The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN 11/12/2008HAZARDOUS MATERIAL MANAGEMENT PLAN ~ ` ~°'r~y ;~ , ~~ s ~ ,~-..~ ~ ~~~a aa.. t~. !"~1.~('~ .d ,~ --~ ,.r~t<.~,~o'g 1"'s€,oi?:+~ ~'~"'~;u . c~,.. E. H.,'~'"'~{. ~F 1 E L:.D Bvsg~aESS ,~cTavaTH~s ~~G~ ~ ~§ ~~~~ D$ /!{1@'flU ~9P'f (HAZARDOUS MATERIAL FACILITY INFORMATION) '~ ;; ~ BAKERSFIfLD FYRE DEPARTMENT Prevention Services 1501 Truztun Avenue , Bakersfield, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 ' i' i . ~ . ~t' . ~ ~ ' ~' . 3j i ~ .i 4 . y~ N }- i ~ . . . ~ . , ~s t>€' ~r ~ ~~_ ~I:~ FACILITYiIDENTIFIC~!-T~ION~~~ ~ ' `` ~ ' ~ - ..:ci . .. i..k~.jn~t ~e. ~ .:.,6. . ~- ~~' _ . . ., . ... , ~ ~~`i.i:,.F~..). .F•~ ~~: . ,. .... . ...,_....,....,... _. . ....~~ .~ .. .................. ....:. .. .~ ::... FACI LI7Y ID #(for~ o~ce use only) 3 EP.A ID # C A~000~?3 7~ ~ BUSI NESS NAME,(FACILITY NAME or DBA) 303 ~v-t-~ Z.o~, ~* 33 l ` ~ ~II. ACTIVITIES D,ECL'ARATION ~ , _.__ DOES Your Facility... . If Yes, Please Complete... 129 , A. HAZARDOUS MATERIAL B Yes ^ No • GHEMICAL DESCRIPTION FORM i3o 1. Have on site (for any purpose) hazardous material • HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 gallons for liguids, 500 pounds for plinimum reduired planning elements: solids, or 200 cu. ft. for compressed gases (include • Eme~gency ReSponse Rlan I liquids in AST and UST)? • Maps , • Training • Prevention • Certification B. REGULATED SUBSTANCES (RS1 ^ ves 0 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 (USTl ^ Yes ~ No • UST FACILITY FORM i3z 1. Own or operate Underground Storage 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 ^ ves ~ 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 ^ Yes o No . UST TANK CLOSURE PORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS ^ Yes ~ No • HAZARDOUS MATERIAL MANAGEMENT PLAN fASTI • 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. HAZARDOUS 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. Recycle more than 100 kg/mo of recyclable ^ ves m rvo . RECYCLING FORM material at the same location it was generated? , 3. Recycle more than 100 kg/mo of recyclable ^ Ves ~ No . RECYCLING FORM li material at an off-site location different from the I point of generation? '~ 4. Treat Hazardous Waste on site? o ves ~ No . TP FACIIITY FORM • TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? o ves O No . CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Yes Q1 No . REMOTE WASTE/CONSOLIDATION SITE NOTIFICATION remote site? FORM NO TE: If you checked YES.to any part of Sections IIA - IIF above, then in addition to the forms requested above, please submit BUSINESS OWNER/OPERATORIDENTIFIC ATION PORM. FD2143 (Rev OS/08) HAZARDOUS MATEyRIAL MANAGEMENT PLAN ~ ~ i~~~:..~. ~w ~,t,:;~i.f.1`E~.si'~`~~~~~ti:ti'a;~.~r.~.~'a°,.^t~.