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Home My WebLink About8430 ROSEDALE HWY (3)~ ~H".AZARDOUS MATERIAL MANAGENiENT PLAN ~~ L"~~w"~~."'.L'~ YT`~. ~~+.'~.i.`~i µ"h':~ *sv~_._~ ~,~f~e5.' e~i~~~t..f~' `a.Es~.St~ xa::~~~.~'~~~~r• ~ ~~ BUSYNESS ACTIVITIES PAGE ~`~ (HAZARDOUS MATERIAL FACILTTY INFORMATION) _:;;; ~ "`~r „~ .. ~ e w~~ n s~ r~i n ~ FIRI 0~6'~,,,BA RTl~~X T BAKfRSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue Bakersfieid; CA 93301 Phone:661-326-3979 Fax:661-852-2171 , , ,_ , ;.. , ,, ; ~ ,,. ~~ I; FACILI'TYgIDENTIFICATION' - ., ~ ~- ~ ~ ~. . . -... ~ ... :.:. . . , ' . - . . ..n>~. -< _~.,..:..->... , ~~~.~...~ i .. , <~r , ~:,~;r.~~ . ' ... .. . .. . .. . . . .: .. :. ~ .. . . ~, ... ~: ..... .: ... ~ ... . .... FACILITY ID # (for o~ce use only) ' - . 3 EPA ID if 1S-~J 60_ 8~I ~ ~. aooao ~t~ BUSINESS NAME (FACILIIY NAME or DBA) . ~ ~p3 z~~~~s ~II.' ACTI~/ITIES`DECLARATION. • - ~ - DOES Your Facility... If Yes, Please Complete... 1z9 A. HAZARDOUS MATERIAI ~Yes ^ No . CHEMICAL DESCRIPTION FORM i3o 1. Have on site (for any purpose) hazardous mate~ial • HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 gallons for liquids, 500 pounds for Minimum reauired olannina elements: solids, or 200 cu. ft, for compressed gases (include • Eme~gency Response Plan liquids in AST and UST)? . Maps • Training • Prevention • Certification B. REGULATED SUBSTANCES (RSl ^ ves ~ No • CHEMICAL DESCRIPTION FORM 131 1. Have on site RS at greater than the threshold • RISK MANAGEMENT PLAN (RMP Submit to USEPA) planning quantities established by the California • CONSOLIDATED COMPLIANCE PLAN Accidental Release Prevention program (CaIARP)? • Incorporating CaIARP Program Elements C. UNDERGROUND STORAGE TANKS (USTI ^ Yes g No • U5T FACILITY FORM 13z 1. Own or operete Underground Storege Tanks? • UST TANK FORM (one per tank) 2. Intend to upgrade existing or install new UST? Yes ~ No • UST FACILITY FORM 133 • UST TANK FORM (one per tank) • UST INSTALLATION FORM (one per tank) D. TANK CLOSURE/REMOVAL ^ Yes pVNo • UST TANK FORM (Closure section - one per tank) 1. Need to report closing an UST that held hazardous material or waste? 2. Need to report the closure/removal of a tank that ^ Yes 4~ No . UST TANK CLOSURE FORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS ^ Yes ~ No . HAZARDOUS MATERIAL MANAGEMENT PLAN (ASTI • Incorporating Federal Spill Prevention Control and Countermeasure 1. Own or operate AST above these thresholds; any (SPCC) Elements pursuant to 40 CFR Part 112. tank capacity is greater than 660 gallons or the total capacity for the facility is greater than 1,320 gallons? F. HAZARDOUS WASTE EPA ID NUMBER - provide on this page 1. Generate hazardous waste? ~ves ^ No . To obtain EPA ID Number, please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable ^ Yes ~ No . RECYCLING FORM material at the same location it was generated? 3. Recycle more than 100 kg/mo of recyclable ^ ves ~ No . RECYCLING PORM material at an off-site location different from the point of generetion? 4. Treat Hazardous Waste on site? ^ res ~ rvo . TP FACILITY FORM • TP UNIT FORM (one per unit) 5. Subject to Financial Assurence requirements? ^ Yes ~ rvo . CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ ves ~ No . REMOTE WASTE/CONSOLIDATION SITE NOTIFICATION remote site? FORM NOTE: If you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested above, please submit BUSINE55 OWNER/OPERATOR IDENTIFICATION FORM. FD2143 (Rev OS/OB) 1 HA2ARDOUS MATERIAL MANAGEMENT PLAN ; ~'~ ~fi'4 37 z(^'(~'°M '~` ~, .i+~~ a~~ F ~ ~. 3 ry`i~5tt r C' n ,y ~ .~ ~" 1 ,~ ~~:"±'.nl,i, :~:caS~~'~i'Sa1Y.t~n~..~.a.~..1.a..r~'~~:~~.,.;isveR~~..~ ~`ia~.~„'~,i.....:.t`ua....a...".~.i„.,...,.~.. ..,,..~s.s,. ~' ~' ,...... ~~ 0 A K, 33 R, 5 P I~~_,D APPLYCATION h ~~R~ BUSINESS OWNER/OPERATOR IDENTIFICATION FORM , p, ~~T~ .~ (HAZARDOUS MATERIAL FACILITY INFORMATION) ~ BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, lst Floor Bakersfield, GA 93301 Rhorie: 661-326-3979 • Fax: 661-852-2171 Page 1 of 2 ' ~ ~ , ~ ~ ~ ~ ~ ~ I. ~;FAGIL~ITY IDENTIFICATION ~ ~ ~ ~ ~ ~ ~ ~ , K ~,:. , ,, ; ~ . ~ , ~,.; ~ • . ~.,~ ,. _.w . . ... , , ~..,,. .s.e_ . . .. , . ~ ~ ~ e . ~ ~ i a ~ . . .. - . ~ ~ x .:: .., i,.:.'