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HomeMy WebLinkAboutBUSINESS PLAN 3/14/1994 03/04 / 94 SAN DENTAL 215-000-000_, e 1 ,~§ Overall Site w itt~ 1 Fac~ Unit~~]--] ~~ ~ ~R~ ~9_._~.~~~- %' General Information r i Lc]~atior,: ..... ' T ~ 0:~ ~IgE~ ~ ~ap:10~ Haz:2 Type: l Com~imnity: B~E~SFIELD STATION 01 ~ Grid: ~4I} F/U: 1 ~OV: 0.0 Contact Name .[ Title I ~aL~oJ ...... o ~ l~Oo~ ~- JERRY WOOLF ' '=' '~7 ......... r'= EVELYN' STEVENS ........... '~ " ~r,=-~ ~ Ad~inistrative Data City: BAKERSFIELD ~~~'-State: CA Zip:~]~t-- Corem Code: 215-001 BAKERSFIELD STATION 01 SIC Code: Owner: JERRY WOOLF Phone: (8o5)-~'~ Address: .~ c - ~ ~l~V~'~ ~ State: CA City: ~LD ~~~ ~]~ Zip: Sur~m~ary 1 B o6 ! I, _%-¢;FC'I.J ~,d(,¢,~l~O Do hereby cedi~ t.h~,t i have -- (Ti~t~n~ name) ' reviewed the a~ched h~ardous mate~bb merit plan ,u, ... ¢ .... . and that it abng with any corrections constitute a complete and correct agement plan for my fadJi~. 03/04/94 SAN JOAQUIN DENTAL 215-000-000957 Page Hazmat Irsverit,z, ry List irs MCP Order 02 - Fixed C,-,ntairsers o'n Site Plr,-R~ef Name/Hazards Form Max Qty MCP ~ I']~~ I DE Gas 65~ High Fire, Primmed Hlth FT3 02-001 OXYGEN ~ Gas 512 Low Fire, Pressure, Immedt~H1 FT3 03/04/94 ' 21 ~-000-00095-,m~ Page 3 02 - Fixed Co~,tainers or~ Site Hazmat I~ve~tory Detail i~ MCP Order 02-002 NITROUS OXIDE Gas ~T~ High Fire, Pressure, Immed Hlth CAS ~: 10024972 Trade Secret: No ~ ~ Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS //~ Daily ~ ~FT3~----'~ Daily Average~ ~}FT~ ~ Ar~r~ua l~oArnour~t6~F'TR .... F Press T Ter~p -- Cone ~ Cor~por~er~ts ~ MCP ---~uide 100.0%~Nitrous O~ide ~Hi~h ~ 14 02-001 OXYGEN Gas ~ ~t~8 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 Ar, r~ual Arnour, t. FT3 ---  torage I' Press T Temp PORT. PRESS. CYLINDER ~Above ~Ambier~t~E -- Co~c ~[ Compo~e~ts MCP ~uide 100.0% ~Oxygen, Cot. pressed ~Low ~ 14 03/04/94 SAN JOAQUIN DENTAL ,215-000-000957 Page 4 00 - Overall Site <D> Not if. /Evacuatior~/Medical <1> Ager, cy Notificatior~ CALL 911 <2> Employee Notif./Evacuation EXITS ARE MARKED BY LARGE SIGNS. EVACUATION PLANS DIAGRAMED IN LOUNGE AND CALL 911. STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY EACH OTHER OF PENDING EVACUATION. <3> Public Notif./Evacuation STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY PUBLIC PERSONS IN THE BUILDING AND TO GUIDE ]'HEM OUT OF ]-HE PREMISES. 03/04/94 SAN lIN DENTAL 2 i 5-000--0009~ Page 5 00 - Overall Site <E> Mitigat ior~/Prever~t/Abate;~t <1> Release Prever, tiors EMERGENCY ESCAPE PLAN AND PRACTICED. FIRE EXITS CLEARLY MARKED. FIRE EXTINGUISHERS IN SEVERAL LOCATIONS. CYLINDERS PROPERLY CHAINED AND USE PROPER VALUES AND FITTINGS. <2> Release Corstairm~er~t <3> Clear~ Up <4> Other Resource Activatior~ ~03/04/94 SAN JOAQUIN DENTAL 215-000-000957 Page 6 00 - Overall Site <F> Site Ers~ergersc. y Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS ........... ~ ~n~ ................ B) ELECTRICAL - ELEC',-FR, Ir''''''s~, ,_ BOX ON ...... , ~,,....,....,.--i tO,.,_.""