~~a~. ~'A`~"~~~ ~~~l~L.wx~ Y'.w~1~'~,"'~`~ ~4PPLYCA'PION BUSINESS 01NNER/OPERATOR IDENTIFICATION FORM (HAZARDOUS MATERIAL FAGILITY INFORMATION) ~ ~~ r, ~ ' : ~, ~~"~ ,~ 6 A~P R 9 P I~$ L, D ~ F~~aE ,~~ ! I~N:Tila$,~~~T BAKERSFIELD FIRE DEPARTMENT Prevention SerVices 1501 Truxtun Avenue, 15C Floor Bakersfield; CA 93301 Rhone.661-326-3979 Page 1 of 2 Fax;661-852-2171 . _ . , ~ - .. . . . : . . .. , - ~~ ~ ~ ~ i ~. 4 ~~ ~ ~' ' ~ ' , I ~jFACIL=ITYf IDENTIFIC~,TIOIV ~ ` `` ' . , . , . .iR . .y.s .~,r,. _ . ~ . . , • - F..~. ' ~ ;.t,y..~J .:., , . . '~ , .. r.t ii,x -~~ ,it~ E , .~, .. • . ~,r~, :l,"'',1'2js ~ ' ' ' ~ ' ~ ~ ~ ~ . ' , . . , ~ ~~ ' f'. '..V.f:' ~. • .. .. ..•'..'.. ......~...~~5`..~5 ..~~:'! _T t'~..c:..,...._ . ~ J~~ '~; t ?:.,. .:.'. e . .:. ..~. ' . Gt....~ _ . _ :._.. . .. . ... ... ... . .. . . . i _. -......... .a . , . .. ..... . ...! - FACILfTY ID 7f '~" ~ ~ '~'' ° ~ 1 ~EAR BEGINNIN6 - ~ ~ ~~ " ~ ~ - ` -"- ~ ~ ~ ~ 1D0 ~ VEAR ENDING ~ - ~ ~ 101 01151NE55.NAME (Seme as FAUUTY NAME or DBA) 3 BUSINESS PHONE - 302 ti Z c~~~3J1 ~co~-~ ~ ~300 SITE ADDRESS - , 103 ~ ~~ ~ V 1...'~ \V~ l ...) ~~ CITV ~/"~~~~~I~~ ~ 104~ c,4 ZIPCODE 305 q 3 3 I~ DUNN 6 BRADSTREEf 7t 106 SIC CODE 107 5-? -3Sl ' -'i COUNTY 108 K~ S ~ OPERATOR NAME 109 OPERATORPHONE 110 ; ~. < G~ / - ~l-? 7 - ~1~ G-G ~ ; ~ _ ~ ~ . ~~ „ ~ ~'~ II O>WI~ER :If~9FORMNTI;OR1 ~ ~ , . ~3 ~ ~~: ~,. , s,..:~~~ ,_ ., .,.. , ,. , . , . _ . . .,. .. , , . _. , ~.::.~. ~ OWNER NAME ~~~~ ~~ ~ ~ 111 OWNER PHONE ~~ ~ ~~~r ~ 112 - ~UO OWNER MAILING ADDRESS ~ ,, 113 ~'~_~ ~.. C C ~ ~"~~ e. c~ ~ CITY . llq e ~~ C S7ATE 115 ~ic~' Zlp CODE ,..~ ,S/G ,3 -.3G0 ? III. = EIVVIR011lNOENTAL~GOi~T~-CT• • . , _ . . ,,,, ._. . ~. ,. ~ ,{ n n lll CONTARNAME / , CONTAC~QO~ _ ~~~ ~ ~.~yy 118 ~ / vi ~ ~ CONTACT MAILING AD`DRESS /~ ~/ 1~ `„' ~_ / 1~. ~--~ O ( / ~ ? ~GUl~ ~~h, -~~ ~f ~~ . ; ~ 119 CIN / ~ 120 /~J STATE 121 ZIP CODE 122 c_!~-, /~I /~ J ~IU~ -.3 ~ U 7 . . _ ... _ .. _ . IV. 'EMERGENCY CONTACTS ~ ~ ;~P~~RINiARY= , ' ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ .'SECO.N~DARY~ ' ~ ~ ~ ~ ~ ~ NAME \ 123 l~ ~: ~ C. ~ lZ NAME 128 '~~C ~~ ~`~ c.~ C TITLE 124 • ~~;s~~; ct c:.r~ . e TITLE 129 hr ~~~~ ~l~C~~~~t~ BUSINE55 PMONE ' 125 C9(~\' ~5~? - ~v'~GU gUSINESS PHONE 130 r'°U-~~ l3 ~~tt~ 3 24-HOUR PHONE 126 C~~ ~~3~~2c~`i3 24-MOUR PHONE 131 Gp-~c3~~~43 CELL PHONE 127 CELL PHONE ~ 132 - i~ A 133 . v. cERTaFic~;Tio~ . , Certification• Base on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined nd am mili r with the i ormat n submitted in this inventory and believe the information is true, accurete, and complete. SIGP7ATU :: OF D JMf::NT [PF7f:R 136 DATE 134 ~~7 ~ ~~AME OF DOCUMEN;' FREPARER (PR]N'O 135 C ~ ~~. f~i: ;~")WP'.!t)(':PEi2n'I';?R :SiF,f~i :. f'i:;N'~! 