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Home My WebLink AboutBUSINESS PLAN 2/24/2012r BUSINESS ACTIVITIES KERN'COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF) 2700. M STREET, SUITE 300 FACILITY INFORMATION BAKERSFIELD, CA 93301 . 661 862 -8700. Fax 661 862 -8701 Page I of I .Z I. FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) 2 BUSINESS NA (Same Fac111 Name of DBA -Doi B s Hess As r 3 �ZzIT 6 , X00 q7t, 111 fir►, �aKc(s�c el c� CAA Cl 0 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner /Operator Identification page (KC Form 2730). Does your facility... If Yes, please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS` Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed . gases (include liquids in ASTs and USTs); or the YES F1 NO 4 HAZARDOUS MATERIALS IN VENTORY — applicable Federal threshold quantity for an :extremely hazardous CHEMICAL DESCRIPTION (KC Form 273 1) substance specified in 40 CFR Part,355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required'pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (KC Form A) 1.. Own or operate underground storage tanks? , ❑ YES P NO 5 UST TANK (one page per tank) (KC Form B) 2. Intend to upgrade existing or install new USTs? []YES P'NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (KC Form Q 3. Need to report closing a UST? � ❑ YES 40 7 Ll UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above a total capacity for the facility of greater than 1,320 gallons? ❑ YES O g NO FORM REQUIRED TO KCEHSD D. HAZARDOUS WASTE 1. Generate hazardous waste? ❑ YES N3 NO 9 EPA ID NUMBER — provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES 92 NO 10 RECYCLABLE MATERIALS REPORT (one _ per recycler) (KC Form 2732) 3. Treat hazardous waste on site? ❑ YES (4NO l I ONSITE HAZARDOUS WASTE TREATMENT — FACILITY (KC Form 17720 ONSITE HAZARDOUS WASTE TREATMENT—UNIT (one page per unit) (KC Form 4. Treatment subject to financial assurance requirements (for ❑ YES LH NO 12. CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (KC Form 1232) 5. Consolidate hazardous waste generated at a remote site? ❑ YES I!� NO 13 REMOTE WASTE / CONSOLIDATION SITE ANNUAL NdfIFICATION (KC Form 1196) 6. Need to report the closure /removal of a tank that was classified as �- [I YES NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (KC Fonn 1249) E. LOCAL REQUIREMENTS 15 A copy of the facility's Contingency/Emergency Response Plan is to be included with the original submission of the Business Plan. KCEHSD is to be informed of any revisions to the plan. Please contact KCEHSD at the above number for assistance in completing the plan. (7/02 rgvised) � El r : -iCES KC Form 2729 BUSINESS OWNER/OPERATOR IDENTIFICATION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF) 2700 M STREET, SUITE 300 FACILITY INFORMATION BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page L of I. IDENTIFICATION FACILITY ID# x. 1 BE INNING DATE 100 END 44G DATEI 101 BUSINESS NAME e1asFAQll1] AMEorDBA ig B?us�ess ) (/'� 3 BUSINESS P O E ' n102 BUSINESS SITE ADDRESS 1 � :^ � 103 U INES� F ,'02a BUSINESS SITE CITY 104 T e CA C oy CO 108 KERN DUN &'BRADSTREET 106 PRIMARY SIC 107 PRI N CS 107a BUSINESS MAII:J A� � 1'� I O 108a. BUSINESS MAILING 108b g� AiE lose Zlp l%pDF. IM BUSINESS OP .� % 109 l BUS S PE OR HON 110 I1. BUSINESS OWNER OWNER NAME Ill ER HO Ll 112 OWNER A I (kDDRESS 1 Its OWNER MAILIN CI n ( 114 S'�� 115 ZIP CODE b 116 1I1. ENVIRONMENTAL CONTACT CONTACT NAME � \ 1 \ l � � ` 117 CO CT HONE � ®SO� Is - — _ CONTAC iG�ES I1 ;1� 119 CONTACT EMAIL 119a CONTACT MAILING CITY( 120 STATE 121 ZIP CODE I2z - PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-, NAME tz3 NAME . 28 lza TITLE, � 029 BUSINESS P NE 125 BUS SS PRONE R�o I 130 24 -HOUR PHOTA 126 24 -HOUR P ONE 131 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED FORMATION: 133 APN:. - - - Certification: aced 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 wi the information submitted and believe the information is true, accurate, and complete. SIGNATU F WNER/OPERATOR OR DESIGN D REPRESENTATIVE ,,.. -" �--�:, DA j 134 AME DOCUMEN VEPARE R t35 j NAM. F SI ER (print) 136 TITLE OF SIGNER 13? 0 (05/2008 revised) KC Form 2730 GrpN HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF) 2700 M STREET, SUITE 300 HAZARDOUS MATERIALS BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -870T (one page per material per building or area)' ❑ ADD ❑ 'DELETE ❑ REVISE 200 page 3 of I. FACILITY INFORMATION BUSIN N E S e as FACIL NAM or DBA— Do B ens Asj 3 CHEMICAL LOCATION 201 CHEMICAL LPeATION CONFIDENTIAL EPCRA 2 02 NO � 1 El YES YES - °'` "- ---- 1 MAP#I (optional) 203 GRID (optional) 204 FACILITY ID # -- 1WFt T-F-1 I I1. CHEMICAL INFORMATION CHEMICAL NAME t 1� 205 TRADE SECRET ❑ Yes U40 206 (, If Subject to EPCRA,. refer to instructions COMMON NAME 207 208 � EHS* El Yes rd'N/ o *If EHS is "Yes ", all amounts below must be in lbs. CAS#1 209 " i FIRE CODE HAZARD C (Not currently required by KCEHSD) 210 HAZARDOUS MATERIAL 211 212 RADIOACTIVE El Yes No 213 CURIES O TYPE (Check one item only) Va. PURE ❑ .b. MIXTURE ❑ c: WASTE PHYSICAL STATE 214 zts LARGEST CONTAINER (Check one item only) ❑ a. SOLID Vb. LIQUID ❑ e. GAS FED HAZARD CATEGORIES 1/' 216 — 2to (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE [ e. RESSURE RELEASE U o. ACUTE HEALTH 4� C CHRONIC HEALTH AVERAG ,DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WA AMOUNT 219 STATE WA TE CODE 220 C/ rv, 1 UNITS* ❑ a. GALLONS ❑ b. CUBIC FEET Vc. POUNDS. ❑ d. TONS 221 DAYS ON SIT 222 (Check one item only) * If EHS, amount must be in pounds. CO STORAGE CONTAINER 223 a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER Z c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k., BOX ❑ .o.. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ZT I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE El a. AMBIENT El b. ABOVE AMBIENT c. BELOW AMBIENT 224 STORAGE TEMPERATURE ❑ a. AMBIENT ❑ b. ABOVE AMBIENT c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS 4 I I oo I a 226 t 227 Yes ❑ No 228 2� C/ _ O'Ll230 229 231 232 233 2 -❑ Yes ❑ No 234 235 236 237 3 ❑ Yes, ❑ No 238 239 240 241 4 ❑ Yes ❑ No 242 243 244 245 5 ❑ Yes [:]'No . If more bacardous components are present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here (5/2008 revised) KC Form 2731 �1 CONSOLIDATED CONTINGENCY ]PLAN I certify under penalty of law that I have personally. examined and 1 am familiar with the information provided by this plan and to the best of my knowledge the information is accurate, complete, and true. KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT' Unified Program Form 2700 M STREET, SUITE 300 COVER PAGE BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page of Z I. FACILITY IDENTIFICATION FACILITY ID # 1 1 EPA ID # (Hazardous Waste Only) Z BU INESS NAME (Same as Facility Name of DBA -Doing Business As) 4�Q9 3 The Consolidated Contingency Plan provides businesses a format to comply with the emergency planning requirements of the following two written hazardous materials emergency response plans required in California: 4 Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729 - 2732), and Q Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.52) This format is designed to reduce duplication in the preparation and use of emergency response plans at the same facility, .and to .improve the coordination between facility response personnel and. local, state and federal emergency responders during an emergency. A copy of the plan shall be submitted to this Department and at least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. Describe below where a copy.of your Contingency Plan, including the hazardous material inventories, Training Records, and Site Map(s), are located at your business: PLAN CERTIFICATION I certify under penalty of law that I have personally. examined and 1 am familiar with the information provided by this plan and to the best of my knowledge the information is accurate, complete, and true. Prin Name of O er/ Op rator Title wner / Opeptor an Signatur o Owner/ Operator, 1 .. : Date v We appreciate he effort of local businesses in completing these -plans and are available to assist in any manner. If you have any questions, please contact this Department at (661) 862 -8700. ADVISORY Page 57 of Z The site - specific Contingency Plan is the facility's plan for handling emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials or waste that could threaten human health and /or the environment. The contingency plan shall be reviewed, and immediately amended, if necessary, whenever: 4 The plan'fails in an emergency d The facility changes in its design, construction, operation, maintenance, or other circumstances in a way that materially increases the potential for fires, explosions, or releases of hazardous waste or hazardous waste constituents, or changes the response necessary in an emergency 4 List of emergency coordinators changes 4 List of emergency equipment changes Submit a copy of any updates or changes to this Department. II. EMERGENCY CONTACTS PRIMARY SECONDARY NAME � � 123 NAME k 128 TITLE, i W24 TITLE 1� ' �► ^ 129 V J�v V1 BUSINESS PHONE s1 125 . �-mu.