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Home My WebLink AboutBUSINESS PLANPrevention Services Unified Permit SUBJECT TO CONDITIONS OF PERMIT THIS PERMITIS ISSUED FOR THE FOLLOWING: · .,~: ,.,* ¢' = / · ....' .'.* .m .... [] Hazardous Materials Plan · ~-'t,?. ' ' i~ * ' ' ' ' ''~ ,?: ~ ~' .: :.:.~.~,: ....... '.~.....* -**-' ~*~. ~ Underground Storage of Hazardous Material · ~?~'~ ~ · ....~? ~¢*~: ~ ~*~:~'~ ~, ~.~, % "';.>~. O Cahfomla Accidental Release Pr~ram · * ~.~=~ *~ ;'~ ??:'~' '~'~-~ . ~:'~ ~; *~ :~.~* ~ ;':;~::~ ~ Hazardous Waste Generator and/or Treatment ERMIT ID ~015~21-000303 . ~'~, ~.~ ?:***/~;~,:~ ~...7~.':.*:~~ ........ *..~ .. 7 ::'..?~. :.*~ j*%.' * *.. ~ Above ground Storage Storage of Petroleum · . "? ' .~ ' '~.~ '- :* ~. '>- *'~'~ ~= ~, '~-~ ·~ Paint Spray Booth PAIN MEDICINE CENT : HE E HSOUTH , ,-;?*',%~5. ~: *'~... ' ~ Industrial Hood S ' - ' . ~.~ ..:/,~, ...,. ~ .~, .: ~.:',~*--L~j~...- - '~: uppress~on ~ystem 2120 19 STREET · ~ ~.... ~ ,.~ .-~ ,~.,~ ~ BAKERSFIELD, CA 93301 ?-,"~r ~'~' -?~ ....... ::~ ~-~'~V '~."([:~' ~ '~ '3 ~ . ,~ .... - ~ :~?'. , .. -" . .: ~ ::. .~:~.... **; : . .' ... :.- Issued by: Bakersfield Fire Department OFFICE O.F: PREVENTION SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 852-2171 Approved by: ~ph Huey, Director-- Prevention services Expiration Date: June 30, 2006 fd1736 Prevention. Services Unified Permit SUBJECT TO CONDITIONS.OF PERMIT THIS PERMIT IS ISSUED FORTHE FOLLOWING: []*Hazardous Materials Plan [] Underground Storage of Hazardous Materials 2120 19TM STREET BAKERSFIELD, CA 93301 Issued by; [] California Accidental Release Program [] Hazardous Waste Generator and/or Treatment [] Above ground Storage Storage of Petroleum [] Paint Spray Booth [] Industrial Hood Suppression System Bakersfield Fire Department OFFICE OF PREVENTION SERVICES 1715 Chester Ave., 3rd Floor~ Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 852-2171 Approved by: Expiration Date: '~(ph Hue[/, Director--- Prevention Services June 30, 2006 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID # 015-021-000303 HEALTHSOUTH LOCATION 2120 lssuedby: Bakersfield Fire Department , · OFFICE OF ENVIRONMENTAL 'SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: This _;~ermit is Issued for the followine_: 12] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program I-i Hazardous Waste On-Site Treatment · June 30. 2003 q-/z-bo Issue Date Hazardous Mater a Permit ID#:: 015-000-000303 BAKERSFIELD EYE LOCATION: 2120 19TH ST Issued by: Bakersfield Fire Department *' OFFICE OF ENVIRONMENTAL .$ER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 .-...: *~ , .:- ".:. , · Approved b~ Expiration Date: 'June 30:2003 Issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE · * . ............ ,~,~,~,~,~,~?,~,~,,~,,, ................ This permit is issued for the following: .,~**~¢i?~!*~'i'.:~ ~,!?~"'"'~':'":;;i iii!iii,, ~ ii!f, iiiill iii;;'-:: iiii i;~ii~e[ground Storage of HazardoUs Materials ~i" ..... ~ '~ "~'<' i ¢I~ .~,, ',, '~.~i~ ' . ' '%'-'"':::.%, qi~ 14J~ ']~%;:"~L,'iL',r ......L;~ ¢,"~' ~¢~' ', ', '¢ '~"'-' .=2% '?% ~ i ~14 P '"'~"~ "'r~..~ ......... _~.~.,:3.~ i~:~E~: .~?" ~ %; .......... ;~%,;]"~-,~i~' ¢" ~¢'~4~ .,;;~;;Z";;;;;;~i~."~i~C~i~J, '%,..~, =,~ ~.,V~' ...... ~,~ ;;;,~::~ .," ,..-'.....'/',.,.'/',,..' /;'.~' ,,, ¢ ¢~:,~6,~~¢~ ..... . Issued by: Bakersfield Fire DePartment OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326.0576 Approved by: ~dlph Huey,~~__=J Office of ~'t~.ental Servid~s Expiration Date:' June 30, 2000 ou are PLAN BAKERSFIELD CITY FI'RE DEPARTMENT' HAZARDOUS MATERIALS DIVISION .~ 2130 "G" STREET BAKERSFIELD, .CA. 93301 RECEIVED ~ INVENTOR HAZARDOUS MATERIALS FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ]. 'BUSINESS NAME- ~-'~(L.~%'J~ ',.~'( ......... · FACILITY NAME SITE ADDRESS ~ J~'O ) q ~ q._~JCg~.~~' CITY ~'~ 0 ~...J'~-~/L~ ~' .~ STATE ~'~- zIP NATURE OF BUSINESS ~j.~U~/~'~_J'~ ~ SIC CODE 'DUN & BRADSTREET NUMBER MAlUNGADDRESS ~O 1~. ~±C~'~ EMERGENCY CONTACTS NAME ~::~,~ ~)~ TITLE ~,-F~. ~ BUSINESS PHONE ,0--~.~ ~'"~'~""',_,3¢3,~0 24-HOUR PHONE ,,.~ -C)C~ NAME %-~ht"-I ¢"'JrO0,~ TITLE (/~,,~,~L¢~,, BUSINESS PHONE ~-'~'-c~'O 24-HOUR PHONE' . June 23, 1 g~3 , REGION'V LEPC STANDARD FORM- BAKERSFiJLD CI.'[Y FIRE DEPAI 'MENT ' HAZARDOUS MATERIALS INVENTORY Page_of_ Business Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: NewV Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET 2) common Name: Jr--fC.L-¥'Y'~C~ (-'~(~")~Oi"'~e_.. }.~p~("~,~L~r"~ 3) DOT # (optional) 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ J Reactive J J Sudden Release of Pressure I ] Immediate Health (Acute) [ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas ../ Pure [ ] Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: ' ' lbs [ ] gal [ ] it3 .! .]_ /~Container: '~'j Annual Amount: · .' c) Temperature: Largest Size Container: # Days On Site ~ Circle Which Months: AllYearl J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: list COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemicaJ components or any AHM components 2) [ ] 3) [ ] 10) Location " CHEMICAL DESCRIPTION _ 1 ) INVENTORY STATUS: New J)4J Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [' ] TRADE SECRET [ ] 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire' [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed HeaJth (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount:· lbs [ ] gal [ J it3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Lm'gest Size Container: ',' # Days On Site Circle Which Months: All Yea~, J, F, M, A, M, J, J, A. S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) chemical components or any AHM components 2) [ 3) 10) [ocation ce~fy under penalty of/aw, that I have personally examined and am familiar with the infomafion submitted on this and ail attached documents. I believe the submitted information is l~ue, accurate, and complete. PRINT Name & Ti#e of Authorized Company Representalfve Signature- Date ---HRALTHSOUTH BAKERSFIELD SURGERY Sit. elD; 015-021-000303 Manager : L P~O~X,S ~ ~F-.r~,°r~3, Bu~Phone~ (661) 323-2020 Location: 2120 '19TH ST $~? ~o ~.,~0~uo Map .' 102 Co~a~Haz : Low City : BAKERSFIELD Grid: 25D FaoUnits: i AOV: EPA N~: ~rad ~ 14-7~S-4062 ..... T~ · . ~ency ~nCact / Titl~ ~rg~ Contact / Ti=le · L ~~0~ / ~M~rS~TOR B BUSH / BUS OFFICE ~ineos P~: (661) 323-2020x Business Phon~: (661} 24-Hour P~ne i (661) ~q-}75Ax 24-Hour Phone : (661} 203-9184x P~ Phone ~ (661) 30q-q~ql.x~ Pager Phone ~ ( } - x ~z~t Hazards: ~n=ac~ : Ph~e~ (661) 323-2020x ~= ~~SO~ ~ ~t~~ ~T~ O~ Pho~: (661) 323-2020x City ~ ~PI~D Zip : 93~01 Period t to Toba~GTs, - ~al Preparer: TotalUSTs: - Certtf' d~ ~: No ParcelNo: ~rgency Directi~s: ~ 'd ~LL$'ON ~)Sdd HlllOSHII¥3H ~dcJO:E; 800~ '8~'d~S '" -... Fast Fo~ ~No~if./~acua~on/~di~al .-: ,~ ~rall St~e ~enay No=ification. -' 09/13/2000 911. Employee No=tr./Evacuation 09/13/2000 FI~E Al.ARM SYSTEM CAN ~ MANUALLY ACTIVATBDAND BLDG ~A~T~. -- Public Notif,/~ac~t~on .,. .... --..~-- .------.. ,.. - 09/1B/2000 T~-T~C ~ SYS~M ~ B~ ACTI~T~ BY ~ING ~ FI~ ~ BOX ~ ~P~YE~8 WO~ ~AC~ ~S~VES ~~L ~e~cy M~ical PI~ ..... 06/26/199~ ~ HO~PI~ - ~215 ~~ AV - 327~3371. ...~ -.. g 'd 'yLLg'ON 3Sdd HIAOSHIIV3H ~dgO'g ~00~ ...... ~ ...... Fas: Fo~: ~Cig~ion/Pr~ent/~atemt ......... -. ~erall Site Release Prevention ....... 09/13/2000 ~ ~ ~ A~A~O TO W~ ~ITS ~ ~T~E ~ITS ~ ~INS ON PORT~ ~~ ~O~S USED CYLI~ERS ~OM P~I~$ ~ ~P~S WI~ FIL~ ~S ~ HOO~S, I~P~~ ~ER DELIV~ ALL DIESEL ~, -- ~eleaee ~o~tainment ........ ~ ....... -Other Resource Activation ......... .. -- ~ 'd ~LLg'ON 3Sdd HIFIOSHI-IV:IH ~dgO:g gO0~ 'g~'eaS. Bite Emergency Factore ,.-. ........ Overall Bite ~SDe¢ial Hasard~ . - ........... U~ili=y Shut-Offs .......... ' .... · ..... "- A) GA~ - N~ CORNER B) ELECTRICAL - INSID; ~ CO~R OE ~LD~ C) WA~ - ~ CO~R 0~SIDE D) SPSCZ~ - NO~ E) L~ ~x - NO -- Fire'Drotec./Avail. Water . _ _ 09/13/2000 ~ PRIVA~ FI~ P~CT[~ - T~-T~ FI~ ~ CO--ION ~R FIRE ~OT~ ~ ~. ....... Builchtng Occupancy Level ......... -4- 0~/33/2003 § 'd tLL$'ON 3Sdd HIrIOSHI'IV~H ~dgO:~; $00~ '8~'aeS ..... ~loyee Trai~ .... - ....... - ......... 09/13/2000 ~ ~ ~T~L SA~ ~TA 8~EETs ON FILE. ~P~TED ~Y. Page 2 ....... . ....... , Held for Future Use -- .__= '-a .... ~-- ;-~ .... Held ~or Future uae -- .~- ---.-...a.~ -. .... -5- 09/23/2003 9 'd fiLlS'ON 3Sdd H£rlOSHJ. IV3H ~NdgO:S 800~ '8~'aeS OF OF ENVIRON,~IENTAL SEI~rlCES 1715 Chester Ave., CA 93301 (661) ' ~"--' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRI~N I. PA~LI~ INFORMA~ON '_ .......... ~J__~~ ~,_. ............ :__.. . 77~ . ......... ..// '- ~'"' ~" l .. o. ~ ~~,~ o. ~~ ~~, '~ " ~ 0 - . . _ ........... .,,~,,.~~ ~ ~....~~~~- ~~~~ _-- .~ ....................... (7/99) : SACUPAFORMS~OE$273t .TV4.wpd '"" · [ L 'd tLL~'ON 3Sdd HlflOSHII¥3H ~d90'S 800~ '&~'ooS i-- CITY OF BAKERSFIELD ~) OFFICE OF ENVIRON~IENTAL SEC'iCES 17 IS Chester Ave., CA ~3301 (6~ l) 326-3979 H~RDOUS MATERIALS INVENTORY CHEMICAL DESC~ION I. FACI~ INFORMA~ON ~Y~ ~Y~ (7/99) SACUPAFORMS~O£S2?3!.TV4.wpd Il 'd tLLS'ON 3S.dd H/IIOSHIq¥~IH ~d80:8 800~ 'f~'deS HA OUS [W. ATE~AL$ ~LA~AGE~! PLA~ SECT[ON {[. I: D{SCOVERY AND. NOT[F/CATIONS A. LEAK DETECTION AND MONITORINO PROCEDURES: B. 'EMPLOYEE AND AGENCY NOTIFICATION: 2 ' Lt 'd 'tLLS'°N 3Sdd HIflOSHIIV]H ~dOl:8 800'~ '""~' crtoN {[ 2' RELEASE RESPONSE PLAN ' ~~i HAZARD ASSESSMEICT AArD pR. EVENTION MEASURES: B. RELEASE CONTA.tNM~NT AND/OK MI'IquA · C. ~~.~ ~ ~CO~RY PRO~~S: UTU~ $I-]~:OI~-FS (LOCATION' OF'SRT}T-OFFS AT YOUR LOCK BOX: pL12VATE FIRE p,.ROTBCT~._ON./W_ATBR AVAILABILIT.¥ A. PRIVATE FIRE PROTECTION: 8l 'd ?LLg'°N OSdd HIflOSHII¥SH ~dOt:~ 800L .- ':' HAZJ~)OUS ~[ATERIAL$ ~,LANAGE~t[I PLAIN CERTIFICATION IS ACCURATE. ! UNDERSTAND THAT THIS INFOR.h~'kT][ON WILL'B~ USE3D TO ~~L ~ ~'s o~nm~o~s ~ ~.,c~o~ ~~ ~ s~ coo~., o~ ~o~ ~~ ~. ~o ~ ~.~ ~c. ~0o ~ ~.~ ~ SIGNAT~ ~LE DATE 4 61 'd tLLS'ON 3Sd.d HI~OSHII¥]H ~dOt:8 $00~ '$~'oo8 ] -. PAIN MEDICINE CENTER OF BAKERSFIELD 2120 19th Street Bakarsfield CA 93301 = Smoke Barrier -- Ex[erior Exit Door LEGEND MEDICAL GAS SHUT OFF OXYGEN TANKS ~x~ous oxzD]~ T~:S EL~C~I~ ~T OFF CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME /"/t~]~"~~, }~[~ ~' ~'6ty ADDRESS ~P j~ ~ PHONE NO. FACILITY CONTACT BUSINESS ID NO. 15-210- ~SPECT1ON TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program I~} Routine [~ Combined [~ Joint Agency [~l Multi-Agency ~.~ Comp?int {~ Re-inspection OPERATION ( C V COM M E~bT-S App[opriate permit on hand ~ Business plan contact information accurate ~ ~ "~ ~%~,/. ~ Visible address ' ~ ~ .~ · ~,:' (' Verification of location /~,~ {~e~ ~ 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 .,, Any hazardous waste on site?: I~ Yes ~] No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector:~,-, ~-"~,~p sA ~ ~ BAKERSFIELD _R~R & SURGERY CENTER SiteID: 015-021-000303 Manager : L,~3~3q~ ~ ~~ BusPhone: (805) 323-2020' Location: 2120 19TH ST Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 25D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad:14-768-4062 Emergency Contact ~/ 'Title Emergency Contact / Title ~ ALLMAlq-a, 5{0c~n%~ / ADMINISTRATOR B BUSH ,,_/ BUS OFFICE MGR Business Phone~ (~) 323-2020x Business Phone: (~) 323-2020x 24-Hour Phone : (~O~S) -$99-b~gx ~'6L~24-Hour Phone : (~ 872-5652x P~f Phone : ~ 63~-6~x~33-0~lZ Pa~3~[ Phone : (6~) ~0~-~/~x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 2120 19TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner R LD SURGERY CENTER Phone: ( ) - x Address : 2120 19TH ST State: CA City : BAKERSFIELD Zip : 933'01 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... SpeGHazlEPA HazardsI Frm DailyMax IUnitlMCP OXYGEN F P IH G 1648.00 FT3 Low NITROUS OXIDE F P R IH DH G 4200.00 FT3 Hi DIESEL ~ _-~ F R IH~ DH L 50.00 GAL Low NITROGEN .-~ ~,~ ~-~ ~~3 P IH DH G 1025.00 FT3 Min ~ ~ · I, ~f' ~~ DO hereby ce~i~ that I have ~ .... reviewed the a~ached h~ardous materials manage- ment plan for ~~ and that i~ along Wi~h (Name of ~sina~) any c°rre~ions constitute a complete and corre~ man- agement plan for my facili~. .~' BAKERSFIELD ~ SURGERY CENTER SiteID: 015-021-000303 ~ 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: NE CORNER OUTSIDE BACK CAS# 7782-44-7 F STATE I TYPE , PRESSURE TEMPERATURE CONTAINER TYPE Ambient PRESS CYLINDER Pure Above Ambient . . Gas PORT AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1648.00 FT3 1236.00 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: NE CORNER OUTSIDE BACK CAS# 10024-97-2 . 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 4200.00 FT3 2533.00 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 R IH DH / / / Hi -2- 08/31/2000 BAKERSFIELD-E~SURGERY CENTER SiteID: 015-021-000303 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME DIESEL Days On Site 319 Location within this Facility Unit Map: Grid: SOUTHEAST CORNER OUTSIDE BLDG CAS# 68476-34-6 r STATE -- TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient IN MACHINE/EQUIP AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 50.00 GAL 50.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No No No No/ CuriesI F R' IH DH / / / Low ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW CORNER PATIENT ROOM 'CAS# 7727-37-9 ~ STATE i TYPE i PRESSURE TEMPERATURE I CONTAINER TYPE Ambient PRESS CYLINDER Pure Above Ambient . . Gas PORT AMOUNTS 'AT THIS LOCATION Largest Container Daily Maximum I Daily Average FT3 1025.00 FT3 I 900.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Nitrogen No 7727379 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA' USDOT# MCP No No No No/ Curies P IH DH / / / Min -3- 08/31/2000 BAKERSFIELD D~-~ SURGERY CENTER SiteID: 015-021-000303 Fast Format ~Notif./Evacuation/Medical Overall Site kgency Notification 01/07/1990 CALL 911 Employee Notif./Evacuation 01/07/1990 FIRE ALARM SYSTEM CAN BE MANUALLY ACTIVATED AND BUILDING EVACUATED. Public Notif./Evacuation 01/07/1990 SONNITROL ALARM SYSTEM CAN BE ACTIVATED BY PULLING ANY FIRE CALL BOX AND EMPLOYEES WOULD EVACUATE THEMSELVES AND ALL BUILDING OCCUPANTS. Emergency Medical Plan 06/26/1997 MERCY HOSPITAL - 2215 TRUXTUN AV - 327-3371. 