137 TITI Oi' U6:. ~ kENi PNE-PARER 138 ~ ' S ! il ut r~~:~l i'1 ft~ ~ ~ z.G'c, i.S ~l , ~ ~ FD2142(Rev 01/OB) 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 lian8le hazardous materials; in HMBP guantities must have.a, written emergency7esponse plan; :In addifion, facilities that generate 1,000 kilograms or more of hazardous waste (or more thari l kilogram of acutely liazardous waste or 100: kilograms of debris resulting from the spill of an acutely hazardous waste) per month, or accumulate more than 6;000 kilo~ams of hazardous waste on-site at any one time, must prepare a hazardous wa5te contingency plan. Because the reGuirements 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 pact of your HIVIBP. This site=§pecific Emergency Response/Gontingency Plan is the facility's plan for dealing with emergencies and shall be implemenfed iminediately whenever ttiere is a fire, explosion, or release of hazardous inaterials that' could tHreaten human healtH and/ot the environment. . At least one copy of ttie plan §hall be maintained at the facility for use in the event of an e.mergency and for inspection by the local agency. A copy of the plan and any revisions must be provided to any contractor, hospifal, or agency with whom special (i.e., contractual) emergency services arrangements have been made (see section 3, below). 1. Evacuation Plan: a. The following alarm signal(s) wil] be used to begin evacuation of the facility (check all that apply): ^ Bells; 0 Horns/Sirens; ~ Verbal (i:e., shoutin~; ^ Other (specify 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 will 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 Hazardous Materials Program ___________ Phone No.: ( ) Californ ia 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 Regional Water Quality Control Board Phone No.: (510) 622-2300 * Phone numbers tor 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 Hospital: Name: Met'Cy F~OSpltal Phone No.: (661) 327-1792 Aaa,~ess: 2215 Truxtun Avenue ~~ty~ Bakersfield ]f you have made special (i.e., contractual) arrangements 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 - 9/15 www.unidocs.org Rev. 07/24/06 Emergency Response/Contingency Flan (Hazardous Materials Business Plan Module) Page of 4. Emcrgency Procedures: Emer~encv Coordinator.Responsibilitie5: 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. ldentify 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, or release. This assessment mu5t consider both direct and indirect effects (e.g., the effects of dny toxic, irritating, or asphyxiating gases that are generqted ~ the effects of any hazardous surface wdter run-off..from water or chemical agents used [o control f re, etc.). m. Acfivate iritemal facihty alaims or communicafions systems; where applicable; to notify all facility persorinel. iv. Notify appropriate local authorrties (~.e., cg11911)_ v. Notify the State O~ce 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, contaminafed soil or surface water, or any other material that results from a expiosion, fre, 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 cleaned, fit for its intended use, and available for use. iv. Notify