-' POST SOUTHEAST C,,...,~-~.,.,,,_R'""'"'""- ' '-""'"~,,. D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - EXTINGUISHERS IN VARIOUS LOCATIONS FIRE EXITS. FIRE HYDRANT - ???????????? <4> Buildirsg Occupar~cy Level 03/(~4/94 SAN J~UIN DENTAL 215-00()-0009J~ Page 7 O0 - Overall Site <G> TrairJirsg > Page 1 WE HAVE ~EMPLOYEES AT THIS FACILITY WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: REVIEW OF MANUAL. MONTHLY MEETINGS AND COURSES. <2> Page 2 as rseeded <3> Held for Future Use <4> Held for Future Use BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 1715 'CHESTER".A~VE:~ BAKERSFIELD, CA. 93301 -,- HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. '2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise cs possible. SECTION l' BUSINESS IDENTIFICATION DATA LOCATION: 5~ Oib ~~ ~ MAILING ADDRESS: DUN & BRADSTREET NUMBER' SIC CODE: PRIMARY ACTIVITY: MAILING ADDRESS: ~ Ol~d~ SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE Hazardous 1V~aterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF'SUMMARY OF TRAINING PROGRAM: SECT[ON 4: EXEMPTION REQUEST: CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS 'OF CHAPTER 6.95 OF THE "CALIFORNIA-HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE 00 HANDLE HAZARDOUS MATERIALS, B'UT THE QUANTITIES AT NO TiMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: !, ~_-~-fJ'Y[~ t/~('7~_ I'~ CERTIFY THAT THE ABOVE INFOR- MATION IS'-~CCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO · FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV., 20 CHAPTER 6.95 SEC.'25500 ET AL.) AND THAT INACCURATE iNFORMATiON.CONSTiTUTES PERJURY. 2. ~B akersflelcl F~re Dept. -~aZardous ~aterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: " SECTION 6': NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: ~ q! 1 B.. EMPLOYEE NOTIFICATION AND EVACUATION: F_,'X'. ltd ~ I'utOa'~ b._.L,L~ C. PUBLIC EVACUATION' O. EMERGENCY MEDICAL PLAN: 5c~~~i c~ ' P,.., va-~ Rd_, ~ · .. 3. ;:[315 Hazardous ~aterials Division ........ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT'PLAN: A. RELEASE PREVENTION STEPS: E. RELEASE-CON-'fAINMENT AND/OR M N MIZATION: C. 'CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT'YOUR FACILITY)' NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION' L.~'¢_..~ B. WATER AVAILABILtTY (FIRE HYDRANT)' '  Bakersfield Fire De~. L~'- HAZARDOUS MATERIALS DIVISION Date Completed Business Name: ~-~ Uo ~,'~ 0~ ~ / Location: ~ ~~ ~~ ~ Business Identification No. 215-000- o~o ~ q ~ ~op of Business Plan) Station No. ~ /~ Shift ~ Inspector ~ ~- ~~ ~~~~ ,',~ Materials Adequate Inadequate fication of In.e,,to~~ ~ ~ ~ ~ ~ _~ Verification of Quantities~ ~ ~ . . . · h Ver,,,ca,,ono, oc ,on ~ ~~- Proper Segregation of Uateri~ ~ Comments: ~ ~ ~ ~ ~ ~ ~ 0 ~/~ ~,' ,~ VerificatiOn of MSDS Availabli~ ~ Number of Employees Verification of H~ Mat lrainin~ ~ Gommonts:. Vodfication of ~omont 8upplios &ProcodurOs ~ Comments: Emergency. Procedures Posted ~ Containers Properly Labeled ~ Comments: Verification of Facility Diagr~ ~ Special H~ards Associated with this Facility: Violations: k~5~~. ~'k~ %~. ~~__ , , P~ All Items O.K. Correction Needed Business Owner/Manager FD 1652 (Rev. 1.90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy ' Bakersfield FireDept.  