Loading...
HomeMy WebLinkAboutBUSINESS PLAN 9/18/2002Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF .PERMIT ON REVERSE SIDE This oermit is Issued for the following: OFFICE OF ENWR ONMENTAL SER WCES ' 1715 Chester Ave., 3rd Floor Approved by: , Bakersfield, CA 93301 Omc~rEv~S~ic= - Voice (661) 326-3979 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ................... ~.,~,:~:,~,~:~,,~, ................... This permit is issued for the following: ..... ,~:.~?:'i~'' i'., ?~:,?i'?'~'::::i }i ii:~ii;~:. ::~iii?iii!~. iii:~:~iiiiiiii::::'~::i il;}ii:~D:-:i~derground Storage of Hazardous Materials LOCATION ' 1205 8TH ~"::,,',..~r~%~ .......... :.:~,' BAK~RS~!~LD CA '? ~" ,:~:~,'i~....'".,,~ ::J:.':.. ' ..::F.:.. -":~'~::~ ~'2 '~::~'~ .... ~ i~L '~ ", '~ '.~!~ ~'~i'~?,~?" "~i' .. '"'.:~. ~,'-~,..? ~ ;~ ~:' ..:,;;;~:~ ........... :.,,::;;.'~:!~;,.: ".~ ~{~'~':,r,,. ~':~'i ~ '?.::::..~ , ~] '- "' '~ ~j ~' - ............ ~..~ :::~' :;Z:.~'?.':~F~::~i"-~i~ '. ~' '~:"~:~.~. ?'j q;:':.::.::~:~:~:~',. ~:"'-. "~, ~;". '? ...... ~"'" "'"'"~'.:;'.,----.~, :~.-:.~::~ ~:" "~..? ~ ~ ~ ~ '~ '~':¥~ ...... :;.q ~:~':'"" .h~ ~,'".._',i~! ~",,."-.,~ ~ ~ ......................... ::.~::'".??~::'.:.~, .~ ', ~' .' ' ' ~ :' ~ % H~ ":"~"" ....... . '".::~ ~:,. '._..'~{ ~=: .- .;:.:::::........." ~:"..:h".....'".~:~',. ~r ,' ~ ,' , :' . ~ , :- ~:: ~ F~ , ~ . '., :, ~:..".....~ :. ~:..~. .~,--.? ...._...:::'.-~[ .' ,: ~]~:._;~: ,~, ,,:.,., ,, ~ .: .,, ~ ~ , . . ~.,~ ~-: ~....,:..~ ~ --.._.... ~...:~ , ~., - ...... ... ........... ,,~ -. ~.~,,' :[ ] :~:~::~:'. ~{'.. --.. ,,~. :~,.'~-" -.~, 'Y'", .?~ ~:~[~ ~':~:~[~[~;~'::~:.[:~:....?. ........ ~LY ~' :.. "... '~;~:.' · ~:.. · ~- .. :.~[ ,.,. ::~ .. -~,::~. '-=:[~r .....~;~,.,, ,:.. ,~ ?' ~ -.. '.:: ~._.._. '.~, .~...,, ~: ...~'-..' ~,,'. .?? .~;' '.: ':~. ~ .... · ",.~:. ~ ' ' ' "~:' ~' .?~ :'. '-,.?' :~}[--....:~ ........ ..: .... :.. , '.'"'...., ; .~='~:,~ .. .... ~-: ........... ~ : ~;~":~ ,::, ,:::, Z....:: -~..; -~ _ "', .~.'? .~ '~ ,,, ...... ' ..... ~ ............ ' .,,.. · -' · .., ,,- ~,.~ .:. I:~, I ~, .. ~ .................. ~ :, ~, ....................... ~H.'~"'~. ~..l~I' ',,~'~i~. .~ .:~.~i: ...... a ' ~ .l:~l '?.~......'" .." ';:'~U;.,.. ::::::~ ':~::~......~{~:"~ i~ '~:.[~i' E~' ...::,~:~:,~'? ~ [ ~ ~--~:~'' [ssu~ by: Bakersfield Fke Depa~ment Approved by: OFFICE OF EN~R O~E~AL S~ ~CES 1715 Chewer Ave., ~rd Floor ~ ~ffice of ~en~l S~ B~e~fiel~ CA 9~01 Voice (805) ~26-3979 F~ (805)~6-0S76 Expiration Date: ~n~ ~0~ ~O00 .4? 1205 8th Street Bakersfield, California 93304 Phone (661) 334-2200 "Our Business is People" ~ . th .~- MAY ~ 1001 Ralph E. Huey, Director Office of Environmental Services 1715 Chester Avenue Bakersfield, CA 93301 Dear Mr. Huey: Enclosed please find a revised site diagram of our facility indicating the locations of the items requested. Our oxygen is stored and chained directly next to the main electrical panel. Our facility is equipped throughout with automatic sprinklers with the main shut-off as indicated on the site diagram. Please note also that there are fire hose connectors located at the main sprinkler valve. If you have any questions or I can be of any assistance, please contact me at (661) 334-2200. Thank you, Tom Harrison Director of Maintenance . . '.. ~.. . · . ~ · . ..  ~ .. . . ' E HOUSE ~ooSE " SXTE/FACI LI TY DX A~R~ NORTH SCALE: BUS INESS N~g: FLOOR: 0F ~ DATE: / / FACILITY N~E: : UNIT ~: OF ;, (CHECK ONE) SITE DIAO~ FACILITY DKAG~ : 'l.nspec~or'8 Comments): -OFFICIAL USE ORLY2 {. HMCU- 13 I,;, SITE/FACILITY D I A~ R~IVl NORTH SCALE: BUS INESS N~g: FLOOR: OF DATE: / / FACILITY N~E: UNIT [CHECK ONE) SITE DIAG~ FACILITY DIAG~ peCtor's Comments}: -OFFICIAL USg ORL¥- HMCU-13 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r" Floor, Bakersfield, CA 93301 ADDRESS I~L.O~ ~71,~.