the California Environmental Protection Agency's Deparhnent of Toxic Substances Control, the local CUPA, and the local fire department's hazardous materiais 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-Incident 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 ar 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 CCR §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 wlnerability to earthquake-related ground motion. 7. Hazard Mitigation/Prevention/Abatement ~19 CCx §z731(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 potentia] of the hazardous materials handled, and the proximity of the business to residential areas and other populations. UN-020 U PCF - 1(1/15 wrvw.u n idocs.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 Inventory Table meets this requirement. E1VIEgtGENCY EQUIPIVIENT INVENTORY TABL,E L Equipment Cate or 2. ~ Equipment T e 3. Locations * 4. _ Descri tion** Personal . ^ Cartridge Res irators Protective ^ Chemical Monitoring E ui ment (desc~•ibe) Equipment, ~ Chemical Protective A rons/Coats Batte char ACid a ron Safety ^ Chemical Protective Boots Equipment, ~ Chemical Protective Gloves Batte char 2 Pair Rubber Gloves and ^ Chemical Protective Suits (describe) First Aid ^ Face Shields ' Equipment 0 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., borr[e ~) Batte char Two 32oz e e wash bottles ^ Res irator Cartridges (describe) ~ Safety Glasses/S lash Goggles Batte ehar S ash o les ^ Safety Showers ^ Self-Contained Breathing A aratuses (SCBA) ^ Other (describe) Fire ^ Automatic Fire S rinkler S stems Extinguishing ^ Fire Alarm Boxes/Stations Systems ^ Fire Extinguisher Systems (describe) ^ Fire Extin uishers (describe ^ Other (describe) ~ Spill ~ ~ Absorbents (describe Sa12S flOOf 8-10 Fort Ib ba s Control ^ Berms/Dikes (describe Equipment ^ Decontamination E ui ment (describe) and ^ Emer enc Tanks (describe) Decontamination ^ ExhaustHoods Equipment ^ Gas Cylinder Leak Re air Kits (describe) ~ Neutralizers (describe) Batte char 301b bucket Soda Ash ^ Over ack Drums ~ ^ Sum s (describe) ^ Other (describe) Communications ~ Chemical Alarms (describe) and ^ Intercoms/ 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 Pages ifNeeded.) ^ ^ ^ * Use the map'and grid numbers from the Storage Map prepaf•ed earlie~~ for your HMBP. ** Describe the equipment and its capabilities. If applicable, spec~ any testing/maintenance procedures/intervals. Attach additronal pages, nzrmhered appropriutely, if needed. UN-020UPCF - 11/1S www.uniducs.org Rev. 07l24/06 Employee Training Plan • - (Hazardous Materials Business Plan Module) Azdhority Cited: HSC, Section 25504(c); 22 CCR ~66262.34(a)(4) Page of All facilities that handle hazardous materials in HMBP quanfities 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 include a copy of your existing document as part of your I~IVIBP. Check all boxes that apply. [Note: Items marked ~~ith an asterisk (*) are required.J: 1. Personnel are trained in the following procedures: ~ Internal alarm/notification * ~ Evacuation/re-entry rocedures & assembly oint locati.ons* . ^ Emer enc incident re ortin~ ^ External emer~enc res onse or anization notification ^ Location(s) and contents of Emer enc Res onse/Contin enc Plan ^ Facility evacuation drills, that are conducted at least (spec~): (e.g., "Quarierly", 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 reguirements, 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 if yoz~ 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 least (specify): (e.g., "Quarterly", etc.) UN-U20UPCF - 12/15 www.unidocs.org Rev. 07/24/06 Record Keeping (Hazardous Materials Business Plan Module) Page of All facilities that handle hazardous materials must maintain records associated with their management. A summary of your record keeping procedures is a required module of the Uriidocs 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 add~esses all subjects covered below; you are nof required to complete this page, but you must include a copy of your existing document as. par-t of your-I31VYBP. 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 closz~re of the faciliry * ~ Former em loyees' training records (to be retained at least three ear,s after termination of em loyment) * ~ Trainin Pro am(s) (i:e., written descri fion of introductory and continuin trainin * ~ Current co of this Emergency Res onse/Contingency Plan * ~ Record of recordable/re ortable hazardous material/waste releases * ~ Record of hazardous materiaUwaste storage area ins ections * ~ Record of hazardous waste tank daily inspections * ^ Descri tion and documentation of facility emer ency res onse drills /vote: 7 he above [ist o~ j records does not necessarily ident~ every rype of record required to be maintained by the facility. Note: T/ze following section applies wlzere 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.or~; you do not need to attach a copy.J c:necx tne appropr~ate box: ^ We will use the Unidocs "Hazardous Materials/Waste Storage Area Inspection Form" to document inspections. - ^ We will use our own documents to record inspections. (A blank copy of eac% document used must be attacl:ed to tliis HMBP) UN-020UPCF - 13/15 www.unidocs.org Rev. 07/24/06 Facility Site Plan/Storage Map (Hazardous Materials Business Plan Module) Site Address: CO( „ ~5 ~~~~G"' /~/ ~ ~~"~ Date Map Drawn: ~ ~ ~ ~ ~S~ 1 2 3 4 5 6 7 8 9 io t~ 12 13 ~4 15 16 17 10 19 20 21 22 23 24 25 26 27 28 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 O R S T U V W X v ~ ~ ~ ~ ~ ~ , - - " -.- -- ~/{~ 3 ~~ zt' ~ o i f5~ g~~ ` ~ ~ N~ ~ ~ - - ~~= 2 P~.- -~ -- - - - -- - - - - ~ ~ '`' _,~~ ~ - - - S - - ; ~o _ n ~~ . ~ k ~ ~ ~N g ~ V ~ ~ ~ ~ -(\' V - ~ti ~ ^' ~ ~ _ ~ _ Sb5 ~~ ~Yu ~ ~ ~~ -- _ _ ~ ~ ___ _ . . ~ N ~ ~ ~' O Instructions are p~inted on the following page. uN-o2n - i v~ ~ S ~~~~L ~~ I = IVcw br~~z.r ie ~ `~. F~~l~ i 1~i c e 2 ~_•: www.unidocs.orgj ~"-ti I~c:l ~l ~ ~ ~ s \`.. 