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HAZARDOUS WASTE
17. s 251 SPACES ., ~1..- '~ ~ SPA~S / 34TH STREET ~,, · '~ C. Larry Cart. President · ~ Board of Directors: ! Gordon K. Foster, Chairman Joel D. Mack, M.D., Vice Chairman Edward H. Shuler, Secretary-Treasurer Bakersfield Memorial Hospital Charles s. Ashmore, M.D. John M. Brook, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Larry Carr Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R. Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W. Smith DECEMBER 4, 1995 DEAR SIRS: BAKERSFIELD MEMORIAL HOSPITAL, EPA ID NUMBER CAL000021754, REPORTED THE CLOSING DOWN OF TREATMENT UNIT #2 KNOWN AS PROCESSOR #2 AS OF 7-1-94. THIS LETTER IS TO INFORM YOU OF THE RE-OPENING OF PROCESSOR #2 THAT HAS TWO SILVER RECOVERY UNITS ATTACHED. IT IS'LOCATED ON OUR THIRD FLOOR IN THE MAIN TOWER BUILDING. WE WILL CALL THIS UNITS AREA THE 3RD FLOOR PROCESSOR. WE ARE PLANNING ON OPENING THIS UNIT ON DECEMBER~ll, 1995o DIRECTOR OF IMAGING I .¢. TRANSMITTAL. ACKNOWLEDOEME~T -~ . "" . .... : · C¢~,. ~ ' , ': .... .-~ " . .,.,~...: ..:. -'. .. . ' , .~ . _. TO: DTSC/PDM- 400 P streot, 4th Floor " SaCrameni°,~ CA "'9581'4 ~'-~;:-~ ~-..;_._: ~ _. ~ - Reg/on: ~ 2 3 ~ -. Da~e ~eceLve~ by ~: ,. diiltltttlttt ttiltttttlilttllttllttttltlllllllltttllllltlt~.~_~lt.~t B. ~nO~t.~ ~SO~lO~ .' ' /.4'-~~' ,~,;.-- _-~ ~ev, ~/12/~S ........................ ' .. .. -" MATERIAL SAFETY DATA SHEET 00000040i/F/USA - D-0028.615 Approval Date: 06/22/1994 Print Date: 06/25/1994 Page 1 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Product Name: KODAK RP X-OMAT LO Fixer and Replenisher Working Solution Catalog Number(s): 884 4664 - To Make 16,800 gallon (U.S.) - Part A 883 0747 - To Make 2,400 gallon (U.S.) 853 7136 - To Make 2,400 gallon (U.S.) 831 2373 - To Make 200 gallon (U.S.) - Part A 842 4855 - To Make 200 gallon (U.S.) - Part A 121 2448 - To Make 20 gallons (U.S.) 840 0251 - To Make 10 gallons (U.S.) 849 3553 - To Make 4 gallons (U.S.) 852 2492 - To Make 16,800 gallons (U.S.) - Part B 180 5159 - To Make 100 gallons (U.S.) - Part B Manufacturer/Supplier: EASTM~ KODAK COMPANY, Rochester, New York 14650 For Emergency Health, Safety & Environmental Information, call: 716-722-5151 For Other Information, call the Marketing and Distribution Center in Your Area. Synonym(s): KAN 965573, D-0028.615; Contains: PCD 5869 - Part A, PCD 5597 - Part B 2. COMPOSITION/INFORMATION ON INGREDIENTS Weight % - Component - (CAS Registry No.) - EC Classification* 80-90 Water (007732-18-5) 10-15 Ammonium thiosu.lfate (007783-18-8) 1-5 Acetic acid (000064719-7) < 1 Ammonium sulfite (010196-04-0) < 1 Sodium acetate (000127-09-3) <, 1 Aluminum sulfate (010043-01-3) 3. HAZARDS IDENTIFICATION LOW HAZARD FOR RECOMMENDED HANDLING }{MIS Hazard Ratings:. Health - 0, Flmmmability - 0, Reactivity.- 0, Personal Protection - B NFPA Hazard Ratings: Health - 1, Flammability - 0, Reactivity (Stability) - 0 MATERIAL SAFETY DATA 000000401/F/USA - D-0028.615 Approval Date: 06/22/1994 Print Date: 06/25/1994 Page 2 NOTE: H!MIS and NFPA ratings involve data and interpretations that may vary from company to company. They are intended only for rapid, general identification of the magnitude of the specific hazard. To deal adequately with the safe handling of this material, all the information contained in this MSDS must be considered. 