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San Joaquin County Hazardous JaIrials 1994 Worksheet If you answer "yes" to any of the following questions, you are then required to submit the updated sections of the HMMP to OES by _,Ianuary 15 1994. You can obtain any necessary forms or plan sections from OES. Section 1 - Has your business name or address changed? _ _ _ _ _ _ _ _ _ _ _ _ _ _ Have emergency notification personnel and/or telephone numbers changed?_ _ _ _ _ _ _ _ _ _ _ _ _ Section 2• Have you reassigned emergency responsibilities for employees?_ _ _ _ _ _ --------------- Has the nature of your business changed? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Has the Business Owner(s) or address changed? If yes, name of owner and date of change Did you document your Business License number and expiration date? _ _ _ _ _ _ _ _ _ Did you document your Dun and Bradstreet number? If not, call (215) 882-7748 _— — _ _ _ _ _ Did you document the Property Owner(s), their mailing address, and Assessor Parcel number? Section 3: Have you reassigned an evacuation leader? --------------------- Have you changed shift hours and number of employees per shift?_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Have you changed evacuation routes and evacuation assembly areas? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Has the area surrounding your business changed (i.e. new developments)?_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ec i n4 - Have 4:Have you reassigned a spill control leader? ----- _ -------------------------- Have ____________Have you added, deleted, or changed your safety equipment, spill control equipment, or monitoring equipment? __ _____ ______ Have you designated or changed a clean-up company which can assist you during a hazardous materials incident? --------------------------- Have you changed your written spill and leak procedures? _ _ _ _ _ __ ------------------ Section S• Has your employee safety and training program changed? _ _ _ _ _ _ _ _ _ _ — Sect Does your facility diagram or topographical map need to be updated?_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ In particular. have you changed, added, or deleted storage locations for any hazardous materials? A No Chemical Inventory- Please complete any necessary Chemical Inventory Forms and the Inventory Certification Form and submit with this worksheet. Return only the original 1994 forms to OES by January 1S 1994 Copies of forms from previous years will not be ac- cepted. I declare under the penalty of perjury that the above -information is accurate.to the.best of my knowledge. I understand that false/ inaccurate information may contribute to complications during a hazardous material incident. This declaration is made in the Goof San Bernardino California. Business Name: Atchison, Topeka & Santa Fe Railway Co. Site Address: iamon Street, Stoc ton, CA 9 205 Telephone Number: (909) 386-4082 Mailing Address: 740 East Carne ie Drive San Bernardino CA 9240$ .'rintName: LaDonna Williams // Job Title•Mgr Environmental O rat Responsible for the completion of EMOW Signature:�T /_ /( ��vii' ��///i?/12i z7 Date: _�//—.3 /y 4