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KRAGEN AUTO PARTS 0273-MING
Manager FELIPE HERNANDEZ
Location: 3650 MING AVE
City BAKERSFIELD
SiteID: 015-021-000508
BusPhone: (661) 834-0261
Map 123 CommHaz High
Grid: 11B FacUnits: 1 AOV:
CommCode: BFD STA 07
EPA Numb: CAL000186882
SIC Code:5531
DunnBrad:04-931-7357
Emergency Contact / Title Emergency Contact / Title
FELIPE HERNANDEZ / MANAGER ADT SECURITY / AVAILABLE 24/7
Business Phone: (661) 834-0261x Business Phone: (800) 848-2872x
24-Hour Phone ( ) - x 24-Hour Phone (800) 848-2872x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: RSs Fire .React ImmHlth De1Hl~th
Contact 3E CO/REG DEPT C/O CSK AUTO INC Phone: (760) 602-8700x
MailAddr: 1905 ASTON AVE 100 State: CA
City CARLSBAD Zip 92008
Owner CSK AUTO INC Phone: (602) 631-7203x
Address PO BOX 6030 State: AZ
City PHOENIX Zip 85005
Period. to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: Yes
ParcelNo:
Emergency Directives,:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG T - ABOVEGROUND STORAGE TANK
F3ased on my inquiry of those individuals
responsible for obtaining the information, I certify
under penalty of law that I have personally ~NT
examined and am familiar with the information D
Fo
4:
p
submit•ed and believe the information is true,
accur e, and complete. U 8 ~~0~
~"_ '~ ~a ~~--
gnature D e
-1- 02/02/2007
:. _!
F KRAGEN AUTO PARTS 0273-MING
~ Hazmat Inventory
~ MCP+DailyMax Order
= SiteID: 015-021-000508 ~
By Facility Unit ~
Fixed Containers on Site ~
Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP
WASTE BATTERIES (SULFURIC ACID) F R IH S 1050.00 LBS Hi
WINDSHIELD WASHER CONCENTRATE DH L 250.00 GAL Hi
LEAD ACID BATTERIES L 1050.00 LBS Low
WASTE ABSORBENT CONTAINING OIL S 550.00 LBS Low
WASTE OIL F DH L 185.00 GAL Low
ANTIFREEZE F DH L 151.00 GAL Low
AUTOMATIC TRANSMISSION FLUID F DH L 150.00 GAL Low
MOTOR OIL F DH L 1044.00 GAL Min
WASTE BRAKE LATHE SHAVINGS (HEA S 60.00 LBS UnR
-2- 02/02/2007
n ~ _7,
-3-
02/02/2007
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 ~
~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
WASTE BATTERIES (SULFURIC ACID) Days On Site
365
Location within this Facility Unit Map:l Grid:D-2
STOCKROOM CAS#
7664-93-9
STATE TYPE ~~ PRESSURE TEMPERATURE ~ CONTAINER TYPE
Solid Waste I Ambient ~ Ambient I OTHER - SPECIFY
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
10.50 LBS 1050.00 LBS 525.00 LBS
HAZARDOUS COMPONENTS
°sWt. RS CAS#
34.00 Sulfuric Acid (EPA) No 7664939
53.00 Lead No 7439921
--- I11iGLi.LC1J HJ JP~.7.71~1.CilV 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No Yes No No/ Curies F R IH / / / Hi
~ Inventory Item 0006 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
WINDSHIELD WASHER CONCENTRATE Days On Site
365
Location within this Facility Unit Map: Grid:
RETAIL SALES FLOOR CAS#
Liquid TMixtur~ Ambient~E ~ AmbientT~E I PLASTOICTCONTAINERE
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
220.00 GAL 250.00 GAL I GAL
iirauri[u~vv.7 L.V1•irV1VJJIV 15
°sWt. RS CAS#
30.00
Methanol
No '
67561
rJli[~ti1C1J ti~ 7.7.GJ J1~1P~1V 1 J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies DH / / / Hi
-4- 02/02/2007
r i
F KRAGEN AUTO PARTS 0273-MING
~ Inventory Item 0008
COMMON NAME / CHEMICAL NAME
LEAD ACID BATTERIES
Location within this Facility Unit
STOCKROOM
SitelD: 015-021-000508 ~
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixture ~ Ambient ~ Ambient OTHER - SPECIFY
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum I Daily Average
10.50 LBS 1050.00 LBS 525.00 LBS
r~~Htu~~ua ~~lnr~lv~ivlJ
oWt. RS CAS#
35.00 Sulfuric Acid (EPA) No 7664939
34.00 Lead No 7439921
31.00 Lead Dioxide No 1309600
riKGF-1KL AJJliJJI~ll";1V 15
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Low
~ Inventory Item 0009 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
WASTE ABSORBENT CONTAINING OIL Days On Site
365
Location within this Facility Unit Map: Grid:
STOCKROOM CAS#
~SolidE TWaste ~mbient~E ~ AmbientT~E DRUM/BARRELEMETALLI~
AMOUNTS AT THIS LOCATION
Largest Co550100rLBS Daily 550100m LBS I Daily 550r00e LBS
ri1-~GL~iK.UVUJ lrV1~lYV1VL'1VJ..7
oWt. RS CAS#
25.00 Waste Petroleum Hydrocarbons No
t1EiGE~tCL 1~J J~JJ1~11;1V1J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / Low
-5- 02/02/2007
T ~ ~1
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 ~
~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
WASTE OIL Days On Site
365
Location within this Facility Unit Map:l Grid:E/F
STOCKROOM CAS#
221
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid Waste Ambient Ambient ABOVE GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
185.00 GAL 185.00 GAL 93_.00 GAL
riAGAlCLVV~ 1.;V1~lYV1VJ;1V"1J
oWt. RS CAS#
100.00 Waste Oil, Petroleum Based No 0
tiHGAKL HS~L5~1~11";1V'1
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
~ Inventory Item 0003
COMMON NAME / CHEMICAL NAME
ANTIFREEZE
Location within this Facility Unit
RETAIL SALES FLOOR
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map:l Grid:E-3
CAS#
107-21-1
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 151.00 GAL 755.00 GAL
tJl-~GKtCLV U .7 1.V1~lYV1V.CilV 1 iJ
oWt. RS CAS#
100.00 Ethylene Glycol No 107211
riHGHKL 1-~.7.7~Ja1~11;1V l
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
-6- 02/02/2007 '~,
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 ~
~ Inventory Item 0007 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
AUTOMATIC TRANSMISSION FLUID Days On Site
365
Location within this Facility Unit Map: Grid:
RETAIL SALES FLOOR .CAS#
64742-56-9
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixture~ Ambient ~ Ambient ~ PLASTIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
0.25 GAL 150.00 GAL 75.00 GAL
- HAZARDOUS COMPONENTS
%Wt. RS CAS#
riAGKKL A~SL"~~~1~1L"~1V 15
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
~ Inventory Item 0001
COMMON NAME / CHEMICAL NAME
MOTOR OIL
Location within this Facility Unit
RETAIL SALES FLOOR
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map:l Grid:B/C
CAS#
8020835
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixture ~ Ambient ~ Ambient ~ PLASTIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
5.00 GAL 1044.00 GAL 522.00 GAL
t1f1GHKLVUA l..Ui~lYUlVL'1VlJ
%Wt. RS CAS#
100.00 Motor Oil, Petroleum Based No 8020835
t1L~~GL~itCL H~ JI~J5J1~1J~J1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Min
-7- 02/02/2007
l ~~
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 ~
~ Inventory Item 0010 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
WASTE BRAKE LATHE SHAVINGS (HEAVY METALS) Days On Site
365
Location within this Facility Unit Map: Grid:
STOCKROOM CAS#
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Solid TWasteAmbient ~ Ambient PLASTIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
60.00 LBS 60.00 LBS 30.00 LBS
HAZARDOUS COMPONENTS
~Wt.
RS CAS#
riAGHKL AS~L~~1~1L"~1V'1'S
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies / / / UnR
-8- 02/02/2007 ~
• } .~
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 10/21/1998 ~
CALL 911.
Employee Notif./Evacuation
10/21/1998
IN CASE OF EMERGENCY EMPLOYEES ARE INSTRUCTED TO ESCORT CUSTOMERS OUTSIDE
THE CLOSEST EXIT. THE STORE HAS TWO EXIT DOORS.
Public Notif./Evacuation 10/21/1998
HAVE INFORMED EMPLOYEES ON HOW TO EVACUATE THEMSELVES AND CUSTOMERS IF AN
EMERGENCY EXISTED. THEY ARE TO EXPLAIN THE EMERGENCY AND TO EITHER EXIT THE
FRONT OR BACK DOOR IN A FAST, CALM MANNER. FRONT AND BACK DOORS WILL BE
FREE TO OPEN DURING BUSINESS HOURS.
Luiciycii~.y -•icui~.ai riait
-9- 02/02/2007
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508
Fast Format
~ Mitigation/Prevent/Abatemt Overall Site
~ Release Prevention 04/20/2006
SINCE PRODUCTS FOR SALE ARE PREPACKAGED, THE SPILLED CONTAINER WILL BE
BROUGHT BACK TO THE UPRIGHT POSITION: SPILLS WILL BE MAINTAINED WITH SPILL
KITS OR ASSISTANCE FROM OUTSIDE EMERGENCY HAZARDOUS SPILL CONTRACTORS. IN
THE EVENT OF A SPILL THE AREA WILL BE SEALED OFF FROM NON-ESSENTIAL PERSONS.
USUALLY AN ABSORBENT MATERIAL WILL BE IMMEDIATELY POURED ON THE SUBSTANCE
AND ANY ADJACENT DRAINS ARE COVERED TO PREVENT CONTAMINATION. IF THE SPILL
IS LESS THAN 5 GALLONS, 3E COMPANY WILL BE CONTRACTED FOR INSTRUCTIONS ON
HOW TO CLEAN UP THE PRODUCT.
9
Release Containment
04/20/2006
EMPLOYEES ARE INFORMED THAT IF ANY LIQUID SPILLS HAPPEN THAT THEY ARE TO
CLEAN UP IMMEDIATELY. OIL ABSORBENT IS USED. MAJOR SPILLS WILL BE
CONTAINED UNTIL THE FIRE DEPT GETS HERE. WE ALSO HAVE TWO EXTINGUISHERS
(ABC TYPE); WE USE THIS TO STOP FIRES. ALL EMPLOYEES ARE INSTRUCTED ON HOW
TO USE THEM.
Clean Up 04/20/2006
CLEAN-UP IS DONE QUICKLY AND EFFECTIVELY. WE USE OIL ABSORBENT TO CLEAN UP
SPILLS. BAKING SODA IS ON-HAND TO NEUTRALIZE ACID SPILLS.
Vt,.11C.L tCCbVULLC a`'1C.:l.1Vdl.1U11
-10- 02/02/2007
F KRAGEN AUTO PARTS "0273-MING SiteID: 015-021-000508 ~
Fast Format ~
~ Site Emergency Factors Overall Site ~
iJ~JCC:1d1 11dGdL U5
Utility Shut-Offs 02/02/2007
A) GAS - REAR OF SHOPPING CTR
B) ELECTRICAL - BACKROOM
C) WATER - REAR OF SHOPPING CTR
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water
02/02/2007
PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLERS IN FRONT AND BACK ROOMS AND
TWO ABC FIRE EXTINGUISHERS IN FRONT AND BACK.
FIRE HYDRANT - W SIDE OF BLDG (SILVER) AND NE CRNR MING & REAL.
Building Occupancy Level
8 EMPLOYEES
03/09/2006
-11- 02/02/2007
J r!
F KRAGEN AUTO PARTS 0273-MING SiteID: 015-021-000508 =
Fast Format =
~ Training Overall Site =
Employee Training 11/15/2006 =
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE MONTHLY MEETINGS. MANAGER HOLDS
MONTHLY MEETINGS AND INCORPORATES FIRE SAFETY AS AN ISSUE. ALL EMPLOYEES
ARE INSTRUCTED HOW TO USE A FIRE EXTINGUISHER, WHERE THEY.ARE LOCATED, THE
FIRE EXTINGUISHER AREAS AND TO KEEP THEM FREE FROM CLUTTER, WHERE THE HAZMAT
BINDER IS LOCATED AND HOW TO READ IT. THE ELECTRICAL BOX IS ALSO TO BE KEPT
FREE FROM CLUTTER. FIRST AID IS AN ISSUE ALSO.
ruyc a
Held for Future Use
nciu ivy.. ru~.utc vac
-12- 02/02/2007
.;
UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
lBakersfielai Fire Dept.
Enironmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
FACILITY NAME !~ 1 l INSPECTION DATE INSPECTION TIME
ADOR 5S PHONE No. No. of Employees
FACILITYCONTACT Business ID Number
15-02 l - c,~CBc3 ,~U~
a
Section 1: Business Plan and Inventory Program
l~Routine ^ Combined ^ Joint Agency ^Mnlti-Agency O Complaint ^ Re-inspection
•
COMMENTS
D NOV 15 D
C V l V=Vio ationnCe) OPERATION
^ APPROPRIATE PERMIT ON HAND
JzI ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ _
PROPER SEGREGATION OF MATERIAL
P ^ VERIFICATION OF MSDS AVAILABILITYE
^ VERIFICATION OF HAT MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE
- ,-t,
XJ ----
^ ----- ------ -- - ------ ----- - _- -------- ---- - -.... _._.
CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
------------
^ ------------- -- -------------------- ------------
SITE DIAGRAM ADEQUATE 8c ON HAND
• QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT 661 326-3979
( )
Ins or Badge No.,
While • Environmental Services Yellow - Staten Copy
Business Si Responsible Pa
Pink -Business Copy
ANY HAZARDOUS WASTE ON SITE: ES ^ NO
f~
~~.
+ KRAGEN AUTO PARTS 273 _______________________________ SiteID: 015-021-000508 +
Manager ROBERT WINTERS
Location: 3650 MING AVE
City BAKERSFIEI,D
BusPhone: (661) 834-0261
Map 123 CommHaz High
Grid: 11B FacUnits: 1 AOV:
CommCode: BFD STA 07 SIC Code:5531
EPA Numb: ~~}L ~C?G'1 ~b ~$2 DunnBrad: 04-931-7357
Emergency Contact / Title Emergency Contact / Title
ROBERT WINTERS / DIST MANAGER ADT SECURITY / AVAILABLE 24/7/-
Business Phone: (559) G~-8-5.6~1-~r~~3?°2 Business Phone: (800) 848-2872x
24-Hour Phone (559) 4-~Er~-8~•6f-~ Z~-'~g~-4 24-Hour Phone ( $DO) $9~ -~~~Z x
Pager Phone ( ~/l~ ) - x Pager Phone (~%!)- ) - x
Hazmat Hazards: RSs Fire React ImmHlth DelHlth
+ Contact 3E COl~,yu~a 1~~arJ-v~t~ri'f~ C1C ~~K !~+•c`b, znL phone: (760) 602-8700x
MailAddr: 1905 ASTON AVE 4-6.6 S'~~~-eIDL> State: CA
City CARLSBAD ~ Zip 92008
Owner CSK AUTO,INC Phone: (602).
Address PO BOXG,8030 State: AZ b3i •- ~-2Q~
City PHOENIX Zip 85005
Period 3~02~~ o2GD~ to 3/~~//~~p~ TotalASTs : I = f $5' Gal
Preparers TotalUSTs: = Gal
Certif~d: RSs: Yes
~ ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG T - ABOVEGROUND STORAGE TANK
ENT'D APR 2 ® 2006
Based on my inquiry of those individuals
responsible for obtaining the information, I certify
under penalty of law that I have personally
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
~ a~6
i a e Dae
-1- 03/09/2006
=1
BAKER$FIELD FIRE DEPT.
HAZARDOUS MATERHIALSPMANAGEMENT PLAN ~~ Pl6V@II~OII SCIV~CCS
UNIFIED PROGRAM CONSOLIDATED FORMS R.1E..t 900 'i5rtuturi Ave.., StC. 210
w~~t Bakersfield, CA 93301
CHEMICAL DESCRIPTION FORM ~~tr rel.: (661) 326-3979
HAZARDOUS MATERIALS INVENTORY ~ Fax: (6C 1) 852-2171
^ NEW ~ ADD ^ DELETE ^ REVISE 2005
(One lorm per material, per building, or area.)
P9na1 nr 7
BUSINESS NAME (Sane ss FAC9-tTY NAME or DBA -Doing Bwkiase As)
Kragen Auto Parts #0273
CHEMMJIl. LOCATION 207 CHEMICAL. LOCATION
Retail Sales Floor CONF9)ENTIAL(EPCRA) 0 Yak(
FACILRY 10 No. 1 MAP No. (opNonN) 203 GRID NO. Iopttonaq
1 D/E-3, E-2
CHEMICAL NAME ~`
TRADE sECR>=T o Ya ~ No
Windshield Washer Fluid
COMMON NAME ~ 207
FJiS' ^ Yes ~ No
Windshield Washer Fluid
CAS No. 209 'If EHS is'Yas,' aq arou><s below mua be
Mixture ~' ~
FIRE CODE HAZARD CLASSES (Cornplab N requeslad by local fire cHeq 21
FLIB, IRR, OHH
TYPE
^ p PURE ~ m MU(TURE 0 w WASTE 211 2/
RADIOACTIVE: ^ Yes ~ No CURIES 21
LARGEST CONTAINER 21
PMYSK:AL STATE ^ e SOLID ~ I LIQUID ^ p GAS 214
220
z1
FED HAZARD CATEGORIES ~ 1 FIRE ^ 2 REACTNE ^ 3 PRESSURE RELEASE ,~ 4 ACUTE HEALTH ~ 5 CHRONIC HEALTH
(CMtlc M em aPWY)
ANNUAL WASTE
AMOUNT 217 MAXIMUM
DAILYAMOUNT 218 AVERAGE
DAILYAMOUNT 219 STATE WASTE
CODE
125 250 O N/A
221 2zz
^ UNRS' pa GAL
'U EHS, amourt mwt be in Ibs.
^ d CU FT ^ Ib LBS ^ tri TONS DAYS ON SITE
365
22
STORAGE CONTAINER
rctnck .n tn.r .ppryJ ^ a ABOVEGROUND TANK 0 t CAN ^ k BOX ^ p TANK WAGON
^ b UNDERGROUND TANK ^ p CARBOY 0 I CYLINDER 0 q RAIL CAR
^ c TANK INSIDE BUILDING ^ h SILO
^ d STEEL DRUM O I FIBER DRUM n ~T~ ~nLE
^ e PLASTICMONMETALLK: DRUM ^ j BAG ^ o TOTE BIN
?2
STORAGE PRESSURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ De BELOW AMBIENT
STORAGE TEMPERATURE ~ a AMBIENT ^ as ABOVE AMBIENT
^ ba BELOW AMBIENT
^ c CRYOGENIC Z2
%WT ~`' .
'` HAZARDOUS COMPONENT
EHS '` ,..
. .,
CAS # . ~:. ' '
1 30 ~g ethanol 227 ^ Yss,~ No 22b 67-56-1 ?Z
2 230 231 0 Yes ^ No 232 2
3 234 235 0 Yes ^ No 238 23
4 238 239 ^ Yaa ^ No 240 241
S 242 243 ^ Yss ^ No 244 2
-~:- :.
~. ; . ; : _ ,~.. :• . ; = 111. SIfNATU1tE. ;`
.;
PRINT NAME ti TrrLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2
Jonita D. Cochran,Agent for CSK Auto, Inc.
Regulatory Compliance Coordinator, 3E Company 03/30/2006
0
FD 2144 (Rev. 09/05)
BAKERSFIELD FIRE DEPT.
(HMMP) 3 Pteveation Services
HAZARDOUS MATERIALS MANAGEMENT PLAN .~
UNIFIED PROGRAM tANSOL~ATEO FORMS ~.r 900 ~13II AVC., StC. 21 O
I/lt Bakersfield, CA 93301
CHEMICAL DESCRIPTION FORM wlirr rel.: (661) 326-3979
HAZARDOUS MATERIALS INVENTORY ~ Fax: (661j 852-2171
~ NEW ~ ADD ^ DELETE ^ REVISE 2005 (One lorm per material, per Duild)np, or area.)
°---. _.
BUSINESS NAME (Suns ss FACILTTY NAME or DBA -Doing Bwinssa As)
Kragen Auto Parts #0273
CHEMICAL LOCATION 201 CHEMK:AL LOCATK)N
CONF~ENTUIL (EPCRA) 0 Yas)9(
Retail Sales Floor
FACILITY ID No. 1 MAP No. (opfkmu) 203 GRID NO.10~~9
1 C-1/2
CHEMICAL NAME 205
TRADE SECRET 0 Yss ,~ IJo
COMMON NAME ~T EHS' ^Yss ,~ NO
Automatic Transmission Fluid
CAS No. 209
'll EHS is'Yas,' a9 amo~r+<: Delow rtant bs
in Wa.
FIRE CODE HAZARD CLASSES (Cornpleb i(roquestad by heal 9ra Wsq 21
IRR, CLIMB; OHH
TYPE
^ p PURE ~(m MU(TURE 0 w WASTE 211 2/
RADIOACTNE: ^Yss ~ pio CURIES 21
LARGEST CONTAINER 21
PHYSICAL STATE ^ s SOLID ~ I UOUID ^ p GAS 214
.25
FED HAZARD CATEGORIES ~ 1 FIRE D 2 REACTNE p 3 PRESSURE RELEASE ,~ 4 ACUTE HEALTH O 5 CHRONIC HEALTH 21
(Check aM that apply)
ANNUAL WASTE
/~pUM 217 MAX9~AUM
DAILYAMOUNT 219 AVERAGE
DAILY AMOUNT 219 STATE WASTE
CODE
0 150 7S N/A
z21 222
^ UNRS' ~ pa GAL ^ d CU FT ^ Ib LBS ^ to TONS DAYS ON SRE
365
9 EHS, emourq moat bs in Ibs.
22
STORAGE CONTAINER
(CMek M/ MN ~ppry) ^ a ABOVEGROUND TANK 0 f CAN ^ k BOX ^ p TANK WAGON
0 b UNDERGROUND TANK ^ p CARBOY 0 I CYLINDER ^ q RAIL CAR
^ c TANK INSIDE BUILDING D h SILO
^ d STEEL DRUM ^ i FIBER DRUM c PLAST~ BOTT~
^ s PLASTIC)NONMETALLK: DRUM ^ j BAG ^ o TOTE BIN
22
STORAGE PRESSURE ~ a AMBIENT O as ABOVE AMBIENT ^ ba BELOW AMBIENT
STORAGE TEMPERATURE ~ • AMBIENT 0 sa ABOVE AMBIENT
^ bs BELOW AMBIENT
^ c CRYOGENIC ZZ
%WT '' ~ ~ HAZARDOUS COMPONENT EHS .;. .. ~ , ..~ CAS #.
1 97 22g lneral Oil, Petroleum Distillates 227 ^ Yesl3(No z2a 64742-65-0 22
2 230 231 p Yes ^ No 232 2
3 234 235 ^ Yea ^ No 238 ~
4 238 239 ^ Yaa p No 240 241
S 242 243 ^Yss ^ No 244 2
• ;~~ 111. $IfaNATURE '. '- ', '
PRINT NAME b TTILE OF AUTHORIZED COMPANY itEPRESENTATNE SIGNATURE DATE 2
Jonita D. Cochran,Agent for CSK Auto, Inc.
Regulatory Compliance Coordinator, 3E Company 03/30/2006
// tU1744 (KeV. U'J/U5)
BAKER,SFIELD FIRE DEPT.
(HMMP) i
r ~ Prevention Services
HAZARDOUS MATERIALS MANAGEMENT PLAN t~..t 900 Truxtun Ave., Ste. 210
UNIFIED PROGRAM CONSOLIDATED FORMS ~~tt Bakersfield, CA 93301
CHEMICAL DESCRIPTION FORM ~~~~ Tel.: (661) 326-3979
HAZARDOUS MATERIALS INVENTORY ~ Fax: (661) 852-2171
^ NEW ~ ADD ^ DELETE 0 REVISE 2005
(One form per material,. per Duildinp, or arse.)
BUSINESS NAME (Sams W FACILITY NAME of DBA - Dok~p Buakrse Aa)
Kragen Auto Parts #0273
CNEMMJIL LOCATION 201 CHEMICAL LOCATION
Stocla-oom CONFtflENTIAI (EPCRA) ^ Yak(
FACILRY ID No. 1 MAP No. (opHOns/) 203 GR10 N0. (opNOnaq
1 E-2
CHEMICAL NAME 205
TRADE SECRET 0 Yss ~ No
COMMON NAME Z07
EHS' ~ Yss ^ No
Lead Acid Batteries 2
CAS No. 209
'It EHS ia'Ya; aq amouras bekrw mart bs
kt ~s.
FIRE CODE HAZARD CLASSES (Complab A rsqusstsd by heal Ike diet) 21
WRII, CORR
TYPE
^ p PURE ~ m MDCTURE ^ w WASTE 211 21
RADIOAC7IYE: ^ Yea ~ No CURIES 21
LARGEST CONTAINER 21
PHYSICAL STATE ^ s SOLID ~ I UOUID ^ q GAS 214
10.5(Electrolyte)
FED HAZARp CATEGORIES 0 1 FIRE ,~ 2 REACTNE ^ 3 PRESSURE RELEASE ,~ 4 ACUTE HEALTH 0 5 CHRONIC HEALTH 21
(Chsdt all that spply)
ANNUAL WASTE 217 MAXIMUM
DAILYAMOUrrr 218 DAIL~AMOUNT 219 CODE WASTE
AMOUNT N/A 1050 525 N/A
z21 222
^ UNRS ^ pa GAL
.B EHS, amourd must bs in Ibs.
O d CU FT ;fsl Ib LBS D to TONS DAYS ON SfTE
36S
22
STORAGE CONTAINER
(l:Mck N! Mu sPVb) ^ a ABOVEGROUND TANK ^ f CAN ^ k BOX ^ p TANK WAGON
^ b UNDERGROUND TANK ^ p CARBOY ^ 1 CYLINDER ^ q RAIL CAR
^ e TANK INSIDE BUILDING ^ h SILO Bette Case
D d STEEL DRUM ^ f FIBER DRUM D ~ ~~ BOTTLE
^ a PIASTICMONMETALLIC DRUM 0 ~ BAG ^ o TOTE BIN
22
STORAGE PRESSURE ~ • AMBIENT ^ as ABOVE AMBIENT ^ Da BELOW AMBIENT
8TORAGE TEMPERATURE jq a AMBIENT ^ sa ABOVE AMBIENT
^ ba BELOW AMBIENT
^ c CRYOGENIC ZZ
%WT ~
~ ''' HAZARDOUS COMPONENT ,
EHS ':` . .
; ..
~ `- ~~ CAS # '
1 35 226 Sulfuric Acid (Electrolyte) 227 Yes ^ No 226 7664-93-9 22
2 34 230 ead 231 ^ Yea ~QNo 232 7439-92-1 ~ 2
3 31 234 ead Dioxide 235 o Yea~(I No 238 1309-60-0 23
4 236 239 ^ Yas ^ No 240 241
S 242 243 ^ Yea ^ No 244 24
;;.
.. ...,.
... .,
111.'SIf NATURE. ', "' . ". ~,'"
,.
PRWT NAME b TRLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2
Jonita D. Cochran,Agent for CSK Auto, Inc.
Regulatory Compliance Coordinator, 3E Company 03/30/2006
v
FD 2144 (Rev. 09/05)
B.AKERSFIELD FIRE DEPT.
(HMMP) i
"~ Prevention Services
HAZARDOUS MATERIALS MANAGEMENT PLAN Rat 900 Truxtun AvC., Stc. 210
UNIFIED PROGRAM CONSOL~ATED FORMS Its Bakersfield, CA 93301
CHEMICAL DESCRIPTION FORM ~itr~ rel.: (661) 326-3979
HAZARDOUS MATERIALS INVENTORY ~ Fax: (661) 852-2171
~ NEW ~ ADD ^ DELETE ^ REVISE 2005 (One form per material, per Ouildinp, or area.)
BUSINESS NAME (Same as FACILRY NAME or OBA - Ooinp Busirrss Aa)
Kragen Auto Parts #0273
CHEMICAL LOCATION I01 CHEMK;AI. LOCATION
Stockroom CONF~ENTULL (EPCRA) ^ Yas~(
FACILITY ID No. 1 MAP No. (opNonsQ 203 GRID NO. top/anq
1 F-2
CHEMICAL NAME 205
TRADE SECRET ^ Yes ~ No
COMMON NAME 207
EHS• o Yea ~( No
Used Absorbent containing Oil
CAS ~~ 209
'U EHS is'Yas,' ab amouras bskyw must be
~ Ws.
FIRE CODE HAZARD CLASSES (Compleb it /aqusstad by Beal tin cf~s1) 21
IRR
TYPE 211
^ p PURE ^ m MU(TURE ~lQ w WASTE 21
RAOK)ACTNE: ^ Yes ~ No CURIES 21
LARGEST CONTAINER 21
PHYSICAL STATE ~ s SOLID ^ I LIOUID ^ p GAS 214
55 gal drum (550 lb. capacity)
21
FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTNE ^ 3 PRESSURE RELEASE ~ 4 ACUTE HEALTH ^ 5 CHRONIC HEALTH
(Chstl~ aM that aPWY)
ANNUAL WASTE 217 MAXIMUM 219
DAtLYAMOUNT AVERAGE 219
DAILY AMOUNT STATE WASTE
CODE
AMOUNT 275 SSO 550 343
221 222
^ UNRS' ^ t7a GAL
.8 EHS, amourq must ba in lbs. ^ d CU FT ~( Ib LBS ^ to TONS DAYS ON SITE
3 65
22
STORAGE CONTAINER
(Cnsck N/ fns/ sOVhJ ^ a ABOVEGROUND TANK 0 t CAN O k BOX ^ p TANK WAGON
^ b UNDERGROUND TANK ^ p CARBOY 0 I CYLINDER ^ q RAIL CAR
^ e TANK INSIDE BUILDING ^ h SILO
~( d STEEL DRUM ^ f FIBER DRUM 0 n PLASTK; BOTTLE
O s PLASTICMONMETALLK: DRUM ^ j BAG O o TOTE BIN
22
STORAGE PRESSURE ~( a AMBIENT O as ABOVE AMBIENT ^ Da BELOW AMBIENT
2Z
8TORAGE TEMPERATURE ~( a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC
%WT ` '. ;.
HAZARDOUS COMPONENT ..
EHS .., .
CAS #
1 25 T28 Waste Petroleum Hydrocarbons 227 ^ Yes, No 2ze Mixture 22
2 75 230 11 Drl Absorbent 231 ^ Yea ~No 232 /A ~ 2
3 234 235 ^ Yes ^ No 238 23
4 238 239 D Yss D No Z40 241
S 242 243 ^ Yes ^ No 244 24
,: ....
.. i-
" ~< III. SifNATURE_
PRINT NAME b TITLE OF AUTHORIZED COMPANY REPRESENTATNE SIGNA DATE 2
Jonita D. Cochran,Agent for CSK Auto, Inc.
Regulatory Compliance Coordinator; 3E Company 03/30/2006
FD 2144 (Rev. 09/05)
BAKER$FIELD FIRE DEPT.
HMMP) ~~
HAZARDOUS MATERIALS MANAGEMENT PLAN P!@V@II~OYI SeIV~CeB
UNIFIED PROGRAM CONSOI.~ATED FORMS ~-~' 900 ~IYl1XtUA Ave.., StC. 21O
/Itt Bakersfield, CA 93301
CHEMICAL DESCRIPTION FORM ~ir/r rel.: (661) 326-3979
HAZARDOUS MATERIALS INVENTORY ~ Fax: (661) 852-21? 1
^ NEW ~ ADD ^ DELETE ^ REVISE 2005
(One lorm per material, per buildfny, or area.)
Pnnw1 of 2
BUSWESS NAME (Same as FACILRY NAME or DBA - Ooiro Business As)
Kragen Auto Parts #0273
CHEMICAL. LOCATION 201 CHEMICAL LOCATION
SLOCkrOOm CONF~EMIAL (EPCRA) ^ Yes(
FACILRY ID No. 1 MAP No. (opHOnan 203 GRID NO. /optbMq
1 F!G-1
CHEMICAL. NAME 205
TRADE SECRET ^ Ya ,~ No
COMMON NAME T07
EHS' ^ Yes ;a( No
Brake Lathe Shavings (heavy metals)
CAS N0' ~
'll EHS is'Yes,' ap amo~atts below mutt be
h ibs.
FIRE CODE HAZARD CLASSES (Compleb 8 roqussbd by local tiw dtiM) 21
IRR
TYPE
^ p PURE ^ m MIXTURE ~S(w WASTE 211 21
RADIOACTNE: ^ Yes ~ No CURIES 21
LARGEST CONTAINER 21
PHYSICAL STATE ~ s SOLID ^ 1 UOUID ^ p GAS 214
5 gal bucket (601b capacity)
FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 RFJICTNE ^ 3 PRESSURE RELEASE ~ 4 ACUTE HEALTH ^ 5 CHRONIC HEALTH 21
(Check aM that appy)
ANNUAL
WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE
.
A~,qU~ 180 DAILYAMOUNT60 DAILY AMOUNT 30 CODE 352
221 222
^ UNRS 0 pa GAL
.a EHS, amount moat bs in roe.
^ d CU FT ~ Ib Lti$, ^ to TONS DAYS ON SITE
365
2z
STORAGE CONTAINER
(cnees alt Ina eppry) ^ a ABOVEGROUND TANK ^ f CAN ^ k BO% ^ p TANK WAGON
^ b UNDERGROUND TANK ^ p CARBOY 0 I CYLINDER ^ q RAIL CAR
^ e TANK INSIDE BUILDING ^ h SILO Plastic Bucket
^ d STEEL DRUM ^ i FIBER DRUM ^ ~ PLASTIC BOTTLE
^ e PLASTICAYONMETALLIC DRUM ^ j BAG ^ o TOTE BIN
ZZ
STORAGE PRESSURE J~ a AMBIENT ^ as ABOVE AMBIENT ^ t>a BELOW AMBIENT
STORAGE TDNPERATURE ~ a AMBIENT 0 as ABOVE AMBIENT
^ ba BELOW AMBIENT ^ c CRYOGENIC Z2
%WT ': ' ` ~ .: HAZARDOUS COMPONENT EHS ~ :'~.. . ` ., . CAS # .
1 100 ~8 rake Lathe Shavings (heavy metals) 227 ^ Yes No 228 Mixture ZZ
2 Z30 231 ^ Yes ^ No 232 2
3 234 235 0 Yes ^ No 238 23
4 238 239 Q Yss ^ No 240 241
5 242 243 ^ Yes 0 No 244 2
~'•~ 111. $If NATURE. ' , ''. ' ` ,
PRINT NAME b TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATU DATE 2
Jonita D. Cochran,Agent for CSK Auto, Inc.
Regulatory Compliance Coordinator, 3E Company 04/03!2006
FD 2144 (Rev. 09105)
°• ~:
-~ Kragen Auto Supplemental Emergency Response Information
Reporting and Notification:
In the event that outside notification would be required for an incident at Kragen, the Manager on
Duty (MOD) or Corporate Personnel (CP) will notify applicable federal, state, and local agencies.
The Fire Department will be contacted immediately for all spills over five gallons, and for small
spills the MOD will contact 3E Company for assistance in clean-up procedures. Any spill occurring
offsite or release into the environment or waterway, the Office of Emergency Services will be
contacted. Administering Agency for this facility is the Bakersfield Fire Department.
• Office Of Emergency Services: (800) 852-7550
• Administering Agency: (661) 326-3979
• Fire Department: (661) 326-3652 (Bakersfield Fire Department)
• 3E Company: (800) 451-8346
Mitigation:
Since products for sale are prepackaged, the spilled container will be brought back to the upright
position. Spills will be maintained with spill kits or assistance from outside emergency hazardous
spill contractors. In the event of a spill the area will be sealed off from non-essential persons.
Usually, an absorbent material will be immediately poured on the substance and any adjacent drains
are covered to prevent contamination. If the spill is less than 5 gallons 3E Company will be
contracted for instructions on how to clean up the product.
Evacuation:
The manager on duty or applicable staff member will notify personnel and customers verbally and
by PA speaker. Employees are trained to evacuate the facility through the nearest emergency exit
and meet at the assigned staging area. Employees will assist customers for immediate evacuation.
Emergency Response Assistance:
The Fire Department will be contacted in the event of a fire or large chemical spill. If the spill is
over 5 gallons or the facility is not capable of in-house clean up a private Emergency Response
Team will be contracted out to assist in clean up. In the event of a medical situation regarding an
exposure to a product, poisoning, or small chemical spi113E Company will be contacted for
assistance. The store manager or any other properly trained employee will be in charge of cleaning
up a spill or notifying the proper agency.
Hazardous Materials at this facility are mainly pre-packaged consumer products located in the
general sales area. Hazardous wastes (i.e. batteries) from customer vehicles are collected and
deposited in the proper storage containers by trained personnel. The Battery cores and used motor
oil are collected from the general public and recycled once a week by Exide Corporation (610)
378-0500 and Safety-Kleen (800) 669-5740.
Medical Assistance:
If a medical situation should arise at Kragen, the manager on duty will assess the situation and
determine whether to administer first aid. If immediate medical treatment is required 911 will be
contacted. In the event of an exposure to a product or poisoning they will contact 3E Company to
receive assistance from Poison Control.
Kragen Auto Supplemental Employee Training Information
Methods for Safe Handling Hazardous Materials:
New employees are trained in the proper handling, recording and storage of Hazardous Materials.
They are trained to read/understand the MSDS and the proper use of PPE such as safety glasses,
gloves and acid apron. The business plan is reviewed at least annually and mandatory monthly
safety meetings cover Hazmat as well as general safety practices. Employee training records are
maintained in the manager's office. Hazmat training logs and inspection sheets are maintained by
the Store Manager.
Procedures for Coordinating Activities with Response Agencies:
All managers will attend aone-hour training annually reviewing the emergency response plan and
emergency notification procedures. This ensures compliance and coordination with local agencies
and clean-up personnel.
Proper use of On-Site Emergency Response Equipment by Employees:
All employees will attend a 2-hour training and BI-annual refresher training. The training will
include annual inspection procedures, review and maintenance of safety equipment, such as fire
extinguishers and eye wash stations. Training content includes review procedures for proper use of
safety and spill equipment.
Familiarization with the Business Emergency Response Plans and Procedures:
All employees receive an annual one-hour training on Emergency Response Plan Implementation.
The training will review emergency response plan, evacuation, and location of emergency shut-off
switches and specific responsibilities of all employees during an emergency. In addition, all
managers are trained on procedures for coordination with emergency response agencies. The
Business Plan and facility diagrams are kept onsite by the store manager and copies are maintained
by CSK Corporate Risk Assessment (602) 631-7203, and 3E Company, Regulatory Department
(760) 602-8700.
Provisions for Ensuring Initial and Refresher Training:
All employees will attend anone-hour bi-annual refresher training on proper procedures for
hazardous waste storage, handling, and labeling. They will review proper methods for all hazardous
waste disposal and record keeping requirements. They will review Material Safety Data Sheets and
the proper use of personal protective equipment. All employees will attend a bi-annual refresher
training for one-hour regarding the maintenance or safety equipment. All employees will attend an
annual one-hour training and review on the emergency response plan, evacuation, and location of
emergency shut-off switches and specific responsibilities of all employees.
ALIFORNIA ANNOTATED SITE MAP ~ BUSINESS NAME KRAGEN #273
A B C D E
2
3
4
5
6
~°
I SITE ADDRESS~~
F G
MING AVENUE Map #1~1 OF 2
SFIELD, CA 93309
H I
ABOYEGROUND
185 STORAGE TANK-
USED MOTOR OIL
SK SPILL KIT
UH USED LEAD ACiD
BATTERIES
AB USED ABSORBENT
CONTAINING OIL
B~ BRAKE LATHE
SHAVINGS
®I MOTOR OIL
AF ANTIFREEZE/
COOLANT
LEAD ACID
BATTERIES
WINDSHIELD
WF WASHER FLUID
O ELECTRIC MAIN
a FIRE
EXTINGUISHER
FIRST AID
TF AUTOMATIC
TRANSMISSION
FLUID
X ~~'
CALIF^RNIA ANN^TATED SITE MAP BUSINESS NAME: KRAGEN #273 SITE ADDRESS:3650 MING AVENUE
BAKERSFIELD, CA 93309 Ma #:2 OF
P
A B C D E F G H I
z
3
4
5
6
f°
RESIDENTIAL
IICHUCK I E
_ _ -
~'
j3 ...
1
~ ~
® 3i
~3
RESIDENTIAL
M DRID AVE UE
~ _
~ ® _
~ ~1 ~1
~ ~ E..., [...,
~ ~ ~ '
W
~
b-~-1 ~ /_
JAPAN SE VACANT DONU
RESTA RANT
MI G AV NLTE
1 SCA E~ NOT T A
3E ~
SAFE REFUGE AREA
STORM DRAIN
FIRE HYDRANT
GAS MAIN
WATER MAIN
Y
X -~
,,
UNIFIED PROGRAM INSPECTION CHECKLIST ~~
?&~Y'i',,::'.c~».~!"~'i^''U,:,e..X..v.zet, .<4. ,,.,'-TZ..U -..,.:.:n., iluc ~:.. ~~.'.....u~.., . -~:'~ :a:-'. .: ,1- d'.L' °.
SECTION 1: Business Plan and Inventory Program
•
BAKERSFIELD FIRE DEPT
Prevention Services
ti ~,~` D 900 ZYuxtun Ave., Suite 210
Awrr t Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
FACILITY NAME INSPEC ON DATE INSPECTION TIME
K b .J /9~rd PART' ~'`z~3 I ~ i~ as-
ADDRESS HONE NO. O OF EMPLOYEES
3losb ~1 /.vb /4 ~3 -6Z ~ l s"
FACILITY CONTACT USINESS ID NUMBER
15-021-
Section 1: Business Plan and Inventory Program
^ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
•
C V ~ C=Compliance OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
~l . ^ BUSInBSS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
~` ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITY
^ VERIFICATION OF HAZ MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND
P OCEDURES
,~ ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARD,yO~US WASTE ON SITE? YES ^ NO
EXPLAIN: l-~1`~~y-~' D/ ~ ----- ---- -
~ 1~"' ~ ~ ---- ---- ---
.QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
Inspector (P ease Print) Fire Prevention / 1°' In / Shift of Site/Station # Business Site/School Site Responsible Party (Please Print)
White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02/05)