Loading...
HomeMy WebLinkAboutBUSINESS PLANI B i BfSK & ASSOCIATES ~ ~ V S-~r-~e ~$ ~^ ,` 'F~ ~ ~~~ ~ ~~~ '~~ t ~ ~ i + BSK & ASSOCIATES ____________________________________ SiteID: 015-021-001390 + Manager Location: 117 V ST City BAKERSFIELD BusPhone: (661) 327-0671 Map 103 CommHaz High Grid: 31D FacUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:8999 EPA Numb: DunnBrad: ency Contact / Title E gency Contact / Title JOHN / MANAGING ENG BRI IER / CI NGINEER Business Pho 6.6327-0671x Business ne: 327-0671x204 24-Hour P~o-ire (6618.- -7760x 24-Hour Pho (661) 393-1929x ~Pa a one ( ) - Pager ne Hazmat Hazards: Fire Press ImmHlt De1Hlt_ Contact Phone: (661) 327-0671x MailAddr: 117 V ST State: CA ~ City BAKERSFIELD Zip '}-~3~6~- ~ ~3 ~ Owner BSK & ASSOCIATES Phone: (209) 497-2878x Address 1645 E ST State: CA City FRESNO Zip 93706 Period to TotalASTs: = Ga Preparers TotalUSTs: = Ga Certif'd: RSs: No ParcelNo: j ~ % Emergency Directives: ~ ~ 6 PROG A - HAZMAT 6 ~ ~ .I ~~~LU~~ RADIOACTIVE MATERIALS ON HAND . pR iGyFQ-e2 ~- ~~-ujA~ S ~r ~/ 3"Z~ O~7/ X Zip ~ eJ S , ~ o,~.~ to ~ ' ~ 2~ 06 7 / ~C Z.O Z~- ~tov~ /p~ / - ~~~ 25~ ~35~ 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 th@ information is true, accurate, and complete. Signature Date ~~~~~ -1- 03/08/2006 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business .Plan and Inventory Program • FACILITY NAME -----~5-~--~----~SSPC /`~r~'--- -- ADDRESS FACILITYCONTACT Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 9330~~ ,rTel: X661)_326-3979 C6a~ 1-I000f TIf1N f~ATF IWCDFf`TIl1N TIIWF ~7 PHONE No. No. of Employees ----_- _ _ - ---- --- --- _ _ _. _- - -- -- ??~~ 7~_1.---- l~ -- - Business ID Number ls-o21-p4/3~/~ Section 1: Business Plan and Inventory Program Routine O Combined O Joint Agency ~ Multi-Agency O Complaint O Re-inspection • x ANY HAZARDOUS WASTE ON SITE7: ^ YES B'NO EXPLAIN: • QUESTIONS REGARDING THIS INSPEC N? PL E CALL US AT ~F)F)'I ~ 326-3979 Inspector (Please Print) Fire Prevention 1st-InIShiR of Site While -Environmental Services Yelbw -Station Copy rn S N O BSK & ASSOCIATES /~l GaiA eZ CaLc./ n>s Manager Location: 117 V ST City BAKERSFIELD CommCode: BFD STA 06 EPA Numb: SiteID: 015-021-001390 BusPhone: (661) 327-0671 Map 103 CommHaz Extreme Grid: 31D FacUnits: 1 AOV: SIC Code:8999 DunnBrad: Emergency Contact / Title Emergency Contact / Title ON-MAN LAU / REGIONAL MGR LARRY COLOCADO / LAB MANAGER Business Phone: (661) 327-0671x206 Business Phone: (661) 327-0671x216 24-Hour Phone ( ) - x 24-Hour Phone (661) 246-6358x Pager Phone (661) 379-0391x Pager Phone (661) 201-4878x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ~ ~ G~ii}- ~Z.- ~-O ~'-"°J ~ Phone : ( 6 61) 3 2 7 - 0 6 71 x~2-9.5• MailAddr: 117 V ST State: CA 'u ~ City BAKERSFIELD Zip 93304 Owner BSK & ASSOCIATES Phone: z ~ ~ ~ ,~„~, 5~~ W~~,t T' S ~-1~4-/fJ a~/c State : CA ~ ~ f ~ ~ ~ D Address .t,~*--~-~-r - ~S ~ `f-g' -~ Ffg City FRESNO 5 ~ ' ~ ~ - { Zip -~3~tr~r,, ~ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'D A U G 3 1 2007 Eased on my inquiry of those individuals responsible for obtaining the information, I certify und~sr penalty of law that I have personally er,~mined and am familiar ~rdith the information submitted and believe the information is true, accurate, and complete. ~/2-,g/Z ®~~ Signature ~ ~ Date -1- 07/10/200'7 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE E F P IH G 900.00 FT3 Hi ACETYLENE E F P IH G 120.00 FT3 Hi SILICON DIOXIDE F DH S 3500.00 LBS Low OXYGEN F P G 125.00 FT3 Low -2- 07/10/2007 -3- o~/lo/aoo~ F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR OF BLDG CAS# 74-98-6 = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 900.00 FT3 900.00 FT3 500.00 FT3 HAGAKllUU~ C:UMYUN~N'1'S %Wt. RS CAS# 100.00 Propane Yes 74986 I1HG1-iCCL HJJ~.7J1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME ACETYLENE Location within this Facility Unit 20FT S OF N WALL lOFT E OF W WALL Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 74-86-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 120.00 FT3 120.00 FT3 60.00 FT3 I11-~GEiKLVU.7 LV1~lYV1VL"1V1J %Wt. RS CAS# 100.00 Acetylene Yes 74862 til-~GEjtCL 1~.7.7~~.71~1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 07/10/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SILICON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: W WALL CAS# 14808-60-7 STATE T TYPE ~~ PRESSURE TEMPERATURE CONTAINER TYPE Solid I Mixture I Ambient ~ Ambient BAG AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 50.00 LBS 3500.00 LBS 200.00 LBS nr~ZARDOUS COMPONENTS %Wt. RS CAS# 50.00 Silicon Dioxide No 7631869 50.00 Sulfur No 7704349 lltiGtiRL tIJ JP.~J J1.11j1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: 20FT S OF N WALL lOFT E OF W WALL CAS# 7782-44-7 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~GaS I Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 125.00 FT3 125.00 FT3 60.00 FT3 17HGtiRLV V J 1.v1"lrvlvr,iv 1 J %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 Ill'i4t1RL liJ JP~J Jl•1LilV 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P / / / Low -5- 07/10/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/05/1999 ~ CALL 911. Employee Notif./Evacuation 11/07/2006 ALL PERSONNEL, INCLUDING THOSE AT 117 V ST, ARE REQUIRED TO LEAVE BUILDING VIA FRONT OR REAR EXITS. IF TIME AND SAFETY PERMITS, STEEL ROLL-UP AND MAIN DOOR AT REAR OF BUILDING SHOULD BE CLOSED. EVACUEES ASSEMBLE IN FRONT PARKING LOT TO VERIFY ALL HAVE EXITED. ~- tU1J111.: 1VV 1.11. / L' Vdl.:Udl.1 V11 Emergency Medical Plan 11/07/2006 CALL 911 AND/OR TRANSPORT IF NECESSARY TO MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. -6- 07/10/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/05/1999 ~ SECURE GAS CYLINDERS, SEGREGATE FLAMMABLE LIQUIDS, SEGREGATE FLAMMABLE SOLIDS. Release Containment 11/07/2006 GAS LEAK - EXTINGUISH ALL SOURCES OF IGNITION, EVACUATE AND VENTILATE. FLAMMABLE LIQUID SPILL - EXTINGUISH ALL SOURCES OF IGNITION, EVACUATE AND WASH OUT BUILDING WITH WATER. FLAMMABLE SOLIDS SPILL - PICK UP AND REPACKAGE. Clean Up 01/06/1998 EVACUATE AND VENTILATE, EXTINGUISH ALL SOURCES OF IGNITION, WASH DOWN, PICK UP AND REPACKAGE. Other Resource Activation -7- 07/10/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 11/07/2006 ~ RADIOISOTOPES ON HAND. Utility Shut-Offs 10/13/2006 A) GAS - METER N END OF W EXT WALL B) ELECTRICAL - METERS E END OF N WALL INSIDE FENCE C) WATER - METER AT ST CURB NEAR S DRIVEWAY D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/21/2006 FIRE EXTINGUISHERS - ONE AT FRONT OF LAB AREA, ONE AT REAR OF LAB AREA. SMOKE AND HEAT DETECTORS SERVICED BY SECURE 326-1747 PERMIT C-4093. NEAREST FIRE HYDRANT - ACROSS ST FRONT OF BLDG. Building Occupancy Level 03/08/2006 14 EMPLOYEES -8- 07/10/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/21/2006 ~ MSDS SHEET FOR EACH MATERIAL. BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE A RADIATION SAFETY PROGRAM FOR NUCLEAR GAUGES, PERIODIC SAFETY LECTURES, AND COPIES OF MSDS ARE AVAILABLE TO ALL EMPLOYEES. WE SEND OUR EMPLOYEES TO OUT-OF-TOWN SCHOOLS FOR TRAINING. rcayc ~ Held for Future Use Held for Future Use -9- 07/10/2007 s AT&T MOBILITY-V ST (14223) Manager DEBRA OKANO Location: 125 V ST City BAKERSFIELD SiteID: 015-021-001866 BusPhone: (425) 580-4902 Map 103 CommHaz High Grid: 31D FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:4812 DunnBrad:10-202-6754 Emergency Contact / Title Emergency Contact / Title DEBRA OKANO / NETWORK MANAGER WIRELESS NETWORK / CONTROL CENTER Business Phone: (562) 468-6495x Business Phone: (800) 832-6662x 24-Hour Phone (800) 832-6662x 24-Hour Phone (800) 832-6662x Pager Phone ( ) - x Pager Phone (~1~1~r ) - x Hazmat Hazards: RSs Fire ImmHlth Contact DEBRA OKANO Phone: (562) 468-6495x MailAddr: 12900 PARK PLACE DR 3RD FLR State: CA City CERRITOS Zip 90703 Owner NEW CINGULAR WIRELESS PCS LLC ~~-RrT~T Phone: (425) 580-4902x Address PO BOX 97061 MOb(~a'~ State: WA City REDMOND Zip 98073-9761 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: PROG A - HAZMAT individuals ~ 5e airy of tho. t. 1 certify fo~~~~!~Q',sonally ina the i sed ~ ~ o pp~~ F~' iPp ® QO~ ~a® HUI~ ~ l Era .n o f r cb! ; !air' tha` n information respons!b:•~ Itl ~ o unifier penal.y fain ;iar yyitYl t,.e informat,on is true, a am ' d nd the ~ lieve exam.ne ue subm!tted ar.~-~ complete. ~ ~l accurate, and ~ V V ~! 13 „~- ,-`. rat Sigh -1- 06/29/2007 F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP F IH S 1140.00 LBS Low L ~ O~dl, - ~ CG ~ IB p~,-}-~,Q;~ -2- 06/29/2007 ~~ ~' -3- 06/29/2007 ;~ F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ..g.~ TT1T~T Days On Site Location within this Facility Unit Map: Grid: INSIDE CELL SITE / 5~~1-~1U~1$~°t' W01.~1 CAS# 5 R.Q. ceYn~or~rvi-5 ~ ~ ~SolidE TMixture ~ Ambient~E ~ A~PeRATURE OTHERONTSPECIFY/~~.~.d~ld S AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 48.00 LBS 1140.00 LBS 1140.00 LBS HAZ ~~ ~5 Zl~ rJtiGlilCL H. 7AP~J.71"1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F IH / / / t5 ~ Low ARDOUS COMPONENTS °sWt . RS CAS# ~ '/. -7--@~@- Sulfuric Acid (EPA) No 7664939 D'1-~--~0' Lead No 7439921 -4- 06/29/2007 F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 03/31/1998 ~ IN CASE OF A HAZARDOUS SPILL ALWAYS CALL 911 FOR THE LOCAL RESPONSE AGENCY. THEN CALL GOVERNORS OFFICE OF EMERGENCY SERVICES. THEN CONSULT THE CALIFORNIA HAZARDOUS MATERIAL NOTIFICATION GUIDE TO SEE IF ADDITIONAL AGENCIES ARE TO BE NOTIFIED. = Employee Notif./Evacuation 08/25/2000 oltSco~~rz.~Cs) ~ oc. a~`ov~ IN CASE OF FIRE EMgb6~E-S`ARE NOTIFIED TO EVACUATE THE AND CLOSE ALL DOORS TO ENSURE PROPER OPERATION OF HALON SYSTEM AND TO ENSURE NO ONE ENTERS '"T' ^_'_"_'ICC UNTIL FIRE DEPT AND HAZAROUS RESPONSE TEAM HAS CLEARED TO DO SO. -1'HQ,v-n ~ l~"'~ ~ S IhY1,VYIGU~IYI.R..p~ . Public Notif./Evacuation 03/31/1998 HAZARDOUS MATERIALS USED AT OUR FACILITY DO NOT POSE A THREAT TO THE PUBLIC. Emergency Medical Plan 03/15/2007 SAN JOAQUIN COMMUNITY HOSPITAL, 2615 EYE ST, 395-3000 -5- 06/29/2007 F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/15/2007 ~ ALL REMOTE LOCATIONS ARE VISITED BY QUALIFIED PERSONNEL TO CHECK FOR LEAKS IN BATTERY AND HALON SYSTEMS ON A WEEKLY BASIS. ~/'~ 1<C/~1/C'~ (d'~QC 1.V111.d1i1lllClll, 1 - l l~ VI J K~ O ~ ~ ~ ~ ~ (6~ ~ ~~ ~ ~ ~ 1. ~ ~..kf~ ~ ~ Q/~ ~-C..Y/V I ~-- W (` l ~' pu=p ~~~' ~ a-~~e.cv~,~O f ~ 'top ~ -~~.~ o ~ ~ ~ r-e. L1Cdll U~J V1.11G1 1CCSVULI:C HL L1Vdl.1Vi1 -6- 06/29/2007 F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l:ld1 ild "G dl US Utility Shut-Offs 08/08/2006 NO UTILITY SHUT-OFFS. t'1LC t'LVI.CC:./tiVd11. Wdl.el Building Occupancy Level 03/08/2006 UNMANNED SITE -7- 06/29/2007 F AT&T MOBILITY-V ST (14223) SiteID: 015-021-001866 ~ ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 08/08/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES THAT HAVE ACCESS TO BATTERY ROOMS AND/OR HALON-PROTECTED FACILITIES ARE FAMILIAR WITH THE MSDS SHEETS FOR THESE HAZARDOUS MATERIALS. NEW EMPLOYEES ARE MADE AWARE OF THE DANGERS OF THE MATERIALS, THE LOCATION OF THE MSDS FOR THESE MATERIALS AND TO CONTACT JOE SANDOVAL OR LARRY GONZALES FOR ANY CONCERNS THAT MIGHT ARISE. rayc ~ _, r_ aic lu tVl r LLl. U1C uw7"C nciu iV1 rUI.ULC U5C -8- 06/29/2007 USID: 9539 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION FACILITY ID# 7 BEGINNING DATE too ENDING DATE tot 1866 8/13/2007 8/13/2008 BUSINESSNAME(SameasFAC~uTYNAMEorDBA-Doing Business As) 3 BUSINESS PHONE toe it AT&T Mobility- V Street (14223) 425-580-4902 BUSINESS SITE ADDRESS to3 125 V St CITY too ZIP CODE toy CA Bakersfield 93304 DUN & BRADSTREET tos SIC CODE (4 digit #) 707 10-202-6754 4812 COUNTY toe KERN BUSINESS OPERATOR NAME 709 BUSINESS OPERATOR PHONE tto AT&T Mobili 425-580-4902 11. BUSINESS OWNER OWNER NAME 777 OWNER PHONE 772 New Cingular Wireless PCS, LLC; dba AT&T Mobility 425-580-4902 OWNER MAILING ADDRESS 773 PO Box 97061 CITY 774 STATE 775 ZIP CODE tts Redmond WA 98073-9761 III. ENVIRONMENTAL CONTACT CONTACT NAME 717 CONTACT PHONE tts Debra Okano 562-468-6495 CONTACT MAILING ADDRESS 779 12900 Park Place Dr. Std Floor CITY 120 STATE 727 ZIP CODE 722 Cerritos CA 90703 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 723 NAME tea Debra Okano Wireless Network Control Center TITLE 724 TITLE 729 Network Mana er, Compliance Control Center BUSINESS PHONE t2s BUSINESS PHONE t3o 562-468-6495 800-832-6662 24-HOUR PHONE 726 24•HOUR PHONE 737 800-832-6662 800-832-6662 PAGER # 127 PAGER # 732 949-338-8434 N/A ADDITIONAL LOCALLY COLLECTED INFORMATION: 733 Property Owner: New Cingular Wireless PCS, LLC; dba AT&T Mobility Note: Please send to the ATTENTION of EH&S. Please note that all Hazmat related Billing, Permitting and Correspondences need to be mailed to the "Owner Mailing Address" listed 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 0 R/OPERATO OR DESIGNATED REPRESENTATIVE DATE t3a NAME OF DOCUMENT PREPARER t35 8/13/2007 Jackie Schnell NAME OF SIGNER (print t36 TITLE OF SIGNER 737 Donald Harris Director, EH&S UPCF (1/99) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRiPTioN one e r material r Duiltlin or area ^ADD ^DELETE ®REVISE 200 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 AT&T Mobilit - V Street 14223 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA zoz Inside cell site ^ YES ® NO FACILITY ID # t MAP# (oprionaij 203 GRID# (optlonai) 2oa 1866 II. CHEMICAL INFORMATION CHEMICAL NAME 2os TRADE SECRET ^Yes ®No zos Lead Pb I(Subjed to EPCRA, refer to instrugions COMMON NAME zos zaa EHS' ^Yes ®No Lead-Acid Batteries CAS# zos 'If EHS is "Yes", all amounts below must be in lbs. 7439-92-1 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 Health: 3 Fire: 0 Reactive:2 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ^ a. PURE ®b. MIXTURE ^ c. WASTE RADIOACTIVE ^Yes ®No 212 CURIES: WA 213 PHYSICAL STATE (Check one item only) ®a. SOLID ^ b. LIQUID ^ c. GAS 214 LARGEST CONTAINER: 48 215 FED HAZARD CATEGORIES 2t6 (Check all that apply) ^ a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ^ d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT zn MAXIMUM DAILY AMOUNT 21a ANNUAL WASTE AMOUNT 21s STATE WASTE CODE 220 1140 1140 N/A N/A 221 DAYS ON SITE: 222 UNITS' ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in unds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTICMONMETALLICbRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CANS ^ j. BAG ^ n. PLASTIC BOTTLE ®r. OTHER -Batteries ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ .TANK WAGON zz3 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 2za STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 65-70°/, 226 Lead (Pb) zz~ ^Yes ®No 22e 7439-92-1 zzs 2 7.g% 23o Sulfuric Acid (H2SOa) z3, ®Yes ^ No 232 7664-93-9 233 3 21-28% 234 Water (H20) 235 ^Yes ®No 23s None 237 q zas zas ^Yes ^ No 2ao za1 6 2az 2a3 ^Yes ^ No 2aa zas If more hazardous components are present at greater than 1% by weight i(von-carcinogenic, or g.1%by weight if carcinogenic, attach ad ditional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION: zas If EPCRA Please Si n Here UPCF (1/99) d - ~ UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION one e r material r buildin or areal ^ADD ^DELETE ®REVISE 200 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 AT&T Mobilit - V Street 14223 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA zo2 Inside Lead-Acid Batteries ^ YES ® No FACILITY ID # 1 MAP# (optional) 203 GRID# (optional) 204 1866 11. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 2os Electrol a If Subject to EPCRA, referto instructions COMMON NAME zoo zoe EHS' ^Yes ®No Lead-Acid Batte CAS# tog 7664-93-9 'If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete a required by CUPA) 210 N/A HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ®b. MIXTURE ^ c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES: N/A 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 21a LARGEST CONTAINER: 1 2t5 FED HAZARD CATEGORIES 218 (Check all that apply) ^ a. FIRE ®b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT z17 MAXIMUM DAILY AMOUNT 21s ANNUAL WASTE AMOUNT z1s STATE WASTE CODE 220 30 30 N/A N/A zzf DAYS ON SITE: ~ UNITS' ®a. GALLONS ^ b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in unds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ i. CANS ^ j. BAG ^ n. PLASTIC BOTTLE ®r. OTHER -Lead-Acid Battery ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ .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 z25 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 40-50% zzs Sulfuric Acid zz~ ®Yes ^ No zee 7664-93-9 zzg 2 50-60% 230 Water 23i ^Yes ®No z3z None 233 9 z3a z3s ^Yes ^ No z3s z37 a 23a z3s ^Yes ^ No zao za1 5 2az za3 ^Yes ^ No zaa zas If more hazardous components are present at greater than 1% by weight If non-carcinogenic, or 0.1% by weight If carcinogenic, attach ad ditional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION: zas DOT Hazard Class (HSsoa): 8.0 If EPCRA Please Si n Here UPCF (1/99) i 3 READY GO MARKET SiteID: 015-021-001394 Manager DENNY Location: 1600 VALHALLA DR City BAKERSFIELD BusPhone: (661) 835-8518 Map 123 CommHaz Moderate Grid: 02C FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title HAN MO CHUNG ~ / OWNER DENNY / MANAGER Business Phone: (661) 835-8518x Business Phone: ( ) - x 24-Hour Phone (661) 213-4974x 24-Hour Phone (661) 373-6877x Pager Phone (661) 373-6877x Pager Phone ( ) - x Hazmat Hazards: Contact HAN MO CHUNG Phone: (661) 835-8518x MailAddr: 1600 VALHALLA DR State: CA City BAKERSFIELD Zip 93309 Owner HAN MO CHUNG Phone: (661) 213-4974x Address 13303 PROVIDENCE PL State: CA City BAKERSFIELD Zip- 93314 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency .Directives: PROG A - HAZMAT PROG U - UST ~~~~~ ~~ ~ ~~~ „~ pn ~y incuiry of those indi~!iduals ~- '"~ certify r oh"a~?I!nCq thF I!~forrrlation, ; ~,,, ..; r~~:~,on:; it~ Ot ,?,1'; that ! I';2.Ve i':erson8iiy ?'lc ~ ' N .5 ,~;, iU~ m `a~`iiiiar ~.'~ih the infcrmation c;~ : rt ~ t ; 1 r;_; , +, ?ra 'iii ~1G~`r ~.~" •.he irforrnation is true, s~tmltt:. ~~ accurate, a-.~+ co;":j.~iete. / ~ b /a ! ~ °- ~°°'" Date Signat~~ e -1- 07/13/2007 -- F READY GO MARKET SiteID: 015-021-001394 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: READY GO MARKET Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: BRUCE HENSLEY Dsg Own/Oper 1064437-UC ICC Nbr: PROPERTY OWNER INFORMATION Name DENNY Phone: ( ) - x Address: City State: Zip: Type TANK OWNER INFORMATION Name DENNY Phone: ( ) - x Address: City State: Zip: Type BOE UST Fee# 037550 Financ'1 Resp: SELF INSURED Legal Notif Business Mailing Address Date:07/21/2000 Phone: (116) 618- x Name:HAN MO CHUNG Ttl:OWNER State UST # 1998 Upg Cert#: 00846 -2- 07/13/2007 t ~ n F READY GO MARKET SiteID: 015-021-001394 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE SUPER UNLEADED GASOLINE L L 8000.00 4000.00 GAL GAL UnR UnR -3- 07/13/2007 -4- 07/13/2007 r ` w F READY GO MARKET SiteID: 015-021-001394 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SPLIT TANK W/SUPREME UL CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixture Tmbient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 8000.00 GAL 8000.00 GAL 500.00 GAL ru~urucLV~J ~.vl•lrvivlJivtJ -- ~Wt• RS CAS# 100.00 Gasoline No 8006619 17t1L~riRL PiJ JIJJ JI.IL~IVIJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SPLIT TANK W/UL GASOLINE CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixtur~mbient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 4000.00 GAL 500.00 GAL °sWt. 100.00 Gasoline HAZARDOUS COMPONENTS RSI CAS# No 8006619 11C1LJt]iCL tiJ JIJJ JI.1Li1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -5- 07/13/2007 T ~ F READY GO MARKET SiteID: 015-021-001394 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/26/2006 ~ TELEPHONE AT COUNTER OR IN OFFICE WOULD BE USED TO DIAL 911 IN THE EVENT OF AN EMERGENCY. FOR NON-EMERGENCY SITUATIONS, THE HAZMAT OFFICE OF THE BAKERSFIELD FIRE DEPT IS CALLED 326-3979. Employee Notif./Evacuation 04/03/2006 WORD-OF-MOUTH WILL BE USED WITHIN STORE TO NOTIFY THE PUBLIC AND EMPLOYEES OF EVACUATION SITUATION. A PUBLIC ADDRESS SYSTEM IS LOCATED AT THE COUNTER TO NOTIFY CUSTOMERS AT THE PUMPS. Public Notif./Evacuation 05/26/2006 YELL TO CUSTOMERS TO VACATE AREA AND NOT TO START CARS IF SPILL IS ON THE GROUND. Emergency Medical Plan 05/30/1995 CALL WHITE LANE MEDICAL CENTER. -6- 07/13/200'7 F READY GO MARKET SiteID: 015-021-001394 ~ ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/26/2006 ~ AUTOMATIC SHUT-OFF ON PUMPS. THE UNDERGROUND TANK SYSTEM IS ELECTRONICALLY CONTROLLED TO SHUT OFF THE PUMPS WHEN A LEAK IS DETECTED IN THE TANK OR PRODUCT LINES. Release Containment 05/26/2006 GREASE SWEEP TO CONTAIN SPILLS. THE UNDERGROUND TANKS HAVE SECONDARY CONTAINMENT AS DOUBLE-WALL FIBERGLASS TANKS. Clean Up 05/26/2006 SUN VALLEY OIL CO WILL BE NOTIFIED TO ASSIST IN THE REMOVAL OF GASOLINE FROM THE TANKS AND/OR SECONDARY CONTAINMENT. ABSORBENT USED TO SOAK UP SMALL SPILLS WILL BE TRANSFERRED INTO A METAL CONTAINER OR OTHER SUITABLE CONTAINER USING NON-METALIC TOOLS UNTIL PROPER DISPOSAL CAN BE ARRANGED, EITHER THROUGH SUN VALLEY OIL CO OR A LICENCED HAZARDOUS WASTE HAULER. v1.11C1 1CCSVULC:C 1~C:l.1VdL1VR -7- 07/13/2007 r F READY GO MARKET SiteID: 015-021-001394 ~ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCU1d1 ridGdlUS Utility Shut-Offs 04/23/2007 GAS - SE CRNR OF BLDG ELECTRICAL - PANEL BOX IN BATHROOM WATER - NW CRNR OF BLDG Fire Protec./Avail. Water 04/23/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN OFFICE AND BEHIND COUNTER. FIRE HYDRANT - NW CRNR OF SITE ACROSS ST. Building Occupancy Level 04/03/2006 3 EMPLOYEES -$- 07/13/2007 4' F READY GO MARKET SiteID: 015-021-001394 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/06/2007 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: IF THERE IS A SPILL, CLEAN IT UP. IF GAS GETS IN EYES OR ON SKIN, WASH WITH WATER. IF LARGE SPILL, CALL FIRE DEPT. IF LEAK, SHUT OFF PUMPS. rayc c _~ , r_ aaclu ivl. r ut.UIC VAC RG1lA 1V1 t'uLUlC V.7-C -9- 07/13/2007 BSK & ASSOCIATES SiteID: 015-021-001390 Manager BusPhone: (661) 327-0671 Location: 117 V ST Map 103 CommHaz Extreme City BAKERSFIELD Grid: 31D FacUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:8999 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / ......... _. Title ON-MAN LAU / REGIONAL MGR LARRY COLOCADO / LAB MANAGER Business Phone: (661) 327-0671x206 Business Phone: (661) 327-0671x216 24-Hour Phone ( ) - x 24-Hour Phone (661) 246-6358x Pager Phone (661) 379-0391x Pager Phone (661) 201-4878x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact RUSSELL ANTHONY Phone: (661) 327-0671x205 MailAddr: 117 V ST State: CA City BAKERSFIELD Zip 93304. Owner BSK & ASSOCIATES Phone: (209) 497-2878x Address 1645 E ST State: CA City FRESNO Zip 93706 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT E~~°p FEB 2 6 2007 Based on my inquiry of these in~lvictu~la responsible for obtaining tha Ir~fdrmr-~ti@vt, i eertify under penalty of law that I have p©rsonally examined and am familiar with thQ information submitted and believe the information is true, te e . d compl an accurate, / ~ ~ i ~ Signature ~ Dat -1- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE E F P IH G 900.00 FT3 Hi ACETYLENE E F P IH G 120.00 FT3 Hi SILICON DIOXIDE F DH S 3500.00 LBS Low OXYGEN F P G 125.00 FT3 Low -2- 01/26/2007 -3- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ----- PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: -- NE CRNR OF BLDG CAS# 74-98-6 STATE TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE Gas TPure Above Ambient I Ambient I PnRT _ PRFSS _ C''YT~TNT~F.R 1 AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 900.00 FT3 900.00 FT3 500.00 FT3 HAZARDO US COMPONENTS aWt. RS CAS# 100.00 Propane Yes 74986 ruic~rutL .-~. 7ar~aJr~~lvtJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies F P IH / / / ~ Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: 20FT S OF N WALL lOFT E OF W WALL CAS# 74-86-2 STATE T -TYPE PRESSURE ~ TEMPERATURE -~ CONTAINER TYPE ~GaS I Pure Above Ambient I Amb; ent I pnRT PRF.~C CVT.TTTTIF.R I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 120.00 FT3 120.00 FT3 60.00 FT3 HAZARDOUS COMPONENTS oWt. RS CAS# 100.00 Acetylene Yes 74862 i11'~[JC]iCL Liw 7 JP~J JI.1L'1V1J TSecret RS BioHaz_ Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SILICON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: W WALL CAS# 14808-60-7 STATE T TYPE ~- PRESSURE TEMPERATURE ~ CONTAINER TYPE Solid I Mixture I Ambient ~ Ambient I BAG AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 50.00 LBS 3500.00 LBS 200.00 LBS HAZARDOUS COMPONENTS %Wt. RS CAS# 50.00 Silicon Dioxide No 7631f369 50.00 Sulfur No 7704349 nt~c~rsRL .-~, ~~~,~~i~ialvia TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Law ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit 20FT S OF N WALL lOFT E OF W WALL ~GasATE TPureE ~-AboveSAmbEent Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: -- CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 125.00 FT3 125.00 FT3 60.00 FT3 rinc~rucLV~~ ~.vrirvlvrlvtS °~wt. Rs cAS# 100.00 Oxygen, Compressed No 778247 ilti[~tiICL H~ J w7 L'.7.71°1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P / / / Low -5- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/05/1999 ~ CALL 911. Employee Notif./Evacuation 11/07/2006 ALL PERSONNEL, INCLUDING THOSE AT 117 V ST, ARE REQUIRED TO LEAVE BUILDING VIA FRONT OR REAR EXITS. IF TIME AND SAFETY PERMITS, STEEL ROLL-UP AND MAIN DOOR AT REAR OF BUILDING SHOULD BE CLOSED. EVACUEES ASSEMBLE IN FRONT PARKING LOT TO VERIFY ALL HAVE EXITED. ru1.111~ 1VV1.11. / r~va~.ua~.ivii Emergency Medical Plan 11/07/2006 CALL 911 AND/OR TRANSPORT IF NECESSARY TO MERCY HOSPITAL, 2215 TRUXTUN AVER 327-3371. -6- 01/26/200'7 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/05/1999 ~ SECURE GAS CYLINDERS, SEGREGATE FLAMMABLE LIQUIDS, SEGREGATE FLAMMABLE SOLIDS. Release Containment 11/07/2006 GAS LEAK - EXTINGUISH ALL SOURCES OF IGNITION, EVACUATE AND VENTILATE. FLAMMABLE LIQUID SPILL - EXTINGUISH ALL SOURCES OF IGNITION, EVACUATE AND WASH OUT BUILDING WITH WATER. FLAMMABLE SOLIDS SPILL - PICK UP AND REPACKAGE. Clean Up 01/06/1998 EVACUATE AND VENTILATE, EXTINGUISH ALL SOURCES OF IGNITION, WASH DOWN, PICK UP AND REPACKAGE. Other Resource Activation -7- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-001390 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 11/07/2006 ~ RADIOISOTOPES ON HAND. Utility Shut-Offs A) GAS - METER N END OF W EXT WALL B) ELECTRICAL - METERS E END OF N WALL INSIDE FENCE C) WATER - METER AT ST CURB NEAR S DRIVEWAY D) SPECIAL - NONE E) LOCK BOX - NO 10/13/200& Fire Protec./Avail. Water 07/21/2006 FIRE EXTINGUISHERS - ONE AT FRONT OF LAB AREA, ONE AT REAR OF LAB AREA. SMOKE AND HEAT DETECTORS SERVICED BY SECURE 326-1747 PERMIT C-4093. NEAREST FIRE HYDRANT - ACROSS ST FRONT OF BLDG. Building Occupancy Level 14 EMPLOYEES 03/08/2006 -8- 01/26/2007 F BSK & ASSOCIATES SiteID: 015-021-00139 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/21/2005 ~ MSDS SHEET FOR EACH MATERIAL. BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE A RADIATION SAFETY PROGRAM FOR NUCLEAR GAUGES, PERIODIC SAFETY LECTURES, AND COPIES OF MSDS ARE AVAILABLE TO ALL EMPLOYEES. WE SEND OUR EMPLOYEES TO OUT-OF-TOWN SCHOOLS FOR TRAINING. rciyc ~ Held for Future Use nC1u LVI r uI.UIC UDC -9- 01/26/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1:. Business Plan and Inventory Program • FACILITY NAME ~s ~ ~ ,ass®e ~~~s ADDRESS - l~ 7 / s~ FACILITY CONTACT ~~' Prevention Services a ., t~ t; R s r t~>wti. ~ 900 Truxtun Ave., Suite 210 B~ersfield, CA 93301 a a R M r ,~ ~- Tel.: (661) 326-3979 Fax: (661) 872-2171 , INSPECTION DATE (INSPECTION TIME ~Pb~( J~~/ rY i O OF EM~ OYEES `/ ~ 15-021- Q(~`j ~8 Section 1: Business Plan_and Inventory Program ~i _ _ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION COMMENTS ' V=Violation ~ ld~ ^ APPROPRIATE PERMIT ON HAND i ~ ~IQ BUSIfteSS PLAN CONTACT INFORMATION ACCURATE ~ ~~ ~~~ n Yom" ^ VISIBLE ADDRESS 1~ ~ IS ^ CORRECT OCCUPANCY ~ I I ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~ N i~ e ®~ inn ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL i ~ ~ fl o (~ . ^ VERIFICATION OF MSDS AVAILABILITY [ I ^ VERIFICATION OF HAZ MAT TRAINING , /~~/~ ~ ~J/JO~ r/~? ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~1/ +r~~ !//'~ C3 ^ EMERGENCY PROCEDURES ADEQUATE I ^ CONTAINERS PROPERLY LABELED I ^ HOUSEKEEPING ^ FIRE PROTECTION ~ I ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES ^~NO QU STI NS~`REGARDIN INSPECTION? PLEASE CALL US AT (661) 326-3979 /~ J Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/Station # White -Prevention Services .Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09105