4. FIRST-AID MEASURES Inhalation: Move to fresh air. Treat symptomatically. Get medical attention if symptoms occur. Eyes: Immediately flush with plenty of water for at least 15 minutes. Get medical attention if symptoms occur. Skin: Wash with soap and water. Get medical attention if symptoms occur. Ingestion: Drink 1-2 glasses of water. Seek medical attention. 5. FIRE FIGHTING MEASURES Extinguishing Media: Use appropriate agent for adjacent fire. Special Fire-Fighting Procedures: Wear self-contained breathing apparatus and protective clothing. Fire or excessive heat may produce hazardous decomposition products. Hazardous Combustion Products: None (noncombustible), (see also Hazardous Decomposition Products section) Unusual Fire and Explosion Hazards: None 6. ACCIDENTAL RELEASE MEASURES Flush to sewer with large amounts of water. Otherwise, absorb spill with vermiculite or other inert material, then place in a container for chemical waste. Clean surface thoroughly to remove residual contamination. 7. IiANDLING A/~D STORAGE Personal Precautionary Measures: Use with adequate ventilation. Wash thoroughly after handling. Prevention of Fire and Explosion: Keep from contact with oxidizing materials. Storage: Keep container tightly closed. Keep away from incompatible substances (see Incompatibility section). M~ATERIAL SAFETY DATA SHEET 000000401/F/USA - D-0028.615 Approval Date: 06/22/1994 Print Date: 06/25/1994 Page 3 8. EXPOSURE CONTROLS/PERSONAL PROTECTION Exposure Limits: ACGIH Threshold Limit Value (TLV): Acetic acid: 25 mg/m3 TWA; 37 mg/m3 STEL Aluminum sulfate: 2 mg/m3 TWA, as A1 soluble salts OSHA (USA) Permissible Exposure Limit (PEL - 1971 Table Z-1 Values): Acetic acid: 25 mg/m3 TWA Aluminum sulfate: 15 mg/m3 TWA, as A1 metal total dust; 5 mg/m3 TWA, as A1 metal respirable fraction Ventilation: Good general ventilation (typically 10 air changes per hour) should be used. Ventilation rates should be matched to conditions. Respiratory Protection: None should be needed. Eye Protection: It is a good industrial hygiene practice to minimize eye contact. Wear safety glasses with side shields (or goggles). Skin Protection: It is a good industrial hygiene practice to minimize skin contact. For operations where prolonged or repeated skin contact may occur, impervious gloves should be worn. Recommended Decontamination Facilities: Eye bath, washing facilities, safety sho~er 9. PHYSICAL A~ND CHEMICAL PROPERTIES Physical Form: Liquid Color: Colorless Odor: Odorless Specific Gravity (water = 1): 1.085 Vapor Pressure at 20 C (68 F): 24 mbar (18 mm Hg) Vapor Density (Air = 1): 0.6 Volatile Fraction by Weight: 80 % Boiling Point: >100 C (>212 F) Solubility in Water: Complete pH: 4.35 Flash Point: None, noncombustible liquid MATERIAL SAFETY DATA SHEET 000000401/F/USA - D-0028.615 Approval Date: 06/22/1994 Print Date: 06/25/1994 Page 4 10. STABILITY AND REACTIVITY Stability: Stable Incompatibility: Strong acids, bases, sodium hypochlorite (bleach), strong oxidizing agents Hazardous Decomposition Products: Ammonia, chloramine, nitrogen oxides (N0x), sulfur dioxide Hazardous Polymerization: Will not occur. 11. TOXICOLOGICAL INFORMATION Effects of Exposure: Inhalation: Expected to be a low hazard for recommended handling. Eyes: No specific hazard known. May cause transient irritation. Skin: Low hazard for recommended handling. Ingestion: Expected to be a low ingestion hazard. 12. ECOLOGICAL INFORMATION This section has not been completed. 13. DISPOSAL CONSIDERATIONS Discharge, treatment, or disposal may be subject to national, state, or local laws. Flush to sewer with large amounts of water. 14. TRANSPORT INFORMATION - For transportation information regarding this product, please phone the Eastman Kodak Distribution Center nearest you: Rochester, NY (716) 588-3536 or 588-3573 or 588-3035; Oak Brook, IL (312) 954-6000; Chamblee, GA (404) 455-0123; Dallas, TX (214) 241-1611; Whittier, CA (213) 945-1255; Honolulu, HI (808) 833-1661. MATERIAL SAFETY DATA SHEET .~.-.. 000000401/F/USA - D-0028.615 Approval Date: 06/22/1994 Print Date: 06/25/1994 Page 5 15. REGULATORY INFORMATION - Material(s) known to the State of California to cause cancer: None - Material(s) known to the State of California to cause adverse reproductive effects: None - Carcinogenicity Classification (components present at 0.1% or more): - International Agency for Research on Cancer (IARC): None - American Conference of Governmental Industrial Hygienists (ACGIH): None - National Toxicology Program (NTP): None - Occupational Safety and Health Administration (OSHA): None - Chemical(s) subject to the reporting requirements of Section 313 or Title III of the Superfund Amendments and Reauthorization Act (SARA) of 1986 and 40 CFR Part 372: None 16. OTHER INFORMATION US/Canadian Label Statements: LOW HAZARD FOR RECOMMENDED HANDLING Keep out of reach of children. For additional information, see Material Safety Data Sheet (MSDS) for this material. Additional hazard precautions for containers greater than 1 gallon of liquid or 5 pounds of solid: IN CASE OF SPILL: Absorb spill with inert material, then place in a chemical waste container..Flush residual spill or area with water. For large spills, dike for later disposal. Prevent runoff from entering drains, sewers, and streams. The information contained herein is furnished without warranty of any kind. Users should consider these data only as a supplement to other information gathered by them and must make independent determinations of suitability and completeness of information from all sources to assure proper use and disposal of the~e materials and the safety and health of employees and customers and the protection of the environment. The information relating to the working solution is for guidance purposes only, and is based on correct mixing and use of the product according to instructions. MATERIAL SAFETY DATA SHEET 200000418/F/USA - C-0133.500D Approval Date:~ 02/16/1994 Print Date: 02/19/1994 Page 1 1. CHEMICAL ~RODUCT A_ND COMPANY IDENTIFICATION Product Name: KODAK RP X-OMAT Developer Replenisher Working.Solution Catalog Number(s): 124 9259 - To Make 10 gallons (U.S.) 171 6828 - To Make 20 gallons (U.S.) 131 8989 - To Make 200 gallons (U.S.) - Part A 817 0748 - To Make 200 gallons (U.S.) - Part A 162 0509 - To Make 200 gallons (U.S.) - Part B & C 851 2295 - To Make 2400 gallons (U.S.) 859 7494 - To Make 2400 gallons (U.S.) 831 7018 - To Make 5400 gallons (U.S.) - Part B 841 416t - To Make 5400 gallons (U.S.) - Part C Manufacturer/Supplier: EASTIiAN KODAK COMPANY, Rochester, New York 14650 For Emergency Health, Safety & Environmental Information, call: 716-722-5151 For Other Information, call the Marketing and Distribution Center in Your Area. Synony~n(s): K_AN 441665, C-0133.500, Contains: PCD 5468 - Part A, PCD 5228 Part B, PCD 5250 - Part C 2. COMPOSITION/INFORMATION ON INGREDIENTS Weight % - Component - (CAS Registry No.) 85-90 Water (007732-18-5) 