the exact time the caller begins the conversation and terminates the call ^ Notify the local police, Director of Operations and the Corporate Director of Security ^ The decision to evacuate is the most important consideration and is a matter of judgment. It is dependent on the circumstances of the threat, and the decision must be made by the most senior member of the management team at the restaurant. ^ If the police give you the direction on evacuation, follow their advice Restaurant version Page 36 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ BOMB THREATS (cont'd) ^ Evacuation has some risks to employees and guests because fear and panic may occur. Be careful not to panic guests during an evacuation by using words like "bomb" or "explosive" ^ The decision to evacuate must be made when a device has been found or when there is strong enough evidence that the threat of explosion is real ^ If a device is located, evacuate immediately, and DO NOT TOUCH OR APPROACH THE DEVICE Restaurant version Page 37 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc DRAiN AND SEWAGE BACKUP • • • Disaster and Emergency Preparedness Manual (~nl ~ „~-~' '~ ~jS `"" F!~ J DRAIN AND SEWAGE BACK-UP ~I 5 ,~\ F Restaurant version Page 38 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual Sewage • Restaurant version Page 39 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ DRAIN AND SEWAGE BACKUP With normal drain backup during floods, fires, hurricanes, etc., please remember the following: ^ Get food products off the floor ^ Destroy any food products coming in contact with sewage or drain back-up ^ After backup through floor drains, and prior to resuming operation, the floors must be scrubbed with a soap solution and sanitized and scrub floor drains with a drain brush and sanitizer. Please refer to the "Sewage Back-Up" flow chart for easy reference. Sewage Treatment Plant Outage If you experience any break in service from your sewage treatment plant, immediately notify the local health department or water department for restart or any other necessary steps. -~ Restaurant version Page 40 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • m 0 m Disaster and Emergency Preparedness Manual i~ ~T ~~. -~~ ~ ' r ~~ ~,. ~,~ ~~~ POWER OUTAGE • Restaurant version Page 41 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ,, ~ ~'a, ~~,~.~ Turn off all electrical and gas equipment. Switch off ' ~`~ Individual circuit breakers to prevent equipment damal Stop Operations. Post someone at front door and don't admit any more guests. Move staff and guests to a secure, well-lit area. Check reslroorns and stock rooms for anymore who may be trapped in the dark. • ~J Keep perishable faad sate by call Povder ~.ompany consolidating it into ~~alk-in refrigerators to find out how long and freezer, and keep them closed. powerv~ill be out. '~Nithin 2 hours, bring in drl+ ice for the ~nralk-in freezers - (2r7D ibs far a 1 G' x 1 p'; 1 Dt lbs. far refrigerator). Using gloves, put the dry ice on the highest shePdes possible in the freezer. Don't put it directly on the food. Glose the doors and post "DO NOT ENTER" signs. Before re-entering walk-ins, open doors and let them stand open 15-20 minutes (dri ice creates carbon dioxide, +.rohich needs to dissipate before you enter the walk- in). For power outages longer than 24 haurs, you may need to arrange +n+ith a faad distribution, produce or ice cream comparry~ or a truck rental vendor far a refrigewted truck to stare faad. C:ontactyour QA Mgr. if faad temps measure over 40°f. Lass of prepared food maybe unavoidable. Ca11 other Darden restaurants in the area to see ifthey are atfiected. Direct guests to closest operating Darden restaurant. PJotify them to expect extra guests. Note: P,estaurant phones may not work during p[roder outage, so you will need to contact RSC to give them cellular phone number to cantactyou if needed. Yau ma~yr need to safely transport food to Another Darden restaurant for storage.. When power is restored, turn on circuit breakers and equipment one a# a time to prevent overload and equipment damage. Restaurant version Page 42 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ POWER OUTAGE Power Failure In the event an incident should occur that causes a prolonged power failure, take action: ^ Consider your need for backup refrigeration equipment ^ If refrigeration equipment is unavailable, dry ice would be the alternative. When a total loss of power is experienced, it is likely that when power is restored, the voltage will be less than normal. When this occurs, please do the following: ^ Turn all disconnects to the OFF position (this will eliminate damage to electrical equipment due to low voltage) ^ Have an electrician test the voltage prior to operating the equipment to insure the voltage is sufficient for safe operations. Please refer to the "Power Outage" flow chart for easy reference. Gas Supply If an impending disaster could seriously damage the restaurant: ^ Shut off the gas supply to all equipment following these procedures - To turn off gas supply at main valve, rotate clockwise until the valve head is 90 degrees to the pipe. A 10 to 12" wrench should provide enough leverage ^ Check gas equipment pilot lights before and after the gas company restores service ^ Remember, if the gas supply is interrupted you must re-light the pilots (do not forget the pilot lights on roof-mounted equipment). Emergency Lighting ^ Your emergency lighting system normally lasts for 1 to 2 hours ^ A flashlight or portable battery-operated lighting unit should be in place for periods after the emergency system is extinguished ^ Do not use candles during a power outage. You may have a gas leak due to broken lines which will cause an explosion. Restaurant version Page 43 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Frozen Foods If the power loss will be more than 24 hours: ^ Try to get an outside frozen storage facility/freezer truck to the restaurant to store the frozen food (local dairies, Marriott (MBM) or local Ryder truck rental services are all possibilities - it should be noted, however, that during emergency situations this equipment is hard to get and you should address your needs prior to actual emergency conditions whenever possible) ^ Monitor food temperatures and initiate steps to insure frozen foods do not reach levels higher than 20°F ^ Temporarily, frozen food can be kept solid by using dry ice that can be purchased locally from ice cream manufacturers, NuCo distributors, etc (check the Yellow Pages for its availability -atypical freezer requires 200 Ibs of dry ice) ^ Using gloves, place the dry ice as high as possible in the freezer on the shelves ^ Do not place dry ice directly on the food ^ Close the freezer door ^ When reopening the freezer door, let the door stand open for 15 to 20 minutes before entering. Warning: Dry ice evaporates into carbon dioxide and will cause unconsciousness if anyone enters prematurely. After using dry ice, never enter a freezer without telling someone where you are. Refrigerated Foods ^ Food products requiring holding temperatures of 34 to 40°F should be monitored and documented ^ Consolidate all foods from all refrigerated reach-in units to the walk-in refrigerator units ^ As the food products move into the danger zone, above 40°F, try to keep them cold using ice or portable refrigeration containers such as trucks designed for this temperature range -contact your local dairy, produce, or Ryder truck rental and if unavailable, contact other trucking companies with refrigerated trucks. ^ If neither of these items is accessible and if the temperature exceeds 40°F, contact your Total Quality Manager immediately to discuss other options and recommendations whether the product should be discarded. Restaurant version Page 44 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Refrigerated Foods continued To aid in maintaining temperatures for the longest possible time, pease do the following: ^ Keep doors closed on refrigerators ^ Accurate external thermometers will help with monitoring temperatures without having to open the refrigerator door Dry ingredients will not be affected by a loss of power or water. However, if flooding should occur, all dry goods, ingredients, napkins, etc., should be stored as far from floor level as possible. In case of a flood the following would apply: Canned Goods ^ Inspect closely and discard all bulging, leaking or dented cans even if you cannot find a leak, bacteria can get into a hole too small for liquids to leak out. ^ Before using any product in solid, sealed cans, write the contents on the lid with a waterproof marker, remove all paper labeling, then wash the can thoroughly in hot soapy water, rinse and submerge them in a sanitizing solution for five minutes. ^ Discard all food items that are not in solid, sealed cans, such as items with caps on them (for example, soft drinks, ketchup, beer, mustard, etc.), or dry goods such as breading, rice, etc. Discard all individual carryout packets of ketchup, mustard, mayonnaise, etc. In the event that any soft drink tanks and beer kegs were submerged, return them to the appropriate suppliers. Single Use Items 0 If any single use items like to-go containers, sav-a-days, and other paper or styrofoam items are exposed to flood water and debris, inventory then destroy them (there is no way to wash and sanitize these products) Restaurant version Page 45 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Refrigerated and Frozen Foods ^ If the refrigerator or freezer was covered with floodwater, the food within them has probably been damaged by seepage, so discard it ^ If the electricity has been cut off and no flood water has entered the freezer, keep the door closed to retain the cold, and then consult with your Total Quality Manager on the status of your food. You can also use the following guidelines: ^ Partially thawed meat can be re-frozen without much loss in quality. Completely thawed meat can be cooked and re-frozen provided the temperature has not reached above 40°F ^ Discard fish and frozen cooked goods that have been completely thawed (however, if they have not reached 40°F they can be used immediately or transferred to another restaurant for immediate use) ^ The flavor and texture of vegetables and fruits are impaired upon thawing and re- freezing -discard these items. If you have any questions regarding the quality or integrity of food, call