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Home My WebLink AboutHAZ-MANAGEMENT PLAN 10/28/2008• Unidocs - Uniform Documents 1~'~` ~'7 i Z ~ ~~~~~~I~,~~ ~~~~r~~~~ ~~~~r~~ ~~~~~~~ ~'r~~~~~ Page 1 of 2 Viewing/Upda#ing Facility Information After modifying the faci lity informatian below, click'Update Faci(ity' ta update the database. No Users Have Access to this Facility I. IDENTIFICATION FACILITY ID#: 1_5„~_..{ 021..._....~^' 004005 ; BEGINNING DATE (MM/DD/YYW) ENDING DATE (MM/DD/YYYY) 10/16/2008....µ ... ..........~ _...~ ~ BUSINESS PHONE (IiN#) tiNk-#### BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) x#If#N GM CUSTOM PERFORMANCE AUTO REPAIR 3 ; _~_. ......... ___~. (661)861-0683 ~ BUSINESS SITE ADDRESS: 332 BRUNDAGE LANE _...~~_~ __.. _ . I ~ .~_ _.._.... _ CITY: ~..._ .... ___ _.... .._.. ~ _. ..._~ ~ _ __ .. ._._~ ... STATE: ZIP CODE. BAKERSFIELD _.~_,., _. ; CA 93304 , _._ _ _.~. DUN & BRADSTREET: _.... __~.. ~ ._..~_. ~ SIC CODE 4 di it #: -~ .~..__~,._._..~..__.....,..._......._..~.._..._........_._.._.._., COUNTY: _..~.. ~: ~~ ...................~ _.~.._.M.._..._._....__~ KERN __ ~ _.. ___._ ~ : _~_.. , _..__. ~ BUSINESS OPERATOR NAME: _...._.. BUSINESS OPERATOR PHONE: (#k#) Nfl#-ftfi## x##~l# OBDELIA GARCIA (661)428 6687 ~ II. BUSINESS OWNER OWNER NAME: OWNER PHONE: (#k#) li##-t~### xlftt## OBDELIA GARCIA __ _. ; (661)428 6687 ~ . OWNER MAILING ADDRESS: __.. _ ..._...~ _ ~~.~._ _ _..~.. 737 S. FAIRFAX ROAD .w„~__.~...~.._.._._..._..~ _ .._..._ : CITY: _....__..~~.....~~ ~ ............._.._....._...__..._. _.__._.~.. ~. ..._.~ _._~ STATE: ZIP CODE: BAKERSFIELD ~ __......,, ~.~_.. .,.,..,~ CA 93307 .. ~ __ ._ . . ~ ~ ~ III. ENVIRONMENTAL CONTACT CONTACT NAME: CONTACT PHONE: (tl##) ###-k#N# OBDELIA GARCIA _... _ _ _ _.. x#{f#k ___.; 661 747-6814 _ ~ , ) ~ _... _._._._... _. CONTACT MAILING ADDRESS: 737 S. FAIRFAX ROAD .~~.._.._....._..._~..~..~ .~ ___.~.~,..~._ ___._._.~_...~ . : CITY: .. _.._....... _._______......___ _...__.__.__.__._ STATE: ZIP CODE: ~BAKERSFIELD I CA ;~ 93307 , IV. EMERGENCY CONTACTS -PRIMARY- -SECONDARY- https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004005 12/3/2008 • ~ ~ '`Unidocs - Uniform Documents NAME: OBDELIA GARCIA TITLE: OWNER BUSINESS PHONE: (~ift#) ~##-##ii# x#kNit ~ (661)861-0683 ~ _....__.~ ....................._..._..........~: 24-HOUR PHONE: (1!N#) ifNti-###ti x#riNH (661)747-6814 ~~ PAGERi-: ~(661)747~6814 ~ ADDITIONAL LOCALLY COLLECTED INFORMATION: NAME: DEMETRIO GARCIA ; TITLE: OWNER ; BUSINESS PHONE: (###) iik#-it### xk#NN (661)861-0683 .. ............._......