HAZARDOUS MATERIALS DIVISION Date Completed Business Identification No. 215-000- oc~o '~ 5" ? (Top of Business Plan) Sta, onNo. I Shift 6 ~nspeotor Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location I~ ~] Proper Segregation of Material ~ I~] 05-'~ Commen, s: .4"1 o','~' ~'0 S~O ~/~/' n,'?r ',~/,o~~'a~- Verification of MSDS Availablity Number of Employees - Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures ~ ~] Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram ~ ]~] Special Hazards Associated with this Facility: Violations: All Items O.K. ]~ Correction Needed I~] Business Owner/Manager. FD 1652 (Rev. 1-90) Whi1~.Haz Mat Div. Yellow-Station COpy Pink-Business Copy Overall Site with 1 Fac. Ursit --Ger~eral Ir~format ior~ Locatiors: 1735 28TH ST Map: 102 Hazard: Low ICcm~r~ur~ity: BAKERSFIELD STATION 01 Grid~ 24D F/U: 1 AOV~ 0~0 JERRyC°r~t aCtwoOLF Na~e ..... ~'[ Tit le .......... ~ 8. ~,)T---' oBusiness~ ....... ~:, - 9 d~' '? ,. ,- Phor~e._.= x --~-~ 24-Houri 80~)' ~= 8 z 1 .--8 ,' ~ .)~Ph°r~e]~' EVELYN STEVENS .~(805) 665-2883 x 805) 398-8028 Adr~ir~istrative Data Mail Addrs: 1735 28TH ST D&B Nu~ber: City: BAKERSFIELD State: CA Zip: 93301- Com~ Code: 215-001 BAKERSFIELD STATION 01 SIC Code: Owr~er: JERRY WOOLF Phone: (805) 398-8028 Address: 7605 EL VERANO ~ State: CA City: BAKERSFIELD Zip: 93309- Sur~r~ary 09/01/93 SAN JOAQUIN DENTAL 215-000-000957 Page 2 Hazr~at Ir~ver~to~y List in ~ICP O~de~- (x--' - Fixed Container-s on Site P 1 n-.Ref Name/Haza~ds Forum ~,~ax Qty ~CP 02-002 NITROUS OXIDE Gas 652 High Fi~-e, P~'essu~-e, I;~r~ed Hlth F'"r3 0~-001 OXYGEN Gas 51;E Low Fi~'e, P~-essur. e, I;~ed Hlth FT3 09/01/9~ '~ SA~-JOAQU i N DENTAL 215-000-~ Page 3 02 --Fixed Co~tai~ers o~ Site Haz~at I~ventory Detail in MCP Order 02-002 NITROUS OXIDE Gas 652 High Fire, Pressure, I~ed Hlth FT3 CAS ~: 10024972 Trade Secret: No For~: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 ....... Daily Average FT3 Ar~r~ual A~our~t FT3 ---- 652 ~ ..... ~o ~6.00 6,520.00 Storage ~ Press T' Te~p -~ Locat ior~ PORT. PRESS. CYLINDER ~Above ~A~bier~t~E WALL OUTSIDE CLOSET -- Corec --I Ccm~por~er~ts 100.0% ~Nitrous Oxide[-'~HiMCP gh ~ 14 02-001 OXYGEN Gas 512 Low Fire, Pressure, In~r~ed Hlth FT3 CAS .~: 7782-44-7 Trade Secret: No Forr~: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS ....... Daily Max FT3 Daily Average FT3 . Ar~r~ual Ar~our~t FT3 ~- 51~ ~56.00 5, 1~.00 Storage F Press T Te~p ~ Locatior~ PORT. PRESS. CYLINDER ~Above ~A~bient~E WALL OUTSIDE CLOSET -- Corec Co~por~err~ s MCF .... ~ui de 100.0% ~Oxyger~, Ccm~pressed ~Low ~ 14 09/01/r ? D~ SAN JOAQUIN DENTAL 215-000-000957 Page 4 00 - Overall Site <D> Not if./Evacuat ior~/Medical <1> Agency Nc, tificat~on~ CALL 91i <2> E~pic, yee Notif. /Evacuatior, EXITS ARE MARKED BY LARGE SIGNS. EVACUATION PLANS DIAGRAMED IN LOUNGE AND CALL 911. STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY EACH