the Total Quality Department at the Restaurant Support Center @ 407-245-5330. i -~ Restaurant version Page 46 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • N c C7 Disaster and Emergency Preparedness Manual r WATER SUPPLY Restaurant version Page 47 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ( Cj Direct guests to the closest Darden Restaurant until you can restore operations. Vlfater outage Discorrtinue Operations. Gontact•srour local Public Vb'orks Gept. to find out how long the outage will last. Contact your Director of Operations, Total Quality Mgr. and Facilities Manager for help. Ifwatervdill be outfor an e~~tended period, Total Quality will need to work+n1ith your local Health Gept. to de~delop acceptable procedures fvr reopening ASAP. Shut offwater at water main, if possible. Turn oft all +nrater'feetl lines to ice machines, soda and water stations, cottee makers and tea brewers, etc. Contact your water! ice vendor to see how much they can deliver and when. If Health Dept. approves and the decision is made to reopen v~nthout water, use single-serrice utensils (e.g., paper plates, plastic silverware, etc.) to avoid having to use the dish machine. Set upthree-compartment sinkto wash, rinse and sanitize any equipment or utensils used. ~ 5uy bottled soda lor_ally. Prepare tea and coffee v~ith water obtained frorrrsafe-source vendor. ~ .7 Start pulling product fora 35-48 hour refrigerated tha5nr. V+Ihen water is restored, flush all equipment with portable water at least half an hour before reusing. Glean and sanitize ice machines, dish machines, soda dispensers, coffee machines, tea brewers, etc. Replace ice machine alters (may require a sen<ice i:all to your H~/.~'~.CIR vendor}. Put hot wvater in r_lean tea dispensers ft 2D°F - hot to the touch without burrring) and set up in guest and employee restrooms and hand sinl~ forwashing hands. Put someone in charge ofmonitoriny and replenishing dispensers. Station someone in guest restrooms to flush toilets with water after use. For an e:~tended outage, setup portable toilets outside the restaurant with operations and Health Gepartment approval. Restaurant version Page 48 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual No Hot V1later ~~~ Determine wh•rthere is no hotwaterand if all s ~~~~~ areas are afrected. Cher.:k pilot lights ors hot ~_:_ +nlater heaters. Gall plumber for assistance. Contact your Director of Operations, Quality Assurance Manager and Facilities Manager ~ Start heating water for dish washing and hand sinlw. ~ Use three-compartment sink for washing, rinsing, antl sanitizing equipment and utensils. For an extended outage, call your chemical company to setup chemical sanitizer on the dish machine. Once chemical sanitizer is set up, you can use the dish machine as Tong as wash water is at least 154-1 r34°F. 7st Sink 2nd Sink 3'~ Sink Soap Ftinse Sanitize Put hvtv~later in clean tea dispensers (120°F hot to the touch without burning} and set up guest and employee restrovms and hand sinks forv,?ashing hands. Yvu rrray need to borrow equipment from other restaurants ar rent it. Employees should use a 50-104 ppm Red 5ucket chlorine hand-dip or a 204 ppm Quart sanitizer solution, if applicable. Institute Mandatory use of gloves for contact with both raw and cooked food. Have equipment repaired or replaced. Note: You mustreplace a leaking hotwater heater. Restaurant version Page 49 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • WATER SUPPLY If the water supply is temporarily interrupted or the main water line is broken, please remember the following: ^ Do not process or serve food if water is not fit for drinking ^ Take a sample of water for microbial testing ^ The local health department will, in most cases, be able to give the quickest information on whether or not operation may continue ^ Turn off all water faucets/outlets until the water supply is restored. Please refer to the "Water Outage" flow chart for easy reference on next page Hot Water Supply Refer to "No Hot Water" flow chart following pages. If you have no hot water, follow the "No Hot Water" section of flow chart. • Restaurant version Page 50 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc W O • O v m • Disaster and Emergency Preparedness Manual ~~~ -~ ~ -~ BOIL WATER ORDER This is a situation where a regulatory agency informs you by person, mail, radio or television that the drinking water supply to your restaurant is unsafe. Immediately contact your Director of Operations and Total Quality Department as well as Facilities Dept @ 407-245-4200 and follow these steps: ^ Turn off the ice machines, water dispensers, dipper wells, coffee and tea makers and soft drink fountains; drain and sanitize ice bins and contact ice supplier ^ All food contact utensils and equipment must be sanitized with 100-ppm chlorine solution before each use (set up chlorine solutions at pot sink, hand wash sinks, dipper wells, and all food production areas) ^ Locate an alternative potable (fit to drink) water source (if stored water must be used for drinking or food production, it must be boiled for a minimum of five minutes or treated as specified by the local health authority) Please refer to the "Boil Water Order" flow chart Restaurant version Page 51 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • ~~ .~"~~ . Boil 1f I~at~ r ~ rd e r Turn off the water supply and the circuit breakers far•}+our ice machines, water dispensers, dipper wells, coffee makers, tea brewers, and soft drink carbonators. Post notes on the equipment and adt+ise employees not to use them. Find aut ho~vt+lana the boil ardarwill be in affectfrom the Health Gegartment ortiiUater Camoanv. +JSe mree-campanment sink for washing, rinsing, and sanitizing equipment and utensils until chemical company sets up dish- machine. Use single serdice utensils, i.e., plates antl plastic forks to avoid having to use dish machine. Bail all water used for lNashing, rinsing and sanitizing equipment, Utensils, and plate ware, ar use water from an outside potable water vendor. You can use 100 ppm rhlorine solution to sanitize equipment or a 200 ppm Quart ~anitizer solution. Contact Director of Operations, QualRy Assurance Manager anti Facilities Manager to help set up for safe food handling and operation during boil water. Get rid of any ice in ice machines. Talkto QA, hAgr. about anyfood that's been in ront~act with ice. Ask ice or v:+ater vendor hov:+much they can deliver and when. Make sure product is from a safe source. Buy bottled soda locally. Prepare tea and coffee ~~n+ith water that's been properly bailed fat least 5 minutes ar per Health Dept. recomrnendations} arobtained from an outside vendor. Do not use equipment that has water plumbed directly to it. Put hot water in clean tea dispensers {120°F - hat to the taurh Witha~t burning) and setup in guest and employee restrooms And hand sinl~ far washing hands. Be sure to bail water first, TI•ien let cool to 120°F. Have someone monitor and replenish dispensers. Employees should use a 50-100 ppm Red Bucket c;hlodne hand dip or a 200 ppm Quart Sanitizer solution. Start pulling product fora 13-48 hour refrigerated thaw+. `fou may have to close your restaurant until everything can pe organized and procedures putinta place by Uperatians and Total Quality+to ensure food, employee and guest safely. Your QA Mgr. will contact the Health Gept. to revie•:a emergency procedures. Girect guest; to the nearest open Garden Restaurant until you reopen b`Uhen the boil order is lifted, have your water tested to make sure is has the proper chlorine level. Flush all equipment with fresh water at least half an hour before reusing. A sen+ice cornpany may need to sanitize equipment like ice machines. P,eplace ail filters. Restaurant version Page 52 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc FOOD HANDLING PROCEDURES • • • Disaster and Emergency Preparedness Manual U (( l~ FOOD PRODUCT HANDLING PROCEDURES Restaurant version Page 53 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ FOOD PRODUCT HANDLING After a natural disaster, power outage, etc., please remember the following: ^ Closely examine all of your food prior to reuse (use of a potentially hazardous product to avoid wasting it is not worth the resulting damage it can do to your restaurant's public image if it transmits a food borne illness) ^ Contact your Total Quality Manager to evaluate any questionable products ^ If the Health Department has put a hold order on your food, you cannot move it for any reason without their approval Generally, fire and smoke damage cause the greatest product loss. Smoke odors can penetrate almost any type of container with the exception of canned goods. However, the heat of the fire generally destroys everything. If a fire occurs, it is generally considered a total product loss. In case of a flood or fire the following would apply: If you have any questions regarding the quality or integrity of food, call the Total Quality Department at the Restaurant Support Center. Canned Goods ^ Inspect closely and discard all bulging, leaking or dented cans even if you cannot find a leak, bacteria can get into a hole too small for liquids to leak out. ^ Before using any product in solid, sealed cans, write the contents on the lid with a waterproof marker, remove all paper labeling, then wash the can thoroughly in hot soapy water, rinse and submerge them in a sanitizing solution for five minutes. ^ Discard all food items that are not in solid, sealed cans, such as items with caps on them (for example, soft drinks, ketchup, beer, mustard, etc.), or dry goods such as breading, rice, etc. Discard all individual carryout packets of ketchup, mustard, mayonnaise, etc. In the event that any soft drink tanks and beer kegs were submerged, return them to the appropriate suppliers. Single Use Items ^ If any single use items like to-go containers, sav-a-days, and other paper or styrofoam items are exposed to flood water and debris, inventory then destroy them (there is no way to wash and sanitize these products) Restaurant version Page 54 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual • Refrigerated and Frozen Foods ^ If the refrigerator or freezer was covered with floodwater, the food within them has probably been damaged by seepage, so discard it ^ If the electricity has been cut off and no flood water has entered the freezer, keep the door closed to retain the cold, and then consult with your Total Quality Manager on the status of your food. You can also use the following guidelines: ^ Partially thawed meat can be re-frozen without much loss in quality. Completely thawed meat can be cooked and re-frozen provided the temperature has not reached above 40°F ^ Discard fish and frozen cooked goods that have been completely thawed (however, if they have not reached 40°F they can be used immediately or transferred to another restaurant for immediate use) ^ The flavor and texture of vegetables and fruits are impaired upon thawing and re- freezing -discard these items. If you have any questions regarding the quality or integrity of food, call the Total Quality Department at the Restaurant Support Center @ 407-245-5033. ~1 U _~ Restaurant version Page 55 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc • • n O v C m m 3 • Disaster and Emergency Preparedness Manual .7 COMMUNITY INVOLVEMENT Restaurant version Page 56 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual ~ Community Involvement When a disaster or emergency strikes your area, it affects employees, their families, friends, neighbors, guests and the building. Darden Restaurants is committed to supporting every community where we have restaurants. During a disaster or emergency, we should respond to the community's needs quickly, whenever it is appropriate and practical. Your restaurant can assist your community during a disaster or emergency by: ^ Evaluating the situation and deciding how you can best help your neighbors ^ Contacting the Red Cross or other relief agencies and law enforcement officials to find out how you can help Suggestions: ^ Deliver complimentary hot coffee and food to road crews clearing streets ^ Stay open later to serve rescue workers and volunteers ^ Send hot coffee and soup to first-aid stations in take-out containers • ^ Have employees assist with distributing food and drinks (make sure they clock in) ^ During a power failure, donate your in-date perishable food rather than throw it away - remembering that we would not want to donate any food we would not serve our guests. ^ Offer the lobbies as pick-up points for needed supplies ^ If you maintain a safe water supply, invite neighbors without water to fill up their containers at your restaurant You will know which action to take by the seriousness of the disaster, the needs of the community and your restaurant's ability to help. Your offers to help should be out of a sense of community spirit ... genuine and non- promotional. For example, offering a 2-for-1 special to families left homeless by a disaster might look like you're trying to build business and profit from the community's misfortune, rather than unselfishly helping those in need. Offers like this could result in negative, rather than positive public relations. In the long run, we want people to remember our generosity during the disaster. Above all, don't make any commitments to the community you can't fultill! _~ Restaurant version Page 57 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc Disaster and Emergency Preparedness Manual Disaster Checklist .. Kee all exits clear. Are alternate exits available? Calm) and order) evacuate buildin .Check restrooms. Call Director of Operations, Total Quality Manager and Facility Manager for assistance •• Post our evacuation plan where all emplo ees can see it Do ou have a flashli ht with fresh batteries? Pen and paper - kee this checklist available Batte - owered radio to monitor weather conditions First aid supplies - is our first aid kit stocked with adequate supplies Emer enc tele hone numbers -See List below Probe (stem) thermometer (0 - 220°F) available to monitor food temperatures during power outa es A 10" to 12" pipe wrench to turn off main valve gas suppl Shut off electricit at main breaker. Shut off individual a uipment or unplu Turn off all water faucets/outlets Shut off gas suppl at main valve. . , Secure all compressed air cylinders in an upright position. Use chains or strapping to e. Secure han in si ns and exterior accessories. Secure or anchor all objects that could become airborne, such as knives, cutting boards, pans, bread carts, etc. Make arrangements to secure a refrigerated truck or a freezer truck if power is to be out for more than 24 hours - we have a cor orate account with R der Order dry ice -Please keep this in mind only as last alternative to locating refrigerated truck for power outa a situations. See Pa a 44 for instructions on handlin d ice. Call our Director, Total Qualit Department and Facilit Mana er for other directions. Have car filled with gasoline Check and record refrigeration/freezer temperatures, compare actual interior tem- erature with exterior au a and record differences. Restaurant version Page 58 of 58 C:\Documents and Settings\GGSDADI\My Documents\Disaster and Emergency Manual.doc _ __ T__ ___ __ `~ ~-: ;~---- w I~ SWRCB, 3anuary 2002 Page ~ of Secondary Containment Testing Report Form This fnrm Lr intandedfor usa by contractorsperformingpariodic tasting of US'T serondary contalnmant .cystams. Use the appropriate pages of thcr foam to report results for all components tested The completedform, written test procedures, and printouts from tests r~applicable), should be provided to the facility owner/operator jor submittal to the !Deal regulatory agency. 1. FACILITY INFORMATION Facility Name: ~Y' t Date ofTesting: - Facility Address: Go~ q~s-{fit, Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency inspector (if present during testi»g); 2. TESTING CONTRACTOR INFORMATION Company Name:RTCH ENVIRONMENTAL Technician Conducting Test: 'i p v~~ pyh~ QL G Credentials: ~ CSLB Licensed Contractor Q S WRCB Licensed Tank Tester License Type. C611D40 License Number: 809850 Manufacturer ~~R tLfactui~er Training Com onent s Date Trainin E Tres INCON INCON TS-STS 3. SUMMARY OF TEST RESULTS Component Pass Fa11 Not Tested Repairs Made Component Pass Fai! Not Tested Repairs Made ,v K ^ o ~[ ^ - S ~ ~ ~fe ~ ^ ^ ^ - uu ^ ^ $C 0 ^ ^ ^ L'1 - ^ ^ ^ ^ 0 ^ ^ ~ o ^ ^ ^ a ^ ^ c ^ ^ ^ ^ ^ ^ ^ 5d' ^ ^ 0 ^ ^ ^ C; fs - ~ a ^ ^ ^ a ^ ^ ^ -t hydrostatic testing was performed, describe what was done with the water after completion of tests: __RECYCLE AND REUS~I) _ CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my ktrowledge, the facts stated In t/ris docatttent are accarate and to fuU compliance with legal requlremenis Technician's Signature: - Date: ~ ` 3 (' ~~ ~yJ . `o YiGG--r,~- n ~. ` ~ ~- ~ 2 a 55 ------ SWRCB, January 2002 Page ~ of ~ „_ d_ TANK ANNiTi.AR TFSTiN(: Test Method Developed By: D Tank Manu$cturer {a Industry Standard D Professional Engineer O Other (Sped) Test Method Used: 0 Pressure ~ Vacuum ^ Hydrostatic p Otfter (.Spec~J Test Equipment Used}.: 9 i n . DIAL GAUGE ~t ~ s ~~ .~' 6 - ASc ~, `~~' a ~~ E` ~`" '~;'let~r ,'t'ank # Tank # Qi' a' ,~ r t c~ ~'-, .,~, c s . Equipment Resolution: . 5% .n .. ~r ~ rt `2 ' nkgc-Yr Tank # Tank # ]s Tank Exempt From Testing?' 0 Yes ~No L] Yes '`!`1.No 0 Yes D No ^ Yes D No 'f ank Capacity: Tank Material: . Tank Maftufacturer: un1(Not,~r~ Un krow-^ Product Stored: Wait time between applying pressure/vacuum/water and starting test: ~1tp ~9rnv~r`ft2 }~~ ~~~L "iaAnk '~10 gr~NU\tgYt ;v~~ ~ra~~ ~F.nX Test Sta~i Time; ]nitial Reading (R~): Test End Time: Final Reading (R~:): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: Test Result: ^ Pass ^ !raft D Pass ^ Fait ^ Pass C7 Fail ^ Pass ^ Fail Was sensor removed for testing? ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA 0 Yes ^ No ^NA ^ Yes ^ No CNA Was sensor properly replaced and verified functional after testin ? 0 Yes D No DNA ^ Yes ^ No DNA ^ Yes D No DNA 0 Yes D No 0 NA COmmerits - (include itfyrmatiorr on re~alrs made prior to testing, and - ~•. ~ L - ~ Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing, tCaiifornia Code of Regulations, Title 23, Section 2637(ax6)} 12055 SWRCB, January 2002 Page 3 of 8 t c~rnrvnsnv prvc Tcc~rrtvr~ Test Method Developed By. ^ Piping Manufacturer ~? Industry Standard 0 Professional Engineer ^ Other (5pec(fyJ Test Method Used: ~ Pressure ^ Vacuum ^ Hydrostatic ^ Other (Spec{jy} Test F.Quipment Used: 41 n . DIAL GAUGE Equipment Resolution: . 5% _~,,, ~ .. Piping Ran # ~' Piping Run # 9 ~ Piping Run # Piping Run # Piping Material: >is i~ 1~ASS Piping Manufactwer: 1 ur T~`n0 W N~ Piping Diameter: " ~ -' Length of Piping Run: y T t} rj fit' Product Stored: ~itGVr - ~~ Method and location of i in -run isolation: ~!"j:/ i4.w ~s^l:" ao DS ~ SuM Wait time between applying pressure vacuum/water and startin test. ~ M 1 N I (~ V+~+ + ~'. Test Start Time: 0: /S O r! 5 rati.. Initial Reading (R~: ~ f'~ Test End Time: ; /S ) ', prn Final Reading (Rr): ~ rJ pS 1 Test Duration: ~ -h ou 2 Change in Reading (RF-R,): °$' g ( S i Pass/Fail Threshold or Criteria: ~_ Dg f i- ,e- X7,5 i Test Result: Pass ^ Fail Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail Commeet3 - (include information on repairs mad~rfor to testrn~' and recommexdedjollow-upjorjaUed tests) r 2 a55 S1A'RCB, January 2QQ2 6. PIPING SUMP TESTING Page 4 of 8 Test Method Developed By: ^ Sump Manufacturer N Industry Standard ^ Professional Ettgineet ^ Other (Sped) Test Method Used: []Pressure Q Vacuum i°l Hydrostatic D Other {Specify) Test Equipment Used: INCON TS-STS Equipment Resotution:~oooin. Sump # $7 Sump # ~ Sump # Sump # Sump Diameter: '3 (~`' 3 ~ ~' Sump Depth: ~ j ~' y5 ~' Sump Material: ~ S1 i ~.v \agS'S Height from Tank Top to Top of Hi hest pi in Penetration: „?t~ [ iti '~ ~ ' 1., Height from Tank Top to Lowest Electrical Penetration: ~ -. ~ -1•, Condition of sump prior to testing: ,~ Portion of Sump Tested' 1 1 Does turbine shut down when sump scnsor detecu liquid (both roduct and water ?~ D Yes L'] No 19.1VA D Yes DNo `9NA ^Yes DNo DNA O Yes DNo ^ NA Turbine shutdown response time l?fI11~C~no1P~ h Is system programmed for fail-safe shutdown?~ Dyes ONo~INA DYes ^No~LINA DYes DNo ONA ^Yes DNo DNA Was fail-safe verified to be o erational?' ^ yes ^ No~NA D Yes D No~B~NA D Yes ^ No ^ NA R Yes ^ No q NA Wait time between appiying pressure/vacuum/water and starting test: ' ;,~ M ; vy Test Start Time: ~0'.~3nw+ 10'.~ll ~ ',3U ~~ ~8 Initial Reading(R~: 3iw .3.~ .). e~.WOi .$w8~ Test End Time: 1U'.33p 1D'.5b~ 1:41 a'03~ n, Final Reading (Rr}: .4-}) i~ 3.4143i~ , a`19' n o1.