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HomeMy WebLinkAboutBUSINESS PLAN (2) Room ]/~ ]atl~ 'Mech. Business o 336 Off~ce Lobby. ~Ac d~u~X-Ray -- -- }ark  loom : Rec ov e ry , ~ Becovery . ' i Fm~6~. 476 i ' · ~. Recovery Surgery Surgery, Lobby 2017 19~ Street '~ , / 2130 "G" STREET' /' BAKERSFIELD', CA 93301 ' (805) 326-3979 OFFICIAL USE ONLY i0# f)() - BUSINESS NAME ~' ~ HAZARDOUS MAT i~. R I ALS ~OR~ ~A 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: L, Paul Knight D.D.S. Inc B. LOCATION / STREET ADDRESS: Z01?-l~th Street CITY: Bakersfield ZIP: 93501 BUS.PHONE: (805) 327-1187 SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. 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. L. Paul KniKht D.D.S. Ph# 327-1187 Ph# 839-3023 B. Susan Little. Ph# Ph# 833-6664 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE:;-..~outh East side of building B. ELECTRICAL: ~Ofl%h~'side of'buildir~ C. WATER: Back 10t of building by the alley D[ SPECIAL: E. LOCK'BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? ~Es / NO MSDSS? YES / NO " FLOOR PLANS? 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 ~H~C~' PROVIDES-~MPLbYEES WITH'INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE,.YE~_.0R-N©- .. ...... INITIAL REFRESHER. A. METHODS FOR SAFE HANDLING OF HAZARDOUS " MATERIALS: - YES NO YES NO 'B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: ........................... YES- NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO. DOES YOUR BUS:INESS, HANDLE HAZARDOUS:MATERIAL IN QUANTITIES LESS THAN~500-.pOUNDS OF A SOLID, 55 GALL0~'0F A LIQUID, oR 20~'CUBIC FEET OF A COMPRESS~D. GASk' -" 'YES NO I,i '~-~ ~, I'~k, { ~q---.h~.q, 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 constitutes perjury. / ,/ - 2B - · BAKERSFIELD CiTY.FIRE DEPARTMENT 2t30 "G"' STREET BAKERSFIELD, CA 93301 L OFFICIAL USE ONLY ID# BUSINESS NAME: BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To.avoid further action, this form must be ret. ucned by: .2. TYPE/PRINT 'YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT.N~ME: .. ..... SECTION 1: MITIGATION, PRElrENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS L~IT ONLY ? If - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility.Unit contain Hazardous Materials? ..... / YES~~ ",,. If'YES, see B. If NO, continue with SECTION 4. ~ B. Are any of the hazardous materials a bona fide Trade Secret YEt If No, 'complete a separate hazardous materials inventory form marked: NON'TRADE.SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form ~4A-2) in addition to tile non-trade secret form. List only the trade-secrets on form 4A-:2. SECTION 4: PRIVATE FIRE PROTECTION 2 - 4 3,~ lb. Dry Chemical extinguishers SECTION 5 ·LOCATION OF-WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS Alley on "D" street between l~th and, 18th streets. -SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS./PROPAN~ Natural gas - shut off at meter on east side of the bldg in the back. B. ELECTRICAL: Back of the building (.facing south) C. WATER: Directly behind the building by the alley. D. SPECIAL: E. LOCK BOX: YES .~IF YES, LOCATION: . IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO BAKERSFIELD CITY FIRE' DEPARTMENT .~ I.D. ~ FORM 4A-1 Page __of wJ NON--TRADE SECRETS HAZ A~RDOUS MATERI ALS. INVENTORY 'BUSINESS NAME: ~... PO[/.{~. ~/N,O~'- ~)'~' '~ OWNER NAME: ~C.t~-('(~ FACILITY UNIT ~: ,- ADDRESS: ~1 ~ - /~ ~ ~ ADDRESS: FACILITY UNIT NAME: CITY, ZIP: ~m~ &,~/~ ~.~30/ CITY,ZIP: ~HONE ': - 3~7-/} ~-7. PHONE ~:' [OFFICIAL USE CFI'RS CODE I 1 2 3 4 5 6 7 8. 9 10 TYPE MAX ANNUA~ CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T. ODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT . WT. CHEMICAL OR COMMON NAME CODE GUIDE Y ~ ~ ' NAME: L. {~o. ui.L ,,mi./~}~'t~ TITLE: d~)c,.~,~eR. SIGNATURE: DATE: EMERGENCY CONTACT: - ~ ~ ~ ~ TITLE: PHONE # BUS HOURS: .... AFTER BUS HRS: EMERGENCY CONTACT: TITLE: .. PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: AFTER BUS. HRS: .J "l L. ~ ~TH EROwF-R~L~ACT $C.r~OOb OlST /-/ ~ISTH I I I II t I ' I.. ~ 's T. :~ .---® :- [ %.'- :'.. ME I~HBORHOOD: .~,~ar~cter: Commercial off retail and older apartment uOs-hotel. ~'~Tren&f Improving.( ) Static ~) Declining ( ) =Buil~-up 95 % Accessibility & Adequacy of: Good Ave. Poor Shopping ( x ) ( ) ( ) Schools ( ) (x) ( ) Transportation (x) ( ) ( ) PROPERTY DATA: Site Analysis: Lot Sketch (See attached Assessor's Plat MaP) Area 37.5' x 122' = 4,575 sq.ft, paving Asphalt To.pography Level at grade Curb' Concrete Zoning C-l: Co~erctal Sidewalk Concrete Water California Water Service Company Sewer Yes Gas & E~ectricity PG&E Septic No Present Use Dental Office Highest & Best Use Dental Office Twenty-foot alley abuts property line access to rear Parking. "~. Improvements: .31-33 ",. Age Effective 20-25 Years I) Dental Office: One-story structure on a concrete Slab foundti°n, with wood framed- stucco exterior walls, except easterly concrete block walls, and a built-up composition roof. According to Dr. Knight. northerly portion of the building was constructed in 1953 and southerly portion in 1955. Overall condition is classed as average. Carpet in other than offices appears new. Dr. Knight indicates roof was replaced 7 years ago and that all plumbing, electrical and mechanical equipment is operative. Heating-cooling are antiquated. AREA: 2,118 sq.ft. 2) Site Improvements: Other improvements include average lan4scaping, concrete flatwork and 1,400 sq.ft, of asphalt paving. Rooms Floors Ceilings & Walls Equipment' Lobby Carpet Ac. Tile & Wood Dark Room Asphalt Tile Plaster & Plaster Business Office Carpet Ac.Tile & Plaster Wood counter 1/2 Bath Carpet Plaster & Plaster Toilet, sink File Room Carpet Ac. Tile & Plaster " 2 Offices Carpet 2"x2" grid & Plaster Wood cab.: I office X-Ray Carpet 2"x2" grid & Plaster 4 Recovery Rooms Asphalt Tile ~laster & Plaster Lobby Car~et Plaster & Piaster Ceiling fan, 2 Surgeries Asphalt Tile Ac. Tile & Plaster Individual stnks 1/2 Bath Linoleum Plaster & Plaster· Toilet,-sink Sterilization Asphalt Tile Ac. Tile & Plaster Formica top,wd.cabs,'sink 2 Exams Asphalt Tile Ac.Tile & Plaster One sink Heating Forced Air Cooling A/C Insulation Walls/Ceiling ~~~1 (according Dr. Knight)