-~'- PHONE NO. FA'CILITY CONTACT'~l,~ ~ ' 05'L. BUSINESS ID NO. 15-210- O~O~'_ INSPECTION TIME ~0 IIA.I~ NUMBER OF EMPLOYEES SeCtion 1: Business Plan and Inventory Program ne [21 Combined ~ Joint Agency I~ Multi-Agency 1~ Complaint I~ Re-inspection OPERATION C V COMMENIS Appropriate permit on hand Business plan contact information accurate n,,/, ~c~vo ~t~,t~-"la'~ .c,r.rr~ . Visible address Correct occupancy Verification of inventory materials !,// Verification of quantities Verification of location v/ ProPer segregation of material k/ Verification of MSDS availability Verification of Haz Mat training ~'/ V~rification of abatement supplies and procedures ~/. ~irItk/6gl~ '~ Emergency proc'edures adequate t/r Containers properly labeled ~" Housekeeping Fire Protection Siie Diagram Adequate & On Hand C=Compliance V=Violation ,I on AnY haz~rdo.qs~ waste site?: [~ Yes [21 No Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party :-VALLEY CONVALESCENT HOSPITAL SiteID: 015-021-000899 Manager : ~£0~,~ ~./~h/od< BusPhone: (805) 334-2200 Location 12058TH ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 3lA FacUnits: . 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:8051 EPA Numb: DunnBrad:77-011-9162 Y~aro/v~ ~6n~c~Oc/~/ Title~4m,~/~rEmergency Contact / Title Em~_~rger~cy RQNALD OI~VER ~ ~W*~E*~ 3 3 ~ ~ gtco JIM DONOV~~ ~'~'~ ~ ~INTEN~CE SUP Business Phone: (~) 334-2200x Business Phone: (~) 334-2200x 24-Hour Phone : (~) 5~-8443x 24-Hour. Phone : (~/ 83~ 4854xTX~-oFFo ~ Phone : (~/) ~/- 3~ ~7/~P~o~g FO~-~ x Pa~er Phonc : (805) 335-421~x Hazmat Hazards: Fire Press Im~lth Contact : ~fw/y~ ~. ~5~/o~/~/ ~~ Phone: (~/)~g -~Oox MailAddr: 1205 8TH ST State: CA City : BAKERSFIELD Zip : 9330% Address : /~5 F*'~+.-~..- · '- State: CAo City .~ ~.~ ~ Zip : Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif ' d: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List r---Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax IUnitlMcP OXYGEN F P IH G 1685.00 FT3 Low ~, (~r~/~ ~ ,,~,s,~/o~ Do hereby certify ~hm ~ have ~rype or print name) ~'eviewed the attached hazardous rnmer~als manage- ~ . ment plan fo~/~/(~-~/,~/,~/'/-~/~/~nd ~ha~ it along wi~h -- /(Name any corrections constitute a complete and correc~ man- agernem plan for my facility. . ' ~.. '.i,.~ '" ,,.- "~'-, ~,'~gnature -1- 09/06/2001 VALLEy CONVALESCENT HOSPITAL ~/~~/~/~ SitelD: 015-021-000899 i i~ Notif:/Evacuation/Medical ~~/~/~/~/~~/~~/~/~ Overall Site i ~/~ Agency Notification ~/~/~~~/~/~~~ 12/19/1990 i o 911 o OFFICE OF EMERGENCY SERVICES 1/800/852-7550 o o i~ Employee Notif./Evacuation/~/~~/~6~6~/~/~/~6~6/~ 12/19/1990 i o CALL 911, REPORT SPILL, AND DETERMINE MATERIALS. LOCATE SPILL, DETERMINE o CONTENTS AND AMOUNT THEN FOLLOW EVACUATION PROCEDURE. DETERMINE IF o NEIGHBORHOOD IS IN DANGER. ° i~6~ Public Notif./Evacuation ~~~6~~~6~6 12/19/1990 i INTERCOM ° ACTIVATE FIRE ALARM SYSTEM AND NOTIFY PLAN AND PROCEDURE o o i~¢~ Emergency Medical Plan ~~~~~~ 12/19/1990 i SAN JOAQUIN COMMUNITY - 2615 EYE ST - 327-1711 ° TRANSFER AGREEMENT 8-1-86. o o -2- 09/06/2001 i VALLEY CONVALESCENT HOSPITAL eeeeeeeeeeeeeeeeeeeeeeee SitelD: 015-021-000899 ~eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Fast Format i ie Mitigation/Prevent/Abatemt eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Overall Site i iee Release Prevention eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee 12/20/1990 i o PRESSURIZED BYLINDERS PROPERLY CHAINED. ALL SUPPLY DOORS LOCKED AND o SECURED. OXYGEN TANKS HAVE CAPS AND PROPER REGULATORS. ieee Release Containment eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee 12/20/1990 i o SHUT OFF VALVE, REMOVE LEAKING OXYGEN TANK, REPLACE TANK ieeee Clean Up eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee 12/20/1990 i O O o EVACUATE PREMISES o ieeeee Other Resource Activation eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeei -3- 09/06/2001 VALLEY CONVALESCENT HOSPITAL/~/~/~/~/~ SiteID: 015-021-000899 i~ Site .Emergency Factors ~~~~~~ Overall Site i i~ Spec'iai Hazards o o i~ Utility Shut-Offs fi~~fifi~~~~6~fifi~ 10/08/1997 o A) GAS - OUTSIDE SE SIDE OF BLDG & OUTSIDE RM 3 NW SIDE OF BLDG B) ELECTRICAL - OUTSIDE DOOR TO LAUNDRY TO THE LEFT C) WATER- SE SIDE NEAR M ST o D) SPECIAL- SITE AND FACILITY MAPS ON INSIDE OF ELECT~CAL BOX E) LOCK BOX -~~/~~'~ O~ ~O~ O~ ~1~ ~ i~ Fire Protec./Avail. Water ~~~~~ 10/08/1997 o P~VATE FIRE PROTECTION - SP~N~ER SYSTEM THROUGHOUT FACILITY, SMO~ DETECTORS, PULL ALARM MINISCAN 424 ALARM SYSTEM. k~ ~[ o FIRE HYD~NT - NE SECTION OF BLDG NEXT TO 8TH ST ENT~NCE GATE. i~ Building Occupancy Level ~~~6~fi~6~~ 10/08/1997 87 RESIDENTS AND ~EMPLOYEES. o MAXIMUM OCCUPANCY 250. -4- 09/06/2001 VALLEY CONVALESCENT HOSPITAL e~e~~e~eeeeeee SitelD: 015-021-000899 ii5~i~i~i5i~i~i~i~i5i5i~i5i5i5i5i~i5i~~i5~e~e~e~e~~ Fast Format o WE HAVE 80 EMPLOYEES AT THIS FACILITY. o WE HAVE MATE~AL SAFETY DATA SHEETS ON FILE. o o BREIF SUMMARY OF T~INING: MONTHLY WITH FIRE D~LLS AND DU~NG O~ENTATION OF ALL NEW EMPLOYEES (~OUTULy ~RI~ ~ re c~o ~ o o O i~ Held for Fumre Use o o i~6 Held for Fu~re Use o o 1205 8th Street Bakersfield, California 93304 Phone (661) 334-2200 "Our Business is People" October 04, 2001 ESTER DURAN OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE BAKERSFIELD, CA 93301 Dear Ms. Duran: Enclosed please find the revised business plan you requested. If there are any questions or if I may be of any assistance, please feel free to contact me at 661-334-2200. Thank you, Tom Harrison Director of Maintenance B D IMPORTANT DO NOT DISCARD FIRE CHIEF Dear Business Owner: RON FRAZE ADMINISTRATIVE SERVICES California Law requires that all Businesses, which at any time during the 2101 'H" Street year handle reportable quantities of hazardous materials, file a Hazardous Bakersfield, CA 93301 VOICE (661)326-3941 Materials Business Plan, including inventory of hazardous materials with FAX (661) 395-1349 the local administering agency. Your business has filed such a plan. SUPPRESSION SERVICES 2101 "H" Street This same regulation requires businesses to review the business plan Bakersfield, CA 93301 -VOICE (661)326-3941 submitted to determine if revisions are needed, and to certify to the FAX (661) 395-1349 administering agencies that the review was made and that any necessary PREVENTION SERVICES changes were made to the plan. As a reminder you are required to notify 1715 ChesterAve. your administering agency within 30 days of any changes including: Bakersfield, CA 93301 VOICE (661) 326-3951 increase of a hazardous material, handling of a new hazardous material, FAX (661)326-0576 ',i change in business ownership, business address or business name. ENVIRONMENTAL SERVICES 1715 Chesler Ave. Bakersfield, CA 93301 Your business hasn't revised their plan since 199 7 To facilitate this VOICE (661) 326-3979 review we have enclosed a computer print-out of the' plan you last FAX (661) 326-0576 submitted. Please review this plan in its entirety and make any necessary TRAINING DIVISION revisions on the print-out. When the review and revisions are completed 5642 Victor Ave. Bakersfield, CA 93308 sign the first page of the plan in the appropriate space certifying that the VOICE (661) 399-4697 plan is complete and correct. Return the business plan alorig with any FAX (661) 399-5763 revisions to this office within 30 days of receiving these forms. Please note that one of the conditibns of your Permit to Operate is that you review your business plan annually. If you have any questions or if we can be of any assistance please do not hesitate to call 326-3979. Sincerely, Esther Duran Office of Environmental Services L D Dear Business Owner: FIRE CHIEF RON FRAZE This notice is meant to act as a reminder that the California Health ADMINIS?RATIVE SERVICES and Safety Code, Chapter 6.95, requires any handler of hazardous materials 2101 'H" Street Bakersfield, CA 93301 to revise their hazardous materials business plan within 30 days of any one VOICE (805) 326-3941 FAX (805) 395-1349 of the following events: '% (~3o--~-- iqt T'oCD \ SUPPRESSION SERVICES 2101 'H'Street (1) A 100 per cent or more increase in the quantity of a Bakersfield, CA 93301 previously-disclosed material. VOICE (805) 326-3941 FAX (805) 395-1349 (2) Any handling of a previously-undisclosed hazardous PREVENTION SERVICES 1715 Chester Ave. material, subject to the inventory requirements of Chapter Bakersfield, CA 93301 VOICE (805) 326-3951 6.95. FAX (805) 326-0576 ENVIRONMENTAL SERVICES (3) Change in business ownership. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 (4) Change in business address. FAX (805) 326-0576 T~N~NO OIVISION (5) Change of business name. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805)399-4697 Any questions regarding these required revisions, please call the FAX (805) 399-5763 Hazardous Materials Division at (805) 326-3979. Sincerely yours, Director, Office ofEnvironmentalSe ices CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NA.ME Xl lle, INSPECTION DATE ~ O -~ dt ADDRESS i~05'<g~- ~ PHONE NO. ,'~c- Z ZOO FACILITY CONTACT "~_0~ }~t.~'p/t BUSINESS ID NO. 15-210- INSPECTION TIME /~Jt~ ~'g:?/gl,% NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program i Routiqe _[21 Combined I~ Joint Agency ~ Multi-Agency [_~ Complaint [~ Re-inspection OPERATION C V COMMENTS APpropriate permit on hand Business plan contact information accurate Correct occupancy ~~--"~---~ Verification of inventory materials Verification of quantities Verification of location Prpper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures h Emergency procedures adequate Containers properly labeled HQusekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes [~.No Questions regarding this inspection? Please call us at (661) 326-39'/9 Business Site Responsible Party White- Env. Svcs. Yellow - Station Copy Pink- Business Copy Inspector: '~/~ Overall Site with 1 Fac. Unit General Information Location: 1205 8TH ST Map:103~~~~:J 3 City : BAKERSFIELD Grid: 3lA F/U: 1 AOV: 0.0 Contact Name Title Contact Name Title RONALD OHAVER / OWNER JIM DONOVAN / MAINTENANCE SUP Business Phone: (805) 334-2200x Business Phone: (805) 334-2200x 24-Hour Phone : (805) 589-8443x 24-Hour Phone : (805) 834a4854 Pager Phone : ( ) - x Pager Phone : (805) 335-4215 x Administrative Data Mail Addrs: 1205 8TH ST D&B Number: 77-011-9162 City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: 8051 Owner: RONALD D. O'HAVER Phone: (805) 589-8443 Address: 17052 ROSEDALE HWY State: CA City: BAKERSFIELD Zip: 93312- - Summary HOSPITAL HAS 87 PATIENTS. i, Ronald D. O'Have_r._ DO hereby cert,[~J th3~ ' ~',/pe orp~m r~ame~. ... reviewed the a~hed h~a~ous match,is n'~ ment plan for Valley Convalesc~ tha~ it atcr. · ' any corr~iOns constitute a complete and ~rrem agement plan for my facili~. 08/08/9'6 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 OXYGEN Gas 1685 Low ~ Fire, Pressure, Immed Hlth FT3 08/08/96 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-001 OXYGEN Gas 1685 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 Daily Average FT3 Annual Amount FT3 1,685 I 1,348.00 I 6,024.00 Storage I Press T Temp I Location PORT. PRESS. CYLINDER Above I Ambient 02 STORAGE ROOM - Conc Components~ MCP ---~uide 100.0% Oxygen, Compressed ILow ! 14 08/08/96 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification 911 OFFICE OF EMERGENCY SERVICES 1/800/852-7550 <2> Employee Notif./Evacuation CALL 911, REPORT SPILL, AND DETERMINE MATERIALS. LOCATE SPILL, DETERMINE CONTENTS AND AMOUNT THEN FOLLOW EVACUATION PROCEDURE. DETERMINE IF NEIGHBORHOOD IS IN DANGER. <3> Public Notif./Evacuation INTERCOM ACTIVATE FIRE ALARM SYSTEM AND NOTIFY PLAN AND PROCEDURE <4> Emergency Medical Plan SAN JOAQUIN COMMUNITY - 2615 EYE ST - 327-1711 TRANSFER AGREEMENT 8-1-86. 08/08/96 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention PRESSURIZED BYLINDERS PROPERLY CHAINED. ALL SUPPLY DOORS LOCKED AND SECURED. OXYGEN TANKS HAVE CAPS AND PROPER REGULATORS. <2> Release Containment SHUT OFF VALVE, REMOVE LEAKING OXYGEN TANK, REPLACE TANK <3> Clean Up EVACUATE PREMISES <4> Other Resource Activation 08/08/96 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST SIDE OF BUILDING & OUTSIDE ROOM 3 NORTHWEST SIDE OF BUILDING B) ELECTRICAL - OUTSIDE DOOR TO LAUNDRY TO THE LEFT C) WATER - SOUTHEAST SIDE NEAR M ST D) SPECIAL - SITE AND FACILITY MAPS ON INSIDE OF'ELECTRICAL BOX E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM THROUGHOUT FACILITY, SMOKE DETECTORS, PULL ALARM MINISCAN 424 ALARM SYSTEM FIRE HYDRANT - NORTHEAST SECTION OF BUILDING NEXT TO 8TH ST ENTRANCE GATE. <4> Building Occupancy Level 250 OCCUPANCY MAXIMUM 08/08/96 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 7 O0 - Overall Site <G> Training <1> Employee Training WE HAVE 86 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BREIF SUMMARY OF TRAINING: MONTHLY WITH FIRE DRILLS AND DURING ORIENTATION OF ALL NEW EMPLOYEES <2> Page 2 <3> Held for Future Use <4> Held for Future Use VALLEY.> CONVALESCENT HOSPITAL-~. ~'/~ ~ I~'! =~j SiteID: 215-000-000899 Manager : , B:sPhone: (805) 334-2200 Location: 1205 8TH ST By' M~p : 103 CommHaz : Low City : BAKERSFIELD ........... ~id: 3lA FacUnits: 1AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:8051 EPA Numb: DunnBrad:77-011-9162 Emergency Contact / Title Emergency Contact / Title RONALD OHAVER / OWNER JIM DONOVAN / MAINTENANCE SUP Business Phone: (805) 334-2200x Business Phone: (805) 334-2200x 24-Hour Phone : (805) 589-8443x 24-Hour Phone : (805) 831-9606x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Agency-Defined Topic Title ~ Hazmat Inventory One Unified List ~--- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lunitlMCP OXYGEN F P IH G 1685 FT3 Low ~y~ ~ p~nt ~) rsvisw~d ~h~ a~ached h~erdous ma~i~ ~~- men~ plan for ~/I~v ~o~u~z~d ~h~ ~ ~long ~h (Na~ of Bus~e~) c,~ any corrosions -1- VALLEY CONVALESCENT HOSPITAL SiteID: 215-000-000899 ~Inventory Item 0001 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit 02 STORAGE ROOM CAS# 7782-44-7 F STATE TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE Pure I Above Ambient I Ambient I PORT. PRESS CYLINDER lGas . AMOUNTS STORED AND IN USE Lrgst Cent.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 1685.00 1348.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 -2- VALLEY CONVALESCENT HOSPITAL SiteID: 215-000-000899 . Fast Format F Notif./Evacuation/Medical Overall Site Agency Notification 12/19/1990 911 OFFICE OF EMERGENCY SERVICES 1/800/852-7550 Employee Notif./Evacuation 12/19/1990 CALL 911, REPORT SPILL, AND DETERMINE MATERIALS. LOCATE SPILL, DETERMINE CONTENTS AND AMOUNT THEN FOLLOW EVACUATION PROCEDURE. DETERMINE IF NEIGHBORHOOD IS IN DANGER. Public Notif./Evacuation 12/19/1990 INTERCOM ACTIVATE FIRE ALARM SYSTEM AND NOTIFY PLAN AND PROCEDURE Emergency Medical Plan 12/19/1990 SAN JOAQUIN COMMUNITY - 2615 EYE ST - 327-1711 TRANSFER AGREEMENT 8-1-86. -3- VALLEY CONVALESCENT HOSPITAL SiteID: 215-000-000899 Fast Format ~Mitigation/Prevent/Abatemt Overall Site Release Prevention 12/20/1990 PRESSURIZED'~YLINDERS PROPERLY CHAINED. ALL SUPPLY DOORS LOCKED AND SECURED. OXYGEN TANKS HAVE CAPS AND PROPER REGULATORS. Release Containment 12/20/1990 SHUT OFF VALVE, REMOVE LEAKING OXYGEN TANK, REPLACE TANK Clean Up 12/20/1990 EVACUATE PREMISES Other Resource Activation -4- VALLEY CONVALESCENT HOSPITAL SiteID: 215-000-000899 Fast Format ~ Site Emergency Factors Overall Site Special Hazards Utility Shut-Offs 12/20/1990 A) GAS - OUTSIDE SOUTHEAST SIDE OF BUILDING & OUTSIDE ROOM 3 NORTHWEST SIDE OF BUILDING B) ELECTRICAL - OUTSIDE DOOR TO LAUNDRY TO THE LEFT C) WATER - SOUTHEAST SIDE NEAR M ST D) SPECIAL - SITE AND FACILITY MAPS ON INSIDE OF ELECTRICAL BOX E) LOCK BOX - NO Fire Protec./Avail. Water 12/20/1990 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM THROUGHOUT FACILITY, SMOKE DETECTORS, PULL ALARM MINISCAN 424 ALARM SYSTEM FIRE HYDRANT - NORTHEAST SECTION OF BUILDING NEXT TO 8TH ST ENTRANCE GATE. Building Occupancy Level -5- VALLEY CONVALESCENT HOSPITAL SiteID: 215-000-000899 Fast Format ~ Training Overall Site Employee Training 12/20/1990 WE HAVE 30 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BREIF SUMMARY OF TRAINING: MONTHLY WITH FIRE DRILLS AND DURING ORIENTATION OF ALL NEW EMPLOYEES Page 2 Held for Future Use Held for Future Use -6- 03/17/92 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 1 Overall Site with 1 Fac. Unit General Information Location: 1205 8TH ST Map: 103 Hazard: Low CommUnity: BAKERSFIELD STATION 06 Grid: 3lA F/U: 1AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- RONALD OHAVER OWNER (805) 334-2200 x (805) 589-8443 JIM DONOVAN MAINTENANCE SUPER (805) 334-2200 x (805) 831-9606 I Administrative Data Mail Addrs: 1205 8TH ST D&B Number: 77-011-9162 City: BAKERSFIELD State: CA Zip: 93301- C~mm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: 8051 Owner: RONALD D.' O'HAVER Phone: (805) 589-8443 Address: 17052 ROSEDALE HWY State: CA City: BAKERSFIELD Zip: 93312- Summary RECEIVED APR 2 9 1992 HAZ. MAT. DIV. Jim Donovan [~ h®r®b¥ c~ify t~ ~ h~ ms~ p~an ?o~ley con~t and ~ha~ ~ a~on~ ~iih - ~te 03/17/92 VA'LLEY CONVALESCENT HOSPITAL 215-000-000899 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN .Gas 1685 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 Daily Average FT3 Annual Amount FT3 1,685 I 1,348.00 I 6,024.00 Storage Press ! Temp Location PORT. PRESS.. CYLINDER IAbove /AmbientlO2 STORAGE ROOM -- Conc Components MCP List 100.0% ]Oxygen, Compressed IL°w I 03/17/92 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification 911 OFFICE OF EMERGENCY SERVICES 1/800/852-7550 <2> Employee Notif./Evacuation CALL 911, REPORT SPILL, AND .DETERMINE MATERIALS. LOCATE SPILL, DETERMINE CONTENTS AND AMOUNT THEN FOLLOW EVACUATION PROCEDURE. DETERMINE IF NEIGHBORHOOD IS IN DANGER. <3> Public Notif./Evacuation INTERCOM ACTIVATE FIRE ALARM SYSTEM AND NOTIFY PLAN AND PROCEDURE <4> Emergency Medical Plan SAN JOAQUIN COMMUNITY - 2615 EYE ST - 327-1711 TRANSFER AGREEMENT 8-1-86.. 03/17/92 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page. 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention j PRESSURIZED BYLINDERS PROPERLY CHAINED. ALL SUPPLY DOORS LOCKED AND SECURED. OXYGEN TANKS HAVE CAPS AND PROPER REGULATORS. <2> Release Containment SHUT OFF VALVE, REMOVE LEAKING OXYGEN TANK, REPLACE TANK <3> Clean Up EVACUATE PREMISES <4> Other Resource Activation 03/17/92 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST SIDE OF BUILDING & OUTSIDE ROOM 3 NORTHWEST SIDE OF BUILDING B) ELECTRICAL - OUTSIDE DOOR TO LAUNDRY TO THE LEFT C) WATER - SOUTHEAST SIDE NEAR M ST D) SPECIAL - SITE AND FACILITY MAPS ON INSIDE OF ELECTRICAL BOX E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM THROUGHOUT FACILITY, SMOKE DETECTORS, PULL ALARM MINISCAN 424 ALARM SYSTEM FIREHYDRANT - NORTHEAST SECTION OF BUILDING NEXT TO 8TH ST ENTRANCE GATE. <4> Building Occupancy Level 03/17/92 VALLEY CONVALESCENT HOSPITAL 215-000-000899. Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAvE 30 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BREIF SUMMARY OF TRAINING: MONTHLY WITH FIRE DRILLS AND DURING ORIENTATION OF ALL.NEW EMPLOYEES <2> Page 2 as needed <3> Held for. Future Use <4> Held for Future Use 10/24/90 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 1 ~ Overall Site with 1 Fac. Ur, it REGEIVED Ger, eral Ir, format i 9 Locatic, r,: 1205 8TH ST Map: ~03 H~i~'~*~V' Ident Number: 215-000-000899 Grid: 3lA A~'~-'~~'"~TI';:;~ V.{1: O. 0 Contact Name 'Title Business Phc, ne ~ 24 Hc, ur Phc, ne] RONALD OHAVER OWNER ~5) )334-2200 (~O5-) 589-8-443 · ~IH D~NOV~N MAINTENCE SUPERVISIOR (805)334-2200 (805) 831-9606 II I I I I ' Administrative Data Mail: Addrs: 1205 8TH ST D&~ Number: 77-0119162 City: BAKERSFIELD State: CA Zip: 93301- Coma Cc, de: 215-OO6 ~AKERSFIELD STATION 06 SIC Cc, de: ' Owner: RONALD D. O~ HAVER Phc, ne: 805 ) 589 - 8443 Address: 17054"ROSEDALE HIG~AY State: CA City: BAKERSFIELD Zip: 93312 [ ~Urllrllar~ ~vs~ Oo hereby certify that I have reviewed the attached hazardous materials manage- ment plan for ¥~-T~LEY CON¥^:b$Ci~]~Tr~{~t~ilong with any corrections constitute a complete and correct man- agement/P]~ for my facility. 10/24/90 VALLEY CONVALESCEN]' HOSPITAL 215-000-000899 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-001 OXYGEN ? 1,255 Low F'T3 1(:)/24/9(-) VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 00 - Overall Site <D) Notif. /Evacuatinr~/Medical <1> Agency Not ificati¢,r, 911 "OFFICE OF EMERGENCY SERVICES 1-800-852-7550 <2> Employee Notif./Evacuatior, CALL 911, REPORT SPILL, AND DETERMINE MATERIALS. LOCATE SPILL, DETERMINE CONTENT'S AND AMOUNT ]'HEN FOLLOW EVACUATION PROCEDURE. DETERMINE IF NEIGHBORHOOD IS IN DANGER. Public Notif. /Evac~aation IN~ERCOR iC~IVi~ ¥IR~ ^C^RM SY$?E~ iND NO~I~¥ ?BiN iND ?ROCEDORE. <4> Emerger,cy Medical Plar, SAN JOAQUIN COMMUNITY - 2615 EYE ST - 327-1711 TRANSFER AGREEMENT 8-1-86. 10/24/90 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 4 00 - Overall Site <E> Mi t i gat i or,/Prevent/Abat emt <1> Release Prevention PRESSURIZED BYLINDERS PROPERLY CHAINED. ALL SUPPLY DOORS LOCKED AND SECURED.c OXYGEN TANKS HAVE CAPS AND PROPER REGULATORS. <2> Release Cor,tainmer, t SHUT OFF VALVE, REMOVE LEAKING 02 TANK, REPLACE TANK. <3> Clellar, Up EVACUATE PREMISE' S. <4> Other Resource Act i vat i or, 10/24/90 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 5 00 - Overall Site <F> Site Erslergency Factors <1) Special Hazards I' <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST SIDE OF BUILDING 8; OUTSIDE ROOM 3 NORTHWEST SIDE OF BUILDING B) EL~ECTRICAL - OUTSIDE DOOR TO LAUNDRY TO THE LEFT C) WATER - SOUTHEAST SIDE NEAR M ST E>D) LuCKS~'ECIAL~ BOX--~W~l~4E 5 ~NO '~ Ee.C.,i[~4~ ~-~-~ Or~ \r~t;b_ ~ ~,\~.r--~d~C~) ~)¢Z~r ~)~)~ <3> Fi~e Protec. /Avail. Water PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM THROUGHOUT FACILITY, SMOKE DETECTORS, PULL ALARM MINISCAN 424 ALARM SYSTEM FIRE HYDRANT - NORTHEAST SECTION OF BUILDING NEXT TO 8TH ST ENTRANCE GATE. <4> Held for Future use 10/24/90 VALLEY CONVALESCENT HOSPITAL 215-000-000899 Page 6 O0 - Overall Site <G> Training <1> Pa~e 1 ! WE H~VE 30 EMPLOYEES AT '[HIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? YES BREIF SUMMARY OF TRAINING: MONTHLY WITH FIRE DRILLS AND DURING ORIENTATION OF ALL NEW EMPLOYEES. <2> Page 2 as r, eeded <3> Held for Future Use <4) Held for Future Use ~ cTI'Y of BAKER,_c;FIELD '~ i HAZARDOUS MATERIALS INVENTORY Farm and ~,gticulture Fi SlJandard Business E] I NON--TRADE SECRETS Pa~e of__ BUSINESS NAME: VALLEY CONVALSCENT HOSPITAIOWNER NAME' RON O'HAVER NAME OF THIS FACILITY: VALLEY CONVALS_CEI~_J~OSPTTAT, ~ c t~o.. ~ '.~-". '.'.~., mo~,~ss. ~ ". ~' ~w C?T~, ZIO;ga~g¢~. ~X ~3a04 citY. zlP}7_~e~b,' ~t 0~312 DuN AND BRADSlREE, NUMBER ................ PHONE ~: '~5 ~-22u0 - PHONE fl: ~89-8443 - - -- -- REFER TO~NSTRUUTIOMS-~R-PROPER CODES , ~ ~ , s s ~ 8 ~ ,o ,, ,~ ,~ ,, Code code Amt Amt~ Es~ Untts on ~ype Press ~emD Stored See instructtons ' ~[?' I,~,::-' I ta~ I r.o~q I.~1 365 I -¢ I t I ~ I.~,- I o~ STORAGE ROOMS 02 OXYGEN (Check all that ap~IH 1~ ~NDERS ~ [ir~ ,~zard ~ r~acti~i(~ ~ Celmd ~ Sudden r~l~ase ~ l~diat~ , Health of Pressure Health ~ Component 13 NAme I C.A.S. Humber I I I I I I I I I I I PhySical ADd ~ell[h HAzard C.A.S. Number Component II Namo I C.A.S, Number (Check !1/ ~hlC Ippl~} Componen~ 12 Name I C.A.S, Number ~ Fire Hmrd ~ Reactivity ~ Delayed ~ Sudd~nRelease ~ Nea/~h of Pressure Component 13 Name I C.A.S. Humber Physical Ind Health Hmrd C.A.S. Humber Componen~ II Name I C,A.S. Humber (Check 811 that apply) Componen~ 12 Name I C.A.S. Number ~ Fire Hmrd ~ Reactivity ~ Delayed ~ Suddenrelesse ~ Immediate Health of Pressure Health Component 13 Name I C.A.S, Number I I I I ' I I I I I I I Physical Ifld Health Hazard ' C.A,S. Number Component II Name I C,A,S, Number (Check ali that apply) Component I~ Name I C.A.5. Number ~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ Immedi~.t~ Health of Pressure ·Healt~ " Component 13 Name t C.A.S. Number EHERGENCY CONTACTS ff [er&ijtioq,(Re~ ahd sign af~pr cpmpl~ti~tg,oll. certify unoer pen~ oI~ Lh~L~ h~ve~ersonm~ exmn~q~qa ~ ~J~.~J~Lhe ~n(or~mon ~u~iLL~ Jn ~Js at~ached .dOc~mc$,suDmttteo ,morma[,o,ln~ls. wue,t~at baSeUac, curare,on.my ,nolnquirYcomplece.gf' ~hose ,nolv,oua/s respomm ,or obtaining ~he ,nrormmon. I believe tha~the ~{Tr~le of o~netl~perator u~ owner/operator's amorized reparative ersfield Fire Dept. ~ ~q~'~ Hazardous Materials Inspection ~i~' Date Completed ~ 2. I ~ 0 Bus~e~ N~e: ~ V ~'~.s c. ~ ~' S e ~ ~ REGEIVED Loca~on: [20~ 8 ~ ~, Plan ID ~ 215-000 8~ (Top right comer Business Pl'an) HAZ. MAT. DIV. Station No. ~F S~ ~ Inspector Adequate Inadequate Vehficafion of [nvento~ Materials Verification of Quantities Verification of Location ~'- ~oper Se~egafion of MatefiE Verification of MSDS Availab~iw Nmber of Employees ~ ~ Verification of Haz Mat Trai~ng Co~5: Ve~cafion of Abatement Supples k Procedures ~N/h Co~5: ~e~encyPr~ed~es Posted ~tc ~ ~ ~ Containers Properly Labeled Co~5: Ve~cafion of Faci~w Dia~m Speci~ Haz~ds ~sociated ~th t~s Fac~W: ~[~N ~ Violafiom: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office B XE SFI .U) FI E REC-IVEDF B~ERSF~ELD, CA 