4~. C~~ 1 r '1. ~'~ ~~I~SGlUe11T OCA~t;. t~ . ~~ ~,._5 t~: 3~1 N~Y ~~~ s C- 1.~..i c: s 1 e c; : l'1 ~~~ K Rev. O1/16/02 Facility Site Plan and Storage Map Instructions ~ (Hazardous Materials Business Plan Module) A Site Plan (public document) and Storage Map (confidential 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 axe 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 provided on the 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; £ 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. Storabe Map (confidential): The map(s) shall contain, at a minimum, the following information: a. General purpose of each section/axea within each building (e. g., "O~ce 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 axea 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 material 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 moriitoring, toxic gas monitoring, etc.). UN-020UPCF - 15/li www.unidocs.org Rev. 07/24/06 iJNIF`IED PROGRAM GONSOLIDATED FORM _ ~ • AA7.A~RDOUS MATERIALS ~;A7A'~2~OUS 1VgA1'E~I;S IN~ENT~RY - CHEl~IICAL DESCRIPTION .~ ~ . . . ~ . . .. . : . .:. ~ ~ ... . ~. ~ .. .. _ , . . ` ~ . :_ . ._ _ .. . . . ~. .. . ,. . .' .. . . _ . .. one - ' e ~c maze~ial _ _.~iil ~ e or-mea't . _ . . ... ...__ . , . .. . . . ' ~ADD,. ODET:F'CR _. - ._. ~REVISE' . __ 200.. .. . .. ._.__ ... __ .. ... Page_ of '_ I. FACILITY INFOItMATION BUSINESS NAME (Same as FACII,ITY NAME or DBA - Doing Business As) , ~ 3 AUTOZONE # 3311 CHEMICAL LOCATION ~ ZP~ CHEIvIICAL LACATION CONFIDENTIAL EPCRA 24z STOCK ROOM ~ _ _ O ~s ~ ivo _ _. _ ._. . _ _ _ FACIL.TTY ID# X ~~ _ t M/~f (opaonatj 203 : GRiD#'(optionalj 2~ ~:~.: II. CHENIICAL INFORMATION CHEMICAL NAME Zos TRADE SECRET Yes No 206 WASTE AB SORBENT iesu~«t co src-w, r~Q co ~~;~ COMMON NAME , zo~ 2os I WASTE ABSORBENT EHS* ' ~ Yes ^ No _ CAS# 209 ~ I 8002-OS-9 '"If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (comp~ete ifr«~u'vnd by Ct7Pn) • zlo COMBUSTTBLE HAZARDOUS MATERIAL 211 7'YPE (Check one item only) ^ a. PURE ^ b. MQC'I'(JRE ~ c. WAST'E RADIOACTNE ^ Yes ~ No 212 CURIES 0 213 PHYSICAL STATE Z~4 (Check one item only) ~ a SOlID ^ b. IdQUID 0 c. GAS LARGEST CONTAINER 440 215 FED HAZARD CAT'EGORIES 2t6 (Chbck all that apply) ~ a FIRE ^ b. REAC1'IVE ^ c. PRESSURE RELEASE ^ d. AC[JTE FiEAI.TFi ^ e. CHRONIC HEALTH AVERAGE DAiLY AMOLINT . 217 MAXIMUM DAII,Y AMOUNT 21E ANNUAL WASTE AMOUNC 2~9 STATE WASTE CODE 220 220 440 1340 352 ZZi UNTfS• ^ a. GALLONS ^ b. CUBIC FEET ~ c POUNDS ^ d TONS DAYS ON SITE: ZZZ . . Check one item onl t If EHS amount must be in ounds. 365 S7'ORAGE CONTAINER ^ a. ABOVE GROiIND TANK ^ e. PLASTTGNONMETALLIC DRiIM ^ i. FIBER DRUM ^ m GLASS BOT'TLE ^ q. RAIL CAR 0 b. UNDEItGROUND TANK ^£ CAN ^ j. BAG D n PLASTIC BOTTLE O r. OTHIIt ^ a TANK INSIDE BUII,DING ^ g CARBOY ^ k BOX ^ o. TOTE BIN ~ d. STEEL DRUM ^ h SII.A ^ 1. CYLINDER ^ p. TANK WAGON ZZ3 STORAGE PRESSURE ~ a AMBIENT ^ b. ABOVE AMBIEN'f ^ c. BELOW AMBIENT 72q STORAGE TIIvIPERATURE ~ a AMB~1T ^ b. ABOVE AMBffi9T ^ c. BEIAW AMB~1T ^ d. CRYOGINIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 50 ZZ6 PETROLEiJM OIL zz~ ^ Yes ~ No zze 8002-OS-9 Z29 2 230 231 ^ Yes ~ NO 232 233 3 Z34 235 ^ Yes ^ NO 236 237 4 Z38 ' 239 ^ Yes ^ No 2ao 241 5 24z zas ^ Yes ^ No zaa zas If more hamrdous components ere present at grearer than 1% by weight if non•carcinogenic, or 0.1'/. by weight if wrtinogenit, attach additional s6cets of paper capturing the required intormatioa ADDITIONAL LOCALLY COLLECTED INFORMATION 2a6 r ~ If EPCRA. Please SiQ n Here UPCF (1/99) 6 , OES Form 2731 UNIFIED PRUGRAM CONSOLIDATED FORM ' . ~,. ~ . xa~aRn~us 1vrATEKx~AI:s HAZA~OUS 1VgE~`~'~+ IZI~S ~NVEN7F~RY - CHENIICAL DESCRIPTION ' : .... _ .. _ . : . __ .. . ~ ~ ..: ., ~~ ~ ~ie;ei .t~;~iam m.~ : _ _. ~ADD . , ODELETE ' ~REVISE . .2~ -- , Page:._ of_ . I. FACILITY INFORMATION - BUSINESS NAME (Same as FACII.TTY NAME or DBA - Doing Business As) 3 AiJTOZONE # 3311 CHEMICALIAGAT'ION 201 CHEMIGAL LACATION CONFIDENTI:4L EPCRA 292 STOCK ROOM ~ O ~s ~ No __.__ _. .._ ,. FACII:ITY ID # ~' . _ ~~~ ~r~ ~ Ivipp# ~a~s,o~> 203 _ G~, (o~~> 2oa ~~ ~r . II. CHEIVYICAL INFORMATION CHEMICAL NAME Zos TRADE SECRET ~ Yes ^ No , zo6 SPENT SULFURIC ACID ~'su~~ m~cxn, n~ ~o ~uo~ COMMON NAME zo~ zos EHS* ~ Yes O No SFENT BATTERY FLUID ACID CAS#. 209 7664-93-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (compia~ ~rny~a by c~mn~ zio CORROSIVE HAZARDOUS MA1'ERIAL 211 TYPE (Check one item only) ~ a. PURE ^ b. MDfT[JRE ~ c. WASTE RADIOACITVE ^ Yes ~ No 212 CCJRIES 0 z13 PHYSICAL STATE 214 (Check one item only) ^ a SOLID ~ b. LIQUID ~ c. GAS LARGEST CONTAINER 30 215 FED HAZARD CATEGORIES zt6 (Check all that apply) ^ a F1RE ^ b. REACTIVE ^ c. PRESSURE RELEASE ~ d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNf 217 MA,lZMUM DAILY AMOUNf 21$ ANNUAL WASTE AMOUNT 2~9 STATE WASTE CODE Z20 1000 1200 30 000 791 iJNITS° ^ a GALLONS. ^ b. CUBIC FEEI' ~ c. POUNDS ^ d. TONS 221 DAYS ON SIT'E: 365 '-22 Check o~ item onl • If EHS, arnount must be in o,~as. STORAGE CONTAINER ^ a ABOVE GROUND TANK ^ e: PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^-m GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK O f. CAN O j. BAG O n. PLASTIC BOTTLE ~ r. OTfffit ^ c. TANK INSIDE BUII.DING ~ g. CARBOY ^ k BOX ^ o. TOTE BIN ^ d. STEEL DRUM O h SIIA ^ L CYLINDER ^ p. TANK WAGON Z2g STORAGE PRESSURE ~ a. AMBIENT ^ b. ABOVE AMB~IT ^ c. BELOW AMBIEN'f zz4 STORAGE TEMPERATURE ~ a. AMBIENT ~ b. ABOVE AMBIINT ^ c. BEIAW AMBIENT ^.d. CRYOGINIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 34 ZZe SULFURIC ACID zz~ ~ Yes ^ No zza 7664-93-9 z=9 2 230 231 ^ Yes ~ NO 232 233 3 z34 ?35 ^ YCS ^ NO 236 237 4 23a 239 ^ Yes ^ No zao za~ 5 242 243 ^ Yes ^ No Zaa zas If more 6amrdous wmpoumts are present et grester Nan 1% by weight if non-careinogenic, or 0.1 •/. by weight if carcinogeniq attach additional shee~ ot paper captnriug the requ"vM informatioa ADDTTIONAL IACALLY COLLECTED INFORMATION za6 If EPC Please Si Here UPCF (1/99) 6 OES Form 2731 UNIFIED PRUGRAM CONSOLIDATED FORM ' ~., ..._ ~.. ... . HA7,ARDOUS MA'Y'ERIAI~S ~A7~,AlR~QUS 1~7~~'ER~AI:,S HNVEN~'~1ZY - CHEiVIICAL DESC1tBETION~ ~ . . . ~ ' ~ : . ~ ... . . . _ _. '. ~ ... _ . ... ~~...: .:_ . . ~ ~ . _ : . ~ , ~ ' (one.~ a' e -~ mazerial . . ..tiuildm -`or ffiea '.. _. _ ... . ... . _ ~ADD _ ... ~DELETE. _ _,. ~REVISE..... : _ . ,. ,. 200 _ .. __ _ _ Page'__ of :_... I. FACILITI' INNg"ORMATION BUSINESS NAME (Same as FACII.TTY NAME or DBA - Doing Business As) 3 AUTOZONE # 3311 ~ CHEMICAL IACATION 201 CHEMICAL IACATION CONFIDENTIAL EEGRA Zo2 STOGK ROOM ' _ _ _ _ _ _ ..._ _ ~ ~s ~ rro _ __ _ __ ' ~~~ } ~~~~ 1 MAP# (~~) zos G~ ~~~~ zoa ~ FACILTI Y ID# S g~ • ~~ a~}:2:. l~ II. CHEMICAL INFORMATION CHEMICALNAME Zos TRADE.SECRET Yes ~ No Zab PETROLELTM OIL ~sug«<<o fircxn, T~a to ~~,o~ COMMON NAME " zo~ zas EHS* ~ Yes O No WASTE OIL CAS# 209 8002-OS-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requ'vod by CUPA) 210 COMBUSTTBLE LI UID HAZARDOUS MA1'ERIAL 21 ] TYPE'(Check one item only) ^ a. PURE. ^ b. MIXTURE ~ c. WAST'E RADIOAC'TIVE ^ Yes ~ No 212 C[JRIES 0 213 PHYSICAL STATE 2~a (Check one item only) ~ a SOLID ~ b. I.IQUID ^ c. GAS . LARGEST CONTAINER 220 215 ~D HA7ARn Cp'j'$GORIES 216 (Check all that apply) ~ a FIltE ^ b. REACTTVE ^ c. PRESSURE RELEASE ^ d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAII,Y AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT z19 STATE WASTE CODE 220 11~ 22~ $~2~ 221 ~~ LINITS' ~ a. GALLONS ~ b. CUBIC FEEf ^ c. POUNDS ^ d. TONS DAYS ON S1TE: 365 ZZZ Check one item onl ' If EFIS, amoucrt must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROiIND TANK ^ e. PLASTTC/NONMETALLIC DRLIM ^ i. FIBER DRiJM ^ m GLASS BOTT7,E ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ a PLASTIC BOTTLE ^ r. OTf~R m c. TANK INSIDE BUII.DING ~ g. CARBOY ^ k BOX ^ o. 1'OTE BIN ^ d. STEEL DRUM ^ h SII.O ^ L CYLINDER ^ p. TANK WAGON yZ3 STORAGE PRESSURE ~ a A1vIB~IT ^ b. ABOVE AMB~1T ^ c. BELOW AMBIENT 224 STORAGE TIIvIPERATURE ~ a. AMBIEN'f ^ b. ABOVE AMBIINT ^ c. BEIAW AMBIII~]'f ^ d. CRYOGINIC 225 %WT HAZARDOUS COMFONENT (For mixture or waste only) EHS CAS # 1 100 Z26 PETROLEUM OIL zz~ ^ Yes ~ No Zzs 8002-OS-9 zz9 2 230 231 ^ Yes ~ NO 232 233 3 234 235 ^}'~ ^ NO 236 237 4 238 239 ^ YCS ^ NO 240 241 5 zaz zas ^ Yes ^ No zaa 2as If more hamMous components are present et Srester then 1•/. by weig6t if non-carcinogenic, or 0.1% by weight if carcinogmic, attacA edditional cLee~ of paper eapturing t6e reqnired Wormation. ADDITIONAL LACALLY COLLECTED INFORMATION . Z46 If EPC Please Si Aete UPCF (1/99) 6 OES Form 2731