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Home My WebLink AboutBUSINESS PLAN_SAVEMART~, ~ ;'RALPH'S GROCERY CO. ~xviu,xES~ ~i9600 HAGEMAN RD #30 ~~ ,. r~ ~~ SAVEMART SUPERMARKET SiteID: 015-021-002406 Manager STEVE WOODS Location: 9600 HAGEMAN RD City BAKERSFIELD BusPhone: (661) 588-4420 Map i 102 CommHaz Extreme Grid: 17C FaCUnits: 1 AOV: CommCode: KCFD STA 65 EPA Numb: SIC Code: DunnBrad:007874480 Emergency Contact / Title Emergency Contact / Title STEVE WOODS / STORE MANAGER DRAKE STRADER / DIRECTOR OF OPS Business Phone: (661) 588-4420x Business Phone: (559) 297-1721x 24-Hour Phone (661) 765-9503x 24-Hour Phone (559) 897-0207x Pager Phone (661) 428-8114x Pager Phone (559) 999-7382x Hazmat Hazards: Fire Press React ImmHlth Contact AARON BORBA Phone: (209) 574-6295x3398 MailAddr: 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Owner BOB PICCININI Phone: (209) 577-1600x Address 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~IVT'D J U L ~ 0 ~~~7 t3ased on my inquiry of those individuals responsible for obtaining the information, !certify under pAnaity of iaw that 6 have personally examined a, d am fameiliar with the information submitted and believe the information is true, accurate, and complete. A~ - _7/`mil G~ ~ig~,ature Oate -1- 07/16/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE E F P IH G 22032.00 FT3 Hi PROPANE E F P IH G 2160.00 FT3 Hi BLEACH IH L 160.00 GAL Hi SODIUM HYPOCHLORITE R IH L 90.00 GAL Hi HYDROCHLORIC ACID E R IH L 70.00 GAL Hi HELIUM F P IH G 651.00 FT3 Min CARBON DIOXIDE F P IH G 80.00 LBS Min -2- 07/16/2007 ~_~ -3- 07/16/2007 fi ~~i z 1 4 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: BLUE RHINO STORAGE CAGE OUTSIDE N ENTR CAS# 74-98-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 612.00 FT3 22032.00 FT3 14688.00 FT3 - HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Propane Yes 74986 t1E~GLjttL Ei~~r,~~1~1r;1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: BACKROOM JANITORS RM CAS# 74-98-6 ~GaSATE TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~ TPure Above Ambient I Ambient I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 720.00 FT3 2160.00 FT3 1440.00 FT3 ntjc~titcLUUa 1.V1~lYV1ValVl~J °sWt. RS CAS# 100.00 Propane Yes 74986 I11~GEitCL H~ .>P~.7.71~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 07/16/2007 L~ iS y ~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: FRONT END AISLE 16 CAS# 07681-52-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.43 GAL 160.00 GAL 125.00_-.GAL t1AGHKL V U 5 l: V 1~1Y V1V ~1V 1 J - %Wt. RS CAS# 100.00 Bleach No 7681529 t1L-~GI~tCL F~.`~ ~ 1; 5 51~1~1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi ~ Inventory Item 0006 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE~ Location within this Facility Unit BACK END AISLE 16 STATE TYPE PRESSURE Liquid Mixture Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7681-52-9 TEMPERATURE ~ CONTAINER TYPE Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 90.00 GAL 80.00 GAL riHGtiK1J V U 7 l.: V 1~1Y V1V i51V 1 %Wt. RS CAS# 12.00 Sodium Hypochlorite No 7681529 t1HGHKIJ 1~55L" 551~1J;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi -5- 07/16/2007 h ..~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0007 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HYDROCHLORIC ACID Days On Site 365 Location within this Facility Unit Map:' Grid: BACK END AISLE 16 CAS# 7647-01-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 70.00 GAL 40.00 GAL HAZARDOUS COMPONENTS sWt. RS CAS# 35.00 Hydrochloric Acid Yes 7647010 tiF~L,KKL Lj~Jl'i~7~`J1~1.C,1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HELIUM Days On Site 365 Location within this Facility Unit Map: Grid: PRODUCE DEPT HALLWAY CAS# 7440-59-7 STATE T TYPE T PRESSURE TEMPERATURE ~~ CONTAINER TYPE ~GaS I Pure I Above Ambient Ambient I PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co217100rFT3 Daily 651100m FT3 I Daily 434r00e FT3 tit3Gt-'att1.JVUA ~vl~trvlvl:,lv1J sWt. RS CAS# 100.00 Helium No 7440597 rlt~~,tatcl~ t~a alJ~~l~ilJlvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 07/16/2007 ~~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: BAKERY/DELI DEPT INSIDE N ENTR CAS# 124-38-9 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 20.00 LBS 80.00 LBS 60.00 LBS tu~~xtct~~ua ~vrirvlvr~lv_l~ ~Wt. R5 CAS# 100.00 Carbon Dioxide No 124389 t11~GHtCL HJ~~~J1~1~1V l~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -7- 07/16/2007 F SAVEMART SUPERMARKET SitelD: 015-021-002406 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/22/2005 ~ CALL 911 AND THE OFFICE OF EMERGENCY SERVICES (800-852-7550) TO REPORT ANY SPILLS THAT ARE A THREAT TO LIFE, SAFETY, OR THE ENVIRONMENT. FOR NON-EMERGENCY SPILL REPORTING, CALL BAKERSFIELD FIRE DEPARTMENT (326-3979). Employee Notif./Evacuation 12/22/2005 PA SYSTEM, ALARM, TELEPHONE, MESSENGER RUNNER. Public Notif./Evacuation 04/30/2007 STORE CHAIN-OF-COMMAND: STORE MANAGER; ASSISTANT STORE MANAGER; HEAD CLERK; AND KEY CARRIER. PERSON IN CHARGE WILL NOTIFY AUTHORITIES IN CASE OF AN EMERGENCY AND CONTACT COMPANY CORPORATE OFFICE. IF MORE THAN ONE PERSON LISTED ABOVE IS PRESENT, THE MOST SENIOR PERSON CAN DELEGATE REPORTING RESPONSIBILITIES TO THOSE LOWER ON THE CHAIN-OF-COMMAND. Emergency Medical Plan 04/30/2007 IN CASE OF AN EMERGENCY WITH CUSTOMERS OR EMPLOYEES, CONTACT 911 IMMEDIATELY. LOCAL MEDICAL FACILITY: MERCY SOUTHWEST HOSPITAL, 400 OLD RIVER RD, 663-6100. -8- 07/16/2007 .,`._.4 . F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 12/22/2005 ~ ALL COMPRESSED GASSES ARE MAINTAINED WITH A SECURITY DEVICE TO AVOID FALLING OVER. ALL COMPRESSED GASSES HAVE A SHUT-OFF VALVE. ALL COMPRESSED GASSES ARE STORED IN WELL VENTILATED AREAS. BOTTLES OF CHEMICALS ARE STORED UPRIGHT IN TIGHTLY CLOSED CONTAINERS TO KEEP FROM SPILLING OR LEAKING. Release Containment 12/22/2005 VENTILATE RELEASED GASSES IF VALVE CANNOT BE CLOSED. (MOVE CONTAINER TO OPEN-AIR LOCATION AWAY FROM ANY IGNITION SOURCE.) DIKE SPILLED OR RELEASED HAZARDOUS CHEMICALS WITH DENSE SODA ASH, LOCATED AT STORE. (FOLLOW MSDS INSTRUCTIONS.) MOVE DAMAGED CONTAINER TO A WELL VENTILATED AREA AWAY FROM ANY OTHER CHEMICALS. Clean Up 12/22/2005 IN THE EVENT OF A PROPANE LEAK, EMPLOYEES CHECK TO SEE IF VALVE IS SECURED. IF NOT, CONTACT THE PROPANE COMPANY AT ONCE. CALL 911 IN ANY EMERGENCY SITUATION. REFER TO MSDS BINDER FOR MORE INFORMATION. FOR CHEMICAL LEAKS, FOLLOW PROPER MSDS GUIDELINES LOCATED IN STORE MSDS BOOKS (X2) ALL EMPTY BOTTLES ARE TO BE PICKED UP BY THE PROPER VENDING COMPANY. V1.11C1 lLC.7'UULC:C HC:l,1Vdl.lUl1 -9- 07/16/2007 - u F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 12/22/2005 ~ ALL COMPRESSED GASSES AND HAZARDOUS CHEMICALS ARE MONITORED DAILY TO ENSURE THEY ARE SECURED, UPRIGHT, AND NOT LEAKING. Utility Shut-Offs 02/06/2007 NATURAL GAS/PROPANE: OUTSIDE NE CRNR OF STORE ELECTRICAL: OUTSIDE NE CRNR OF STORE WATER: BACK RM OF STORE ON WALL L OF DOUBLE EMER EXIT DOORS SPECIAL: NONE LOCKBOX: NO Fire Protec./Avail. Water 02/06/2007 AUTOMATIC SPRINKLERS, PORTABLE FIRE EXTINGUISHERS AND DRY CHEMICAL SYSTEMS FOR BAKERY FRYERS. FIRE HYDRANTS: 2 HYDRANTS 45FT FROM NW CRNR AND 60FT FROM SW CRNR. Building Occupancy Level 03/28/2006 75 EMPLOYEES -10- 07/16/2007 a5-t.~, _~c F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/20/2006 ~ BRIEF SUNIlKARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AT INITIAL ORIENTATION. EMPLOYEES ARE RETRAINED EVERY YEAR UPON ANNUAL REVIEW. RECORDS CAN BE FOUND IN EMPLOYEES PERSONNEL FILES. rayC a Held for Future Use n~iu ice.[. r u~.,uiC ~aC -11- 07/16/2007 SAVEMART SUPERMARKET _ SitelD: 015-021-002406 ~~~~~ Manager STEVE WOODS BusPhone: (661) 588-4420 Location: 9600 HAGEMAN RD ~~~ ~ ~ ~~~~ Map 102 CommHaz Extreme City BAKERSFIELD Grid: 17C FacUnits: 1 AOV: ~~G$~#~lC, ~~PT. CommCode: KCFD STA 65 EPA Numb: SIC Code: DunnBrad:007874480 Emergency Contact J Title Emergency Contact / Title STEVE WOODS / STORE MANAGER DRAKE STRADER / DIRECTOR OF OPS Business Phone: (661) 588-4420x Business Phone: (559) 297-1721x 24-Hour Phone (661) 765-9503x 24-Hour Phone (559) 897-0207x Pager Phone (661) 428-8114x Pager Phone (559) 999-7382x Hazmat Hazards: Fire Press React ImmHlth Contact AARON BORBA Phone: (209) 574-6295x3398 MailAddr: 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Owner BOB PICCININI Phone: (209) 577-1600x Address 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Period to TotalASTs: Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~An ~~ ~~~°B APR 3 4 2007 Based on my inquiry of those individuals responsible for fining the information, !certify under Pena y o 12N1 th have personally ex fined m fame ' r nth the information bmit an elie the information is true, accur e - m te. . ~J /~ _ G~'~~ i at r Date -1- 04./23/2007 ,~ ,, F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE E F P IH G 22032.00 FT3 Hi PROPANE E F P IH G 2160.00 FT3 Hi BLEACH IH L 160.00 GAL Hi SODIUM HYPOCHLORITE R IH L 90.00 GAL Hi HYDROCHLORIC ACID E R IH L 70.00 GAL Hi HELIUM F P IH G 651.00 FT3 Min CARBON DIOXIDE F P IH G 80.00 LBS Min ~~~~ ~~~~ ~.~i~~~~~~IN~ -2- 04/23/2007 ~~~~~~ ~~'~6~~~~Ii~G ~E~'T. -3- 04/23/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: BLUE RHINO STORAGE CAGE OUTSIDE N ENTR CAS# 74-98-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure ~-Above Ambient .Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 612.00 FT3 22032.00 FT3 14688.00 FT3 t1Y,Gt~2tLV V ~ ~Vl~lrvlvJ:,ly 1 %Wt. RS CAS# 100.00 Propane Yes 74986 t1EiGHtCL L-1~75J"_i.7.71~1L'1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: BACKROOM JANITORS RM CAS# 74-98-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co720100rFT3 Daily2160100m FT3 I Daily1440r00e FT3 t1HGtitCLVV~ 1..V1~lYV1VL'1V1J oWt. RS CAS# 100.00 Propane Yes 74986 riHGLitC1J 1-1J J L" .7 w'71~1L" 1V -1 .7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~~~~~ ~~~ ~ ~ ~~ ~~~~~1~~ DEPT. -4- 04/23/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: FRONT END AISLE 16 CAS# 07681-52-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.43 GAL 160.00 GAL 125.00 GAL I1tiGtiRLVU~J l.Vl"!t'V1VL~1V1J gWt- RS CAS# 100.00 Bleach No 7681529 l1t1Gt1RL HJ JL' JJ1~1L' 1V 1 ~.