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HomeMy WebLinkAboutBUSINESS PLAN 9/2007II i~ ~ICAL WATER SERVICE CO. (STA 1Ob01) ~~~1108 MADISON STREET _~ -,J', CALIFORNIA WATER SRV 102-O1 Manager TIM TRELOAR Location: 108 MADISON ST City BAKERSFIELD CommCode: BFD STA 06 EPA Numb: SiteID: 015-021-002376 BusPhone: (661) 396-2400 Map 124 CommHaz High Grid: 05B FacUnits: 1 AOV: SIC Code:4941 DunnBrad: Emergency Contact / Title Emergency Contact / Title TIM TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGR Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 837-7200x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gall Gal Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Salad on my inquiry of those individuals responsible for obtaining the information, I cartify under penalty of law that I have personally examined and am familiar with the informatl~on submitted and believe the information is true, accurate, and complete. ` 7 i~ 07 nature Date ~~ ,~~~ ~ 0 2007 -1- 07/10/2007 ~_ F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE R IH L 200.00 GAL Hi -2- 07/10/2007 -3- 07/10/2007 F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: AT PLANT CAS# 7681-52-9 Liquid TMixtur~ Ambient~E ~ AmbientT~E ABOVEOGROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL rir~~rj.tcuvu5 wrir~iv~:l~~1~5 °sWt. RS CAS# 12.50 Sodium Hypochlorite ~ No 7681529 nt~~titcL r~~a~~~ri~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi -4- 07/10/2007 n F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ tigeiicy 1vc~LiticaLion Employee Notif./Evacuation ,~ ruuti~. ivv~it . / .c~va~:ua~.ivit Emergency Medical Plan 10/17/2006 MEDICAL ASSISTANCE WOULD BE PROVIDED BY MERCY HOSPITAL, TRUXTUN AVE. -5- 07/10/2007 F CALIFORNIA WATER SRV 102-O1 SiteID: 015-021-002376 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/10/2002 a DAILY SITE VISIT BY CWS PERSONNEL TRAINED IN HAZMAT REPORTING. Release Containment LIQUID CHLORINE - SECONDARY CONTAINMENT 10/17/2006 Clean Up 10/17/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. Other Resource Activation -6- 07/10/2007 F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~:iai nac,aiu5 V1.111~.y R711U 1.-V11~J Fire Protec./Avail. Water Building Occupancy Level 03/08/2006 UNMANNED SITE -7- 07/10/2007 F CALIFORNIA WATER SRV 102-O1 SiteID: 015-021-002376 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/17/2006 ~ MSDS IN FIELD OFFICE AND STATION ELECTRICAL PANEL. BRIEF SUMMARY OF TRAINING PROGRAM: SITE VISITS ARE MADE DAILY BY PUMP OPERATORS TRAINED IN HAZMAT REPORTING PROCEDURES. MONTHLY COMPANY SAFETY PROGRAM ALSO ADDRESSES HAZARDOUS MATERIAL TRAINING. rayC ~ nclu tvi ruLUle use nciu iui ru~ure use -8- 07/10/2007 ~'" ., .r CALIFORNIA WATER SRV 102-01 Manager TIM TRELOAR Location: 108 MADISON ST City BAKERSFIELD SiteID: 015-021-002376 BusPhone: (661) 396-2400 Map 124 CommHaz High Grid: 05B FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:4941 DunnBrad: Emergency Contact / Title Emergency Contact / Title TIM TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGR Business Phone: (661) 837-7200x Business Phone: (661) 83.7-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 3~-~400~ Address 3725 S H ST State: CA 937,72ov City BAKERSFIELD Zip 93304 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gall Gal Emergency Directives: PROG A - HAZMAT PROG T - P,BOVEGROUND STORAGE TANK Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. o--,u.~,~.. z r ature Dat ENT ~°Ee z s 2007 -1- 01/26/2007 n F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HY~OCHLORITE R IH L 200.00 GAL Hi -2- 01/26/2007 -3- 01/26/2007 F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE ~ Days On Site 365 Location within this Facilit Unit M G id y ap: r : AT PLANT CAS# 7681-52-9 STATE TYPE PRESSURE Liquid TMixture ~mbient ~ TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL HAZARDOUS COMPONENTS %Wt• RS CAS# 12.50 Sodium Hypochlorite No 7681529 iltil~KRL tii J Jt..7.71"1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi -4- 01/26/2007 ~~ n F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ tiyCllC:y 1VV1.1L1C:dL1U11 r~Ul~J1VyCC 1VVl.1l . J ~VdGUdl.lVil ~ ~ i ~.. r l.Ll.Jl ll. 1VV{..11 ~ P~VCL C:UdI.l Vll Emergency Medical Plan -10/17/2006 MEDICAL ASSISTANCE WOULD BE PROVIDED BY MERCY HOSPITAL, TRUXTUN AVE. -5- 01/26/2007 F CALIFORNIA WATER SRV 102-O1 SiteID: 015-021-002376 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/10/2002 ~ DAILY SITE VISIT BY CWS PERSONNEL TRAINED IN HAZMAT REPORTING. Release Containment 10/17/2006 LIQUID CHLORINE - SECONDARY CONTAINMENT Clean Up 10/17/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. VI..11G1 1\G r7VULl..G 1'11. 