HomeMy WebLinkAboutHAZ-BUSINESS PLAN 2/27/2008 (COPY)HAZARDOUS MATERIAL MANAGEMENT PLAN
APPLICATION
BUSINESS OWNER/OPERATOR IDENTIFICATION FORM
(HAZARDOUS MATERIAL FACILITY INFORMATION)
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BAKERSFIELD FIRE DEPARTMENT
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p/pg 1600 Truxtun Ave., Suite 401
AR~IN 1 Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 2
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FACILITV ID # ~ 1 VEAR BEGINNING 100 YEAR ENDING 101
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BUSINE55 NAME (Same as FACILITY NAME or DBA) 3 BUSINESS PHONE 102
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SITE ADDRE55
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CITY ~~~E~~~~~~ 104 ZIPCODE ( 105
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DUNN & BRADSTREET tt 306 SIC CODE ~ 107
COUNTV ~ 108
OPERATOR NAME 109 OPERATOR PHONE 110
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II. OWNER INFORMATION'
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OWNER NAME 111 OWNER PHONE 112
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OWNER MAILING ADDRESS ~ 113
CITY llq STATE 115 ZIP CODE 116
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' III. ENVIRONMENTAL CONTACT ~
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CONTACT NAME 117 CONTACT PHONE 118
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CONTACT MAILING ADDRESS 119
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CITV 120 STATE 121 ZIP CODE 122
" IV. `EMERGENCY CONTACTS "`
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.PRIMARY :, • ' SECONDARY.
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NAME
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. 123 NAME
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TITLE 124
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BUSINESS PHONE A 125
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24-HOUR PHONE 126
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CELL PHONE 127
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,, ,; V. CERTIFICATION , .p ..."
Certification: Based on my inquiry
t se individuals responsible for obtaining the information, I certify under penalty of law that I have personally
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examined and am familiar with ' f rma 'on submitted in this inventory and believe the information is true, accurate, and complete.
SIGNATURE OF DOCUMENT PREPARER ~ 136 D~E_ ~~~ fo ~134
2 NAME OF D~~~PREPARE~ T) 135
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NAME OF OW /OPERATO SIGN B F T) 137 TITL OF DOCUMENT PREPARER ~ 138
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~ FD2142 (Rev 08/07)
HAZARDOUS MATERIAL FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
Please submit the Business Activities page, the Hazardous Material Facility Information (HMMP) Business Owner/
Operator ldentification Form, and Hazardous Material Inventory Chemical Description Form for all hazardous material
inventory submissions. For the inventory to be considered, please complete this page; it must be signed by the
appropriate individual.
NOTE: The numbering of the instructions follows the data element numbers that are on the Business Owner/Operator
Form page. These data element numbers are used for electronic submission and are the same as the numbering used
in 27 CCR, Appendix C, Business Section of the Unified Program Data Dictionary. Please number all pages of your
submittal. This helps our CUPA or AA identify whether the submittal is complete and if any pages are separated.
1 FACILITY I.D. NUMBER - This number is assigned by the CUPA or AA. This is the unique number which identifies your facility.
3 BUSINESS NAME - Enter the full legal name of the business.
100 BEGINNING DATE - Enter the beginning year and date of the report.
101 ENDING DATE - Enter the ending year and date of the report.
102 BUSINESS PHONE - Enter the phone number, area code first, and any extension.
303 BUSINESS SITE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This
information must provide a means to geographically locate the facility.
304 CITY - Enter the city or unincorporeted area in which business site is located.
305 ZIP CODE - Enter the zip code of business site. The extra 4-digit zip may also be added.
306 DUNN & BRADSTREET NUMBER - Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be
obtained by calling 610-882-7748 or by Internet.
107 SIC CODE - Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more
than 4 digits, report only the first four.
108 COUNTY - Enter the county in which the business site is located.
109 BUSINESS OPERATOR NAME - Enter the name of the business operator.
110 BUSINESS OPERATOR PHONE - Enter business operator phone number, area code first, and any extension.
111 OWNER NAME - Enter name of business owner.
112 OWNER PHONE - Enter the business owner phone number, area code first, and any extension.
113 OWNER MAILING ADDRESS - Enter the owner mailing address.
114 OWNER CITY - Enter the city for owner mailing address.
115 OWNER STATE - Enter the 2 character state abbreviation for the owner mailing address.
116 OWNER 2IP CODE - Enter the zip code for the owner address; extre 4-digit zip may also be added.
117 ENVIRONMENTAL CONTACT NAME - Enter the name of the person who receives all environmental correspondence and will respond
to enforcement activity.
118 CONTACT PHONE - Enter the phone number at which the environmental contact can be contacted, area code first, and any
extension.
119 CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent.
120 CITY - Enter the name of the city for the environmental contact mailing address.
121 STATE - Enter the 2 character state abbreviation for the environmental contact mailing address.
122 ZIP CODE - Enter the zip code of the environmental contact mailing address; extre 4-digit zip may also be added.
123 PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency,
involving hazardous material, at the business site. The contact shall have FULL facility access, site familiarity, and authority to make
decisions for the business regarding incident mitigation.
124 TITLE - Enter the title of the primary emergency contact.
125 BUSINESS PHONE - Enter the business number for the primary emergency contact, area code first, and any extensions.
126 24-HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one
which is answered 24-hours a day. If it is not the contact home phone number, then the service answering the phone must be able to
immediately contact the individual.
127 CELL NUMBER - Enter the cell number for the primary emergency contact.
128 SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that
the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make
decisions for the business regarding incitlent mitigation.
129 TITLE - Enter the title of the secondary emergency contact.
130 BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extension.
131 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24-hour phone number must be one
which is answered 24-hours a day. If it is not the contact home phone number, then the service answering the phone must be able to
immediately contact the individual. -~
132 CELL NUMBER - Enter the cell number for the secondary emergency contact.
133 ADDITIONAL LOCALLY-COLLECTED INFORMATION - This space may be used for CUPA or AA to collect any additional information
necessary to meet the requirements of their individual progrems. Contact your local agency for guidance.
134 DATE - Enter the date that the document was signed.
135 NAME OF DOCUMENT PREPARER (FULL PRINTED NAME) - Enter the full printed name of the person who prepared the inventory
submittal information.
136 SIGNATURE OF DOCUMENT PREPARER (FULL SIGNATURE) - Enter the full signature of the person preparing the page. The signer
certifies to a familiarity with the information submitted and that based on the signer inquiry of those individuals responsible for
obtaining the information, all the informetion submitted is true, accurate, and complete.
137 SIGNATURE OF OWNER/OPERATOR/DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or o~cially-designated
representative of the Owner/Operator, shall sign and print in the space provided. This signature certifies that the signer is familiar
with the signer belief that the submitted information is true, accurate, and complete.
138 TITLE OF DOCUMENT PREPARER - Enter the title of the person preparing the page.
Page 2 of 2 FD2142 (Rev OS/07)
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HAZARDOUS MATERIAL MANAGEMENT PLAN
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BUSINESS ACTIVITIES PAGE
(HAZARDOUS MATERIAL FACILITY INFORMATION)
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1600 Truxtun Ave., Suite 401
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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BUSINE55 NAME (FACILIIY NAME or DBA) io3
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DOES Your Facility... If Yes, Please Complete... 129
A. HAZARDOUS MATERIAL es ^ No • CHEMICAL DESCRIPTION FORM i3a
1. Have on site (for any purpose) hazardous material • HA2ARDOUS MATERIAL MANAGEMENT PLAN
at or above 55 gallons for liquids, 500 pounds for Minimum reauired olanning elements:
solids, or 200 cu. R. for compressed gases (include • Emergency Response Plan
liquids in AST and UST)? • Maps
• Treining
• Prevention
• Certification
B. REGULATED SUBSTANCES [R51 ^ Yes 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)? • Incorporeting CaIARP Program.Elements
C. UNDERGROUND STORAGE TANKS (UST) ^ Yes o • UST FACILITY FORM 13z
1. Own or operate Underground Storege Tanks?
Yes~ • UST TANK FORM (one per tank)
UST FACILIIY FORM 133
2. Intend to u rade existin or install new UST?
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UST TANK FORM (one per tank)
• UST INSTALLATION FORM (one per tank)
D. TANK CLOSURE/REMOVAL o ves o • 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~ • UST TANK CLOSURE FORM
was classified as hazardous waste and cleaned
onsite?
E. ABOVEGROUND PETROLEUM STORAGE TANKS ^ Yes o • HA2ARDOUS MATERIAL MANAGEMENT PLAN
jASTI • Incorporating Federel Spill Prevention Control and Countermeasure
1. Own or operete 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 ^ ves ~ . RECYCIING FORM
material at the same location it was generated?
3. Recycle more than 100 kg/mo of recyclable
^ Yes~
• RECYCLING FORM
material at an off-site Iocation different from the
point of generation?
4. Treat Hazardous Waste on site? ^ ve~NO . TP FACILITY FORM
^ Yes No • TP UNIT FORM (one per unit)
CERTIFICATION OF FINANCIAL ASSURANCE
5. Subject to Financial Assurance requirements? •
6. Consolidate Hazardous Waste generated at a ^ Yes ^ o . 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 submlt
BUSINESS OWNER/OPERATOR IDENTIFICATION FORM.
FD2143(Rev OS/07)
HA2ARDOUS MATERIAL MANAGEMENT PLAN : f ~
APPLICATION'Fw ~~~~ ~~.~ ~'" ~ B R 3 P I n
' ' P/R/
SECTION DISCOVERY & NOTIFICATION A/~1M r
(FORMS) ~'''
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.
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BUSINESS NAME (FACILITY NAME or DBA)
ADDRESS (for local use only)
FACILITY ID #
I
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1600 Truxtun Ave., Suite 401
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 2
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A. LEAK DETECTION AND MONITORING PROCEDURES: '
'i~3i~~~~ tPIS'P ~C`~1A'N ~!~Z ~AA~~~3 ~,TFt.t~ U S~~~sl A ~~,~£C-1C~,i y
B. EMPLOYEE AND AGENCY NOTIFICATION:
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C. ENVIRONMENTAL RESPONSE MANAGEMENT:
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B. RELEASE CONTAINMENT AND/OR MITIGATION: ~~ ~
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C. CLEAN-UP AND RECOVERY PROCEDURES:
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fD2169 (Rev OS/07)
Page 2 of 2
~.. ~~`" '3~`~'~~ ~~'~3~ ~SEC~T~IO.N.,I~I~~2: RELEASE,RESPONSE€PLAN~ ,CONT~. '~~~~~~~~~;~~_ '.s ~ ~;.~~
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UTI~ITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILifY) 5~~ O~S ~~~ `-~'~~ G\J ~~~ l~"i~ ~n~~+~S •
NATURAL GAS PROPANE: 1 ~S , ~
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PRIVATE FIRE PROTECTION/WATER AVAILABILiTY:
A. PRIVATE FIRE PROTECTION:
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B. WATER AVAILABILITY (FIRE HYDRANT):
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MATERIAL SAFETY DATA SHEETS ON FILE: YES 0 NO IF YES, LOCATION:
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BRIEF SUMMARY OF TRAINING PROGRAM:
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Based on my inquiry of hose individuals responsible for obtaining the information, I certify under penalty of law that I have personally
examined and am fa ili with the information submitted and believe the information is true, accurate, and complete.
SIGNATURE OF O E ERAT SIGNATED REPRESENTATIVE
` DATE 47
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NAME OF SIGNER ( IN
TITLE OF SIGNER 479
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~ v FD2169 (Rev 08/07)
KIEWIT PACIFIC CO.
Bakersfield WWTP #3 Project
Spill Prevention Program
This is a procedure established as a spill prevention countermeasure plan for Kiewit
Pacific Co. far the Bakersfield Project located in Bakersfield, California.
1. Containment: The first and most important step is to contain all contaminants
immediately. During the containment phase the competent person in charge will
determine whether or not the size and scope of the spill will be manageable. If the
spill is deemed unmanageable then the following Company will be notified:
Enviroserve 1-562-788-0829
The Containment process will include:
• A buoy system designed specifically for containing petroleum-based
products will be placed around the perimeter of the spill
• Absorbent pads will be thoroughly spread out to absorb spilled material
• Absorbent pads will be placed down stream of spilled material
• Earthen dams may be constructed to prevent the spill from spreading
2. Removal Of Contaminated Soil: All materials negatively effected by the
spill; determined so by a qualified representative; will be disposed of following
California State E.P.A. guidelines
• The contaminated material will be shoveled into 55-gallon drums
• The 55-gallon drums will then be taken by an approved environment
waste removal company. to a certified waste dumpsite. This
information will be maintained by the office.
In the occurrence of a spill of 5 gallons or more District Environmental
Manager Mike Verza and Construction Manager Tom Trimble should be
notified immediately.
Mike Verza Dist. Env. Manager 925-405-3240
Tom Trimble Project Manager 925-595-8774
California State Environmental Protection Agency 1-800-468-1786
FIRE HYDRANT LOCATION
MAIN SWITCH GEAR BUILDING - Electrical shutoff located near operation building
PLANT WATER PUMPS & TANK - Pumps need to be turned off prior to tank ~
valves are closed which are located on the tank. On the background is secondary clarifiers
HAZARDOUS MATERIAL MANAGEM NT PLAN ~'
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INSTRUCTIONS ~~'
SITE & FACILITY DIAGRAM
~r~ ,r .~ ~ss _..~_„~
B H R 3 P I D
FIIfL
ARTN T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1600 Truxtun Ave., Suite 401
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171 '
Page 1 oi 2
These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium-
size businesses will only have to submit a site diagram. If you have subdivided your business into smaller
areas because of the complexity or size, then you will be completing an additional detail map, facility diagram,
for each of these areas. Include instructions that show the route to your business if it is in a remote location.
All diagrams must be on 8~/zxli-inch paper and drawn using a straight edge tool.
SITE DIAGRAM INSTRUCTIONS
The site diagram is used to show your business and to indicate the businesses that immediately surround your
property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site
diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map
must include all of the following information:
1. Check the box on the top left corner of the form provided that indicated "Site Diagram."
2. Print the name of your business, as shown in your HMMP, on the top of the diagram.
3. Label tHe location of the hazardous material and identify them by name and type of hazard (flammable
liquid, corrosive solid).
4. Label the location of utility shut-off points for gas, electric, and water services.
5. Label the location of fire hydrants.
6. Label portions of the building protected by automatic sprinkler systems.
7. Label the direction representing north on the diagram. (The diagram form provided includes a north
a rrow. )
8. All labeling and identification on the diagram must be legible and easily understandable at the scale
submitted. Diagrams must be sufficiently legible to produce a legible copy. Try to avoid the use of
abbreviations or symbols. If you must use them, provide a legend explaining your system.
Maps may be returned for correction if you fail to follow these instructions.
FACILITY DIAGRAM INSTRUCTIONS
Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large
business.
1. Check the box in the upper right hand corner of the form provided that indicated "Facility Diagram."
2. Print the name of your business as shown on your HMMP. Print the name of the area that this map
represents. This name should be the same name that you used on this area's inventory report.
3. Indicate which area the diagram represents and the total number of facility diagrams that you are
including. If a map represented the first of four areas, it would be labeled "1 of 4."
4. Follow instructions 3- 8 for site diagrams regarding the specific details to be included on each facility
diagram.
UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: If you operate an Underground Storege
Tank (UST) facility, the facility diagram shall also specify the location of the UST continuous leak monitoring
system and/or the location where the UST monitoring will be performed.
FD2170(Rev 08/07)
HAZARDOUS MATERIAL MANAGEMENT PLAN'~,;».
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SITE & FACILITY DIAGRAM
BAKERSFIELD FIRE DEPARTMENT
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SITE DIAGRAM FACILITY DIAGRAM
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Business Address: ~ ~~~ {~-S~rC ~~
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1600 Truxtun Ave., Suite 401
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HAZARDOUS MATERIAL MANAGEMENT PLAN
CHEMICAL DESCRIPTION FORM
HAZARDOUS MATERIAL INVENTORY
^ NEW ^ ADD ^ DELETE 0 REVISE zoo
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
H a R 1600 Truxtun Ave., Suite 401
F/Ri Bakersfield, CA 93301
ARTM l Phone: 661-326-3979 • Fax: 661-852-217
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BAKERSFIELD FIRE DEPARTMENT
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1600 Truxtun Ave., Suite 401
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Phone:661-326-3979 • Fax:661-852-2171
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
n s R S P i n 1600 Truxtun Ave., Suite 401
FlRi Bakersfield, CA 93301
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JOB#036-21722 I N V E NTO RY
MATERIAL PRODUCI' NAME CHEMICAL NAME TYPE OF CONTAINER TOTAL VOLUME
~HEVERON ULTRA DUTY GREASE Petroleum Hydrocarbon 20 GALLON BARREL 1025 gallons
~ CHEVRON SOWT HYP Petroleum Hydrocarbon 225 GAL TANK 225 gallons
CHEVRON RPM 10WT Petroleum Hydrocarbon 225 GAL TANK 225 gailons
~•~CHEVRON DRIVETRAIN 30 WT - Petroleum Hydrocarbon 142 GAL TANK 142 gallons
_:~ CHEVRON GEAR 80)90 Petroleum Hydrocarbon 142 GAL TANK 142 gallons
MEVRON DEXCOOL EXT LIFE COOLAN ~~ Ethylene Glycol 142 GAL TANK 142 gallons
d~ MOBILE SYNTHETIC Petroleum Hydrocarbon 55 GALLON 55 gallons
--~;/ CLEAR DIESEL Petroleum Hydrocarbon 1,000 GAL TANK 1,000 gallons
-,:~ RED DIESEL Petroleum Hydrocarbon 10,000 GAL TANK 10,000 gallons
-' WASTE ANTIFREEZE Petroleum H drocarbon 55 GALLON BARREL 55 allons
~- .CHEVRON UNIVERSAL GEAR OIL Petroleum H drocarbon 55 GALLON BARREL 55 allons
-7: MOBILE SYNTHETIC OIL Petroleum H drocarbon - 55 GALLON BARREL 110 allons
:~CNEVRON DEXCOOL ANTIFREEZE Eth lene GI col 55 GALLON BARREL 55 allons
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- CHEVRON HIP ON 15046 Petroleum H drocarbon 55 GALLON BARREL 40 allons
/# WASHER FWIN Petroleum H drocarbon 55 GALLON RLASTIC DRUM 45 allons .
~/ GASOLINE Petroleum H drocarbon 5 GALLON CAN 85 allons
AQUA RESIN CURE WHITE White i ment water based resin formin curin 5 GALLON BUCKETS 50 allons- -
AQUA:RESIN CURE WHITE White pigment water based resin forming curing 55 GALLONS DRUM 220 gallons'
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PROPANE GAS TANK (Plant Owned) - Shutoff located on the tank.
On the background is Operation building ~
PROPANE GAS TANK (Plant Owned) - Shutoff.located on the tank.
Located between the Digester Tanks 3,4,5, and 6.
On the background is operation building
FRESH WATER TANK (Plant Owned) - Shutoff located on the tank.