OTHER OF PENDING EVACUATION. <3> Public Nntif./Evacuatir~n STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY PUBLIC PERSONS IN ~'HE BUILDING AND TO GUIDE THEM OUT OF THE PREMISES. <4> E~erger~cy Medical Plar~ SAN JOAQUIN HOSPITAL - 2615 EYE STREET - 327-1711 09101193. · )AQUI N~ DENTAL 215-000-~ 57 Page 5 00 - Overall Site <E> Mi t i gat i or~/Prever~t/Abat e~nt <1> Release Prever~tior~ EMERGENCY ESCAPE PLAN AND PRACTICED. FIRE E~ITS CLEARLY MARKED. FIRE EXTINGUISHERS IN SEVERAL LOCAT'IONS. CYLINDERS PROPERLY CHAINED AND USE PROPER VALUES AND FITTINGS. <2> Release Cor~tairm~ent <3> Ciear~ Up <4> Other Resource Activatior~ 09/01/93 SAN JOAQUIN DENTAL 215-000-000957 Page 6 00 - Overall Site <F> Site Emerger~cy Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - SOUTHWEST CORNER OF BUILDING B) ELECTRICAL - ELECTRICAL BOX ON '[ELEPHONE POST SOUTHEAST CORNER OF BUILDING C) WATER - IN SIDEWALK IN FRONT OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PRO}ECTION - EXTINGUISHERS IN VARIOUS LOCATIONS FIRE EXITS. FIRE HYDRANT - ???????????? <4> Buildir~g Occupar~cy Level 09/01/9~ - ~' JOAQUIN DENTAL 215-000-( 57 Page 7 O0 - Overall Site <G> Trair~i rsg <1> Page 1 WE HAVE 9 EMPLOYEES AT THIS FACILITY WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE~ BRIEF SUM~4ARY OF TRAINING: REVIEW OF MANUAL~ MONTHLY ~4EETINGS AND COURSES. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use . C,T¥ OF. E.SF, ELD'. STATEMENT oEACCOUNT ~ ' PLEASE MAKE CHECKS PAYABLE TO: P.O. BOX 2057 ACCOUNT NO." 'H~{4:~9!O~)~ i.: ':::''' ~':'' .~I'' ' CITY OF BAKERSFIELD ,, ...... , . '. :...,. -, i ::',.~ ;? ;;..:..:,C?: :.' ...: . ;: BAK'ERSFIE~D, CA 93303-'2057 .':' !; ;':0 ,rRTH~NT ,~0~, . . .!4.....,:,'.-..,,,.. ;. ,: , :i.!': ~ ........... ..,, .,. .'"' '.'.",".-.~:~ ",'. 4 .... ' .-".- · ~i,V~ ~; ,. :- ' . .., ;.....~ . ..,; .. ..... ....-::,. :?. ,.,;,...,. ,;;: ;....:.:.,:..1.;~:,,.~:,;,,?~ _ ',L!~QUIR!E~.C~N~ER~!NG..THI ~S BILL., ?LEASE PHONE: 3 2 6--: . . · :.'":. ::? !:. "::ii .: ' "" "'. ~:-.(::'"':i'~. ' ' '~ .-,..::,.,:',~.'., ';:".' -"; .D CJ'.. ,!;i:.:; .. ..: ': ' ,'*' i.'? ':~e :"Xf:i.;'I [~[."; !,.. ~ ' .'".""" :" '.": · ' ' :,::.i..i .. :- :..: .... .'.<". .... ' .... r , ...... ...:?,.. . ' ' "' "":":;: ' ' ":,'::'//¢.F:'::.:f;,:.i. ...... :. · 't .': . ,'i.!,:,, .:....... ::. ~"'"' '" :': t'i i~:.:.i.! t';i. -. =0 -00 03/17/92 SAN JOAQUIN DENTAL 215-000-0009, 'age 1 Overall Site with i Fac. Unit By_ General Information Location: 1735 28TH ST Map: 102 Hazard: Low Community: BAKERSFIELD STATION 01 Grid: 24D F/U: 1AOV: 0~0 Contact Name ~ Title Business Phone 24-Hour Phone- JERRY WOOLF I' "I(805) 327-9925 x 1(805)'~J-1-~ EVELYN STEVENS (805) Administrative Data Mail Addrs: .1735 28TH ST D&B Number: City: BAKERSFIELD State:CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: Owner: JERRY WOOLF Phone: ( - )~ -~o~/~ Address: 5~9~10--6~F~E ~o~ ~ UF~do. State: CA City: BAKERSFIELD ~F~©5 Summary / the ~ h~dous ~r. la~ ~na~ ~iswed plan ~or ~- ~F ~,and th~t~ along with ~emem~plan ~or my ~acil~ty. /.': 03/17/92 SAN JOAQUIN DENTAL 215-000-000957 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN Gas 512 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 512 I 256.00 I 5,120.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Iabove ~AmbientlE WALL.OUTSIDE CLOSET -- Conc Components MCP List 100.0% IOxygen, Compressed ILow' I 02-002 NITROUS OXIDE Gas 652 High · Fire, Pressure, Immed Hlth FT3 CAS #: 10024972 Trade Secret: No Form: Gas . Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 Daily Average FT3 ~-- Annual Amount FT3 652 Storage Press I Temp'~ Location PORT. pREss. CYLINDER Above ~AmbientlE WALL OUTSIDE CLOSET --'Conc Components MCP List 100.0% INitrous Oxide IHigh 03/17/92 SAN JOAQUIN DENTAL 215-000-000957 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency 'NotificatiOn CALL 911 <2> Employee Notif./Evacuation EXITS ARE MARKED BY LARGE SIGNS. EVACUATION PLANS DIAGRAMED IN LOUNGE AND CALL 911. STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY EACH. OTHER OF 'PENDING EVACUAT I ON. <3> Public Notif./Evacuation STAFF HAS BEEN TRAINED TO VERBALLY NOTIFY PUBLIC PERSONS IN THE BUILDING AND TO GUIDE THEM OUT OF THE PREMISES. <4> Emergency Medical Plan SAN JOAQUIN HOSPITAL - 2615 EYE STREET - 327-1711 03/17/92 SAN JOAQUIN DENTAL 215-000-000957 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention 'EMERGENCY ESCAPE PLAN AND PRACTICED. FIRE EXITS CLEARLY MARKED., FIRE EXTINGUISHERS IN SEVERAL LOCATIONS. CYLINDERS PROPERLY CHAINED AND USE PROPER VALUES AND FITTINGS. <2> Release Containment <3> Clean Up <4> Other Resource Activation 03/17/92 SAN JOAQUIN DENTAL 215-000-000957 Page 5 00 - Overall Site~ ' <F> Site Emergency Factors~ <1> Special Hazards <2> Utility Shut-Offs < A) GAS - SOUTHWEST CORNER OF BUILDING B) ELECTRICAL - ELECTRICAL BOX ON TELEPHONE POST SOUTHEAST CORNER OF BUILDING ~ C) WATER - IN SIDEWALK IN FRONT OF'BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Av. ail. Water PRIVATE FIRE PROTECTION - EXTINGUISHERS I'N VARIOUS LOCATIONS FIRE EXITS. FIRE HYDRANT - ???????????? <4> Building Occupancy Level 03/17/92 SAN JOAQUIN DENTAL 215-000-000957 Page 6 00 - Overall Site <G> Training I <1> Page 1 WE HAVE 8 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING:.~0~ ~ ~]~~f,~ ~~/~-~-~~ <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY of BAKERSFIELD "WE CARE" /,P..- Ic/- 90 FIRE DEPARTMENT 2101 H STREET D S. NEEDHAM BAKERSFIELD 93301 FIRE CHIEF 326-3911 Dear Business Owner: Enclosed please find a copy of your response to the Hazardous Material Management Plan (HMMP) request. We have found it necessary to re.ject your plan for the f611owing reason(s) as checked below. ~--~ Illegible Management Plan (please print or type information). Section(s) O ~. ~ D~(~Z~~//>f HMMP incomplete.~ Inventory Missing ~r I&'"'J Incomplete. Diagram Missing or Incomplete· This is to be corrected and resubmitted within 30 days to: City of Bakersfield, Fire Department Hazardous2130 G Street Materials Division ~-J~ J~ ~/ Bakersfield, CA 93301 If additional copies of any forms are needed they can be picked up 'from the Hazardous Materials Division at 2130 G Street in person. Sincerely yours, · Hu .~ .., Hazardous Materials Coordinator..:.' REH/ed 10/P3/90 SAN-JOAQUIN DENTAL 215-£)£)£)-£)£)£)957 RECEIVED Page 1 Overall Site with 1 Fac. Unit .O. EC o 6 General Irsformat iors H~ MAT. DiV.  Location: 1735 28TH ST Map: 10~ Hazard: Low Ident Number: 215-000-000957 Grid: 24D Area c,f Vul: 0.0 Contact Name Title Busir, ess Phone ~ 24 Hc, ur Phor~e- EVELYN STEVENS (8(:)5) 834-2728 x ( ) Administrative Data Mail Addrs: 1735 28TH ST D&B Number: City:~ BAKERSFIELD State: CA Zip: 93301- Corem Code: 215-001 BAKERSFIELD STATION 0i SIC Code: Owner: JERRY WOOLF .... Phone: ( Address: 5~"~.-.~ ......... ~,~...~"=~'_~. ~o5 ~~~ State: CA City: BAKERSFIELD Zip: 9330~- [Surnrnary (Type or print name) ...... ,~,~,.".':~d ~:" !'.. ''~ ~':'". materials manage° · ,,....C_.~ ~;]A-L~(~O i'{ along wi~h men[ plan ~u~ ..~ ........ -~ ~.. :~' ?. a,;u,,,~,,~,~ and corre~ m~n- any correc{.oa~ agemen[ plan 10/23/90 SAN JOAQUIN DENTAL 215-000-000957 Page 2 Hazmat Inventory List irs MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCF~ 02-002 NITROUS OXIDE ? 652 High FT3 02-001 OXYGEN ~ 512 Low FT3 02-003 HELIUM Gas 0 Unrated Fire, Pressure, Immed Hlth 1(') o~ ~- ~/~/~0 SA OAQUIN DENTAL 215-0C)0-0 7 Page O0 - Overall Site <D> Not if. /Evacuation/Medical <1> Agerscy Notificatior~ CALL 911 <2> Er~lployee Notif./Evacuation ~ EXITS ARE MARKED BY LARGE SIGNS. EVACUATION PLANS DIAGRAMED IN LOUNGE AND CALL 91 1. <3> Public Notif. /Evacuation <4> E~erger~cy ~edical Plar~ SAN JOAQUIN HOSPITAL - 2615 EYE STREET - 327-1711 10/23/90 SAN JOAQUIN DENTAL 215-000-000957 Page 4 00 - Overall Site <E> Mitigation/Preve~t/Abatemt <1~ Release Preverstion EMERGENCY ESCAPE PLAN AND PRACTICED. FIRE EXITS CLEARLY MARKED. FIRE EXTINGUISHERS IN SEVERAL LOCATIONS.~ CYLINDERS PROPERLY CHAINED AND USE PROPER VALUES AND FITTINGS. Release Cor, t a inr~er, t <3> Clears Up <4> Other Resource Act i vat i ors 10/23/90 SA OAQUIN 'DENTAL 215-000-0[ ? Page 5 O0 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - SOUTHWEST CORNER OF BUILDING · B) ELECTRICAL - ELECTRICAL BOX ON TELEPHONE POST SOUTHEAST CORNER OF BUILDING C) WATER - IN SIDEWALK IN FRONT OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3) Fire P~-oteo./Avail. Water PRIVATE FIRE PROTECTION - EXTINGUISHERS IN VARIOUS ' LOCATIONS FIRE EXITS. FIRE HYDRANT - ???????????? , <4> Held for Future use 10/2.3/90 SAN JOAQUIN DENTAL 215-000-000957 Page 6 O0 - Overall Site <G> Trainir, g <1> Page 1 BRIEF SUMMARY OF TRAINING: <2> Page 2 as r~eeded <3> Held fcir Future Use <4> Held for Future Use CITY of BAKERSFIELD HAZARDOUS MATERIAL8 INVENTORY Farm and Agriculture l1 Standard Business [] NON--TRADE SECRETS Pa~je of__ BUSINESS NAME: --]/.~'..,~..~'~' '~,~,x~-,c¥~~ OWNER NAME: .]~-J~(.,, ~,/o~/~-- ' NAME OF THIS FACILITY: ...... ~L~).C,A. TIO..N;. /'~--~/,-v,~ c-;~ ..~ ADDRESS; /7~---~y~,~ .~'~,. STANDARD IND. CLASS CODE. t 2 3 4 5 6' [ 8 9 to tt t2 ,3 Trans lyre Naa Avfrage Annual HRasFre · t~y~, , ~onL ~ont ~onC ~e tocaLion.