HomeMy WebLinkAboutBUSINESS PLAN 1/16/2009UNIFIED PROGRAM INSPECTION CHECKLISTj'
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SECTION 1: Business Plan and Inventory Program ~
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9 A A P. R S P 1 H. D
F/RE
6~ARTM ~ ~
Prevention Services ~`
900 Truxtun'Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
FACILITY NAME
C~~• ~~~~ INSPECTION DATE
/~~~""°Y INSPECTION TIME
13 yZ.
ADDRESS I ~
~ ~l / --~Yf'~- c ,L d~v PHONE NO.
~37 ~ 7 2~ ~ NO OF EMPLOYEES
~~~
FACILITY CONTACT
•~j C' r}~ c r ~-.- R G_-G c/ C~ S USINESS ID NUMBER
15-021- C: U)`I ~j U
Section 1: Business Plan and Inventory Program ~
^ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ( c=comP~iance~ OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
^ BUSIf12SS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ 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 8 ON HAND '
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN
^ YES ^ NO
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
~"~ ; k'~- c~1 v Y~ -~ Sv+-~ ~~~
Inspector .(Please Print) Fire Prevention / 1" In / Shift of Site/Station # Business Site / Responsible Party (Please Print)
White - Prevention Services Yellow - Station Copy Pink - Business Copy FD 2155 (Rev. 09/OS
+ CADZFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
Manager : TIM TRELOAR BusPhone: (661) 837-7200
Location: 601 TERRACE WY Map : 124 CommHaz : High
City : BAKERSFIELD Grid: 06B FacUnits: 1 AOV:
CommCode: BFD STA 06 SIC Code:4941
EPA Numb: DunnBrad:00-691-3578
+______________________________________________________________________________+
+_______________________________________+______________________________________+
Emergency Contact / Title Emergency Contact / Title
TIM TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGR
Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x
24-Hour Phone :(661) 837-7200x 24-Hour Phone : (661) 837-7271x
Pager Phone : ( ) - x Pager Phone : ( ) - x
+---------------------------------------+------------------ --------------------+
~ Hazmat Hazards: RSs Fire Press ImmHlth ~
+---------------------------------------------------------- --------------------+
Contact : BILL ROSICA Phone: (661) 837-7278x
MailAddr: 3725 S H ST State: CA
City : BAKERSFIELD Zip : 93304
+---------------------------------------------------------- --------------------+
Owner CALIFORNIA WATER SERVICE CO Phone: (661) 837-7200x
Address : 3725 S H ST State: CA
City : BAKERSFIELD Zip : 93304
+---------------------------------------------------------- --------------------+
Period . to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: Yes
ParcelNo:
+------------------------------------------------------------------------------+
~ Emergency Directives: ~
PROG A - HAZMAT
PROG T- ABOVEGROUND STORAGE TANK
+______________________________________________________________________________+
-1- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+= Hazmat Inventory _________________________________________ By Facility Unit +
+_= MCP+DailyMax Order ______________________________ Fixed Containers at Site +
+--------------------------------+-------+-----------+-----+----------+----+---+
~ Hazmat Common Name... ~SpecHaz~EPA Hazards~ Frm ~ DailyMax ~Unit~MCP~
+--------------------------------+-------+-----------+-----+----------+----+---+
I SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi I
+______________________________________________________________________________+
-2- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+= Inventory Item 0001 _______________ Facility Unit: Fixed Containers at Site +
+_= COMMON NAME / CHEMICAL NAME ______________________________+________________+
SODIUM HYPOCHLORITE Days On Site
365 I
Location within this Facility Unit Map: Grid: +----------------+
FENCED ENCL NEXT TO PUMP I CAS# I
7681-52-9
+_____________________________________________________________+________________+
+= STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+
~ Liquid I Mixture ~ Ambient ( Ambient ~ ABOVE GROUND TANK ~
+_________+__________+_______________+_______________+_________________________+
+__________________________+ AMOUNTS AT THIS LOCATION =________________________+
I Largest Container I Daily Maximum I Daily Average I
200.00 GAL 200.00 GAL 200.00 GAL
+__________________________+_________________________+_________________________+
+_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+
I 12t50ISodium Hypochlorite INosl CAS#7681529I
+_______+__________________________________________________
------------ ------------ +___+_______________+
+_______+___+______+__________= HAZARD ASSESSMENTS =__+_________+________+_____+
ITSNc~retlYeslBNoHaz) RN~d~oactive/Curles I FPP HalHrds I jFjA/ I USDOT# I HiP I
+_______+___+______+____________________+_____________+_________+________+_____+
+__________________________ MISC. LOCAL AGENCY DATA =__________________________+
~ Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: ~
Ag.Defined5: Ag.Defined6: Ag.Defined7:
Ag.Defined8: Ag.Defined9: Ag.Definel0:
+- Ag.Definell ----------------------------------------------------------------+
+______________________________________________________________________________+
-3- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+_________________________________________________________________ Fast Format +
+= Notif./Evacuation/Medical ____________________________________ Overall Site +
+_= Agency Notification ___________________________________________ 08/08/2006 +
CALL 911 AND 800-852-7550 OR 916-427-4341.
+______________________________________________________________________________+
+__= Employee Notif./Evacuation _______________________________________________+
+______________________________________________________________________________+
+___= Public Notif./Evacuation ____________________________________ 08/08/2006 +
WE WOULD PREFER TO RELY ON EMERGENCY SERVICE PERSONNEL TO DETERMINE IF AN
EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL
POPULATION, AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE.
+______________________________________________________________________________+
+____= Emergency Medical Plan _____________________________________ 08/08/2006 +
MERCY HOSPITAL, TRUXTUN AVE.
+______________________________________________________________________________+
-4- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+_________________________________________________________________ Fast Format +
+= Mitigation/Prevent/Abatemt ___________________________________ Overall Site +
+_= Release Prevention ____________________________________________ 08/08/2006 +
SODIUM HYPOCHLORITE IS STORED IN AN ABOVEGROUND SECURE AREA.
+______________________________________________________________________________+
+__= Release Containment __________________________________________ 04/06/1999 +
THE SODIUM HYPOCHLORITE HAS SECONDARY CONTAINMENT.
+______________________________________________________________________________+
+___= Clean Up ________________________________________________________________+
+______________________________________________________________________________+
+____= Other Resource Activation ______________________________________________+
_--- -------------------------------------------------------
+------------------------------------------------------------------------------+
-5- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+_________________________________________________________________ Fast Format +
+= Site Emergency Factors _______________________________________ Overall Site +
+_= Special Hazards ___________________________________________________________+
+______________________________________________________________________________+
+__= Utility Shut-Offs ____________________________________________ 07/20/2007 +
ELECTRICAL - SERVICE BOX INSIDE SITE
+______________________________________________________________________________+
+___= Fire Protec./Avail. Water ___________________________________ 08/08/2006 +
FIRE HYDRANT - WELL DISCHARGE
+______________________________________________________________________________+
+____= Building Occupancy Level ___________________________________ 02/27/2006 +
UNMANNED SITE.
+______________________________________________________________________________+
-6- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+_________________________________________________________________ Fast Format +
+= Training _____________________________________________________ Overall Site +
+_= Employee Training ____________________________________________= 02/26/2007 +
MSDS SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE CO PROVIDES THE
FOLLOWING TRAINING: SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS
RELEASE OR THREATENED RELEASE; HAZARD COMMUNICATION STANDARD; EVACUATION
PROCEDURES; PROPER HANDLING OF HAZARDOUS MATERIALS; AND HMMP IMPLEMENTATION.
t______________________________________________________________________________+
+--- Page 2 ___________________________________________________________________+
+______________________________________________________________________________+
+___= Held for Future Use _____________________________________________________+
+______________________________________________________________________________+
+____= Held for Future Use ____________________________________________________+
+______________________________________________________________________________+
-7- 08/25/2008
+ CALIFORNIA WATER SRV 066-02 _________________________ SiteID: 015-021-001940 +
+_________________________________________________________________ Fast Format +
+= Response/Risk Management _____________________________________ Overall Site +
+_= Operations _________________________________________ +
+______________________________________________________________________________+
+__= Planning _________________________________________________________________+
+______________________________________________________________________________+
+___= Logistics ______________________________________________ +
+______________________________________________________________________________+
+____= Finance/Administration _________________________________________________+
+______________________________________________________________________________+
-8- 08/25/2008