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: BACK END AISLE 16 CAS# 7681-52-9 Liquid TMixture~ Ambient~E ~ AmbientT~E -~STICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 90.00 GAL 80.00 GAL iZC~[~t1LtLVVJ t.Vl~lt VlV l~1V1J aWt. RS CAS# 12.00 Sodium Hypochlorite No 7681529 TTT ATTlT1 T AATlTIlwwr~~.Trr~n rll"1.L,riRL ti~ 7 a7 Jj J .71T1L'1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi ~~~~ ~ ~~Gf~9fr~f~fN~ D~f~~ -5- 04/23/2007 F SAVEMART SUPERMARKET ~ Inventory Item 0007 COMMON NAME / CHEMICAL NAME HYDROCHLORIC ACID Location within this Facility Unit BACK END AISLE 16 STATE TYPE PRESSURE Liquid TMixtur~mbient SiteID: 015-021-002406 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7647-01-0 TEMPERATURE CONTAINER TYPE Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 70.00 GAL 40.00 GAL nr-~~r-~tcL~ua ~~i~ir~iv~;ivl~ ~Wt. RS CA5# 35.00 Hydrochloric Acid Yes 7647010 t1AGAttL r-~~a~~ari~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME HELIUM Location within this Facility Unit PRODUCE DEPT HALLWAY STATE - TYPE PRESSURE _ Gas Pure Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7440-59-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co217100rFT3 Daily 651100m FT3 I Daily 434r00e FT3 t3tiGtittUVU~ l,Vl~lrV1V~1V1S %Wt. RS CAS# 100.00 Helium No 7440597 t1HGl-~KL H. 7.7~551~1~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~~~~~~ ~~~o~~~~i~~ ~~~ r -6- 04/23/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE ~ Days On Site 365 Location within this Facility Unit Map: Grid: BAKERY/DELI DEPT INSIDE N ENTR CAS# 124-38-9 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 20.00 LBS 80.00 LBS 60.00 LBS HAZARDOUS COMPONENTS %Wt• RS CAS# 100.00 Carbon Dioxide No 124389 TTT A T TT1 T A ATl I'1 f111 IfT1LTTA I1tiL~tiRL L-~.7 .71',J JI•1L'1V 1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~~G~~~~RING ~E~~ -7- 04/23/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/22/2005 ~ CALL 911 AND THE OFFICE OF EMERGENCY SERVICES (800-852-7550) TO REPORT ANY SPILLS THAT ARE A THREAT TO LIFE, SAFETY, OR THE ENVIRONMENT. FOR NON-EMERGENCY SPILL REPORTING, CALL BAKERSFIELD FIRE DEPARTMENT (326-3979). Employee Notif./Evacuation PA SYSTEM, ALARM, TELEPHONE, MESSENGER RUNNER. 12/22/2005 Public Notif./Evacuation 12/22/2005 STORE CHAIN-OF-COMMAND: 1. STORE MANAGER; 2. ASSISTANT STORE MANAGER; 3. HEAD CLERK; 4. KEY CARRIER. PERSON IN CHARGE WILL NOTIFY AUTHORITIES IN CASE OF AN EMERGENCY AND CONTACT COMPANY CORPORATE OFFICE. IF MORE THAN ONE PERSON LISTED ABOVE IS PRESENT, THE MOST SENIOR PERSON CAN DELEGATE REPORTING RESPONSIBILITIES TO THOSE LOWER ON THE CHAIN-OF-COMMAND. Emergency Medical Plan 07/20/2006 IN CASE OF AN EMERGENCY WITH CUSTOMERS OR EMPLOYEES, CONTACT 911 IMMEDIATELY. LOCAL MEDICAL FACILITY: MERCY SOUTHWEST HOSPITAL 400 OLD RIVER RD 663-6100 ks~~~~-~"b ~~ ~~ ~ ~ ~~~~ E~~~~~E~Rf~G DERV -8- 04/23/2007 ~~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 12/22/2005 ~ ALL COMPRESSED GASSES ARE MAINTAINED WITH A SECURITY DEVICE TO AVOID FALLING OVER. ALL COMPRESSED GASSES HAVE A SHUT-OFF VALVE. ALL COMPRESSED GASSES ARE STORED IN WELL VENTILATED AREAS. BOTTLES OF CHEMICALS ARE STORED UPRIGHT IN TIGHTLY CLOSED CONTAINERS TO KEEP FROM SPILLING OR LEAKING. Release Containment 12/22/2005 = VENTILATE RELEASED GASSES IF VALVE CANNOT BE CLOSED. (MOVE CONTAINER TO OPEN-AIR LOCATION AWAY FROM ANY IGNITION SOURCE.) DIKE SPILLED OR RELEASED HAZARDOUS CHEMICALS WITH DENSE SODA ASH, LOCATED AT STORE. (FOLLOW MSDS INSTRUCTIONS.) MOVE DAMAGED CONTAINER TO A WELL VENTILATED AREA AWAY FROM ANY OTHER CHEMICALS. Clean Up 12/22/2005 IN THE EVENT OF A PROPANE LEAK, EMPLOYEES CHECK TO SEE IF VALVE IS SECURED. IF NOT, CONTACT THE PROPANE COMPANY AT ONCE. CALL 911 IN ANY EMERGENCY SITUATION. REFER TO MSDS BINDER FOR MORE INFORMATION. FOR CHEMICAL LEAKS, FOLLOW PROPER MSDS GUIDELINES LOCATED IN STORE MSDS BOOKS (X2) ALL EMPTY BOTTLES ARE TO BE PICKED UP BY THE PROPER VENDING COMPANY. Other Resource Activation .~~ ~'~ -9- ~~~~~~~ ~~'~~• 04/23/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 12/22/2005 ~ ALL COMPRESSED GASSES AND HAZARDOUS CHEMICALS ARE MONITORED DAILY TO ENSURE THEY ARE SECURED, UPRIGHT, AND NOT LEAKING. Utility Shut-Offs 02/06/2007 NATURAL GAS/PROPANE: OUTSIDE NE CRNR OF STORE ELECTRICAL: OUTSIDE NE CRNR OF STORE WATER: BACK RM OF STORE ON WALL L OF DOUBLE EMER EXIT DOORS SPECIAL: NONE LOCKBOX: NO Fire Protec./Avail. Water 02/06/2007 AUTOMATIC SPRINKLERS, PORTABLE FIRE EXTINGUISHERS AND DRY CHEMICAL SYSTEMS FOR BAKERY FRYERS. FIRE HYDRANTS: 2 HYDRANTS 45FT FROM NW CRNR AND 60FT FROM SW CRNR. Building Occupancy Level 03/28/2006 75 EMPLOYEES -lo- E'~~~~~~Ri~G ~E~T 04/23/2007 'r ~k ~! ~ ~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/20/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AT INITIAL ORIENTATION. EMPLOYEES ARE RETRAINED EVERY YEAR UPON ANNUAL REVIEW. RECORDS CAN BE FOUND IN EMPLOYEES PERSONNEL FILES. ra.yc ~ nci.u ivi r u~uic u5c nclu 1VL ruI. ULC V.7C ~~~~~`~ -11- ~~~'~~~~~~(~ ~~~~ 04/23/2007 ~ a, SAVEMART SUPERMARKET SiteID: 015-021-002406 Manager STEVE WOODS Location: 9600 HAGEMAN RD City BAKERSFIELD BusPhone: (661) 588-4420 Map 102 CommHaz Extreme Grid: 17C FacUnits: 1 AOV: CommCode: KCFD STA 65 EPA Numb: SIC Code: DunnBrad:007874480 Emergency Contact / Title Emergency Contact / Title STEVE WOODS / STORE MANAGER DRAKE STRADER / DIRECTOR OF OPS Business Phone: (661) 588-4420x Business Phone: (559) 297-1721x 24-Hour Phone (661) 765-9503x 24-Hour Phone (559) 897-0207x Pager Phone (661) 428-8114x Pager Phone (559) 999-7382x Hazmat Hazards: Fire Press React ImmHlth Contact AARON BORBA Phone: (209) 574-6295x3398 MailAddr: 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Owner BOB PICCININI Phone: (209) 577-1600x Address 1800 STANDIFORD AVE State: CA .City MODESTO Zip 95350 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT Based on my inn~~ir~~ of fii;?°a,<v .r:,, responsible for or~rai ~~~ °',e ~, ;,,=;r:~;t~cn, s c.~~ und ` ~I~ I oD ~~~ f~ ~ ~QO~ er penait ~ , a•~ that. ' havE: ~,~.r~i~;-,-s~ examined ar am ~amiiiar ritt~+ tnti .r-tc~:^.;~t,- u6mi ~ s tte nd f wlievs tie intorma~um i, try: accura ;, d ,mplet . ~~- ~~ ure o;,{,,. -1- 02/06/2007 n ~ F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE E F P IH G 22032.00 FT3 Hi PROPANE E F P IH G 2160.00 FT3 Hi BLEACH IH L 160.00 GAL Hi SODIUM HYPOCHLORITE R IH L 90.00 GAL Hi HYDROCHLORIC ACID E R IH L 70.00 GAL Hi HELIUM F P IH G 651.00 FT3 Min CARBON DIOXIDE F P IH G 80.00 LBS Min -2- 02/06/2007 _3_ 02/06/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: - Grid: BLUE RHINO STORAGE CAGE OUTSIDE N ENTR CAS# 74-98-6 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Co612100rFT3 Dai12203210Om FT3 I Dai114688r00e FT3 ruyuru~LVVa L.vllrvlv~ly t J %Wt. RS CAS# 100.00 Propane Yes 74986 L1tiLitil.CL 1ii J •7 L' w7 J1.1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map:. Grid: BACKROOM JANITORS RM CAS# 74-98-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 720.00 FT3 2160.00 FT3 I 1440.00 FT3 ruyuruwvva 1.V1~1rV1VL~1V1J %Wt. RS CAS# 100.00 Propane Yes 74986 i1tiL+riRL li. 7 JL~J.71.1L~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 02/06/2007 II l ~ SAVEMART SUPERMARKET ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME BLEACH Location within this Facility Unit FRONT END AISLE 16 STATE TYPE PRESSURE Liquid TMixture~Ambient SiteID: 015-021-002406 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 07681-52-9 TEMPERATURE CONTAINER TYPE Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.43 GAL 160.00 GAL 125.00 GAL nr~~r-ucL~ua 1.V1~lYV1V1",1V l w7 %Wt. RS CAS# 100.00 Bleach No 7681529 riAGHK1J H~SL'~551~1~LV1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi ~ Inventory Item 0006 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Location within this Facility Unit BACK END AISLE 16 STATE TYPE ~ PRESSURE Liquid Mixture l Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7681-52-9 TEMPERATURE CONTAINER TYPE Ambient PLASTIC CONTAINER. AMOUNTS AT THIS LOCATION Largest Contiin0e0rG~ Daily M90100m GAL I Daily A80r00e GAL nr~artcLVUa ~Vlnrvtvnlvt5 %Wt. RS CAS# 12.00 Sodium Hypochlorite No 7681529 riHGH1CL Ei.7 .7~.7J1Y1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi -5- 02/06/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0007 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HYDROCHLORIC ACID Days On Site 365 Location within this Facility Unit Map:.. Grid: BACK END AISLE 16 CAS# 7647-01-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 70.00 GAL 40.00 GAL t1YaGL-itCLVUJ 1:V1~lYViVL'1V1~ %Wt. RS CAS# 35.00 Hydrochloric Acid Yes 7647010 tiljGliK.1J 1~J 5L' ~~1~1L" 1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / j Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HELIUM Days On Site 365 Location within this Facility Unit Map: Grid: PRODUCE DEPT HALLWAY CAS# 7440-59-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co217100rFT3 Daily 651100m FT3 I Daily 434r00e FT3 nr~c~s~c1JV u a ~.vlnrvly lJly 1 ~ °~Wt. RS CAS# 100.00 Helium No 7440597 rii-~GE-~tCL E~J.71;5.71~11;1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 02/06/2007 ;, F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: BAKERY/DELI DEPT INSIDE N ENTR CAS# 124-38-9 ~GaSATE TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE TPure Above Ambient I Ambient PORT. PRESS.. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ~ Daily Average 20.00 LBS 80.00 LBS 60.00 LBS - r~~HtcL~u~ ~~inr~iv~ivla %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 nx~titcL Ha~~aain~iv 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -7- 02/06/2007 F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/22/2005 ~ CALL 911 AND THE OFFICE OF EMERGENCY SERVICES (800-852-7550) TO REPORT ANY SPILLS THAT ARE A THREAT TO LIFE, SAFETY, OR THE ENVIRONMENT. FOR NON-EMERGENCY SPILL REPORTING, CALL BAKERSFIELD FIRE DEPARTMENT (326-3979). Employee Notif./Evacuation 12/22/2005 PA SYSTEM, ALARM, TELEPHONE, MESSENGER RUNNER. Public Notif./Evacuation 12/22/2005 STORE CHAIN-OF-COMMAND: 1. STORE MANAGER; 2. ASSISTANT STORE MANAGER; 3. HEAD CLERK; 4. KEY CARRIER. PERSON IN CHARGE WILL NOTIFY AUTHORITIES IN CASE OF AN EMERGENCY AND CONTACT COMPANY CORPORATE OFFICE. IF MORE THAN ONE PERSON LISTED ABOVE IS PRESENT, THE MOST SENIOR PERSON CAN DELEGATE REPORTING RESPONSIBILITIES TO THOSE LOWER ON THE CHAIN-OF-COMMAND. Emergency Medical Plan 07/20/2006 IN CASE OF AN EMERGENCY WITH CUSTOMERS OR EMPLOYEES, CONTACT 911 IMMEDIATELY. LOCAL MEDICAL FACILITY: MERCY SOUTHWEST HOSPITAL 400 OLD RIVER RD 663-6100 -8- 02/06/2007 a F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 12/22/2005 ~ ALL COMPRESSED GASSES ARE MAINTAINED WITH A SECURITY DEVICE TO AVOID FALLING OVER. ALL COMPRESSED GASSES HAVE A SHUT-OFF VALVE. ALL COMPRESSED GASSES ARE STORED IN WELL VENTILATED AREAS. BOTTLES OF CHEMICALS ARE STORED UPRIGHT IN TIGHTLY CLOSED CONTAINERS TO KEEP FROM SPILLING OR LEAKING. = Release Containment 12/22/2005 = VENTILATE RELEASED GASSES IF VALVE CANNOT BE CLOSED. (MOVE CONTAINER TO OPEN-AIR LOCATION AWAY FROM ANY IGNITION SOURCE.) DIKE SPILLED OR RELEASED HAZARDOUS CHEMICALS WITH DENSE SODA ASH, LOCATED AT STORE. (FOLLOW MSDS INSTRUCTIONS.) MOVE DAMAGED CONTAINER TO A WELL VENTILATED AREA AWAY FROM ANY OTHER CHEMICALS. Clean Up 12/22/2005 IN THE EVENT OF A PROPANE LEAK, EMPLOYEES CHECK TO SEE IF VALVE IS SECURED. IF NOT; CONTACT THE PROPANE COMPANY AT ONCE. CALL 911 IN ANY EMERGENCY SITUATION. REFER TO MSDS BINDER FOR MORE INFORMATION. FOR CHEMICAL LEAKS, FOLLOW PROPER MSDS GUIDELINES LOCATED IN STORE MSDS BOOKS (X2) ALL EMPTY BOTTLES ARE TO BE PICKED UP BY THE PROPER VENDING COMPANY. ~,_ V 1.1161 1\~. A7VUIVG 171.. 1.1V0.1.1 V11 -9- 02/06/2007 iii F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 12/22/2005 ~ ALL COMPRESSED GASSES AND HAZARDOUS CHEMICALS ARE MONITORED DAILY TO ENSURE THEY ARE SECURED, UPRIGHT, AND NOT LEAKING. Utility Shut-Offs 02/06/2007 NATURAL GAS/PROPANE: OUTSIDE NE CRNR OF STORE ELECTRICAL: OUTSIDE NE CRNR OF STORE WATER: BACK RM OF STORE ON WALL L OF DOUBLE EMER EXIT DOORS SPECIAL: NONE LOCKBOX: NO Fire Protec./Avail. Water 02/06/2007 AUTOMATIC SPRINKLERS, PORTABLE FIRE EXTINGUISHERS AND DRY CHEMICAL SYSTEMS FOR BAKERY FRYERS. FIRE HYDRANTS: 2 HYDRANTS 45FT FROM NW CRNR AND 60FT FROM SW CRNR. Building Occupancy Level 03/28/2006 75 EMPLOYEES -10- 02/06/2007 -i. (r!ls F SAVEMART SUPERMARKET SiteID: 015-021-002406 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/20/2006 ~ BRIEF SUNIMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AT INITIAL ORIENTATION. EMPLOYEES ARE RETRAINED EVERY YEAR UPON ANNUAL REVIEW. RECORDS CAN BE FOUND IN EMPLOYEES PERSONNEL FILES. rc~yc ~ nci~.a tvt r u~.uLC ~5c nc.LU ivi r u~..uic vac -11- 02/06/2007 + SAVEMART SUPERMARKET ________________________________ SiteID: 015-021-002406 + Manager STEVE WOODS Location: 9600 HAGEMAN RD City BAKERSFIELD BusPhone: (661) 588-4420 Map 102 CommHaz High Grid: 17C FacUnits: 1 AOV: CommCode: KCFD STA 65 SIC Code: I EPA Numb: DunnBrad:007874480 Emergency Contact / Title Emergency Contact / Title STEVE WOODS / STORE MANAGER DRAKE STRADER / DIRECTOR OF OPS Business Phone: (661) 588-4420x Business Phone: (559) 297-1721x 24-Hour Phone (661) 765-9503x 24-Hour Phone (559) 897-0207x Pager Phone (661) 428-8114x Pager Phone (559) 999-7382x Hazmat Hazards: Fire Press React ImmHlth Contact AARON BORBA Phone: (209) 574-6295x3398 MailAddr: 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Owner BOB PICCININI Phone: (209) 577-1600x Address 1800 STANDIFORD AVE State: CA City MODESTO Zip 95350 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT /~~ ~D~ ~" ENT JuL 2 p 2006 ~1 AAnnd I~ in uir of those individuals Based on my q Y responsible for. obtairnng the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted d believe the information is true, accurst d compiete. fc~ Z~ O,~ Signature Date -1- 03/28/2006 - - ~ (HMMP) ~ BAKERSFIELD FIRE DEPT. ` HAZARDOUS MATERIALS MANAGEMENT PLAN ' ~~ Prevention Services (UNIFIED PI20GRAM CONSOLIDATED FOF:AA) _ 9OO TI•UXtUri AVe., SUlte `Z 1 O ~~ - _ _- - - - a E R S F I D `44F~~~ ~ ~ ~ : _ . ,: .,. __ _ _ _. Bakersfield, CA 93301 ~ B M t Tel.: (661) 326-3979 APPLICAl10N A ~T BUSNES.S ONVN~/OPQiATOR DBYTFK'.ATiON FORM ~ Fax: (661) 852-2171 aEC (HAZARDOUS MATERIALS FACILITY INFORMATION) 2 ? ?Q p~ ~ Page 1 of 2 I. F,.ACILITY.IDENTIFICATION 1 1 FACILITY ID NO. , Year Beginning ,09 Year Ending ,o, BUSINESS NAME (Same as FACILnY NAME or DBA- Doing Business As) 3 ~v~ ~n~T Su ermarKe.TS BUSINESS PHONE ,02 loG/- ~8' - ~(~Zo SITE ADDRESS 103 ~c~o(~ N~ a>n CITY ~KarsF~el ,~< CA IP Q33/Z ,°~ DUNN 8 BRADSTREET po7~7 ~~~~ ,~ /, / (41 Dig#) Q7 `'~ ~ 107 COUNTY t98 >~G //t OPERATOR NAME ,09 SAVe./~lar~' ~r c/~a--Kofs OPERATOR PHONE 110 209- S77 - /(oo 0 IL QWNER.INFORMATION OWNER NAME ~~t OWNER PHONE 112 o~ ;~ • ; - zo9- r? ~-l6 ao OWNER MAILING ADDRES S ,73 / //~~ A /St9~ ST"QN~iTb/c/ ~/G• CITY „a STATE „s IP „8 ~vto~G s~o C•4 9S3 So III. ENVIRONMENTAL CONTACT _ CONTACT NAME ,n ~ '~ CONTACT PHONE 118 , .-o /ba tat- S7~ -~z9~ r. X398 RESS Call - ~ 985--?Z~/ 119 CONTACT MAILING ADD l $OV St'a N~i vc~ ~/c . CITY 120 STATE ,2, Zlp t22 l ~ cq- 9f3 rr~ ao c o , - PRIMARY IV. EMERGENCY CONTACT$ -SECONDARY- NAME 123 NAME 128 S /~ G~ar~S [7,/a KG ,S~vaaf< v TITLE 124 TITLE 129 S o/~ I~aNQ / /~ ~i,('GG a/ 87- d eda ~ar.S BUSINESS PHONE 125 j- - ~Zo BUSINESS PHONE 130 ,~59'-397-r72r 24HOUR PHONE 126 24HOUR PHONE 131 PAGER NO. 127 PAGER NO. 132 lpl,(- y28 - ~ 1 /~ SS9- - 738 133 _ V. CERTIFICATION Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that 1 have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. SIGNATURE OF SIGNER f 136 Aron ~jo-" Ij ~ DATE 134 (l ~0 Zoos NAME OF DOCUMENT PREPARER 135 ~Q /or. ~o rba NAME OF OWNER/OP TOR (SDIGNATURE & PRINT) 137 TRLE F OW N ER/OPERATOR 138 _ n I'~fs~ I-''ptnQ9GivtZµ~ SN~trvi50~ FD 2142 (Rev. 09/05) ' (HMMP) z~ ,~; HAZARDOUS MATERIALS MANAGEMENT PLAN ~_.a 'l APPLICATION FOR SECTION DISCOVERY AND ~ NOTIFICATION (FORMS) I H R 9 F I D P/R! A~ T 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. _ _ ~ T SECTION L FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) " ~ J AVe i~Ar ( Su e/-MarY~ 5 ADDRESS (For local use only) Q(o00 ~a ew~Qn (~vctll~rs.~cld CA 43312 FACILITY ID NO. ~ SECTION 11.1: DISCOVERY.AND NOTIFICATIONS ,_.~. , ., A. LEAK DETECTION AND MONffORING PROCEDURES: / / ''``__ .A(I eoMPre~ac/9QSSe5vNd 1~azgrdou5 ctie..+iGa/5 a/~/>toKi~o/tdo/a~/f/ /'~ GNS!(rYiT+'~~~/QrIL SCG4~lc% L/~Orlg~~~ONd w~ CeaKi-+p . B. EMPLOYEE AND AGENCY NOTIFICATIO/~N~: A CnC : Ca 11 9"14 C/Nol 1~L orr-iGC? B~4NlC/gGwC~ SfJ~IJiGG$ ~tgo0"gSZ' 7~~IO ~ /YPpIr' Ort~/ fr7i/~f ~Of'd/~o >~iYinf 16N>~- ~/ i'l o/N - 2rNC/~s.sCr 5Pi y /C~oc~'.41j Ca !/ ~aKeiS~-;e /~ ><it a/e~ar~Mew1- (~(o(- 324-3 or {~a G'NVi /oN~ Sa~sfy /o ~.i {[ ~ ~. LL .~ ~o' G PA sys~e.M , /.~lar.Hl TL'lG/1~iCI7e~ ~6sSGN4!/ Q4NNC/ l C. ENVIRONMENTAL RESPONSE MANAGEMENT: 5~ure CN4;N vFCor++n4aNd= l.Sfarel'~anape/ Z.Rss~s~ONfS{y,re Marw9ev 3•NecEdClerlC ~• l<ey Carr;c/. ~' ConaOany Co.para~+e o~iGe. Off eMerye.+cygw~/ co~~ac Cgse o~ N G~.arc~aWlll kofi~ au >~Gor,~it5 TN so~ ? ~~er J~-" L L L 1 ' / ~FirJ/t Tv~ON ~ ~C f$prI (js~~ Q~7OV6 /S ~I'e,SGN7'~C /MOST .SCK~O /~C Y50N CG'N dC~CO RrC rC~o/~MG rt$~ONSibl~l ~fl ~0 J J -ll~o a tow </ oN ~k a Cua; N oF' Cca+.~ na Kd. D. EMERGENCY MEDICAL PLAN: T.~ ease oFQa EntevgtNCY wi~+ CuS~oMerf o/ EMPloyaes Co-?tar~ 9•/-y i~tlwtada~e/y, Coca /Midi ca. / ~e;/,iLy : lrfercy Sovl~Gu~esf l~osp;~r l lt6o p~Q/ /?i uc/ 1Qd , `____ BaKevS+~e%f / G4 ir33/ z ~.. (o(~/-(oG3 (o/Ob SECTION 11.2:' RELEASE RESPONSE PLAN A. HAZARD ASSESMENT AND PREVENTION M1EASURES: t 11 cowtpresscJgassCf pYG W1QiNYai Ntd W~Q SeGUr~fy dev~eeI fo QVO%d ~~~1 Ky ever, 1[•I) Co MJ rC~jEJ ~adsEs l+O VC O S~M~' i41! CowlQ reSSed 9aJSet 4vs .S~3rec/ iN well Ik~A~ilatGoi a/eas. f3o~~ct of C(~en4i co(S Orc t~arac( 4~ri9N~ i -, VaIvG , ~9~~ closed CoKy7~iMe~f ~ Keel 1"'roN, S~ilk-/ ar Ccall Hy. B. RIIE~LEASE CONTAINM/ENT AND/OR MILTIGATION: / L IiLNTj7QZLG IrCIZASCo' ~RfSCS R" Ua~VG GAIN /~d•T ~6 G~oScd•Cl"IouG CAN-yaiNC/ Tn OpCrt-Clir tACQ'~'l~U QWOy FfOM QH~( /gNl~l~V S0~ PiKG y~illcd o/ valtaitJ IngZav~%uf C1,c~rvtita/s w+~ l7ensc sOGlq ~4s'l. Iaaa.,Esd a{~-S-~ort • ~rsllaw MSDJ i-~d~r~cl~oN.t~ N1ovc daw~a9eol CoN~a~ae/ Jo a w~l( /ekfi7a~zc( grace q~aY fv'ow~ .4n7( o~e/ Cl~e-s~ rc«>'r. ~l~o w P c / MSDS k; dGliN c f {~/ SMa 1/ ,, ,1/ C/ea N ci . C. CLEAN-UP AND RECOVERY PROCEDURES: ~ ~ e•Tf' BFq ~roPaHG IeAK/ eMgployf.Lf Cl~euK To Sam ~ Tr fir; ev ,1vs is Secviec! . ~ ttor~ CoH-foc~ " ~,e yro~ant t / / ~ e COMPONy Q7 ON~G. (alb 9•/•/ iN Q11y CMdB/Y~N4~,/ SI~L/QY-/IN. IC.~ft/ 7~ ~DS bTk~t./{o///JoY4 iH~/-Offifa•~ION . fDr G~enriQ 1 ~~~ Fo low~voyc/ Msas~µidclitaes loc~~lzc/rN Sort /yfDS }~ooKS ~X~--l./F//GH~~ bo,~c/arc T ~G H ~TeKeJ /' y ~lre m e/ /eNdt Co ax '74 ~ ` ~ __ - FD 2169 (Rev. os/os> Page 2 of 2 SECTION 11:2: RELEASE RESPONSE PLAN-CONT. ,,s ,.. ~, x ..,__., UT-0FFS AT YOUR FACILITY) UTILITY SHUT-OFFS (LOCATION OF SH / 0 /~ C4 S Go rNGr ©~ Ji~a re . NATURAL GAS/PROPANE: D f S L ELECTRICAL: ON ~l dL 0 />~ G4 T /'M / ~ ~ S rC . //~~ 1 ~ //~~ 'n WATER: G vu Qf .S prG ON I,JCe1~ ~ ~ le Ot' YOU ~ ~me/ CNG eXl~ doOVS. SPECIAL: ONG PRNATE FIRE PROTECTIONNVATERAVAILABIUTY: A. PRNATIE FIRE PROTECTION: - 14u~eMo+~ G Spr,NK/e /sr P/~a6/e ~'rc ext!i'u9uifkev,f, ~ry c~c», i cap./ syr~ruAt F,r ~,~er I, Y ~'~~• B. WATER AVAILABILITY (FIRE HYDRANT): _?nL/~ A/e 2 ire bydra~fs Gvo~~p~lepCn/ ~~.. (aca~-iev. aG~-1~.~. S~'ert. ~'I APP/nX. 4S~Fr. Fowl fltc )-for~WtSf' co~'NCV Q~ S~ova ~z '4PP-''',l. (QOM}' ~ow~ ~c ~ou~wt,F~l' C~vwc/ of S}arc. SECTION III: TRAINING - .. .. ~ - ~ NUMBER OF EMPLOYEES: A ' roy~ . 7S MATERIAL SAFETY DATA SHEETS ON FILE: 11 / ~ / I 1 n ~GS. LOCa-r~cl iv- }~iNde/5 4'~' Z ~OGat'~oN.l rl.~. ~F-fa~ X70/L. ~l ~Q-1,~t0/5 tc.0ow~ ~Z SFJ''viGC t;CN~r/ BRIEF SUMMARY OF TRAINING PROGRAM: -~I! en.,Ployee3 urt a'r.,-Keof of ~-H;~;a/ D/,-tNfa~ioN. Em~ /oyetS arc ra-~raiNtc/e/er~ }/ear t~oN a~-aua/ ~o lersoHde/~7et Ces /ds cc,K >~ie 1^ouHd iH Eiy / ~ '~ew P y ~ . , . GCo ev -Yc t4lso Sce a~'I'acdned Ta;y;Ny aNd ~a~arwra~~oH ~orp.rs ~.. ' CERTI°FIGATION 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 F WNER / OPERATOR OR DESIGNATED REPRESENTATIVE DATE 477 /! 3b Zuo~ NAME F SI NE (print) 478 TIT LE OF SIG N R 479 NAron 80/6G ~J ,,~ I L l~/S~ r~rGtNQ NT ~U G/lIl$0/ FD 2169 (Rev. osios> UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (one page per material per building or area) ® ADD ^ DELETE ^ REVISE zoo. Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACII.ITY NAME or DBA -Doing Business As) 3• Savemart Su ermarkets CHEMICAL LOCATION '-°l • CHEMICAL LOCATION CONFIDENTIAL EPCRA 2°'-• Produce de artment hallway ^ YES ®No FACILITY ID # I• MAP # zo3. GRID # ?<la. (Agency Use Only) II. CHEMICAL INFORMATIO N CHEMICAL NAME 205• TRADE SECRET ^ Yes ®No zo6• Helium If Subject to EPCRA, refer to instructions COMMON NAME zo7. zos. EHS* ^ Yes ®No Helium CAS# 209. *If EHS is "Yes," all amounts below must be in lbs. 7440-59-7 FIRE CODE HAZARD CLASSES (Complete itrequired by local agency) ''-lo~ Inert Gas HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 2n. RADIOACTIVE ^ Yes ®No 212. CURIES 213. TYPE (Check one item only) PHYSICAL STATE 2[a. (Check one item only) ^ a. SOLID ^ b. LIQUID ®c. GAS LARGEST CONTAINER 217 Cu. ft. 215. FED HAZARD CATEGORIES 2[6. (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT zts~ ANNUAL WASTE AMOUNT 219. STATE WASTE CODE zzo• 434 cu. ft 651 cu. ft. 0 221. DAYS ON SITE 222. UNITS* ^ a. GALLONS ®b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 (Check one item onl) * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVEGROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ®I. CYLINDER ^ p, TANK WAGON 72$. STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 2?a. STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225. % WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I • zz6. 227. ^ Yes ^ No z2s. 229. 2• 230, zit. ^ Yes ^ NO 232. 233. 3, 234. ?35. ^ YCS ^ NO 236. 237. 4, z3s. 239. ^ Yes ^ No 2ao. eat. 5, za2. za3. ^ Yes ^ No zaa. 2a5. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 11.1 % by weight if carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 'za6. DOT Hazard Class: If EPCRA, Please Sign Here. UPCF hwf2731(1/99) -1/2 http://www.unidocs.org Rev. 04/17/00 ' ~ _ UNIFIED PROGRAM CONSOLIDATED FORM .` HAZARDOUS MATERIALS . HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION ' ~ - ~ - ~ - „ _ (one page per material per building or azea) ®ADD ^ DELETE ^ REVISE - 200 Page _ of ' I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) ~ 3, . Savemart Su ermarkets - CHEMICAL LOCATION zo1. CHEMICAL LOCATION CONFIDENTIAL EPCRA zoz. Bacla~oom Janitors Room Area ^ YES ®NO FACILITY ID # - - 1 MAP # 203 GRID # zoa. (Agency Use Only) II. CHEMICAL INFORMATIO N CHEMICAL NAME 205• TRADE SECRET ^ Yes ®No zo6. PIO ane ~ - ~ If Subject to EPCRA, refer to instructions COMMON NAME zo7. - zos. EHS* ^ Yes ®No Pro ane CAS# zo9. *If EHS is "Yes," all amounts below must be in lbs. 74-98-6 - FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210. HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 211. RADIOACTIVE ^ Yes ®No 2t2. 213. CURIES TYPE (Check one item only) PHYSICAL STATE 21a. (Check one item only) ^ a. SOLID ^ b. LIQUID ®c. GAS 215. LARGEST CONTAINER 20 Ibs FED HAZARD CATEGORIES ~ 216. (Check all that apply) ®a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 21.7. MAXIMUM DAILY AMOUNT z1s. ANNUAL WASTE AMOUNT z1q. STATE WASTE CODE z2o. 401bs 601bs 0 221. DAYS ON SITE 222. UNITS* ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS - 365 Check one item onl * If EHS, amount must be in Quads. STORAGE CONTAINER ^ a. ABOVEGROUND TANK ^ t:. 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 ®1. CYLINDER ^ p. TANK WAGON 223. STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT zza. STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225. WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. 2z6. zz7. ^ Yes ^ No 2zs. - zz9. 2. 230. 231. ^ YeS ^ NO 232. 233. 3, 234. 235. ^ Yes ^ NO 236. ~ 237. 4. 23fi. ~ 239. ^ Yes ^ NO 240. 241. 5, za2. za3 ^ Yes ^ No zaa. zas. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogeniq attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION za6. DOT Hazard Class: _ - If EPCRA, Please Sign Here. UPCF hwf1731(1/99) -1/2 http://www.unidocs.ore `Rev. 04/17/00 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION " - ~ - (one page per material per building or area) ®ADD ^ DELETE ^ REVISE '-oo• Page _ of _ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3. Savemart Su ermarkets CHEMICAL LOCATION ''-01 • CHEMICAL LOCATION CONFIDENTIAL EPCRA '-o'--• Front end of aisle #16 ^ YES ®NO FACILITY ID # ~ 1• MAP # ''-(13• GRID # z0`+• (Agency Use Only) _ _. , . II. CHEMICAL INFORM , ATION..... .. CHEMICAL NAME ''-05• TRADE SECRET Yes ®No ~~• SOdlum hypOChlOrlte If Subject to EPCRA, refer to instructions COMMON NAME '20~. zos. EHS* ~ ^ Yes ®No Bleach CAS# zo9. *If EHS is "Yes," all amounts below must be in lbs. 07681-52-9 FIRE CODE HAZARD CLASSES (Complete if required by local agency) 210• 'HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 21 t. RADIOACTIVE ^ Yes ®No 212. CURIES 213. TYPE (Check one item only) PHYSICAL STATE zla. (Check one item only) ^ a. SOLIb ®b. LIQUID ^ c. GAS _ .LARGEST CONTAINER 1.43 gallons 215. FED HAZARD CATEGORIES 216. (Check all that apply) ^ a. FIRE ®b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 21z. MAXIMUM DAILY AMOUNT 21 R. ANNUAL WASTE AMOUNT 219• STATE WASTECODE 220." 125 allons 160 allons 0 - 221• DAYS ON SITE 222• UNITS* ®a. GALLONS ^ b. CUBIC FEET ' ^ c. POUNDS ^ d. TONS ~ 365 (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 B[N ^ d. STEEL DRUM " ^ h. SILO ^ 1. CYLINDER ^ p. TANK WAGON "223. STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 32a. STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW-AMBIENT ^ d. "CRYOGENIC 225. % WT HAZARDOUS COMPONENT (For mixture or Waste only) EHS CAS # 1, zw:. zz7. ^ Yes ^ No 228. 2z9. 2, z3o. zs1. ^ Yes ^ NO 232. 233. 3, 234. 235. ^ Yes ^ NO "236. ~ 237. 4. 238. z3v. ^ Yes ^ No zao. zat. 5• za2. za3. ^ Yes ^ NO 244. 2a5. If more hazardous components are present at greater than 1 % by weight iT non-carcinogenic, or tl.l % by weight if carcinogenic, attach additional sheets of paper capturing the required intormalion. ADDTI'IONAL LOCALLY COLLECTED INFORMATION ''-45 DOT Hazard Class: , - ff EPCRA, Please Sign Here. UPCF hwf273i(U99) - I/2 http://www.unidocs.org Rev. 04/17/00 UNIFIED PROGRAM CONSOLH)ATED FORM ` - - HAZARDOUS MATERIALS , HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION - ~ (one page per material per building or area) ®ADD ^ DELETE ^ REVISE 200' Page,_of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3. Savemart Su ermarkets CHEMICAL LOCATION - 201 CHE_ MICAL LOCATION CONFIDENTIAL EPCRA zoz. Blue Rhino stora a ca a outside North entrance ^ YES ®No FACILITY ID # t. MAP # 203' GRID # 2oa. (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 2os. TRADE SECRET ^ Yes ®No zob. PIO ane ~ ~ _ If Subject to EPCRA, refer to instructions COMMON NAME 207. 2os. EHS* ^ Yes ®No Propane CA$# ~ - 209. "`If EHS is "Yes," all amounts below must be in lbs. 74-98-6 FIRE CODE HAZARD CLASSES (Complete if required by local agency) _ 2t°' HAZARDOUS MATERIAL TYPE (Check one item only) ®a. PURE ^ b. MDCfURE ^ c. WASTE zu. RADIOACTNE ^ Yes ®No z12. 213. CURIES PHYSICAL STATE eta. (Check one item only) ^ a. SOLID ^ b. LIQUID ®c. GAS 215. LARGEST CONTAINER 17 lbs ' ' FED HAZARD CATEGORIES 216. (Check all that apply) ®a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2t7. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 2z0: 4081bs 612 1bs 0 22t. DAYS ON SITE 22'-- UNITS* ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 ' Check one item onl * If EHS, amount must be in ounds. STORAGE ' CONTAINER ^ a. .ABOVEGROUND TANK ^ e. PLASTTC/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 ®1. CYLINDER ^ p. TANK WAGON zz3. 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 Iriixture or waste only) EHS CAS # 1, 226. 227. ^ Yes ^ NO 228. 229. 2, ~ 230. ~ 231. ^YCS ^ NO 232. ~ 233. 3,- 234. 235. ^YCS ^ NO 236. ~ ~ 237. 4, 23a. 239. ^ Yes ^ No zao. 241. $. 242. ~ 243. ^YCS ^ NO _ 244. - 245. If more hazardous components are present a[ greater than 1 % by weight ifnon-carcinogenic, or 0.1 % by weight if carcinogenic, attach additioual sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zab. ', DOT Hazard Class: . If EPCRA, Please Sign Here. UPCF hwf2731(1/99) -1/2 http://www.unidocs.org Rev. 04/17/00 ' ~ UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS - HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (one page per tnaterial per building or area) ®ADD - ^ DELETE ^ REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3• Savemart Su ermarkets CHEMICAL LOCATION 201• CHEMICAL LOCATION CONFIDENTIAL EPCRA zo2. Bake /Deli De artment inside north entrance of store ^ YES ®NO FACILITY ID # 1. MAP # - 203. GRID # _ 204. (Agency Use Only) II. CHEMICAL INFORMATIO N CHEMICAL NAME ~ 205• TRADE SECRET ^ Yes ®No zoe. CO2, - . - If Subject to EPCRA, refer to instructions COMMON NAME 207. zos. EHS* ^ Yes ®No Carbon Dioxide CAS# zo9. *If EHS is "Yes," all amounts below must be in lbs. 124-38-9 FIRE CODE HAZARD CLASSES (Complete if requved by local agency) 210• Inert Gas HAZARDOUS MATERIAL ®a. PURE ^ b. MLYTURE ^ c. WASTE 211. RADIOACTNE ^ Yes ®No 212. 213. CURIES TYPE (Check one item only) PHYSICAL STATE - ua. (Check one item only) ^ a, SOLID ^ b. LIQUID ®c. GAS 215. LARGEST CONTAINER 201bs FED HAZARD CATEGORIES zle. (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2t7. MAXIMUM DAILY AMOUNT 218. -ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. 601bs ~ 801bs 0 - 221. DAYS ON SITE 222. UNITS* ^ a. GALLONS ^ b. CUBIGFEET ®c. POUNDS ^ d TONS 365 (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 ®1. CYLINDER ^ p. TANK WAGON. 223, STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224. STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225. WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1, zzs. 2x7. ^ Yes ^ No 228. 229. 2, 230. ~ '231. ^YCS ^ NO 232. 233. 3. 234. 235. ^YCS ^ NO 236. 237. 4• - ~ 236. 