1.1V0.1.1 V11 a -6- 01/26/2007 ., F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, ,_ JNG~~a~ 11GLL~G111A~ V 1.11.E 1..y J11UL-V11A ~. 1'116 r1Vl.G l..~L'1V0.11 YYQ l.C1 Building Occupancy Level 03/08/2006 UNMANNED SITE -7- 01/26/2007 •= ~ F CALIFORNIA WATER SRV 102-01 SiteID: 015-021-002376 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/17/2006 ~ MSDS TN FIELD OFFICE AND STATION ELECTRICAL PANEL. BRIEF SUMMARY OF TRAINING PROGRAM: SITE VISITS ARE MADE DAILY BY PUMP OPERATORS TRAINED IN HAZMAT REPORTING PROCEDURES. MONTHLY COMPANY SAFETY PROGRAM ALSO ADDRESSES HAZARDOUS MATERIAL TRAINING. ruy~ ~ . ~ i r _ 17C 111 1V1 rul.utc Vw7C 17C 111 1V1 rUI.UlC VSC -8- 01/26/2007 Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST.- A ~ R S F , 900 Truxtun Ave., Suite 210 FARE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program gRrM r Tel.: (661) 326-3979 Fax: (661) 872=2-171 FACILITY NAME INSPECTION D TE INSPEC,TION TIME / -_ ADDRESS /^yAJ rt / PHONE NO. - NO OF EMP OYEES . © 7 " ` V [ Y FACILITY CONTACT BUSINESS ID NUMB1 5-02~ -`-v ~~ ~r6 Section 1: Business Plan and Inventory Program rr -,~,~~ _ _ - _ - - _ - ~ - -~ L~f ROUTINE ~^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTIO C V ~ C=Compliance OPERATION V=Violation COMMENTS Ill ^ APPROPRIATE PERMIT ON HAND LY ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ' ^ VISIBLE ADDRESS ~NT ~ - ^ CORRECT OCCUPANCY ' ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES D ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ r CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # Business Site /Responsible Party (Please Print) ^ YES ~ NO White -Prevention Services Yellow -Station Copy Pink -Business Copy _ FD 2155 (Rev. 09/05 _, + CALIFORNIA WATER SRV 102-01 _________________________ SiteID: 015-021-002376 + Manager TIM TRELOAR BusPhone: (661) 396-2400 Location: 108 MADISON ST Map 124 CommHaz High City BAKERSFIELD Grid: 05B FaCUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:4941 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title TIM TRELOAR / DISTRICT MGR ~~ f2udy Valley / ASST DIST MGR Business Phone: (661) 396-2400x Business Phone: (661) 3-36- 2i~~837-72 / 24-Hour Phone (661) 396-2400x 24-Hour Phone (661) 396-2400x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React ImmHlth Contact ~ I~P3-S6N- $i I ( ~ 05 i c A Phone : ( 6 61) ~6 "-~-~^~- MailAddr: 3725 S H ST State: CA ~~~'~~~~ City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 396-2400x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT 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 and beliAve the information is true, accurate, and complete. • ~,~ ,P, 3 I ature Da e ENro M qR l ~ 2pp6 -1- 03/08/2006 ~ 1AIICIGf1 DDA~DAIIA 11-ICDCf'`TIAI-1 ~41Cif~1[1 ICT SECTION 1 Business Plan and Inventory Program - , ~ ~~' ~ `_~ • ADDRESS _ __r o~ -~o.d: FACILITYCONTACT ~~~ =GQ----- Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 9 301 Tel: (661)326-3p ; INSPECTION DATE INSPECTION TIME ~-°`~- ~\l2q_~d5_ _ 153 PHONE No. No. of Employees dtA~ ~ ^ Business ID Number 1 ~ Z~~ 15-021-~Z~~~ Section 1: Business Plan and Inventory Pn~gram ^ Combined ~ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C V \V=Voatolnncel OPERATION ^ APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ~C ^ CORRECT OCCUPANCY y~ ^ VERIFICATION OF INVENTORY MATERIALS IA----- ---- - ------------------------...._----- ^ VERIFICATION OF QUANTITIES f~ ^ -VERIFICATION OF LOCATION~_ _ _ -_ _ -_ ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE ~' ^ VERIFICATION OF FIAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE St ON HAND COMMENTS ANY HAZARDOUS WASTE ON SITE: ^ YES ~NO EXPLAIN: "~ QUESTIONS PLEASE CALL US AT ~G6'I ~ 326-3979 r---._.__..