______ 24-HOUR PHONE: (#ii#) Hk#-#illf# xN#kN (661)428-6687 ~~ PAGERtt: (661)428~6687 ~ ~~ Page 2 of 2 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certity under penaltyof law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. DATE: (MM/DD/YYYY) 10/16/2008 NAME OF SIGNER:~~ ~~ ~~~~~~~~~~ OBDELIA GARCIA NAME OF DOCUMENT PREPARER: OBDELIA GARCIA TITLE OF SIGNER: ~~~ OWNER ; UPCF(1/99 revised) Back._to._Activity._Selection OES FORM 2730 (1 /99) home ~ whaYr new ~ mem¢err a~~nc..ie..s.. ~ doc~ment~anci r~rvices ~ rg~rC_h._4~ni~iocs ~ contact Ng related_links ~ training and. meetings For comments or questions regarding the HMIS project, contact the Qn.l.ine_D.~ta.b..aSe._A.d..mini.$tr.ztqr. hosted by Ci.ty_of._Palo Alto https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004005 12/3/2008 ~,w'~ 0 HA~ARDOUS MATERIAL MANAGENIENT PLAN ~.~ , . , "" .:: .: : . .. : .. .. . . „ ,.: . :, -., : "..h:'^ r ~d,'` ~ ~: APPLICATION BUSINESS OWNER/OPERATOR IDENTIFICATION FORM '~ (HAZARDOUS MATERIAL FACILITY INFORMATION) g~~2 F/R6 A~ T BAKERSFIELD FIRE DEPARTMENT Prevention Services , 1501 Truxtun Avenue, 1~` Floor Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 2 r . , .,, ... : . , I ~FACILITY IDENTIFICATION~~ ~ ~ # +~- ,Y~ ~ ~ , ., . , . . ~ , .~ , . . ; ~. . , _ ~ ,~ .. , , . , , . . .: . , . , . r ~ ,, ~ g . . ... . . . ,. ,.. _.. .. , ~._ . _ _ . ~,_ , ~. .~ _ .. , ~. . .. ~ ~. . ~ .. . ~ . .'. ~ ~ _. .. FACILI7Y ID # / , ~ " b p tI b 1 YEAR BEGINNING 100 YEAR ENDING ioi ~.y T BUSINESS NAME (Same as FACtLITY NAME or OBA) 3 BUSINESS PHONE lpZ ~~1`~ ~ ~ ~ 1- 6~ r r c~ o i Sl'fE ADDRESS 103 ~ a r~ cc ~ L . Cm, g~C V~~S~I C~T -~ ~ a~ ZIP CODE 105 1~ . . C~ ~~J3~ DUNN & BRADSTREET # SO6 SIC CODE 107 g COUNTY lpg .e~ ~r. C~.~n OPERATOR NAME 109 OPERATOR PHONE 110 i f ' }f 4. / % { '''~~ V 1}~1 ',1~ ~th ~{~t ~slM1t L k~~,jXS( ~ p1 (i `~' Fi~" ~'i E_'.'1 Hk i~" kF" ...4 ~ F } n,, s : I~ t~~ 0 ..-'f~~. ) ~ t ~ ~~ 1 1 t !' l df I t .~ S.. .. l. .~ l"~( ~ t! ~ ~f t .. 4 4 ' 4' F'v"`~tF i'? '!~~^N ~ Yif f} ~ , 4 ~. ~^t 44g W:...4~'~f 5 TM~17~ k r~f e ~1~ k 1 . 4 ~ ' C ~] '~ . 7 T', i~ 4' 1 r f - i t ~ ~d ~' T ~ 3 ~ x ~ y ~ 'w 1 J ~ '~M1t ~ , .~ y 1 n.. I~ .. l ' 4"~ r~ F , i~ 1 ' 'S f II OWNER INF , ORMATION r~ ~ ~ ~ t ~~ s ~ '' ~ ~ ~ l M ~i {;. lA t l ~: ,1 h ~i h 1 F I R~ t ,t ,.k ; ~~"a/" Y.. 3'd ~ , 5 L 1 1. M - 9 :,h'. .. ~ , p ~~: r > t°~ ~ ~ ~~ ~ F ~ a s ~ ' ~ x E ;:;L , ~~~ < .~~ ~ t~~ " nti ~ :,}~s,.. , ,. ~u.~ . ~i;~ ..rf,~ ,~ i~~. ~~ „ .. ~ . ~ , ~_ ..:h ~ ~.,9~y1'. ~iw~~~r~~Y:,~'',t~, ~o ~.,;h~~D~"1~~'~4"Gt.aN~1 ~}. ~~3~,~},N t '~ , >., wT, ~ ~ 3q,.+«' - . . ~ . . ,. ~ ., ,~ a . .~ . _.r ., ...~ i ~r ~ ~ , ~ ~ , ~,. ,, .., ~ . ~ "Y wq+t1~ t~,~uy .r S+d~., s p E "~Ce ~. ~~f~"`~ ~U1a .lt~wd "F~'~5~ ~7~fri t~ . M i . ... „ . ..~ ,,.v . ,., ., .. . . ~ , m ., M ~, , x .~, OWNER NAME 111 1 ~ d~ ` ~ OWNER PHONE 112 ~ ~em~kY ~O o~rc'~ - ~h~~7 a~S -(ob l OWNER MAILING ADDRE55 113 -~ a ~ s~ ~~,~ -cux ~~ Cm 114 STATE 115 ~ I~ ~d c f~ h~ ZIP CODE 116 ~ 3 D ers e, 3 1 r 'd~'~ * .