239. ^YCS- ^ NO 240. 241. $. 242. ~ - - 243. ^ Yes ^ ~ NO 244. ~ 245. If more hazardous components are present at greater than 1 % by Weight ifnon-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION '2a6. DOT Hazard Class: - - I If EPCRA, Please Sign Here. ~ UPCF hwf2731(1/99) -1/2 http://www.uuidocs.org Rev. 04/17/00 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (nne page per material per butlding or area) ® ADD ^ DELETE ^ REVISE 200• Page _ of _ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3• Savemart Su ermarkets CHEMICAL LOCATION 201• CHEMICAL LOCATION CONFIDENTIAL EPCRA zo2-. Back end of aisle #16 ^ YES ®NO FACII.ITY ID # j 1 • MAP # 203• GRID # zoa. (Agency Ure Only) II. CHEMICAL INFORMATIO N CHEMICAL NAME 205• TRADE SECRET ^ Yes ®No zo6. Sodium Hypochlorite If Subject ro EPCRA, refer to instructions COMMON NAME 2°7. 2°R. EHS* ^ Yes ®No Pool Chlorine CAS# aov. *If EHS is "Yes," all amounts below must be in lbs. 07681-52-9 FIRE CODE HAZARD CLASSES (complete a required by local agency) 21°• HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 2I1. RADIOACTIVE ^ Yes ®No 212. CURIES 213• TYPE (Check one item only) PHYSICAL STATE (Check one item on-y) ^ a. SOLID ®b. LIQUID ^ c. GAS 214. LARGEST CONTAINER 1 Gallon 215. FED HAZARD CATEGORIES 216• (Check all that apply) ^ a. FIRE ®b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT ''-1R• ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220• 80 Gallons 90 Gallons 0 221. DAYS ON SITE 222 UNITS* ®a. GALLONS ^ b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 (Check one item onl) * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVEGROUND TANK ^ e. PLASTICMONMETALLIC 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 ^ I. 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 2?5. % WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I, z26. z27. ^ Yes ^ No 22R. 229. 2, 230. 231. ^ YeS ^ NO 232• 233. 3, 234. 235. ^ YaS ^ NO 236. 237. 4, z3a. z39. ^ Yes ^ No zao. zal. 5, zaz. za3. ^ Yes ^ No zaa. zas. If more hazardous components are present al greater than 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION za6. DOT Hazard Class: If EPCRA, Please Sign Here. UPCF hwf1731(1/99) - 1/2 http://www.unidocs.org Rev. 04/17/00 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (one page per material per building or area) ® ADD ^ DELETE ^ REVISE 200• Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3• Savemart Su ermarkets CHEMICAL LOCATION 201•. CHEMICAL LOCATION CONFIDENTIAL EPCRA '-°z• Back end of aisle #16 ^ YES ®NO - 1 • MAP # 203. GRID # FACILITY ID # zoa. (Agency Ure Only) II. CHEMICAL INFORMATIO N CHEMICAL NAME ''-05 TRADE SECRET ^ Yes No 2°6. Hydrochloric acid If Subject to EPCRA, refer to instructions COMMON NAME 207• 208• EHS* ^ Yes ®No Muriatic Acid CAS# ''-09~ *If EHS is "Yes," all amounts below must be in lbs. 07647-01-0 FIRE CODE HAZARD CLASSES (Complete i£requved by local agency) '210• HAZARDOUS MATERIAL ®a. PURE ^ b. MIXTURE ^ c. WASTE 2t I. RADIOACTIVE ^ Yes ®No 212. CURIES 213. TYPE (Check one item only) PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 214. LARGEST CONTAINER 1 Gallon 215• FED HAZARD CATEGORIES 216• (Check all that apply) ^ a. FIRE ^ b. REACTIVE ^ a PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217• MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT '219. STATE WASTE CODE z20• 40 Gallons 70 Gallons 0 221. DAYS ON SITE 222. UN1TS* ®a. GALLONS ^ b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 (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 ^ I. CYLINDER ^ p. TANK WAGON 27,3• STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224. STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225. % WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1, zz6. 2zz ^ Yes ^ No zz8. zz9. z, z3o. 231. ^ Yes ^ NO 232. 233. 3, 234. 235. ^YCS ^ NO 236. ?37. Q, 238. 239. ^YCS ^ NO 240. ?41. 5, uz. ?a3. ^ Yes ^ No za4. zas. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION ~6• DOT Hazard Class: If EPCRA, Please Sign Here. UPCF hwf1731(1/99) - 1/2 http://www.unidocs.org Rev. 04/17/00 (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN (UNo-IED PROGRAM CONSOIJDATED FORM) BUSINESS ACTIVITIES PAGE (HAZARDOUS MATERIALS FACILITY INFORMATION) ' H B R S F I A FIRB A~ ! 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 ~ ~a e, Y1r)4r7'~u evmarlCe S II. ACTIVITIES DECLARATION - - - ---- --- - . -- DOES Your Facility ... If Yes, Please Complete ... _ 'Z A. HAZARDOUS MATERIALS / • CHEMICAL DESCRIPTION FORM 13 1. Have on site (for any purpose) hazardous f~J Yes ^ No • HAZARDOUS MATERIALS MANAGEMENT PLAN materials at or above 55 gallons for liquids, Mini mum required planning elements: 500 pounds for solids, or 200 cu. ft. for Yes ^ No • • Emergency Response Plan Maps coin ressed ases include li uids in ASTs and P 9 ( q • Training USTs)? • Prevention B. REGULATED SUBSTANCES (RSl ~ • CHEMICAL DESCRIPTION FORM 131 1. Have on site RS at greater than the threshold ^ Yes P No planning quantities established by the California • RISK MANAGEMENT PLAN (RMP Submit to USEPA) Accidental Release Prevention program • CONSOLIDATED COMPLIANCE PLAN (CaIARP)? . Incorporating CaIARP Program Elements C. UNDERGROUND STORAGE TANKS IUSTsI f ^ UST FACI ITY FORM 13 1. Own or operate Underground Storage Tanks? No Yes E L • UST TANK FORM (One Per Tank) 2. Intend to upgrade existing or install new USTs? ^ Yes o • UST FACILITY FORM 13 • UST TANK FORM (One Per Tank) • UST INST L ION FORM n P r T nk D. TANK CLOSURE /REMOVAL 2. Need to report closing an UST that ~ hazardous ^ Yes [3'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 Leaned on- site? E. ABOVEGROUND PETROLEUM STORAGE TANKS (ASTs) ^ Yes C~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 ~N10 • To obtain EPA ID Number, please phone (916) 324-1781 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 kglmo 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 • CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Yes o 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. 09/05) ~ (HMMP) °;'' ~; " HAT:AFtDOUS MATER4ALS MANAGEMENT PLAN - - r:~? ~;.., ... • - 3Ks'~,:,~f«ta"*"ue ^'s?~~i~,~3~` 1 ~+'"N~ ~,'sm`'~c} , }~'~ ,~ y'r ~, ' t+e+H~.i4«~nr":..~;us...~,s~Ria?r.,:~dSr~,~5+4s1iE:k,~~+y,t ~;iL~.:.~,._r~:.~~F,:..~x.Y. sf~r~ ~ F~c~Li-rv~ ®ti,~~~~ ~ . ~~4 ~; Page 2 of 2 ~+ ~,Y,, [ '~_ SITE DIAGRAM I3~lKERaFIELI) FIRE DEPT''. /'~. ~ ,~„,; I~revention Services , n ~ ~ 5 " ~ -" 900 Truxtun Ave:, Suite 210 "~~'~`~ ~ Bakersfield, CA 93301 ~~~~ _ Tel.: (661) 326-3979 Fax: : (661}.852-2171 FACiLiTY DIAGRAM Business Name: 5~ vc/~a rT Su~c~-~Q~k~~S____.__~_~_.~___--------__-~___~_.-__.______ Business Address: _ ~~~ d / ~, ~al~c~~.il d, C~} I~,3/ Z . II 5 ~--- t t ~ ~ 6 ! s D x +~ It - , ~ F'- 's ! St : ~ ~ ~ . _ f , •; 4 o i i F ~ . 7 ! ~ ~ . ~ ~ i`.R ~ t I d ~ ~ ~ l~ 9 W~ ~ - (E ~` ' ' J ~ _ N I ~ 9 .'! ~ w .ii. ' ' ~. El~a!-r)c./ SHuroGF - - SPRtNKCEtL~ w4~r s-,4f.1~ ,~,,w r~~a<cy eF;r X BvCi'c• ~Cfve NA=ard~ X ~ Eh~i7~ a'~orm if. Pra~neTanK6 ~rafeefGd fries ~tn,~'orS Jd\ GFu~ow7a~iG S~rTN/~er3 ~ Cos1r/ Loo ! ~ l1! I ;] 1 l; 71 '~EI 4 F 7; 1 I ~ ~ ~ ~3 ;~ . .~"~ ,~4~__ ~~ [ ~s~-iii I Et~t~ryiney G><11+ e1i~f3 ~ ~~~pG t l~~ 4 P , ~ L-17 ' ~ i .9 t ~ ' :Prassv~ ~' ~ "V ~. c Coy ~ , t ~ sit rays ~~s~ ~ ~ ~ x rte... - ~ L~ L~ g~ ~ BIuG ~b+ho X ~roP~„c TnnKS} ~ ( E~=7 ~cj~uwt (I~rc39urc ~:Y ~GIGgiG gnKS `~ '.f ~•~.' i ~~i & ~ }5 -, ~ ~• -, ~1 ~~ .- ~ I :r +.e SP 3 ~ , . Y-- _ ~~~ :~ y ` ~ . 3 B1e~c4k .~ .!~;r ~QLQG{iYb 1a42ard) I !P . _~ I #~ Souk ~ ~ri~~a~~ ~;~ ~~~~K~ ~ ~ T Please indicate direction of North FD 2170 fRev. 09/051 i` ~; ~ ;. Memo To: Bakersfield Fire Department, Prevention Services From: Aaron Borba Date: 11 /30/2005 Re: Emergency action plan manual information The attached information is located in the Emergency Action Plan Manual located at the service center at the front of the store. All of the fields are filled in with the correct information and phone numbers specific to that store (9600 Hageman Bakersfield, CA 93312). Each one of our stores has one of these binders located in their facility. II~TTIZ®I~UCTI®l~T This manual is designed to provide guidance to you when you encounter an emergency situation. It is critical that the EMERGENCY COMMAND TEAM (Refer to section "Emergency Command Team" for OHSA's definition) learn and become thoroughly familiar with each of the areas outlined in the Table of Contents. Please fill. in the appropriate telephone numbers wherever blank spaces have been provided. THIS MANUAL MUST BE READILY AVAILABLE. IT IS IMPORTANT TO REVIEW THE CONTENTS W{TH YOUR EMPLOYEES AS WELL AS YOURSELF REGULARLY SO YOU KNOW THE CURRENT NAMES AND PHONE NUMBERS TO USE IN THE EVENT OF AN EMERGENCY. Emergency response/evacuation training is to be documented as required by CAVOSHA (Job & Safety Health Regulation 771.252). Training (Job & Safety Health Regulation 771:252) Employees must be trained to assist in a safe and orderly evacuation before any emergency action plan can be put into effect. All employees should be trained in evacuation plans, alarm systems, reporting procedures for personnel, shutdown procedures, and types of potential emergencies. Employees should be trained initially when the plan is developed and at least annually thereafter. Training should be repeated whenever new equipment, materials or processes are introduced or procedures have been revised or when exercises show that employee performance requires improvement. All new employees and transfers also should be trained. A drill should be held for all personnel, at random intervals at least annually. When possible, drills should include groups supplying outside services such as fire and police departments. STORE EMERGENCY RESPONSE TELEPHONE DIRECTORY STORE LOCATION #: STORE ADDRESS: STORE TELEPHONE NUMBER: PAY PHONE NUMBER: C®N~I®ENTIAL DATE UPDATED: EMERGENCY TELEPHONE NUMBERS FIRE DEPARTMENT: PARAMEDICS: POLICE DEPARTMENT: HELP DESK (EMERGENCY CENTER): STORE MANAGER: Home Phone Number: DIVISIONAL MANAGER: Home Phone Number: GROCERY SUPERVISOR: Home Phone Number: MEAT SUPERVISOR: Home Phone Number; PRODUCE SUPERVISOR: Home Phone Number: BAKERY/DELI SUPERVISOR: Home Phone Number: ~ EMERGENCY :911 HOSPITAL. NAME: PHONE: E. R. #:, CONTRACTED VENDORS FOR: WATER ®AMAGE PLUMBING: PHONE #: SPRINKLER: PHONE #: FIRE EXT'INGIJISHER CONTRACTED WITH: PHONE #: ALARM C®MPANY CONTRACTED WITH: PHONE #: GLASS REPAIR CONTRACTED WITH: PHONE #: ~LECTRiCAL CONTRACTED WITH: PHONE #: RE~RIGERA~I®N CONTRACTED WITH: PHONE #: ESTABLISH A CHAIN ®F COMMAND "EMERG'ENCY C®MMAND TEAM" A chain of command should be established to minimize confusion so that employees will have no doubt who has authority for making decisions. Responsible person should be selected to coordinate the work of the emergency response team. Adequate backup must be arranged so that trained personnel always ,are available to perform .these important functions. The duties of the Emergency Response Team is as follows: 1. Assess the situation and determine whether an emergency exists which requires activating the emergency procedures. 2. Direct all efforts in the area including evacuating personnel and minimizing property loss. 3. Ensure that outside emergency services such as medical aid and local fire departments are called in when necessary. 4. Direct the shutdown of business operations when necessary. El~/IEIZGE~TCY C®I~I~.l~D TE1~'S IZESP®~TSI~ILITIES 1. Each Team Member is responsible for his or her assigned area. Additional areas of responsibility will be assigned as required. 2. Each Team Member is required to perform the, following: a. Encourage those working around you to remain clam, do not panic and continue working if possible. b. Request that all unnecessary hazards, such as cigarettes, heaters, computers, etc., be extinguished and/or turned off. c. Know and educate co-workers of the location of emergency equipment as follows: FIRE/EMERGENCY ACTION MANUAL FIRE EXTINGUISHERS ( AX - FLASHLIGHTS SPRINKLER RISERS SPRINKLER SHUT-OFF TOOL(S) DRAIN TEST VALVES ELECTRICAL MAIN SWITCH GAS MAIN SHUT-OFF WATER MAIN SHUT-OFF REFRIGERATION MAIN SHUT-OFF d. Be aware of "Key Personnel" on duty at all times. e. Know the location and evacuation routes and exit doors in your store. f. Know the designated meeting place. g. Request that all unnecessary hazards, heaters, computers, etc., be turned off. _ I~LJTIES ®F IZESP®I~TDI~TG ~ . SLTPEIZ~TIS®I~Z 1. Designate a person to inspect the accident area and report the condition. 2. The area should be kept clear of unnecessary personnel and equipment. 3. Contact necessary emergency/medical authorities if needed. 4. Direct responding authorities to the location and offer assistance. (Refer to Facility Systems Setup) 5. Refer to "Confidential After Hours Emergency Call List" if the situation warrants. 6. Report the emergency to the Risk Management Department after situation is under control. i The following personnel are designated as .the members of this store's EMERGENCY COMMAND TEAM. Each team member is expected to become familiar with his or her' individual responsibilities in his or her assigned area. M EAT BAKERY/DELI ~. PRODUCE GMT JANITORIAL SECURITY BACK ROOM RECEIVING POS~ - VIDEO Employees should know the location of the fire extinguishers nearest their work areas. Each store manager is responsible for mapping the location of all fire fighting equip- ment, including risers. This map is to be made a part of this Emergency Manual. 1. IF A FIRE IS DETECTED: a. The person finding the fire must call the office immediately. b. The person in char~P must notify the fire department immed~ately~ - ' Telephone #: , , ,~ , _ or 911. ~. _ 1 c. Get the nearest fire extinguisher and attempt to put out the fire; aim at the base of the fire, if safe to do so. DO NOT USE WATER ON ELECTRICAL FIRE. ALL STORE FIRE EXTINGUISHERS ARE EQUIPPED TO HANDLE ELECTRICAL FIRES. d. Do not use fire hoses. They are for trained personnel only! 2. PERSON IN CHARGE WILL: a. Proceed immediately to fire location. b. Take charge of the fire fighting activity if it is safe. to do so. c. Be alert to the safety of all employees. d. Attempt to keep damage to merchandise to a minimum. 3. NOTIFICATION TO FIRE DEPARTMENT: a. If a sprinkler head is activated, a signal is automatically transmitted to the fire department. The person in charge is, however, ultimately responsible and must ensure the-fire department is contacted. ~ ~ 4. IF EVACUATION IS ORDERED: a. Proceed to the next section, EVACUATION PROCEDURES. ~, E~T1~C~T1~TI®liT PIZ®CEI~~JIZE~ 1. Do not evacuate the store unless directed to~ do so by the local law enforcement, or fire department, the President, a V.P., Corporate Director, or their designated representative. 2. IN THE EVENT OF AN EVACUATION a. If directed to evacuate by local authorities notify personnel listed in the Store Emergency Response Telephone Directory. b. Make the following public address announcement: "MAY I HAVE YOUR ATTENTION PLEASE. IT HAS BECOME NECESSARY TO EVACUATE THE BUILDING OF ALL CUSTOMERS AND PERSONNEL. WILL ALL CUSTOMERS AND EMPLOYEES PLEASE LEAVE THE BUILDING BY THE USING THE NEAREST EXIT." PLEASE WALK! DO NOT RUN!!! DO NOT PANIC!!! c. Appoint one man and one woman to clear all restrooms. d. The person in charge will notify the Emergency Center (Help Desk) that the store is being evacuated. e. Shut down all equipment. Bring the store Master Schedule Book out, and take roll to ensure all scheduled employees have evacuated. f. Secure the building and act on the recommendation of law enforcement and fire department officials. 3. MONEY AND RECORDS PROTECTION a. The cashiers will place all money and records in the safe. Lock the safe and then leave the store. 4. NOTIFICATION a. The person in charge will make the notifications. Use the "Store Emergency Response Telephone Directory". b. Establish an information/emergency command post. Compile a list of employees to determine who is missing or injured. c. The following is a list of people you may need to call after an emergency: 1 PLUMBER - Phone #: 2. ELECTRICIAN 3. GLASS COMPANY Phone #: 4. REFRIGERATION Phone #: - 5. JANITORIAL STAFF Phone #: 6. POLICE DEPARTMENT Phone #: 7. FIRE DEPARTMENT Phone #: 8. AMBULANCE Phone#: ~1-~CILIT'Y SYSTEM SETUP Review Map Layout to identify location of system setup equipment. 1. ALARM SYSTEMS & EQUIPMENT ` a. Sprinkler Alarm Company Phone #: b. In-Store location of the sending and set-up units for the alarm systems: c. Exact location of sprinkler risers: d. Location of sprinkler shut-off tool(s): e. Location of waterflow or drain test valves: b. Location of gas main shut-off: c. Location of water main shut-off: * A gas/pipe wrench may be necessary to turn the gas main valve. d. Location of refrigeration main shut-off: 2. ELECTRICAL GAS AND WATER CONTROL a. Location of electrical main switch: 3, BAKERY/DELI DEPARTMENT a. .The gas valve in the Bakery area is located ._~ ... _ _ The fitted wrench is attached to the valve for quick and easy shut-off. b. The gas valve is open when the wrench is parallel to the wall. The valve is shut by moving the wrench to a position perpendicular to the wall. NOTE: The pilot light to the stove grill and fryer is easily blown out. This allows a small amount of gas to leak out into the bakery. The gas leak is small enough that the Manager can safely re-light the pilot. It is not necessary to close the main gas valve for this purpose. 4, HOT WATER HEATERS a. There hot water heater, and they are located b. There are two valves on each water heater that will shut off the gas ( to the heater. 1) Valve #1 is located on the gas line itself. 2) Valve #2 is located on the water heater thermostat. 5, POWER SHUT DOWN a. Proceed to the electrical room. b. To shut off power to a specific area, the Main Service Disconnects must be switched to "OFF". NOTE: Phone lines should not be affected since they are operated on a separate electrical. system. 6, TO RESTORE POWER TO AN AREA a. Turn all branch connectors to the "OFF" position. b. Switch the Main Service Disconnects to "ON". c. Once on, turn the branch connectors back to "ON". Y The person in charge will delegate an individual for each of the following responsibilities. a. Coordinating and integrating emergency plans. b. Assuming overall jurisdiction of personnel, equipment, and - facilities involved in the emergency. c. Maintain liaison with local civil defense, law enforcement agencies, alarm companies and municipal fire departments. d. Notifying appropriate members of management and keeping them informed of subsequent conditions. Refer to section titled "Confidential After Hours Emergency Call List" of this manual for the list of individuals to be called. Begin efforts to secure building and minimize loss. Notify the Help Desk at 1-800-287-6583. 1. DISASTERS (EARTHQUAKE, VIOLENT STOR~S, EXPLOSIONS. ETC.) During severe earthquakes or other disasters, the first inc{ination is to get home to one's family as quickly as possible. It is our policy that you do so. During and after a general disaster, however, roads and communications will be universally disrupted so that getting through may be impossible. Announcements wi{I be made over the public address system or via runners as quickly as possible, so ,that you will be informed of the safest route home. a: During a disaster, take cover to protect yourself from injury. During a severe earthquake, crouch under the nearest heavy table, desk, bench, or machine. Know in advance where available cover is located in your store. Other safe areas are doorways, under door sills, or heavy upright beams. Avoid area near glass windows. Know what might fall or tip over in your area and stay clear. b. Do not run from buildings during an earthquake. Most injuries and fatalities occur outside from falling debris, falling objects, or from fallen high voltage wires. i.i ' ' 2. Priorities are to be established immediately after the disaster. The first things to .consider are the following: a. Absolutely NO SMOKING due to the possibility of natural gas leaks from broken pipes. b. Participate in the rescue of injured personnel. c. Aid in debris clearing. d. If fire breaks out, assist in fighting the fire until the Fire Department arrives, only if it is safe to do so. e. Assist in damage assessment. 