HomeMy WebLinkAboutHazardous Materials Declaration PacketHAZARDOUS MATERIALS
DECLARATION PACKET
Rifle Fire Protection District
"The mission of the Rifle Fire Protection District is to enhance health
and safety, and to protect the life, home and property of the people we
serve."
--u.
RIFLE
COLORADO
1850 Railroad Ave.
Rifle, CO 81650
www .riflefiredept.org
970-625-1243
The following declaration serves as a means to obtain information about hazardous
materials that are stored, used, dispensed or handled. The information collected in this
packet is reviewed to ensure code compliance during the preconstruction and plan review
stage, the information is then retained by the Rifle Fire Protection District to serve as an
inventory reference in the event of an emergency.
On page number two of this packet you will discover a document titled Hazardous
Material Declaration Form. This one page declaration shall be completed by a company
representative and attached to each set of commercial construction plans that contain or
have the potential to contain hazardous materials.
If when completing this declaration form it is determined that the premises "does" meet
or exceed the exempt amounts, then the Hazardous Material Inventory Statement shall
also be completed and attached to each set of commercial construction plans. Material
Safety Data Sheets shall be provided with the submittal to the Rifle Fire.
Rifle Fire Protection District
06/2009
HAZARDOUS MATERIAL INVENTORY APPLICATION
BUSINESS INFORMATION (Part 1)
Business Name: Bayou Well Services, LLC
Business Address: 28730 Highway 6 & 24
City, State and Zip: Rifle, Colorado 81650
Telephone: 970-625-0552 Fax: 866-535-9776
Principle Business Activity: Oilfield Services
Number of Employees: Hours of Operation: 2417/365
AFTER HOURS EMERGENCY CONT ACT (Part 2)
Primary Contact: Myk Thornton Telephone Number: 970-625-0552
Mobile Phone Number: 970-773-8368 Pager Number: N I A
Secondary Contact: Andy Zanski Telephone Number: 970-625-0552
Cellular Number: 970-773-8960 Pager Number: NI A
PERSON RESPONSIBLE FOR COMPLETING THIS PACKET (Part 3)
Name: Myk Thornton Title: HSE Manager
Email: mykthomton @bayouwellservices.com Telephone Number: 970-625-0552
ON-SITE RESPONSIBLE OFFICIAL. (Part 4)
Name: Myk Thornton
Telephone Number: 970-625-0552
Mobile Phone Number: 970-773-8368
Title: HS E Manager
Email Address:
mykthomton(@ bayouwellservices.com
Pager Number: N I A
I dec lare lhnt the infonnntion provided in thi s Hazardous Mnterinl Pennit Applicntion 1111d nttnched Hnznrdous
Sign&ture & D~:riol• 1~~""" md oo~•t to tho ""'of my knowkdg<.
PROPERTY OWNER (Part 5)
Name: Bayou Well Services, LLC
Address: 800 Gessner, Suite 1000
City, State and Zip: Houston, TX 77024
Telephone Number: 713-935-8900
Rifle Fire Protection District
06/2009
HAZARDOUS MATERIAL INVENTORY REPORTING CHART
Business Name: Bayou Well Services, LLC
Business Address: 28730 Hiehwav 6 & 24. Rifle. Colorado 81650 ------.
Chemical or Concen CAS Hazard Physica MAXIMUM AMOUNTS
Trade Name tralion Number Class I Stale Storage Used Use Open (%) Closed
Motor Oil >90% 64742-48-9 Combustible Liquid 8,650 gal. 8,650 gal.
Liuuid ( 11 IB)
Oxygen 100% 7782-44-7 Oxidizing Gas Gas 2.150 lbs. 2,150 lbs .
Acetylene 100% 74-86-2 Flommnble Gas 1,900 lbs. 1.900 lbs.
Gas
Coolant 50% 107-21-1 Combuslible Liquid 1.600 gal. 1,600 gal.
Liauid (1118)
Diesel fuel #2 100% 68476-34-6 Combusliblc Liquid 500 gnl. SOOgal.
Liauid (II)
Completed By: Myk Thornton
Page:_of_
INDOORS J OUTDOORS w
NFP A 704 Rating
Health Fire Reactivity Other
(H) (F) (R)
I I 0 0
0 0 0 0
I 4 2 0
0 I 0 0
0 2 0 0
Telephone Number: 970-773-8368
Rifle Fire Protection District
06/2009
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