--------------- --------------------------- - Badge No., Business Site Responsible Party White -Environmental Services Yellow -Station Copy Pink -Business Copy CALIFORNIA WATER SI 102-01 Manager : ~ Location: 108 MADISON ST City : BAKERSFIELD ~%% %% %%%% CommCode: BAKERSFIELD STATION 06 EPA Numb: BusPhone: Map : 124 CommHaz : Grid: 05B FacUnits: SiteID: 01~-021-002376 (661) 396-2400 1 AOV: SIC Code:4941 DunnBrad: Emergency Contact / Title MELVIN BYRD / DIS~ Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Emergency Contact / Title ~REL©AtL / ADST Di~I~ Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Hazmat Hazards: React ImmHlth Contact : ~'9~%g~==~Ya%~ MailAddr: 3725 S H ST City : BAKERSFIELD Phone: (661) 396-2400x State: CA Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Address : 3725 S H ST City : BAKERSFIELD Phone: (661) 396-2400x State: CA Zip : 93304 Period : Preparer: Certif'd: ParcelNo: to Emergency Directives: TotalASTs: = TotalUSTs: = RSs: No District Manager-Tim Treloar Asst. Dist Manager-Bill Harper Contact Person-Tarnara Johnson Same Phone Numbers Gal Gal I]~[-jmrq £~q ~J0a~O~Do hereby certify that I have ~y~ or ~int n~e) ~iewed ~he ~acheo n~ar~o~s mamrials manage- ment plan fo(~BuP (j.~ar~-i and t;'..' it along with ~Neme of ~uusJne~l any correctio ns constitum a ¢ompie[s and correct man- agement plai~ ~or m~ ';acility. -1- 10110/2003 CITY OF BA~ltSFIELD , 1715 Chester Ave. Bake~field, CA (6615 326-3979 INSTrUCTiOnS: /.Z ¢'- o $~ To avoid further action, return this form within 30 days of receipt., TYPEFPR.INT ANSWERS~IN ENGLISH. ~d/? Answer the questions below fOr the buSiness as a whole. 550d2 / Be as brief and'concise as possible. You may also attach BUSiness Owner/OPerator Form and ChemicalDescr/ptien to the'front ofthis plan instead of'comPleting sECTrOI~L below f6r iniffaI submission. 'SECTION I: BUSINESS IDENTWlCATION DATA LOCATION: MilLING ADDKESS: crrY: z ~,/~ER_ fk~'U~ PR.IIVIARY ACTIVITY': MAILING ADDRESS: EMERGENCY NOTIFICATION CONT^CT TITLE BUS. PHONE 24 H~ PHONE 'B. Do BNIERGENCY M~DICAL PLAN:" 2 HAZARDO US iYL4.TER/AL$ ~tAINAGEM. E1NT PLA~ 'SECTION ri.2: RELEASE RESPO .NSE PLAN Ao 'H..AZARD ASSESSMENT AND PREVENTION D~/~ ~' ~/?~ ~/~/2- bY c, ~(. ~, Bo RELEASE CONT. AINN~NT AN'D/OR MITIGATION: cLEAN. -UP AND RECOVERY PROCEDURBS: LOCK BOX: YES~ IF YES, LOCATION: PRIVATE FItLE PROTECTION/WATER AVAILABII'ITY''? Bo PR.[VATE FIRE PROTECTION: WATER AVAILABU._rTY (FIRE I-I-YDRANT): ~.AZA.RDOU'$ t~L4.TERIAL$ M.A~A'GEi~,EEMT PLAN SECTION [II: TRAINING, M_AT~ SAFETY' DATA· SI-~EETS ON FILE: CERTIFICATION IS AC~TE~ I ~ERST~ ~T ~S ~O~ON ~L'BE.uS~ TO CODE" ON ~OUS ~~S ~W: 20.~~'6.~ SEC. 25500 ET:~.) ~ ~T ~AC~~ ~O~ON CONS~S PE~Y. DATE MAT ~N~ANT PLAN 4 CITY OF B.AKE~~LD OFFICE. OF E ~NVIRO~NTA. L SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 ' FACi.i iTy INFORM,~,TION Business Activities I. FACILITY IDENTIFICATION FACItJT~ ID ~ (F~' o~ca use on~ - ~ease leave blan~) 0DA/FACIlITY NAME Page 2 2. II. ACTIVITIES DECLARATION If YeS, Please Complete... Does. Your Facility... HAZARDOUS MATERIALS . (~ES ONO ' ~ ~purpbse) hazardous' materials at 0r' ' above55 gail~n~ fo~.!l~luids;'500 pounds for ~olids, or200 I cuff for compressed'gases (include liquids in ASTs and 1 USTS)? Have any amount of. an explosive matedal (olher than ammunition) on site? REGULATED SUBSTANCES (RS) Have onsite RS atgreater than. the threshold planning quantifies established by the California Accidental Release Prevention,,pmgram (CalARP)? UNDERGROUND STORAGE TANKS (USTs.) Own or Operate Unden:jmund:Storage Tanks7 Intend to upgrade existing Or install new USTs? OYES 4NO OYES (~NO OYES (~NO O, TANK CLOSURE / REMOVAL : i OYES (~NO 1. Need to'report CtOsing~a UST that held hazardous ' mateda!s orWaste? ' 2.' Need to report the closure/removal of a tank that was ! OYES· ~/NO classified as hazardous waste an(~ c~eaned onsite? E. ABOVE'GROUND PETROLEUM S~ORAGE TANKS (AST~)- Own or operate ASTs above these ~hresholds: any tank .capacity is great~ than 660 gallons or the total capacity for the facility is greater than 1,320'gallons. HAZARDOUS WASTE: Generate hazardous waste? Recycle more than-lOO kg/mo o{ recyclable materials at the same location it was generated? Recycle more than 100 kg/mo Of recyclable materials at an offsite location different from the point of generation? Treat Hazardous Waste on-site? _ Subject to Financial Assurance requirements? Consolidate Hazardous Waste generated at a remote site? PERMIT CONSOLIDATION ZONE: Intend to consolidate o~e¢ CalJEPA agency ~ermits? (If yes, please complete Section III and attach) OYES OYES ,, OYES OYES OYt~S OYES ~NO 18 OES FORM 2731 (C~mi~ CONSOLIDATED C. OMP!LIANCE pLAN Minimum ~ui~', pla~nin Eme~en~ Respo~e Plan Maps Training Prev~fl0n OES FORM 2731 (Chemi~l RISK MANAGEMENT PLAN (~, su~mit m usEP^) CONSOtJDATED. COMPLIANCE PLAN. Incorporating CalARP.Program Elements UST FACII.JTY FORM .UST TANK UST FACILITY FORM UST TANK FORM · UST INSTALLATION FORM (<~e pe' ta~) . UST TANK'FORM (c~su~ ea~on-~ae ~er tar~) TANK CLQSLI.RE FORM': CONSOLIDA~'~D COMPLLANCE PLAN incomorafing Federal Spill Prevention Contrcl and Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112 EPA ID number--provide on this page To obtain EPA ID#, please phone(916) 324-1781 RECYCLING FORM RECYCLING FORM TP FACILITY FORM (DTSC Form 1772) TP'UNIT FORM (one per unit) CERTIFICATION OF FINANCIAL ASSURANCE REMOTE WASTE. 1. CONSOIJDAq'ION SITE NOTIFICATION FORM CONSOLIDATED COMPL~NCE PLAN' Incorporating all other environmental permit requirements per 2T CC:R 10410 3TE: , ~ If you checked YES to. any part of Sections tlA-IIG above, the~ in addition to the forms requested-above, please Submit OES Form 2730. UPCF (7/99) S:\CU PAFO RM~ACTIVlTY.wI3d CITY OF'BAKERSFIELD OFFICE OF ENSqlIO~NT~. SER~CES 171'5 'Chester Ave., Bakersfield, CA 9330,1 (661)'326-3979 FACILITY INFORMATION Business Activities Addendum F~ge- .._; af F'ACII.J'T'Y ID.# (F~' office use only - please leave t~anl~) I. FACILITY' IDENTIFICATION ' DBA/FACIMTY NAME EPA ID # '- '111. coNSOLIDATED PERMIT ACTIVITIES Is your Fa_,cility Comp lance. Plan ,subject to review by..., for satisfying the. conditions ofthese permits? H. DEPARTMENT' OF TOXIC: SUBSTANCES' CONTROL SAN JOAQU.IN'VALLEY UNIFiED.AlR. POLLUTION j CONTROl. DiST3:~ICT J j J. sTATE WATER RESOURCES- CONTROL BOARD :NTRAL VALLE-"( REGIONAL WATER QUALITY CONTROL '-~OARD (~YES OYES OYES OYES OYES OYEs OYES OYES OYES K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD (~YES L KERN COUNTY RESOURCEMANAGEMENTAGENCY M. CITY OF BAKERSFIELD WASTE-WATER DIVtSION (~O YNO ~NO ~NO · STA N DARDI~ ..PERM i~,- ' Ncn-RCRA HAZARDOUS-WASTE FACILITY RCRA HAZARDOUS WASTE FACILITY AUTHORITY TO CONSTRUCT · ~YES ONO' OYES (~NO OYES (~/NO OYES (~/NO OYES OYES OYES ~NO OYES PERMIT TO OPERA,TE - - WASTE DISCHARGE REQUIREMENT (VVDR) GENERAL PERMITS sPECIFIC PERMITS NATIONAL POELU'FION DISCHARGE EE.IMINATION SYSTEM (NPDES): REGISTRATION PERMIT ENVIRONMENTAL HEALTH SERVICES PERMITS.' 'J. 'Dem'estic-Water Well permit Haz Mat'Monit°dng Well Permit Septic System Permit Public Swimming Pool Permit Food Facili~ Construction permit Solid Waste Local'Enf0mement Agency (LEA) Related Pem3itS Medical Waste R~lated Permits INDU~TNIAL WA'~ 1 ~. WATER DISCHARGE PERMIT NOTE: ' · ¢ If you checked, YES 'to'any part of Sections III-H to III-M above, then please address all applicable permit requirements in the .Facility Compliance Plan. CITY OF BAKERSFIELD OFFICE O'F' ENVIRONMENTAL SERVICES 17t5 Chester Ave., CA 93301 (661) 326-3979 BUSINES'S OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION Page ~ I. FACILITY IDENTIFICATION ' ,, ' ~ i i 11 Year Beginning : ~[.JSINESS NAME (Same as FACILITY NAME or. DBA- Doing Business As) ,no i. Year Ending ! 3, i BUSINESS PHONE 101 102 103 DUN & ~oa ~. SiC CODE It. O~ER INFORMA~ON OWNER MAlUNG ADDRESS 113 zc~///rZ./zy//[~.z2 ' . ".i BT^TE Z',Z/ ,,~,iZ'P IlL ENVIRONMENTAL CONTACT 116 CONTACT NAME ,~'EE /~"~::~V/ 117 , CONTACT PHONE CONTA~ ~ILING ADDRESS ~' .-PRIMARY- IV. EMERGENCY CONTACTS ~ECONDARY- NAME 130 '131 132 2~HOUR PHONE ~E 1~'~ 2~HOUR PHONE V. CERTIFICATION 133 Certification: Based on my inquiry of those individuals, responsible for obtaining the information, I certify under, penalty of law that t have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accum:te, and;complete. · 136 , TITLE OF OWNER/OPERATOR ~37 j. ./V',~/,dT~,,t/,~"~' Business Owner/Operator Identification Please submit the ~usiness Activities page. the Business OwnertOperetor ldeo~cation page Des~plion pages (OES Fora3 2731) for ail hazardous materials Jnventory'sut~mlssions. For the inventory to be considered complete, this page must be signed by the a00mpriate individual. 'qote: the numbering of the insa~Jctions follows the data element numbers that are on, the. UPCF page~_ Thesedata element numbers are used~ .~r alec~nic sui3mission and are the same as the numbering used in 27 OCR, Appendix C, the Business sectie~ of the Unified Pn3grarn Data-~lc~0nary.) Please' number all pages (3f your submittal. This helps your CUPA er AA iclen~'¥ w~ether the submittal iS comptete and if any pages am separeted. 1. FACItJTY ID NUMBER - This numbei' is assigned by the CtJPA or AA. This is the unique number whic~ identifies your facilib/. 3. ~ BUSINESS NAME - Enter the ~ll legat name of. the business. 100. BEGINNING OATE -Enter the baginnir~g year and date of the report. (YYYYMMOO) 101. ENDING DATE - Enter the ending year and date of the report. (YYYYMMDD)' 102_. BUSINESS PHONE - Enter the pttone number, area code flint, and any extension. 103. BUSINESS SiTE ADDRESS - Enter the street address where the facJitiy is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 10.4. CITY - Enter the city or unincorporated area in which business site is located. 105. 7~p CODE - Enter the ;dp cc~e of business site. The exlm 4. digit zJD may also be added. 106. DUN & BRAD.STREET - Enter the Dun & @radstreet number for the facility..The Dun & Bradstreet number may be obtained by calling , (610) 882-7748 or by Intemet. 107. SiC CODE - Enter the pdmary Standard JndustJ'ial Classification Co, de number for pdmary business ac~vity. NOTE: Jf code is more then 4 dJgffs, report only the first four. 108. COUNTY ~ Enter the county in wi'tic~ the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business, operator. 110. BUSINESS OPERATOR PHONE - Enter busin~as operator phone number, if different from business phone, ama code first, and any extension. · 111. OWNER NAME - Enter name of business owner, if different ffx3m business operator. 112- OWNER PHONE- Enter the business owner's phone number if different from business phone, ama code first, and any extension. 113. OWNER. MAILING ADDRESS - Enter the owner's mailing address !f different f~om business site address.. , .. 114. OWNER CITY - Enter the name of the city for 1fie owner's mailing address. 115. OWNER STATE - Enter the 2 cflarecter state abbreviation ~r the owner's malilng~addres& 116. OWNER 7_JP. CODE - Enter the zJ~ code for the awne~ address. The ex~ 4 digit zJl3 may also be added. 117. ENVIRONMENTAL CONTACT, NAME- Enter the name of the person, if different f~'om,the Business Owner or Operator, who receives all environmental .correspondence anti WlTI respond to enforcement ac~vity. 1'~8. C~NTACT PHONE - Enter the phone number~ if di~erent f~3m ~wne~ ~r ~peda~nr~ at wi~c~ the environmenta~ c~ntact can be contacted~ area c~e flint, and any extension. 119. CONTACT MAILING ADDRESS - Enter the mailing address where ail environmental contact corresPonden .~e should be sent. if different from the site address. 120. C~TY - Enter the name of the city for the environmental ?ontact=s mailing addrees. 121. STATE - Enter the 2 ci3aracter state abbreviation for the environmental contact=s mailing address. 122. ZiP CODE - Enter the zip, code for the envimnment=t contact=s mailing address; The extra 4 digit zip may also be added~ 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be COntacted in case of en emergency involving hazardous materials at the business site. The c~3ntact shall have FULL facility a _c.c~___s, site famli;~a~f, and authority to make decisto~s for the business regarding incident mitigation. 124. TITLE - Enter the title of the primary emergency contact. 125. BUSINESS PHONE - Enter the business number for the primary emergency contact, area code §rst, and any extensions. 126. 24-HOUR PHONE - EDter a 24-hour phone number for the primary emergency contact, The 24-hou~ phone number must be one answered 24 hours a day. If it is not the contact's home phone number, immedtatety contact the individual stated above. 127. PAGER NUMBER - Enter the pager number for the pdmary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a seconda~ representative that can be contacted in the event that the primary emergency contect is not available. The contact shall have FULL facli'~y access, site familiarity, and aul~3rity to make decisions for the btzsiness regarding incident mitigation. 129. T~TLE - Enter the title of the secondary emergency contact. 130. BUSINESS PHONE - Enter the business ~elephone number for the secondary emergency contact, ama c~le first, and any extensio~ 131. 2.4-HOUR PHONE - Enter a 24-hour phone number for ~e secondary emergency contact.. The 24 hour phone numl3er must be one answered 24 hours a day. If it is not the contact's home phone number, the~., the service answering the phone must he al31e to immedtataly contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the seconda~ emergency contact, if available. 133. ADDITIONAL LOCALLY CO[.L.ECTED INFORMATION - This space may be used for CUPAs or A~s to collect any additional information necessary to meet the requirements of their indMduai programs. Contact your local agency, for'guidance. 134. DATE - Enter the date that the document was signed. (¥YYYMMDD) 135. NAME OF 0GCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal' information. 138. NAME OF SIGNER - En .t~' the fuji printed name of the person signing the page. The signer certlfle~ to a'famillarity with the in~i3rmalien submitted and that based on the signer~ inquiry of those individuals resl3onsible for obtaining the information, all the information submitted is true, accurate and complete. SIGNATURE OF OWNEPJ OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, er officially designated representative of the Owner/Operator, shall sign in the space provided. This signaf~m certes that the signer is familiar with Itle information submitted and that based on the sign~ inquiry of those indlvidua, is responsible for obtaining the information it is sign~ belief that the submitted information is t~ue, accurate and completa. 137. TITLE OF SIGNER - Enter the title of ~e person signing the page. ~NEW ~ ^00 [] OELETE CITY OF BAKERSFIELD OFFICE OF EN-VIRONM~ENT~ SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION t'~ RL=ViSE 2D0 L FACILITY INFORMATION (one [Dim per materiai per ~uilding or Page ~ of BUSINESS NAME (Same as FACILITY NAME or DBA ~ Ooing BuSiness As) I!. CHEMICAL INFORMA~ON 2o1! CHEMICAL LOCATION ' C~NFIDENTIAL (E~CRA) 203 G~ID # (oo~ional) [ If Subject to EPCP, A. refer to ins~mc~ons 207 . TYPE PHYSICAL STATE r FED HAZ'~°'D CATEGORIE~ (r'*' ..~:Z ail that apply) ,- J'-] p PURE [~rn MIXTURE [] w WASTE 211 i RADIOAC-nVE []Yes [~No 212 CURIES 213 ~ s ~UD UOUIO ~ g ~ 21~ ~ ~GE~CO~AI~ffi ~ 21S STORAGE CONTAINER ~ ;,,Z~J,~,(J '[] GLASS BOTTLE [] q RAiL CAR 2:23 L~ a ABOVE'GROUND T~NK [] e PLA~C, tNONMETAL.[JC DRUM [] i FIBER DRUM m (Check all that apply) [] b UNDI~GROUND TANK r-~f CAN [] j BAG ~ Pt_Ab-~3C 8oTrt. E [] r OTHER ["]¢ TANK iN$1nE BUiLDING []g C_.ARBOY ['-~'k BOX [] o TQTE BIN [] d STEE~DRUM [] h SILO [] I CYLINDER [] p TANK WAC~ON STORAGE PRESSURE ~'a AMBIENT [] aa ABOVEAMBIEN~ [] ha' SELOWAMBIENT 22.4. STORAGE TEMPERATURE ~'a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] ¢ CRYOGENIC 225 %WT HAZARDOUS coMpoNENT EH$ CAS ~= 23o 242 227 239 [] Yes [~No 228 ' [] Yes [],No 236 ~yes [] No. 2~ Z33 ')41 245 IlL $1GNATUEE DATE 246 Hazardous Materials Inventory - Chemical Description you must complete a separate Hazardous MateriaLs inventory - Chemical 0ascription page ,'or each hazardous material .(hazardous suhs~ance~ and hazardous waste) that you handle at your fasitity in aggregate quantities equal ld or greater than 500 pounde, 55 gallons- 200 cubic feet of gas (calculated at standard temporaire or the federal threshold planning quantity for Extremely Hazardous Subslances, wttichever ia less. Also cornoista a page for eac~ radioac~ve matadal haneted over' quantities for whictt an emergency plan is requireri to be adopted pursuant to 10 O]=R P~arts 30, 40, or TO. The completed ldventoty should reflect all reportaOis quantifiee of hazardous materials at your facility, reported separately for eacri building or outside adiacent area. with segarate pages for unique occun'ences of physic~ state, storage' temperature and storage pressure. (Note: the numt)ering of the instructions follows the data element numl~em that are on the UPCF pages. These data element numbem are used far electronic submission and are the same as the numbering useri in 27 OCR, Appendix C, the au-.~ness Section of the Unified Program Oats Olot~ona,'y.) numt)er ail pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FAC1L~TY ID NUMBER - This number is aesigned by the CUPA or AA. This ie [he unique number which identifias your facitity. ~-, 3- BUSINESS NAME - E.qter the tull legal name of the business. 200. ADO/0ELETF-] REVISE - Inritcata if the matarial is being added to the inventory, deleted from the inventory, or if the information previously sut~mitted is being revised. NOTE; You may c~oose to leave this blank if you rasuPmit your entire inventory annually._ 201. CHEMICAL LC)CAT[ON - Enter the builriing or outside/ac~acent area wllere the hazardous matahat is handled. A chemical [hat ia stored at the same pressure and temperature, in multiple ldcati?na within a building, can be reported on a ~singie page. NOTE: ThLS information is not suhjes~ ld pul31ic diccJOsura pumusnt to HSC §25506. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are subject to the Emergency Plan!ling and Community Right to Know Act (EPCRA) must chec. A "Yes" to keep d]l&m~al location information confidential If the business does not wish to keep chemical location information confidential check. 'No'. 203. MAt= NUMSE~ - If a map is included, enter the number of [he map on wllich the location of [he hazardous material is shown. 204. GRID NUMBER - If god coordinates are useri, enter the griri coordin~tas of the map [hat correspond to [he location of the hazardou~ material. If appllcaDle, multiple grid coordinates can be listed. 205. CHEMICAL NAME - Enta~ the proper chemical name a...%~:)ciated with the Chemical Abstract Service (CAS) number of the hazardous materiaL. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on [he Material Safety Data Sheet (MSDS). NOTE: If the chemical LS a mixture, do not coml~lete this field; complete the "COMMON NAME" field instead. .. · 206. TRADE SECRET.- Cbec~ "Yes' if the information in this sen~on ia declared a tmrie secret, ar "No" if it is not. State reduiremenl: if yea, and business is net subject to EPCRA, disclosure of the designated trade sesmt infon'nalion is bound by HsC ~.5511. Federal requirement: if yes, and business is ~uhject to EPCRA, d~ ~f the designated Trade Secret informaUon is bound by 41) CFR and the bUSineas must submit a "Substantiation to ACCOmPany C~im~ of Trade Secrecy' fo~'m (40- CFR 350.27) ld USEPA. ' 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS - C~es~ "Yes" if the hazardous matmial is an Exl~mely Hazardoue Substance (EHS), as definsd in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section btsnl~ and c~mpldta the section on tlazardoua c~mponents be/aw. 209. CAS # - Enter the Chemical Abstrac~ Service (CA,S) number for [he hazardous material. For mixtures; enter [he CAS' number of [he m'~ture if it has'been assigned a number distinc~ from its components. If the mixture has no CA~ number, leave this column btsn~ and rapo~t the CAS numbers of the individual hazardous components in [he appropriate section below. 210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to fimt reeponriera the type and level of hazardous materials wilich a business handles. This information shall oely be previderi if the local fire ch!el deems it nece..~.sary and requests the CUPA ar AA ld collect it. A list of the ha.zard ctaeses and instrucl~ns on how to determine which c~aes a materfat fails under are included in the appendices of Arddie 80 of the Uniform Fke Corie- if a materisl has more than one · ' applicable haZard class, Jnciuds ail. Contact CUPA or AA for guidance. 211.' HAZARDOUS MATERIAL TYpE - C~ec~ the one bo.~ that best describes the type of hazardous material: pure, mixture or waste. If waste malarial, chec~ only that box. If mixture or waste, complete hazardous components seet~n. 212. RAOIOAC'[qVE - Chec~ 'Yes" [f the hazardous mstartsl-.~ rad]oac~ve or "No' if it is 21:3. CURIES - If the hazardous materfal is radioactive, ~ this area to ?part [he astJvity in caries. You may use up to nine digit~ with a.fioal~g decimal point to regort activity in cubes- 214. PHYSICAL STATE - ChacX the one box that best describes the state in w~ictt the hazardous matarial is hand]ed: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total capacity of the largest container in which the mats~al is stored. 216. FEDERAL HAZARD CATEGORIES - Chec~ all catec~odas that describe [he physical and health hazards associated ~h [he hazardous material. PHYSICAL- HAZARDS I HEALTH HAZARDS Fire: Fiammabld LJquids and Solids, Combustible Lk~ulds./=~'ophorica, OxidizersJ Acute Heat. th (Immedtste): Highly Toxic` Toxic, Jrritsnts. Sensitizers, Reactive: Unstable Reactive. Organic Peroxides. Water Reac~ve, Radioactive other hazardous chemicals with an adverse effect with abort term exposure Chronic Health (Delayed): Caminagens. other ilazerdous chemicals with an adveme effect with Ion.q term exposure Pressure Release: Explosives, Compressed Gases, Blasting Agents 217. AVERAGE DAILY AMOUNT - Caicutsta the average daily amount of the hazardous material or mixture containing a hazardous matsdal, in each building or adjacent/ outside area. Calculations shall be baaed on the previous year's invento~ of matadal reported on [his page. Total all daily amounts and d~lde by the humidor of days 'the chemical will be on ~te. [f this is a material that has not previously been present at this location, [he amount shall be the average daily amount you project to be on hand during [he course of the year. This amount s~ouid be consistent with [he units reported in box 221 and should not exceed l~at cf maxknum daily amount. . Z18. MAXIMUM DAILY AMOUNT - Enter[he maximum amount of eactl hazardous'material or mixture containing a haz~lrdous material, wilictt is hanaled in a bui]clillg or adjacent/outside area at any <)ne time over [he coume of the year. This amount must contain at a minimum last yea~e inventory of [he material reported on this page, with the rellection of addJttoos, deletions, or revisions projected for the current year. This amount stlould be consistent with the units reported i]1 box 221. 219. ANNUAL WASTE AMOUNT - if the hazardous material being inventoried is a waets, provide an estimate of the annual amount handled. 221). STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3--digit hazardoue waste code as listed on the bac~ of the Uniform Hazardous Waste Manifest. 221. UNITS - Check the unit of measure that is most appropriate for the r~atedel being reported on this page: gallons, pounds, cut)ic feet or tons. NOTE; if the mata;'isl ia a federally defined Exlremely Hazardous Substance (EHS), all amou~'tts must be reported in bounds. If material is a mixture containing an EH$, report ~e units that [he material is stored in (gallons, pounds, cubic feet, or tone). _ 222- DAYS ON SITE * List [he total number of days during the year that the material ia on site. 223. STORAGE CONTAINER - Chec~ all boxes [hat desc~ha [he type of :storage containem in which [he hazardous material is stored. NOTE; If approprial~ you may choose more than one. 224. STORAGE PRESSURE - Chec:~ the one box that beet deschbes the pressure at which the hazardous ~tedal is stored. 225. STORAGE TEMPERATURE - Chec~ the one box [hat hast desc,dbee the temperature at which the hazardous matsdal is storact. 226. HAZARDOUS COMPONENTS 1-5 (% l~Y WEIGHT) - Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is avalis~le, report the I~ighest percentage in [hat range. (Report for components 2 througti 5 in 2~0, 234, 238, and 242.) 227. HAZARDOUS COMF~NENTS' 1-5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names of hazardoue components in Ihat mixture by percent weight (refer'to MSDS or, in the case of trade sec,ets, refer to manufacturer). All hazardous components in [he mixture present at greater than 1% by weight if non-carcinogenic` or 0.1% by weight if carcinogenic, should be reported. If more then fwe' h .a~a. rdous compCthents are present absve these pementagea, you may attach an aridibonal sheet of paper to capture the required information. When rapping waste mixtures, mineral and chemical should be listed. (Report for components 2 through 5 in 231,235. 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 ENS - Ohec~ `yes~ if the component of the mixture is considered an Extremely Hazes'daUb Substance aa defined in 40 CFR, Part 35,5, or "No' jr, it ia not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS - List the Chemical Abstract So,ice (CAS) numbers as ralateq to [he hazardou~ components in the mixture. (Repeat for 246. LOCALLY COLLECTED INFORMATION * This space'may be used by ~he CUPA or AA [o c~llect any additional inf~znation necessary lo meet [he requirements of their individual programs. Conta~ the CUPA or AA for guidance. UPCF (1/99) 7 OES Form 2731 )6" D] EWAY " E-,- 7654 16" D I E -76'54.' 16" D I E-8327 £/,~6 STA. 102-017 '., E~7~ E -7654 'E-76'5~ "" 16" D.I. usiness Name: Business Add~ess: ,] FACILITY DIAGRAm! ~ S:\PKOC~DUR,~ MA~AL'~.~v~j'