3. , Do these things as soon as the area is safe: (This is in the event that the building has serious damage to it.) 1) Shut off the main gas valve. 2) Turn off all electrical switches. Do not turn on any lights or electrical equipment. 3) In the event of broken water pipes, locate the main water shut off and shut it off. 5) CAUTION: Look for electrical lines in water. Do not walk in the water if this has happened. Board up broken windows and doors as necessary to prevent looting. When walking in the building, make sure you are wearing good shoes to protect yourself from broken glass and nails. Rope off or tape doors that need to be isolated. 6) Remove the less injured. If the area is dangerous make the area safe prior to any reuse. Debris and shelving should be checked to make sure they will not fall. 7) Cover the injured with blankets, only move the injured if they're in danger of further injury. ,;.' i r A} Announce that it has become necessary to evacuate the building of all customers and personnel. (Please leave the _ building at the nearest exits. "DO NOT RUN"). B) Appoint someone to clear all restrooms. C) Acting Manager obtain the Master Grocery schedule before evacuating the building. (The Emergency Command Team) is responsible for securing the department before evacuation. If for any reason a schedule is destroyed or cannot be found, - the buddy system would apply. D) Where to meet outside the building to take roll. - E) Each employee should know the location of the nearest exit (to their department). F) Each employee should know the location of the nearest fire extinguisher (to their department). G) Each employee should know the location of emergency equipment (flash lights, fire extinguishers, electrical main main switch, main gas valve). N®TE: In case of an actual emergency, Management shmulsl refer t® "EM ERGENCY ACTI®N iPILAN". =. HAZARD COMMUNICATION PROGRAM I. Purpose Save Mart desires to minimize the health risk to employees posed by the use of hazardous substances. Hazardous substances are those potentially harmful or obnoxious materials which may release infectious, irritating, flammable, explosive, corrosive, asphyxiating, toxic or dangerous dusts, fumes, gasses, mists, vapors, fibers or ionizing radiation. Included in this program will be the lists of hazardous substances compiled by Federal OSHA and State OSHA agencies. As a company,-Save Mart intends to provide information about hazardous substances and the control of hazards, via our hazard communication program, which includes employee training, material safety data sheets (MSDS) and labeling. A. Authority 1. Store Manager will have overall authority for monitoring the Hazard Communication Program. The Store Manager will be responsible for ongoing evaluation of the program for compliance and effectiveness. B. Responsibi{{ties 1. The Store Manager will be responsible for: ~ a. Assuring that an updated list of hazardous products and complete MSDSs for those products are maintained. Copies of the appropriate MSDSs should be kept in each department where the product is being used. b. Evaluating the use of all hazardous products presently used in the store. c. Assuring that Hazard Communication training is provided to all potentially exposed employees and that documentation is maintained. d. Assuring that all chemical containers are adequately labeled, according to Right-To-Know and/or NFPA 704 standards. e. Assuring that written emergency procedures for the spills, leaks, fires, etc., are covered with all members of management and employees on an annual basis. f. Providing employees with access to medical records and exposure level data upon request. ,,. ~- ~. 2. a. Department Supervisors are responsible for the management of the Hazard Communication Standards within their areas. This includes: b. Personal knowledge of the Hazard Communication Program. - c. Knowing the location of the written Hazard Communication Program and the MSDS binders. d. Making MSDSs available to employees upon request. e. Training employees regarding the chemicals they work with, including identification of the chemical, its hazardous effects, safe work procedures, use of personal protective equipment and emergency - procedures. This must be accomplished prior to the assignment of the employee in an area where the chemical substances are used. f. Assuring of labeling of primary and secondary chemical containers. g. Notifying the Store Manager of any new chemical or hazardous substances that are brought in to the store location on even. a temporary basis. h. Reporting immediately any of the following conditions to the Store Manager: (' (1) Chemical spills. (2) Employee complaints relating to alleged exposures. (3) A possible contamination of grocery product from in-house or outside sources. II. Employee Training A. Orientation 1. During orientation, the Store Manager will be responsible for providing employees with general training on hazardous substances, including: . a. An overview of the requirements contained in the Hazard Communication Regulation, including how to read MSDSs and warning labels. b. Employee's rights under the Hazard Communication Regulation, including access to medical records and exposure level data. c. Employee responsibilities necessary for the successful running of the program. ~~ B. Specific Training , 1. Prior to starting work, employees will receive specific training from their supervisor on: a. The location of availability of the written Hazard Communication Program, MSDSs and operations and their work area where hazardous substances are present, including information on the steps that the store has taken to control exposures. b. Physical and health affects of the hazardous chemicals with which the employee may come in contact. c. Required safe work procedures and handling practices, including the use of personal protective equipment when necessary. d. Emergency and first aid procedures to follow if employees are exposed to hazardous chemicals through spills, leaks, fumes, etc. 2. All employees will receive specific training when new hazardous chemicals are introduced to the work area, training will be given prior to the employee working with or around that substance. 3. General training and specific training on hazard chemicals will be documented on Form RM1 and kept in the employee's file. III. Material Safety Data Sheets A. Manufacturer/Supplier Compliance 1. The MSDS is the primary means used to convey necessary information about the hazards of the chemicals used at Save Mart stores. The manufactures and suppliers are responsible for providing Save Mart with MSDSs. _ 2. If no Material Safety Data Sheet is sent from the manufacturerlsupplier, a written request must be sent for one. If no response is received within 25 working days, a copy of the request must be sent to the regional OSHA office nearest the store. 3. In the meantime, the chemical product can not be distributed or used by the stores and every attempt should be used to find an alternative product which accomplishes the same results and for which a MSDS exists or is not needed. ,~ B. Lists Updated master lists for all hazardous substances and chemicals to which Save Mart employees might be exposed, should be kept in the Store Manager's Office and the janitorial closet area. The Store Manager is responsible for maintaining and sending Material Safety Data Sheets to each area or department where the chemical product is used. The Store Manager is also responsible for reviewing incoming Material Safety Data Sheets for completeness. C. Availability of Material Safety Data Sheets to Employees 1. Material Safety Data Sheets must be readily available to all employees for review during their work shift, upon request. Material Safety Data Sheet binders should be kept near the written Hazard Communication Program in both the Store Manager's office and janitorial closet. IV. Labeling A. Primary Containers 1. The Store Manager is responsible for assuring that all primary containers containing chemical or hazardous substances have legible and prominent l warning labels. Labels should include the name and address of the manufacturer, as well as the appropriate physical and health hazard warnings associated with the product. B. Secondary Containers 1. As hazardous substances are transferred from original containers to portable or stationery containers, Department Supervisors are responsible for assuring that all such secondary containers are labeled as to the contents and appropriate physical and health hazard warnings. 2. Exceptions a. Individual stationery process containers do not require labeling if other written materials include the required information. This - information must be clearly identified on the container to which it applies. b. Portable containers do not require labels when the hazardous chemical has been transferred into a portable container from, a labeled container and is to be used immediately by the employee making the transfer. ~a ~ - ~~ .~.. , . ,~ -~: •I - b V. Non-Routine Tasks A. Periodically, employees will be required to perform non-routine tasks involving hazardous chemicals or substances. Prior to starting work on such projects, each affected employee will be given information by his/her supervisor or the Store Manager, about the chemical products or hazards to which they may be exposed during such an activity. This will include specific information regarding the nature of the hazard, the protective equipment which should be worn, any safety measures which must be used and other measures that Save Mart has taken to lessen the hazards. VI. Hazardous Substances In Pipe Systems A.. To ensure that employees who work on unlabeled piping systems have been. informed as to the contents of that pipe, the following procedure should be followed. Prior to starting work on unlabeled piping systems, employees are to contact the Store Manager for the following information: 1. The nature of the substance in the pipe. 2. Any potential hazards. 3. The safety procedures and precautions that should be taken. VII. Outside Contractors A. Contractors responsibilities: 1. Provide Save Mart management or the Store Manager with a copy of the contractor's written hazard communication program. 2. Provide Save Mart management or the Store Manager with a list of any hazardous chemicals or substances which will be brought onto the Save Mart premises, as well as a copy of the appropriate MSDSs. B. Save Mart responsibilities: 1. Inform outside contractors of any hazardous chemicals or substances to which their employees may be exposed. 2. Inform the contractors of the precautions their employees should take to minimize the possibility of exposure of those chemical substances through the appropriate use of protective measures. 3. Save Mart management is responsible for evaluating any potentially hazardous products or substances to be brought onto Save Mart property, as well as the safeguards that wilt need to be taken by the contractor to minimize exposure to Save Mart employees, i.e., posting of warning signs, keeping work areas off limit to Save Mart employees or providing necessary personal protective equipment as needed. FAClLITYNAME~S @,(D(I,t) ~,{) CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 171SChester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE /D!tz/ð4- Section 4: Hazardous Waste Generator Program EP A ID # o Routine ¡)( Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made ~~ EP A ID Number ~/:) ?~6h» ?~~ArA.fJ .1 r Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C-ComPliance) .ð i»iola~Y)ß Inspector: Q// j/ M ~ '1ló1 Office ~~ ~onmentaIS~i!LLD~..I 326-3979 White - Env. Svcs, ~ iA /f~ Business Site Responsible Party Pink - Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST ~~~~~~~~~a~~~1:ZJ"Æ!4Þi¡,tØ~?ft(.1!W~i&~~f"'!-~JQ'rot~ SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME I t1 Q ,000,,5 ~Jl'-!a~~-;J~;::1J::L3}J~~m~ . FACILlTYCONTACT .---::::/ _____._._.._ .__.l.__..,....___.________ Business ID Number 15-021- Section 1 : Business Plan and Inventory Program CJ Routine \(combined o Joint Agency o Multi-Agency o Complaint CJ Re-inspection C V iCJ ( C=Complian~e ) V=Violation OPERATION COMMENTS ApPROPRIATE PERMIT ON HAND --~_._------_._--~------_._------~-.~-_._._-~--~--------------.------....---- - _..._-_._---~ .. ... ~_._._-- ---..... ---- ...-.. -.. ~_ CJ ____~USINESS ~.:.~~~_~~~~_N~~_~~A~~~~~~~~~~::___~_ ___n__....__ ----. -.". -.--..- ..-.. --.. - --...---..--.-------.-.-.-.----.-..-.--.---.- -.- ..- ---------...,_.~_.__.- .-----.-- " CJ VISIBLE ADDRESS -~ ~- CO~~~~~CCU~:~;;------------ ------- -..------------------ - --- -- .- ..------------- ~[]_=~E~;;TI;,,~;~~~~~~;,,--=~_~=_=--- ..~.. .~....( ...~.... -_~- ...:~-==.--~ , CJ VERIFICATION OF QUANTITIES .A~v~+ 13> c:!íI~ V.b>.u ~ í i ' _._._-._---~---...._----,--~------------- --...-.. '---.-'.'-- .---.---- -._--_._-----.~--_.. ---~----_..- ...---- -----...--------- . _ _ .__. _ _ ___~, _ __.____~_.n. ----.--------------'-----.. _._~---.__._. -.-.------ ._.-.----._-.._---- ..___.__ __. __.__._______u ______ .., -- --_... -----. .. - .- '-'-"-- .,.---- - --.".------. -...- --..-....---- '-.'-.'.. --- -.-----. -"-'---'--'----.--" . ..n. _ _ ._. __ .._ ___.. u ___ ..__.._.___,. __..___ _.____ _.. ________.___~__..____,_... CJ VERIFICATION OF HAØAAT TRAINING !~~~~~~~i~~~~~~N ~;-~;~~~~~~~~~~.I~_;~~~_~~~.~~·~~~.~.··..· ~ CJ EMERGENCY PROCEDURES ADEQUATE ëi--c]---C~~~~~~RS _P-;~;~~~~_~~~~~-u . ..------------ --------..--- ;á--r;---H~~~~;~PI~--..-------_..--- ....--------------- ~ ---C]-·--F~~;-P~~~~~;~~-~m--..-----------~---- ..,____._u._____n__._ ___.._ . .----"." - --. --.-----.. ...-------. .__._~.._-_._._-~ ....- -......------ - ._---_.._._------.-----,-~.._._, - -.. .--..-.-...-- .-. ... . .-...------------"--.--.--...-----.-....- ..__________.. _. .,.___._.____~ .___"_______..____ -.__ __ ._n._..___ --...-,-----..-" --"'--- --..-.--- ...Þ bÉi \ 7f~ O~ ~1L-5 __ ___~_._ ._._.. __._ ..____. _. .__ ,_..u._,_=~._ ______.__ _ _. n _.. .'___ ..__._____ ._.__..__r__________._.._ .. u______..~.__._...__ ___.__ _ .... "___ __~_.____.._____.____._____u_ _..__________ _______._____.____...__ _.._____._.._. ,____._______,.___.... ·_u. .___.___._______ _._._____...__.___ _ _____... --.-------- --..-.." -- --.-- --._-- -- -----~----_.~~-._.__._-_._----- CJ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: CJ YES )riNO EXPLAIN: THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ - --F;;ep";;;;;¡¡;,",'¡:¡;;lSh;ft~ S"' ---- White - Environmental SeNices Yellow - Station Copy ,,/lL'i ~____ ¡Business Site Responsible Party (Please Print) '" ~ N J2 Pink· Business Copy i' 1::- , RALPHS GROCERY COMPANY SiteID: 015-021-002406 Manager : Location: 9600 HAGEMAN 30 City 'BAKERSFIELD BusPhone: Map : 102 Grid: 17C (661) 588-4420 CommHaz : FacUnits: 1 AOV: CommCode: COUNTY STATION 65 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title SCOTT GOLD / STORE DIRECTOR Business Phone: (661) 588-4420x 24-Hour Phone : (661) 722-2835x Pager Phone : ( ) - x Emergency Contact / Title / Business Phone: ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Fire Press ImmHlth Hazmat Hazards: Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 588-4420x State: CA Zip : 93312 Phone: (661) 588-4420x State: CA Zip : 93312 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : SCOTT GOLD MailAddr: 9600 HAGEMAN 30 City : BAKERSFIELD Owner Address City RALPHS GROCERY COMPANY : 9600 HAGEMAN 30 : BAKERSFIELD Emergency Directives: ç G D© !nIsr~[g~ ©~rtiiy ~ha~ ~ havs I ~C.OTT ()Lf) (iype or print name) . ~ - - h d h"''9ardous ma~snals manage reviewed the attac e Q&o , h ~ pH ~ #1> t> ~l11d ~hai i~ <aI'ºflQ1 with mem plan for~~irñeofBußine¡¡¡¡) any corrections consmu~s a compl~~s ~no1 rorwsd man- agement ptan for my iacili~y. _/t 1-.~ ~ -1- 10/08/2004 i" /{' F RALPHS GROCERY COMPANY f= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-002406 By Facility Unit Fixed Containers at Site BLEACH PROPANE HELIUM E F P F P IH IH IH L G G 9 9 9 I DailyMax IUnitMCP 1.a>(!) ~ (;;9. eo, GAL Hi 10.00 GAL Hi 873.00 FT3 Min Hazmat Common Name... specHazEPA HazardS Frm -2- 10/08/2004 t;' ~. F RALPHS GROCERY COMPANY f= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME BLEACH SiteID: 015-021-002406 ì Facility Unit: Fixed Containers at Site ì .^. Days On Site 365 Location within this Facility Unit ASILE 16 Map: Grid: CAS # STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 60.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 60.00 GAL Daily Average 60.00 GAL HAZARDOUS COMPONENTS ~ CAS# I 7681529 I l~~~óoIBleaCh TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi HAZARD ASSESSMENTS Ag.Definedl: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -3- 10/08/2004 ,-;-- f F RALPHS GROCERY COMPANY f= Inventory Item 0002 = COMMON NAME / CHEMI CAL NAME PROPANE SiteID: 015-021-002406 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit JANITORS ROOM Map: Grid: CAS# 74-98-6 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 10.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 10.00 GAL ZARD U OM NE %Wt. RS CAS# 100.00 Propane Yes 74986 HA 0 SCPO NTS A TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD SSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined8: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Define10: Ag.Defined5: - Ag. Define11 -4- 10/08/2004 .' ,. ,4' F RALPHS GROCERY COMPANY f= Inventory Item 0001 === COMMON NAME / CHEMICAL NAME HELIUM SiteID: 015-021-002406 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Location within this Facility Unit CORNER HALLWAY ~ FLoOh-At... 1-}1L';~ Map: Grid: CAS# 7440-59-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 873.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 873.00 FT3 Daily Average 873.00 FT3 %Wt. RS CAS# 100.00 Helium No 7440597 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag.Define11 -5- 10/08/2004 /// / • ~ ~ ~ =-RALPHS GROCERY COMPANY SiteID: 015-021-002406 T Manager BusPhone: (661) 588-4420 Location: 9600 HAGEMAN 30 Map 102 CommHaz ' City BAKERSFIELD _ Grid: 17C FacUnits: 1 AOV: CommCode: COUNTY STATION 65 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ~~ L $Cc~rr Ge+~D/ STORE DIRECTOR / Business Phone: (661) 588-4420x Business Phone: ( ) - x 24-Hour Phone (b6i ) 7~dL -2S 3.i x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact ~.i.~-L ,)CpTT V°~~ Prione: (661) 588-44~Ox MailAddr: 9600 HAGEMAN 30 State: CA City BAKERSFIELD Zip 93312 Owner RALPHS GROCERY COMPANY Phone: (661) 588-4420x Address 9600 HAGEMAN 30 State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~~ `C , ~Y~ ~,~~......_. ~c har~-~~~ G~~{fy that I have rev)~~ad ~~~ C~. tt~S"rti 6~?~„~ r~{.~i~!'.G~~~I,~`: ''. >",~•y}~:• ri'r.~i3 ~l12~@- ment plan tor'ivy~~h~~: ~..~~~ ~$ any corrections constitute a camp;ar~ and correct man- agement plan for my facility. ~, l BILL ARIAL ~ Store Director .cam- - RALPHS GROCERY COMPANY - i #30-Riverlakes 9600 Hageman ~ Bakersfield, CA 93312 {661) 588-4420 ~ -1- 06/12/2003 /~2 ~~~ c. - ~1 ~S ~pUttU ~S ~/3 7 4~ F''~~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT ~~Qg b OFFICE OF ENVIRONMF,NTAIL SERVICES ~ SSdU ~ •" UNIFIED PROGRAM INSPECTION CHECKLIST ;wF' ~~,i!t~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME 'i~a,Py 's ~ 3o INSPECTION DATE r°%~ (°Z ADDRESS 7~ ~-~~`"''~^j PHONE NO. ~fS- 4~~ FACILITY CONTACT 13t c.c A~~Ac. BUSINESS ID NO. 15-21U- ~~ INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ^ Routine ^ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ~tt!„t_ S~-N+> r~ ,.r i4Ppa_~ co.v+u,.~ Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~jt~A,~ ~Qd~ (~C~~1 Verification of quantities zgl cr< x3 2 x S-gu( ~ g,o~ Verification of location ~O~ s ~4s'LE /6 t.lAc+.w,~,v Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection ~KliWS ~icTr~Cs~uts4tr- V'et~-trr•~ ~,r~ Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ~ o Explain: Questions regarding this inspection'! Please call us at (661) 326-3979 Business Site Responsible Party White -Env. Svcs. Yellow -Station Copy Pink -Business Copy Inspector: 1 t Nt S