~hece. ~ by Names of ,ixture/Coeponents Code cBoe AeC Ret Est units on fype Press ~e~p Storeo,l~ P[Cll,lCy , wt See Instructions ~e ~,~ Component ,2 Name, C.A.S. Number '1 Hazard ~ ReacLivity ~ Delayed ~enRelease ' Health .of Pressure Component 13 Name I C.A.S. Number Physical Dod Health PeTard C.A.S. Number Component II Name I C.A.S:Number tCheck ali that app/yl Component I~ Name t C.A;S. Number HeaKh Component 13 Name I C.A.S. Number Physical and Health Hazard C.A.S. Number Component II Name I C.A.S. Number [Check all that agpl~) Component 12 ~ame I C.A.S. ~umber ~ Fire ~azard ~ Reac[ivit~ ~ Belayed ~ Sudden ~elease ~ Immediate ~ea/[h of Pressure ~ealth  Component 13 Name I C.A.B. ~umber Component I~ Name I C.l.$. Number ~ Eire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Health of Pressure Component 13 Name I C.A.S. Number EMERGENCY CONTACTS fll ~ee Tl[le ~r Phone ~ae HtTe erti[iatioq ,(Ref~ ~,n~.~ign after compl~tiog.~ll sec~i~n~) cer[uy unoer penal[~ ol~a~ [n{t ~nave pe[sonH~L eXaaln~O~a {= ~aail~a(.~it~the~nloraaHpn ~u~aittfO in this.lnd all at~acned .docgeen[~, an~ t~a[ oaseo on.ay ~nqu~ry ~.tnose ~no~vloua~s respons~a/e ~er obtalnin~ the tntoreauon, I believe that the suB,it[aB in~or~ltlo~ IS [rue, lccurlte, ino comp/et8, g~5~F~(le of ownet/ooerator OH owner/operator's authorized representative ~Ufe Dear Business Owner: ' Enclosed Dlease find a ~copy of your response to the Hazardous Material Management Plan (HMMP) request. We have found it necessary to re.ject your plan for the f611owing reason(s) as checked below. ~--~ Illegible Plan (please print or type Management information). Section(s) D ~ ~'~ ~(~~~/>f~ ~~complete. Inventory Missing or Iv ]. Inco p . Diagram Missing or IncomDle'te. This is to be corrected and resubmitted within 30 days to: City of Bakersfield, Fire Department . Hazardous Materials 'Division ~ d(~Z '<' ~! 2130 G Street Bakersfield, CA '93301 If additional copies of any forms are needed they can be picked up from the Hazardous Materials Division at 2130 G Street in person. Sincerely yours, Hazardous Materials COordinator REH/ed Hazardous Materials Inspection Date Completed ~7/~/~ ~ Plan ID # 215-000/J0~ ~r"9(Top right comer Business Plan) Adequate Inadequate RECEIVED Verification of Inventory Materials JUL 0 6 1989 Verification of Quantities [] [--] HAT.. MAT. DiV. Verification of Location [~ [~] Proper Segregation of Material [~ [-~ Comments: ~_.,~ er~ss~.l f~c, to~ Verification of MSDS Availability [] Number of Employees Lt~- ] Verification of Haz Mat Training [-~ [-~ Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled [-2 [--] Comments: Verification of Facility Diagram i-J] [-~ Special Hazards Associated with this Facility: Violations: /~]op~' FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office .~ ~"J ~)~i~?O-~,_ ..~? BA~KERSFIELD CITY' FIREDEPAR~ RECEIVED  ~o "~" s~T B~ERSFIELD,CA 93301 ~EP 2 ~ 1987 (805) 326-3979 )0~~ A ' ~ ~ ~,sd ............  O~IC~AL USE ONLY 5~ ~~ ~~ ~' 000957  S ~NgSS ~B HAZARDOUS ~TER] ALS ~ ~- BUS~NESS PL~ AS A WHOLg INSTRUCTIONS: 1. To avoid further action, return this form by IO-['~-c~ 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: ..~/0 ~D~,~QO,,O ~T~ B. LOCATION / STREET ADDRESS: /7~" ~<~4~- SECTION 2: EMERGENCY NOTIFICATIONS In case of an emer$ency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7~50 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. SECTION '3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE , A._~T. GAS/PROPAnE:. -~'~. ELECTRICAL: ~'~ - ~_j~L~l~ffX r~+~.~P~,,~._ :00~ ~. ~~t '" C. WATER:' ~~ ~ ~~ ,~ 1~ ~'t~~ ~ D. SPECIAL: E. LOCK BOX: YES /~IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES ~ MSDSS? YES FLOOR PLANS? YES ./~ KEYS? YES SECTION 4:. PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EXPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EXPLOYEES WITH INITIAL REFRESHER TRAINING IN THE FOLLOWING AREAS. 4 CIRCLE YES OR NO ~ INITIAL REFRESHER .................................... B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO ~IE'S~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ ~-~NO ~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES SECTION 7: ~AZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS ~RTERIAL IN QUANTITIES LESS THAN SOO POUNDS OF A SOLID, 85 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES~ I, ~2a~ ~OQA-~, 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. Z0 Chapter 6.98 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. - 2B - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS'NAME: BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. TO avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED 'EELOW · 4. Be as BRIEF and CONCISE as possible. SECTION 1: MITIGATION, PRE~NTION, ABATEMENT PROCEDL~ES ' SECTION 2: NOTIFICATION.~%~ EVACUATION PROCEDU~ES AT THIS b~iT ONLY SECTION S: ~HAZARDOUS MATERIALS FOR ~THIS UNIT ONLY A. 'Does this Facility Unit contain Hz?.zardous MaterJa!s? ...... YES If YES, see B. If NO, continue'witkSECTIOM.4.- ~ ~ B..Are any of .the hazardous ma-teria]s a bona flde Trade Secret YES If No, complete a separate hazardous mat'eria~ls inventory form marked: .NON-TRADE SECRETS oNLY (~.,J~ite form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE'SE~CRET$ ONLY (yellow form ~4A-2) in addltion to the non-tuade secret/~orm. List only the trade secrets on form~4A-2. / / SECTION 4: BRIVATE FIRE PROTECTION SECTION'5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY R. ESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A, NAT. GAS/PROPAN~] B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES /~ I~ YES, LOCATION: tF YES, SITE PLANS? YES / NO MSDSs9 YES / ~0 FLOOR PLANS? YES / NO KEYS? YES /' .~C BAKERSFIEI, D CITY FIRE DEPARTMENT NON--TRADE SECRETS HAZARDOUS MATERI ALS . INVENTORY BUSINESS NAME: q~ "~k)~q0~0 ~C OSNER NA~E:_ ~~ ~O&ff FACILITY UNIT ADDRESS: [~8~ ~ ~, ADDRESS: ~O0 5F~p~ FACILITY UNIT NAME: PHONE ~: ~27~~ PHONE ~: ~z-~TGa ~OFFICIALONLY USE CFIRS, CODE 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 . ~T. CHEMIqAL OR COMMON NAME CODE GUIDE E~R6ENCY CONTACT: TITLE: ' 0 -Bus H0~RS: PRINCIPAL BUSINESS ACTIVITY: ' /~O~c~ AFTER BUS. HRS: