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HomeMy WebLinkAboutBUSINESS PLANGMRI INC DBA RED LOBSTER 6289 Manager :. oCttWAie,O l~l%37vn1 Location: 8180 ROSEDALE HWY City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: SiteID: 015-021-003382 BusPhone: (661) 589-9956 Map 102 CommHaz Low Grid: 20D FacUnits: 1 AOV: SIC Code:5812 DunnBrad: Emergency Contact / Title Emergency Contact / Title KELLY BALTES / EXEC VP THOMAS CIPOLLONE / DIR RISK MGMT Business Phone: (407) 245-5611x Business Phone: (407) 245-5198x 24-Hour Phone (407) 491-0242x 24-Hour Phone (407) 496-8141x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact THOMAS CIPOLLONE Phone: (407) 245-5198x MailAddr: PO BOX 593330 State: FL City ORLANDO Zip 32859-3330 Owner DARDEN RESTAURANTS INC Phone: (407) 245-4000x Address PO BOX 593330 State: FL City ORLANDO Zip 32859-3330 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directi ves: ENT'D J U L 2 3 2007 PROG A - HAZMAT Based Or, my int,~irar ~rf t~•PO~i~ 6;,7dSU+iL~u~15 resporisib?e for ohta?Wing tt~~ Pni ` ' u 7 mE:u~Tr"t, ?Certify under penalt of leer that 3 h ex d _ ave amined an persona?ly am familiar With the rnfarmati submitted and on bel?eve the information is true, acc ate, and complete. ignat ~` -~ e D e -1- 07/11/2007 F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CARBON DIOXIDE REFRIGERATED LIQ F P IH L 3400.00 FT3 Min -2- 07/11/2007 -3- 07/11/2007 r. F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE REFRIGERATED LIQUID Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid Pure Above Ambient Ambient_ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 3400.00 FT3 1700.00 FT3 ru~~HtcLUU~ ~ulnruiv~ivla %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 riAGHK1J A~~~~SL~Lr;1V~1~5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 07/11/2007 F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/06/2007 ~ SEE PAGE 6, ATTACHED. Employee Notif./Evacuation SEE PAGE 7, ATTACHED. 03/06/2007 Public Notif./Evacuation SEE PAGES 6, 7, AND 9, ATTACHED. 03/06/2007 Emergency Medical Plan 03/06/2007 SEE PAGES 6 AND 7, ATTACHED. -5- 07/11/2007 ~ t n. F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/06/2007 ~ SEE PAGE 7, ATTACHED. Release Containment 03/06/2007 SEE PAGE 7, ATTACHED. Clean Up 03/06/2007 SEE PAGE 7, ATTACHED. Other Resource Activation -6- 07/11/2007 ~. ~ q F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~Nc~:iai na~ciiu~ Utility Shut-Offs 03/06/2007 SEE ATTACHED SITE PLAN, PAGE 5 - BY DUMPSTER PAD DIRECTLY TO THE RIGHT WHEN FACING DUMPSTERS AT REAR OF RESTAURANT. Fire Protec./Avail. Water 03/06/2007 SEE ATTACHED SITE PLAN, PAGE 5 - BY DUMPSTER PAD DIRECTLY TO THE LEFT WHEN FACING DUMPSTERS AT REAR OF RESTAURANT. Building Occupancy Level 03/06/2007 234 PERSONS - SEATING AVAILABILITY -7- 07/11/2007 ~ ~ :V F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 03/06/2007 ~ SEE TRAINING, ATTACHED. rayc c. rac.~.u Lvt r u~.uLC lJ.>C ncl.u ivL r u~uiC use -8- 07/11/2007 - ~~ ~;~. GMRI INC DBA RED LOBSTER 6289 Manager ~f}i/! 1, t7,u,TTh /1. Location:~8180 ROSEDALE HWY City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb:_ SiteID: 015-021-003382 BusPhone: (661) 589-9956 Map 102 CommHaz Low Grid: 20D FacUnits: l AOV: SIC Code:5812 DunnBrad: Emergency Contact / Title Emergency Contact / Title KELLY BALTES / EXEC VP THOMAS CIPOLLONE / DIR RISK MGMT Business Phone: (407) 245-5611x Business Phone: (407) 245-5198x 24-Hour Phone (407) 491-0242x 24-Hour Phone (407) 496-8141x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact.: THOMAS CIPOLLONE Phone: (407) 245-5198x MailAddr: PO BOX 593330 State: FL City ORLANDO Zip 32859-3330 Owner DARDEN RESTAURANTS INC Phone: (407) 245-4000x Address PO BOX 593330 ~ State: FL City ORLANDO Zip 32859-3330 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT EN~~ ~AA 3ased on my inquiry of those individuals res onsible for obtainin the info ti I tif ~1~ p g rma on, cer y ~ ^ penalty of law that I have personally UQ~ exami d and am fam~ ' r with the information submit d and 1ie~ ne infor ation is true, t accura , an o o Si nature Date -1- 01/31/2007 -_,-~ ~-~ - . F G~2I INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at-Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CARBON DIOXIDE REFRIGERATED LIQ F P IH L 3400.00 FT3 Min -2- 01/31/2007. ~ _~Y -3- O1j31j2007 ` T F GMRI INC DBA RED LOBSTER 6289_ SiteID: 015-021-003382 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE REFRIGERATED LIQUID Days On Site 365 Location within this Facility Unit Map:. Grid: CAS# 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TPure -Above Ambient Ambient- PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest ContainerFT3 Daily3400100m FT3 I Daily1700r00e FT3 rlti~tittl~vu5 ~vrirulv~;iv~l~5 %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 riHGHKL A5 51;a~l~ll~;1V-1"5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 01/31/2007 ., ,~ F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Notif,/Evacuation/Medical Overall Site ~ ~ Agency Notification _ 5~ ~ ~~e ~ . ~~-~~~~J Employee Notif./Evacuation J -~'C ~~/~"~f-- ~ , GL ttGc c- ~~ Fr/ '`` ~ ~G`~~ ~ry i/- T- h_- : ; - { ~ ~ r" vc c/ Y/u r c~ ~~s ~ _,_ , rUJJllV 1VV V11.~J:1V0.l~1L0.1.1V11 ~~ ~ _ L~UIClyClll:y 1.1CU1l: CL1 t'1C111 -5- 01/31/2007 !' `, ,~ ,. F GN.IRI INC DBA RED LOBSTER 62$9 SiteID: 015-021-003382 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ K~1~dS~ YLCV~11L1Vi1 ~J Release Containment ,' dean up V1.11C1 1~.C w7V UL l:C L"llrL1VGLLJ. Vll -6- 01/31/2007 F GMRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7jJeC:lcl1 riciGciLU~ I~ 'Utility Shut-Offs- -2 -(' ~'`~Cn-:.n ~ ~ t I -~ 1" L ~ ~ '` ~ ~ ~ l'/1 v-1 t/I a ~ lA / ~ 6t c;.~ j/~, f fY L f t ~f r ~ ~ ~~ u/h ~ /1 ~"u t t ~- 5 ~ vt vn ~ ; ft r S G 1 ` ; ~~'rr / c~ •~ ! ~ S 77~ u ~ G ~ ~7` ~.~ ~ • `~ , 1I C. t'i VI.CC:. /liV d11 Wdl.Cl ~ L-~ Fi w~-~ch F~~~~~ ~u~~r ~.~-c~~ ~.~f ~~~~ o~ !~/J ~'uur~r,~,a~T~ f ~~~ 3 .O U11U111y Vlar U~Jd~l/.:y ,/~LCVC1'~ -7- 01/31/2007 -: - .., ~/ F G1YlRI INC DBA RED LOBSTER 6289 SiteID: 015-021-003382 ~ Fast Format ~ ~ Training Overall Site ~ ~Ldll~J1V~/CC 1Ld111111y '~-~ !t-'~Ct C 't /YI P ~r t, ~~~L J9" i Yl/t ~ h ~/ Ydy C G nciu 1_v1. ru~u.LC vac nciu 1_vL ru~.us_c v~C -8- 01/31/2007 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 10 I. FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) z. (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA -Doing Business As) 3. GMRI, Inc. DBA Red Lobster # 6289 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 your facility... if Yes, lease com lete these ages 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 ®YES ^ NO a HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold . _ CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency lan is re uired ursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly 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 FACILITY 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 portion -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 ^YES ®NO s. NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ^YES ®NO 9. EPA IDNUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT (one materials (per H&SC §25143.2)? ^YES ®NO 10. perrecycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ^ YES ®NO 1 L TREATMENT -FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNTI' (one page per unit) (Formerly DISC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for Permit by ^YES ®NO 12 CERTIFICATION OF FINANCIAL Rule and Conditional Authorization)? . ASSURANCE (Formerly DISC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE /CONSOLIDATION ^ YES ®NO 13. SITE ANNUAL NOTIFICATION (Formerly DISC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ^YES ®NO la HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? . CERTIFICATION (Formerly DISC Forth 1249) E. LOCAL REQUIREMENTS ls. (You may also be required to provide additional information by your CUPA or local agency.) www.unidocs.org Rev.12/12/05 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Pa e 2 of 10 I. IDENTIFICATION FACILITY ID # ~ BEGINNING DATE loa ENDING DATE lol. (Agency Use Only) December 12, 2005 December 12, 2006 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3. BUSINESS PHONE 102• GMRI, Inc. DBA Red Lobster # 6289 6615899956 BUSINESS SITE-ADDRESS X03• 8180 ROSEDALE HIGHWAY CITY ioa, ZiF' C,OI)E tos. ~ A BAKERSFIELD 93312 DUN & BRADSTREET toe. SIC CODE (4 digit #) 107. N/A 5812 COUNTY los. Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE Ilo. GMRI, Inc. 407-245-4000 II. BUSINESS OWNER OWNER NAME tlt. OWNER PHONE nz. Darden Restaurants, Inc. Attention: Risk Management 407-245-4000 OWNER MAILING ADDRESS 113. P.O. Box 593330 CITY tta. STATE lls. ZIP CODE 'la. Orlando FL 32859-3330 III. ENVIRONMENTAL CONTACT CONTACT NAME t lz CONTACT PHONE 118- Thomas Cipollone 407-245-5198 CONTACT MAILING ADDRESS 119. P.O. Box 593330 CITY I2~. STATE 121. ZIP CODE 12z. Orlando FL 32859-3330 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NA NAME 128. Chris Plunkett Thomas Cipollone TTI'LE TTI' TITLE t29. Senior Vice President Director Risk Management BU4iN~ESS'PHONE BUS BUSINESS PHONE 130. 480-483-2455 407-245-5198 ?~-HOLiR PHONE* 24- _~ 23`HOUR PH©NE* I3t. {602) 549-5411 _ 407-496-8141 PAGER # 127. PAGER # 132. N/A N!A ADDITIONAL LOCALLY COLLECTED INFORMATION: 133. Property Owner: N/A Phone No.: Billing Address: Certification: Based on my inquiry of those indi viduals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiaz with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135. 12/12/06 Thomas Ci ollone N E O S GNER (print) 136. TITLE OF SIGNER 137. Thomas Cipollone Director Risk Management * See Instructions on next page. www.unidocs.org Rev. 12/12/05 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (one page pcr material per building or area) ^ ADD ^ DELETE ^ REVISE 2D0- Page 3 of ]0 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAb4E or DBA -Doing Business As) 3. GMRI, Inc. DBA Red Lobster # 6289 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202. Needao call restaurant ._ .................. _........ ^ YES ®NO FACILITY ID # ~ ~ 1. MAP # 2os. GRID # zoa. (Agency Use Only) II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^ Yes ®No 206. Carbon Dioxide Refrigerated Li uid If Subject to EPCRA, refer to instructions COMMON NAME 207. zos. Exs* [] Yes ®No Carbon Dioxide CAS# 209. *If EHS is "Yes," all amounts below must be in lbs. 124-38-9 FIlZE CODE HAZARD CLASSES (Complete if requved by focal agency) 2to. HAZARDOUS MATERIAL ^ ®a. PURE ^ b. MIXTURE c. WASTE 2t t. ^ ®No 212 RADIOACTIVE Yes 213. CURIES TYPE (Check one item only) PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS eta. 215. LARGEST CONTAINER FED HAZARD CATEGORIES 216. (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. 200 400 N/A N/A 221. DAYS ON SITE 222. UNITS* ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 days per year (Check one item onl * If EHS, amount must be in onnds. STORAGE CONTAINER ^ a. ABOVEGROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ®I. CYLINDER ^ p. TANK WAGON 223. STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224. STORAGE TEMPERATURE ^ a. AMBIENT ^ b. ABOVE AMBIENT ®c. BELOW AMBIENT ^ d. CRYOGENIC 225. % WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1. zzb. zz7. ^ Yes ^ No 228. zz9. 2. 230. 231. ^YCS ^ NO 232. 233. 3. 23a. 235. ^ Yes ^ NO 236. 237. 4. 238. 239. ^YCS ^ NO 240. 241. 5, 2a2. za3. ^ Yes ^ No zaa. 2a5. If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1% by weight i[ carcinogenic, attach additional sheets or paper capturing the required information. ADDTI'IONAL LOCALLY COLLECTED INFORMATION za6. DOT Hazard Class: If EPCRA, Please Sign Here. www.unidocs.org Rev. 12/12/05 acility Site Plan/Storage Map (Hazardous Materials Business Plan Module) Site Address: 8180 ROSEDALE HIGHWAY BAKERSFIELD, CA 93312 Date Map Drawn: _~~ ~ `- Map`Scale. r` " " " "'~ ;• "" Page 4 of ] 0 ~ B C D E F G H I J K L M N O P Q R S T U V W X Y 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Instructions are printed on the following page. www.unidocs.org Rev.12/12/OS acility Site Plan/Storage Map (Hazardous Materials Business Plan Module) Site Address: 8180 ROSEDALE HIGHWAY BAKERSFIELD, CA 93312 Date Map Drawn: __~ ~ _ Map Scale: Page 5 of 10 4 B C p E F G H I J K L M N O P Q R S T U V W X Y Z ~ -~~......r-a-.-,, -- --- - ~ --- - - ~- _ E t f ~'~ - al T .~ f !' ~ 1 I~ ~ t. Y P15:~l.Y` f Rt`i.OY t ~."yNY!' E 1Y94r, ~. ac 1 ' ..v ___ __ _~.- _ --___ +1t +~t li ~ ~ ~, ~~ ~ M.-~ w. -n ~..,., .. _ ~ -- -- -- - - '' - ~ _.~ ~.._ __-- = - t~,~ ~- b ~ ,I ~ - I ~ ~t ~ ~ ~ --- - i C~ --- --- ` - - --- b I ~~~ '~ 1~ z ~, - T, ~ ~ { -.~ . @ E ~E I ~ _. _ ~ ~-~.;~ jI ~ i~-~ w~ ~ , r~ ~~ Sl~w~~~4'~ '"' -._ p ~ s ~ -- ___~_ - __ ' _ - - --_ _-- ~-~-' ~ a x 1 i ~"` ~ ~ ~~ ...,_~, _I. ~ ~ }~ i ~. ~ {j s ~ i j I t~ ~ 3 ~ I ~ ~ ~ ...».