HomeMy WebLinkAboutBUSINESS PLAN (2) 2005 ' I 7Trt STREET FAX: 6lB 1'324'~)3
L.~WRENCE O. LEFF, M.D.
pP~C't"ICE LIMITED TO UROLOGY
YOUR NF_X~ APPOINTMENT IS
MON. TUES. WED. THURS. FRI.
TIME: DATE:
IF UNABLE TO KEEP APPOINTMENT, KINDLY GIVE 24 HOURS NOTICE
YOUR NEXT APPOINTMENT IS
MON. ~ ~ T'U~ES. ~WED.~ THURS. FRI.
TIME: ..... DATE:
--IF UNaBLE-TO KEEP APPOINTMENT, KtNDLY GIVE 2~ HOURB NOllCE
i-=-ROBERT: L:WAGUESPACK, MD
A PROFESSIONAL CORPORATION
_ ~ ' BOARD CERTIFIED UROLOGIST
2005- 17th Street Phone: 661-327-4252
LEFF, MD SiteID: 015-021-002251
Manager : ~%%~% BusPhone: (661) 327-4252
Location: 2005 17TH ST '% Map : 102 CommHaz :
City : BAKERSFIELD ~ Grid: 25D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 01 SIC Code:8011
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
/ /
Business Phone: ( ) - x Business Phone: ( ) - x
24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: React
Contact : Phone: (661) 327-4252x
MailAddr: 2005 17TH ST State: CA
City : BAKERSFIELD Zip : 93301
Owner LEFF, MD Phone: (661) 327-4252x
Address : 2005 17TH ST State: CA
City : BAKERSFIELD Zip : 93301
Period : to ...... Tot~alASTs: = Gal
Preparer: TotalUS~Ts-: . = Gal
Certif 'd: RSs:
ParcelNo:
Emergency Directives: o?
Do .hereby certify that I have
I, _ cry. o~ p~.~.~----
reviewed the attached hazardous materials manage-
e~cl that it along with
ment plan
any corrections constitute a complete and correct man-
agement plan for my facility.
-- Signature
-1-. 08/22/2003
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROG~M INSPECTION CHECKLIST
1715 Chester Ave., 3~" Floor, Bakersfield, CA 93301
FACILITY NAME ~$ ~~~
~ Routine ~Combined ~ Joint Agency ~ Multi-Agency ~ Complaim ~ Re-inspection
OPERATION C V COMMENXS
Appropriate pe~it on hand
Business plan contact info~ation accurate
Visible address
Co.eot occupancy
Verification of invento~ materials
Verification o~ quantities
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of H~z Mat training
Verification of abatemenl 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?: ~es
Questions res.ding mis inspection? Please call us at (661) 326-39~9
White - Env. Svcs. Yellow - Station Copy Pink - Business Copy In
'. '. ., ~6~1
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST /
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME ~-')R-$ b~A~u,~:~(-.. ~ ~.C~.F INSPECTION DATE i.I
ADDRE~ss 'ZOO.S-' ! '7 -r,a- ~5 t-,. PHONE NO. ~ Z'7 - ,~. ~
FACILIT, Y coNTACT BUSINESS ID NO. 15-210-
INSPECTION TIMI~ NUMBER OF EMPLOYEES
Section 1: Business Plan and Inventory Program
[~l Routine [~Combined [~ Joint Agency [~ Multi-Agency [~1 Complaint [~ Re-inspection
OPERATION C V COMMENTS
Appropriate Permit on hand
Business plan contact information accurate
Visible address
Correct occupancy
Verification of inventory materials
Verification of quantities .,~-
Verification of location
Proper segregation of material
Verification' of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
~ ' ,
C=Compliance' V=Violation
Questions regarding this inspection? Please call us at (661) 326--3979 Busine~ ~'~ie RespOnsible Party
/
White - Env. Svcs. Yellow- Station'Copy Pink - Business Copy Inspector: ~ t ,'x~C'~, ~ /
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME 'D8.,$ ~~$~e-../~ ~ /__~'1~ INSPECTION DATE
Section 4: ttazardous Waste Generator Program EPA ID #
[] Routine [~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made
EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #)
Authorized for waste treatment and/or storage
Reported release, fire, or explosion within 15 days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames
Containers in good condition and not leaking
Containers are compatible with the hazardous waste
Containers are kept closed when not in use
Weekly inspection of storage area
Ig~aste located at least 50 feet from property line
~Secondary containmen)provided
Conducts daily inspection of tanks
Used oil not contaminated with other hazardous waste
Proper management of lead acid batteries including labels
Proper management of used oil filters
Transports hazardous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazardous waste analysis for 3 years
Retains copies of used oil receipts for 3 years
Determines if waste is restricted from land disposal
C=Compliance V=Violation
Inspector: ~ t~
Office of Environmental Services (661) 326-3979 .gite Responsible Party
White - Env. Svcs. Pink - Business Copy
s~[~~.~,..--~., CITY OF BAKERSFIE~
OFFICE OF ENVIRONMENTAL SERVICES
~4a,~rz 1715 Chester Ave., CA 93301 (661) 326-3979
'~~'~' H~RDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
(one ~ per matedal per building or ama)
~ NEW D ADD ~ DELETE ~ REVISE 200 Page ~
' ~*~* *,.-~:~:':> ~:i~ ~*: ?'~ ;";=~ ...... ' I.'FACILI~ INFORMATION
8usiNgss ~ME ~Si~s aS' F~C~u~ fih'~-E~g~'b'~[~"g6~$~¥~)' ........ 3
CHEMICAL LO~TION I ~ 5 ta ~ ~'~ ~ ~ 201~ CON¢IDEN~L (EPc~)CHEMIC& LO~TION
............................. L
'~ ";;?';' ~ ~' '~,'; "~; q¥5;~¥~?'~; ~ ~ ' ' ' ~ · II. C~EMICAL INFORMATION , '. ........ ; ?'¥:~: ~'~ ':~:
T~DE SECR~ ~ Y~ ~ No ~6
CHEMI~L ~ME
207
COM~. ~ME ~ ESS' D V~ D .o 20S
................. ~ .................................... ~ ., .:.~'~?~;7;,,;~,::~,:.;;f?~-':~.'~b.~*~[;,,;,~
.... ~ -~E~s i~:Y~' ~ ~~'~
FIRE CODE H~RD C~SSES (~plete if r~u~t~ by I~1 fire chie~ 210
~PE
~ p PURE ~ m MIX. RE ~w WAST~ 2;; i R~OIOACTIV~ ~ Y~ ~ No 212
CURIES
213
PHYSI~LSTA~ ~ s SOLID ~LIQUID ~ g GAS 214~; ~RGESTCO~AINER ~ 215
FED H~RD CATE~RIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE RELEASE ~ ACUTE HEALTH ~ 5 CHRONIC H~LTH 216
(Ch~ all that apply)
~ DAM~IMUMLy A~U~ 218 ~ AVENGE 219 I STA~ WAS~ CODE
ANNUAL WASTE / 217 , ~ DAILYA~UNT
a~U~
~ ........... ~-- ~ --- [ ~ DAYS ON S~
~.,=~-~ ~.~ m ~ c~ ~ ,. ~smt. ~o.s ~, ,
;* If EHS. am~nt must be in lbs.
STOOGE ~AINER ~ a ABOVEGROUND TANK ~ P~STI~NONM~ALMC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL
(Check all ~at apply)
~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~STIC BO~LE ~ r O~ER
~ c T~K INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TO~ BIN
~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N
STOOGE PRESSURE ~a AMBIENT ~ aa ABOVE AMBIENT ~ ba 8ELOWAMBIENT ~4
STOOGE TEMPE~TURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ b3 BELOW AMBIENT ~ c CRYOGENIC ~5
12 ~ 230 231 D Y~ ~ No ~2 ~
~3
.......................
238 239 ~ Y~ ~ NO 2~ 241
242I 243 ~y~ ~No 2~ 245
PRINT NAME & T/~E OF AU~ORI~D COMPA~ REPRESENTATIVE S~GNATURE ~ ~DATE 246
UPCF (7199) S:\CUPAFORMS\OES2731 .TV4.wpd