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HomeMy WebLinkAboutBUSINESS PLAN 8/6/2007li H ii OLD COUNTRY BUFFET ' . P 4221.SOUTH H STREET I - -- - -- ~ -T --- --_ ~ -- ---- - --l ,- __ _ _ - - - I ~ :~~' ,~ Q~ :} ~ouniary ~;Ot~tn~'y ~ ~ ~'g ~J c, ~ J ~ y anc~a~ c `f ~u=:- ~~3~a9f ~t • ,K 1460 Buffet Way ~ EAGAN, MN 55121-1133 ~ (651) 994-8608 .1~C?ME~QRIN ~~UFF~'T"' December 15, 2006 Bakersfield Fire Department Ralph Huey Director of Prevention Services 900 Truxtan Ave. Ste. 210 Bakersfield, CA 93301 ENr'D Q~'G ~ 8 2~D6 ~~3 Dear Ralph Huey, ~ '~~ t This letter serves as otification that we operate a HomeTown Buffet restaurant that contains a 170 cubic foot, 700 pound CO2 container. We have enclosed a restaurant floor plan for your convenience. Our HomeTown Buffet restaurant is located at 4221 SOUTH H STREET, BAKERSFIELD, CA 93304. Please feel free to contact us if you need any additional information. I may be reached at 651- 365-2541. r ~ i ~I Regards, 1 `.~ ~ n f _I to nr I ~ ~ / ~5 Ili ~` ~~ Brent Mortensen (~ , Risk Management Specialist f `. oa~c Enc. Floor Plan ,~ ~~ \ m /,~ 1 ~. J :. . ti i ~. `~ ~ I i x b z .~ I ~--~ Q U i' ~~~ ~~ili ~ ~~~~~ M 11 1 1 I 1 I~ O ~~ ~ ~ ~ ~ rW---~ I - _ l_ J I ~ Q ~ I I _=-Y Lj - 0 _-..-_-. - - --- -- -_ --- -~ - 1 ~ f-_ V.... -_-iv-_-i ~: _- _- i-_ _-it-_-i - l._-ii..._-i - _ _ .,.~ r-... °~ ~_-.. ~-,. - ~ .. .. __ . ~ . . . . . ..S.I ..L.. ..~.. .....: :....L.: ..~.. -....-- .._.. -....... ..~.. ...... T--f . l-.{-~-T--{- - I._f-.-y..f~.-l--f'. T--l-•-1!.f-• T--f 1T.-I' ~,y .. f.v ' I I i I I I ~~ I © ~ I I ~ 0 9 o S Y 't ~ ~ L _~ FROM :HDMETDWN BUFFET FAX ND. :3970349 Jul. 25 2007 01:50PM P3 Y. ~ HOMETOWN BUFFET Si trelD: 015-021-042613 Manager STE'V`E LUECKE BusPhozxe: {561) 397-9363 Location: 4221 S H ST Map 123 CommHaz Low City $AI{ERSFZELD Grid: 13D F~.CLTnits: 1 AOV: CommCode: BFD STA 05 SIC Code:S$ 12 EPA Num17• rn~nnRrad:12,117-739$ Emergency Cantact / Title Emergency Contact / Tit3.e RAY TAVOKOLI / SR AREA DIR RICHARD MARIENTHAL /REGIONAL VP Business Phane: (209) 403-3861x Business Fhone: (3&0) 608-0802x 24-Hour Phone : (209) 403~3861x 24-Hour Phone (360) 608-0802x Fager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire press ImmHlth Contact TERI SUTHAYf8~2ENT MORTENSEN Phone: {651) 365-2296x MailAddr: 1460 BUFFET WY State: MN C1'tY = ~~ Zip 55121-1].33 Owner I~OMETOWN BUFFET ZNC Phone ; (&51) 994-860$x Address 1460 BUFFET WY State: MN City EAGAN Zip : 55121-1.133 Period to TataIASTs: Gal Preparers TotalUSTS: - Gal Certif ~ d: RSs : Na ParcelNV: Emergency Directives: PROD A - HAZMAT ' PROG C - CO1KM HOOD EIVT'D n ~ r n Q ~nn~r '~ ~Inc.- Brent Mortensen Risk Management Specialist 1460 Buffet Way Eagan, MN 551 Z 1 X651 ~ 365-2541 Fax (651 ~ 365-2356 brent.mortensen©buffetsinc.com www.buffet.com COi~.[rib'y HOMETOWN - -- - .3a,ri ~Ulr;, .,f +, F;rfg@ I r'i•.;~ , c~xzrrener, ar;o am ,: rc•r~0^~Fy st;:~!~^~i;Y^:: r,C: ~, :^; i;Z;' v, i h th^ s7fpr-~,a_;~, cc;ur~te, a ,t ''`` ` :rf, itifGi-?'ia,iQ^ is true Date ~~ -1- 07/x2/2007 i FROM :HOMETOWN BUFFET FAX N0. :3970349 Jul. 25 2007 01:51PM P4 / -2_ D7/12/20D7 ~ HOMETOWN BUFFET SiteZD: 015-02~.-002613 ~ Hazmat Inventory --- $y Facility Unit ~ MCQ+DailyMax Ox'd.~r Fixed Containers ~~ Site FROM :HQMETQWN BUFFET FAX N0. :3970349 Jul. 25 2007 01:51PM P5 -~° 07/12/2007 FROM :HOMETOWN BUFFET FAX NO. :3970349 Jul. 25 2007 01:52PM P6 p HOMETOWN' BUFFET SiteID. 015-021-p02613 ~ Inventory Item 0001 -- Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility TJnit Map: Grid: I]RY STORAGE RM CAS# 124-3$-9 STATE ~-- TYPE PRESSCTRE -~- TEMPERATURE ~ CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLYNDER ~.~17 124389 MCP Min -4- o~/1a/2ao~ AMOUNTS AT THIS LdCATIpN Largest Caritainer Daily Maximum ]]ally Average 1720.00 FT3 1720.00 FT3 854.00 FT3 ___ V T 9 R riTr~rrn .tir.a w,-.,~.~.w..~... ~. FRDM :HDMETDWN BUFFET FAX ND. :3970349 Jul. 25 2007 01:52PM P7 F RQMETOWN BUFFET SitelrD: 015-021-002613 Fast Format ~ Natif . /Evacuation/Medical ---~--- - --- - - -- Overall Site ~ Agency Notification p1/~fl/~pp~ RAY TAVAKOLI, AREA DIRECTOR Employee Notif./Evacuation 0l/30/200~: RAY TAVAKdL,T, AREA DIRECTOR Public Notif./Evacuation 07./30/2007 RAY TAVAKOLI, AREA DIREGTOR ~- Emergency Medical flan 01/30/2007 DESIGNATED MEDZC"p,L FACILTTy: WILLARD B CHRISTIANSEN MD NI>aD CLINIC, 1800 WESTWIND DR ~5 07/12/2007 FROM :HOMETOWN BUFFET FAX NO. :3970349 Jul. 25 2007 01:52PM PB F HOMETOTNN BUFFET SiteTD: 015-021-002613 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention - - 01/30/2007 REGULAR VISUAL, INSPECTION Release .Containment 01/30/200? REG'U'Z,AR VISUAL INSPFCTIOi~T BY SUPPLIER Clean Up 01/30/2p07 RELY ON SUPPLIER FQR CLEAN-UP Otlxer Resource Activation _6- 07/12/2007 FROM :HOMETOWN BUFFET FAX N0. :3970349 Jul. 25 2007 01:53PM P9 ~ T F HOMETOWN BUFFET Sit~ID: 015-021-002613 Fa.St Format ~ Site Emergency Factors Overall Site ~ Special Ha~,~,rd,s Utility Shut-Offs 04/23/2007 - NATUR.A,Ir GAS/PROPANE: KITCHEN ELECTRICAL: OUTSIDE MECHANrCAL RM WATER: BOILER RM LOCK BO%: 3:N FRONT Firs Protec./avail. Wader O1/3a/2o07 PRrVATE FIRE PROTECTION: SPRINKLERS ANp FYRE EXTINGUTgu~c, FIRE HYDRANT: HOOK-UP AT H ST NE%'~' TO $LDG. Building Occupancy Leve]. 03./30/2007 25-40 EMPLOYEES -~ 07/12/2007 - `: FROM :HOMETOWN BUFFET FAX N0. :3970349 Jul. 25 2007 01:53PM P10 .a ~ e ~ HOMETOWN BUFFET SiteID: 015-021-0026.3 Fast Format ~ Training Overall Site ~ Employee Training 01/30/2007 MSDS ON FILE NEXT TO TTNlL CLOCK. BRIEF SUMMARY OF TRAINING PRQGRAM: ANNUAL HAZ COMM TRAINING; QUARTERLY EVACUATION URII.,LS; MONTHLY SAFETY MEETINGS TO REVIEW VARIOUS PROCEDURES & HAZARDS; AND EMPLOYEES AO NOT HANDLE C02 - SUPPLIER REPLENISHES C02 F'OR SODA DISPENSING. Page 2 Held for Fu~Gure Use Held fQr Fta.ture Use -g- o~/iz/2007 ~` (H~MP) IiA~~US MATERIALS MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM) 'APPLICATION BUSNESS OWNS/OPEFZATOR DENTFK.ATION FORM (HAZARDOUS MATERIALS FACILITY INFORMATION) B B R S F I D P/R8 A~ T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Te1.:661-326-3979 Fax: 661-852-2171 n~ ~ Page 1 of 2 ~! ' ` ~(-/) J ~n 1~v ., ~ L FACILITY IDENTIFICATION FACILITY ID N0. t Year Beginning too 2c~ Year Ending tot BUSINESS NAME~me as FACILI NAM or DB OII~/1 -Doing Business As) 3 BUSINEiS PHONE ~ .. ^ ~ ~ ~ 102 Ott/~v-/ 7 SITE DDRESS q ~ 103 Il ~ - 4 ~ e " 4 ~ '•e ~' ~ 9 t J ~F w too CITY CA Ip 105 ~O~ DUNN & BRADSTREET ' ~ ' ~ ~ t~ ~ICD 90#E ~~ 707 COUNTY ~ ~~, toe OPERATOR NAME ~,~Q~{ ~Q f ' , n ' `/ p f D ~~ n tog 'O^PERATOR PHONE q ~j~ tto II. OWNER INFORMATION ___ _ __ ' _ _ _ OWNER NAME j~~ ~ ~Q~- ttt tt2 OWNER PHOQNE ~/~/')Q OWNER MAILING ADDRESS 1t3 1 y ~o ~- t,.~,I~-- CITY ttq ~ ~%, STATE 1t5 ~ t~ IP 118 ~s t2 t III. ENVIRONMENTAL GONTAGT CONTACT NAME 1 177 1 ?,1%i 1~'j~. _ rrJlr'sw~ I~ar~r~ec~Se-~'~ CONTACT PHONE t051-~5'Z2~1(p CQ~1 r3b~~1a CONTACT MAILIN[G~AtD^D`R~ESS ~ 11g 1 ~/ V ~ Vl..'~ . CITY ~ c,W, t20 STATE ~ t2t r, rM' ZIP~~~~ ~ ts2 >PRIMARY IV.: EMERGENCY CON I TACTS -SECONDARY- i NAME ~ ~^`~~'~ tl 123 WW 1 NAME t ',,` - ~ A - 128 , ~jV 1GY ~ ~ CC.I~ 1 Q~ ?/lU TITLE ! 124 S Q.IA 1 C~`~ ~Q Z ~ 11 /"Q ~i~~ TITLE ` 1 1n ~ 129 V ~\ (.~ r 1/~.S 1 ~Y /~ ~ ' "''~ I V * • 2X BUSINESS PHON ~ on + ~~ ~ ~^'w j 125 C. -l V W BUSINESS PHONE ~~ O ~D~ D~O~ 130 24-HOUR PHONE 126 e~ 24-HOUR PHONE ~~ 131 w~ J~Y•,~ PAGER N0. 127 - 5 PAGER NO. 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 information submitted in this inventory and believe the information is true, accurate, and complete. SIGNAT F SIGN 136 -~ DA 134 ~ 1 ~3 ~ N E OF DO MENT PREPARE 135 ~w~- yYl~ v ~~~ NAME OF OWNER/OPERATOR (SDIGNATURE & PRINT) 137 - TITLE OF OWNER/OPERATOR 138 ~- ~ ~ " ~'~ ~- ~~ v ~-~ v1S e-v~ v ~ ~. ,o -tom ~ s~~ ~~~ ~~~ f D 2142 (Rev. 09/05) > ~~ ~-:: I (Hazardous Materials Facility Information - HMMP) ``` Business IJwnedOperator Identification Please submit the Business Activities page, the Hazardous Materials Faci/itylnformation (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 numbe are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Progrvm Data Dictionary. Please numbers//pages ofyoursubmittal. This helps our CUPA orAA identify whether the submittal is complete and ifany pages are separated. 1 FACILITY I.D. NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3 BUSINESS NAME - E_ nter the full legal name of the business. , 100 BEGINNING DATE - Enter.the beginning year and date of the report. (YYYYMMDD) ~ ~ ~ . 101 ENDING DATE -Enter the ending year and date of the report. (YYYYMMDD) , 102 BUSINESS PHONE -Enter the phone number, area code first, and any extension 103 BUSINESS SITE ADDRESS -Enter the street address where the faality is located. No post office box numbers are allowed. This information must provide a means to geographically Ibcate the facility. ~ • ~• ~ ' 104 CITY -Enter the city or unincorporated area in which business site is located. 105 ZIP CODE -Enter the zip code of business site. The extra 4 digit zip may also be added. ¢ • 106 DUNN & BRADSTREET -Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be obtained by calling (610) 882- 7748 or by Internet. " 107 SIC CODE -Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE.• lfcode is more than 4 digits, report only the first four ° 108 COUNTY -Enter the county in which the business site is located. 109 BUSINESS OPERATOR NAME -Enter the name of the business operator. 1 i0 BUSINESS OPERATOR PHONE -Enter business operator phone number, if different from business phone, area code first, and any extension. 111 OWNER NAME -Enter name of business owner, if different from business operator. 112 OWNER PHONE -Enter the business owner's phone number if different from business phone, area code first, and any extension. 113 OWNER MAILING ADDRESS -Enter the owner's mailing address if different from business site address. 114 OWNER CITY -Enter the name of the city for the owner's mailing address. 115 OWNER STATE -Enter the 2 character state abbreviation for the owner's mailing address. i 16 OWNER ZIP CODE -Enter the zip code for the owner's address. The extra 4 digit zip may also be added. 117 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. 118 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. 119 CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact correspondence should be sent, if different from the site address. 120 CITY -Enter the name of the city for the environmental contact's mailing address. , 121 STATE -Enter the 2 character state abbreviation for the environmental contact's mailing address. 122 ZIP CODE -.Enter the zip code of the environmental contact's mailing address. The extra 4 digit zip may also be added. , 123 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 regarding incident mitigation. 124 TITLE -Enter the title of the primary emergency contact. 125 BUSINESS PHONE. - Enter,the business number for the primary emergency contact, area code first, and any extensions. 126 24-HOUR PHONE - Enter a 24-hour phone. number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day..lf it is not the~contact's home phone number, then the service answering the phone must be able to immediately contact the individw stated above. 127 PAGER NUMBER -Enter the pager number for the primary emergency contact, if available. 128 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. 129 TITLE -Enter the title of the secondary emergency contact. 130 BUSINESS PHONE -Enter the business telephone number for the secondary emergency contact, area code first, and any eMension. 131 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 132 PAGER NUMBER -Enter the pager number for the secondary emergency contact, if available. 133 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. 134 DATE -Enter the date that the document was signed. (YYYYMMDD) 135 NAME OF THE DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. 136 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. 137 SIGNATURE OF OWNER/OPERATOR/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. 138 TITLE OF OWNER/OPERATORlOR DESIGNATED REPRESENTATIVE (SIGNER) -Enter the title of the person signing the page. • Page 2 of 2 FD 2142 (Rev. 09/05) - .~ (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN BAKERSFIELD FIRE I~~:PTr. ,, ,~- .~ :. SITE 8~ FACILITY DIAGRAM Page 2 of 2 I SITE DIAGRAM FACIZITY DIAGRAM i Business Name: ~.-~~,Q~~7~ ~~~ Business Address: 4 ZZ ~ S " ~.~ ~ ~- ~a~(S-~s ~i-e ~~ C~9 ~ 330 ,~,(~ S / i ~ lU~~ ~ P -` c /.e~-~,-,c~ ~- - _ i ,~_ `lr ___ ._~. .._.. ..... lr ~ NORTH ~/ease indicate direction of North ~z `~~- S~~-~a6 fir - 7~---- ~ - ------- --- -----------~--- Prevention Services e. R R s, F I n 900 Truxtun Ave., Suite 210 P~R~ Bakersfield, CA 93301 r Tel.: 661-326-3979 Fax: 661-852-2171 FD 2170 (Rev. 09/05) a