~ 1~ S 4'. ~} u ~'~'H.j f ~, 9 Fr rL ;° .T'` 4 k ~` ~' y~".*~'- r*J .`c.t"` _ q~"~`! F~,F"n. 1'e S v: 4 ^k- y3 .`~y.W 5~.• ' 1 t \' 4 } iS ~, Y ~ ~ ~ ~ ~ ~ ~; ~ ~ ~ F ~ ~ u ~ ' ' ° i II ~' ~ ~ ' ~ I `~ E NIR AL~C T ~~ ` ~r N ONMENT` ONTAC ' ~ ~~~ t ; Y ' , a ' ~ ~ ~ ~ ~ . , ~ ,z ~ z~ <~ ~ $,.~~ ~ ~ - ry~t.. y ) • y .b Y .:S ~ r''! S , . i~:, u ~, +k~ f, sa`,'~''~.. f#~,aS.~ `2~ Y-:.,.yM1.~t~°;tis~.r ..t'~ _ 3 Y.'_'$.::~*,.~ .t~. ~'k, 4" Y~.. '. s 1 , • ~'S. .'~'' r: `~ ,~ !''t`. .~f. , ~,-,~'•l~..a `SK'4.~~! CONTACT NAME 117 C~~A~T ~ONE 116 obde~:c c~ ~c~ru~ Cio(~~~~~41- ~~ ~g CONTACT MAILING ADDRE55 ~~9 ~~ 31 S-'~ci, ~~~~ x ~ et CITV 12(1 ~~~1~e~sr-;tic~ STATE 121 c ~ ZIP CADE 122 ~3 ~~ _ . , . ~ :IV `EMERGENCY CONTACTS ~. ~- ~ µ ~, > , ~ ., ~ k r l ~ ~ , , v .° - t ' . , ' Y, # ~~ G?. ~: 3 .. a+ L Y& j : ~; PRIMARY ' ~~_ ~r~ ~ ~~~ = S CO D < ; k ~~ ~~: s.~ ~~~~, ~ E N ARY, ~ ~ ,. ~ ,~ NAME 123 ~~oc~~~~c~ ~GfG~ NAME 128 ~en e ~~ O ~~~ ci ~ T~T~E 124 TfTLE 129 (~CN ~JL ~ C7 W 1'`R ~ BUSINE55 PHONE 1Z5 (~~~ ~8 ~ (-~1~g3 BUSINESS PHONE 130 (~~i~ ~sc~ ~- ~1~~3 24HOUR PHONE 126 24HOUR PHONE 131 ((o~Dl~ ~~ 1 - ~g ( ~ (o(P (~ ~f ~ ~S -lo (o fr' ~7 CELL PFiONE 127 CELL PHONE lgZ C(~ (~ ~7 `7q 1- l~ g ~~ (o c~~ 4~ 8' -~ c~8 ~7 133 3 t~I N~;, '~~~.i ~ ,I~'t M1r~it kkid` '°I, dl$ 4i~~.j~ j tk w~.: ~~~.;R~~':-r ~v.t~~ ~ Ek~. lY ~ J N l7 N 4~k4 Y1~!~~ y r i ~ ~6 r N n ~.. C, '-~ F.~fv 4~ Gj~ f ~ TK; k.4~`,.i ~~~4 W~ 4 11,~ w.~4 ~k~p~r?' ~ ~~ ~ ( ' ` ' ~ " ~ ' " ` ` ~ t , ~ ~ ~ ~ 4 ~ ~ R hv'~ 6'M17 k~`~ !M~~~ I { 1 ~ ~ t~ { ~ CERTIFICATION ~i ~~~F f w E '~ ,~'f~l ~R { ~' hM1":~i~' ~ ~~f~ '~ N~~{, Fli {~ : ~, \ 1 a h':if"n~UJ K r! ~ S l~ J:~, "^~ ~/ ~ t'a ~ 4 `; ~ ~ ~ `A E ~4 ~ ;q ~ G~ ~ C L } ~i` » 0`.7~ N ~ ; ~, t t ~k ~' ~' '~ 1 "~ '~ Y ~ ~ ~~ 1 ks •'~ ~ ~ n ' ~ 1 C~' ~ ~ ~ .f ~ ~ 4 i f d n ~. ~ ,y 5 ~' ~ .: I" N' P 1 1/ N -I 1 ` ~1':;i.,p 4 ~Vly~: . .4 ~ .F~~YI'A ,. . ~ 1~ iria l~kl r~'~Ir d ~Tr '~~. . ~ t ~~k' «'t~lM1. «i~u~. n~ . ,~~J~'~.h~. .,~t~~.rth?~,..n~,.' ,F,.. ~il.~..4M1k. ,~.N!R.. 4 {-.~,Y~:wi.~t, ~ '~.~F..~~k i~~:4b~f>~, ~X~~.h.~i'1- 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, accurete, and complete. SIGNATU E OF DO UMENT PREPARER 136 ~ ~ ~ATE 134 ` NAME OF DOCUMENT PREPARER(PRINT) 135 ~ ~G . ~ ~~r~ ~ ~~ ~~bIG ~b~~e~ ~~ c~~~~:~~, NAME OF OWNER/OPERATOfi (SIGN ~ PRINT) 137 TITLE OF DOCUMENT PREPARER 138 ~ a aRSnr n FD2142(Rev O1/08) HAZARDOUS MATERIAL MANAGEMENT PLAN~; .~ APPLICATION - FOR SECTION DISCOVERY & NOTIFICATION z'~ (FORMS) BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1~` Floor a s x s r i a nBakersfield, CA 93301 P/R! Phone: 661-326-3979 • Fax: 661-852-2171 ~ ARTM + T ~ 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. Be as brief and concise as possible. .. . . . ~ ~' " 3.' ~~ ~ p" z~..; .