$~y ih Tes[ Duration; \~j ~[-~•; ~ 15 r„~; „~ Change in Reading (Rr-R,): .oa~'~ , p~ . Uci ; r • CAa',n Pass/Fail Threshold or Criteria: t\ hy5 Test Result: ^ Pass '-Fall '7~Pass D Fall ^ Pass ^ Fail ^ Pass D Fatl Was sensor removed for testing? Yes ^ N o DNA 1~Yes ^ No Q NA ^Yes DNo RNA D Yes DNo ^ NA Was sensor properly replactd and verified functional after testin ? Yes ^ No ^ NA Yes DNo DNA D Yes DNo DNA D Yes ^ No DNA C'4mtneDts - {include in ormatlon on re airs made rfor to teslln and recommended ollow-u or ailed tests 9is, 1 - _ i It the entire depth of the sump is not tested, specify haw much was tested. If the answer to ~y of rite questions indicated with an asterisk (") is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-l60} -~ ! Zo 5S SWRCB, January 2402 Page 5 of 8 7_ ?iNDFR_1lICPF.NCF,R C[lNTA1fNMENT fUDC) TESTING Test Method Developed By: ^ UDC Manufacturer i>d Industry Standard ^ Professional Engineer D Other (Specify) Test Method Used: ^ Pressure ^ Vacuum ~ Nydxostatic D Other (Specify) Test Equipment Used: INCON TS-STS Equipment Resolution: . oooin . F~>E - - ' unc ~ ! +~ vnc ~ 3 +t.l ulx~ tt + tlnc # UDC Manufacturer: r\Gv.aWt• 1MK~+n Vr~no~'~ UDC Material: .barn 4~J '.bat 1,gss ~ S UDC De the * " ' Height from UDC Bottom to Top of Hi hest Pi in Penetration: ~ V1 ` tL v1 t + ~~ Height from UDC Bottom to Lowest Electrical Penetration: r h„~ d 1 ~ ~ ,~-, Condition of UDC prior to testis : \C'P~ `QxatJ r;.~>~ Portion of UDC Tested rr. o~ Does turbine shut down wben UDC sensor detects liquid (both roduct and water ?~ ^ Yes ^No ~QNA ^Yes ^No~NA Dyes ^No~NA ^Yes DNo DNA Turbine shutdown res onse tune 1Z O +n N [s system programmed for fail- safeshutdown?` OYes ^No~'.?NA DYes ONo~NA ^Yes ONo19NA OYes ONo DNA Was fai I-safe verified to be o erational?` ^ Irk D Nom NA DYes ^ No~^ NA ^ Yes D No~J NA ^ Yes D No ^ NA Wait time between app{ying pressure/vacuum/water and startin test ~ ~ m+ r. \ l1 r^ ~ ti.. Q w~~ ~n Test Start Time: 3 Ain O an. ', wr„ 1'S~wr. '. 3a4+ 9 : wy^ Initial [teadin ~ , .T'2t~',y, ~ .l.)$;~ .9 1q~~ Test End Time: + ra \D:05gt•. 9'.4 wn. ~0~0 ,~ 9: gates \o:G ar Fina( Readin RF :. .'1'n;n .')l9 ~h. 3,Lig~r 3 .b1 :w `t.Rlr1-~, ~'1.918~~ Test Duration: 1 rr..,,. \5 r•.:~. ) r.:r. Chan in Readin (Rp-Rt}: `t~ . ~Oi L A ,001 iv. ~ n . Co\', n Pass/Fail Threshold or Criteria: '"6`~ 'a P 1 p S ASS PAfS qSS wf! Test Result: Pass l7 Fail Pass ^ Fail ~3' Pass 0 Fail ^ Pass ^ Fail Was sensor removed for testing? DYes ^No NA ^Yes C}No A ^Yes GNo A ^Yes 0No ^NA Was sensor properly replaced and verified functional after testis 7 \/ ^ yes ^ No ~BNA DYes D No ~VA l7 Yes ^ No ~NA DYes D No DNA _ COIDmeRtS -- include information on repairs made prior to testin& and recommendedfollow-upfor jailed tests) ~I O $GY~5o45 'tr d;Sp6rc.e~aJ. ' if the entire depth of the UDC is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asterisk (t} is "NO" or "TIA", the entire UDC must be tested (See SWRCI3 LG-l64) -+~ _~ 1 Za 5S SWRC13, January 2002 Page ~ of 8_ Fii.i. RiSFR CONTAi1VI1'IEiVT SUMP ?ESTING Facili is Not ui With Fifl Riser Containment Sum Fill Riser Containment Sumps arc Present, but were Not Tested ^ Test Method Developed By: ^ Sump Manufacturer t$ Industry Standard ^ Professional Engineer ^ Other (specify) Test Metbod Used: 0 Pressure ^ Vacuurn sly Hydrostatic ^ Other (5`pec~) Test Equipment Used: INCON TS-STS Equipment Resolution:.000in. Fill Sum # Fill Snm # ~ r Fill Sum # Filt Sum # Sum Diameter: Sum De the Height from Tank Top to Top of Hi est Pi in Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portioa of Sum Tested Sum Material: Wait time between applying pressurelvacuum/wateraad startin test• Alo :~~ Spy-+ps N ~ 'G ~~~ S~v^~ Test Start Time; lnitiai Readin R Test End Time: Final Readin R Test Durazion: Chan a io Readin R R,): PasslFaii Threshold or Criteria: Test Result: 0 Pass ^Faii ^ Pass ^ Fail ^ Pass ^ Fail ^ Pass Cl Faii Is there a sensor in the sump? ^ Yes 0 No ^ Yes ^ No ^ Yes ^ No ^ Yes ^ No Does the sensor alarm when either product or water is detected? ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No f 7 NA Was sensor removed for testing? ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA O Yes ^ No ^ NA ^ Yes ^ No ^ NA Was sensor properly replaced and verified functional after testin 7 ^ yes ^ No 0 NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No P_ NA Comments - (include information nn repairs made prior to testing, and recommende~o!!ow-up for failed tests) ~ - - - -- - SWRCB, January 2002 9. SPii,iJOVERFiLL CONTAINMENT BOXES 2 d 55, Page ? _ of 8 Facili is Not E ui ed With S i11/Overfili Containment Boxes ^ Spill/Ovefil! Containment Boxes are Present, but were Not Tested Q Test Method Developed By: ^ Spill Bucket Manufacturer >~ Industry Standard ^ Professional Engineer ^ Other (Specrjy) Test Method Used: ^ Pressure ^ Vacuum ~ ~Jydrostatic ^ Other (Spec~J Test Equipment Used: INCO N TS-STS Equipment Resolution: • cOOin . ~~'' um~ Spiil Box # ~ Spill Box # a~ Spiii Boz # Spill Box # Bucket Diameter: ~ ~~~ ~b~' Bucket Depth: 1~1" [y" Wait time between applying pressure/vacuumhveter and startin test: tv-~ r 10 lr~ ~ r Test Start Time; W'•a3aar [0'.y~ qr W:~w l0••'~1\ qr~ Initial Reading('R,): p~>n .~ pti• 1.3tiy',,, 1.31y~r Test End Time: y0','38a 1D'. {~q1a~ It): q ~0'~ bgtr+ Final Reading(Rr•}: ~°1~~"n :v~ ~.31y~nr. l• W~'n Test Duration: ~5.w.•r~ ~Sbn;b. Change in Reading (R~R~): ,-~ ~, ~ ~ Pass/Fail Threshold or Criteria: ~tq5 S ~pSS Test Resait: Pass ^ Fail ass ^ Fail ^ Pass 4 Fa7 ^ Pass ^ Fail Comments - (inclade trrjormatfon on repairs made prier to testing, and ~ecammendedjollow-up~or jailed teats) ., 1 ~oSS .~-----_ -- ;~_ =Ii ' - 1 1 _ _ . _~ _ ~ - - - ~;NCr tfE ~4Fi~~2 _ _.:~. , ~. ' ~ : ~~POi??' SUt9P' _'EAK "i E:;7 t~EPUftT _ ~_:'?1 ,,:.'.G~k~i; ':~L T Trii<1 4v~ 1l1: l~ itiM ._ . _.~ ,. , ~Yn~r`.-1 Itl TEST ~.1 rtft: S LrJ !n1 j,i2 j2ki0n -.. _;c5~ Rt; ~,EGIN ~E:~t_L 3.4'34 IN _ _ 1,:: 1;.._~tl:IG ENC~ TIt`!E iCU3~ riff ;.Y~lv '1N - E:Nfi C:ri7c: 61'31x2056 - - . - -_...i.._ _, «,:'rr:~~ :;; ENG LEUEL 3.4713 IN ._ .._. ~ ~nILEG 'Erik: THRE.SHnLi~ 5.552 TN TE'T RESULT FAILED ~ : S7 5P~~~ C5 ed. ~; . ,r ' ~ " : -. 114205x, ~' - - ~ TEST ^'THRTE~ 1t~:23 Atrt _ ~> -`E~:T ~. ; h~"tTE'v 1~1 x31 x 2536 . c~r56 r1M EE~IN LEUEL 0.4457 IN - ." .- _ ~~,:~::ir~_6~0~~ cNG '_PI- 13:35 HM _. ..... r~,'~1.%05 :ta ENv C}AYE 51/3ir209C -. .sti;;_i;~ :t. k3e11 ih1 -- EiiG LE.t1EL ri.495 IN _ -_._-, f-•r;5'cG LEtiK THR}SHOED H. 552 Ihi T='~T F?ES(.iLT PASSED , S,r;`„ {~~,+, . _ ti:=,u4- q, se~~ spy ~:: ~;~.al riP1 - - ~.-; _ - 3•ix1~=36 T,-:; ~TR~:rE~ li~:l~ Hr~ _ .-. .".~ .. =:144 IN , TEST ~TnRTED k3ix31r2006 _ _.. 1e?':~E RPi hEtilN LEt)f=L 1.314u IN =i;; x7:006 ENC? TiftE 16:3c~ Rhi .., ~ i44 IN EtiG v~r1TE: Eilx31x2006 -=3r.:~1~ _.>~l'~2 iN ENU Lcf1E:. 1:3145 Ik --.-.. .-.......__- PhSb"EG i_Er'if•: '+i-iF~ESi;4LL~ b.5~12 IN TEc;? fiESl tLT PASSED yi !=ILL C+Ia 1 STS c^ SRL'O t4E ~34k~7: 1-8p0-v84-62r~i, 31x32r1005 1:45 Phi SUMP LEAK T=ST REPORT ~"D S U M ~n '~ TEST STARTED 1:3© P!q TEST STRRTEG 01r31x200E t+EGiN LEUEL 2.8S0i IN Eh(G TIP)E 2:45 PAt END CinTE 01r31r2006 ENG LEUEL 2.8x,95 IN LEHK 7HF,ESHOLCJ 3.002 IN TEST RESULT PRSvEG ". SILL DI8 DIS SRCG ME 04p72 Fi,•31xg006 2:03 PPI 'D'UMP LErtK TEti T REPORT CdSPi -;! TEST S.TriRTEG 1:48 Pt9 TEST STARTED k91:31!ipF36 SEC+IN LEUEL ~. t•4$~~ IN END TIME 2:03 Phi =NG DriTE 01x31 ~'0~ ENG LEUEL 2.$4x~Ei IN 'ERK THRESHOLG 0.002 IN TEST RESULT PH~SEG <'' ', i~ ':~1 =i(_ l`15 i'l 1 4~ 1:! Si•i?1P :_r_riF: TEti~ r' tu'+JNT GPi-2 TE.^T ^TAF'TEG +~1~i ~':~ ~!2b0~., ,_ ENG TIM1, ±~]:t~ Hf•1 ~}dG L''ATE i~ir';1r•~y,0~ =yY. T;ir~E'_:~il1LG U.+~02 I^r 7E~'T RESULT PH•JJEG .3~-~~yJ 'r'Jf_~ TE•S7 STAi?TED yc5~~r;r^• TEST c;TritlTEp ~ijr,;i.`2Eirr EEGIt; LEVEL .~•~3r' It+ ENG TIME J;t~.%J~ rill END DR-fE Eti2!~;:r20~ LEAk: THP.ESHULG ~~. ~=iFi2 IN 1"i.S7 =~EULT ~RSED TEST =,TRRTEC' =:5k~ AJ~ TEST STARTED O'i'"ir:~i0b c~EGIN LEVEL 4.9190 'tJ ENG TIME 11:05 Rhi t'i~IG C'RTt ~.~1r'•iirN30b ENG LEVEL +~9IE" IN LEi~}; THRESHOLD 0. L~2 _N TEST RESULT PR;iaEG 6 >i FiLL DIti 47'`; 'r SRCO t9E Et40''~ 1-80a-9a4-b266 F11.!~•1!2E~0E 9:45 HP'I SUr1P (_EAY•, TEST REEL+f~T DSFl-2 "i'EuT ~Tr",kTEu 9:33 Arl TEST STARTED 01!31~`2Q~ ~SEGIN LE+JEL ~.'7~7 IN ENG TIh]E 9:45• AP] ENG f.~RTE rtir~i!~e06 END LEVEL ~.7?74 IN i~ERK: T}iRES'HOLD 0.002 IN TEST RESULT PASSED 3 -~r DsP TEST STARTEG 9:33 AM TEST STARTED 01!31!2006 BEGIN LEVEL 's. 6204 IN END TIME 9:413 RM END DRTE 01!312006 E}iD LE+.)EL 3,E190 IN LEAK THRESHOLD 0.002 Tt~+ TEST RESULT- PASSED GSPS-h TE:;T STARTED 9::;3 Rti TEST STARTEG 01!31!2Qa6 SEGIN LEVEL 4.9197 IN ENG TTP]E 9:48 RM cND GATE al!31!2006 ENG LEVEL 4,91?0 IN LEAK THRESHOLD 0.+02 IN TEST RESULT PASSED )zoS.S r :~ r , ,z~o5s gig SB989 TESTING FAILURE REPORT 3I TE NAME : ~ 1 Y' L {~, ~G11 DATE : `\~-~3~,1~'~0 ~O (~ ADDRESS: ,~~,~ ~~.5~ ~w~,~ TECSNICIAN:~('1~1Y\ t~OAIIK~•~~'~K.S R1~ CITY : ~ aktxs-fi e1[~ s I aNATORB :~r._~i(- SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE SB989 TESTING. LIST OF PARTS REPLACEb/REPAIRED: ,/~ REPAIRS:r„~~~ l~lR~oh SoWVO r1-~,~.~~4~~AlYe(y LABOR : ~ p'n.Q~ PARTS INSTALLED : N b1~r UNDERGROUND STORAGE TANK ~, ~~~~ ~~~ B B R S F I D PERMIT APPLICATION t~ f/RB A~ T TO OPERATE AN UST PERMIT NO. TYPE OF APPLICATION (CHECK) ^ OPERATE NEW FACILITY TRANSFER OF OWNERSHIP BAKERSFIELD FIRE DEPT. Preveation Services r J~ 900 Truxtun Ave., Ste. 210 ~ c V ` ~ Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ TO OPERATE AN EXISTING FACILITY ~ . PREVIOUS~T INK ~~ER if9 ' li8able~ ' NA61E HONE N0. I PDDRESS ITY - - IP CODE i `, "- :. NEW TANK OWNER ;' NAME ~R c~,~lE g~VA,~~ HONE NO Glv/-- 3~ ~ 3t/a2~ _ ADDRESS ITY IP CODE -. BILLING ADDRESS 9 S~ Q~,~G ~A- ITY .9-~~ ~~ - IP CODE 9 3 3 v AMI~ E ' TANK40PERATOR'(ddif{e[erit~fromo_wrier)° ~ ~~HONENO a~ CODE vier) ,,"I CODE - --_ _ - =ACILITY NAME PPERATUR NAME ,... HONE NU IP CODE CODE Do you have a HAZARDOUS MATERIAL RESPONSE PLAN? ^ YES ^ NO Do you have an OWNER -OPERATOR AGREEMENT? ^ YES ^ NO Have you filled out a HAZARDOUS MATERIAL BUSINESS PLAN? ^ YES ^ NO FOR OFFICIAL USE ONLY The applicant has received, understands, and will comply with the attached conditions of the permit and any other state, local and federal regulations. This form has been completed under penalty of perjury, and to the b~ of my knowledge, is true qnd correc>~ APPLICANT SIGNATURE: APPLICANT NAME (PRINT:) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY: FD2087 (Rev. 09/05) UNDESG~®~n~D sT®RAGE T~N~cs .~ ~ - ~;., ~ ~SF~LD ~Iit~ D~. ~~- :~~ ~~ ~ , F~~='~ 900 Truxtun Ave., Ste. 210 ,~(~~~~~,~~~ ' ~ '~: : ~ Bakersfield, CA 93301 TO PERFORM ELD 1 LINE TESTING TeI.: (661 326-3979 / SB989 SECONDARY CONTAINMENT TESTING ~`ax: (661 852-2171 /TANIG TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION ?age 1 of 1 PERMIT NO. ~""' G~i ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINfviENT TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL ArIONlTORING CERTIFICATION S~TE.INF-.OHi1AT!Oh FACILITY J/~- ~-~-~~ ~~-1- NA~~Iw & PI;ONE NUPatBER OF CONTAC7~ bERSO~t - ADDRESS l~ ^n pWNERS NAME i ~ j PERAT{7RS NA~i7E ,PERMIT TO OPERATE NO. j i 'NUMBER OF TANKS TO BE TESTED ~ TA N !L # - ~ ----------- IS PIPING GOING TO BE TESTED? YES ______._^ NO ((~ ----- - ~'- ~ ~ --- ~ - -- VOLUME ! CONTENTS --_- - ~ --- i ~ ~ _-_-- ---- ___- . ---- - I i ~ ~ ~ ---- ---- - ! a r --- j -- ----- ~ ~ - - ------ ----- -- ------------ I I j ~ ~ __--- -- - _ - -_ ~ ~ __ _ -- _ _ __ ~ I TANK TESTItVG CORhPANY NAM OF TESTING COM`PAN.Y . INANE Pl-IOPJE NUM~3E. OF CONTACT' PERSON ' ~ ~t ~~~-rani ~9~-~ . ~ ~ c~a.n.~, . ~c,~-.-~.~ (c(~ ~ -Q3~1-(~9Q ~ ~MAILIt~G ADDRESS !NAM & PHONE (NUMBER OF TESTER OR SPE~AL INSdECTOR ERTIF(CATION ~: ~ ~-~ ~ ~ifc~~~~~'~ , D 0 ~~- 6 63S 13~- ATE TIME TEST TO BE CONDUCTED jiCC #: EST METHOD __~i1 ~~ ~o2b6(o 4;00 ~ Sa~[9 a.~~- UT ~ ~-tic-6~..J ~IG{yATURE ~ t~'PLICANT ,ATE _ 72-/1 t~ APPROVED BY (DATE U FD2106 ~ ..:~ i~ ~~. UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~ ~ O BAKERSFIELD FIRE DEPT. b._ B R S P I n prevention Services P/Rt A/rrM T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661} 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ T(7 PFRF(1RM FI1FI MnNITnRING CERTIFICATION SITE INFORMATION FACILITY ~ ~ NAME 8 PHONE NUMBE OF CONTACT PERSON /~G'L~ ~GI -~ /~,g-c~= ~~/-~~ ADDRESS/ ~/~ ~~ ~~~D/ OWNERS NAME ~'- ~/y/ ~jl2LI ~j I'ZCi1Z OPERATORS NAME ~~ l ~ PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ~^~ J YES ^ NO TANK# VOLUME CONTENTS ~- ~ ~ Cam) ~~ ~9r.~C,~/.~c ' TANK TESTING COMPANY NAME OF TESTING COMPANY v NAME & PHONE NUMBER OF CONTACT PERSON MAILING ADDRESS ~7~~ AG. ~u~ti~s s ~T~ t.~- u~ ~es~,v z Gas ~~.~- NAME 8 PHONE UMBER OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #: ~ ~ _ j ~b~ DATE 8 TIME TEST TO BE CONDUCTED ~ ICC #: TEST METHOD SIGNATURE OF APPLICA DATE - ~~ APPROVED BY sf+. f2C~8~ _V~ DATE 1 /~i o6 ~y~a.,r~, p~D~~~-~T,C2 ~,~~j ~ ~` ~rr~,/,~vo FD 2095 (Rev. 09/05) /cSf~r+k•~ct~ 1 /~ s jcf` ,. . Praxair Services, Inc. Date: 1/2/06 To: Jerry Hill D&J Construction 661-201-3707 Re: C ircle Deli Mart -ELD /Leak Locate -Work Plan Site Name: Circle Deli Mart Site Address: 1416 Golden State Ave. Site City Bakersfield Site State CA Site Zip 93301 Praxair Services, Inc. 3755 N. Business Center Drive Tucson, AZ 85705 Tel: (800) 3949928 Fax: (520) 293-1306 History: Praxair Services performed ELD testing at the Circle Deli Mart, Bakersfield, CA on September 19, 2005 under contract with Shirley Environmental. The results of the testing indicated that a below ground release is occurring in the immediate area of the Automatic Tank Gauge (ATG) riser on the 87 Tank. The release was detected utilizing Helium during the initial check of accessible tank and piping fittings. Samples collected from the probes placed to test the top of the tank showed high helium concentrations in the area of the 87-ATG. Tracer was then placed in the tank to double check the findings. Tracer A was detected at high concentrations at the same location in a short period of time. Release locations associate with this area include: ATG-Tank riser connections, buried tank bongs, vent and vapor lines in the immediate area. Due to the high concentration level, it was determined to suspend testing and recommended that this area be exposed and repairs made before resuming testing. The high concentrations encountered could easily mask additional below ground issues or be the result of several release locations in the same area. It is Praxair's understanding that repairs were made in this area and that subsequent helium testing performed by Shirley Environmental indicates that a problem still exists. The goal of the following work plan is to outline a testing process that will isolate as much as possible each component of the tank system (Tanks, VentNapor Recovery Piping and product piping) and hopefully pin point areas for repair. This should expedite repair efforts. INFORMATION CONTAINED WITHIN IS CONSIDERED CONFIDENTIAL, PROPRIETARY INFORMATTON OF PRAXAIR SERVICES, INC. =~ -= = PRaJrA/R PI"c7Xai1' Set"VICES, ,LnC. Praxair Services, Inc. 3755 N. Business Center Drive Tucson, AZ 85705 Tel: (800) 3848828 Fax: (520) 293-1306 woxx PLAN: In order to expedite testing and isolate system components, the station should be prepared to suspend operations during testing. A repair contractor will also need to be on- site equipped to provide system modifications described below. Product Lines: It will be necessary to purge all fuel from the product lines and provide access to the lines at each shear valve at each dispenser. A tracer helium mixture can then be added to the lines and almost immediate test sampling can occur through the secondary containment. Secondary access (shreader valve, Test port) needs to be available at the turbine sump. Secondary access at each dispenser would also be preferred or at least, the ability to pull back secondary boots to allow air flow. Vent/Vapor Lines: The isolation of the Vent/Vapor lines will involve the installationof an Extractor Plug by a Repair Contractor and access to the Vapor Recovery shear valves within each dispenser. With the vent and vapor lines isolated from the tanks, a Tracer/Helium mixture can then be used to test these lines separately. The time involved for the testing will be based of movement of a simulated Leak within the backfill - Typically 2 to 12 hours. Tanks: The addition of the Extractor plug will isolate the tanks from the vent/VR piping. A temporary Vent will need to be installed on each tank. This can be accomplished by removing the fill drop tube and installing a riser or stand pipe to the top of each fill riser. A Pressure relief Cap can then be installed on the top of the temporary riser to allow adequate testing pressure to be applied as well as over pressure venting to occur. Separate tracers can then be added to each tank for testing. The time involved for the testing will be based of movement of a simulated leak within the backfill -Typically 2 to 12 hours. Testing of the product line through the accessible secondary will be almost immediate and if tracer is detected the release point can be located relatively quickly. Test sampling of the tanks and Vent/VR Lines will be performed by sampling the existing probe system. Samples will be collected at intervals after each item is inoculated and the anticipated tracer concentration monitored as they develop. Location of each tracer detection will then be mapped and reviewed during testing with contractor to determine most likely source for repair. Separate tracers can and will be used to help eliminate or confirm release locations. Additional test probes can also be installed if necessary to further locate area of release. Scheduling and coordination with the owner and repair contractor will be needed to help minimize costs. Any site prep that can be accomplished prior to Praxair's arrival INFORMATION CONTAINED WITHIN IS CONSIDERED CONFIDENTIAL, PROPRIETARY INFORMATION OF PRAXAIR SERVICES, INC. _- ~- ' PRAXAIR ~} T _ Praxair Services, Inc. _~- P .R 3755 N. Business Center Drive Tucson, AZ 85705 Praxair Services, inc. Tel: (800) 394.9929 Fax: (520) 293-1306 should be accomplished. Praxair will provide all assistance possible to advise, schedule and complete testing in as timely a manner as possible. REPAIRS: Once release locations are identified, the time and method of repairs can be reviewed. Praxair will do everything possible to assist in the physically locating and confirming repair completion in as costly a manner as possible. If you have any questions or require any additional information concerning this Work Plan or ELD testing procedures, Please contact me at 520-271-4540. Mark D Caldon ELD Project Manager Praxair Services, Inc. 3755 N. Business Center Drive Tucson, AZ 85705 Tel: ($00) 394.9929 -x248 Cell: (520) 271-4540 Fax: (520) 293-1306 'Thanks Mark D. Caldon ELD Project Manager Praxair Services, INC. Off: 520-545-0248 Fax:520-293-1306 Cell: 520-271-4540 INFORMATION CONTAINED WITHIN IS CONSIDERED CONFIDENTIAL, PROPRIETARY INFORMATION OF PRAXAIR SERVICES, INC. ~: =FRAXAtR 1tC 12 c'_CJ4l'~ 11 lEiiii'1 hi° L_S~SE:R.;E_.y.. :i~'JO ., _ "b~1~a,!1'.fD~ ~~t5~ ~5;i5b71&:4 ~9G .F , v ... ca . aai~ry M•oY ~~ G 6 .-~~vP ~Y wrlnYOe .. YAw~MIIA..... Jam. Yas~r 8 . ., .~ ~' , --- ..._.....~_-___._~ti....._..... ~J~ ~ ~~~~ ~ s ,~ ~: -' N T ~ -~ -~ ~ 1 i.i .c~G i ~~ ~ ~~ i ~~ r e (~ ~~ ~~~~ a~ ~ ~~~ ~~ ~l (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM} APPLICAl10N BUSNESS OIMVB~/ OPF~tATOR DBVT'FKA110N FOFiIIA (HAZARDOUS MATERIALS FACILITY INFORMATION) B__ __L_ R_S_ ",_7 P FtRB ~Rrr r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 2 1. FACILITY IDENTIFICATION 1 FACILffY ID N0. 1 Year Beginning too Year Ending 101 BUSINESS NA E (Same FA ILITYt/uy,(e='^•,~•E or BA- Doing Business As) 3 ~ BUSINESS PHONE ~/ ~~ ~ ^ 102 ~~C ~ ~ •YI \ O SITE ADD $ ~ ~ { to3 ~ t ` 1oa CITY IP ~ ~~© / / tos CA DUNN 8 BRADSTREET 1t)8 SIC CODE 107 (4 Digit #) COUNTY 1C8 1os OPERATOR NAME OPERATOR PHONE ^ ~~ 1m ~ ~ ~ 11. OWNER INFORMATION OWNER NAME 111 OWNER PHONE 112 r s ~ ~3~•3~au OWNER MAILING ADDRESS ~ c Its CITY na STATE 115 IP 11e '~a r t ~- q 33 -111.. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 ~cNA ~ ~ 3a ~3~1 a ~ CONTACT MAILING ADDRESS ~ tt9 coL ( ~ S ©. CITY ~ 120 STATE t21 ~ ZIP ci 330 t22 - PRIMARY:- Iv. EMERGENCY coN rACrs -SECONDARY- NAME 123 iN1 NAME 128 c,r ~ TITLE 124 TITLE 129 ~ ~ r BUSINESS PHONE 1 125 l r d- BUSINESS PHONE 130 24-HOUR PHONE 126 24-HOUR PHONE 131 f ~ ~ 3~ ~'~i~~( PAGER NO. 127 PAGER N0. 132 133 V. CERTIFICATION Certification: 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 informatio n su bmitted in this inventory and believe the information is true, accurate, and complete. SIGNATURE OF SIGNER y~C~i~~~~/v" ~ 136 ~ ~ Jl DATE 134 3 -7 ~~~ NAME OF DOCUMENT ?RFP.4RER 135 NAME OF OWNER/OPERATOR ;SDIt;NAit1RE s °RINT 137 TITLE OF OWNERlOPERATOR 138 FD 2142 (Rev. ~9/175) (Hazardous Materials h~tci(eti~ Information -HMMP) Business Owner/Operator Identification Please submit the Business Activities page, the Hazardous Materials Facititylnformation (HMMP) Business Owner/Operator Identification Form, and Hazardo~ Materials Inventory Chemical Description Form for all hazardous materials 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 fo/%ws the data a%ment numbers that are on the Business Owner Operator Form page. These data a%ment numb8. are used fore%ctronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary. Please number a!! pages of your submittal This helps our CUPA or AA identify whether the submittal is comp/ete and if any pages are separated. 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 Page 2 FACILITY I.D. NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. BUSINESS NAME -Enter the full legal name of the business. BEGINNING DATE -Enter the beginning year and date of the report. (YYYYMMDD) ENDING DATE -Enter the ending year and date of the report. (YYYYMMDD) BUSINESS PHONE -Enter the phone number, area code first, and any extension 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. CITY -Enter the city or unincorporated area in which business site is located. ZIP CODE -Enter the zip code of business site. The extra 4 digit zip may also be added. DUNN & BRADSTREET -Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be obtained by calling (610) 882- 7748 or by Internet. SIC CODE -Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE.' /fcode is more than 4 digits, report on/y the first four COUNTY -Enter the county in which the business site is located. BUSINESS OPERATOR NAME -Enter the name of the business operator. BUSINESS OPERATOR PHONE -Enter business operator phone number, if different from business phone, area code first, and any extension. OWNER NAME -Enter name of business owner, if different from business operator. OWNER PHONE -Enter the business owner's phone number if different from business phone, area code first, and any extension. OWNER MAILING ADDRESS -Enter the owner's mailing address if different from business site address. OWNER CITY -Enter the name of the city for the owner's mailing address. OWNER STATE -Enter the 2 character state abbreviation for the owner's mailing address. OWNER ZIP CODE -Enter the zip code for the owner's address. The extra 4 digit zip may also be added. ENVIRONMENTAL CONTACT NAME -Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. CONTACT PHONE -Enter the phone number, if different from the Owner or Operator, at which the environmental contact can be contacted, area code first, and any extension. CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact correspondence should be sent, if different from the site address. CITY -Enter the name of the city for the environmental contact's mailing address. STATE -Enter the 2 character state abbreviation for the environmental contact's mailing address. ZIP CODE -Enter the zip code of the environmental contact's mailing address. The extra 4 digit zip may also be added. PRIMARY EMERGENCY CONTACT NAME -Enter the name of a representative that can be contacted in case of an emergency involving hazardou materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regardint incident mitigation. TITLE -Enter the title of the primary emergency contact. BUSINESS PHONE -Enter the business number for the primary emergency contact, area code first, and any extensions. 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's home phone number, then the service answering the phone must be able to immediately contact the individu; stated above. PAGER NUMBER -Enter the pager number for the primary emergency contact, if available. SECONDARY EMERGENCY CONTACT NAME -Enter the name of a secondary representative that can be contacted in the event 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. TITLE -Enter the title of the secondary emergency contact. BUSINESS PHONE -Enter the business telephone number for the secondary emergency contact, area code first, and any extension. 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's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. PAGER NUMBER -Enter the pager number for the secondary emergency contact, if available. ADDITIONAL LOCALLY COLLECTED INFORMATION -This space may be used for CUPA's or AA's to collect any additional information necessan to meet the requirements of their individual programs. Contact your local agency for guidance. DATE -Enter the date that the document was signed. (YYYYMMDD) NAME OF THE DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. NAME OF DOCUMENT SIGNER (FULL PRINTED NAME) -Enter the full printed name of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer's inquiry of those individuals responsible for obtaining the information, all the information submitted is true, accurate and complete. SIGNATURE OF OWNERtOPERATOR/OR DESIGNATED REPRESENTATIVE -The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the signer's belief that the submitted information is true, accurate and complete. TITLE OF OWNER/OPERATOR/OR DESIGNATED REPRESENTATIVE (SIGNER) -Enter the title of the person signing the page. of 2 FD 2142 (Rev. 09/05) (HMMP) BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIALS MANAGEMENT PLAN H., ,E R 9 _P,1 _ D Prevention Services ~,~ ,..... :,- :.:.., . , = P/R/ 900 Truxtun Ave., Ste. 210 INSTRUCTIONS ARTM f Bakersfield, CA 93301 FOR HMMP SECTION DISCOVERY ~ Tel.: (661) 326-3979 AND NOTIFICATION (FORMS) Fax: (661) 852-2171 Page 1 of 2 SECTION I. -BUSINESS IDENTIFICATION DATA: The Business Owner /Operator Identification Form FD2089, Chemical Description Form(s) FD2086, and other forms (e.g.; underground storage tank information, hazardous waste treatment, etc., as needed) may be submitted as the first section of the Hazardous Materials Management Plan in order to avoid duplication of information for initial submissions. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 11.1 -DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Describe the procedures and equipment used to detect any release or threatened release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EMPLOYEE AND AGENCY NOTIFICATION: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -What procedures are used to notify these parties? At a minimum, you must calf 9-1-1 and the Office of Emergency Services at 1-800- 852-7550 to report any spills that are a threat to life, safety or the environment, or for other non~mergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident involving Hazardous Materials used at your business. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 11.2 -RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C. CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be implemented in case of a release at your business. This should address small spills, as well as a major release of material once the material is contained. Hazardous Waste: Please provide the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removed. Please keep all disposal receipts for the last three years available on site for inspection. FD 2169a (Rev. 09/05) HAZARDOUS MATERIALS MANAGEMENT PLAN SEC710N 11.2 -RELEASE RESPONSE PLAN tCONT.) UTILITY SHUT-OFFS List locations of shut offs using compass points and known or obvious landmarks. if you have a lock box containing keys and maps of the facility for the Fire Department to use, please list its location also. PRIVATE FIRE PROTECTIONNVATER AVAILABILITY A. Private Fire Protection: Describe on-site fire protection for your business or facility unit, including sprinklers, fire extinguishers, alarm systems and private response teams. B. Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the Fire Department in case of an emergency. SECTION III -TRAINING List the number of employees that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to be in those areas. Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS must be readily available on sit in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a program which provides employees with initial and refresher training in the following areas: 1. Methods for safe handling of the hazardous materials used by your business. 2. The Cal OSHA Hazard Communication Standard. 3. Correct use of emergency response equipment and supplies available at your business. 4. The prevention, minimizing and clean up procedures you have developed for your business. 5. The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6. Procedure to coordinate with and assist the local emergency personnel that may respond to your business. 7. Who and how to call for immediate assistance in the event of an accident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, ins°entory forms, and map ~~~ithin 30 da~~s of receipt. If you have any questions please callus at (661) 326-3979 Thank you for helping to keep our All America Ciry cleaner and safer. CITY OF BAKERSFIELD BAKERSFIELD FIRE DEPT., OFFICE OF PREVENTION SERVICES 900 Truxtun Avenue, Suite 210, Bakersfield, CA Page 2 of 2 FD 2169a (Rev. Qs105) (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN APPLICATION FOR SECTION DISCOVERY AND NOTIFICATION (FORMS) B,_ HR9F~ D ~IR% ARTM r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (6611852-2171 INSTRUCTIONS Page 1 of 2 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: FACILITY IDENTIFICATION . BUSINESS NAME (Same as FACILITY NAME or DB - Doingsines As) ADDRESS rFOr local use oNyy .~,q ~nj, ~ ~ ~ / -V 1A1~. © FACILITY ID NO. ~ $ECTION 11.4: DISCOVERY AND NOTIFICATIONS A LEAK DETECTION AND MONRORING PROCEDURES: r rr ff ~~ // / ~ ~0.5 S~~oN ~cc~~C C~ctcc'~lo~ gyS`1r~ ~ & W t t~ d.t0 QGt ~~ l C t c~Cs p-F L15~ S~.s~C'~ B. EMPLOYEE AND AGENCY NOTIFICATION: q ~~ (h -~~ ~o)ca~ A-F ~ Cd).~CLS~'~~cC. I~c.~CaSf... C. ENVIRONMENTAL RESPONSE MANAGEMENT: c ~~ ~~tt~S tt}cl~ t}S~ ~c~.y 1~-~-cr ~~ ~h l~scr~-6e~ D. EMERGENCY MEDICAL PLAN: S4N ~ ©ay~~~, ~Q~~~ SECTION 11.2: RELEASE RESPONSE. PLAN A. HAZARD ASSESMENT AND PREVENTION MEASURES: 1 R B. RELEASE CONTAINMENT AND/OR MITIGATION: t ~-y ~~ ~r C. CLEAN-UP AND RECOVERY PROCEDURES: [( ~ }, f r n ~\ R f v l~ ` S 1 FD 2169 (Rev. Os/o5) Page 2 of 2 SECTION 11.2: RELEASE RESPONSE PLAN-CONT. UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: t~ ,I WATER: SPECIAL: n PRNATE FIRE PROTECTIONM/ATERRVAILABILITY: A PRNATE FIRE PROTECTION: B. WATER AVAILABILITYc(FIRE HYDRANT): CS ... , ~.;, SECTION III: TRAINING ; NUMBER OF EMPL~EES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SU RY OF TRAINING PROGRAM: ~(~ ct~- I o~c~.s cv ~ tl ~ ~ t~acrnc~ am c~ (.~f' ~o c~a ~f Qti C~v ~e ~ ~ CG`CCI~., ~~ '~CfC..1 ~i'~ONL ~CI~j'~If~ S~ l~ ~bl~C- ~A~'KS _. CERTIFICATION Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that 1 have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF ER I OPE TOR OR DESIGNATED REPRESENTATIVE DATE 477 I NAME~O( F~SGIG R/~(p/r~int) CC ~+,/~ ,QQ ']-/, 478 / ~/ G~ (iL~C J /~~ I/Il~/ `^c~/ C/ ' TITLE OF SIG,N~/E/R~' 479 (1/T/~~~ FD 2169 (Rev. astos> (HMMP) BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIALS MANAGEMENT PLAN Prevention Services n... A_x__s..r__i n 900 Truxtun Ave., Ste. 210 f/RE Bakersfield, CA 93301 INSTRUCTIONS ~Arr r Tel.: (661) 326-3979 FOR ~~I~-~~~~ ~ ~ Fax: (661) 852-2171 HAZARDOUS MATERIALS INVENTORY FORM Make as many copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of a gas. Report any amount of any hazardous waste being generated or handled on site. I. FACILITY INFORMATION: Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Enter the business name at the top of the form. Enter the page number in the right hand comer. Describe the exact location of the hazardous waste or material being reported. NOTE: Chemical location information is considered confidential unless you check "no." If a site map is being submitted, you may refer to the map number and grid coordinates for the approximate location of the material, as shown on the map. II. CHEMICAL INFORMATION: Each of the instructions below correspond to the entry field with the same number on the chemical description form. CHEMICAL NAME 205 Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture or a hazardous waste, do not complete this field; complete the "common name" field instead. TRADE SECRET 206 Check "Y" for yes if the information in this section is declared a trade secret, or "N" for no, if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by Health and Safety Code, Section 25511. Federal Requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by Title 40 Code of Federal Regulations (CFR) and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. COMMON NAME 207 Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. EHS 208 Check "Y" for yes if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, Leave this section blank and complete the section on hazardous CAS 209 Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the section below. FIRE CODE HAZARD CLASSES (Please leave blank) 210 HAZARDOUS MATERIAL TYPE 211 Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. RADIOACTIVE 212 Check "Y" for yes if the hazardous material is radioactive or "N" for no, if it is not. CURIES 213 If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. PHYSICAL STATE 214 Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gaseous (gas). LARGEST CONTAINER 215 Enter the total capacity of the largest container in which the material is stored. FEDERAL HAZARD CATEGORIES 216 Check all the physical and health hazards associated with the hazardous material: PHYSICAL HAZARDS: Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents Page 1 of 3 FD 2145 (Rev. 09/05) HEALTH HAZARDS: Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short term exposure. Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with long term exposure. ANNUAL WASTE AMOUNT 217 If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. MAXIMUM DAILY AMOUNT 218 Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacenUoutside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. AVERAGE DAILY AMOUNT 219 Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. STATE WASTE CODE 220 If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. A list of common State Waste Codes are included on page 3 of these instructions. UNITS 221 Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). DAYS ON SITE 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER 223 Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT 1 - 5 (% by weight) 226, 230, 234, 238, 242 If a range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1 - 5 Name 227,231,235,239,243 When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT 1 - 5 EHS 228,232,236,240,244 Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "N" for no, if it is not. HAZARDOUS COMPONENT 1 - 5 CAS 229, 2.33, 237, 2415 245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: 246 Please print name, title, sign and date each chemical description form. if you have any questions Please call us at (661) 326-3979 FD 2145 (Rev. 09/05) CALIFORNIA WASTE CODES Code Description Inorganics III 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) contain- ing reactive anoins. (azide, bromate, nitrite, Perchlorate and sulfide anions) 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues 100% or more 134 Aqueous solution with total organic residues less than 10°I° 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 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 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste 261 PCB's and material containing PCB's 271 Organic monomer waste (includes Code Description Organics (con't) 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 Sludg es 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 Sulfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 Tetraethyl lead sludge 491 Unspecified sludge waste Miscellaneous 511 Empty pesticide containers 30 gal or more 512 Other empty container 30 gal or more 513 Empty containers less than 30 gal 521 Drilling mud 531 Chemical toilet waste 541 Photo chemical/photo processing waste 551 Laboratory waste chemicals 561 Detergent and soap 571 Fly ash, bottom ash, and retort ash 581 Gas scrubber waste 591 Bag house waste 611 Contaminated soil from site clean-ups 612 Household wastes Page 3 of 3 FD 2145 (Rev. 09/05) (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIALS INVENTORY ^ NEW ^ ADD ^ DELETE ^ REVISE 200 B . A x„s...p_.r, n ~/~/ ABfA1 T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 (One form per material, per building. or area.) Paoe~ of 2 1. FACILITY INFORMATION oing Business As) me as FACILITY NAME or DBA - D BUSINESS NAME (Sa i r l CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 ~^- ~ `, ! C,~ ~~ CONFIDENTIAL (EPCRA) ^ Yes C N FACILITY ID No. 1 MAP No. (optional) 203 GRID N0. (optional) 2 il. CHEMICAL INFORMATION CHEMICAL NAME ~ 205 2 TRADE SECRET ^ Yes ^ No 0150 i COMMON NAME 207 ` EHS' ^ Yes ^ No p,S (t zo CAS No. 209 •If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE 211 212 RADIOACTIVE: ^ Yes ^~ CURIES 21 0 p PURE MIXTURE ^ w WASTE _ ~ LARGEST CONTAINER 21 PHYSICAL STATE ^ s SOLID i~fLIQUID ^ g GAS 214 ~ ~~~ ~'" ~~~~ FED HAZARD CATEGORIES 1 FIRE (Sr.,2'REACTIVE ^ 3 PRESSURE RELEASE ^ egr+~uTE ,.,, ~~ HEALTH L1.~Fll;HRONIC HEALTH 21 (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 22 AMOUNT DAILY AMOUNT ~+ i ~ ~{ DAILY AMOUNT ~ ~ I~ CODE 221 222 ^ UNITS 7 GAL ^ cf CU FT ^ Ib LBS ^ to TONS DAYS ON SITE If EHS, amount must be in lbs. 22 STORAGE CONTAINER (C~eck all that apply) u a OVEGROUND TANK ^ f CAN ^ k BOX ^ p TANK WAGON UNDERGROUND TANK ^ g CARBOY C I CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE ^ e PLASTIClNONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 22 STORAGE PRESSURE ~' a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT 22 STORAGE TEMPERATURE AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC %WT HAZARDOUS COMPONENT EHS CAS # 1 226 227 C Yes ^ No 228 22 2 230 231 ^ Yes ^ No 232 23 3 234 235 ^ Yes ^ No 236 237 4 238 239 i~~ Yes ^ No 240 241 5 242 243 ^ Yes ^ No 244 2q 111. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIG NATURE DATE 24q FD 2144 (Rev. 09/05) Hazardous Materials Inventory -Chemical Description UNIFIED PROGRAM CONSOLIDATED FORMS You must complete a separate at ~uantitiesaequal to oegreater than 5 01 poundsti55 gaUons,r200 c tic feet of gas (rcalculated a~ standard temperature and p essure))ohthe federal handle at your facility in aggreg q threshold planning quanti d torbe adopt d pursuant to 10s CFR Parts 30v 405or~0. The comp eted nventory shoulddrreflect allnreportable quaClties of hazardous materials at your emergency plan is regw e faGlrty, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage to egeof our subm ttalgeTh s helps (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission an are ndix C, the Business Section of the Unified Program Oata Dictionary.) Please number all pag Y the same as the numbering used in 27 CCR, Appe your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID 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. 200. ADDlDELETE/ REVISE -1 this bla k you resubm'd you enU'ere inveentory annumyeleted from the inventory, or if the information previously submitted is being revised. N You may choose to leave 201. CHEMICAL LOCATION -Enter the building oroutside/ adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure an temperature, in multiple to NIFIDENTIALa EPCRA A11 businesses which a el subject t NhOe Emergency Plann nig and Community Rightito Know Act EPC tRA) must check "Yes 202. CHEMICAL LOCATION CO to NUMBER - If acamap is i c udednenterthe number of thelmap on wtirch the otcation of the hazlardous materia as showy dential check "No . 204. GRID NUMBER - If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple gri 203. MA coordinates can be listed. 205. CHEMICAL NAME - Enter the emrper BUPA ) name fosund on~theiMatena SafetylData Sheet (MSDS)ASNOTEbIf thetchehmicalas amixture, do not complete this field; complete Union of Pure and Applied Ch ry the "COMMON NAME" field instead. 25511. 206. TRADE SECRET -Check "Yes" ff the information in this section is declared a trade secret, or "No" if it is no . State requirement: If yes, and business is not subject to EPGRA, disclosure of the designated trade secret information is bound by HSC § Federal requirement: If Yen C aims of Trade Seicre ~ form ( 01 CFRu350.27) toeUSEPA. Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompa y 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous mama 208. EHS -Check "Ye Sifleave thisrsection blank and complet the sectionuon hazardous(components below. 40 CFR, Part 355, Appendix A. if the material is a mixture containing an EH 209. CAS # - Enter th~tme ne ~ b If the mixture has no CASbnumbehefeave th suco umn blank and reporrt the CAS numbers ofbthee mdividualthazardous components ndthe um r distinct from its mpo appropriate section below. 210. FIRE CODE ~Adea fhe S~1 firelrchief deemsat necessary and requests the UPA or AA topcolled itVeA 1 st o the hazard classes ands structions ondhow to determines or which class a material falls under are inGuded in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard Gass, inGude al . shall only be pro Contact CUPA or AA for guidance. a of hazardous material: pure, mixture or waste. 1f waste material, check only that box. If 211. HAZARDOUS MATERIAL TYPE -Check the one box that best describes the typ mixture or waste, complete hazardous components section. 212. RADIOACTNE -Check "Yes" if the hazardous material is radioactive or "No" if it is not. 213. CURIES - K the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating dedmal point to report activity m curies. 214. PHYSICAL STATE -Check the one box that best describes the state in which the hazardous material is handled: solid, liqui or gas. 215. LARGEST CONTAINER 'Enter the total capaGty of the largest container In which the material is stored. user ru unzARDS ,.,.~,~~ rtie,-4 ~u ~~reonries that describe the h sisal and health hazards associated with the hazardous material. other hazardous chemicals with an Pressure Release: Explosives, Compressed Gases, tslasung r1gc~~.~ adverse effect with Ion term ex sure 217. AVERAGE DAI~oYrAMOU be based ont the previous year'sanventoryfof matznal ~eported onlthis pagers o talrall daily amounts a dtdivade by the nummber of days th chemical area. Cafcufa will be on the ear.hiThis amotunt shouttd be co sistent with the units reportedsinobox 221 and should tlexceed thatt of maximum daily amount to be on hand during e 218. MAXIMUM DAILY AMOUNT -Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or course of y adjacenUoutsidetions, deletions, or revis onshprojected forththe curie t yea m Th s amount should be cons ste t with the un ~ reported n box 22t1reported on this page, with the reflection of add 219. ANNUAL WASTE AMOUNT - If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handle . 220. STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the back of the Unifomt Hazardous Waste Manifest. 221. UNITS -Check the Hazardous Substantce (EHS) apl amnounts must betrenported 9 rpounds. olf m terial is a Imixtureocontainingran EHS, report the units that the matelcialisestored defined ExVemely in (gallons, pounds, cubic feet, or tons). 222. DAYS ON 517E -List the total number of days during the year that the material is on site. 223. STORAGE CONTAINER -Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: H appropriate, you may choose more than one. 224. STORAGE PRESSURE -Check the one box that best describes the pressure at which the hazardous material is store . 225. STORAGE TEMPERATURE -Check the one box that best describes the temperature at which the hazardous material is stored. 226. HAZARDOUS CO eP0 ha~range 5 ~°R ~~ fog ~Hmponen~ 2 th ough San 2301234238, and 242.) ~m~nent in a mixture. If a range of percentages is available, report the highest percentag 227. HAZARDOe ht OreferOto MS S o5 irithte case of trade seaets,arefer~o manufacturer)!s Allnhazardous ompo tints n the mixture presen tat greatpthan 1% by weight If non- grpnogenic, or 0.1% by weight if carcinogenic, should be reported. ff more than five hazardous components are present above these percentages, you may atta an perce t 9 additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS -Check "Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR,Part 35 , or "No" if it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229. HAZARDOCOLLECTED W FORMATION This space may be used by the CUPA o)r AA to collect any additionalanformatiorn ecessaryit meetithe requ rr ments of their 246. LO individual programs. ContadtheCUPAorAAforguidance. FD 2144 (Rev. 09105) Page 2 of 2 (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM) ~, BUSINESS ACTIVITIES PAGE (HAZARDOUS MATERIALS FACILITY INFORMATION) B E R S T i D_ F/RB ARTAI T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 I. FACILITY IDENTIFICATION FACILITY ID # (For Office use only -please leave blank) 3 EPA ID # DBA /FACILITY NAME to ( ~u II. ACTIVITIES DECLARATION DOES Your Facility ... If Yes, Please Complete ... i2 A. HAZARDOUS MATERIALS ~ // • CHEMICAL DESCRIPTION FORM 13 1. Have on site (for any purpose) hazardous ftrYes ^ No HAZARDOUS MATERIALS MANAGEMENT PLAN materials at or above 55 gallons for liquids, pQjni mum required Ip anning elements: 500 pounds for solids, or 200 cu. ft. for ^ Yes ^ No • Emergency Response Plan Maps compressed gases (include liquids in ASTs and Training USTS)? Prevention B. REGULATED SUBSTANCES (RSl 131 1. Have on site RS at greater than the threshold files ^ No . CHEMICAL DESCRIPTION FORM planning quantities established by the California RISK MANAGEMENT PLAN (RMP Submit to USEPA) Accidental Release Prevention program • . CONSOLIDATED COMPLIANCE PLAN Incorporating CaIARP Program Elements (CaIARP)? C. UNDERGROUND STORAGE TANKS (USTsI `~ /~ ^ N UST FACILITY FORM 13 1. Own or operate Underground Storage Tanks? 6YYes o • UST TANK FORM (One Per Tank) 2. Intend to upgrade existing or install new USTs? ^ Yes ^ No UST FACILITY FORM 13 • UST TANK FORM (One Per Tank) • UST INSTALLATI N F RM One Per T nk D. TANK CLOSURE I REMOVAL 2. Need to report closing an UST that ~ hazardous ^ Yes ^ No • UST TANK FORM (Closure section -one per tank) materials or 3. Need to report the closure /removal of a tank that ^ Yes ^ No • UST TANK CLOSURE FORM was classified as hazardous waste and cleaned on- site? E. ABOVEGROUND PETROLEUM STORAGE TANKS (ASTsI ^ Yes ^ No • HAZARDOUS MATERIALS MANAGEMENT PLAN 1. Own or operate ASTS above these thresholds; • Incorporating Federal Spill Prevention Control and any tank Capacity is greater than 660 gallons or the Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112. total capacity for the facility is greater than 1,320 F. HAZARDOUS WASTE EPA ID NUMBER - Provide on this page 1. Generate hazardous waste? ^ Yes ^ No To obtain EPA ID Number, please phone (916) 324-1761 2. Recycle more than 100 kg/mo of recyclable ^ Yes ^ No • RECYCLING FORM materials at the same location it was generated? 3. Recycle more than 100 kg/mo of recyclable ^ Yes ^ No RECYCLING FORM materials at an off-site location different from the point of generation? 4. Treat Hazardous Waste on site? ^ Yes ^ No TP FACILITY FORM • TP UNIT FORM (One per unit) 5. Subject to Financial Assurance requirements? ^ Yes ^ No • CERTIFfCATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Yes ^ No • REMOTE WASTE /CONSOLIDATION SITE NOTIFICATION FORM remote site? NOTE: If you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested above, please Submit ~ BUSINESS OWNER/OPERATOR IDENTIFICATI ON FORM (FD2089) ~ FD 2143 (Rev. oslo5) HMMP) BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIALS MANAGEMENT PLAN Prevention Services a _. ~_. x_ s. P ~ n 900 Truxtun Ave., Suite 210 SITE & FACILITY DIAGRAM wR ~ T Bakersfield, CA 93301 Tel.: (661) 326-3979 Page 2 of 2 ~ Fax: (661 } 852-2171 a SITE DIAGRAM FACILITY DIAGRAM ~, ~ Business Name: _ __. _. _ . -- Business Address: /i\ f NORTH Please indicate direction of North i i i Frl 717!1 ioa., nor~~~ (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN ., . INSTRUCTIONS SITE & FACILITY DIAGRAM A D _R, 5 P,I D P/Re ~~rr r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page loft 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 and 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 %2 x 11 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 will 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 materials and identify them by name and type of hazard (i.e., flammable liquid, corrosive solid). 4. Label the location of utility shutoff 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. 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. FD 2170 (Rev. 0905) CAL VALLEI' PAGE 02 08f08/2006 08:57 6613252529 .r ,. CAL VA[,l.EY EE]UIPM~NT 35Q8 Gumore Aire ~aakerstieid, Cs 933138 881-327-8341 fax 861-~5-2*~9 ll1iPR~SSIeq CtaRRENT C.~4y75it'~tNG PR~7kC77~Jlf CER~iCATfON OATS: ~ 3I-0.~ __ $!T"E: CiY'C ~~~1.: Cocc~l~11 ~1e~7'r<'C ~tf~ ~ In5'tallatla~- c/)la+ie: Mvycte! ~ ~u~rS~ ,~u,se_ria~ #.~ ~]~`.'2 $'6 Ad]ustmen#: -f' ~. C~-V"riS~ CaarSe: ~ Flee: S~ruettlre to Sal) Potentiai l~eaciit~gs For tireu~otrsly IrtsratiQd Sysberhs RSYg~ idff I or E ! center I N ter Tank Have l3een Met 1._.~~ H2n-e Nqt Been Met for the systems referenced above: taken N1 aooi~rdanCe with the rr~inimem standards of the National As.~ocietion of Coimslan Iwr~ineers, end as done to comply wi#1t 1`pA and State pir+sctives T~hnlclan PerttarmirMg Test Str~tnre ~ Sp#1 Potential Readings Far Rrevioasly lnstaliad Systems [ System +Dn ) I hereby Certifjl thtlt the minimum system potential regnir+emertts for impressed Currant Cathodic PmdtECH~rI: UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMfr NO. ` B P ~ia~ ARTM f ~~ BAKERSFIELD FIRE DEPT. Preveatioa Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANKTIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION ~ Ca7`~o~+'~ Pv~~ecr;ati ~-~~y~ SITE INFORMATION FACILITY Circle Deli NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS 1416 GOlden State Hwy. OWNERS NAME Same OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK # VOLUME CONTENTS 1 87 UL 2 91 UL TANK TESTING COMPANY NAME OF TESTING COMPANY Cal-Valley Equipment Bruce W. Hinsley 661-327-9341 MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308 Bruce W. Hinsley 661-327-9341 CERTIFICATION #: 006-05-1178 DATE 8 TIME TEST TO BE CONDUCTED JUIy 31, 2006 13:00 ICC #: SIGNATURE OF APPLICANT ~~ -~ DATE July 26, 2006 APPROVED BY DATE a Z FD 2095 (Rev. 09/05) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMff NO. ~~ ~_....~~~ ._.. ^ ENHANCED LEAK DETECTION ^ TANKTIGHTNESSTEST ^ LINE TESTING P D wi~i ARTS 1' '~ TO PERFORM FUEL MONITORING CERTIFICATION 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 ^ SB-989 SECONDARY CONTAINMENT TESTING ^ Cathodic Protection Testing SITE INFORMATION FACILITY CI~CIe D6II NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS 1416 Golden State Ave. OWNERS NAME Same OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK# VOLUME CONTENTS 1 87 UL 2 91 UL TANK TESTING COMPANY NAME OF TESTING COMPANY Cal-Valley Equipment Bruce W. Hinsley 661-327-9341 MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308 Bruce W. Hinsley 661-327-9341 CERTIFICATION #: 006-05-1 178 DATE 8 TIME TEST TO BE CONDUCTED AU9USt 16, 2OOB 08:00 ICC #: SIGNATURE OF APPLICANT ~ DATE Augu3t 3, 2006 APPROVED BY DATE FD 2095 (Rev. 09/05)