9330~ OFFICIAL USE ONLY B~SINESS S~E HAZARDOUS ~IATE R I ALS BUSINESS PLAN AS A WHOLE FOR~I 2A INSTRUCTIONS: O0 ~B99 1. TO avoid further action, return this form bi 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 B.,' LOCATION / STREET ADDRESS: SECTION 2: E~4~RGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4841. This will notify your local fire department and the State Office of Emergenc~ Services as required la~. EMPLOYEES TO NOTIFY IN CAS~ OF EMERGENCY: NAME AND TITLE ~_c~3 DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SR~3T-OFFS FOR BUSINESS AS A W~OLE A. NAT. GAS/PROPANE: B. ELECTRICAL: ~o~(d~ ~d~ ~o~ ~ C~gr? ~ ~ C~ C. WATER: ~ o ~ D. SPECIAL: E LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS.° YES / NO MSDSS? YES / NO FLOOR PLANS9 YES / NO KEYS? YES / NO 2A - SECTION 4~ PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CiIRCLE YES OR NO INITIAL REFRESHER Bi. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... Y~. NO ~E_~ NO C. PROPER USE OF SAFETY EQUIPMENT: ..................{ NO~ NO D.. EMERGENCY EVACUATION PROCEDURES: ................. NO NO E!. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO NO SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... Y~ NO , certify that the above information is accurate. I understand that 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 6.95 Sec. 25500 Et Al.) and that inaccurate information cons~titutes perjury. SIGNA TITLE /~m,2 ~ ~0. DATE ! .... KERN COUNTY FIRE DEPARTMENT 5642 VICTOR STREET BAKERSFIELD, CA 93308 OFFICIAL USE ONLY BUSINESS NAME: BUSINESS PLAN SINGLE FACILITY UNIT FORM INSTRUCTIONS , ~. To avoid furtl~er aotion, this form must be returned by: ~U6 0 5 1987 I 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. i 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW ' 4. Be as BRIEF and CONCISE as possible. SECTIO~ 1: ~ITIGATION, PREVEI~ION, ABATEI~I~I' PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY HMCU-6 SECTION 3: HAZARDOUS NATERIALS FOR TfIIS UNIT ONLY A. Does this Facility Unit contain HaZardous Materials? ...... ~ NO If YES, see B. If NO, continue with SECTION 4. B. Ar'e any of the hazardous materials a bona fide Trade Secret as defined by Section 6254.7 of the Government Code? ......... YES If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (~hite form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form .#4A-2) in addition to the non-trade secret form.' List only the trade secrets on form 4A-2. '!SECTION 4: PRIVATE FIRE PROTECTION ;SECTION 6: ~OCATION OF iA. NAT. GAS/PROPANE: ~B. ELECTRICAL: ~. C. .I J D. SPECIAL: E. LOCK BOX: YES ~ IF YE~, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? · YES / NO fI~CU-6 BAKERSFIELD CITY FIRE DEPARTMENT ' I.D. # FORM 4A-1 Page ~of- NON--TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: VALLEY CONVALESCENT HOSPITAL OWNER NAME: RONALD D. O'HAVER FACILITY UNIT #: ADDRESS: 1205 8TH STREET ADDRESS: 5726 DONNA AVENUE FACILITY UNIT NAME: CITY, ZIP: BAKERSFIELD, CA 93304 CITY,ZIP: TARZANA, CA 91356 PHONE #: (805) 324-9468 PHONE #: (818) 34~1449 ' [OFFICIAL USE cFiRS CODE I ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT. WT. CHEMICAL OR COMMON NAME CODE GUIDE NA~E: TITLE: SIGNATURE: DATE: E~ERGENCY CONTACT: TITLE: PHONE · BUS HOURS: AFTER BUS HRS: E~ERGENCY CONTACT: TITLE: PHONE ~ BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: 4A-1 - BAKERSFIELD CITY FIRE DEPARTMENT I.D. ~ FORM 4A-1 Page of" NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUS:INESS NAME: VALLEY CONVALESCENT HOSPITAL OWNER NAME: RONALD D. O'HAVER FACILITY UNIT #: ADDRESS: 1205 8TH STREET ADDRESS:. 5796 DONNA AVENU~ FACILITY UNIT NANE: CITY, ZIP: BAKERSFIELD, CA 93306 CITY,ZIP: TARZANA,.CA 91356 PHONE ~: (805) 326-9668 PHONE ~: (818) 343-1449 ~FICIAL ~SE CFIRS C00E / ONLY I 2 3 : 4 5 6 7 8 9 10 TYPE ~AX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CODE AMOUNT A~OUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR CO~ON NAME CODE GUIDE NAME:: TITLE: SIONATURE: DATE: EMERGENCY CONTACT: TITLE: PHONE # BUS HOURS: : AFTER BUS HRS': ~MERGENCY CONTACT: TITLE: , PHONE # BUS HOURS: · 'RINCIPAL BUSINESS ACTIVITY: AFTER BUS HR$: