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Home My WebLink AboutBUSINESS PLAN (2) Central Valley Pulmonary Medical Group Robert L. Laughlin, M. D.,F.C.C.p. DIPLoivIAT~, A-'hlL-~RIOAN BOARD OF PULMONAF~ DISEASE AND INTERNAL MEDICINE CHEST DISEASES - CRmCAL CARE SLEEP DISORDERS BAKERSFIELD, CA 93301-j (66 ~ ) 327iS30 , (66 I ) CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r" Floor, Bakersfield, CA 93301 FACILITY NAME ~'~.,-x~"~, ////~/[.~ _,~/,'... INSPECTION DATE .//- / ADDRESS / '~ ~- $ / '/ .c-t', ' PHONE NO. FACILITY CONTACT ..~,a,.,'Z"a~cl,/i'''. BUSINESS IDNO. 15-210- · INSPECTION TIME /~,' ,,,.,, ,,,., NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ..~' Routine [~ Combined [~ Joint Agency [~ Multi-Agency [-] Complaint {~ Re-inspection OPERATION C V COMMENTS Appr. opriate permit on hand Business plan contact information accurate J' Visible address d ~ /7/17.) Verification of inventory materials d lf//~',' ~' t3 3'e Verification of quantities j ...,-Yc.o ~.c,t.E-,~ Verification of location d ~ /'//'r) Proper segregation of material ' ' 4 ,~V fid Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures 4 Emergency procedures adequate D( /,/~ Z ~,'~ ~L .,~?~ Containers properly labeled , ~J ,. Housekeeping 4 Fire Protection J /' Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardotls, wa~e on $ite~: ~e~9 I~ No' Questions regarding this inspection? Pi~a~a call us at (661 ) 326-3979 ible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: CENTRAL VALLEY PULM Y MED GRP SiteID: 015-021-002270 Manager : BusPhone: (661) 327-5301 Location: 1925 17TH ST Map : 102 CommHaz : Minimal City : BAKERSFIELD Grid: 25D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code:8011 EPA Numb: DunnBrad: _ ~=- Emergency Contact / Title Emergency Contact / Title TIM RAINBOLT / / Business Phone: (661) 327-5301x Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire React ImmHlth DelHlth Contact : TIM RAINBOLT Phone: (661) 327-5301x MailAddr: 1925 17TH ST State: CA City : BAKERSFIELD Zip : 93301 + Owner Phone: ( ) - x Address : 1925 17TH ST State: CA City : BAKERSFIELD Zip : 93301 Period : to TotalASTs: = Gal Preparer~~l_ TotalUSTs: = Gal Certif'd: v~-~-v- RSs: No ParcelNo: Emergency Directives: -1- 07/30/2003 UNIFIED PROGRAM INSPECTION CItECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME CC-~'re'~l/~-cc'~) ~t..na,,tm~C_~ INSPECTION DATE ADDRESS Iq Z~ lq ~t4--'sr PHONE NO. 3Z'7 - FACILITY CONTACT -']~,',,-x. ~zk4,Og-xaz,'r- BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES /6225'0 / Section 1: Business Plan and Inventory Program [~l Routine ~(.Combined [~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~~ ~ }/,~ Verification of quantities f' Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Questions regarding this inspection? Please call us at (661) 326-3979 Business ~~,'lJle White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: i~ CITY OF BAKERSFIELD FIRE DEPARTMENT I OFFICE OF ENVIRONMENTAL SERVICES " UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 FACILITY NAME C"C'~re-~"V~,ccEU ~c~,'z~'C~ ~SPECTION DATE ADD'SS J~ Z~ tO ~m ~ PHONE NO. FACILITY CONTACT.~/~ ~M~L~ BUSINESS ID NO. 15-210- ~SPECTION TIME NUMBER OF EMPLOYEES .. ~...~ Section 1: ,:. Business Plan and lnvento~ Program ~ Routine ~ombined ~ Joint Agency ~ Multi-Agency ~ Complain&~ ~ Re-inspection OPERATION C V COMMENTS ,, . Appropriate pc~it on hand Business plan contact info~ation accurate Visible address Co~cct occupancy :,. Verification of invento~ materials Verification Of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures [mergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Explain: ~ ~ ~ ~,~ Questions reg~ding ~is insp~gfion? Plgas~ gall us~ a~6 i~) 326-3979 BUSlr~ess: 'Site- Respom Pa~/ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ t//'rt~'g I:;D~ ~ INSPECTION DATE /..{/~d5 A Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~/J~Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line <.~Secondaryco~tainmen~rovided ~/ ?LCa~-~ f~'n/,O~' Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal Inspector: L/X~(/x/'E2-~ 'l 1 ~LA~ x Office of Environmental' Services (661) 326-3979 ness S~'Respon~ible Party White - Env. Sves. Pink - Business Copy CITY OF BAKERSFIE~ O~ICE OF ENVIRONMENTAL~I~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 "~""""~"'"'~'"'" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per matedal per building or a~a) ~ NEW ~ ADD ~ DELETE ~ REVISE 200 Page BUSINESS ~ME (Same as FACILI~ NAME or DBA - Doing Busings As) 3 CHEMI~LLO~TION 2012 CHEMI~L LO~TION ~ y~ ~ ~.. · No 202 ' CONFIDENTIAL (EPC~) FACILI~ ID ~ ' ~ ~;~-~'- ~ ~-'-~ .... ~'~i~ -- 203[GRID~(opt~naO 2~ (~ ~ If Subj~ to EPC~. refer to instm~ions 207 COM~N ~ " EHS* ~ Y~ ~ No 208 FIRE ~DE H~RD C~ES (~plete if r~u~t~ by I~1 fire ~ie~ 210 ~ CURIES 213 ~PE ~ p PURE ~ m MIX. RE ~ w WASTE 2~ .~_RAOIOACTIVE ~ Y~ ~ No 212 PHYSI~LSTA~ ~ s SOLID ~1 LIQUID ~ g ~S 214 ~ FED ~RD CATE~RIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE RELEASE ~ 4 ACUTE HEALTH ~ 5 CHRONIC H~LTH 216 (Ch~ all ~at apply) ANNU~ WASTE 217 M~IMUM 218 ~ AVENGE 219 STATE WASTE CODE ~0 ~ DAILYAMOU~ ' L DAILY A~UNT A~UNT UNITS' ~ ga GAL ~d CU ~ ~ lb LBS ~ tn TONS 221 DAYS ON SITE ~2 · If EHS. am~nt mu~t Fe in lbs. STOOGE CO~AINER ~ a ABOVEGROUND TANK ~ · P~STI~NONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR 223 (Check all that apply) ~ b UNDERGROUND TANK ~ f ~N ~ j 8AG ~ n P~STIC BO~LE ~ r O~ER ~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TOTE BIN ~ d STEEL DRUM ~ h SILO ~ CYLINDER ~ p TANK WAGON a AMBIENT ~aa ABOVE AMBIENT ~ ba BELOWAMBIENT 224 STOOGE PRESSURE STO~GETEMPE~RE ~aAMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIENT ~ c CRYOGENIC 225 22~ 227 ~ ~ ~ ~o ~28 220 2a0 23~ ~ Y~ ~ ~o 232 ' 230 ~ Y~ ~ ~o 240 24a 242 243 ~ Y~ ~ No 244 ~ 245 PRINT ~ME & TI%E OF AU~OR~ED COMPANY REPRESENTATIVE SIG~TURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd B~~__ -.~w~-~ ~-,- oFCITYENvI RONMENTAL~IJ~ RVIcEsOF BAKERS FIE~i~ I gt~ ~ ~ICE ~nn~~ 1715 Chester Ave., CA 93301 (661) 326-3979 "~~'~ H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per martial per building or ama) ~EW ~ ADD ~ DELVE ~ REVISE ~ Page ~ of BUSINESS ~ME (~me ~ FACILI~ NAME or DBA - Doing Busings ~) 3 . - 201', CHEMICAL LO~TION ~ Y~ ~ No 202 c.~,~o~,o.. ~.n~ ~-~ ~ ~ ..................................... , ' ~NFIOENTIAL (EPC~) FAClLIWlD~. ~ ~-~ .... ?-~--~'~ ~P ~ (op~naO 203 I GRID ~ (optionaO 2~ ' 20~ T~eE SECR~ ~ Y~ ~ No 206 CHEMI~L ~ME ~~ ~( ~ If Subj~ I0 EPC~ ref~ to inst~ai~s 207 ~M~N ~ EHS' ~ Y~ ~ No 208 CAS ~ 209 *If EHS ia~.~ ~ ~ ~*'~ ~ FIRE CODE H~RD C~ES (~plete if r~u~t~ by I~1 fire ~ie~ 210 ~PE ~ p PURE ~ m MIXTURE ~w WASTE 2~; ~ RADIOACTIVE ~ Y~ ~ No CURIES 213 212 PHYSI~LSTA~' ~ s SOLID ~ LIQUID ~ g GAS 214 ~ ~RGESTCONTAINER ~ 215 FED ~RD ~TE~RIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE RELEASE .~ ACUTE HEALTH ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) ANNUAL WASTE 217 M.~IMUM 218 AVENGE 219 ~ STATE WAS~ ~OE UNITS' ~ga ~L ~ d CU~ ~ lb LBS ~ tn TONS =1 ~ DAYSONSI~ ' If EHS, am~nt must Oe in lbs. STOOGE ~AINER D a ABOVEGROUND TANK ~P~STI~ONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~ 2~ (Check afl ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j 8AG ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN D d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON ~a AMBIENT ~ aa A~VEAMBIENT ~ ba 8ELOWAMBIE~ STOOGE PRESSURE ~4 STOOGE TEMPE~TURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW A~IE~ ~ c CRYOGENIC ~5 226 227 ~ ~ y~ ~ No 228 229 230 ~1 ~ ~y~ ~No 232 233 2~ 235 ~ Y~ ~ No 236 237 238 239 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ No 244 245 PRINT ~E & TITLE OF AUTHOEIZED CO~PANY~PRES~NTATIVE SIGNATURE DATE 246 UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd