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Home My WebLink AboutBUSINESS PLAN 7/31/2007~ BIG LOTS #4063 ~ 3580 WILSON ROAD i ~~ ,; . __. ~~ UNIFIED PROGRAM INSPECTION CHECKLIST __ .. rte;-... ___: _ .._. _. -=.. -. :. .:- ~:,-~ .. ;._:. - SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT 8 A >, p , D Prevention Services ,wf~~ 900 Truxtun Ave., Suite 210 attfM r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS IjON ~ .` ~ ` O OF~OYEES FACILITY CONTACT ~~~ ~ USINESS ID NUMBER 15-021- Qp~~,,,, v Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMMENTS ___ __ ____ ^ APPROPRIATE PERMIT ON HAND ~ - ~. ^ BUSlrft?SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS i ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION t (~ U ^ PROPER SEGREGATION OF MATERIAL ~ ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ~ ANY HAZARDOUS WASTE ON SITE? ^ YES ~NO EXPLAIN: - QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) ~ Fire Prevention / 1°' In /Shift of Site/Station # Business Site/School Site Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev.02/OS) rr~~ ~- i W~ BIG LOTS 4063 ~> SiteID: 015-021-003027 Manager :.,,.~/~~K1~- Z~,~~~aS~ BusPhone: (661) 834-2109 Location: 3580 WILSON RD Map 123 CommHaz High City BAKERSFIELD Grid: 11D FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code: EPA Numb: ~ DunnBrad: Emergency Contact /S•~h'1.Title Emergency Contact. / Title L ~ I ~. ~A>~5~ /STORE- /Yt 6 i~ / Business Phone~l(S'3~) g3U - of /Oqx Business Phone : ( ) - x 2 4 -Hour Phone ((~ 1 ) ,~9$ -~' SaI x 2 4 -Hour Phone ( ) - x Pager Phone (bbl ) ~'0~' - ySIL x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth Contact :CprQ oaA1-,~- Dffl« l-bSS AR~u~-"''i~``~ Phone• ~ / (661) 834-2109x MailAddr: 3 0 PHILLIPI State:_ OH City COLUMBUS Zip 43228 Owner BIG LOTS STORES Phone: (800) 877-7253x Address 300 PHILLIPI RD State: OH City COLUMBUS Zip 43228 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT (~~~ V" Based on my inquiry of those individuals resprnsil~!e for ohtaining the information, I certify u, der penalty of law that I have personalty er, mined and am familiar with the information su~ rt:itted an U the information is true , ac rat , _~ comps te. F ~7 Si a .atu~ ~ Date ~N~'p ,~ U N 19 X007 -1- 05/21/2007 F BIG LOTS 4063 SiteID: 015-021-003027 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP BLEACH, HOUSEHOLD L 150.00 GAL Hi PAINTS F IH L 150.00 GAL Mod -2- 05/21/2007 -3- 05/21/2007 F BIG LOTS 4063 SiteID: 015-021-003027 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ ry/17~R11R/1TT TTT TRT ~ ITTTTTRT /"YT T T~TT TRTI AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.OO.GAL 150.00 GAL I 150.00 GAL rtt~t~ruvJV V.7 t.V1Tlr VlV LilV1J °sWt• RS CAS# 6.00 Sodium Hypochlorite No 7681529 -riti/~riR1J tia Dr,.7 Jl•1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi -4- 05/21/2007 5'1'A'1'E 'T'YPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixtur~ Ambient ~ Ambient -~LASTIC CONTAINER F BIG LOTS 4063 SiteID: 015-021-003027 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PAINTS Days On Site 365 Location within this Facility Unit Map: Grid: REAR OF STORE CAS# 64742-47-8 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 150.00 GAL 150.00 GAL S I11iGriRLVIJJ l.Vl•lr V1V Li1V1 oWt. RS CAS# 5.00 Mineral Spirits No 8030306 5.00 Ethylbenzene No 100414 10.00 Toluene No 108883 40.00 Xylene, Mixed No 1330207 5.00 Methyl Ethyl Ketone No 78933 15.00 n-Butyl Acetate No 123864 I11"~L~tiiCL HJ J~w7 i71~1P.~1V 1w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mod -5- 05/21/2007 ~ F BIG LOTS 4063 SiteID: 015-021-003027 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification L~Ill~J1VyCC 1VV 1.11 ~ P~VCi l: UC1L1V11 Public Notif./Evacuation Emergency Medical Plan -6- 05/21/2007 F BIG LOTS 4063 SiteID: 015-021-003027 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention Release Containment dean up _ ~~~L~ ~'~/ ~ C Other Resource Activation -7- 05/21/2007 F BIG LOTS 4063 SiteID: 015-021-003027 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ OtJC l,:1Q1 naz~ai u5 U1..1111.Y O11UL-Vlla ~ ~ 5~~~. / Go~cNea G~~,L~~oU~ Fire Protec./Avail. Water. Sys ~~ .Building Occupancy Level ~ ~~ ~ -8- 05/21/2007 F BIG LOTS 4063 SiteID: 015-021-003027 ~ Fast Format ~ ~ Training _ Overall Site ~ P~lll1J1 V_ yCC 1.1 CL111111y i,/ice ~ ' i i2r~ i ^-' rr,~~ ~ ~ri- ~ ~~ ~--a~-' c y /Yl.~-~O S rays ~ nciu 1_vi rul..uic v5c n~.LU tt~l_ r ul,u.[.c lJSC -9- 05/21/2007 ~~ ~ ~ ~ Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECIICLIST Environmental Services :~~ ~~~ ~~''~"" 900 Truxtun Ave., Suite 210 SECTION 1 Business .Plan and Inventory Program Bakersfield, CA 93301 Tel: (661) 326-39~~ FACILITY NAME ~- '~ "" `~ """ ~ "'" ------------------------- -- ADDRESS PHONE No. No. of mployees FACILITYCONTACT Business 1 umber 15-021- /~L~f i Section 1: Business Plan and Inventory Program ~j8~-'~ ~outine O Combined ~ Joint Agency ~ Multi-Agency O Complaint O Re- pection ~~ ANY HAZARDOUS WASTE ON SITE EXPLAIN: O Yes ,,~lo QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~GC)'I ~ 328-3979 Inspector (Please Print) Fire Prevention t st-In/Shik of Site White - EnvironmenUl Services Yelknv -Station Capy Pink -Business Copy Print) B