—(�UNO BUSINESS PHONE I f n t 130 24 -HOUR PHONE � O f-'\ 126 . 24 -HOUR PHONE os C 131 PAGER # ry 127 PAGER # 132 III. EMERGENCY RESPONSE PLANS AND tROCEDURES A. Notifications Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous material to local fire emergency response personnel, this Department, and the Office of Emergency Services. If you have a release or threatened release of hazardous materials, immediately call: FIRE /PARAMEDICS/PO LICE /SHERIFF PHONE: 911 AFTER the local emergency response - personnel are notified, you shall then notify this Department and the Office of Emergency Services. r Kern County Environmental Health Department: (661) 862 -8700 or after hours, call Dispatch at (661) 861 -2521 State Office of Emergency Service: (800) 852 -7550 or (916) 262 -1621 National Response Center: (800) 424 -8802 Information to be provided during notification: Q Your name`and the telephone number from where you are calling. 4 Exact address of the release or threatened release. 4 Date, time, cause, and type of incident (e.& fire, air release, spill etc.) 4 Material and quantity of the release, to the extent known. 4 Current condition of the facility. 4 Extent of injuries, if any. 4 Possible hazards to public health and/ or the environment outside of the facility. B. Emergency Medical Facility Page of List the closest emergency medical facility that will be used by your business in the event of an accident of injury caused by a release or threatened release of a hazardous material HOSPITAL /CLINIC: i PHO N S�V� lJ ADDRESS: V Q CITY:. n ZIP CODE: C. Private Emergoicy Emergency Response, DOES YOUR BUSINESS HAVE A PRIVATE ON -SITE EMERGENCY RESPONSE-TEAM? 0 Yes 7NO If yes, provide an attachment that describes what policies and procedures your business will follow to notify your on -site emergency, response team in the event of a release or threatened release of hazardous materials. CLEANUP/DISPOSAL CONTRACTOR List the contractor that will provide cleanup services in the event of a release. NAME OF CONTRACTOR: NO: _ C ,d ' �PHONE ADDRESS: K .� CITY: ZIP CODE: I O D. Arrangements with Emergency Responders If 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 in the space below: I� E. Evacuation Plan 1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply): P erbal (Telephone (including cellular) ❑ Alarm System ❑ Public Address System ❑ Intercom ❑ Pagers ❑. Portable Radio ❑ Other (spec): 2. vacuation map is prominently displayed throughout the facility. 3. M7Name of individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has been evacuated: F. Earthquake Vulnerability Identify areas of the facility where, releases could occur or would require immediate inspection or isolation because of the ulnerability to earthquake related ground motion. Hazardous Waste/ Hazardous Materials Storage Areas ❑ Production Floor ❑ Process Lines ❑ Bench/ Lab ❑ Waste Treatment ❑ Other: Identify mechanical systems where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. ❑ Utilities ❑ Sprinkler Systems ❑�/ Cabinets El Shelves ❑ Racks ❑ Pressure Vessels lvJ Gas Cylinders ❑ Tanks ❑ Process Piping ❑ Shutoff Valves ❑ Other: G. Emer'enc . Procedures Page L of Z Briefly describe your business standard operating procedures in the event of a release or threatened release of - azardou� materials /wastes: 1. PREVENTION (prevent,the spill/release) -. Consider the types of spills /releases associated with the hazardous materials /wastes present at your facility. What actions does your business take to prevent these spills /releases from occurring? You may include a discussion of safety and storage procedures: as -4Cj 2. MITIGATION (stop the release /spill) - Describe what actions are taken to reduce the harm or the damage to person(s), property, or the'environment, and prevent what has occurred from getting worse or spreading. What is your. immediate response to a leak, spill, fire, explosion, or airborne release. at your business? G� l a-e o� o� o► 'anorw fly- a S o �2a . 3. ABATEMENT (clean up the spill /release) - Describe what you would do to clean up the spill/release. How do,you handle the complete process of cleaning u .and disposing of released materials at your facility? zz— SAM- c- .. , IV. Emergency Equipment Page 19 of 22 CCR, Section 66265.52(e) [as referenced by Section 66262.34(a)(3)] requires thaf emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. E 'mpment Category, 2. Equipment :T e. 3. Location: 4. Description* 'Personal Protective,.' rotective; ' ❑ Cartridge Respirators ❑ Chemical Monitoring Equipment (describe) Equipment, ❑ Chemical Protective Aprons/Coats' Safety ❑ Chemical Protective Boots" . Equipment, ❑ Chemical Protective Gloves and ❑ Chemical Protective Suits (describe) First Aid ❑ Face Shields Equipment First Aid Kits /Stations (describe) ❑ . Hard Hats ❑ Plumbed Eye Wash Stations Portable Eye Wash Kits (i.e.. bottle e) V ❑ Res iratbr Cartridges (describe) E3--gafety Glasses /Splash Goggles X411 ❑ Safety Showers ❑ Self - Contained Breathing Apparatuses (SCBA) ❑ Other (describe) Fire ❑ Automatic Fire Sprinkler Systems Extinguishing ❑ Fire Alarm Boxes /Stations Systems Fire Extinguisher Systems (describe) ❑ Other "(describe Spill ❑ Absorbents (describe) Control ❑ Berms/Dikes (describe Equipment ❑ Decontamination Equipment (describe) and ❑ Emergent Tanks (describe) Decontamination Exhaust Hoods V, UNA S Equipment ❑ Gas Cylinders Leak Repair Kits (describe) ❑ Neutralizers (describe) ❑ Overpack Drums ❑ Sumps (describe) ❑ ' Other' „(describe) Communications ❑ Chemical Alarms (describe) and ❑. intercoms/ PA Systems Alarm ❑ . Portable Radios Systems Telephones ❑ Underground Tank Leak Detection Monitors ❑ Other (describe) Additional Equipment_. (Use Additional Pages if Needed.) * . Describe the equipment and its capabilities. If applicable, specify any testing /maintenance procedures /intervals. Attach additional pages, numbered appropriately, if needed. ” r I L �o I O � rn Z �I 1 CONSOLIDATED CONTINGENCY PLAN i KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET, SUITE 300 SITE MAP, BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 I -' • Storm and Sewer Drains .` ! Page Of I. FACILITY IDENTIFICATION. FACILITY ID # • Locations and Names of Adjacent Streets.and Alleys i EPA ID # (Hazardous Waste Only) Z BUSS) S NAME (S e as Facility N oin Business As) 3 7 Mof W_q j SITE RES 103 CITY 104 Z CODE 105 J For Storage Map DATE MAP DRAWN MAP # SUB- FACILITY # (if needed) Area r I L �o I O � rn Z �I 1 u ;..; tip :.. •; DC. 1 i NORTH i For Site Map i 7':.`; • Loading Areas Parking Lots • Internal Roads I -' • Storm and Sewer Drains .` ! ! • Adjacent Property. Use • Locations and Names of Adjacent Streets.and Alleys • Entrance and Exit Points and Roads D j • Evacuation Routes - For Storage Map • Location of Each Storage Area • Location of Each Hazardous Material _- Handling Area • Location ofEmergency Response Equipment u ;..; tip :.. •; DC. 1 i NORTH i r- rx VID Portable Wash -Kft J'5 X A %A, Pfe_ P ?rep Gtr C-CA q• c P ck r R "s, Xti her's F, )ds Wivitlibyho I 'k<A-"Qn- _ * 11vacua 1. --, � A- S 0', ca. les Office area 41 Cook.Ttatiox R?Batbrooms V%e- y6k of-Ftce. #069 BAKERSFIELD - CONSOLIDATED CONTINGENCE' PLAN _ KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET, SUITE 300 SITE MAP. BAKERSFIELD, CA 93301 661 862 -8700 Fax 661 862 -8701 Page of Z L. FACILITY IDENTIFICATION FACILITY ID # . EPA ID # (Hazardous Waste Only) z BUSIJESS NAME (Salpe as Facility N of DBA- oin Business A s rrAA 3 SITE ADDRESS, 1 J03 CITY 104 ZIE CODE ios' C DATE MAP DRAWN MAP # SUB- FACILITY # (if needed) rFor -Sites e.Map', • Loading Areas • Parking Lots • Internal Roads • Storm and Sewer Drains • Adjacent Property. Use • Locations and Names of Adjacent Streetsand. Alleys dg j • Entrance and Exit Points i' and Roads +.,. __3..�, £' Traffic • Evacuation Routes - For Storage Map • Location of Each Storage f �� I Area r " • Location of Each - Hazardous Material Handling Area - a F • Location of Emergency j Response Equipment 1 Google Maps Page 12__0 X22 obemaps Get Google Maps on your phone k• «, Text the word ;WAPS "to 466453 A. Sizzler 900 Real Road, Bakersfield, CA - (661).325 -2976 19 reviews http: / /maps.google.com /maps ?hl= en &ie= UTF8 &q= 900 +REAL +RD +BAKERSFIELD +SI .'.. , 2/21 /2011