HomeMy WebLinkAboutBUSINESS PLANIN & OUT AUTOMOTIVE
'~ ; 4106 WIBLE ROAD
s~ ~~ ~
UNIFIED PROGRAM INSPECTION CHECKLIST
;: ~~ ~~~
SECTION 1 Business .Plan and Inventory Program
FACILITY NAME
_ 1~ - - ------- - - .. __~._.~.- .. __._.. --- _
ADDRESS --- Ir- ---- -- -- - - -- -
~ ~, d lD L.,J t 13~ (~
FACILITYCONTACT
Bakersfield Fire Dept.
Environmental Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 933 Z ~ 10~
Tel: (661) 326-3979 _ _ _ 5
No.
Business ID Number ~
15.0 ~
Section 1: Business Plan and Inventory Program ~ Z 7~ S
^ Routine Combined ^ Joint Agency OMulti-Agency ^ Complaint ^ Re-I
C V (v=woationnCel OPERATION I COMMENTS ~~~/~
~
^ ^ APPROPRIATE PERMIT ON HAND ~
^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
^ ^ VISIBLE ADDRESS
^ ^ CORRECT OCCUPANCY
ANY HAZARDOiJSAAWASTE ON SITE`'?~: Q ~^f YES ^ IVO
EXPLAIN: ~ K ~ ~ `? v l ~~
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~6C)'I ~ 326-3979
Inspector (Please Print) Fire Prevention 1st-In/Shift of Site ess S' onsible Party (Please Print)
S
White -Environmental Services Yellow • Station Copy Pink -Business Copy
:.,~. CITY OF I~f~KERSFIELD -
a ~F~Re ' ° OFFICE OF ENVIRONMENTAL SERVICES
- ~RrM t 1715 Chester Ave., CA 9330.1 (661) 326-3979 _' ~ •
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
,,~~{{ (one loan per material per building or area)
U~I.I:tEW ^ ADD ^ DELETE ^ REVISE 200 Page _ of _
_ _ I. FACILITY I~IFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3
l~l ~__ ~" _~.rrorwz/C _ _ _ _
CHEMICAL LOCATION 4 rt 20t CHEt.11CAL LOCATION ^ Yes ^ No 202
~~SrA[ ~Z.7~ ~ ~ (..JCL CONFIDENTIAL(EPCRA)
FACILITY ID # i~ -_r i i 7 MAP.M (optronaQ - - _ -- 203 GRID d (ophonaQ 2W
.j
H. Ci~EMICAL INFORMATION
205 TRADE SECRET ^ Yes ^ No 206
CHEMICAL NAME -
w/k3^C- O I 1 I! Subject to EPCRA, refer to instructions
------ ----- ------ - 207
~: COMMON NAME - EHS'
^ Yes ^ No 208
CAS # 209 ~ •I[ EHS is'Yu,• all amounts lxlow must lx in lbs. '
FIRE CODE HAZARD CLASSES (Complete it requested by local fire chief
270
--- --- ------- -- -- .- .._ - -- - - - - - ------ - CURIE -----
TYPE ^ p PURE ^ m MIXTURE ~- NJA~"-. .. r.-.L'IOACTIVE ^ Yes ~No 212 S 273
PHYSICAL STATE ^ s SOLID 4~'LIQUID ^ g G:.S 2,4 LARGEST CONTAINER S~ 275
FED HAZARD CATEGORIES 7 FIRE ^ 2 REACTIVE ^ 3 PR_S;3 iRE F:ELE.;SE ~_ •: a-:U--E HEALTH ~ CHRONIC HEALTH 216
(Check all that apply)
AMOUNTWASTE 277 Dt~YAMOUNT ~b ~ c18 ~ DAILY~AtrOUNT ~ ~~ 279 ~ STATE WASTE CODE 220
--- ---- ----- -...-- -¢.-.~-...._ --- -------- -----. ...--... - -- - - - ---- - -- SO ST 222
. UNITS' .~ga GAL ^ d CU FT ^ Ib LBS ^ to TONS 227 i DAY N 1 E
. ~ ' If EHS. amount must be in lbs.
STORAGE CONTAINER ^ a ABOVEGROUND TANK ^ e PLASTIC/NONb1ETALLIC DRUIv1 ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223
(Check all that apply)
^ b UNDERGROUND TANK ^ f CAN ~ j BAG ^ n PLASTIC BOTTLE ^ r OTHER
^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ o TOTE BIN
STEEL DRUM ^ h SILO ^ I CYLINDER ^ p TANK WAGON
I
STORAGE PRESSURE ,~ gMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AM81EN7 224
t - ------------- - ----~- --~ -- - - -._ ..-- -- . - - _. - _.----- ~ ---------------- -
s STORAGE TEMPERATURE ,~MBIENT ^ as ABOVE AMBIENT ^ b3 BELOW AMBIENT ^ c CRYOGENIC .225
°joWT HAZARDOUS COMPONENT EHS ~ CAS #
- ~--~-------._.._._...------------------------- 227
1 226 ~ ; ^ Yes ^ No 226 229
2 230 ~ 23t j ^ Yes ^ No 232 233
i
3 234 i 235 - 237
~ ^ Yes ^ Na 236
-- - ---- --------- ----I --- -
4 ! 238 ~ 239 ^ Yes 247
I ^ No 240
i
~ 5 242 2;3 ^ Yes ^ No 244 215
i
III. SIGNATURE
'. PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ SIGNATURE DATE 246
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;_,.! ' _ CITY OF I3AkERSFIELD -
B E R s F ( _p OFFICE OF ENVIRONMENTAL SERV[CES ~I,,,~,
ARTM T 1715 Chester Ave., CA 93301 (661) 326-3979 _' ~, •
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
(one Jorm per mafenal por building or area)
W ^ AOD ^ DELETE ^ REVISE 200 Page of
I. FACILITY.I~IFORMATION
BUSINESS NAME1SameRas FACILITY N/A~M~E oar D~B~A -Doing B~u/s~in~ess As) - - 3
CHEMICAL LOCATION Ie l~ tl~~ n~~~ t I ~rr `( 201 CHEftICAILOCATION
,V E, l_ ~~L CONFIDENTIAL (EPCRA) ^ Yes ^ No 202
`------~ - - t- -_.. ~ ~ -- -- - .. _ _..
FACILITY ID # ~ (;; •' t ! - 1 MAP # (optionaQ 203 GRID # (oplrona~ ~ - 20a
~ _ ~ ^ ,__t I I - - - - --- -- ---- --
II. C~IEMICAL INFORMATION
205 TRADE SE R ^ Yes ^ No 206
- CHEMICAL NAME
~0,~~ Q ~ ~ 1' Subject to EPCRA, refer to instructions
---- ----~--- - 207 -
COMMON NAME EHS'
^ Yes ^ No 208
i
CAS # 209 •If EHS is Yes, all amounts below must be m tbs.
FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief)
210
TYPE ~-~( PURE ^ m MIXTURE ^ w WASH=
iY-.J~-.P~. r..!~IOACTIVc ^ Yes ~0 212 CURIES 2t3
PHYSICAL STATE ^ s SOLID (~LIOUID ^ g GAS 2ta LARGEST CONTAINER ~~ 215
FED HAZARD CATEGOR IES t FIRE ^ 2 REACTIVE ^ 3 PR_SS ;RE ':EL6:SE ~ > :U--E HEALTH ^ 5 CHRONIC HEALTH ~ 2t6
(Check all that apply) - _ -
ANNUAL WASTE 217 ;d4XIMUA,M 218
~ ~~ AVERAGE / 2t9 ~ STATE WASTE CODE
T
~
6 220
AMOUNT DAILY AMOUNT /
DAILY Ah10UN
_ UNITS' ~ ga GAL ^ Lf CU =T ^ Ib LBS i~ In TONS 221 ~ DAYS ON SITE 222
If EHS, amount must be in lbs. _ ~ -
STORAGE CONTAINER ^ a ABOVEGROUND TANK ^ e PLASTIC/NONMETALLIC DRUM ^ i RBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR - 223
(Check all that apply)
^ b UNDERGROUND TANK ^ f CAN
v j BAG ^ n PLASTIC BOTTLE ^ r OTHER
-
^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ a TOTE BIN
j ~ ~_STEEL DRUM ^ h SILO ^ I CYLINDER ^ o TANK WAGON
STORAGE PRESSURE ~a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT 224
STORAGE TEMPERATURE t.~a AMBIENT ^ as ABOVE AMBIENT ^ b3 BELOW AMBIENT ^ c CRYOGENIC 225
CAS #
229
233
237
a i 238 239 241
i i ^ Yes ^ No 2a0
--'----------'------r---.._. _ ._-..- ..
5 242 i 2T3 ~ ^ Yes ^ No 244 2a5
~ I ~ - -- -- --.... ----------- -
--------------------------. .__...._.._ _ __ _ . _ ..... _ -_ .... _. - -... ._. __. ---_.._.__...- --~- I
III. SIGNATURE
j
--
`- PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ ~ SIGNATURE ~ ~ l GDA/TE 246
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' ~~A O ~ ~ Slice o~ Ca~~fwna
{x~ LICENSED
~ sMO~
~ ~ ~CK
661-831-1004 Rn~cStation
Smog Checks • Oil Changes • Diagnositics • Tune Ups
Air Conditioning • Brakes • C. V. Boots • And More
i
(Fleet Accounts Welcome)
4106 Wible Road #C M-F 8-5 SAT 9-2
Bakersfield, CA 93313 James & AmberYocum
(next to Urner'sl Owners ~