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HomeMy WebLinkAboutBUSINESS PLAN 7/12/2005ELEPHANT BAR 10100 STOCI~ALE HWY. ~ - _ 1` `I~~ I? i ~' I I' I~ ~~ ~; h i r i ~~, I' UNIFIED PROGRAM INSPECTION CHECKLIST _.._.._._._._____ v___~_ __ _ __ _ __- SECTION 1 Business ,Plan and Inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661)_326-3979 __ INSPECT N DAT INSPECTION TIM FACILITY NAME / ~[n i ADDRESS PHON o. No. of Emplo ~(0 t oo ~--cx-~s~.~~ ~ ~~ G~ ~j3 f FACILITYCONTACT Business ID Number 15-021 Section 1: Business Plan and Inventory Program ^ Routine O Combined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection (C=Compliance J C V \V=Violation ) OPERATION COMMENTS ~p~1~~ ^ ^ APPROPRIATE PERMIT ON HAND f ~~ ` ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ ~ VERIFICATION OF INVENTORY MATERIALS ~~ i' v ~~ ^ ^ VERIFICATION OF QUANTITIES Z S~ ^ ^ .VERIFICATION OF LOCATION (~St DE .f2lOr~ ^ ^ PROPER SEGREGATION OF MATERIAL n D I ~,_ _... __ _.. --- _ .. ___ __ l._. _... ^ ^ VERIFICATION OF MSDS AVAILABILITYE I - ---------- -- - -----.. _. ---. _.._._..._ -.._._.._. .. .._.._r -.._-.. - - _ ...-- -.. .. _. _ .... _ __. ~ .~. ---_ ^ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 1 ----------- -- ----------..------------___._. _.... _..__._. ___ I __ _ - .. ._...:...-..__ __ .. _. .._._ ..__......_---- ----___._..._.._._......_....._ ^ ^ EMERGENCY PROCEDURES ADEQUATE }}~ ----------- -------_-----....._-__------.....---_-.___---------........_.._-I-------. .._._._....- -- _ ---..._..._.._._._.._...._...........-----... .___ --- ..... ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING ^ ^. FIRE PROTECTION ~ ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: ^ YES ~O EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~G6'I ~ 326-3979 1~J i ~~-5 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site White -Environmental Services Yellow -Station Copy Pink -Business Copy s Site Responsible Pally (Please Print) g k {HMMP) RDOUS MATERIALS MANAGEMENT PLAN '' UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FORM HA~ZA/RDOUS MATERIALS INVENTORY 'ANEW I-: ADD ~~ DELETE ~ REVISE 200 B., _ B_,L~S .P_[ A ~~R~ ~rrr r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 !One form oer material, per bu,tding, or area.J I. FACILITY INFORMATION r I BUSINESS_NAME (Same as FACILITY NAME r DBA -Doing Business As) 31 CHEMICAL LOCATION 201 CHEMICAL LOCATION 2p~ . t nJ ~ ~ ~ {) /n rj ~ w~L(~~ .~~~rj q ~, ~ /~~ f,_ /~ ~~L~.'^r t.. ~(' ~ (~ `-"'K~3 , '`t ( ` ` -' ° _ l CONFIDENTIAL (EPCRA) ^ Yes ^ N ~ FACILITY ID No. 1 tlonel) 203 M A P N o. ( o p GRID NO. (optionaQ 2 II. CHEMICAL INFORMATION 205 CHEMICAL NAME 2 ~ /1 s ~ ~a ~ ,, ` (~ ~p { ~~.. ~E~/ ~- ~ /`. TRADE SECRET ^ Yes G No 207 COMMON NAME EHS' ^ Yes ^ No 20 CAS No. 209 ,d EHS is "Yes; all amounts below must tie in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE ~ 211 21 RADIOACTIVE: ^ Yes _ No CURIES 21 `moo PURE ^ m MIXTURE ^ w WASTE I ~- LARGEST CONTAINER 21 PHYSICAL STATE ^ s SOLID ^ I LIQUID ~~g,GAS 214 ~~ ©~ 21 FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE PRESSURE RELEASE ACUTE HEALTH G 5 CHRONIC HEALTH (CheGc all that apply) ANNUAL WASTE AMOUNT 217 MAXIMUM 218 DAILY AMOUNT ~ Gi-Q~ AVERAGE 219 DAILY AMOUNT ~~~ STATE WASTE 22 CODE 221 222 i UNITS ^ ga GAL ~~ cf CU FT G Ib LBS ^ to TONS DAYS ON SITE If EHS, amount must Ile in lbs. 22 STORAGE CONTAINER ~ k BOX u p TANK WAGON (Check all Ihet apply) ^ a ABOVEGROUND TANK u f CAN ~ G' b UNDERGROUND TANK ^ g CARBOY C.Y,LINDER ~_ ~ ~ ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ^ d STEEL DRUM ^ i FIBER DRUM ~~ n PLASTIC BOTTLE ^ e PLASTICINONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 22 STORAGE PRESSURE ^ a AMBIENT ~aa ABOVE AMBIENT ^ ba BELOW AMBIENT 22 STORAGE TEMPERATURE ^ a AMBIENT ^ as ABOVE AMBIENT ~ba BELOW AMBIENT ^ c CRYOGENIC %WT HAZARDOUS COMPONENT EHS GAS# 1 226 227 ^ Yes ^ No 228 22 2 230 231 ^ Yes ^ No 232 23 3 234 235 ^ Yes ^ No 236 23 4 238 239 0 Yes ^ No 240 241 5 242 243 ^ Yes ^ No 244 24 111. SIGNATURE PRINT NAME & TITLE OF AUTHORlZEO COMPANY REPRESENTATIVE SIGNATURE GATE 2 FD 2144 (Rev. 09105) Cb (HMMP) RDOUS MATERIALS MANAGEMENT PLAN UNIFIED PROGRAM CONSOLIDATED FORMS CHEMICAL DESCRIPTION FOR HAZARDOUS MATERIALS INVENTORY M [NEW ~' ADD _; DELETE J REVISE 200 BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 i0ne lorm per material, per bw!ding. or area.) Paae1 of 2 I. FACILITY INFORMATION ILITY NA ME or DBA -Doing Business As) BUSINESS NAME ( Sa me a S F AC 3 + ' Q M A ~ ~ ~ 1 1..' ~frq~V ~ t~ec-e ~r CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 ( ~(S f /~~ (~ ~. pn C/~-y,./~r,,,~y ~~, n ,A~, ,~- AC? ,~,^ ~ ~ ' `°` I"' V ~ \ f'^ { cs "'+ `•. (v-+ ~~ `• - ~ ` '! ` CONFIDENTIAL (EPCRA) ^ Yes ^ No FACILITY ID No. 1 r ion a( ) M A P No . ( op 203 GRID NO. (optioneq 204 II. CHEMICAL INFORMATION CHEMICAL NAME ~ f / -y-~ /+ p" / V 1 I ~`~ l}°G~ 205 TRADE SECRET ^ Yes ^ No 2 COMMON NAME 207 EHS' ^ Yes ^ NO 20 CAS No. 209 •If EHS is "Yes,' all amounts below must t>a in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE 211 21 CURIES 21 PURE ^ m MIXTURE ^ w WASTE RADIOACTIVE: ^ Yes ^ No LARGEST CONTAINER 21 PHYSICAL STATE ~.~ s SOLID ^ I LIOUID GAS 214 ~ ~~ FED HAZARD CATEGORIES ~ 1 FIRE ^ 2 REACTIVE PRESSURE RELEASE ^ 4 ACUTE HEALTH ^ 5 CHRONIC HEALTH 21 (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 22 AMOUNT DAILY AMOUNT ~~°^~ 3 DAILY AMOUNT ~~ CODE 221 222 ~~ UNITS ^ ga GAL ~ ~c{ CU FT ^ Ib LBS ^ to TONS DAYS ON SITE lf EHS, amount must qe in lbs. 22 STORAGE CONTAINER ^ k BOX ^ p TANK WAGON (CAack ell Cher epplyJ ^ a ABOVEGROUND TANK ^ I CAN ^ b UNDERGROUND TANK ^ g CARBOY CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ~ ^ d STEEL DRUM C i FIBER DRUM ^ n PLASTIC BOTTLE ^ e PLASTICINONMETALLIC DRUM ^ j BAG ^ o TOTE BIN STORAGB PRESSURE ^ a AMBIENT ~ as ABOVE AMBIENT ^ ba BELOW AMBIENT ( ~ 22 ~.I STORAGE TEMPERATURE io~a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ! ~ ^ c CRYOGENIC 22 %WT HAZARDOUS COMPONENT EHS CAS# 1 226 227 ^ Yes ^ No 228 22 2 230 231 (~ Yes ^ No 232 23 3 234 235 ^ Yes ^ No 236 23 4 238 239 ^ Yes ^ No 240 241 5 242 243 CI Yes ^ No 244 24 III. SIGNATURE PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DA T E 2 ^ ~ 9._. B_ Ifl S P t _. R f/RI ~rrr r FD 2144 (Rev. 09105)