~ -'~ag '::.~, ,.~'~, -' y ~'4, ;... b , ~, $. ~,::'1 ^`s.:.< \' 'i` S 'l+ '. SECTION''I FACILI=T~1(~IDENTIFICATION "~ . , . . _ :..,. ., __ v, _ ~ _ _, __ ~. . , . , ~ ,w . . BUSINE55 NAME (FACIIITY NAME or DBA) ~ ~ 1 ~ u~ r ADDRESS (for local use only) ~ ~ ~.~ ~ ~ ~t/11 ~.~Q , _' ` " FACILITY ID # r 1 ~ , .i~,. 4 , ~ 'ttt 7 " ' '~` "L"~ ~~~. P' -~:..'t 5.:~./ p p ~ts ~ykt ~~ ^ ~"~ ~ m 3F(S a~ F ~'c,~" ~ ,:aWr C~" ,.s ~; ,'~n ,~f ~ RL'~ c a`:x~i k'`fi 4~ r Q i G . ~ YT ;, yy` ~a' .-~ 'hy~~;: . .. ~ ~ ~ ° , ~ SECTION II ly: y ~DISCOUERY~AND NOTIFICATIONS~ ~ ° "- ~ ~ ` "~~ "' " , ~, , ~ . . s ~ , . ~.... _ ~, , . ~ ' . t ~ ., -.,4 .a,., _..... _ ..... . z'~.~ . ~a .. .~~k . ,.._ . _ ... x P ~' d k , ~ c,.y ~~' .. ~.. ~ .. ~. . . . ..... _...,. . . ... _. . ..~... _ ~,..:.._. ~ A. LEAK DETECTION AND MONITORING PROCEDUR : ~" v d•~.'1 ec1' c~ lz a 1c_. •C~-r v^c~ 0 r.~.~c ~; 2 0~~-k~~ ~ v~.~.C v,! ~,' l\ jvi S~ i la -~i c-~, '~~ 'y-~i ~~.c.c~S c~..,i, I e--(~, ~z~e. ~av~. B. EMPLOYEE AND AGENGY NOTIFICATION: co~~\ pb~e, ~~+ ,41-t~g~9 ~~r ~.e~,~,-1~-~o c~-~r ~1a8-~~K7 t,•s cc~-~ `1 I~ . c~r (.~~-~~ t_,.P ~ ~fr ~'~C.C'i~e'~;SCt1CvJ SE~~l1CES 'A.--~ ~8O • ~5~~~1~d C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENGY MEDICAL PLAN: ~~ 1l~ino ~II~ • . ~ ' - - ~ . ~ - 1 ?t ,:t-a ...+ c~t ~"yy ~ ~:~~° ... ~r s .. .~,.. ~, t ~ , a~ r , , ~SECTION°II.2 ;:RELEASE RESP`ONSE PLi4N ;;r ' ~ t A. HAZARD ASSESMENT AND PREVENTION MEAS ES: ~ ~~vlJ ~.. (~~ i"~%t •'~2~5 v~ ~, .i ~ +~ --~ G1 S ~~~ Z ~ ~ 5 ~= ~ ~~. `~"~'UZ."v,~- iNG ' ~~~ IJ ~ 1\i'~' ~~~-~c-l:t'N'~~ ~w1Ct (r~G'l~~ ~~, ~i~L~'1 C'~~.t~, ~ ~~ ~,~ d ~ v ~ ~. B. RELEASE CONT~, NMEN+T- AND/OR MITIGATION: ~~ Ul C~1 YJ~c'~ (~~,21~(.~1c2v~ ~~ ~:iC ~'~`"~ `__~~L~a. a-~.i..•J.,2J,SC?l~?n .~ 1'Z~l~L(~Z L'i~ (~- ~ . ~N~C I :~t.~.-~~.vr~- c_~-~.~, a~C -~.~- c~~.r.:-t-u--~,,,~.~- b ~~ .~ , ~''~ `j t2,~\c`.~:~~ ~ v~~~~N i-~--~:2(..~ ~ ' c~.~vlG v1c ~ ~~ix?c;l- C. CLEAN-UP AND RECOVERY PROCEDURES: ~~.~~ ~. u~ ~ ~ a5. FD2169 (Rev 01/08) Page 2 of 2 ; ~ - - ~ ` ~SECTION~II.2•~ ~RELEASEa RESPONSE P~LAN ~'(CONT) ` ~`~~a ; ` ~,M T .r. .,~:r. ~~,~xr~: ~i.~• .a. <.M t~. UTILIfY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) ~ ~'1 ~ ~ rl`~" ~l /1 b ~ ~ ~T ~•'l ~~ f t G~L 1 W ~l C O O 21r, T ' ~ ~ ~~l' ~~%C d-~1 ~~ ~, ~ ~ . PRNATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: -(~ r ~ ~w -4-i n o~~c,<:c ~ ~'~ - -~ - f ~ c~v~ (~ ~ y~e~ t-~-~ ~ • ~ -~'tY~ 1~C~~~/~'LC-S ~(S. ~ b B. WATER AVAILABILITY (FIRE HYDRAN'~: C~ ~ Y ~- h~~/LGtt,-~ • ~ ~ ~ ,~~ ~ ~-~-~ . ~ ~ ~ , r~ c~ ., . ,.. . '° ~ `SECTION~ III:, TRAINING - :~~ :~:~. `.; 5 _=x ., _. .. . : , . . ,~. . 4. , y. . ,,.._ ~_.