.,, .::,~~ .. . i , ; . ...-. ,.. . ... ..........~ . ..:.. .. •• `3 .,•.,,.. ± , FACILIiY ID # "~?~ 1 VEAR BEGINNING 100~ YEAR ENDING ~ ~ 301 BUSINESS NAME Same es FACILITY NAME or DBA) 3 BUSINESS PHONE 102 ~~o #- S 33 (~ ~ C~ ~ - ~{ - 7 S SITE ADDRE55 (`~ ( ~ . ~ , 103 U I C' ~. ~ ~ \ ~ ' ` \ C ..^ CITY gf~K,ERS~IELD . 104 ZIPCODE 105 c~ q 3 ~ DUNN & BRADSTREEf # 106 SIC CODE io~ , _ 7 f"' CJ' -, couN~r 308 ~ ~ ~I OPERATOR NAME ~\ ,( '\ ~ / ~ ~\ 109 OPERATOR PHONE - 110 ~lJ ~ V ~ lJ ~ \~. ~\ . - Yd . l. ~l , . , . . . .. , . . . . z, .. .. . . ti . ~ ~ ~ ~ , ~ ~ ~ ~ ~I3~. >OWNER ~INFOR~NIA-TI.ON : ~ ~ ~ ~ ~ ~~ , ,, , ~ , ,: „, ~ .. x,. *~ ; ... ' , ~ _. OWNER NAME ~ yZ 111 OWNER PHONE ' 112 v o oC~~.. - (oJ ~ C U l~`~ OWNER MAILING ADDRESS ~ ~'CGh ~ ~'~ se ~ ~ 113 ~ITM 114 STATE 115 ZIP CODE 116 ~ ~~ III. , ENVIRO;NMENTAL CONTACT ,: . .. CONTACT NAME Q r e u..~ l~ e~ 117 COMACT PHONE lp ~_~~ ~l S-(, ~'( L( 118 CONTACT MAIIlNG ADDRESS ~ ' ~z ' ~S G cs~ ~O ~1 ~`~G 119 CITV ~1e~ h~ s 120 STATE 121 ~~ ~c 2IP CODE ~ St~3 122 ~IV. EMERGEIVCY CONTACTS ' • ` PRIMARY rSECONDARY ~ NAME j~ ` ~LJ ~ 1(7~ ~. 123 NAME /-~ ~ C.IC~ l~~ l C`CL 128 TITLE ~ ~ ~ ' 'T'~ 124 TITLE r', 4t1he~ ~O(C1i`~-C1~ lZ9 BUSINE55 PMONE ~ Co(o ~~l s-7s-7~ 125 BUSINE55 PHONE ~s~O~~3~~-4~~~ 130 24-HOUR PHONE '~0~3~3 -`~~~3 126 24-HOUR PHONE c~U-3\3- ' ~~ 131 CELL PHONE ~ 127 CELL PHONE 132 N 133 ~ . ~ ~ ~ ~ ~ ~ V. =-~CERTI~FICATION,: • ~ ~~ ~ ~ ~ Certlfication: sed on my Inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally ezamined am amiliar with the information submitted in this inventory and believe the information is true, accurate, and complete. SIGNATII : OF D 1MENT Pft ARER ~ 136 DATE 134 ME C1F DONPicN'f PFiEPAREk (PNIN"I~) 135 ll 1~ o ~c ~ c c~i ~7• OF!)tYtlP~;i:P@~ 1'qRrili6N:.PcJN'.i C ~ 137 ~iIl"L Or'~D~UMENTn!7EPARER ' l ~ , 138 l ~ ~Cl J f C. / L~ ~ FD2142(Rev O1/08) Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Authority Cited: HSC~ 25504(b); 19 CCR ~2731; 22 CCR ~66262.34(a)(4) Page of All facilities that handle hazardous materials in ~IIVIBP quantities must have a writteri emergency response plan. In addition, facilities that generate 1,000 kilogramS or more of hazardous waste (or more than i kilob am of acutely hazardous waste or 100 kilo~ams of debris resulting from the spill of an acutely hazardous waste) per month, or accumulate' more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a hazardous waste contingency plan. Because the requirements are similar, they' have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contirigency Pla~ is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazaidous materials that could threaten human health and/oi the environment. At least one copy of tfie plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency: A copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom s}iecial (i.e., contractual) emergency services arrangements have been made (see section 3, below). 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ^ Belis; ^ Horns/Sirens; ~ Verbal (i.e., shoutin~; ^ Other (spec~ b. ~ Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it wil! be visible to employees and visitors. 2. a. Emergency Contacts*: Fire/Police/Ambulance Phone No.: 911 -------------------------------------------------------- State Office of Emergency Services ~ Phone No.: (800) 852-7550 ------------------------------------------- b. Post-Incident Contacts*: Certified Unified Program Agency (CUPA) ____________ Phone No.: ( ) Fire Department Haza rdous Materials Program _ _ _ _ _ _ _ _ _ _ _ _ Phone No.: ( ) California EPA Department of Toxic Substances Control _ ._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone No.: (510) 540-3739 ' Cal-OSHA Division of Occupational Safety and Health ______ Phone No.: (408) 452-7288 Air Quality Management District Phone No.: (415) 771-6000 Regionai Water Quality Control Board Phone No.: (510) 622-2300 * Phone numbers for agencies in Unidocs' Member Agency geographic jurisdictions are available at www.unidocs.org. c. Emergency Resources: Poison Control Center* _ _ _ _ _ _ _ _ _ _ Phone No.: (800) 876-4766 Nearest Hosp~ta~: Name: Bakersfield Memorial Hospital Phone No.: (661) 327-1792 Address: 