4 08/31/2000 BAKERSFIELD ~Y-U~__SURGERY CENTER SiteID: 015-021-000303 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site Release Prevention 06/09/1997 ALL TANKS ARE ATTACHED TO WALL UNITS AND PORTABLE UNITS HAVE CHAINS ON PORTABLE CARTS. SIR ~±~u±ff REMOVES USED CYLINDERS FROM PREMISES AND REPLACES WITH FILLED CYLINDERS ON AN ON CALL BASIS. ~c,~Pm~R MEDICAL PROVIDES MAINTENANCE FOR VALVES AND HOOKUPS. INDEPENDENT VENDER DELIVERS ALL DIESEL FUEL. Release Containment Clean Up Other Resource Activation -5- 08/31/2000 BAKERSFIELD E~SURGERY CENTER SiteID: 015-021-000303 Fast Format ~ Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 06/09/1997 -- A) GAS - NORTHWEST CORNER B) ELECTRICAL - INSIDE NE CORNER OF BLDG C) WATER - NE CORNER OUTSIDE D) · SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 06/26/1997 PRIVATE FIRE PROTECTION - SONITROL FIRE ALARM CONNECTION FOR FIRE PROTECTION. FIRE HYDRANT - SW CORNER ON ALLEY AND C ST Building Occupancy Level -6- 08/31/2000 BAKERSFIELD ~SURGERY CENTER SiteID: 015-021-000303 Fast Format F Training Overall Site Employee Training 06/09/1997 WE HAVE 18 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MATERIAL SAFETY DATA SHEETS ARE AVAILABL'~ TO EMPLOYEES, THEY ARE LOCATED IN THE RECOVERY ROOM. HAZARDOUS MATERIALS TRAINING IS GIVEN TO EACH NEW EMPLOYEE DURING ORIENTATION AND REPEATED ANNUALLY. Page 2 Held for Future Use Held for Future Use -7- 08/31/2000 H i iL , FAX TRANSMITTAL SHEET FROM: LORI STERBENK RN, ASSISTANT ADMINISTRATOR/DON DATE: September 11, 2000 FAX NUMBER: (661) 323-6552 TOTAL # OF PAGES: (including cover sheet) COMMENTS: Enclosed please find corrected business plan for Healthsouth Bakersfield Surgery Cemer. To follow is an MSDS sheet for Helium Gas Mixture used with our Excimer laser. This gas is only ordered for Prevemive Maintenance visits and handled only by a certified laser technician. The laser room is vetoed per regulations. Tanks are sent and received per Fedex delivery. Also find enclosed a copy of our current MSDS index. If there are any questions or concerns, please do not hesitate to call me at 323-2020. Thank You,. Loft Sterbenk If there are problems receiving this transmittal please call: Bakersfield Surgery Center (661) 323-2020 _HSFax.dot One HealthSouth Parkway, Birmingham, AL 35243 3/2797 MATERIAL SAFETY DATA'SHEET Hazardous Cou~ne~t Manufacturer Chemical Name: Neon, Ne Spectra Gases, Inc Helium, He 277 Colt Street Argon, Ar Irvington, N.J. 07111 Fluorine, F2 201-372- 2060 'Common Name: Excimer Laser Premix Fluorine~ 7782-41-4 Argon: 7440-37-1 ~eon: 7440-01-9 Helium: 7440-59-7 Date Prepared: 2/17/93 Update: Spectra Gases emergency contact: 201-483-0257 8:00am - 5:00pm 24 hr ~mergency contact, Chem~rec= 800-424-9300, 202-484-7616 Note~ The p~rce~t&ges of the above ~omponents are Droprletary in£ormatlonan~have been purposely left o££ t~is MSDS. The health a~ ~ysieal hazards assooiate~ with =hi~ ~ix=u=e ~re clearly stated below. I~ in an emergency situation this information is - 'needed, please con=act Spectr~ ~ases Inc. an~ this information will b~e D=ovided promptly. The mai.or health hazard associated wi~h this ,mixture is ~hat it contains fluorine. Fluorine i~ a toxic gas wzth ..a""sharp pungent odor. t~at helps provide ample warnin~ of toxic' level~ in the atmosphere. Fluorine readily reacts with 'moisture to foTM hydrofluoric acid. Hydrofluoric acid is irrita~in~ and highly corrosive to all living tissue. Normal atmospheric moisture and that con%ained in skin, eyes, lungs and nasal passages is suffi- cient for the ~ormation of hydrofluoric acid. Fluorine -is an extremely s~rong oxidizer that will cause acid-like burns on skin, eyes and the mucus membranes of the lung and nose. The argon, neon ~und helium 'contained in this mixture are stabel,inert, non- · --'flammable, nontoxic gases that pose no health hazard. Because s~eci£i~ toxicolo~y da~a is not available for this mixture, s~oul~ be hah~led carefully and with the assumption t~a= i= is a ~oxic, corrosive ~s. F~l~osure Limits OSHA TWA: ppm N/A N/A N/A OSHA PEL:' 0.1 ppm N/A N/A N/A OSHA STEL: 2.0 ppm N/A N/A N/A AC~IH TLV: 1.0 ppm N/A N/A N/A NIOSH IDLE: 25.0 ,ppm N/A N/A N/A 08/08/96 THI~ 10:40 FAX 617 ~.~8 SE~IT TECI~'OLOGY - ~002 Carclno~en Data NTP: No No No No I.A.R.C. Monographs: No No No No' Othe= Exposure Limits: Concentrations of 5-i0 ppm fluorine will cause irritation of the eyes and mucus membranes of the lung and nose. Concentrations of as little as 25 ppm over 5 minutes may cause symptoms of severe exposure and possibley, be fatal. These t~l~eS O~ eXposUres ~re possible e~en ~hough the concentration of fluorine in this mixture is only 0.5%. Routes of Entry, S~mptom8 o£ ExpOsure,' First Ai~ Procedures WARNINg= If resole personnel need ~o enter an area suspeoted of having a toxic level of fluorine they should be equIp~ea with a self contained breathing apparatus and if available a full body chemical resistant= suit. Sk~nt When the fluorine contained in this ~ixture comes into con~ tact wi~h skin it may cause mild irritation ~o severe acid-like burns dependin~ on ~he length of exposure. Symptoms include severe pain, redness, swellin~ and possible tissue damage or destruction. ~&=~'Aia~ ~f the skin contact includes contac~ with the victim's clothing, this clo=hin~ must be removed immediately to lim~ burns. Burn area should'be flushe~ with. large amounts of wa~er for approx- imately fifteen minutes. If the .burns cover a large part~o~ the body the victim should be put under ~ shower and his clothing re- moved while under the shower. Seek medical attention immediately for any'severe burns involving fluorine. ~urns may be treated with 2-3% aqueous ammonia solution, followed by liberal rinses of fresh water. Following this, an ice-cold saturated solution of magnesium sulfate (Epsom salt} or iced 70% alcohol should be applied wi~h cold compresses every two minutes, ~or a total of thirty minutes. If medical attention is no= immediately available, then apply a thick paste of U.S..P magnesium oxide powder and.U.S.P glycerin. Do not use any type of oils or greases. Eyes= The fluorine contained in this mixture will cause severe burn~ of the eyes. Symptoms of exposure include excessive tearing, redness, swelling and possible blandness if not treated immed- iately. Never wear contact lenses when handlin~ this mixture. Firs= Aid: Affected area needs to be immediately washed with large amounts of water for at least fifteen minutes, Eyelids should be held open ~o assure complete flushinu. Anesthetic eye drops, used after an initial two