„.;:•, ~ . ... , ~. . , r ~. ~_ . . . , . ~: , ,-;ak ~, _~.i , , ..r . , .: ... ... - , NUMBER OF EMPLOYEES: 'i'Z r~~r .~ ~;~ ~ ~ 4 ~~~ " ~~ ~~'1~-w1 ber• ~~~1--e~. v;~r MATERIAL SAFEfY DATA SHE N FILE: ^ YES ~NO IF YES, LOCATION: BRIEF SUMMARY OF TRAINING PROGRAM: .- . ~:' CERTIfIC~ATIO'N ~~~. ~ - , .. ~ . . . . , .; . , ~ ., , . : , . .z~,~a ... ,,~ . .~.~ ..t .. ,., , - ~ ~ ~~ 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. SIGNATURE OF OWNER/OPERATOR OR ~,/c9~~~ ~ ESIGNATED REPRESENTATIVE ~~ ~ DATE 477 tb la-~ ~a~S NAME OF SIGNER (PRINT) 478 ~'Uc~Q,~ f G~ ~c~Ll ~ 7n~E OF SIGNER 479 ~C.~~(lQ~(, FD2169 (Rev 01/08) HAZARDOUS MATERIAL MANAGEMENT PLAN ;:~ CHEMICAL DESCRIPTION FORM ~" HAZARDOUS MATERIAL INVENTORY r'~Y ^ NEW ^ ADD ^ DELETE ^ REVISE zoo B B R S P I D P/R6 A~ f BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1~ Floor Bakersfield, CA 93301 Phone:661-326-3979 • Fax:661-852-2171 Page 1 of 2 llne F...... .. ~.1 ~} . " . . - - t: .. .~ ~" .Y+ . , , .~ ,ti~ ~ ~ '~°~ ~ fi~~ A~I FACILITIf INFORMATION ~ ^ ': ~ ~ _ _ ~~~ ; ~ ~ " ~ ~_ ° t ~ , ; ,C ,., . . , . „ ~ . . : ~' .:.~ S _. F . - . ..k ,~ . . ~. . ., ~~.i . ~ . , _.. .„..> ._. .,., ,. _ .~...,. ~ , ~~.~.:._,. , .~. ,. a~ ~+- , . „~ -k.~~ ... .. ,.. . ,. ..._. ...,_ .. F ,..... . , n . BUSINESS NAME (FACILITY NAME or DBA) 3 --~. 1 ~ ~~ " ' ' ; , ~ ~~ ~ ~- i~ ~,~~,nC~ ~. ~ ~ CHEMICALLOCATION '_ 201 CHEMICALLOCATION 202 ~ ..;1v~ ~ - CONFIDENTIAL (EPCRA) ^ Yes ^ No FACILIIY ID # ~. ~ '+ 1 MAP #(optionai) 203 GRID #(ovtionap 20a ":.,' ~ ~~~ ~: r;5 ' .. Y 4 !N'.l ~F6'~.'4 ~ ,lryy..'i~ 4y~ µIT..~ ~ p I < ..~. R ~C Z ~.,~ ^F~ ~$ 4. ~}` r5 .} ,~~,r,,,NYk~,YRC f rt"..t«'itij{ tM 5~ M1t,'hr ty~ '~ t ~ ~' ~ ~ ~~ ~.n.~x}ss~„i~r ~,~:~t,~ar~t~~~ ~a~h'~r r~ !~f ~la r~,.."~" ~ ~f of ky d}~ "t~,~z'~'{ k~`~xF ~ ~'~ '~ ~, ~ ~ . ^ ,,. , „ ~ ~,, ' ~ a ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ I ~~ M AL I FORM TI ~ ~ 4 ~ ~ a ~ r ~~ ~ ~ k ~~ a ~ ~x ~; I CHE IC N A ON ~ x ~ 4 ~ ~Z 7 ~ h ~ ~ ~; ~ , } , ,µ 9 , . a~ r ~ ~v ~ , ,i r a , ~, :. . ~, r4 . 1 7 ~ h.. ylilr 7 . . s~,3 ~ ':2 x e fi~Ai ., .N v~' , ~ ~.51 4rnte, 4 ~ ~~~..i . ,YC~, ~' ~ { 1 a ~ ~ ~ .s:~ ~ ~ ..l.7~ a . L. ,~1.. , 3.-'`~a., ~ .~.1~.? CHEMICAL NAME 205 206 TRADE SECRET ^ Yes ~ No [f subjec[ to EPCRA, refer to instructions COMMON NAME Zp7 - EHS* ^ Yes f~ No r!1 " 208 CAS # 209 'If EHS is yes, all amounts below mu5t be in pountls. FIRE CODE NAZARD CLASSES (complete if requested by local fire chie~ 210 TMPE -." Zll ^ PURE y~ MIXTURE ^ WASTE RADIOACTIVE: ^ Yes ^~o Zlz CURIES 2i3 /V LARGEST CONTAINER 2i5 PHYSICAL STATE 0 SOLID ~ LIQUID ^ Gas 21a ~S ~I 216 FED HAZARD CATEGORIES ^ FIRE ^ REACTIVE 0 PRESSURE RELEASE 0 ACUTE HEALTH ^ CHRONIC HEALTH (Check all that apply) ANNUAL WASTE 217 MAXIMUM Zlg AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT DAILY AMOUNT CODE ~ ~ ~ ~~~ 221 DAYS ON SIfE 222 ^ UNITS~ ^ GAL ^ CU FT ^ LBS ^ TONS ~Ii ENS, amount must be in IDS. STORAGE CONTAINER: ZZ3 `ry y~ ABOVEGROUND TANK ^ CAN ^ BOX ^ TANK WAGON \ ^ UNDERGROUND TANK ^ CARBOY ^ CYLINDER ^ RAIL CAR ^ TANKINSIDE BUILDING ^ SILO ^ GLASS BOTTLE ^ OTHER ^ STEEL DRUM ^ FIBER DRUM '~1 PLASTIC BOTTLE 0 TOTE BIN ^ PLASTIC/NONMETALLIC DRUM ^ BAG 22a STORAGE PRESSURE: ^ AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT 225 STORAGE TEMPERATURE: ^ AMBIENT ^ ABOVE AMBIENT ^ BELOW AMBIENT ^ CRYOGENIC %WT HAZARDOUS COMPONENT EHS CAS # 1 226 227 ^ Yes ^ No 228 229 2 230 231 ^ Yes ^ No 232 233 3 234 235 ^ Y25 ^ NO 236 237 4 238 239 ^ YES ^ NO 240 241 5 2a2 2a3 ^ Ye5 ^ No 2aa 2a5 t + ~ ' y vx~ x * ~r ~ r i~r,.' ' Y ~' i - ~~y ti q -. ~ a ., ~ ~ .. ~`. ~ { £ j ^ < ~ ~ ~ tA ~ ,~ y ~ ~ ~ `L` 1 k.? i L l ~F ~1 A ~ y k. ?, +`t, 5~,*. ' G : .y~" ' F~S L { ,} +'kl~jr' .! '~. r.~ `kf ~ 4'C ~ r ~" `, ~ r III SIGNATURE 3 , ~. ~ ~ ~ f ~~ , ' ,. .G ,. , . ~ ~ ~ : ~ ~ ~ ~ , , ,M , , ~y ~ ?~~ ~ ~q;. ~ , , ;, ~ . r . ~, . ., wF~, ~ ~M , C4A_;~A~ ~ i , ~ ~ ~ , a w,M E~ ~ . ,~`. ;k, .~ ~ ~ ~ . . . . w „-c ~ F < _ kL+ .. r s 1. ~. , "W . . ..L~G ..'s!~ . , n . y'~ri . ~ m. ."F , v ~ ~,:' , i 4 .. . . ~...t ... . ..,,..r~. PRINT NAME & T1TLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 FD2144 (Rev 01/08) HAZARDOUS MATERIAL MANAGEMENT PLAN 1~ ~. - :z ..:~.~. H H R S A I D BUSINESS ACTIVITIES PAGE ~Rru r (HAZARDOUS MATERIAL FACILITY INFORMATION) ~ Paae 1 of 1 BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1~` Floor Bakersfield, CA 93301 Phone:661-326-3979 • Fax: 661-852-2171 1:~ 1 h f. 4y ~ T'~ t {~ ~ d~l i}~' ~ ~ Z'~. } ~It.~e.7•L h~ ~..7'~ G y ~ F .~1t' y''t i. r j:5 _ Y~ ..+ ~ `.i ~ ~ Fr. ~ ~I ~ ~ ~ ~ ~ ~ ~ ~ ~ ':4.i .{~ {~ f~ 6 i~; ( Mt ~ C 1~ ". K ~ F H ; ~ ~ 4 h' ;~ X't s~" : F `x F ~ 3'L '1 t r T d 'M n r ~; ,, E ~~ ~ ~ I~~ F~ACILITY IDENTIPICA-TION ~~ ~ ~~ € a ~ ~~ ~ ~~ ~' ~ , , , ~ h~, xt ~~ ~, L~ ~ ~ , ~ ~ , 1,~ X ~ , .. , _ ~ . _ .rN.~. [ ~l~ ~~ ~. .. .. ,~ . ........ ,e. ... ~ ., , ...T~.: _. ~ ~ a. ~ t , a.,s. a 3) _ ~Sh b tkM„ .G.. .{},. b4. ntl`~trLtl~'t ,.l S.1...}{'~F '~ i''hb. h'1'e. .Y~ of ~.~i~ .Y.. ~r~ I.H'k.,~i:i~~ FACILITY ID #(for office use only) 3 EPA ID # BUSINE55 NAME (FACILITY NAME or DBA) ' 103 ~m ~ ~. S~ ~ ~ ~~a~~~ -s-a ~~ ~ ~ ~. 4 1 `f ~1 3 "SL~-I ~ E t t alif , 4..i A~ ~! ~#~~,4~ ~ ~~ ~ ~r' :. 5 ~4 3 ~.. . ~~ ~ .. ~ ~ ' 7 4 ~' 3 " y~ , ~ L~ v' N 4~Y S S~ ,P r L~ t 4N ~h J ~ ` .: :; ; ` `~x ' ~ ~~ ~~~ x ' II ~ ACTIVITIES DECLARATION~ ' 7 x ` ` ~~ ' ~ ~ r - ry `,; ~' ~ , , ~f ; : , ~~ ~ t ~ . r, ~ ~ ~ .. ~ y~a f _ f d .fi1~ ~?~i. , .. , . , a_. . . .. . ..,. .. . . . ._. ~ , .. . DOES Your Facility... If Yes, Please Complete... 1z9 A. ^ Yes' No . CHEMICAL DESCRIPIION FORM i3o 1. Have on site (for any purpose) hazardous material • HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 gallons for liquids, 500 pounds for Minim~m ren ~ir d lanntng I m n c: solids, or 200 cu. ft. for compressed gases (include • Emergency Response Plan Ilqulds in AST and UST)? • Maps • Training • Prevention • Certificatfon B. REGULATED SUBSTANCES (RSl ^ Yes No • CNEMICAL DESCRIPTION FORM 131 i. Have on Site RS at greater than the threshold • RISK MANAGEMENT PLAN (RMP Submit to USEPA) planning quantlties established by the California • CONSOLIDATED COMPLiANCE PLAN Accidental Release Prevention program (CaIARP)? • Incorporating CaIARP Program Elements C. UNDERGROUND STORAGE TANKS (UST) ^ Yes No • UST FACILITY FORM i32 1. Own or operate Underground Storage Tanks? • UST TANK FORM (one per tank) 2 I d t t d i i ll Yes No ~ • UST FACILIIY FORM 133 . n en o upgra e ex ng or insta new UST? st • UST TANK FORM (one per tank) • UST INSTALLATION FORM (one per tank) D. TANK CLOSURE/REMOVAL ^ Yes o • UST TANK FORM (Closure Section - one per tank) 1. Need to report closing an UST that held hazardous materlal or waste? 2. Need to report the closure/removal of a tank that ^ ves f~NO . UST TANK CLOSURE FORM was classiFled as hazardous waste and cleaned onsite? E. ABOVEGROLND PETROLELIM STORAGE TANKS ^ Yes o • HAZARDOUS MATERIAL MANAGEMENT PLAN ~AST) • • 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 capaclty is greater than 660 gallons or the total capactty for the facility is greater than 1,320 gallons? F. HAZARDOUS WASTE EPA ID NUMBER - provide on this page 1. Generete hazardous waste? ^ ves ~No . To obtain EPA ID Number, please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable ^ ves ~)vo . RECYCLING FORM material at the same location it was generated? 3. Recycle more than 100 kg/mo of recyclable ^ Yes ^ rvo . RECYCLING FORM material at an ofF-site location different from the polnt of generation? 4. Treat Hazardous Waste on site? O Yes ~, No • TP FACILITY FORM • TP UNIT FORM (one per unit) 5. SubjeCt to Flnancfal Assurance requirements? ^ Yes ~rvo • CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Yes~rvo . 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 BUSINESS OWNER/OPERATOR IDENTIFICATION FORM. FD2143 (Rev O1/08) HAZARDOUS MATERIAL MANAGEMENT PLAN SITE & FACILITY DIAGRAM ~ Page 2 of 2 ~-~ SITE DIAGRAM Business Name: ~~ FACILITY DIAGRAM V~ ~~ ~-2,1c:~,; Business Address: ~`~ -- ~ ~ _~ ~ t,\ ~' `C~C_t.__~~ ~~' ------- ----- ~ ~"i~2 -P~c-~I n G~ ~~ ~S~rs Swc~,~~~ ccol~r ~leck-rlct~,~ Shtii-o~{' ~ i ~~ L_ i ! ~ I I ~ j `~L---.~.~.,- - - , , - -- --~..m,. ,, ~ , ~ I ~ ~f-~o c~ ~ w a-~e r 5n~h-a~~;j fl , I ~ ~ -~~ - - ---- _____~' ~ ~~~2_ ~~G~r~+~ +~j r ~~n~0. ~e- Lr~ - r S~o'~qc~e, a-{- USe GI a~ I`J~ 9a~. i ~«~- / ~,f, I ~ j % }~~ ~sm ,, 9~ / ~ - /~ ~ ; ~ -~ ~ ; ~ -~-~ ~ . . ~ ~ , ~~ - ~ ~ ~~ ~ ~, Na~-r~t1 C-xis s~N~".-°~ ~~ ~ ' ' ~ .-J ~ ~+.c:~n L- r _,zn c~ ., _ ----t-- .- - - NORTH Please indicate direction of North BAKERSFIELD FIRE DEPARTMENT Prevention Services H e R s r ~ n 1501 Truxtun Avenue, 1~` Floor P/RB Bakersfield, CA 93301 ARfM T Phone: 661-326-3979 . Fax: 661-852-2171 FD2170 (Rev.01/08) , ~, ~ -- -. _ :; '~ ~ ~ BAKERSFIELD FIRE DEPARTMENT ' ~~,,~ Prevention Services iAZARDOUS MATERIAL MANAGEMENT PLAN ,,--°~ ~„~,,.~..~,~..,.... M ~~~ ~ H s R s.p I __ P/ n 1501 Truxtun Avenue, 1~` Floor B k fi ld :~ CHEMICAL DESCRIPTION FORM ~'~ RI AR1~ T a ers e , CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 HAZARDOUS MATERIAL INVENTORY ~ ~ Page 1 of z ^ NEW ^ ADD 0 DELETE ^ REVISE zoo BUSINESS NAME (FACILITY NAME o/rDBA) (^ ~ ~O ~ • ~ l_1.1LS~ . ~~ r~Z~'f dY1Ci\~ C~ CHEMICAL LOCATION ` ' ~ ~~ ~e o-~ C'~t , FACILIIY ID # ~~~,~i,~ 9~,'~ti ` 1 MAP #(opttonal) ~~T 'd~ i 3 201 CHEMICAL LOCATION ZpZ , CONFIDENTIAL (EPCRA) ^ Yes ^ No 203 GRID # (optional) Zp4 CHEMICALNAME ~ l COMMON NAME c~-~ l CAS ~ FIRE CODE MAZARD CLASSES (complete if requested by local flre chie~ TYPE ^ PURE ^ MIXTURE ~ WA$TE PHYSICAL STATE 0 SOLID -~ LIQUID ^ GAS fED FIAZARD CATEGORIES ^ FIRE ~ REACTIVE (Chetk all Nat apply) ANNUAL WASTE Z17 MAXIMUM AMOUNT DAILY AMOUNT ~ UNITS' ^ GAL 205 206 TRADE SECRET ^ Yes 0 No If sub ect to EPCRA, refer to InsWCUOns ~o~ ENS* ^ Yes ^ No 208 209 fIf EHS is yes, all amounGS pelow must be In pounds. 210 211 RADIOACTIVE: ^ Yes ^ No LARGEST CONTAINER 214 ~ ~ ^ PRESSURE RELEASE ~ ACUTE HEALTH ZIg AVERAGE DAILY AMOUNT CURIES 213 215 0 CHRONIC HEALTH ~ ~ 219 STATE WASTE 220 CODE ZZ1 DAYS ON SIfE 222 u w ri u L85 ^ TONS 'If EMS, amount must be In IDS, STORAGE CONTAINER: ~ ABOVEGROUND TANK ~ ~N ~ Z23 B~X ^ TANK WAGON O UNDERGROUND TANK 0 CARBOY ^ CYLINDER 0 RAILCAR ^ TANKINSIDE BUILDING ^ SILO ^ GLASS BOTTLE ^ OTHER 0 STEEL ORUM ^ FIBER DRUM 0 PLASTIC BOTTLE ^ TOTE BIN ^ PLASTIC/NONMETALLIC DRUM ^ gq(', STORAGE PRESSURE: ^ AMBIENT ^ ABOVE AMBIENT ~^ BELOW AMBIENT 2Z4 STORAGE TEMPERATURE: ^ AMBIENT ^ ABOVE AMBIENT 0 BELOW AMBIENT 0 CRYOGENIC ZZS %WT HAZARDOUS COMPON ENT EHS CAS # L 226 . e 227 ^ Yes ^ No z28 229 t 230 b ~ 231 ^ Ye5 ^ No 232 233 ! 234 235 ^ YES ~ NO 236 23~ ~ Z~ 239 ^ Yes ^ No zoo zai ~ `.S~u Z4Z 4~"'r.~Jr~•::''~cY+~,:tit:~s,'.~~erc :;nr.'~x,-:az:.~ .:.x.~ _.. ~w._ -,. .,e.~~. ~ 3t:. .,<. ..~_ .,.v.N„~~, _,._ ...-__....- - za3 -._.._._. .. ... ^ Yes 0 No zaa za5 .___... .:........~.. ,., „ „~::,. < ..~..,:.~, .a , ~:~.::, . vY.::F,; af swr~''t n.a tR,9,,;s( PRINT NAME & TIfLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE ~ATE . Z46 . ,~~r~~.~~ ~a~r~:~ ~ ,~6~~,~;,ys~~U~ c~ lag I~s~ FD2144 (Rev 01/08)