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HomeMy WebLinkAboutBUSINESS PLAN 4/27/2007TAHOE JOES FAMOUS STEAKHOUSE Manager : ~evt~.t Ooc~Sa;~ Location: 9000 MING AVE P City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: ~II~56a BusPhone: Map 123 Grid: 05C SiteID: 015-021-002674 (661) 664-2626 CommHaz Low FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ~er.d; 17~c1s~ w. /~ewe.~~l Nh~ar~age~ / Business Phone: (l~tn` )t~~~t -~t I~x Business Phone: ( ) - x 2 4 -Hour Phone (~ ~ 1) 5 ~ `~ - ®t~~'~ x 2 4 -Hour Phone ( ) - x Pager Phone (, ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact :~ed~i ~0~~4"~ i Phone: (661) 664-8723x. MailAddr: 9000 MING AVE P State: CA City BAKERSFIELD Zip 93311 Owner TAHOE JOES FAMOUS STEAKHOUSE Phone: (651) 994-8608x Address 1460 BUFFET WY State: MN City EAGAN Zip 55121-1133 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Direct ives: ~ I PROG A - HAZMAT t ~,/~,~ PROG C - COMM HOOD ~/~ ~NT'p ~ id~~ais di i ~~ n ~ ~' 11 E3ased on my inquiry of those n v , ~ O~ V responsible for obtaining the information, ! ~.ertify under penalty of law that 1 have personaNy examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- 04/24/2007 TAIIOE JOSS FAMOUS STEA~k"IIOVSE~ 9000 MING AVENUE, SUITE P I - - ~~ i ' F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CARBON DIOXIDE F P IH G 5702.90 FT3 Min -2- 04/24/2007 -3- 04/24/2007 s F TAHOE JOES FAMOUS STEAKHOUSE ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit STATE TYPE PRESSURE _ Gas Pure Above Ambient SiteID: 015-021-002674 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 124-38-9 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest C5702190rFT3 Daily57l02190m FT3 I Daily5702r90e FT3 riAGF~tCLV U 5 1:V1~1Y V1V ~1V ~1~5 %Wt. _ _ _ RS CAS# 100.00 Carbon Dioxide No 124389 tiL~L,HK1J Y.~ ~ L' J J1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 04/24/2007 F TAHOE JOE5 FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification _, _ ,~ Prlll~JlVyGG 1VV 1.11. ~ P~V0.1.UQ1.1 V11 i~ t LLU11l.: 1VV 1.11. ~ P~VCi 1: UCLL1V11 Emergency Medical Plan -5- 04/24/2007 ~x F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ICCICGL~C YI_ C V Cll l.1 V11 Release Containment 1..1CQ11 V~1 V 1.11C 1. iCC.7-V U1l.:C t1l:V1VC1 l..1 Vll -6- 04/24/2007 r: F TAHOE DOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .~1/c~..idi ndc~a.LU~ - U 1. l 1 1 ~. y ai/ioul.. - v t 1 .7- i'11c r1Vl..CI: ~tiVdll. WdI.CL ~es D Ull11111t~. Vl: l: lL~J dill: ~/ LL''V~'1 -7- 04/24/2007 F~ Yi .! ~. P TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Training Overall Site ~ Employee Training ~~~ Page 2 Held for Future Use nciu ivi r u~.uic vac -8- 04/24/2007 _ ~ U1V1NiL'L YKVliKA1V11.:VIVJVLliIAllLL rVi(lVl ~ FACILITY INFORMATION t A BUSINESS OWNER/OPERATOR IDENTIFICATION ~ ~`~ Page _ of I. IDENTIFICATION FACILITY ID# t BEGINNING DATE too ENDING DATE tot BUSINESS NAME (Same as FACILITY NAME or DBA -Doing easiness As) 3 BUSINESS PHONE 102 T hoe 23 661- 4- 2 BUSINESS SITE ADDRESS to3 in A n Bd P CITY toa ZIP CODE tos CA DUN & BRADSTREET tob SIC CODE (4 digit #) to7 12-117-73 12 COUNTY ~~~~ 1v~ ~• J t~ K rn BUSINESS OPERATOR NAME tog BUSINESS OPERATOR PHONE tto L rr a h 661- - 723 II. BUSINESS OWNER OWNER NAME tlt OWNER PHONE tt2 B f In -4 41 OWNER MAILING ADDRESS tt3 1 0 B ffet CITY tta STATE tts ZIP CODE tt6 E n M 5512 III. ENVIItONMENTAL CONTACT CONTACT NAME tt7 CONTACT PHONE tta Bren r n en 1- - 541 CONTACT MAILING ADDRESS t t9 e n CITY tzo STATE t2t ZIP CODE tz2 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME tz3 NAME tza L rr r L c r TITLE tza TITLE tz9 ENE L AN G R RE IRE T R BUSINESS PHONE tzs BUSINESS PHONE t3o 61-4- 6 61-4- 1 24-HOUR PHONE tz6 24-HOUR PHONE tat PAGER # t27 PAGER # t3z ADDITIONAL LOCALLY COLLECTED INFORMATION: NSA 133 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 r nt Mort nsen 1 Brent Mortensen NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 rn en n R'k n mn ci Revised (5/03) ~~ UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL nESCRIPTION (one a er material er buildi or area) ®ADD ^DELETE ^REVISE 200 Page _ of _ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Tahoe Joe's CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 Dry Storage Room EPCRA ^ YES ® NO _ 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^ Yes ® No 206 Carbon Dioxide Refri erated Li uid If Subject to EPCRA, refer to instmctions COMMON NAME zo7 zos EHS* ^ Yes ®No Carbon Dioxide CAS# 209 124-38-9 *If EHS is "Yes", all amo unts below must be in lbs. 2to FIRE CODE HAZARD CLASSES (Complete if required by CuPA) HAZARDOUS MATERIAL TYPE (Check one item only) ®a. PURE ^ b. MIXTURE ^ c. WASTE 21t RADIOACTIVE ^ Yes ®No 212 213 CURIES PHYSICAL STATE 21a (Check one item only) ^ a. SOLID ®b. LIQUID ®c. GAS 215 LARGEST CONTAINER 48 gallons FED HAZARD CATEGORIES 216 (Check all that apply) ^ a. FIRE ^ b. REACTIVE 181 c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 2001bs / 24 allons* 453 ]bs / 48 gallons N/A N/A 221 DAYS ON SI"I'E: 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. ABOVE GROUND 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 22a 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 z27 ^ Yes ^ No 2za 229 2 230 231 ^ yes ^ NO 232 233 3 234 235 ^ Yes ^ NO 236 237 4 z3s 239 ^ Yes ^ No 2ao eat 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 o f paper capturing the required information. NFPA HAZARD INDENTIFICATION: HEALTH_3_ FLAMMABILITY_0_ REACTIVITY_0_ SPECIAL HAZARD_SA 2a6 HAZARD CLASS OR DIVISION # 2.2 UN# 2187 _ If EPCRA, Please Sign Here * The gas cubic foot capacity of the liquid carbon dioxide tank is 3,959 cf for gas. However,the material in the tank is liquid and is only transformed into a gas state oES Form 2731 once it flows throu h the tank's valve and into the su I -line for the beverage dispensers. Revised (5/03) HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES Emergency response plans and procedures are an integral part of the HMBEP. By taking the time to develop plans and procedures for your business, you will avoid complications resulting from inaction or misguided action during an emergency. Once the plans and procedures are developed, your employees will have an informative guide to follow in the event of an emergency. You must address each of the following items, however, the amount of detail you provide will depend upon the size and nature of the business, the damage potential of the hazardous materials handled and the location of the business with respect to residential or other populated areas. 1. EMERGENCY RESPONSE PLANS AND PROCEDURES A. If you have a release or threatened release of hazardous materials, your business is required by state law to provide immediate notification to the following agencies: Immediately call: Local emergency response personnel 911 (Fire, paramedics, police or sheriff) State Office of Emergency Services (800) 852-7550 or (916) 262-1621 Immediately call the appropriate jurisdiction: Person(s) within the business required responding to a hazardous materials incident: Name: Larry Zachary Telephone: 661-664-8723 Name: Larry Zachary Telephone: 661-342-9516 B. Identify the local emergency medical facility that will be used by your business in the event of an injury caused by the release of a hazardous material: Name: Mercy Southwest Hospital Address: 400 Old River Rd City/St/Zip: Bakersfield, CA 93311 Phone: 661/663-6000 Revised (5/03) 2. PREVENTION Describe the kind of hazards associated with the materials present at your business. Provide information on the steps taken at your business, or the policies or procedures now in place, to help prevent an accidental release of a hazardous material. Issues for discussion may include safety, storage, and containment procedures. Be specific for each type of hazardous material at your business. May cause asphyxiation if released in a confined area; and frostbite on contact with the liquid product. The liquefied gas cylinder is firmly secured to the ground to prevent falling or being knocked over. Connections and hoses are checked daily. Empty soda bags are immediately replaced. All appropriate employees are trained upon hire and provided annual refresher training on the hazards associated with this material. No attempt to repair, adjust or modify the operations of the cylinder by employee is tolerated. _ 3. MITIGATION Describe the procedures to be followed to reduce the severity of a release or threatened release of a hazardous material at your business. The procedures should detail the actions to be taken by employees to stop a release, contain a release, or to reduce the problems associated with a release. What is your immediate response to a spill, fire, explosion or airborne release at your business? Do not write procedures that exceed the capabilities of employees or equipment at your business or that violate any worker safety laws. Stop the flow of gas b cy losing valve if this can be done without risk. Ventilate enclosed areas. 4. ABATEMENT Describe what you would do to stop and remove each hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing of released materials at your business? What aspects of the response are beyond your ability and need to be handled by others? Who would you call to handle the release? Close valves if it is safe to do so. Ventilate the area. Evacuate employees from affected area. Call Revised (5/03) 5. EVACUATION Describe the procedures to be followed for immediate notification and evacuation of your business: Announcement will be made for people to calmly evacuate the building_through the nearest exit door. Refer to attached evacuation plan. 6. EARTHQUAKES Identify the areas and equipment in your business, which would require immediate inspection or isolation due to their vulnerability to earthquake related ground motion. Check for equipment such as gas cylinders, piping, drums, etc., that may need to be secured or spillage that may require mitigation or abatement. The gas cinder will be inspected for damage or leaks after earthquake. Cylinder is firmly secured to avoid damage or tipping over in case of an earthquake. 7. HAZARDOUS WASTE CONTINGENCY Specific procedures for prevention, mitigation and abatement of a release of hazardous waste generated at your business. This section only applies to hazardous waste generators. N/A 8. UNAUTHORIZED RELEASE RESPONSE PLAN Specific procedures for mitigation, abatement and reporting of an unauthorized release from an underground storage tank (UST). The plan must address a release from a single wall or a double wall tank system as applicable. This plan should cover the entire UST system. This section only applies to UST owner/operators. 9. SITE SECURITY As applicable on an individual facility basis, you should assess the security and vulnerability of your business from intentional acts both from within your business (sabotage) and from the outside (vandalism and terrorist acts). This assessment should consider testing your security system and procedures on a regular basis. Details of this assessment should not be included in this plan as it is a public document. Revised (5/03) Employee Training Plan Businesses that handle hazardous materials are required to have a program which provides employees with initial and refresher training. The HMBEP shall include a training program, which is reasonable and appropriate for the size of the business and the nature of the hazardous materials handled. The training program shall take into consideration the responsibilities of the employees to be trained. The training program shall, at a minimum, include: A. Methods for safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material and measures employees can take to protect themselves from chemical hazards; B. Procedures for coordination with local emergency response organizations; C. Proper use of personal protective equipment; D. The prevention, abatement and mitigation procedures you have developed for your business and explained in the HMBEP, including proper use of emergency equipment and supplies; E. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care; F. Procedures to coordinate with and assist the local emergency personnel that may respond to your business; G. Who and how to call for immediate assistance in the event of an accident involving hazardous materials; H. Procedures for ensuring that appropriate personnel receive initial and refresher training. All employee training shall be documented and updated annually 1. Personnel A. Are there any specially trained hazardous materials emergency response personnel at your business? Yes No X Number Trained B. Do you have decontamination capabilities for victims of exposure to hazardous materials at your business? Yes No X Type of Decon C. Do you have personnel that will provide site security at your business during and after a hazardous materials incident? Yes X No 2. Equipment A. List the type and location of equipment that can or will be used for response to hazardous materials incidents at your business. N/A Employee Training: Newly hired employees are trained initially on hazardous materials, including, but not limited to, their proper storage and handling. Refresher training occurs annually at our monthly safety meetings. The training includes safety procedures in the event of a release or threatened release of a hazardous material, including, but not limited to, familiarity with the hazardous material business plans. All employees are required to participate both the initial training and refresher training. Any material deviations from the hazardous materials business plan are discussed, in detail, at the refresher training. Revised (5/03) Facility Site Map and Storage Map Instructions A Site Map and Storage Map must be included with your HMBEP. For relatively small facilities, these documents may be combined into one drawing. Since drawings are intended for use in emergency response situations, larger facilities (generally those with complex and/or multiple buildings) should provide an overall site map and a separate storage map for each building/storage area. All maps must be drafted in black ink on 8%2" X 11" map grid, which has been provided on the last page. All lines must be neatly ruled and all writing, symbols, and notations must be clearly legible. 1. Provide a Facility Site Map, which includes the following elements: A. Scale of drawing (e.g., 1 inch =10 feet); B. Site orientation (north, etc); C. All streets bordering the facility; D. Access and egress points and roads; E. Internal roads and parking areas; F. Storm drains and sanitary sewer drains; G. Indicate locations of floor drains, sewers and sumps; H. Locations of all buildings and other structures; I. Location and names of adjacent streets and alleys; J. Hazardous materials loading and unloading areas; K. Outside hazardous materials storage or use areas; L. Primary and alternate evacuation routes; M. Primary and alternate staging areas; N. Location of any on-site fire hydrants and/or fire protection equipment. 2. Provide a Storage Map, which includes the following elements: A. Building floor plan including entrances, exits, interior walls, partitions, and doors; B. General purpose of each area within each building (e.g., office area, manufacturing, etc); C. Location of each hazardous materiaUwaste storage, dispensing, use, or handling area. Each area shall be identifiable by a grid number, to be used in item #204 on the Hazardous Materials Inventory -Chemical Description pages of the HMBEP; D. Location of each emergency utility shut-off point (i.e., gas, water, and electric); E. Location of emergency response equipment. For example, equipment for fire suppression, approach and mitigation, protective clothing, medical response, etc. Revised (5/03) ~V~e ~~23 ~/`z~'l CA Annotated Map: F3usiness Name: Site Address: ~~~ ~ 1 m ~~ C~ZJ~~ ~~~~ ~1/~11~ ~ V~ ~~~~~ CSC Q A B C D Et~ F G H W N ~ ~ ~ g ~; U 4 O o ~ ~~~ L Q.. O N N .~ (D O U .--. A A, ~ b ~ ~1" a''e9`" ~ © '~~' ~ 1 ~C ~ E ~ I r 1 ~CY L~ 1'1~{:~~~~ S Map#: I ~rrc~ J .,, .~, ., ,~ ~~ ~l v~ '~\ -v ,~~` W' 5 ~/1~~ 4~J '`~C C~ ~~ UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATIQN BUSINESS ACTIVITIES Pa e 1 of I. FACILITY IDENTIFICATION FACILITY ID k 1 EPA ID k (Hazazdous Waste Only) 2 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 Tahoe Joe's Famous Staeakhouse II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does our facilit ... If Yes, lease com lete these a es of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold ®YES ^ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part -CHEMICAL DESCRIPTION (OES 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Fonnedy SWRCB Form A) 1. Own or operate underground storage tanks? ^ YES ®NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTS? ^ YES ®NO 6 UST FACILTI'Y UST TANK (one per tank) UST INSTALLATION -CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ^ YES ®NO 7 UST TANK (closure potion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ^ y~ ®NO g NO FORM REQUIRED TO CUPA ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ^ YES ® NO 9 EPA ID NUMBER -provide at the top of this page Complete the Hazardous Waste Generator, County of Riverside Form. 2. Recycle more than 100 kg/month of excluded or exempted ^ yES ®NO 10 RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? per recycler) 3. Treat hazardous waste on site? ^ YES ®NO 11 ONSITE HAZARDOUS WASTE TREATMENT -FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT -UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for ^ YES ®NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DISC Form 1232) 5. Consolidate hazardous waste generated at a remote site? ^ YES ® NO 13 REMOTE WASTE /CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ^ YES ®NO 14 HAZARDOUS WASTE TANK CLOSURE hazazdous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Forn 12a9> E. LOCAL REQUIREMENTS Note: If you have answered "NO" to question A listed above, complete and submit the Statement of Exemption page. Revised (5/03) _ ._ ,~~ ~~ F TAHOE JOES FAMOUS STEAKHOUSE Manager WENDI DODSON Location: 9000 MING AVE P City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: BusPhone: Map 123 Grid: 05C SIC Code: DunnBrad: SiteID: 015-021-002674 (661) 664-2626 CommHaz Low FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title WENDI DODSON / GENERAL MANAGER / Business Phone: (661) 664-7750x Business Phone: ( ) - x 24-Hour Phone (661) 599-0897x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact WENDI DODSON Phone: (661) 664-8723x MailAddr: 9000 MING AVE P State: CA City BAKERSFIELD Zip 93311 Owner TAHOE JOES FAMOUS STEAKHOUSE Phone: (651) 994-8608x Address 1460 BUFFET WY State: MN City EAGAN Zip 55121-1133 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ENT'D ~l~ ~ 0 ~ ZQ07 PROD A - HAZMAT PROG C - COMM HOOD (3a~ed an my inquiry of those individuals responsit;le ~Jr Or~tainil ~c~ the infarmation, I certify under penalty of lain that i have personally examined aced um farroifiar bvith the infarmation ~:~' ~~.;` ed 7nd ~~~:!ieve the infarmation is true, ~~ccur ~ and campiete. ,~/ Si .,: c . - ~ Date ' ~~ ..LLB`-'~ } -1- 07/16/2007 ~. , 1 i F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CARBON DIOXIDE F P IH G 5702.90 FT3 Min -2- 07/16/2007 j -3- 07/16/2007 ~ • t ~ F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5702.90 FT3 5702.90 FT3 5702.90 FT3 tiHGKKLVU~J 1:V1~lYV1V1'',1V1~ %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 riEiGEiKL LiJ~1;.7J1~1L'1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 07/16/2007 F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Notif./Evacuation-/Medical Overall Site ~ ~ Agency Notification ,... ~lllt.ll V~/CC 1VV l~1.l ~ P~VdVLLdl.l Vll Public Notif./Evacuation r+lllC l.yC11C:y 1~1C U1C:d1 Y1dil -5- 07/16/2007 F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ ~ Mitigation/Prevent/Abatemt Overall~Site ~ ~ Release Prevention lCC1Cd5C 1rV111.d111IlIClll. ~..LCali vZ/ V~.11C1_ xCSVUic:C HC,L1VaLlOi1 -6- 07/16/2007 ,_ s` F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCL 1CL1 I1dGdL U5 Utility Shut-Offs ,_ r.LLC rLVl.Ctr.~t]VQ11. YYGII.Cl i7U11lAllly VV~.. U~JQlll..y LCVCl -7- 07/16/2007 F TAHOE JOES FAMOUS STEAKHOUSE SiteID: 015-021-002674 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training ruyc ~ nclu iv.~ r ut_uiC u~c nvlu tV3. rul.uLC UDC -8- 07/16/2007 ~~ ~ F C;our~da~y I~ot~t~y ~L ~~,~ F~snc~us Sceal~hous~ •B~ur~~t.• •.Bt~~"~~ 1460 Buffet Way ~ EAGAN, MN 55121-1133 ~ (651) 994-8608 .1~oNr~~o~~v December 15, 2006 Bakersfield Fire Department Ralph Huey _ Director of Prevention Services_ 900 Truxtun Ave. Ste. 210 ENT'D D ~ C 2 7 2006 Bakersfield, CA 93301 ~Q~ Dear Ralph Huey, ~`~~ ` 1 This letter serves as no ' ication that we operate a Tahoe Joe's restaurant that contains a 170 cubic foot, 700 pound CO2 container. We have enclosed a restaurant floor plan for your convenience. Our Tahoe Joe's restaurant is located at 9000 MING AVENUE, BUILDING P, BAKERSFIELD, CA 93311. Please feel free to contact us if you need any additional information. I may be reached at 651- 365-2541. Regards, w- Brent Mortensen Risk Management Specialist Enc. Floor Plan ~~~ ~~~~ ~~ , `\ h ~~,~,~, °~~` 5~' ~,~,6 - - I 1 CA Annotated Map: Husiness Name: Site Address: q~ ~~~ ~,1 ~ ~ ~~~~ ~~ f11~1 ~ : A V~° ~~~~ ~C A B C D E F G ~, H Map#: I J ~, ~~~ ~ ~'° SELF-CERTIFICATION CHECKLIST ~.s^,nw~~~~~r:TM.~~..t,xu~;...m_ .~s~..-.~;_:c,N;~a,c..,,.,~cL._.,._r~..~src.,wxa,,..:~.w. ~.,, s.~..-._.u. -~c...>..r....~.ar,:.,. `-'~. Commercial Hood Program BAKERSFIELD FIRE DEPT. ~'~ Prevention Services e~ x s a I D 900 Truxtun Ave., Suite 210 F/R!' Bakersfield, CA 93301 'ARTM T Tel.: (661) 326-3979 ~1. Fax: (661) 872-2171 FAQ ` ITY AM,E~) ...~-"' ELF-CERT`~ ICATIOfI DATE ~. AD ~ ~ HONE NUM ER e- FACILI CpNTAC ` 1 ~ i j , F Z~l,tr~ l.~ ~ J~I I DO NOT DISCARD -FAILURE TO RETURN WILL RESULT IN FIRE DEPARTMENT INSPECTION - - INSTRUCTIONS: Please verify and check each item as appropriate. Include comments on en completed, keep the second copy for your records and mail the top copy to the address above. each line or at the bottom as necessary. Failure to return will result in inspection. Y N OPERATION COMMENTS ^ Hood Fire Suppression System is serviced every 6 months ^ Hood and filters are grease-free and thoroughly cleaned every 3 months ~' ^ Unobstructed access to Hood Fire Suppression System pull handle ~, ^_ All appliances under the hood are protected by suppression system nozzles ^ Current annually serviced "K Class" fire extinguisher within 30 feet of hood ^ °Current annually serviced "ABC Type° fire extinguisher every 75 feet. of travel ^ Extension cords not used in place of permanent wiring ~' ^ All exits indicated by exit signs ~l ^ All exit signs illuminated, not more than 100 feet apart, where occupant load is 100 or more ~- ^ Minimum of 30 inches clearance in front of electrical panels 7`~3 ^ Cover plates installed on all electrical outlet, switch, and junction boxes ^ Flammable and combustible material stored properly and not adjacent to a source of ignition ^.. Waste batteries saved in suitable container for annual recycling* ^ Spent fluorescent tubes saved in a suitable container for recyGing* .. ° ^ Discarded electronic devices saved for recycling* r ^ Discarded items containing Mercury saved for recyGing" ^ Discarded non-empty aerosol spray cans saved for recycling* ~c~aTfFielCern oun~specia~fe cilffy~ d~93'C3"fandard-STree~;~~a7i"ers ~eTd,~1f~37721`F~7b67j8GZ=89fi1- COMMENTS: _.y QU 10 ~ DIN .THIS CHECKLIST? PLEASE CALL US AT (661 6-3979 . ~,/'" ~ .~~ ~ ~~ Sigrte ~ Business Site /Responsible Party (Please Print) "r9 FD 2155a (RA.09~6~}