~~` ~ I- - ~ i--- µ ~~ ~ ~ 4 ~ ~ n ~ kI ~ a ~ I I, I ~ ~ _ _ ~ ~ ~ _., m, {{1 3 -- ~ ~ ~ j ~ ! ~ ,~) ~-rn.~? ~ ( gy'm'" 1: 3 - .` .__ -- -- . - --- t, ' ' f 1J I, ~ ~ I ~ I - 1 N ~ ~ ~ ~ '! I '~ ~~~ ~ ,sue ~ - ~ --.. I ~ ~ l~~ I I ~ ~ a ~ -- ,i 5 F ~_ v. ~„ , ~'~ .~ ~ J. ~ _ ___._. _ _ . _.._ _._-_ _ I ~ _ ~ _. _ ,.w w ~.- ~ _ - _.._ ..~ ..~ ~. ~ ~ - - ,-.. _.. ~. ~. .._ . ,_ ...._ ~..~.. ~. ~ ~- -- ~ ~ - ~ -~-- .: - .~ r~ - ~..n .~~,..~,. ~ I ~. ~ ~ ~~ www.unidocs.org Rev. 12/12/05 Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Authority Cited: HSC, Section 25504(b); Title 22, Div. 4.5, Ch. 12, Art. 3 CCR Page 6 of 10 All facilities that handle hazardous materials in specified quantities must have a written emergency response plan. In addition, facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a contingency plan. Because the requirements are similar, they have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall he maintained at the facility for use in the event of an emergency and for inspection by the local agency. Within Santa Clara County, hospitals and police agencies have delegated receipt of these plans to the local agencies administering Hazardous Materials Business Plans, so additional copies need not be submitted. However, a copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom special (i.e. contractual) emergency services arrangements have been made (see section 3, below). 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ^ Bells; ^ Horns/Sirens; ®Verbal (i. e. shouting); ^ Other (specify) b. ®Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drativing (or any other drawing that shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it will be visible to employees and visitors. 2. a. Emergency Contacts*: Fire/Police/Ambulance ......................................... Phone No. 911 State Office of Emergency Services .............................. Phone No. (800) 852-7550 b. Post-Incident Contacts*: Fire Department Hazardous Materials Program ................... Phone No.: (66i) 868-3C~7(i i/oenl:I3azlVlatRegulatory Agency ... '` . ,Phone N<~. (661) 32G-3751 CalifoirniazE~P1~I)epartmertt of Toxic SubstanccsControl' ..'.......'; . '~ Phon~No.{alp) 972=3.188 Cal=OSHA Division pf Occupational Safety and Health ......:.....:: Phcin~ N~~. (~G'1) 868-3801 AirQualityN'IanagementDistrict_ ..'...:':.......'....`...... `-PhoneN~. (661)°326=6900 RegionahWater Quality CvntroLxBoacd, .....':... :.;....::'...:. . .. Vhyn~No. (661)334-2755 x These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may be required to be notified. c. Emergency Resources: Poison Control Center ....................................... Phone No. (800) 876-4766 Nearest HospitaL• Name:Mercy~Southwest Phone No.: (bbl) fi63-6000 tlddress: -IOO Oltl IZi~-er Read City: Bakersfield 3. Arrangements With Emergency Responders: If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements below: www.unidocs.org Rev. 12/12/05 Emergency Response/Contingency Plan (HMBP Module) Page 7 of 10 d. Emergency Procedures: Emergency Coordinator Responsibilities: a. Whenever there is an imminent or actual emergency situation such as a explosion, fire, or release, the emergency coordinator (or his/her designee when the emergency coordinator is on call) shall: i. Identify the character, exact source, amount, and areal extent of any released hazardous materials. ii. Assess possible hazards to human health or the environment that may result from the explosion, fire, or release. This assessment must consider both direct and indirect effects (e.g. the effects of any toxic, irritating, or asphyxiating gases that are generated, the effects of any hazardous surface water run-off from water- or chemical agents used to control fire, etc.). iii. Activate internal facility alarms or communications systems, where applicable, to notify all facility personnel. iv. Notify appropriate local authorities (i. e. call 911). v. Notify the State Office of Emergency Services at 1-800-852-7550. vi. Monitor for leaks, pressure build-up, gas generation, or ruptures in valves, pipes, or other equipment shut down in response to the incident. vii. Take all reasonable measures necessary to ensure that fires, explosions, and releases do not occur, recur, or spread to other hazardous materials at the facility. b. Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall: i. Provide for proper storage and disposal of recovered waste, contaminated soil or surface water, or any other material that results from a explosion, fire, or release at the facility. ii. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas of the facility affected by the incident until cleanup procedures are completed. iii. Ensure that all emergency equipment is cleaned, fit for its intended use, and available for use. iv. Notify the California Environmental Protection Agency's Department of Toxic Substances Control, the County of Santa Clara's Hazardous Materials Compliance Division, and the local fire department's hazardous materials program that the facility is in compliance with requirements b-i and b-ii, above. Responsibilities of Other Personnel: On a separate page, list any emergency response functions not covered in the "Emergency Coordinator Responsibilities" section, above. Next to each function, list the job title or name of each person responsible for performing the function. Number the page(s) appropriately. 5. Post-Incident Reporting/Recording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility's operating record. Within IS days of any hazardous materials emergency incident or threatened hazardous materials emergency incident that triggers implementation of this plan, a written Emergency Incident Report, including, but not limited to a description of the incident and the facility's response to the incident, must be submitted to the California Environmental Protection Agency's Department of Toxic Substances Control, the County of Santa Clara's Hazardous Materials Compliance Division, and the local fire department's hazardous materials program. The report shall include: a. Name, address, and telephone number of the facility's owner/operator; b. Name, address, and telephone number of the facility; c. Date, time, and type of incident (e.g. fire, explosion, etc.); d. Name and quantity of material(s) involved; e. The extent of injuries, if any; f. An assessment of actual or potential hazards to human health or the environment, where this is applicable; g. Estimated quantity and disposition of recovered material that resulted from the incident; h. Cause(es) of the incident; i. Actions taken in response to the incident; j. Administrative or engineering controls designed to prevent such incidents in the future. 6. Earthquake Vulnerability: (19 CCR §2731(e)1 Identify any areas of the facility and mechanical or other systems that require immediate inspection or isolation because of their vulnerability to earthquake-related ground motion: www.unidocs.org Rev. 12/12/05 Emergency Response/Contingency Plan 7. Emergency Equipment: Page 8 of 10 22 CCR §66265.52(e) [as referenced by 22 CCR §66262.34(a)(4)] and the Hazardous Materials Storage Ordinance require that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. Equipment Category 2. Equipment Tye 3. Locations * 4. Description** Personal ^ Cartridge Respirators Protective ^ Chemical Monitoring Equi ment (describe) Equipment, ^ Chemical Protective Aprons/Coats Safety ^ Chemical Protective Boots Equipment, ^ Chemical Protective Gloves and ^ Chemical Protective Suits (describe) First Aid ^ Face Shields Equipment ®First Aid Kits/Stations (describe) 2 Locations Office, Alle ^ Hard Hats ^ Plumbed Eye Wash Stations ^ Portable Eye Wash Kits (i.e. bottle type) ^ Res irator Cartridges (describe) ^ Safety Glasses/S lash Goggles ^ Safety Showers ^ Self-Contained Breathing A paratuses (SCBA) ^ Other (describe) Fire ®Automatic Tire Sprinkler Systeu~s 2 Locations Dinin Room, Ansol Extinguishing ^ Fire Alann Rocs/Sta~iims Systems ®Fire Extinguisher Systems (~1e~scribc) 6 Locations Patio, Restroom, Frontdoor, Bar, Breakroom, Kitchen ^ Other (describe) Spill ^ Absorbents (describe) Control ^ Berms/Dikes (describe) Equipment ^ Decontamination E ui ment (describe) and ^ Emergency Tanks (describe) Decontamination ~ E~Ilaust I~o~ds Kitchen Equipment ^ Gas Cylinder Leak Repair Kits (describe) ^ Neutralizers (describe) ^ Ove ack Drums ^ Sumps (describe) ^ Other (describe) Communications ^ Chemical Alarms (describe) and ^ Intercoms/ PA Systems Alarm ^ Portable Radios Systems ®;Telephunes 4 Locations 2 Bar, 1 Alle , !office ^ Underground Tank Leak Detection Monitors ^ Other (describe) Additional ^ Equipment ^ (Use Additional ^ Pages if Needed.) ^ * Use the map and grid numbers from the Storage Map prepared earlier for your HMBP. ** Describe the equipment and its capabilities. If applicable, specify any testing/maintenance procedures/intervals. Attach additional pages, numbered appropriately, if needed. www.unidocs.org Rev. 12/12/05 Employee Training Plan (Hazardous Materials Business Plan Module) a Y Authority Cited: HSC, Section 25504(c); Title 22, Div. 4.5, Ch. 12, Art. 3 CCR Page 9 of 10 All facilities that handle hazardous materials must have a written employee training plan. This plan is a required module of the Hazardous Materials Business Plan (HMBP). A blank plan has been provided below for you to complete and submit if you do not already have such a plan. If you already have a brief written description of your training program that addresses all subjects covered below, you are not required to complete the blank plan, below, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. (Note: Items marked with an asterisk (*) are required.): 1. Personnel are trained in the following proceeiures: Into-rnal al~rriri/notiticalir~n '' Fvaeuatiort/re eiitrv prciccdures ~l assembly .oint-locations* Emc~gencv incident rcportim~ ^ ` Extrrnalcrnergencv res ~onse or~aniiation noti licalici^ L~icatian(sy and c~>ntents of En1cr~;enc y Res x~n~c/Contingcticv C'la~ti ^ Facility eutcuation drills; that are atnducted at ]cast (s~ecifj) _ _ (e.~s;: '`t~uurterl~~" etc.) 2. Cherrucal Handlers are aadifioially trained in the' following: Safe meffiod~ for handlin~* and st<rrage of hazardous materials '' Loeationls)~and proper use ref fire and spi]l`conlitrl e,qui, mint ^ Spill pr~rccdures/cmer~TcncYproccdurrs :Proper use of ~crsonalprotective egiripment'~ ® Spectlic'harard(s) <ifeachchemical to ~i~hich they may beexp<~sed, including routes cif evprtuire (i.c~. iili~lut'ion, ingestion;: absnr/ttiorr j ~~ Hazardous Waste Handlers/Managers arc trained in all aspects `of ha~ai-dous ~ti~aste'ntanagementspeeilic totheir joh duties (e.g: container cu~crururlcttiort tune reyur~ement~. lubelit}g r~c'yuirerraetits. .clot{lbd areu ifispeetiora requi~~errterits, ntunifeettng reguireirrertts', et<~:) ` 3. Emergency Respcil~se Team Men~ber5 are capable of and ,engaged in;the f~~llowing ^ Pcr~rnnel rescue procedwcs Shutd<~wnof-operations ^ , Liat~on with respondint_* agencies Use, mtiintenuncc, and replacenic;nt ofctnergenc} resp~ns~ equipttleit ~' 'Refresher training, which is provided alleast annually ^ Emcruency response drills, which are conducted at lciitt (specifi~) _ (e.~: "~uaterl~'"; etc.) www.unidocs.org Rev. 12/12/05 Record Keeping (Hazardous Materials Business Plan Module) Page 10 of 10 All facilities that handle hazardous materials must maintain records associated with their management. A summary of your recordkeeping procedures is a required module of the Hazardous Materials Business Plan (HMBP). A blank summary has been provided below for you to complete and submit if you do not already have such a document. If you already have a brief written description of your hazardous materials recordkeeping systems that addresses all subjects covered below, you are not required to complete this page, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. The following records are maintained at the facility. [Note: Items marked with an asterisk (*) are required. J: ® Currciri'en~ _ lovccs~ traitiin~> records (to be retained iuitil clasli~re of the futility) l~onncr employees' training rec~~rds (tote retained dt'leuat three ~~ears utter termindtinn ~f e;rp~oyntiet~t);'~ ® 'Gaining F'rogram(s} (i.e' writteiidescrij~tin~i of intrudiu~tnrv muLcnntiriuirig traiiiing)'r (Current copy of this Emer~_*encv Response/Contingency-.Plan. Record of recordahle/reporiahle~hacardous<mateual/waste ~elcase~" Record of hazardous anaterial/waste storage area mspecUons Record'of huzar~luus N,aste tank daily nspections`;f: 1~cscri~tign and"documentation ail facility emergency response drills Note: The above list of~records does not necessarily identify every t)~pe of record required to be maintained by the facility. A copy of the Inspection Check Sheet(s) or Log(s) used in conjunction with required routine self- inspections of your facility must be submitted with your HMBP. (Exception: Available from your local agency is a Hazardous Materials/Waste Storage Area Inspection Form that you may use if you do not already have your own form. If you use the example provided, you do not need to attach a copy.) Check the appropriate box: w. We will'usc the tJnidocs "Hazardous IV4aterials/Waste Sto'rage;AreaTnspec>li~n Fgnn" to document inspcctions_ ^ We ~~;ilLuse our o~~ adi~cumcnts to record inspections.,(A Clank copy~~of eacladueunaent usedsmust be aftached to.~this~fINIBP) www.unidocs.org Rev. 12/12/05 i e .~~~~ TRAINING The purpose .of training is to ensure the employees, outside contractors, and other affected individuals are adequately educated about potential chemical risks and how to respond to such hazards. It is important that all questions are answered - we don't want to minimize a hazard, however, we also don't want to exaggerate risks. Although employee training has always been a part of most programs, it is not necessary to establish very formal, documented programs. It is recommended that we continue the on-the-job explanation. of specific health and safety hazards with any particular -job (especially those tasks done very infrequently or for the first time), but supplement this with generic chemical safety training. Since explaining the health and safety risks is part of a job indoctrination, we need to be sure that this is always done. Any training program given to employees must be formally documented. Each employee should signify his/her attendance by signing in on the Chemical Safety Training Log. These forms should be filed permanently in this manual in the Employee Training section. TRAINING MUST CONSIST OF: • Information on the requirements of OSHA Hazard Communication standard and applicable state/ local chemical safety laws and regulations; • Information on operating procedures in their work area where hazardous chemicals are present; • Information on where the Material Safety Data Sheets (MSDS), the written program (this. Manual); and the list of hazardous chemicals are kept; Y • Review and explanation of the appropriate Material Safety Data Sheet (MSDS); • Methods employees can use to protect themselves, such as: work practices and the use of personal protective equipment;, • How to read and interpret information on labels; • How employees can obtain and use the available hazard information; • Information on the established procedures in the safe handling, storage, and disposal of chemicals; • Information on the hazards of non-routine tasks such as area and/ or equipment cleaning, maintenance, or repair as well as hazards associated with chemicals contained in unlabeled pipes in the work area; • How to clean up and respond to medical concerns as a result of exposure to a chemical spill. r CONTRACTED SERVICES (Preventative Maintenance, Hood Cleaner, Refrigeration, etc.} As part of OSHA's Hazard Communication Standard, contractors must be informed of any chemical hazards their employees may be exposed to during the time they work in your restaurant. Although the contractor is responsible for training his personnel, contractors and all other outside vendors must follow our safety rules. Contractors' employees should also be confined to their specific job area. All contractors should be informed of hazardous materials in the areas in which their employees will be working. The restaurant's Chemical Safety Program should also be explained and any related questions answered. Additionally, contractors must be in compliance with federal OSHA and state/local Iaws and regulations regarding chemical safety and must supply us with Material Safety Data Sheets (MSDS) for any hazardous chemicals they bring into the workplace. EMPLOYEE MEETING O I.I~TLINE SUBJECT: CHEMICAL SAFETY PROGRAM PARTICIPANTS: ALL RESTAURANT EMPLOYEES (Only 1 work area in attendance per meeting.) PREPARATION: 1. Obtain a container of each hazardous chemical used by the work. 2. Have a copy of the MSDS for each chemical in that work area. 3. Have the meeting attendance sheet from the Chemical Safety Program Manual; each employee needs to verify his or her attendance. MEETING: 1. Begin the meeting by mentioning the word "chemicals". Ask the employees for examples of different chemicals that are found at home (hair spray, fertilizers, fly spray, etc.} and at work (dish machine detergents, bleach, window cleaner, etc.). 2. Remind them that some chemicals are not hazardous, however many have some degree of hazard. 3. Ask them two questions: • "How do you know the difference?" • "How can you protect yourself?" 4. To help you answer these questions, the Occupational Safety and Health Administration (OSHA) _ has issued a standard called "Hazard Communication -Your Right to Know". Explain that this standard is intended to ensure chemical manufacturers evaluate their products for safety and this information is passed on to all users. Since you use many chemicals in the restaurant, it is important to know which products are hazardous and proper procedures to handle and use these products. 5. Always remember your safety is very important to many people: a. To OSHA b. To the Chemical Suppliers c. To your employer d. To you 6. Labels are important, they tell (show the Label from one of your demonstration chemicals you have in the room): a. Product name b. Product's intended use c. Using directions d. Any special instructions i.e., Keep out of reach of children e. Signal words i.e.: Danger, Warning, Caution f. Hazardous ingredients that may be in the product g. Precautionary measures i.e. physical/health hazards, protective gear and first aid instructions h. Safe handling and storage instructions i. Name and address of the manufacturer 7. Material Safety Data Sheets (MSDS's) (Pass around some sample MSDS sheets for viewing) The Material Safety Data Sheets (MSDS) provides us with information for using a chemical safely. It identifies the substance(s) of concern in the chemical and potential hazards. The sheets describe precautions for use, handling, storage and also, gives procedures for emergency situations. Each MSDS will be divided into sections, each section will tell different information about the product. For example, typical sections on an MSDS will tell the following: • Identify the product • Hazardous chemicals in the product • Physical and chemical characteristics of product (appearance and odor) • Physical hazards of the product • Health hazards -(first aid procedures) • Special precautions (how to store, what to do in case of leaks, how to dispose of product) 8. We have obtained information regarding the hazardous chemicals in the restaurant. This information includes: • -MSDS Sheets on every chemical • A guide on how to read an MSDS sheet r • A guide on how to read a product label • A list of the hazardous chemicals in each work area This information is on file in the Manager's office. Additionally, this information is available on wall charts that will be posted so you may refer to it easily. We also have an inventory of chemical products in the restaurant. . (Tell employees where they are stored.) We will be giving new employees this training and everyone will receive information regarding any new hazardous chemicals in the restaurant. 9. So far we have talked about the government's (OSHA's) role, the chemical supplier's role, and our role in chemical safety. The last and most important person in the chain is you. We need you to help protect yourself. Do this by: • Using the proper chemical for the job • Following correct procedures • Reading labels • Knowing where to find information about the chemicals • Knowing how to handle and use the chemicals you work with • Wearing and taking care of protective gear • Following warnings and instructions • Learning emergency procedures • Becoming familiar with how the products look and smell • Asking the manager on duty when in doubt 10. REMEMBER TO TREAT ALL CHEMICALS WITH RESPECT AND NEVER MIX CHEMICAL PRODUCTS TOGETHER. 11. Ask if there are any questions. Answer any. 12. Have employees sign attendance sheets. Place signed attendance sheets in your Chemical Safety Program Manual. CHEIVII CAL SAFETY TRAINING L O G SUBJECT: RESTAURANT ##: TRAINER`S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATURE CHEMICAL SAFETY TRAINING .LOG. SUBJECT: RESTAURANT #: TRAINER'S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATURE CHEMICAL SAFETY TRAINING L O G SUBJECT: RESTAURANT #: TRAINER'S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATURE ~. CHEMICAL SAFETY TRAINING L O G SUBJECT: TRAINER'S NAME: TRAINER'S TITLE: EMPLOYEE NAME OB TITLE DATE SIGNATURE RESTAURANT #: