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N O PP !L11111 * O1110 lei 4LI IWA 1. <br />C. Private Emergency Response <br />DOES YOUR BUSINESS HAVE A PRIVATE ON-SITE EMERGENCY RESPONSE TEAM? ❑ Yes ® No <br />If yes, provide an attachment that describes what policies and procedures your business will follow to notify your <br />on-site emergency response team In the event of a release or threatened release of hazardous materials. <br />CLEANUP/DISPOSAL CONTRACTOR <br />List the contractor that will provide cleanup services in the event of a release. <br />NAME OF CONTRACTOR: <br />PHONE NO: <br />SAFETY-I<LEEN <br />_ - (800) 468-1760 <br />ADDRESS: 5360 LEGACY DRIVE, BLDG 2, SUITE 100 <br />CITY:QIP <br />IRVINE <br />CODE: <br />75024 <br />D. Arrangements With Emergency Responders <br />If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, <br />contractor, or State or local emergency response team to coordinate emergency services, describe those <br />arrangements on the lines below: <br />E. Evacuation Plan <br />1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply): <br />® Verbal ❑ Telephone (including cellular) ❑ Alarm System [I Public Address System ] Intercom <br />❑ Pagers ❑Portable Radio ❑ Other (specify): <br />2. ® Evacuation map is prominently displayed throughout the facility. <br />3. ® Individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has <br />been evacuated: <br />ON -DUTY MANAGER <br />F. Earth wake Vulnerability <br />Identify areas of the facility where releases could occur or would require immediate inspection or isolation <br />because of the vulnerability to earthquake related ground motion. <br />Hazardous Waste/ Hazardous Materials Storage Areas ❑ Production Floor ❑ Process Lines <br />❑ Bench/ Lab ❑ Waste Treatment ❑ Other: <br />Identify mechanical systems where releases could occur or would require immediate inspection or isolation <br />because of the vulnerability to earthquake related ground motion. <br />❑ Utilities ❑ Sprinkler Systems ❑ Cabinets ® Shelves <br />❑ Racks ❑ Pressure Vessels ❑ Gas Cylinders Q Tanks <br />❑ Process Piping ❑ Shutoff Valves ❑ Other: <br />