minute eye wash, will reduce eye spasms as well as facilitate eye flushing. Do not use any type of oils or ~reaSes. Seek medical attention immediately for any eye exposure to fluorine. Inhalation: The ~luorine contained in this mixture will caus~ 08/08/98 THU 10:40 FAX 817~ 0;398 SI.'t~IT TECtINOLOG¥ [~003 severe irritation of the lungs and nasal passages. Symptoms of exposure include coughing, difficulty breathing, and abnormal fluid formation in the nose, mouth and throat. Deep inhalation of this mixture will cause inflammation and abnormal fluid build uD in the lungs which may be fatal. First Ai~: Victim should be removed from contaminated area. If not breathing~ give artificial.respiration. If breathing is difficult, give oxygen. In cases of extreme exposure,-administer 100% oxygen to reduce lung congestion. Keep victim warm and quiet. Assure that mucus or vomited material does' not obstruct airway by using positional drainage. Oxygen should be administered by trained rescue personnel.' In all cases of inhalation~ medical at~ention should be sought immediately and the victim observed for twenty .four to seventy ~wo hours for possible delayed pulmonary distress. Medical c~itions aggravate4 by exposure: Pulmonary diseases. Acute effects of exposure: See above C~ronio effects of exposure: Extended Iow level absorption of fluorine may cause fluorosis, an abnormal calcium accumulation in the bones, 'SECTION II P~SIcAL HAZARDS ( FIRE~ EXPLOSION, REACTIVITY ) The major physi¢~l hazard a~sociated wit~ this mixture i~ that it contains fluorine. Fluorine is a powerful oxidizer and extremely c0rro~ive. The hydrofluoric acid formed, when fluorine comes into contact with moisture, will corrode gas handling systems and other ~tructures, possibly causing leaks and damage to expensive equipment. -Pure fluorine reacts with almost all inorganic, organic and flammable substances. However, the concentration of fluorine contained in this mixture substantially reduces the heats of · .reaction and the risk for fire and explosion. Because specific · physical data on this mixture is not &reliable, it .should be ~a~led ~arefully wi~h the assumption that its physical hazardous, toxic, corrosive gas that has high heats of reaction and oonsi4ere4 a fire aha exploslon hazard. This mixture should never be intentionally, mixed with flammable gases or sttbstances. The flu~ine in this mixture will react with metals, though the teac=ion is relatively slow at room temperature. Systems should still be thoroughly cleaned, dried and then passivated with a small ~ample of the mixture. The argon, neon and helium contained in this mixture are nonflammable, inert, nontoxic and stable and do not pose any unusual physical hazards other tha~ that they are stored as a compressed gas and should be handled appropriately. 08/08/96 TIEr 10:41 FAX 617 0398 _. S[~IT TECHNOLOGY ~ i ~004 Flammability Data for the Mixture Flammability: Nonflammable Oxidizer: Yes Lower Explosive Limit( % in Air): N/A Upper Explosive Limit( % in Air): N/A Flammability Range( % in Air): N/A Autoigniton Temperature: N/A Pyrophoric: No Extinguishing Media: See Fire Fighting ~rocedures Fire Fighting Procedures: This mixture is nonflammable, However, in the event of a fire it does pose hazards. Fire fighters ~hould use extinguishing media '.applicable to what initially caused the fire. Fire fighters Should be equipped with self contained breathing apparatus and chemical resistant suits if available. Fires involving this mixture or in an area containing stored cylinders, should be trea~ed as an extreme emergency situation. If leaking, =he fluorine contained in this mixture is toxic and exposure should be avoided. Ail nonessential personnel should be evacuated and =he fire fou~h~ ~rom a safe distance. If this mixture is not leaking and not actively par~ of the fire, remove cylinders from fire area,.if this-is not possible, cool cylinders With a water spray to insure tha~ they do not rupture violently. -. Note~ Water a~d fluorine react to produce hy~rofluoric acid. Fire fi~ers and ~ersonnel s~oul~ be aware of this additional hazard · whez~ fighting £ires tnVolvln~ this mixture. Unu'sual 'Fire and. Explosi°n Hazards~ Fluorine. produces toxic, corrosive and reactive co~bus~i0n products such as, hydro~en fluoride, oxygen difluoride, and ozone. Keact!~i~y Da~a for the Mixtuxe~ Stable: Yes Un~table: N/A Conditions'to Avoid if Unstable: N/A Thermal Decomposition: Yes - Byproducts of Thermal Decomp: F~: CO,HF,0F~ Hazardous Polymerization: Will not occur Conditions to Avoid if PolYm~rizes~ N/A incom~a~bili~ies~ .~. Flammables, Wa~er a=d Water -v&~or, Metals, Mos= Or~ani= an~ Inor~aniu Materials, Combustibles Fluorine is inco~paiible with almost'al~ ma~erial~ except certain inert gases and perfluorina~ed compounds. SECTION III PHYSICAL AND'.CHE~.ICAL PROPERTIES. For Mixture .~hysical state: Cylinder Pressure: 1800 psig Appearance and Odor: Colorless ~as with a sharp irritating odor __ 08/08/96 THIT 10:42 FAX $17 $90 0398. S[T~[IT TECHNOLOGY ~)00~ Pot individual Components ~2 A~ N_me H_~e Molecular Weight: . 38,00 g/mole 39.95 20.18 4.00 Spec. Vol.. at 21 aC, i arm: 10.2 itS/lb 9.73 19.18 97.09 Boiling Pt. at I arm: -188.1 '°C -185.9 -246.0 -~68.9 Densityi at 25 CC, 1 arm: 1.554 kg/m~ 1.6S0 .83536 0.165 Relative Density (air -- I): 1.312 i.38 .696 0.138 Critical Pressure: 756.4 psis 711.5 384.9 33.0 Critical Temperature: -128.8 °C -122.3 -228.8 -267.9 Leak Speotra Rases Inc. strongly recommends that this mixture only be handled in areas with extensive venting capabilities. Fluorine and or hydrogen fluoride detectors are strongly recommended. Detectors will help to detect small leaks that may cause exposure above the TLV or give warning that a large leak has occurred. Cylinders should .be stored and used within a venUilated enclosure. Gas cabinets, designed for toxic,, corrosive gases are recommended. In ~he even~ of a leak, gas cabinets allow the gas ~o be vented safely. If the leak takes place outside a gas cabinet all personnel ~hould be evacuated from affected area. Wear a self contained brea~h~ng apparatus and a chemical resi~tant suit ~ud attempt to stop leak if possible. If not possible, provide forced ventilation (fans, fume hoods, exhaust vents) and remove leaking cylinder to outdoors away f~om personnel and. populated 'areas. The .above information is only a recommendation. Facilities should have an emer~en~yresp~se pro~r~_~ in place before this mix=ute is brought O~ Si~e, Small quantities of Chis mixture may be disposed of by slowly ventin~ through a solid caustic, scrubber. Soda lime ~s the preferred solid scrubbing media, although alumina or molecular sieves may be used. Do not ~se au%irate4 o~ar=oal or carbon. The' reaction of fluorine with these materials may generate excessive heat-with the evolution of fire under certain conditions, Do not dispose of u~used product, please return unused portions to Spectra Gases Inc.; 320 Mount Pleasant Ave, Newark, NJ 07104 or 1261 Activity Drive, Vista, CA 92083. SECTmONV 'STO~A~E AND a~NDLZNG ~ROCED.~UA%~.s . Storage Spectra Gases Inc. recommend~ that this mixture be store~ for no longer than one year. Cylinders should be stored separately from 21ammables, sources of ignition and any combustible 'or explosive. 08/08/96 THIT 10:42 FAX 617 0398 SElf'IT ~CHNOLOG¥ materials. Do not expose cylinders to direct sunlight or heat.' Cylinders should be stored upright in a cool, dry; well ventilated plac~ away from excessive heat, (not above 125 0 F). Cylinders should not be s~ored near heavily trafficked areas and should not block emergency exits. Cylinder plugs and caps should be in Place when cylinders are not in use. Empty cylinders should be stored separately from full cylinders. Full cylinders ~hould be used according to a first-in first-out basis. Do not slide, drag, roll- or knock cylinders against sharp objects. Always use a cylinder hand'truck when transporting cylinders. Handling and Control Me=hods This mix~ure is an extremely hazardous compressed gas and should on1¥ be hanalea by trained pers.nnel.'A self contained brea~hing apparatus and chemical resistant suit should be stored near the 'work area in ~he event of an emergency.. Contact lenses should never be worn when handling this mix,urn. Cylinders should only be used inside' an appropriate ventilated enclosure such as a gas cabine=. Under all circumstances cylinders should be secured to a wall or work bench to assure that they are not knocked over. If a cylinder i~ knocked over there is a danger of the valve sheering off or being knocked open thus increasing the risk of exposure to fluorine. Nickel, stainless steel, and monel are the recommended materials for regulators and piping. All equipment used for this mixture must first be thoroughly cleaned, degreased, dried then treated wi~h a sample o~ the mixture ~o passivate the equipment. Ail equipment should be kept scrupulously dry to limit corrosion. When working with this mixture always use a pressure reducing regulator, equipped 'with a tide diaphragm, to lower pressure to a sa.re working level. Ail gaskets and washers used with this mixture should be made of lead or teflon. Systems. should have purging capabilities, that include isolation valves, so that atmospheric contaminants a/ud residual gas mix,ute can be purged from piping and regulator~ before and after use. Do not heat cylinders by any means to increase the discharge rate of product from cylinders. cylinders should not be artificially cooled. Certain types' of steel LL~dergo proper=y changes when cryogenically coole~ thus making the steel unstable. Safety shield: Face shields of standard chemical resistant materials and s~andard safety glasses made of chemical resistant materials. Gloves: Neoprene or lea=her gloves. Should be loose fitting. Protective Suit: Chemical resistant aprons for routine handling. Use chemical resistant suits made of neoprene if " there is suspected hydrogen fluoride formation. Safety shoes: Standard leather safety shoes are sufficient. 08/0~/95 TBU 10:4~ FAX 617 890 0~98 ~. S~MIT TECHNOLOG¥ '" All protective equipment Should be choroughl¥ cleaned and checked after use. Gloves and.coats should be examined for holes before they are reused. All protective clothing must be designed so that it can be easily shed in the event of an emergency.. Make eyewash stations and safe=y showers available in areas where this mixture is being handled or stored. Ventilation an~Exhaus~ Systems This mixture should always be used within a ventilated enclosure such as a gas cabinet. OSHA recommends that tke face velocity for ~hese inclosure be 200 ft/~in, of air. Other forced ventilation systems should be such that the concentration of airborne fluorine is below the OSHA TWA of .~ ppm. State and local regulations may require additional scrubbin9 of :he vented fluorine. All ventila- t±on equipment must be nonsparking and electrically ~rounded. Information contained in this material 'safety data Sheet is provided to our cus=omers ~o they may comply with 29 CFR 1910.1200, Hazard Communication Standard. The intent of this material ~afety da~a shee~ Ks to provide end users of this product with the health s_nd physical hazards associated with possible e.xposure =o this product. All s~atements, technical data and recommendations are based Qn readily available texts and data that Spectra Gases believes to be reliable and accurate. Spectra Gases makes no warranties, guarantees or representations of any kind with respect ~o ~his product or this data. The Department of Transportation, Occ%%pa=ional Safety and Heal=h Administration, Pood and Dru~ A~ministration and other government agencies have specific guiaelines and regu!a~ions governin9 =he handling, storage and transportation of ~his product and should be consulted for further information. HAZARDOUS SUBSTANCE LIST IN AND IDEX OF MSDS'S INDEX I · MSDS'S # HAZARDOUS SUBST/~NCES AREA/OPERATION USED IN FILE HAZARDOUS SUBSTANCE LIST AND INDEX OF MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES AREA/OPERATION USED IN FILE HAZARDOUS SUBSTANCE LIST AND INDEX OF MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES AREA/OPERATION USED IN FILE HAZARDOUS SUBSTANCE LIST AND INDEX OF MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES AREA/OPERATION USED IN FILE t f, t HAZARDOUS SUBSTANCE LIST AND' INDEX OF. MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES ARENOPERATION USED IN FlEE HAZARDOUS SUBSTANCE LIST AND INDEX OF MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES AREA/OPERATION USED IN FILE HAZARDOUS SUBSTANCE LIST AND INDEX OF MSDS'S INDEX MSDS'S # HAZARDOUS SUBSTANCES AREA/OPERATION USED IN FILE BAKERSFIELD EYE & SURGERY CENTER~, ~: SiteID: 215-000-000303 JUN "6 1997Bc&.,Phone:I (805) 323-2020 Manager : Location: 2120 19TH ST ,~y~ Mapi: 102 CommHaz : Low City : BAKERSFIELD ............. _Gu~: 25D FacUnits: 1AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad:14-768-4062 Emergency Contact / Title Emergency Contact / Title 'BETTY J. TIIOMAS g.~ ~|~'l~-I-x-~-~:~ ~. ~ Business Phone: (805) 323-2020x Business Phone: (~oS)~% -~x 24-Hour Phone : (805) 399-Qx3~8~x~9~ 24-Hour Phone : Pager Phone : (~o~) $~5 _~o~ x Pager Phone : ( ) '- x Hazmat Hazards: Fire Press React ImmHlth DelHlth Agency-Defined Topic Title ~ Hazmat Inventory One Unified List ~-- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... [SpooHaz[EPA Hazards[ Frm DailyMax IUnit[MCP NITROUS OXIDE F P R IH DH G 4200 FT3 Hi OXYGEN F P IH G 1648 FT3 Low DIESEL F R IH DH L 50 GAL Low NITROGEN ~U~ ~ ~ ~ ~T~o~ P IH DH G 1025 FT3 Min I, K,~-~'-N ^u.~ Do hereby ce~ify tha~ ~ have (]'y~s or p~nt ~me) reviewed the ~.~,~hed h~ard~s materials manags- ment plan for ~<~~ and that it along with (Name of any correctioqs constitute a complete and correm man- agement plan ~or my facili~. BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit NE CORNER OUTSIDE BACK CAS# 10024-97-2 FSTATE TYPE PRESSURE TEMPERATUREI CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 4200.00 2533.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Nitrous Oxide No 10024972 BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 F Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit NE CORNER OUTSIDE BACK CAS# 7782-44-7 F STATE -- TYPE , PRESSURE , TEMPERATURE CONTAINER TYPE PureI Above AmbientI Ambient . Gas PORT. PRESS CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 1648.00 1236.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 -3- BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME DIESEL Days On Site 319 Location within this Facility Unit SOUTHEAST CORNER OUTSIDE BLDG CAS# 68476-34-6 ~ STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE /~Liquid Pure Ambient Ambient IN MACHINE/EQUIP AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 50.00 50.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 -4- BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 F Inventory Item 0004 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME NITROGEN ~ O~/~Et~ ~rml Oh ~~l~t O~ Days On Site Location within this Facility Unit ~[UD]~-[~ 365 SW CORNER PATIENT ROOM ~g ~%F~ZO~ CAS# ~ O3~ ~?~ ~q I~ ~C~ ~ ~CO~~ 7727-37-9 ~ STATE -- TYPEpure IPRESSUREAbove Ambient [ TEMPERATUREAmbient CONTAINER TYPE. . Gas PORT PRESS CYLINDER AMOUNTS STORED AND IN USE Lrgst Cent.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 1025.00 900.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Nitrogen No 7727379 BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 Fast Format ~ Notif./Evacuation/Medical Overall Site Agency Notification 01/07/1990 CALL 911 Employee Notif./Evacuation 01/07/1990 FIRE ALARM SYSTEM CAN BE MANUALLY ACTIVATED AND BUILDING EVACUATED. Public Notif./Evacuation 01/07/1990 $ONNITROL ALARM SYSTEM CAN BE ACTIVATED BY PULLING ANY FIRE CALL BOX AND EMPLOYEES WOULD EVACUATE THEMSELVES AND ALL BUILDING OCCUPANTS. Emergency Medical Plan 01/07/1990 MERCY HOSPITAL 2215 TRUXTUN AV 327 3371 ~-~xzxz~z~ BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site Release Prevention 01/07/1990 ALL TANKS ARE ATTACHED TO WALL UNITS AND PORTABLE UNITS HAVE CHAINS ON PORTABLE CARTS. HOPPER MEDICAL REMOVES USED CYLINDERS FROM PREMISES AND REPLACES WITH FILLED CYLINDERS ON AN ON CALL BASIS. HOPPER MEDICAL PROVIDES MAINTENANCE FOR VALVES AND HOOKUPS. SULLIVAN'S PETROLEUM COMPANY DELIVERS ALL DIESEL FUEL. Release Containment Clean Up Other Resource Activation -7- BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 Fast Format Site Emergency Factors Overall Site Special Hazards Utility Shut-Offs 01/07/1990 A) GAS - NORTHWEST CORNER B) ELECTRICAL --NORTII SIDE OF BU-I-L-E~I-NG C) WATER - INSIDE NORTHEAST CORNER D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/07/1990 = PRIVATE FIRE PROTECTION - SONITROL FIRE ALARM CONNECTION FOR FIRE PROTECTION. FIRE HYDRANT - SOUTHWEST CORNER ON ALLEY AND C STREET Building Occupancy Level BAKERSFIELD EYE & SURGERY CENTER SiteID: 215-000-000303 /I/~ Fast Format Training Overall Site Employee Training 09/08/1993 WE HAVE 18 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. MATERIAL SAFETY DATA SHEETS ARE AVAILABLE TO EMPLOYEES, THEY ARE LOCATED IN THE RO~-~LEERF~--T=q~--6%%~--f~L-I-ND'KhgS--A-~E--K-E-P~AND IN-~HE--F-~DE--I~N--~HE--PRQNT QF-F~-~E. HAZARDOUS MATERIALS TRAINING IS GIVEN TO EACH NEW EMPLOYEE DURING ORIENTATION AND REPEATED ANNUALLY. Page 2 Held for Future Use Held for Future Use -9- 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 Page 1 Overall Site with 1 Fac. Unit General Information Location:-2120 19TH ST Map: 102 Hazard: Low Community: BAKERSFIELD STATION 01 Grid: 25D F/U: 1 AOV: 0.0 'Contact Name Title Business Phone 24-Hour Phone- BETTY J. THOMAS (805) 323-2020 x (805) 399-0908 GREGORY STAINER (80'5) 3qq-~3ql x ( ) - Administrative Data Mail Addrs: 2120 19TH ST D&B Number: 14-768-4062 City: BAKERSFIELD State: CA Zip: 93301- COmm Code: ·215-001 BAKERSFIELD STATION 01 SIC Code:· Owner: BAKERSFIELD~& SURGERY CENTER Phone: ( ) - -Address: 2120 19TH ST State: CA City: BAKERSFIELD Zip: 93301- Summary !, ~e'Ttw ;;r'. T/VO~,./~-~ Do hereby certify that I have ~ ' I(l'ype or pdnt name) reviewed the attached hazardous materials manage- . ~I~L~,~',-Z~ <~u~-~,~'~ that it along with ment plan Tot c~--.-,'~'~. . ='"-' (Name of Bumness) any corrections constitute a complete and correct man- agement plan for my facility: 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 .Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-002 NITROUS OXIDE Gas 4200 High · Fire, Pressure, Reactive, Immed Hlth, Delay Hlth FT3 02-003 DIESEL LiqUid 50 Low · Fire, Reactive, Immed Hlth, Delay Hlth GAL 02-001 OXYGEN Gas 1648 Low · Fire, Pressure, Immed Hlth FT3 02-004 NITROGEN Gas 1025 Minimal · Pressure, Immed Hlth Delay Hlth FT3 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 Page 3 02 - Fixed Containers on Site .Hazmat Inventory Detail in MCP Order 02-002 NITROUS OXIDE Gas 4200 High · Fire, Pressure, Reactive, Immed Hlth, Delay Hlth FT3 CAS #: 10024-97-2 Trade Secret: No ~ Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 Daily Average FT3 Annual Amount FT3 -- 4,200 I 2,533.00 I 19,268.00 Storage Press T Temp Location PORT..PRESS. CYLINDER Above /Ambient. NE CORNER OUTSIDE BACK --Con~ Components MCP ---~Guide 100.0% INitrous Oxide IHigh ~ 14 02-003 DIESEL Liquid 50 Low · Fire, Reactive, Immed Hlth,' Delay .Hlth GAL ~ CAS #: 68476-34-6 Trade Secret: No Form: Liquid Type: Pure Days: 319 Use: ANESTHETIC Daily Max GAL Daily Average GAL Annual Amount GAL -- Storage IIPress'T Temp Location IN MACHINE/EQUIP IAmbient/AmbientlSOUTHEAST CORNER OUTSIDE BLDG -- Conc ' . Components MCP --~Guide 100.0% JOxygen, Compressed JLow J 14 ~02-001 OXYGEN Gas 1648 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-~44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3~ Daily Average FT3 Annual Amount FT3 -- 1,648 '1 1,236.00 I 19,200.00 Storage. Press T TempI Location PORT. PRESS. CYLINDER Above JAmbientlNE CORNER OUTSIDE BACK -- Conc Components MCP.---~uide 100.0% JOxygen, Compressed 'JLow "J 14 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 Page 4 02- Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-004 NITROGEN Gas 1025 Minimal ~ Pressure, Immed Hlth, Delay Hlth FT3 CAS #: 7727-37-9 Trade Secret: No Form:'Gas Type: Pure ' Days: 365 Use: ANESTHETIC Daily Max FT3 Daily Average FT3 Annual Amount FT3 1,025 I 900.00 I 3,000.00 Storage I Press I Temp I ' Location PORT. PRESS. CYLINDERIAbove IAmbientISW CORNER PATIENT ROOM --'Conc'~ ~ ' Components [ MCP ~Guide 100.0% INitrogen IL°w I 21 06/30/93 BAKERSFIELD'SURGERY CENTER 215-000-~000303 Page 5 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> EmplOyee Notif./Evacuatlon FIRE ALARM SYSTEM CAN BE'MANUALLY ACTIVATED AND BUILDING EVACUATED. ~<3> Public Notif./Evacuation' .~ SONNITROL ALARM SYSTEM CAN BE ACTIVATED BY PULLING ANY FIRE CALL BOX AND EMPLOYEES WOULD EVACUATE THEMSELVES AND ALL BUILDING oCCUPANTS. <4> Emergency Medical Plan MERCY HOSPITAL 2215 TRUXTUN AV 327-3371 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 Page 6 00 - Overall 'Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALL TANKS ARE ATTACHED TO WALL UNITS AND PORTABLE UNITS HAVE CHAINS ON PORTABLE CARTS~ HOPPER MEDICAL REMOVES USED CYLINDERS FRoM.PREMISES AND REPLACES WITH FILLED CYLINDERS ON AN ON CALL BASIS. HOPPER MEDICAL PROVIDES MAINTENANCE FOR VALVES AND HOOKUPS. SULLIVAN'S PETROLEUM COMPANY DELIVERS ALL DIESEL FUEL. <2> Release Containment <3> Clean Up <4> Other Resource Activation 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 Page 7 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards' <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER B) ELECTRICAL - NORTH SIDE OF BUILDING C) WATER - INSIDE NORTHEAST CORNER D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION '- SONITROL FIRE ALARM CONNECTION FOR FIRE PROTECTION'. FIRE HYDRANT - SOUTHWEST CORNER ON ALLEY AND C STREET <4> Building Occupancy' Level 06/30/93 BAKERSFIELD SURGERY CENTER 215-000-000303 ., Page 8 00 - Overall Site <G> Training <1> Page 1 WE HAVE ,?' EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. MATERIAL SAFETY DATA SHEETS ARE AVAILABLE TO EMPLOYEES, THEY ARE LOCATED IN THE ROOM WHERE THE GAS CYLINDERS ARE KEPT AND IN THE FILE IN THE FRONT OFFICE. HAZARDOUS MATERIALS TRAINING IS GIVEN TO EACH NEW EMPLOYEE DURING ORIENTATION AND REPEATED ANNUALLY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future use Do beteL3~ c=~ti~-- ~ that I have ~ev~ewem the at~ached Hazardous Ma'rerials ~or BaKersfield Surgery Center, Inc. ~.~0~~ ~~ ' ~ and'that it along with the attaohed additio~ .... e~ eo~ectio~s constitute ~ oom~'Zete ~n~ eo~eot - Business Plan for mM facilitY. ~ ~z~anure ~ate · ' NOTE NAME CH~E~ (DELETE EYE & ) ~ i,~UMBER~ ~U'S~NESS NAME BAKERSFI~LD ~ SURGERY CENTER 215-000-000303 LOCATION 2120 19TH ST HIGH HAZARD RATING 2'. 1 o OVtEl~V I E r~ LAST CHANGE 12/04/87 BY ESTER JURIS CODE 215-001 JURIS BAKERSFIELD STATION 01 MAP PAGE '102 GRID 25D FACILITY UNITS 1 .HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) SONITROL CONNECTED TO FIRE ALARM SYSTEM. EMERGENCY CONTACTS 2A SEC 2) BETTY J. THOMAS - 323-2020 OR 399-0908 GREGORY STAINER - 393-2331 EXCHANGE UTILITY SHUTOFFS 2A SEC 3) Ai. GAS-£ NW'CORNER- 'B)'ELECTRICAbJ- NORTH SI-DE OF BUILDING -- C) WATER - INSIDE NE CORNER D) SPECIAL - NONE E) LOCK BOX - NO 2 . NOT I F I CAT I ON . / I~UBL I C EVACUAT I ON LAST CHANGE 1 /23/ 89 BY M J COASH SONNtTROL ALARM SYSTEM CAN BE ACTIVATED BY PULLING ANY FIRE CALL BOX AND~EMPLOYEES WOULD EVACUATE THEMSELVES' AND ALL BUILDING OCCUPANTS~ < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 12/16/88 12:16 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 NOTE NAME CHANGE (DELETE EYE & ) BUSINESS NAME BAKERSFIELD ~' -~ SURGERY CENTER ID NUMBER 215-000-000303 LOCATION 2120 19TH ST HIGH HAZARD RATING. 2 3 .. H~Z ~AT TRAINING SUMMARY LAST CHANGE 1/23/ 89 BY M J COASH MATERIAL'SAFETY DATA SHEETS ARE AVAILABLE TO EMPLOYEES, THEY ARE LOCATED IN THE ROOM WHERE THE GAS CYLINDERS ARE KEPT AND IN THE FILE IN THE FRONT OFFICE. HAZARDOUS MATERIALS TRAINING IS GIVEN TO EACH NEW EMPLOYEE DURING ORIENTATION AND REPEATED ANNUALLY. < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 12/04/87 BY ESTER 2A SEC 5) MERCY HOSPITAL 2215 TRUXTUN AV 327-3371 PAGE 2 12/16/88 12:16 MATERIAL SAFETY DATA'SYSTEMS, INC. (805) 64'8-6800 .NOTE NAME.CHANGE('DELETE~E & ) ~US~NESS NAME BAKERSFIA"LDW _ '~- SURGERY CENTER }MBER 215-000-000303 LOCATION 2120 19TH ST " HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTOR] SEE NEW ATTACHED INVENTORY SHEETS LAST CHANGE DISREGARD OLD IN~RMATION LISTED BELOW 1/23/89 BY M J COASH ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE OXYGEN 1536 FT3 HIGH NE CORNER OUTSIDE BACK PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LIS! 2359.00 100.0 OXYGEN; COMPRESSED HIGH 2 PURE NITROUS OXIDE 8286 FT3 MODERATEi NE CORNER OUTSIDE BACK PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LIS1 '2345.00 100.0 NITROUS OXIDE MODERATE 3 PURE oXYGEN 46 FT3 HIGH IN PATIENT ROOMS PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LISq 2359.00 100.0 OXYGEN, COMPRESSED HIGH 4 PURE NITROGEN 500 FT3 MODERATE SW CORNER PATIENT ROOM PORTABLE PRESS'. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LIS' 2324.00 100.0 NITROGEN MODERATE B . FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 12/04/87 BY ESTER 3A SEC 4) SONITROL FIRE ALARM CONNECTION FOR FIRE PROTECTION. 3A SEC 5) FIRE HYDRANT IS LOCATED ON SOUTHWEST CORNER ON ALLEY & C ST. PAGE 3 12/16/88 12:16 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 NOTE NAME CHANGE (DELETE EYE & ) BUSINESS NAME BAKERSFIELD ~ SURGERY CENTER 'iD NUMBER 215-000-000303 LOCATION 212'0 19TH ST HIGH HAZARD RATING 2 D . EMPLbYEE NOTIFICATION / EV'ACUAT I ON LAST CHANGE 12/04/87 BIT ESTER 3A SEC 2) FIRE ALARM'SYSTEM CAN BE MANUALLY ACTIVATED AND BUILDING EVACUATED. E . MITIGATION / PREXTENT I ON /' ABATEMENT LAST CHANGE 1/23/89 BY M J COASH 3A SEC 1) ALL TANKS ARE ATTACHED TO WALL UNITS AND PORTABLE UNITS HAVE CHAINS ON PORTABLE CARTS. HOPPER MEDICAL REMOVES.USED CYLINDERS FROM PREMISES AND REPLACES WITH FILLED CYLINDERS 'ON-AN ON-CALL'BASIS. HOPPER MEDICAL-PROVIDES ~AI'NTENANCE FOR VALVES 'AND HOOKUPS. SULLIVAN'S PETROLEUM CO. DELIVERS ALL DIESEL FUEL. PAGE 4 12/16/88 12:16 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 .~..~ CITY of BAKERSFIELD ' NON-- T RAD E S E C R ETS ' oa~, 3.__°f.1. BUS~ESS SAH~-: gak~rsfield Surgery Cente¢Ind)W~rR ~AHr-: Betty Thomas Cn-nwn~r . ~ o~ ~S r~ci~YBa, ke,r'g~ie']~d Su:r~[ 3Y C~TY, Z~: gfi~6rSf~.bla2' Ca. 93301 ,' ClT~, ZZ~: Bakers~e~08 : DUN AND C~e C~e Mt Mt Est Units m Site T~ ~l T~ ~ St~ in F~tltty ' ~ I~t~ti~ ._UI.~__g~.~_]F~311236 [T~5200 [T~ZT~ 36S 1 04 1,2 I 4 I 27 .J~L corner :outside bacr a0]~~ ........... ] _ ~de of lding .., ~; 2 '" ~urgur-y SuiL~s 3 ~idu l~'l~rrrff P~tc41 ~ ~lth ~ze~ C.A.S. ~ 7727-37-9 ~t B1 ~ & C.A.S. Ft~e HazaPd [ ~ RflCtivity [~] ~1,~ [~] ~ Relme ~ H~lth of P~su~ HNIth ' ~' ':, " H~lth of Pr~sure Health ' ',Certification (Read and siKn after compJetinE ali sections) ,i~art~f¥ trader Nnalty of law that I have oersonally examined end am f~iliar v~th t~ tnfor~ti~ su~itt~ tn thtg ~ ell att~ ~ts. ~ t~t:.~s~ ~ ~ i~t~ of t~e t~tvt~is ~sible (~: Ba,tv Thomas C6~0~ne~JAdministrator . ' ~ . ~ ~ SECTION S: HAZARDOUS ~MATERIALS FOR THIS UNIT ONLY "~:'~ .A. Does thisiFacility Unit'¢o~tain Hazar*dous 5ia. re. rials? ...... NO If YES, seC B. If NO, continue ~ith SECTION 4. · B. Are any of the. hazardous materials a bona f_~de Trade Secret YES If So, complete a separate hazardous materials' inuentory . form marked: NON-TRADE SECRETS ONLY (~hite form ~4A-1) If Yes, complete a hazardous materia~s_.~ inventory ~o..m ~ ,' mar~<ed:' ,4A-,.) in addi,.lon to the non--~.rade TRADE SECRETS ONLY (yellow form ~ o secret form. List only the trade secrets on form 4A-2. ...... . .... SECT i-ON .---4 ..--=-pR iV/~TE~Fi RE~PROTECTi O.:il. Sonitrol fire alarm connection SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E~!ERGENCY RESPONDERS Southwest corner on alley C Street SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. >/AT GAS"~°~P~~°'~' Northwest back Side of building alley entrance B. ELECTRICAL: Northwest corner b]d§-a]]ey entrance Northwest corner bldg-alley entrance O ~PECIA~: E LOCK BOX: YES ./~ IF YES, [,OCATION: IF YES, SITE PLANS? YES / NO MSDSs9 YES / NO FLOOR PLANS'? YES / NO KEYS'? YES / NO - 3B - ~' ~-BARERSFIELD CITY FIRE DEPARTMENT /- 2130 "G" STREET BAKERSFIELD, CA 93301 OFFiCiAL USE ONLY ID# BUSINESS NAME: ··BUSINESS PLAN SINGLE ·FACILITY UNIT FORM SA .INSTRUCTIONS 1. To. avoid further action, this form must be returned b¥:'- 2. TYPE./?R!NT YOUR ANSWERS IN ENGLISH. 3. AnS~er'the questions below fo~ THE FACILiTY'UNiT LISTED BELOW '" ....... 4. Be as BRIEF a'nd CONCISE as possible. ' FACILITY.UNIT# { FACILITY UNIT NAME: Bakersfie]de.ve & Surqer.¥ Center, Inc. SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES All tanks are attached to wall .units and port'able unit§ have chains on portable carts. ~'...~ SECTION 2: NOTIFICATION ~ .EVACUATION PROCEDb~ES AT THIS UNIT' ONLY Fire alarm system can.be'manuall~ 'activated and'building evacuated. - 3A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE Sonitrol connected to fire alarm system. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:.... .................................... ~ NO .~E NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO ~S NO C. PROPER USE OF SAFETY EQUIPMENT:..~ ................ YE NO ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. NO NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO NO .SECTION__7_:__~HAZ~H~DOUS_MATERIAL ........ ~ __. CIRCLE YES OR NO, DOES YOUR BUSINESS HANDLE HAZARDOUS'MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A_ OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... 'YES~N0~,) SOLID, $$ GALLONS OF A LIQUID, v nde~~d~}~~ ~ . ~ , certify that the above information is accurate.. I'u I ghat this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.05 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. ~ 1~, ,~ :[ .~: BAKERSFIELD CITY FIRE DEPARTMENT .> .z~-:. 2130 · "G" STREET BAKERSFIELD, CA 93301 ~-~JS~ / ' (805) 326-39'79 OFFICIAL USE ONLY BUSINESS NAME HAZARDOUS I~IAT E ALS ~~0 BUSINESS PLAN AS R~ WHOLE" FORi~ 2A .......... INSTRUCTIONS: ........................ 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: Bakersfield Eye & Surgery Center, Inc. B.:LOCATION / STREET ADDRESS: 2120 19th Strppt CITY: Bakersfield Z~P: CA ~Of BUS.PHONE: (805) SECTION 2: EBiERGENCY NOTIFICATIONS In case of an emergency involvin~ the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local-fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Betty J. Thoma~ Ph# 323-2020 Ph# 399-0908 B. Gregory A. Stainer, M.D.F.A.C.S. Ph# 393-2331 Ph# 393-2331 exchange SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~/~ ~J ~w'--~a~f B. ELECTRICAL: . Ncrtc(~.9_~Pm or/ ~ ~% C. WATER: '~o ~//e (~-~ ' D. SPECIAL: ~ E. LOCK BOX: YES /. IF YEs, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO BAKERSF1E1, D CITY FIRE DEPARTMENT .. I.D. ~ ( FORM 4A-1 Page NON--TRADE SECRETS HAZARDOUS MATERIALS INVENTORY ADDRESS: ~t~- ia ~, ~$:- ~ ADDRESS: 212~'i~[~g~r~i'~ ....... ~C'ffi'i~V UNIT NAME: CITY, ZIP: ~MKc~'~-:~ il · ('/~ 9 ~,~O] 'CITY,ZIP: Bakersfield, CA 93301 PHONE~ ,: '~-:} :'4~2_~.~0' PHONE ~: '323-2020/393-2331/399-0908 [OFFICIALoNLY USE CFIRS CODE ! 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN Tills % BY HAZARD D.O.T CODE AMOUNT A~OUNT UNIT CODE CODE FACILITY UNIT I~T., CHEMIqAL OR COMMON NAME CODE GUIDE -- ' 3- eere~ - E H Tank cont[i~n 25[ cubic feet each oxygen . E Tank cont[~n 23 cubic f~et each .. nxw~n E Tank n~tr(us ox3~de ccata~n 6.4~:~ounds ]~qu~d ~' H Tank n~tr(us ox3~de ccata~n 64.4 pounds ]~qu~c ~~' T Tank cont[~n 30[ cubic feet n~trogen H Tank rnnfF in 2Rf rmJhir fppf nifrn~pn EMERGENCY ~'ONTACT: Betty d. Thomas TITLE: Adm/ PHONE # BUS HOURS: 323-2020/393-2331 -.,. AFTER BUS HRS: 399-0908/323/2331 EMERGENCY CONTACT: Gregory A. Stainer, M.D.F.A.CT~TLE: Pres/owner PHONE # BUS HOURS: 323-202O/393-2331 PRINCIPAL BUSINESS ACTIVITY: Ambulatory Surgery Center AFTER BUS HRS:393-2331/399-0908 - 4~-1 - ~qAME :.' ' )mas T I TLE: I GNATURE: :, -~. ~; -%,' SI.TE/FACILITY DIAGR~ ~NORTH SCALE: BUSINESS NAME: FLOOR: OF DATE: / /. FACILITY N~ME: UNIT ~: OF (CHECK ONE) · SITE DIAGRAM FACILITY'DIAGR.~M ~' (Inspector's Comments)' -OFFICIAL USE ONLY- - SA- < , SiTE D[A~R,M,'I (Re< items) i. Address: Zdentify the 9. Lock (key) Box " principle buildings ~, ~., }:, by the'Street numbers. 10. MSDS Storage Box 2 Street(a), At'iSys';. Il, Railroad Tracks Driveways, and Parking - - Areas adJa&ent to the 12. Fence o3 B~'rrler ~'~ property. Include the : _ a. Wl[.e ~- b.,M&~onryI 3. Storm Drains. Culverts, - , Yard Drains c. Wood 4. Drainage Canals. Ditches, d. Gates Creeks, _ : - 13. Powerilnes ~ 5. BuildinEs a. Frame construction 14. Guard Station · ,b. ~asopry conatruc-t~on i5. Storage Tanks: Identify the c. Mete! construction capacity in gui. a. Above ground d. Access Door b. Underground 6. Utility Controls ~. Electricity> ~-17. Evacuat~ou-Rou[e~, c'.'Weter j:r ::.{8. Eva~uatjon-kr~. .. --' ldenti~y the 7. Fire Suppression Sym[ea,: · ~.location where a. Fire Hydr~ta 'eaployee~.wi~i b. Fire Sprinkier '19. Outside Hazardous. Connections wam~e_Storage. -' c. Fire Standpipe 20. Outside Hazard,ua Conuec~ioue ~ateriai Stora~e d. Water Control Vaivem ~. Outside Hazard,ua for protection systeme ~aterial Ome/Handlln8. e. Fire P~ 22. Type o~ Hazardous Material/Waste Stored 8. Fire Department Access or Used (See ~iow) TYPE OF ~Z~U9 ~TERIA~ F - Fixable /~'.; ~lomive, ~ ~iquid R - Radiologlcal C -Corroaive 0 - Oxidize~ -~'~ - Ga; · P - Poi;on W - Mater Reactive T - Toxic ~ - S°iid B - Cryogenic D - Wa, ate B - 8tlological Example: Fishable ~lquid - FAC[L[~ DIAO~ (Required items in addition to the a~ve) 1. Risers for Sprinklers 8. Fire gacapea ~. Partitions ~. Al~'Co~dtti~ning-Unl._~. 3. S~alrwaya: Indicate ~he 10; Mlnd~-. levelm ae~ved ~rom highe~ to lowe~. ' il, lnmide Ha~ardoum Ma~e 4. Escala[or: Indicate the levels served froa Ii. Inside Eazardoua htghea~ ~o lo~est. ~a[ertals Storage 5. Elevator 13. Inside ~azardous 6. Al[lc Access 14. Se~r Drain Inlets LY..SkyiI~h[a CHANGES T _ADDITIONAL CONTACT PERSON: dOHN BROAD,RN BUSINESS # 323-"2020 HOME #872-2548 BUSINESS NAME: BAKERSFIELD SURGERY CENTER 2120 19TH STREET BAKERSFIELD~i CA 93301 805-323-2020