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Home My WebLink AboutBUSINESS PLAN (2)~' II BEREAN AUTONiOTIVE ` <' i~ 4308 WIBLE RD ~- ..... - r-`/--- ---- - / =~~ '.: r, Y ~~ ~-I(ol-7DI ~~ I ~~~ ~, 4 ~i w~ ~_:_~; J ~ (~, ~ `~ `l ~ ; ~j2rt,~- ~or rnh -b ~ t l oc.~.~- --~o~ Ch~e~ ~ ml.Jne/~:~. ` ~ _. ' !/? D Gv'tsc,a_ 1.~ ,gvsresj ~~ > » BAKERSFIELD FIRE DEPT r'°r 6~`~ ~''` Prevention Services UNIFIED PROGRABIA INSPECTION CFIECKLIST ~` B ~irR~ r n 900 TruxtunAve., Suite 210 ~_ x - _.a -_ .~~ .;, _ _ e~ : _ . <_: , ~„ _ ..:: ~.... _ _. , - ~. _ ~,;: w;erur r Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program P Tel.: (661) 326-3979 Fax: (661) 872-2171®E~ 2'2 ~qn~ FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS ~ ` HONE NO. ` O OF EMPLOYEES ~j~g LJ' l,o\~ i -3sDV ldc~ -~3 FACILITY CONTACT USINESS ID NUMBER 15-021- cx~ (ad ~ Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPE TION C V ~ C=Compliance OPERATION V=Violation COMMENTS ___.___ ^ ^ APPROPRIATE PERMIT ON HAND ^ BUSilless PLAN CONTACT INFORMATION ACCURATE I ~ p-~ ~~' - /lpr ~IA.T Oe evt` ~p~ IJc) Sr'~QS 5 ^ ^ VISIBLE ADDRESS I ^ ~ CORRECT OCCUPANCY AL,~ ~.v ~ r UNI~,~, U~ M4 Snuch~a ^ ^ VERIFICATION OF INVENTORY MATERIALS I ^ ^ VERIFICATION OF QUANTITIES ^ ^ VERIFICATION OF LOCATION ^ ^ ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ ^ VERIFICATION OF HAZ MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING ^ ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: QUESTIONS REGA"R~~DING THIS INSPECTION? PLEASEICALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # Business Site/School Site Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02105) + BOOKOUT AUTO CENTER =___-.____________________________ SiteID: 015-021-000171 + Manager BusPhone: (661) 835-0082 Location: 4308 WIBLE RD Map 123 CommHaz Low City BAKERSFIELD Grid: 14D FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:7538 EPA Numb: DunnBrad:77-0425425 Emergency Contact / Title Emergency Contact / Title GREGORY C BOOKOUT / OWNER LISA E BOOKOUT / OWNER Business Phone: (661) 835-0082x Business Phone: (661) 617-1454x 24-Hour Phone (661) 872-9398x 24-Hour Phone (661) 872-9398x Pager Phone (661) 979-1771x Pager Phone (661) 703-5472x Hazmat Hazards: Contact GREGORY C BOOKOUT Phone: (661) 979-1771x MailAddr: 4308 WIBLE RD State: CA City BAKERSFIELD Zip 93313 Owner GREGORY C BOOKOUT Phone: (661) 979-1771x Address 4308 WIBLE RD State: CA City BAKERSFIELD Zip 93313 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN 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. Signatur ~ ~'-'°~ OHO ate EN1~ MA ~ z 6 ~dO6 -1- 03/09/2006 UNIFIED PROGRAIVi INSPECTION CHECKLIST=' SECTION 1 : BUS9n@SS Pt611 and It1Ve61f01')/ PCOgram Tel.: (661) 326-3979 • Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS - -Y HONE NO. O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER G- ~ 1 0 15-021- ~ OBI Section 1: Business Plan and Inventory Program ~ 0 ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • ~\ C V ~ C=Compliance ®pERATION V=Violation NTD ~~~~ 1 ~ 206 COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE i ^ VISIBLE ADDRESS ` ^ CORRECT OCCUPANCY 6~~ ~•~^ ~ ~-~„~ 4M' lti ~t, ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL - ^ i VERIFICATION OF MSDS AVAILABILITY ~ ----- - ---- ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND I ANY HAZARDOUS WASTE ON/S_IT,E? ~9nYES (t~~^ NO EXPLAIN: ~ ~ ~ ~'^_~._ Ah t % +ve~ .QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 S C ecr- JTA.n~Y. ~ tc Inspector (Please Print) Fire Prevention / 1s' In / Shift of Site/Station # Business S' School Site Responsible Party (Please Print) BAKERSFIELD FIRE DEPT e a P r D Prevention Services /lRO 900 'IYtr<xtun Ave. , Suite 210 aura r Bakersfield, CA 93301 White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02/05) i ' (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORM) i APPLICAl10N ~ Free t--;~ T BUSNESS ONVN~2/OP02ATOR DBYTFIC',ATION FORM ~-} (HAZARDOUS MATERIALS FACILITY INFORMATION) mix BAKERSFIELD FIRE DEPT. Preveation Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 ~~) Fax: (661) 852-2171 _ Page 1 of 2 ` L FACILITY-IDENTIFICATION FACILffY tD NO. i 1 Year Beginning 10o Year Ending tpt BUSINESS NAryIE (Same as FACI ITY NAME or Dl}A- Doing us_ine s As) fi ~ !mil 3 USINES H E~ _ -~ ioZ SITE DDRESS 4 ~ ~ ~ ` . CITY ~ ti~ I C` '~ CA IP 1 LJ~ ~J ~ os DUNN & BRADSTREET ~ ~ _ ;~ /~ (1 C A ~ ~" v`-t O~ J ~{ ` J Boa SIC CODE- ~1 ~ ~ (4Digit#) T X07 COUNTY ~ ~V L7't--~Y~ ,oe OPERATOR NAME ~~,, rr11 (~ tos OP RATOR PHO ~ ; - ,;:~ IL OWNER`INFORMATION OWNER NAME C . G ~~. - ~ . ~~Q~ ~~~ ~~''C O NER PHO ~C1- ~~ ~ ~'- ~ 112 . I \I? OW ER MAILING A RE`SSRR ~~ \ ,~ (~ .~~~'. ~V > Y~~ 1~-~ 113 CITY ~, ttq STATE 115 Ip c c~ 11a III. .., ENVIRONMENTAL CONTACT CONTACT NAME 117 NTACT HONE 118 CONTACT MAILING ADDRESS 119 CITY l 120 STATE tzt ~~ ZIP `~ ~ ~ v' i~ -.PRIMARY = IV. EMERGENCY CONTACTS '-SECONDARY.- NAME ~~, f 123 NAME / (,~ 8 TITLE 11 ,, ~~ ~~ nn W ' 124 TITLE ~ 129 W ~ BUSINESS P NE ~ ; ~` ~ ~` _ LJ~ ~ 125 gU INESS PH 1 ~ ._ ~ ~ 130 24-HOUR PHO E ~~ 2 G ~ 'J\ ~ ~ ~- ~J 1 126 24 UR PHONE C~ Q/ ~~P ~-c ~ ~~-~~ 1 0 131 PAGER N0. ~~-~ ~~~-17 ~ 127 PAGER N0. ~~~ X03- ~~`7~ 132 - 133 V.;CERTIFICATION 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 in this inventory and believe the information is true; accurate, and complete. SIGNATti SIG 13g DATE . 134 NAME OF DOCUMENT PREPARER ~~(~~ 135 NAME OW ~ PE DIGNATURE & PRINT) 137 TITLE OF NE OW R/OPERATOR 13g Q ,~ C1 ~~ 1 molt 1\ J FD 2142 (Rev. 09/05) ~~ 1~~~ dap l a~ ENT'D F E B 2 8 2006 (Hazardous Materials Facility Information - HMMP) Business Owner/Operator Identification Please submit the Business Activities page, the Hazardous Materials Faci/itylnformation (HMMP) Busaness Owner/Operator Identification Form, and Hazardo~ Materials Inventory Chemical Description Form for all hazardous materials inventory submissions. For;the inventory to be considered, please complete this page, it must be signed by the appropriate individual. • NOTE.• The numbering ofthe instructions fo/%ws the data a%mentnumbers thatare on the Business Owner Operator Form page. These data a%ment numbe. are used fore%ctronic submission and are the same as the numberrng used in 27 CCR, Appendix C, N~ie Business Section ofthe Unified Program Data Dictionary. P/ease numbers//pages ofyoursubmitta/. This he/ps our CUPA orAA identify whether the submittal is comp/ete and ifany pages are separated. i.. 1 FACILITY I.D. NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3 BUSINESS NAME -Enter the full legal name of the business. j 100 BEGINNING DATE -Enter the beginning year and date of the report. (YYYYMMDD) ~ _ 101 ENDING DATE -Enter the ending year and date of the report. (YYYYMMDD) 102 BUSINESS PHONE -Enter the phone number, area code first, and any extension 103 BUSINESS SITE ADDRESS -Enter the street address where the facility is located. No post-office box numbers are allowed. This information must provide a means to geographically locate the facility. _ - 104 CITY -Enter the city or unincorporated area in which business site is located. - - _ -- .- 105 ZIP CODE -Enter the zip code of business site. The extra 4 digit zip may also be added: ~ - - - - 106 DUNN & BRADSTREET -Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be obtained by calling (610) 882- 7748 or by intemet. 107 SIC CODE -Enter the primary Standard Industrial Classifigtion Code number for primary business activity. NOTE.• /fcode is more than 4 digits, report only the firstfour. - .- _ - . 108 COUNTY -Enter the county in which the business site is located. 109 BUSINESS OPERATOR NAME -Enter the name of the business operator. 110 BUSINESS OPERATOR PHONE -Enter business operator phone number, if different from Ibusiness phone, area cede first, and any extension. 111 OWNER NAME -Enter name of business owner, 'rf different from business operator. 112 OWNER PHONE -Enter the business owner's phone number if different from business phone, area code first, and any extension. 113 OWNER MAILING ADDRESS -Enter the owner's mailing address rf different from business.site address. 114 OWNER CITY -Enter the name of the sty for the owner's mailing address. 115 OWNER STATE -Enter the 2 character state abbreviation for the owner's mailing address. 116 OWNER ZIP CODE -Enter the zip code for the owner's address. The extra 4 digit zip may also be added. 117 ENVIRONMENTAL CONTACT NAME -Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118 CONTACT PHONE -Enter the phone number, 'rf different from the Owner or Operator, at which the environmental contact can be centacted, area code first, and any extension. 119 CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact cerrespondence should be sent, if different from the site address. - 120 CITY -Enter the name of the city for the environmental contact's mailing address. 121 STATE -Enter the 2 character state abbreviation for the environmental contact's mailing address. _ - - 122 ZIP CODE -Enter the zip code of the environmental centact's mailing address. The extra 4 digit zip may also be added. 123 PRIMARY EMERGENCY CONTACT NAME -Enter the name of a representative that can be contacted in case_ of an emergency involving hazardou materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regardinc incident mitigation. 124 TITLE -Enter the title of the primary emergency contact. - 125 BUSINESS PHONE -Enter the business number for the primary emergency centact, area code first, and any extensions. - 126 24HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the centact's home phone number, then the service answering the phone must be able to immediately contact the individu, stated above. 127 PAGER NUMBER -Enter the pager number for.the primary emergency centact, if available. - 128 SECONDARY EMERGENCY CONTACT NAME -Enter the name of a. secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. - f 129 TITLE -Enter the title of the secondary emergency centact. " 130 BUSINESS PHONE -Enter the business telephone number for the secondary emergency oontact, area code first, and any extension. 131 24HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24-hour phone number must lie one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately centact the individual stated above. 132 PAGER NUMBER -Enter the pager number for the secendary emergency contact, 'rf available. 133 ADDITIONAL LOCALLY COLLECTED INFORMATION -This space may be used for CUPA's or AA's to collect any additional information necessan to meet the requirements of their individual programs. Contact your local agency for guidance. 134 DATE -Enter the date that the document was signed. (YYYYMMDD) 135 NAME OF THE DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. 136 NAME OF DOCUMENT SIGNER (FULL PRINTED NAME) -Enter the full printed name of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer's inquiry of those individuals responsible for`obtaining the information, all the information submitted is true, accurate and complete. 137 SIGNATURE OF OWNERIOPERATOR/OR DESIGNATED REPRESENTATIVE -The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the signer's belief that the submitted information is true, accurate and cemplete. 138 TITLE OF OWNER/OPERATOR/OR DESIGNATED REPRESENTATIVE (SIGNER) -Enter the title of the person signing the page. Page 2 of 2 FD 2142 (Rev. 09/05) ' (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN ;a APPLICATION FOR.SECTION DISCOVERY AND ,t NOTIFICATION (FORMS) ! '' ,:;; t1 H S B 9 F I D P/Re ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1~of 2 INSTRUCTIONS - - -' • ' ~ •~ ~' •~ 1. To avoid further action,, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4_ 6e as brief and concise as oossible_ SEC710N I FACILITY IDENTIFICATION BUSINES e as FACILITY NAME or DBA -Doing Business As) S NAME (Sa m \ ~ { ~ U ~ ~ /~ ~ L.L~ ) ADDRESS (jF~or local use only) ~j FACILfrY ID N0. ~ SECTION 11.1: DISCOVERY AND-NOTIFICATIONS _ A. LEAK DETECTION AND MONRORING PROCEDURES: -~/~p~ C7 \ ~ 1 h Q W~.4.'1QS~-- ~Y~~C}`t~ ` - _' 1~ Q.. ~-C, ti ~ ~- ~ ~~; ~ ~ ~ se.,o~~~ d~e~ a~ d. e~~Y~- ~ B. EMPLOYEE AND AGENCY NOTIFICATION: ,~ ~~~ ~ ~ w .~ ~~ ems. ~~, ~ aat~ C. ENVIRO~NC~ TAL RESPO~E MAN; MEND` T~ /, Q_. „ ~-, ,~~ ~` ~~~~ r~ ~~y~) n vri- ~~~ ~R~~ 1 Cl ``~~~c``__~t ~-. CJL, YlQSL ~ (Yti ~rr ~~ ~no r' y \ ,~ ' z ` '- l C3~~ Vc~J . 1 v\ - - ~- d~ G 1~-G y~~ ~L Y ~ ~ ,, D. EMERGENCY MEDICAL PLAN: - R-~-~ - =~ SECTION 11:2.. RELEASE RESPONSE PLAN A. HAZARD ASSESME~N-T~eANsD P~REVENTIO•N~MEASURES: i /~ ~'~.` ~ ~"~ lJ`~~~~ ~ ~ ` ~ LV~~ 1 ~ ~~'L ~. cn B. RELEAS NTAINMENT A OR MITIGATION: ~, Uc w~ i gv~-o~-~~ ~~- -~Cl9tc: ~ r~tr.9 -L~ V~c~ r~ l--mss.. ~~- c~vL.- '~ Ot~ eQtY~c~~- ~ ~(Y`~cC~T~cs~S>` ~ji l.S_- tJCi Cam:-2?t9~ ~~~ ~,LY16t:J ~ Cu ~ ~- ~ ~ t~ ~~~'L' ~' C. CLEAN-UP AND RECOVERY PROCEDURES: ,,nn $~ ~ t ~~ ~ ~lA. ~~ YVl/J ~,c~c~~ ~CRXI ~ ~ J C G~~`eC~c (Y) ~ r u z-I ba (Rev. osros) Page 2 of 2 _- _ SECTION If 2: RELEASE-RESPONSE PLAN-CON'T ~ ~`~ i UTILITY SHUT-0FFS (LOCATION OF SHUT-0F F A T YOUR FACI S LITY) ~ ~ ( ,~ L NATURAL GAS/PROPANE: VL.. \ ~ Q ~'( ~1' S ~ • ` ELECTRICAL: ~ ~ ~~/'~ - WATER: ` v SPECIAL: PRNATE FIRE PROTECTIONNVATER AVAILABILITY: A. PRNATE FIRE PROiT,ECT~ION~: '1 ~ S ~' l V -~ ~ ~ ~ 6LI~-~XI~V k,^,~~ 1 ,- , _. ~. - _ B. WATER AVAILABILITY (FIRE HYDRANT): C~, .,~. .- -. U- .. _. ,- -. _ j; "; : ~ SECTION I11: T.RAINiNG ,, .; =V. _ _ = -- NUMBER OF EMPLOYEES: ~ _. MATERIAL SAFETY DATA SHEETS ON FILE: , BRIEF SUMMARY OF TRAININ\G PROGRAM: ~ ^ ~_ ( ~ ~q~-~, ~j .- ~1~~(~. ~~~~~3'~1~~ ~~~ ~~~ V7~ll~~L. ~ W wV v~- C~~~-P~~~s~ ~a~ti-~ -~ rn~1~a~ ~~. c~ ~`~ ea c~- s . ~ _ ~_ - .3_, CERTfFICA~TION ,._ Based on my inquiry of those individuals responsible for obtaining the information; ~l certify under penalty of law that 1 have personally examined and am familiar with the information submitted and believe the information is tn~e, accurate, and complete. SIGNATURE ,. OWNER / RAT. OR DE ED REPRESENTATIVE ~~~ DATE ~ _ 477 a t ~ ~ 1 ~~ .. NAMEc F (print) (~ 478 ~- ` ~ ~ CA ~ TITLE OF SIGNIE,~R,~ n 47g ~ . ~ L F-~R r ~1` `~ u FD 2169 (Rev. osios) (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN ~ UNIFIED PROGRAM CONSOLIDATED FORMS ~ ; CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIALS INVENTORY ~dEW ^ ADD ^ DELETE ^ REVISE 200 B B R S P I D F/RB wR~ >f BAKERSFIELD FIRE DLPT: Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 (One form per material, per building, or area.) Paae1 0 L` FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doi Business s 3 Ivu~ ={ 4~ CHEMICAL LOCATION ' ~) ~ ~ ~C` I', ~~ ~GL.' 201 ~ ~.~~~ CHEMICAL LOCATION 20 CONFIDENTIAL (EPCRA) C Yes t7 N FACILITY ID No. 1 MAP No. (optional) 203 GRID N0. (optional) 2 il. CHEMICAL INFORMAT ON CHEMICAL NAME ' " ~ 205 2 TRADE SECRET ^ Yes ^ No I r COMMON NAME .. 207 - EHS' ^ Yes ^ No l 1 20 CAS No. Y09 •If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete'rf requested by local fire chief) ~ 21 TYPE u p PURE ^ m MIXTURE w W STE 211 RADIOACTIVE: ^ Yes No 212 CURIES 21 LARGEST CONTAINER 21 PHYSICAL STATE ^ s SOLID I UID ^ g GAS 214 FED HAZARD CATEGORIES 1 FIRE ^ 2 REACTNE _ 3 PRESSURE RELEASE ^ 4.ACUTE HEALTH ^ 5 CHRONIC HEALTH 21 (Check all that apply) ANNUAL WAST AMOUNT ~•~ 217 MAXIMUM 21g DAILY AMOUNT ~. 1 AVERAGE 219 DAILYAMOUNT~ (~Q~ STATE WASTE CODE 22 ~ ~ ^ / "'''""~O t].. ~ ~ 222 u UNRS ga AL ^ d CU FT ^ Ib LBS ^ to TONS DAYS ON SITE If EHS, amou ust be in lbs. ' STORAGE CONTAINER (Check all that apply) ~ ABOVEGROUND TANK ~ f CAN ~ k BOX ^ p TANK WAGON 22 ^ b UNDERGROUND TANK ^ g CARBOY, ^ I CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ~ ~d STEEL DRUM ^ i FIBER DRUM T ^ n PLASTIC BOTTLE - a PLASTIC/NONMETALLIC DRUM =~ j BAG ^ o TOTE BIN STORAGE PRESSURE ^ a AMBIENT ^ as ABOVE AMBIENT ~ ~ ba BELOW AMBIENT 22 STORAGE TEMPERATURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 22 %WT HAZARDOUS;COM. PONENT :EHS CAS:# 1 226 227 , Yes C No 228 22 2 230 231 ^ Yes ^iNo 232 23 3 234 235 ^ Yes ~~ No 236 ~ 23 4 238 239 ^ Yes '7 No 240 241 5 242 ~ 243 ^ Yes 7 No 244 24 111. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNAT b~ ~ ~ - ATE ~ ~ 2 C R,e ~ ~ ~ r~.e..~. ~~ ~ ~ ~ FD 2144 (Rev. 09/05) CALIFORNIA WASTE CODES Code Description Inorganics III Acid solution 2 < pH < 7 with metals (antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, silver, thallium, vanadium and.zino}. _ 112 Acid solution without metals 113 Unspecified acid solution 121 Alkaline solution pH >12.5 with metals (see 111) 122 Alkaline solution without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12.5} contain- ing reactive anoins. (azide, bromafe, nitrite, perchlorate and sulfide anions) 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues 100% or more 134 Aqueous solution with total organic residues less than 10% 135 Unspecified aqueous solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 161 FCC Waste 162 Other spent catalyst 171 Metal sludge (see 111) 172 Metal dust and machining waste (see 111) 181 Other inorganic solid waste Organics 211 Halogenated solvents (methylene chloride, chloroform, TCE, TCA) 212 Oxygenated solvents (acetone, butanol, MEK) 213 Hydrocarbon solvents (stoddard solvent, xylene) 214 Unspecified solvent mixture 221 Waste oil and mixed oil 222 OiUwater separation sludge 223 Unspecified oil -containing waste 231 Pesticide rinse water 232 Pesticide and other waste associated with 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste 261 PCB's and material containing PCB's 271 Organic monomer waste (includes Code Description Organics (con't) 272 Polymeric resin waste 281 Adhesives 291 _ . ,Latex waste ~ . 311 Pharmaceutical waste ;.:; 321. .Sewage sludge _ ~ ,' _ ,• 322 _ Biological waste other than sewage sludge 331 Off-spec, aged or surplus organics 341 Organic liquids (non-solvents) with halogens 343 Unspecified organic liquid mixture 351 Organic solids with halogens Sludges 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 Sulfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 Tetraethyl lead sludge 491 Unspecified sludge waste Miscellaneous 511 Empty pesticide containers 30 gal or more 512 Other empty container 30 gal or more 513 Empty containers less than 30 gal 521 Drilling mud 531 Chemical toilet waste 541 Photo chemical/photo processing waste 551 Laboratory waste chemicals 561 Detergent and soap 571 ~ Fly ash, bottom ash, and retort ash 581 Gas scrubber waste 591 Bag house waste _ 611 Contaminated soil from site clean-ups 612 Household wastes Page 3 of 3 FD 2144a (Rev. 09/05) (HMMP) HAZAFYDOUS.MATERIALS MANAGEMENT PLAN 'P ~~%z#~ (~N~~D FRAM CONSOLIDATED ~ 8 R S F D ~. _ ~ . ~. ~ ~ ~ . ~ .~ W ~~ ~ a PIRG BUSINESS ACTIVITIES PAGE ~ ~' ArttrM r ~:.i (HAZARDOUS MATERIALS FACILITY INFORMATION) BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979- Fax: (661) 852-2171 Page 1 of 1 I. FACILITY IDENTIFICATION _.._ _ FACILITY ID #,(For Office use only -please leave blank) 3 ~ EPA ID # ~ ~- L oor~~~ ~,a-' IL ACT{VITIESbECLARATMON DOES Your Facility _;~, If Yes, Please Complete ... tz A. HAZARDOUS MATERIALS • CHEMICAL DESCRIPTION FORM 13 1. Have on site (for any purpose) hazardous ^ Y s No • HAZARDOUS ,MATERIALS MANAGEMENT PLAN materials at or above 55 gallons for liquids, Minimum required planning elements: 500 pounds for solids, or 200 cu. ft. for ' Emergency Response Plan compressed gases (include liquids in ASTs and ^ Ye o Maps USTS)? Training • Prevention B. REGULATED SUBSTANCES (RSl 1. Have on site RS at greater than the threshold ^ Yes • CHEMICAL DESCRIPTION FORM 131 planning quantities established by the California RISK MANAGEMENT PLAN (RMP Submit to USEPA) Accidental Release Prevention program • CONSOLIDATED COMPLIANCE PLAN (CaIARP)? Incorporating •CaIARP Program Elements C. UNDERGROUND ST RAGE TANKS (USTsI - ~ • ~ -• • 1. Own or operate Underground Storage Tanks? ^ Yes ^ o • UST FACILITY-FORM 13 • UST TANK FARM (One Per Tank) 2. Intend to upgrade existing or install new USTs? ^ YesiCj~,1Jo • UST FACILITY FORM 13 ``~Y • UST TANK FORM (One Per Tank) D. TANK CLOSURE /REMOVAL • UST INSTALLATION FORM One Per Tank 2. Need to report closing an UST that ~ hazardous D Yes o • 'UST TANK FORM (Closure section =one per tank) materials or 3. Need to report the closure /removal of a tank that ^ Yes UST TANK CLOSURE FORM was classed as hazardous waste and cleaned on- _ site? : . E. ABOVEGROUND PETROLEUM STORAGE TANKS (ASTsI ^ Yes o • HAZARDOUS MATERIALS MANAGEMENT PLAN 1. Own or operate ASTs above these thresholds; • Incorporating Federal Spill Prevention Control and any tank capacity is greater than 660 gallons or the , Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112. total capacity for the facility is greater than 1,320 __ F. HAZARDOUS WASTE •. EPA ID NUMBER -Provide on this page 1. Generate hazardous waste? ^ No To obtain EPA ID Number, please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable Yes O/A~ RECYCLING iFORM materials at the same location it was generated? ~.J ~ .. 3. Recycle more than 100 kg/mo of recyclable ^ Yes • RECYCLING FORM materials at an off-site location different from the point of generation? 4. Treat Hazardous Waste on site? ^ Yes o • TP FACILITY FORM • TP UNIT FORM (One per unit) 5. Subject to Financial Assurance requirements? ^ Yes. No • CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Ye o REMOTE WASTE /CONSOLIDATION SITE NOTIFICATION FORM remote site? NOTE: If you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested above, please Submit BUSINESS OWNER/OPERATOR IDENTIFICATION FORM FD 2143 (Rev. 09/05) Hazardous Materials Inventory -Chemical Description ' UNIFIED PROGRAM CONSOLIDATED FORMS ~~ You must complete a separate Hazardous Materials Inventory -Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you handle at your fatality in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10' CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your fatality, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure. (Note: the numbering of the instruGions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, tfte Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and 'rf any pages are separated. 1. FACILITY ID NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identfies your fatality. 3. BUSINESS NAME -Enter the full legal name of the business. 200. ADD/DELETE/ REVISE -Indicate if the material is being added to the inventory, deleted from the inventory, or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201. CHEMICAL LOCATION -Enter the building or outside/' adjacent area where the hazardous material is handled. A chemipl that is stored at the same pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disGosure pursuant to HSC §25506. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA -All businesses which are subject to the Emergency Planning and Community Right to Know Ad (EPCRA) must checc "Yes' to keep chemipl location information confidential. If the business does not wish to keep chemical location information confidential check "No°. 203. MAP NUMBER - lt a map is incuded, enter the number of the map on which the location of the hazardous material is shown. 204. GRID NUMBER - If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed. 205. CHEMICAL NAME -Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemipl is a mixture, do not complete this field; completE the "COMMON NAME" field instead. 206. TRADE SECRET - Checc "Yes" if the information in this section is declared a trade secret, or "No" if it is not State requirement If yes, and business is not subject to EPCRA, disGosure of the designated trade secret information is bound by HSC §25511. Federal requirement: If yes, and business is subject to EPCRA, disGosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrete' form (40 CFR 350.27) to USEPA. 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208. EHS - Checc "Yes" if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209. CAS # -Enter the Chemipl Abstract Service (CAS) nermber_for the hazardous material. For mixtures, enter the CAS number of the mixture 'rf lt has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210. FIRE CODE HAZARD CLASSES -Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This informatior shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard Gasses and instructions on how to determine which Gass a material falls under are included in the appendices of ArtiGe 80 of the Uniform Fire Code. If a material has more than one applicable hazard Gass, indude all. Contact CUPA or AA for guidance. 211. HAZARDOUS MATERIAL TYPE - Checc the one box that best describes the type of hazardous material: pure, mixture or waste. lt waste material, check only that box. lt m"ucture or waste, complete hazardous components section. - 212. RADIOACTNE - Checc "Yes" if the hazardous material is radioactive or "No° if it is not. 213. CURIES - lt the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating detamal point to report activity in curies. 214. PHYSICAL STATE - Checc the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total capacity of the largest container in which the material is stored. 216. FEDERAL HAZARD CATF(,ORIFS _ (:hark all ratannries that tiaccriha The nhveirol ~nrl hanMh hwerrie ~cenrie4e`i with the hoewin, m~reriel PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Li uids and Solids, Combustible Li uid o horics Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Iritants, Sensitizers, Corrosives, Reactive: Unstable Reactive Or anic Peroxides Water Reactive Radioactive other hazardous chemigls with an adverse effect with short term ex sure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Cartanogens, other hazardous chemicals with an adverse effect with Ion term ex sure 217. AVERAGE DAILY AMOUNT -Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacenU outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemigl will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218. MAXIMUM DAILY AMOUNT -Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacenUoutside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT - lt the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the baGc of the Uniform Hazardous Waste Manifest. 221. UNffS - Checc the unit of measure that is most approprate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federelh defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the un"rts that the material is stored in (gallons, pounds, cubic feet, or tons). 222. DAYS ON SITE -List the total number of days during floe year that the material is on site. 223. STORAGE CONTAINER - Checc all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: lt appropriate, you may choose more than one. 224. STORAGE PRESSURE -Check the-one box that besf describes the pressure at which the hazardous material is stored. 225. STORAGE TEMPERATURE -Check the one box that best describes the temperature at which the hazardous material is stored. 226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) -Enter the percentage weight of the hazardous component in a. mixture. If a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.) 227. HAZARDOUS COMPONENTS 1-5 NAME -When reporting a hazardous material that is a mixture, list up t0 five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non- - prcinogenic, or 0.1% by weight if prcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemigl composfion should be listed. (Report for components 2 through 5 in 231, 235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - CheG< "Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR,Part 355, or "No" if lt is not (Report for components 2 through 5 ih 232, 236, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS -List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2=5.) 246. LOCALLY COLLECTED INFORMATION -This space- may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs. ContaG the CUPA or AA for guidance. Page 2 of 2 ~ FD 2144 (Rev. 09/05) HMMP) HAZARbOUS MATERIALS MANAGEMENT PLAN SITE ~ FACILITY DIAGRAM ~~ Page 2 of 2 ~. BAKERSFIELD FIRE DEPT. -. Prevention Services a BF/RE n 900 Truxtun`Ave., Suite 210 A~ r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 -~ SITE;DIAGRAM FACILITY DIAGRAM ,_ . Business Name: ~~~~ ~ -~ f~~~ . Business Address: ~~~~ ~~ ~~ __._ ~~~~~~ a V 1~ 5h.s-~~- ~-~-. ~/ ~~~~ ~ ~~~~ i C,~ V v~ NORTH Please indicate direction of North FD 2170 (Rev. Os/o5) (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN - INSTRUCTIONS ~Rrr r SITE & FACILITY DIAGRAM K~ BAKERSFIELD FIRE DEPT.. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 2 These instructions explain the use of the site -diagram and the facility diagram. Normally; small and medium size businesses will only have to submit a site diagram. If you have subdivided your business. into smaller areas because of the complexity or size,. then you will be completing and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a_ remote location. All diagrams must be on 8 '/2 x 11"paper and drawn using a straight edge tool. ' SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet: If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: J _ ; 1. Check the box on the top left corner of the form provided that indicated "Site Diagram". 2. Print the name of your business, as shown in your I-IlVIlVIP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (i.e., flammable liquid, corrosive solid). 4. Label the location of utility-shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic.~sprinkler systems. 7. Label-the direction representing north on the diagram. (The diagram form provided includes a north arrow). 8. All labeling and identification on the diagram must be legible and easily understandable at the scale submitted. Diagrams must be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. FACILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details•of a large business. 1. Check the box in the upper right hand corner of the form provided that indicated "Facility Diagram". - 2. Print the name of your business as shown on your 1-IlVIIvIP. Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled # 1 of 4. 4. Follow instructions (3 -8)* for site diagrams regarding the specific details to be included on each facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: * If you operate an Underground Storage Tank (UST) facility, the facility diagram shall also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring will be performed. FD 2170 (Rev. 09/05)