420 34th Street' ~~tY~ Bakersfield If you have made special (i.e., contractual) anangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements below: NONE UN-020UPCF - 9/li www.unidocs.org Rev. 07/24/06 Emergency Response/Contingency Plan (Hazardous Materials.Business Plan Module) Page of 4. Emergency Procedures: Emer encv CoordinatorResoonsibilities: a. Whenever there is an imminent or actual emergency situation such as a explosion, fire, or release, the emergency coordinator (or his/her designee when the emergency coordinator is on call) shall: i. Identify the character, exact source, amount, and areal extent of any released hazardous materials. ii. Assess possible hazards to human health or the environment that may result from the explosion, fire, ar release. This assessment must consider both direct and indirect effects (e.g., the effects of any toxic, irritating, or asphyxiating gases that . are generated, the effecfs of any hazardous surfa¢e water run-offfrom water or chemical agents used to control fire, etc.). ni. Activate intemal facility alarms orcommunicafions systems, wlieie applicable, to notify all facility personnel. iv. Notify appropriate local authorities (i. e., cd11911). v. Notify ihe State Office of Emergency Services at 1-800-852-7550. vi. Monitor for leaks, pressure build-up, gas generation, or ruptures in valves, pipes, or other equipment shut down in response to the incident. vii. Take all reasonable measures necessary to ensure that fires, explosions,~and releases do not occur, recur, or spread to other hazardous materials at the facility. b. Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall: i. Provide for proper storage and disposal of recovered waste, contaminated soil or surface water, or any other material that results from a explosion, fire, or release at the facility. , ii. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas of the facility affected by the incident until cleanup procedures are completed. iii. Ensure that all emergency equipment is cieaned, fit for its intended use, and available for use. iv. Notify the California Environmental Protection Agency's Department of Toxic Substances Control, the local CUPA, and the local fire department's hazardous materials program that the facility is in compliance with requirements b-i and b-ii, above. Responsibilities of Other Personnel: On a separate page, list any emergency response functions not covered in the "Emergency Coordinator Responsibilities" section, above. Next to each function, list the job title or name of each person responsible for performing the function. Number the page(s) appropriately. 5. Post-lncident Reporting/Recording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility's operating record. Within 15 days of any hazardous materials emergency incident or threatened hazardous materials emergency incident that triggers implementation of this plan, a written Emergency Incident Report; including, but not limited to a description of the incident and the facility's response to the incident, must be submitted to the California Environmental Protection Agency's Department of Toxic Substances Control, the local CUPA, and the local fire department's hazardous materials program. The report shall include: a. Name, address, and telephone number of the facility's owner/operator; b. Name, address, and telephone number of the facility; c. Date, time, and type of incident (e.g., fire, explosion, etc.); d. Name and quantity of material(s) involved; e. The extent of injuries, if any; f. An assessment of actual or potential hazards to human health or the environment, where this is applicable; g. Estimated quantity and disposition of recovered material that resulted from the incident; h. Cause(es) of the incident; i. Actions taken in response to the incident; j. Administrative or engineering controls designed to prevent such incidents in the future. 6. Earthquake Vulnerability: ~19 CC[t §2731(e)~ As an attachment to this plan, you must identify any areas of the facility and mechanical or other systems that require immediate inspection or isolation because of their vulnerability to earthquake-related ground motion. 7. Hazard Mitigation/Prevention/Abatement ~19 CCR §2731(e)~ As an attachment to this plan, you must include procedures that provide for mitigation, prevention, or abatement of hazards to persons, property, or the environment. These procedures must be scaled appropriately for the size and nature of the business, the nature of the damage potential of the hazardous materials handled, and the proximity of the business to residential areas and other populations. UN-020UYCF - IO/15 w~vw.unidocs.org Rev. 07/24/06 Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Page of 8. Emergency Equipment: 22 CCR §66265.52(e) [as referenced by 22 CCR §6626234(a)(4)] requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment lnventory Table meets this requirement. EMERGENCY EOUIPMENT INVENTORY TABLE 1. Equipment Cate or 2. Equipment T e 3. Locafions * 4. _ Descri tion** Personal ^ Cartridge Res irators Protective ^ Chemical Monitoring E ui ment (describe) - Equipment, ~ Chemical Protective A rons/Coats Batte char ACid a fOn Safety ^ Chemical Protective Boots Equipment, ~ Chemical Protective Gloves Batte char 2 Pair Rubber Gloves and ^ Chemical Protective Suits (describe) First Aid ^ Face Shields ' Equipment ^ First Aid Kits/Stations (describe) Rest Room One lar e first aid kit ^ Hard Hats " ^ Plumbed E e Wash Stations ~ Portable E e Wash Kits (i.e., borrle e Batte char Two 32oz e e wash bottles ^ Res irator Cartridges (describe ~ Safe Glasses/S lash Go gles Batte char S ash O les ^ Safet Showers ^ Self-Contained Breathin A aratuses (SCBA) ^ Other (describe) Fire ^ Automatic Fire S rinkler Systems - Extinguishing ^ Fire Alarm Boxes/Stations Systems ^ Fire Extinguisher Systems (describe) ~ Fire Extinguishers (describe ^ Other (describe) Spill ~ Absorbents (describe Sales floor 8-10 Fort Ib ba s Control ^ Berms/Dikes (describe) Equipment ^ Decontamination E ui ment (describe and ^ Emergenc Tanks (describe) Decontamination ^ Exhaust Hoods Equipment ^ Gas C linder Leak Re air Kits (describe) ~ Neutralizers (describe) Batte char 301b bucket Soda Ash ^ Ove ack Drums ^ Sum s (describe) ^ Other (describe) Communications ^ Chemical Alarms (describe) and ^ lntercoms/ PA S stems Alarm ^ Portable Radios Systems ~ Tele hones Counter 5-6 Hard Line Phones ^ Tank Leak Detection Systems ^ Other (describe) Additional ~ 55 Gallon Steel Drum Stock room Equipment ~ Mo s, brooms, mo bucket Stock room (Use Additional ~ Trash Ba s, Sales ba s Puges if Needed.) ^ ^ ^ " Use the map and grid numbers from the Storage Map prepared earlier for your HMBP. ** Describe the equipment and its capabilities. If applicable, spec~ any testing/maintenance procedures/intervals. Attach additional pages, numbered appropriately, if needed. UN-020UPCF - 11/1S www.unidocs.org Re~~: 07/24/06 Employee Training Plan (Hazardous Materials Business Plan Module) Authority Cited: HSC, Section 25504(c); 22 CCR ,¢66262.34(a)(4) Page of All facilities that handle hazardous materials in HMBP quantities must have a written employee training plan. This plan is a required module of the Hazardous Materials Business Plan (HMBP). A blank plan has been provided below for you to complete and submit if you do not already have such a plan. If you already have a brief written description of your training program that addresses all subjects covered below, you are not required to complete the blank plan, below, but you must inelude a copy of your existing document as parY ofyour,I~MBP. Check all boxes that apply. ~Note: Items marked with an asterisk (*) are required.J: 1. Personnel are trained in the following procedures: ~ Internal alarm/notification * ~ Evacuation/re-entry rocedures & assembly oint locations* ^ Emer enc incident re ortin ^ External emer enc res onse or anization notification ^ Location(s and contents of Emer enc Res onse/Continaenc Plan ^ Facility evacuation drills, that are conducted at least (specify): (e.g., "Quarterly", etc.) 2. Chemical Handlers are additionally trained in the following: ~ Safe methods for handling and storage of hazardous materials * ^ Location(s) and ro er use of fire and s ill control e ui ment ^ S ill rocedures/emergency rocedures ~ Pro er use of ersonal rotective e ui ment * ~ Specific hazard(s) of each chemical to which they may be