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HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous WaSte Unified Permit CONDITIONS OF--PERMIT ON REVERSE SIDE This i)ermit is Issued for the following: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials Permit ID #:: 015-000-000052 [3 Risk Management Program PLANNED PARENTHOOD OF r-, .,,z.r~o-~ w.~t. O.-S~t,,'rr.,,t.~,.t LOCATION: 2535 16TH ST 100 OFFICE OF ENVIRONMENTAL SER VICES- 1715 Chester Ave., 3rd Floor Approved by: '~<' c~' Bakersfield, CA 93301 k.~v~u~.t~to. ~_.a.~.~.~,~e~,~ .~ ' Issue Dale Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: .lun~- -~'~! ~'~-~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........... ,,,,~,~?:;,.:,~?~:.:~,, ........... This permit is issued for the following: ......... ?,,~:~? ?'~: i~; i".i ~::iii:i:;:iii:~ii::ill ::!:ii::,:,i::':iillii':;:~:~:~'!!!:!::~.~'~'Hazardous Materials Plan .... ::.~'~?:.}'.~::::~:?:~'.?:"'~':~:~:~::~ i';iiii}}::,: :~:i;!iii:!.i.!?::i~. ii!~i!~!iiiiiii:~::'::} ?~D~i0~derground Storage of Hazardous Materials ...... , ........ ~..~. ~ .... .::ii'!'i~d~.. [:: ~I' .~ ...... ~-~i!ii~::'~ ~, '"'"'" LOCATION 2535 16TH ,~i '..:--..:~ ~: ":?'.::,, _ 00 BAKERSF!EI~D CA ~.::~;~:. :". ~:....;.:~:~ ~[': :.. "., ~ ~$~:.. ..:~ ~.'? .... '"~=~:' ~..: ..~-:':.~Z~-.::~:~:,-'~]~:]~:~' ~:~ ~ [. ~%~. ~. :~. :.:.~=. _ ~= ~[.. '"...~ ~..'.'-'-..~"~ ~:-.{ :~,,~ .................. ~,~=,,~;g~ ~ .~?:n~i .... ~-~ ~ ~: i~ ???~~. ~ %~ ~" '~ =~'-- ~. "'-...',[[=:..~ .~-.' .......... -'.~:~' = ' -. '; ~'~,'.,':.~ ~;~ ..~ ..~ :: ~' , .~ ~., . . ' :' ~'~ b .~ =~.. "..,.':~ ~?'.....".[ =:=~:~.~ ~.~ ~ ................... ~ ~ . ~4'::~',~!~2'.~,,~[~;,~=~,~:'.,.'' ';~ ,~ :~ ~.'.._..':~ ~,,. ~ ,~.' ..... . ,i, -~. .,~ .~ ,~ ,~. ~. ,~ ~- Is~ by:  B~er,field Fke D~a~ment Appmv~ by: ~ 1715 Chewer Ave., 3rd Floor ~ Office of ~en~l S~i~ B~e~fiel~ CA Voice (805) ~979 F~ (S05) 326~576 Expiration Date: June 30, 2000 ITE DIAGRAM ! ~"! ~ FACILITY DIAGRAM CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 013'I' UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 PHONE NO. b3~/- fOOo - AnnRESS 1 6fl' ~"~tl,/~ BUSINESS ID NO. 15-210-Oi~ 70~1.,.0.'9~ FACILITY CONTACT INSPECTION TIME l.l ;~.9 --'l[:~t/ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program utine [~ Combined [~ Joint Agency {~ Multi-Agency ~,~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation ~' ~__.~__. tO Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow - Slation Copy Pink - Business Copy Inspector: ; z ,' PLANNED PARENTHOOD ~~~ SiteID: 015-021-000052 M~vto ~-r-~ RECEIVED ~&/ Manager :~--~ ~OA'~-~O~ ~ BusPhone: (~5) 634-1000 Location: 2535 16TH ST 100 OCT 04 ~000 Map : 123 CommHaz : Minimal City : BAKERSFIELD Grid: 02A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION ~V!~©~'~5~V~OSSSIC Code: EPA Numb: DunnBrad:23-711-4083 _ N~F~<~ Emergency Contact , / Title ,:mergency uonsact / Title · : e 634-1020x Business Phone.-- (~C5') 634-1025x 872-7844x 24-Hour Phone ~&l(~5~) -398-2455x~2q Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : SANDI MOHIZ Phone: (~) 488-4932x MailAddr: 633 N VAN NESS AVE State: CA City : FRESNO Zip : 93728-3476 Owner PLANNED PARENTHOOD MAR MONTE Phone: (408) 287-7532x Address : 1691 THE ALAMEDA State: CA City : SAN JOSE Zip : 95126 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List ~--- As Designated Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax IUnitlMcP OXYGEN F P IH G 6792.00 FT3 Low ," NITROUS OXIDE F P IH G 218.00 FT3 Hi I~"~q ~[.,T/.Cb6-~ Do hereby certify that I have (Typ~ or pdnt name) reviewed the attached hazardous materials manage- ment plan for (:b~eoD~nd that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. ~.~ -z- IO-'o).Ob 09/28/2000 Date PLANNED PARENTHOOD OF CENTRAL CA SiteID: 015-021-000052 F Inventory Item 0001 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: WORK STATION CAS# 7782-44-7 V STATE ~ TYPE i PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 6792.00 FT3 6792.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: EXAM ROOM #3 CAS# 10024-97-2 FSTATE -- TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 218.00 FT3 178.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -2- 09/28/2000 PLANNED PARENTHOOD OF CENTRAL CA ~~~ SiteID: 015-021-000052 i i~ Notif./Evacuation/Medical ~~~~~~ Overall Site i i~ Agency Notification ~~~~~~~ 10/14/1992 i o CALL 911 ° o ii~/~ Employee Notif./Evacuation ~/~/5~/~/~/~~/~/5~ 10/14/1992 i o THE FACILITY MAINTAINS AN EVACUATION PLAN AND DIAGRAM WHICH IS POSTED o THROUGHOUT THE FACILITY (REQUIRED BY STATE HEALTH LICENSING). STAFF IS o ROUTINELY DRILLED ON EVACUATION PROCEDURES. o O i~ Public Notif./Evacuation ~~~~~~ 10/14/1992 i O EMPLOYEES ARE TRAINED IN EMERGENCY EVACUATION PROCEDURES TO FOLLOW TO ASSIST o PATIENTS/VISITORS FROM THE BUILDING, FOLLOWING POSTED EVACUATION PLANS. o o i/~8~5/5~ Emergency Medical Plan ~5/~88/~8~5/~/~8~5~5~/5~8~~ 10/14/1992 i O STAFF IS TO CALL THE 911 EMERGENCY NUMBER TO SUMMON THE FIRE DEPT/PARAMEDIC o TEAM FOR ASSISTANCE. EMERGENCY MEDICAL ASSISTANCE IS ALSO AVAILABLE AT: o KERN MEDICAL CENTER - 1830 FLOWER ST - 326-2000. o O -3- 09/28/2000 PLANNED PARENTHOOD OF CENTRAL CA i~ Mitigatio~Prevent/Abatemt ~~~~~ Overall Site i~ Release Prevention ~~~~~~~ 07/06/1998 o THE OXYGEN IS STORED IN A STANDARD CYLINDER AND IS ROUTINELY CHEC~D BY o PERSONNEL FOR LEAKS AND LOSS OF PRESSURE. SUPPLY COMPANY REPLACES CYLINDER o UPON ~QUEST. o o i~ Release Contai~ent O o o i~ O~er Resource Activation o o -4- 09/28/2000 PLANNED PARENTHOOD OF CENTRAL CA 6~/5~/~6~/~ SiteID: 015-021-000052 i/5 Site Emergency Factors ~/~/~/~/~/~/~/~/~~~ Overall Site i i~ Special Hazards o o ii~ Utility Shut-Offs ~/J~~/~/~/~/~/J~/~/J~/~/J~/J~~ 06/18/1998 o A) GAS - NONE o B) ELECTRICAL - UTILITY LOCATED AT W END OF BLDG o C) WATER - OUTSIDE FRONT DOOR OF BUSINESS o D) SPECIAL- NONE ° E) LOCK BOX - NO o O i~iJ~ Fire Protec./Avail. Water/~6~/~~~/~/~/~/~/~ 07/06/1998 o PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON SITE. o O O O FIRE HYDRANT - W OF BLDG ON 16TH ST. o o ii~/~i~i~ Building Occupancy Level 0 0 -5- 09/28/2000 PLANNED PARENTHOOD OF CENTRAL CA EEEEEE/~EEE/~EEEE/~/~EE/~ SiteID: 015-021-000052 i~ Training ~~~~~~~~ Overall Site i~ Employee Trai~ng ~~~~~~~ 07/06/1998 WE HAVE fl EMPLOYEES AT THIS FACILITY. o O WE HAVE MATE~AL SAFETY DATA SHEETS ON FILE. O GIVE A B~EF SUMMARY OF YOUR T~INING PROG~M: o o o o i~ Held for Fumre Use o o i~ Held for Fumre Use O o -6- 09/28/2000 PLANNED PARENTHOOD OF CENTRAL CA JUN ~ ~ ~ 13~8 SiteID: 215-000-000052 Manager : ~: BusPhone: (805) 634-1000 Location: 2535 16TH ST 100 - ---Ma~r~=---~: 123 CommHaz : Minimal City : BAKERSFIELD Grid: 02A FacUnits: 1 AOV: .CommCode: BAKERSFIELD STATION 03 SIC Code: EPA Numb: DunnBrad: 23-711-4083 Emergency_ _Contact / Title Emergencv Contact / Title '~-~'~V ~Jr~'co'62~' / CENTER MANAC-~-~ .g~?~e(.-~.-~.,.~_~ / ~/~_,~ ~_~..~u~... Business Phone: (805) ~3~-/0~o Business Phone: (805) 24-Hour Phone : (805) -~'~Q-_?~'%/~ 24-Hour Phone : (805) Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : ~01 ~0~7_ Phone: (~)~ -~95P-x MailAddr: 633 N VAN NESS AVE State: CA City : FRESNO Zip : ~ 57.D~% .... Owner ~c~ Mc.-6 .~...~/l~-~ 17~oO]D . ~Z ~. · ~v~ ~ ~ :V ~ Phone: (g~_,. ~-~ Address : }(~ 9 J TH-~'--: l~t~.-l~aq ~-'/31q State: CA City : ~ ~t~ -Jo$ ~ ~ ~ Zip : . q~{ a Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certlf 'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List t-- As Designated Order Ail Materials at Site I Hazmat Common Name... ISpocHazlEPA HazardsI Frm DailyMax IunitIMcP OXYGEN F P IH G 6792 FT3 Low NITROUS OXIDE , [~%j~ ~'v~.L.~,. ~ DO hc.<~,%y certify th~l have I .--~ F P G 218 FT3 Hi .... ,...,:. at~ached hazardous materials manage- merit p,.:~n for t~L~u~ ~)~-~rr~and that it along with (l~mo of I~us-'zsss) any corrections constitute a complete and correct man- agement plan for my facilibj. -1- 06/11/1998 PLANNED PARENTHOOD OF CENTRAL CA ~~~~ SiteID: 215-000-000052 ~ i~ Notif./Evacuation/Medical ~~~~~~~~ Overall Site ; i~ Agency Notification ~~~~~~~~~ 10/14/1992 ~ O CALL 911 o O aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeef i~ Employee Notif./Evacuation ~~~~~~~ 10/14/1992 ~ O THE FACILITY MAINTAINS AN EVACUATION PLAN AND DIAGRAM WHICH IS POSTED o THROUGHOUT THE FACILITY (REQUIRED BY STATE HEALTH LICENSING). STAFF IS o ROUTINELY DRILLED ON EVACUATION PROCEDURES. o O O EMPLOYEES ARE TRAINED IN EMERGENCY EVACUATION PROCEDURES TO FOLLOW TO ASSIST o PATIENTS/VISITORS FROM THE BUILDING, FOLLOWING POSTED EVACUATION PLANS. o O O STAFF IS TO CALL THE 911 EMERGENCY NUMBER TO SUMMON THE FIRE DEPT/PARAMEDIC o TEAM FOR ASSISTANCE. EMERGENCY MEDICAL ASSISTANCE IS ALSO AVAILABLE AT: o KERN MEDICAL CENTER - 1830 FLOWER ST - 326-2000. o O -2- 06/11/1998 i PLANNED PARENTHOOD OF CENTRAL CA i~ Miti~ation/Prevent/Abatemt ~~~~~~~ Overall Site i~ Release Prevention ~~~~~~~~~ 05/08/1990 O o THE OXYGEN IS STORED IN A STANDARD CYLINDER AND IS ROUTINELY CHECKED BY o PERSONNEL FOR LEAKS AND LOSS OF PRESSURE. SUPPLY CO. REPLACES CYLINDER UPON o REQUEST. O i~ Release Containment ~~~~~~~~~~~i O O O O i~ Other Resource Activation O O -3- 06/11/1998 i PLANNED PARENTHOOD OF CENTRAL CA ~~&~&~~ SiteID: 215-000-000052 i~ Site Emergency Factors ~~~~~~~~ Overall Site i~ Special Hazards ~~~~~~~~~~~~i O O O o A) GAS - NONE o B) ELECTRICAL - UTILITY LOCATED AT WEST END OF BUILDING o C) WATER - OUTSIDE FRONT DOOR OF BUSINESS o D) SPECIAL - NONE o E) LOCK BOX - NO O i&&&& Fire Protec./Avail. Water &&&&&&&&&&&&&&&&~&&&&&&&~&~&&&&& 12/19/1991 O o PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON SITE O O O o FIRE HYDRANT - AT EAET END OF BUILDIN~ TWO, COP~ER OF STOCKDAL~ HwY & o MCuONALD WAY AT NORTHW~S'i CORNER. b3~ o~ ~o(=~mO~ o 0M 1%+~ %a-~C~7-. O O -4- 06/11/1998 PLANNED PARENTHOOD OF CENTRAL CA ~~~~ SiteID: 215-000-000052 i~ Trainin~ ~~~~~~~~~~~ Overall Site i~ Employee Trainin~ ~~~~~~~~~ 10/14/1992 WE HAVE 5 EMPLOYYEES AT THIS FACILITY WE HAVE MATEIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TP. AINING: 5 06/11/1998