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0 Consolidat "ontingency Plan <br /> Environmental Health Division(CUPA) For Hazardous Materials,Hazardous Waste&Underground Storage Tanks <br /> ' Submit completed document to BaaCCounty Environmental Health @ <br /> FACILITY IDENTIFICATION/OPERATIONS OVERVIEW <br /> BUSINESS E _l/ ,I FACILITY ID - DATE <br /> C/A„1(/Jt, J KA r1 0/ ( � O <br /> eINE ADDRESSD - ` /� / <br /> 3 Check elements covered by this consolidated pl /��/���l�v <br /> Hazardous Materials❑ Hazardous Waste Underground <br /> Storage Tanks ❑ <br /> 4 supplemental elements submitted: UST Written Monitoring Plan ❑ <br /> b TYPE OF BUSINE,S$(X p�ntin c n ctor) INCIDENTA OPERATIONS (e.g.fleet maintenance) <br /> a HAZARDS/EVENTS COV/EERRREED BY PLAN(e.g.chemical spills,fire,earthquake,etc) <br /> EMERGENCY COORDINATOR &ON-SITE TECH ADVISORS/ INTERNAL RESPONSE <br /> Identify your Emergency Coordinat r&On-site Technical Advisors: <br /> Name/Position: <br /> Emergency Coordinator: Address: <br /> Must have the authority to classify the Phone#s: Day D �ry/ After hours: <br /> release,make management decisions, & Responsible for: spill prevention contacting facility responders <br /> determine appropriate response <br /> emergency assessment I authorizing spill response work <br /> (check all that apply) management <br /> Person is: <br /> 0\0 <br /> on-site or E] on-call <br /> ❑ interfacing with public emergency <br /> ❑ initiating alarms __mspomders <br /> ❑ agency notification ❑ other: <br /> e A temate#1 Alternate 2 <br /> Name/Position: , <br /> COQ ................ <br /> Address: / /�xf/✓' __. S <br /> Alternate Emergency Coordinators: city: <br /> List In order of responsibility. Zip: -- - -- <br /> , Day phone: X)15,9 USF <br /> After hours phone: <br /> / ...................r.�./ .._ <br /> Person is: on-site or ❑on-call Egon-site or ❑on-call <br /> 10 On-Site Technical Advisors `/J7 <br /> (Available to provide site-specific technical Owner: �'( I/` Supervisor: <br /> 1 <br /> advice to off-site emergency responders) Manager: Other: <br /> 11 Identify type of internal response: <br /> tz i Team Members(name or position): Responsibilities: <br /> 1 ❑ Internal facility <br /> response team <br /> Option (attach additional pages if needed: Q, <br /> S: <br /> indicate an attachment by checking ----- --- ---------'--'-'-"'-'-'-'-- ---''--- <br /> 3. <br /> this box❑) <br /> (check 4. <br /> 13 one or <br /> Name: ---- Describe role/responsibilities: <br /> more) I <br /> ❑ Contractor address: <br /> phone#: <br /> .............................................................................................................................. <br /> Page: BP-1 <br />