exposed, including routes of exposure (i.e., inhalation, ingestion, absor tion * ~ Hazardous Waste Handlers/Managers are trained in all aspects of hazardous waste management specific to their job duties (e.g., container accumulation time requirements, labeling requirements, storage area inspection requirements, manifesting re uirements, etc.) * 3. Emergency Response Team Members are capable of and engaged in the following: Complete this section only ifyou have an in-house emerQency response team ^ Personnelrescue rocedures ^ Shutdown of o erations ^ Liaison with res onding agencies ^ Use, maintenance, and re lacement of emergency res onse e ui ment ~ Refresher training, which is rovided at least annually * ^ .Emergency response drills, which are conducted at ]east (spec~): (e.g., "Quarterly", etc.) UN-020UPCF - 12/15 www.unidocs.org Rev. 07/24/06 Record Keeping - (Hazardous Materials Business Plan Module) Page of All facilities that handle hazarcious materials must maintairi reeords associated with their management. A summary of your record keeping procedures is a required module of the Unidocs Hazardous Materials Business Plan (HMBP). A blank summary has been provided below for you to complete and submit if you do not already have such a document. If you already have a brief written description of your hazardous materials record keeping systems that addresses all subjects covered below, you are not required to complete this page, but you must include a copy of your existing document as part of your HIVIBP. Check all boxes that apply. The following records are maintained at the facility. ~Note: Items marked with an asterisk (*) are required. J: ~ ~ Current em loyees' training records (to be retained until closure of the faciliry * Former em lo ees' training records (to be retained at least three years after termination of em lo ment * ~ Training Pro ram(s) (i.e., written descri tion o introducto" and continuin trainin * ~ Current co y of this Emergenc Res onse/Contirigency Plan * ~ Record of recordable/re ortable hazardous materiaUwaste releases * ~ Record of hazardous material/waste storage area ins ections * ~ Record of hazardous waste tank daily ins ections * , ^ Descri tion and documentation of facilit emergency res onse drills fvace: 1 ne uawe usc o~ recoras aoes noz neeessariry raent~ every rype o~ recorct regutred to be maintained by the faeility. Note: T/ze following section applies wliere local agencies require facility owners/operators to perform and document routine facility self-inspections: A copy of the Inspection Check Sheet(s) or Log(s) used in conjunction with required routine self- inspections of your facility must be submitted with your HMBP. [Exception: Unidocs provides a Hazardous Materials/Waste Storage Area Inspection Form that you may use if you do not already have your own form. If you use the Unidocs form (available at www.unidocs.org~, you do not "need to attach a copy.J Check the appropriate box: ^ We will use the Unidocs "Hazardous Materials/Waste Storage Area lnspection Form" to document inspections. ^ We will use our own documents to record inspections. (A blank copy of each documei:t used must be attaci:ed to t/:is HMBP.) UN-020LIPCF - 13/15 www.unidocs.org Rev.117/24/0(, Facility Site Plan/Storage 1VIap ~ (Hazardous Materials Business Plan Module) Site Address: ~ `I ~ ~QS~~~ 1'g~ ~w~ i3~~~~~'i,EL ~~ Date Map Drawn: .7 I~ I ~~. Map Scale: NOT TO SCALE Page 1 of 1 A B C D E F G H I J K L M N. O P n R s T_iT V w x v ~ 1 2 3 4 5 6 ~ s 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ~ Lc _ _ ~ ~. , a~ 9 _~~ , ` ~ ' ~ ._., ~tS _ ._ ~ --~ _ p! i ~;~L i0 - --- - - - - --- ~ - ~ ~ - - ~ _- b ~ ~ ! I ~ -co~ ~f=-L-.I_I I-i-t-l-L'_Is,1'~ o ~ ~N .~ ~ _ r \ ~ y_ • r~ . . O '~ _ ~N °~' " g=~ - ~ n ~ ~ . ; , ~ ati . ~.. ~ °~- '~ ~ .. . ~ . ~ ~ ~ '~. 1 : ~11 - b~ ` -~ ~ ~' I I~ ~~~ ~~i ~~-~ ~i ~ . ~ , ~~ ~ ~ ~0 £ ( t~l ~ ~ tnstructions are printed on the following page. UN-020 -11/17 , www.unidocs.org Rev. Ol/16/02 Facility Site Plan and Storage Map Instructions (Hazarclous Materials Business Plan Module) A Site Plan (public document) and Storage Map (conf clential document) must be included with your HMBP: For relatively small facilities, these documents may be combined into one drawing. However, if combined, the combined Site Plan/Storage Map will become a public document. If you are concerned about displaying the storage locations of hazardous materials to the public, you must provide a separate facility Storage Map. Since these drawings are intended for use in emergency response situations, larger facilities (generally those with complex and/or multiple buildings) should provide an overall site plan and a separate storage map for each building/storage area. A blank Facility Site Plan/Storage Map sheet has been pr.ovided on tlae previous page: You may complete that page or attach any other drawing(s) that contain(s) the information required below: 1. Site Plan (public document): This drawing shall contain, at a minimum, the following information: a. An indication of North Direction; b. Approximate scale (e.g., "1 inch = 10 feet".); c. Date the map was drawn; _ d. All streets bordering the facility; e. Locations of all buildings and other structures; f. Parking lots and internal roads; g. Hazardous materials loading/unloading areas; h. Outside hazardous materials storage or use areas; i. Storm drain and sanitary sewer drain inlets; j. Wells for monitoring of underground tank systems; k. Primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas. 2. Storage Map (confidential): The map(s) shall contain, at a minimum, the following inforrnation: a. General purpose of each section/area within each building (e.g., "Office Area ", "Manufacturing Area ", etc.); b. Location of each hazardous material/waste storage, dispensing, use, or handling area (e.g., individual underground tanks, aboveground tanks, storage rooms, paint booths, etc.). Each area shall be identifiable by a Grid Number, to be used in item 204 on the Hazardous Materials Inventory - Chemical Description pages of the Business Plan; c. For tanks, the capacity limit in gallons and common name of the hazardous materia] contained in each tank; d. Entrances to and exits from each building and hazardous material/waste room/area; e. Location of each utility emergency shut-off point (i. e., gas, water, electric.); f. Location of each monitoring system control panel (e.g., underground tank monitoring, toxic gas monitoring, etc.). UN-U20UPCF - li/15 www.unidocs.org Rev. 07/24/06 ~ UNIFIED RROGRAM CONSOLIDATED FORM > > - AA7.ARnOUS MATERIALS i-TA7.ARi)OUS MAT~+-I~LS INV~+ 1~T`I'ORX - CHENdICAL DESCRII'TION ' . . ' . - ._. . . ` ~ ' . ~ fone ' e - ~ mateiial ~- build'me or mea -, ~ADD ~DEI:EI'E ^REVISE zoo Page _ of_ I. FACILTTY INFORMATION BUSINESS NAME (Same as FACII.ITY NAME or DBA - Doing Business As) 3 AUTOZONE # 5336 - CHEMICAL LACATION Zo~ CHEMICAL LACATION CONFIDENTIAL EPCRA Zo2 STOCK ROOM O ~s ~ No . FACII;TTY ID # ~~" ~_ ;i . #s ~~`~ . ~ ~ zos MAP# ~apuo~~ Gg~ ~a~~~ zoa ~ ~~ ~~ ~~<., . II. CHENIICAL INFORMATION CHEMICAL NAME zos TRADE SECRET ^ Yes ~ No zo6 PETROLEUM OIL - usu~~ ~o spcxn, refer to insVUCtions COMMON NAME 20~ zos WASTE OIL EHS* ~ Yes ^ No CAS# 209 8002-OS-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE~HAZARD CLASSES (co~i~~ ~ny~ffea ny c[mn~ z~o COMBUSTIBLE LI UID HAZARDOUS MATERIAL 2t 1 T'YPE (Check one ium only) ^ a. PURE ^ b. MDCTURE ~ c. VJASTE RADIOACTIVE ^ Yes ~ No 212 CURIES 0 213 PHYSICAL STATE 215 Zi4 (Check one item only) O a SOLID ~ b. LIQUID ~ a GAS LARGESTCONTAINER• 220 , FED HAZARD CATEGORIE$ 216 (Check all that apply) ~ a. FIRE ~ b. REACITVE ^ c. PRESSURE RELEASE 0 d. AC[TTE HEALT'fi ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNf 217 ~p~JM DAII Y AMOLINT 218 [~INUpL, WASTE AMOUN'I' 219 STATE WASTE CODE 220 11~ 22~ 5~20 221 ZZi LJNITSs ~ a. GALIANS ^ b. CCIBIC FEE,T ~ c. POUNDS ^ d TONS DAYS ON SITE: ZZz . Check orn item onl • I£EHS amoum must be in ounds. 365 ~ STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRIJM ^ m GLASS BOTTLE ^ q. RAII, CAR ~ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG O n PLASTIC BOTTLE ^ r. OTHIIt ~ c. TANK INSIDE BUII,DING ^ g. CARBOY ~ k BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SII,O ^ I. CYLINDER ^ p. TANK WAGON ZZ3 STORAGE PRESSURE ~ a. AMBIEN'I' ~ b. ABOVE AMBffidT 0 c. BEI.OW AMBI~TIT 22a STORAGE TEMI'ERATURE ~ a. AMBIENT ^ b. ABOVE AMB~IT ^ c. BEIAW AMBIINT ^ d. CRYOGEPIIC ~ 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 ZZ6 PETROLEUM OII. zz~ ^ Yes ~ No ZZS 8002-OS-9 zz9 Z 230 231 ^ YES ~ NO 232 233 3 z34 235 ^ YCS ^ NO 236 237 4 23$ z39 ^ Yes ^ No Zao zal S 242 243 ^ 1'CS ^ Tj0 244 245 If morc hanrdous components ere preseet at y~reater than 1% by weight if non-rareinogmic, or 0.1 % by weigAt if eartinogenic, attach additional s6cets of papv eapturing the requ'veel~iuformation. ADDITIONAL IACALLY COLLECTED INFORMATION 2ab ff EPC Please Si Here UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM AA7.ARilOUS MATERIAI.S ~TA7,~~2,~OUS MA~EY~Y.S INV'~+ NTOIZ~.' - CHENIICAL DESCRIPTION , . r~~ ~ ,~t~ e~ia;e m ~ : ~ADD DDELEPE ' • ^REVISE ' 200 , page _ of_ I. FACILITY INFORMATION ~ BUSINESS NAME (Same as FACII,TTY NAME or DBA- Doing Business As) 3 AUTOZONE # 5336 ~ ~ CHEMICAL LOCATION Zo~ CHEMICAL LACATION CONFIDENTIAL EPCRA 2~2 ' STOCK ROO1v1 _ O ~s ~ rro _ _. ._ _ FACILTTY ID# ~~' ~ ~~ r~~' ~~ ~ MAP# (opaouatj zo3 GR~ ~op~~~ 204 s ; . II. CAENIICAL INFORMATION CHEMICALNAME zos ~DESECRET ~ Yes ^ No 206 SPENT SULFURIC ACID usub;~ to Ercxa., ~a ~o ;~c;o~ COMMON NAME zo~ zos SPENT BATTERY FLUID ACID EHS* ~ Yes ^ No CAS~ 209 7664-93-9 *If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (comP~~~ ~~~a by c~mn~ zto CORROSIVE HAZARDOUS MATERIAL 211 T'YPE (Check one item only) ^ a. PURE ^ b. MLITCTRE ~ c. WAST'E RADIOACTIVE ^ Yes ~ No 212 C[JRIES 0 213 PHYSICAL STATE 215 21a (Check oru item only) ^ a. SOLID ~ b. LIQUID ~^ c. GAS LqRGEST CONTAINER 30 FED HAZARD CATEGORIES 216 (Check all that apply) ^ a FIRE ~ b. REACfIVE ^ c. PRESSURE RELEASE ~ d ACI7TE HFALTH ^ e. CHRONIC HEAL'1'H AVERAGE DAII,Y AMOUNT 217 ~M DAILY AMOUNT 2~8 ANNUAL WASTE AMOUNf 2t9 STATE WASTE CODE 220 1000 1200 30.000 791 ZZ~ UNTfS• ^ a. GALIANS ^ b. CUBIC FEEI' ~ c. POUNDS ^ d TONS DAYS ON S1TE: 222 . . Check one item onl ' If EHS amount must.be in ,~as. 365 S7'ORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRiJM ^ i. F1BER DRiJM ^ m GLASS BOT'fLE ^ q. RAII, CAR ^ b. UNDERGROUND TANK ^£ CAN ^ j. BAG ^ a PLASTIC BOTTLE ~ r. OT'f~R ^ c. TANK INSIDE BTJII.DING ^ g CARBOY ^ k BOX ^ o. TOTE BIN ^ d. STEEL DRUM ~ h SILO ^ L CYLINDER ^ p. TANK WAGON ZZ3 STORAGE PRESSURE ~ a. AMB~iT ~ b. ABOVE AMBIENT ^ c. BELOW AMBIEN'f - 224 STORAGE TEM['ERATURE ~ a AMBIENT ~ b. ABOVE AMBIINT ^ c. BELOW AMBIIIVT ^ d. CRYOGINIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 34 z26 SULFURIC ACID z2~ ~ Yes ^ No us 7664-93-9 229 2 230 231 ^ 1'CS ~ NO 232 233 3 234 235 ^ Yes ^ T10 236 237 4 238 239 ^ 1'PS ^ j10 240 241 5 zaz _ , 2as ^.Yes ^ No zaa zas If more hamrdous components are present at greahr than 1% by weight if non-arcinogenic, or 0.1 % by weight if prcinogmie, ettach additional aheets o( paper eapturing t6e required iuformation. ADDTTIONAL LACALLY COLLECTED INFORMATION za6 If EPCRA Please Si H~e UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM GONSOLIDATED FORM AA7.ARDOUS MATERIALS ~A7ARnOiTS MATE~Ab.S INVENTORY - c~~c~; ~ESCx~TTON. _ _ . ~one e~ mazmal ,xiuld~ ,m.mea _ ~ADD ~DELETE ~REVISE 200 Page _ of_ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILTTY NAME or DBA - Doing Business As) 3 AiJTOZONE # 5336 CHEMICAL LOCATION Zol CHEMICAL LACATION CONFIDENTIAL EPCRA Za2 STOCK ROOM _ _ 0 ~s ~ No FACILITY ID # ~~~ye ~ ~~~ ~~, :.A 1 MAP~ (opnonal) 203 GRIIl# (optional) 2~ ~ ~~'~` • II. CHEMICAL INFORMATION CHEMICAL NAME zos ~DE SECRET ^ Yes ~ No zoe WASTE ABSORBENT ~esub;«K ~o secxn, r~ to m~.,,M:o~ COMMON NAME zo~ zos EAS' ~ Yes ^ No WASTE ABSORBENT CAS# zov 8002-OS-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (co~iao ~ran,~a ny ctmn~ 2to COMBUSTIBLE HAZARDOUS MATERIAL T'YPE (Check one item only) ^ a PURE ^ b. MiXT[JRE ~ a WASTB 21 ~ RADIOACTNE ^ Yes ~ No 212 213 CURIES 0 - PHYSICAL STATE 214 (Check one item only) ~ a SOLID ^ b. LIQUID ^ a GAS 215 LARGEST CONTAINER 440 FED HAZARD CATEGORiES zt6 (Check ell that apply) ~ a FIRE ^ b. REACTNE ^ c. PRESSURE RELEASE ^ d. ACUTE HEALTH ^ e. CHRONIC HEALTH • AVERAGE DAILY AMOLJNT 217 Mp){IM[JM DAILY AMOiJNT 218 ANNi7AL WASTE AMOLJNT 219 STATE WAST'E CODE ~o 220 440 1340 352 TONS ZZ~- LINITS• ^ a GALIANS ^ b. CUBIC FEET ~ c POUNDS ^ d DAYS ON STTE: ZZZ . . Check one item onl ' If EHS amouut must be in o~a~. 3 65 STORAGE CON'fAINER ^ a. ABOVE GROUND TANK ^ e. PLASTTC/NONMETALLIC DRiJM ^ i. FIBER DRiJM ^ m GLASS BOTTLE ^ q. RAII, CAR ^ b. UNDERGROUND TANK ~ f. CAN ^ j. BAG O n. PLASTIC BOTTI;E ^ r. OTI~R ^ c. TANK INSIDE BLJILDING ^ g. CARBOY ^ k BOX ^ o. T'01'E BIN ~ d. STEEL DRUM ^ h SILO ^ 1. CYLiNDER ^ p. TANK WAGON ZZg STORAGE PRESSURE ~ a. AMBIENT ^ b. ABOVE AMBIEN'C ^ c. BELOW AMBIEN'T 224 STORAGE TEMPERATURE ~ a. AMBIII9T ^ b. ABOVE AMBIENT ^ c. BELOW AMBIEN'f ~ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 50 ZZ6 PETROLEUM OIL Z2~ ^ Yes ~ No Zzs 8002-OS-9 2z9 2 230 ?31 ^ Yes ~ NO 232 233 3 234 235 ^ Yes ^ NO Z36 237 4 238 , 239 ^ Yes ^ TIO 240 241 5 z42 zas ^ Yes ^ No zaa zas If more hamrdous rnmponwta pre preseet e[ greater than 1% by weight if non-carcinogentc, or 01 % by weight if prcinogenic, attaeh additional sheets of paper capmriag the reqn'ved iuformetion. ADDITIONAL LACALLY COLLECTED INFORMATION za6 _ ~ If EPC Please 5i Here UPCF (1/99) 6 OES Form 2731 ~o~ HAZARDOUS IWATERIAL MANAGE(NENT PLAIV €~ ~"~.~~~~ ' ., , ~ .~~.~~~~.~~~~'~~.~.~ ,~„ ~'?`~;~L~~~s~'~`~,~~„~~ ;~~~~:~ ~~ BlJSa1VESS ACTYVFTYES P~-GE ¢ ~ (HAZARDOUS MATERIAL FACILITY INFORMATION) ,~~. ,~~" ~ ~, , 8 ~ S~M ~y~.p ~ Fll~'B £ ~ ~'Al ~TN@'~~~ BAKERSFIELD FIRE DEPARTMENT Preve:nfion Services 1501 Truxtun Avenue Bakersfield, CA 93301 Phone:661-326-3979 Fax:661-852-2171 x~ . ° - ; . ~ ~ ~ ' ~ . , , ,., , _ , ~ `, ~~ ' ~ ~I:: ~FACILITY~~YDENTIFIC~1~ ~I011~~ ~ ~ , . • ~ f ~ ~ ~ ~ ~ _ ~, , ~~ ,~ ~• ~ ~~ . . ~ . _.. r ~.,,, , ,<.~ ,. ~e, . _ .... ._.. ..,. _._. . _ . . . ~ FACILITY ID #(for.office use only). 3 EPA ID # G9t oooa77~d1 BUSINESS NAME (FACILITY NAME or DBA) io3 ~ ~ ~ufoZ~ne 3.;6~/ II ~ACTIV,ITIES DECLARATION DOES Your Facility... If Yes, Please Complete... 129 A. HAZARDOUS MATERIAL ~ Yes ^ No • CHEMICAL DESCRIPTION FORM iso 1. Have on site (for any purpose) hazardous material '• HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 galions for liquids, 500 pounds for Minimum ~eauired annina elements: solids, or 200 cu. ft. for compressed gases (indude • Emergency Response Plan liquids in AST and UST)? • Maps • Training • Prevention • Certification B. REGULATED SUBSTANCES (RS) ^ ves m No . CHEMICAL DESCRIPTION FORM 131 1. Have on site RS at greater than the threshold • RISK MANAGEMENT PLAN (RMP Submit to USEPA) planning quantities established by the California • GONSOIIDATED COMPLIANCE PLAN Accidental Release Prevention program (CaIARP)? • Incorporating CaIARP Progrem Elements C. UNDERGROUND STORAGE TANKS (USTI ^ Yes No . UST FACILITY FORM 13z 1. Own or operete Underground Storage Tanks? • UST TANK FORM (one per tank) 2. Intend to upgrade existing or install new UST? ves fi~ No • UST FACILITY FORM 133 • UST TANK FORM (one per tank) • UST INSTALLATION FORM (one per tank) D. TANK CLOSURE/REMOVAL ^ ves m No • UST TANK FORM (Closure section - one per tank) 1. Need to report closing an UST that held hazardous . , material or waste? 2. Need to report the closure/removal of a tank that ^ ves q~ No . UST TANK CLOSURE FORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS ^ Yes ~ No • HA2ARDOUS MATERIAL MANAGEMENT PLAN IAST) • Incorporating Federel Spill Prevention Control and Countermeasure 1. Own or operate AST above these thresholds; any (SPCC) Elements pursuant to 40 CFR Part 112. tank capacity is greater than 660 gallons or the total capacity for the facility is greater than 1,320 gallons? F. HAZARpOUS WASTE EPA ID NUMBER - provide on this page 1. Generate hazardous waste? ~ Yes ^ No . To obtain EPA ID Number, please phone (916) 324-1781 2. Retycle more than 300 kg/mo of recyclable ^ Yes ~ No . RECYCLING FORM material at the same location it was generated? 3. Recycle more than 300 kg/mo of recyclable ^ ves p No . RECYCLING FORM material at an off-site location different from the point of generation? 4. Treat Hazardous Waste on site? ^ Yes p No . 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 ^ Yes m No . REMOTE WASTE/CONSOLIDATION SITE NOTIFICATION remote site? FORM NOTE: If you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested abave, please submit BUSINESS OWNER/OPERATOR IDENTIFICATION FORM. FD2143 (Rev OS/OB)