5~.10 Potassium sulfite (010117-38-1) Hydroquinone (000123-31-9) 1-5 Potassium acetate (000127-08-2) 1-5 Glutaraldehyde bis(sodium bisulfite) (007420~89-5) 1-5 Potassium hydroxide (001310-58-3) 3. HA/A3IDS IDENTIFICATION W~N!NG] CONTAINS: Hydroquinone (000123-31-9), potassium hydroxide (OOt 310-58-3) CAUSES,'SK!N AND EYE IRRITATION MAY CAUSE ALLERGIC SKIN REACTION h-MIS Hazard Ratings: Health - 2, F!m~ability - 0, Reactivity - 0, Personal Protection - C NFPA Hazard Ratings: Health - 1, ?lammability - 0, Reactivity Stability) - 0 M~TERIAL SAFETY DATA SHEET 200000418/F/USA - C-0133.500D Approval Date: 02/16/1994 Print Date: 02/19/1994 Page 2 NOTE: HiMIS and NFPA ratings involve data and interpretations that may vary from company to company. They are intended, only for rapid, general identification of the magnitude of the specific hazard. To deal adequately with the safe handling of this material, all the information contained in this MSDS must be considered. 4. FIRST-AID MEASURES Inhalation: Move to fresh air. Treat symptomatically. Get medical attention if symptoms occur. Eyes: Immediately flush with plenty of water for at least 15 minutes. Get medical attention. Skin: Immediately flush with plenty of water and wash with a non-alkaline (acid) type of skin cleaner. If skin irritation or an allergic skin reaction develops, get medical attention. Remove contaminated clothing and shoes. Wash contaminated clothing before reuse. Destroy or thoroughly clean contaminated shoes. Ingestion: Drink~-~ glasses of '~-ater. Seek medical attention. 5. FIRE FIGHTING MEASURES Extinguishing Media: Use appropriate agent for adjacent fire. Special Fire-Fighting Procedures: Wear self-contained breathing apparatus and pr2tective clothing. Fire or excessive heat may produce hazardous decomposition products. Hazardous Combustion Products: None (noncombustible),. (see also Hazardous Decomposition Products section) Unusual Fire and Explosion Hazards: None 6. ACCIDENTAL RELEASE MEASURES Flushl.to sewer with large amounts of water. Otherwise, absorb spill with vermiculite or other inert material, then place in a container for chemical waste. Clean surface thoroughly to remove residual contamination. 7. H~NDLING A/qD STORAGE Personal Precautionary Measures: Avoid contact with eyes, skin, and clothing. Use with adequate ventilation. Wash thoroughly after handling. The routine use MATERIAL SAFETY DATA SHEET 200000418/F/USA - C-0133.500D Approval Date: 02/16/!994 Print Date: 02/19/i994 Page 3 of a nonalka~line (acid) type of hand cleaner and regular cleaning of working surfaces, gloves, etc. will help minimize the possibility of a skin reaction. Prevention of Fire and Explosion: No special precautionary measures should be needed under anticipated conditions of use. Storage: Keep container closed. Keep away from incompatible substances (see Incompatibility section). 8. EXPOSURE CONTROLS/PERSONAL~PROTECTION Exposure Limits: ACGIH Threshold Limit Value (TLV): Hydroquinone: 2 mE/m3 TWA Potassium hydroxide: 2 mg/~u3 Ceiling OSHA (USA) Permissible Exposure Limit (PEL): Hydroquinone: 2 ma/m3 TWA Potassium hydroxide: 2 mg/m3 Ceiling Ventilation: Good general ventilation (typically 10 air changes per hour) should be used. Ventilation rates should be matched to conditions. Use process enclosures, local exhaust ventilation, or other engineering controls to maintain airborne levels below recommended exposure limits. Respiratory Protection: None should be needed. Eye]oProtection: Wear safety glasses with side shields (or goggles). Skin Protection: Wear impervious gloves and protective clothing appropriate for the risk of exposure. Recommended Decontamination Facilities: Eye bath, washing facilities, safety shower 9. PHYSICAL AND CHEMICAL PROPERTIES PhysiCal Form: Liquid Color: Yellow Odor: Slight Specific Gravity (water = 1): 1.086 Vapor Pressure at 20 C (68 F): 24 mbar (18 mm Hg) Vapor Density (Air = 1): 0.6 Volatile Fraction by Weight: 85-90 % Boiling Point: >t00 C (>212 F) MATERIAL SAFETY DATA SHEET 200000418/F/USA - C 500D Approval Date: 02/16/!994 Print Date: 02/19/1994 Page 4 Solubility in Water: Complete pH: 10.3 Flash Point: None 10. STJ~BILITY ;~ND REACTIVITY Stability: Stable Incompatibility: Strong acids Hazardous Decomposition Products: Carbon dioxide, carbon monoxide, sulfur dioxide Hazardous Polymerization: Will not occur. 11. TOXICOLOGICAL INFORMATION Effects of Exposure: Inhalation: Expected to be a low hazard for recommended handling. Eyes: Causes irritation. Skin: Causes irritation. May cause allergic skin reaction. 'Ingestion: Expected to be a low ingestion hazard. May cause irritation of the gastrointestinal tract. 12.'.ECOLOGICAL INFORMATION Introduction: This environmental effects summary is written to assist in addressing emergencies created by an accidental spill which might occur during the shipment of this material, and, in general, it is not meant to address discharges to sanitary sewers or publical!y owned treatment works. Summary: Data for the major components of this material have been used to estimate the environmental impact of this material. However, this material, itself, has not been tested for environmental effects. This material is a moderately alkaline aqueous solution, and this property may cause adverse environmental effects. it is expected to have the following properties: A low biochemical oxygen demand and little potential to cause oxygen depletion in aqueous systems, a high ootential to affect some aquatic organisms, a moderate potential to affect' secondary waste treatment microbial metabolism, a iow ootential to affect the germination and/or early growth of some plants, a low potential to persist in the environment, a low potential to bioconcentrate. After dilution MATERIAL SAFETY DATA SHEET 200C00418/F/USA - C-0133.500D Approval Date: 02/16/1994 Print Date: 02/19/1994 Page 5 with a large amount of water, followed by secondary waste treatment, this material is not expected to cause adverse environmental effects. 13. DISPOSAL CONSIDERATIONS Discharge, treatment, or disposal may be subject to national, state, or local laws Flush to sewer with large amounts of water. 14. TRANSPORT INFORMATION - For transportation information regarding this product, please phone the Eastman Kodak Distribution Center nearest you: Rochester, NY (716) 588-3536 or 588-3573 or 588-3035; Oak Brook, IL (312) 954-6000; Chamblee, GA (404) 455-0123; Dallas, TX (214) 241-!611; Whittier, CA (213) 945-1255; Honolulu, HI (808) 833-1661. 15. REGULATORY INFORMATION - Material(s) known to the State of California to cause cancer: None - Material(s) known to the State of California to cause adverse reproductive effects: None - Carcinogenicity Classification (components present.at 0.1% or more): - International Agency for Research on Cancer (IARC): None - ;~nerican Conference of Governmental Industrial Hygienists (ACGIH): None - National Toxicology Program (NTP): None - Occupational Safety and Health Administration (OSHA): None - C~emical(s) subject to the reporting requirements of Section 313 or Title III of the Superfund ;~nendments and Reauthorization Act (SARA) of 1986 and 40 CFR Part 372: Hydroquinone 16. OTHER INFORMATION US/Canadian Label Statements: CONTAINS: Hydroquinone (000123-31-9), potassium hydroxide (001310-58-3) WARNING] CAUSES SKIN A_ND EYE IRRITATION MAY CAUSE ALLERGIC SKIN REACTION Avoid contact with eyes, skin, and clothing. Wash thoroughly after handling. FIRST AID: In case of eye contact, immediately flush eyes with plenty of water for at least 15 minutes, in case of skin contact, wash skin wi~h soap MATERIAL SAFETY DATA SHEET '. 200000418/F/USA - .500D ,.-.'.. Approval Date: 02/16/1994 Print Date: 02/19/1994 Page 6 and plenty'of water. Get medical attention. Remove contaminated clothing and shoes. Was~ clothing before reuse. Destroy or thoroughly clean contaminated shoes. Keep out of reach of children. For additional information, see Material Safety Data Sheet (MSDS) for this material. Additional hazard precautions for containers greater than 1 gallon of liquid or 5 pounds of solid: Since emptied containers retain product residue, follow label warnings even after container is emptied. The information contained herein is furnished without warranty of any kind. Users should consider these data only as a supplement to other information gathered by them and must make independent determinations of suitability and completeness of information from all sources to assure proper use and disposal of these materials and the safety and health of employees and customers and the protection of the environment. vou Hospital £mergency Information Dial 70 ............. Security Emergency Dial 77 .............. Emergency Codes Code Red .......................... Fire Code Blue ..... ~ Clinical Patient Emer~ency/^rrest Code Green. . . . . . . . . . . ER Security Activated Code White ................. 0 Bomb Threat Code Pink Infant-Security Code Yellow ........ ....... 0 Chemical Spills Hospital Mass Casualty Plan Code Med Alert ................ O Arrival of Patients Code Triage O Process of Sorting Code Disaster .......... O Hospital Structural Damage Safety Hazard Hot Line ..................... 4357 Security ............................... 4744 ©1995 Department of Education STATEMENT JIM WARREN ][-RAY SOLUTION SVC. INC. 9104 Thurber in. l~,3ksmfleld, CA 93311 Bakersfield Memorial Hospital 420 34th Street Bakersfield, CA 93301 $ January Invoices TOWER Chemistry 249gals Dev ~ 3.75 933.75 364gals Fix ~ 2.50 910.00 Parts ~L~ ,205.55 Labor 487.50 Sales Tax 220.34 $3 757 14 Mammo 15gals MRI 17½gals OR 5ga 1 s =401½Tga~k~ LAST AMOUNT tN BALANCE COLUMN · 8S874/8P874 POLYPAK (50 SETS) CARBONLESS SPEEDISET STATEMENT STATEMENT JIM WARREN WARREN X-RAY SOLUTION SVC. INC. X-RAY SOLUTION S¥C. INC. 9104 Thurber in, 9104 Thurt~r Ln. Ba~mfield, CA 93311 Bakersfield, CA 93311 Bakersfield Memorial Hospital 420 34th Street Bakersfield Memorial Hospital Bakersfield, CA 93301 420 34th Street Bakersfield, CA 93301 _j L J $ January Invoices Jamuary Invoices MRI 97. 19 ~7. lC~ MAMMO 203.20 203. ~ 0 PAY LAST AMOUNT IN BALANCE COLUMN · PAY LAST AMOUNT Itt BAI. ANCE COLUMN · ~ r~ '~ &'r~/I Eqq ~.PEEDI.:ET ~¥;%:.~,:,f'?::.t pml yf' ~v r,'.n ¢ ' STATEMENT STATEMENT JIM 'WARREN JIM WARREN X-R~ $0LUT~0N SVC. INC. X-RAY SOLUTION SVC. 9104 Thurber Lq. 9104 Thurber Ln. Bakersfield, CA 93311 Ba~rsfleld. CA 93311 Bakers£ield Memorial Hospital ~akersfield Memorial Hospital ,420 34th Street 420 34th Street Bakersfield, CA 93301 Bakersfield, CA 93301 L_ ._l L_ _! $ December Invoices /~^ December Invoices Tower /~U MRI 99.21 19.21 Chemistry:~/~~ 193 Gals Der ~ 3.75 ' 723.75 307½gals Fix ~ 2.50 768.75 Parts 15.85 Labor 75.00 Sales Tax 109.36 $ ,692~71 Total Gallons Fixer 338 I PAY LAST AMOUNT IN BALANCE COLUMN · PAY LAST AMOUNT tN BALANCE COLUMN 8S" '874 POLYPAK (50 SETS) CARBONLESS SPEEDISET 8s87~/sP87,~ POLYPAK (50 SETS) CARBONLESS SPEEDISET STATEMENT JIM W~REN ][-RAY SOLUTION SVC. INC. 9104 Thurber In. Bakersfield, CA 93311 Bakersfield Memorial Hospital 420 34th Street Bakersfield, CA 93301 $ December Invoices Mammography Chemistry 81.25 Parts 752.20 Labor 90.00 Sales Tax 60.43 $ 83.8 ,.51 Al I:NII:I,,I I JIM WARREN ][-RAY SOLUTlflN SVC. INC. 9104 Thurbel Lq. Bakersfield, CA 93311 f-- Bakersfield Memorial Hosp. 420 3qth Street Bakersfield, CA 93301 $ November Invoices Tower Chemistry: ~780.00 208gals Dev ~ 3.7 314gals Fix ~ 2.5 V85.00 Parts i.F~,Y 75.45 Labor !. 240.00 !Sales Tax ~118.94 $ ,999.39 Fotal Gals Fixer/ ~ 348½ REDIFOe,~ 85874/8P874 POLYPAK (50 SEIS) CARBONLESS SPEEDISET ! STATEMENT - STATEMENT J~M WARREN JIM WARREN X-RAY SOLUTION SVC. INC. i ][-PAY SOLU~nN SVC. INC. 9104 'l~urber L~. [ 9104 Thurue, Ln. Bakersfield, CA 93311 I ~ Ba~rslielo, ~A 93311 Bakersfield Memorial Hospital Bakersfield Memorial Hospital 420 34th Street 420- 3qth Street Bakersfield CA 93301 ' Bakersfield, CA 93301 L -J , L $ $ November Invoices MRI 120.66 120.66 November Invoices Mammogr a phy 207.40 207.40 PAY LAST AMOUNf IN BALANCE COLUMN & PAY LAST AMOUtlT If,I BALA,~CE COtUMH /~ .AM WAR"a X..RXY soureD, svc. INC. Balmr~field, CA 93311 Bakersfield Memorial Hospital 420 34th Street Bakersfield, CA 93301 October Invoices Chemistry: 21gals Der ~ 3.75 78.75 26gals Fix ~ 2.50 65.00 Parts 261.00 Labor / 90.00 Sales Tax~., 29.35 $524.10 8sg?.4,'Bp~?4 POLYP^K (50 SETS) CAf~BC)A/LESS SPEE/~/$ET L STATEMENT STATEMENT ~ W~R~ ~M W~REN ~ SO~ON SVC. INC.' ~ SOL, ON SVC. INC. ~ ~u~r ~. Bakersfield Memorial Hospital 420 34th Street Bakersfield Memorial Hospital Bakersfield, CA 93301 420 34th Street .Bakersfield, CA 93301 $ Mammography 136.58 136.58 Tower Chemistry: 200 gals Dev ~ 3.75 750.00 768.75 Parts 117.85 l Labor 187.50 . Sales Tax 118.66 $ ,942. Total Gallons i Fixer 343½ '{':~,',1/81'~7,1 PO' vpAK (~0 SFtS~ CARBONLESS SPEED/SET RSR?,I/SP874 POI YPAK r~O SETS) CARBO~!I.E,?S SF'EFm" HAZARDOUS MATERIALS AND WASTE MANAGEMENT PLAN Bakersfield Memorial Hospital 420 34th Street Bakersfield, Ca 93301 (805) 327-1792 C. Larry Car~ P~s'~ent /i~ ] ! .; 1 SignatUre'' ",. ~t~ Gerald Start Sr: V~P=~ Oper~_tions Signature ~-' Date ~ke Wood Safety Officer Revised 07/11/94 BAKERSFIELD MEMORIAL' HOSPITAL HAZARDOUS MATERIALS AND wASTE MANAGEMI~NT PLAN Table of contents Description Page Number HAZARDOUS MATERIALS & WASTE MANAGEMI~NT PLAN Review of Policies & Procedures 1 Laws & Regulations Hazardous Material Program 2 Hazardous Waste Program 4 Employee Information & Training 6 Spills and Leaks 7 Hazardous Waste Transportation from Point of Use to Storage Sites 7 Waste Segregation 7 Hazardous Substance Monitoring 7 LAZARD ASSESSMENT 8 Hazardous Substance Inventory 8 Facility Drainage Adjoining Land Uses . 9 Spill Potential 9 Fire Potential 9 Haz Mat Information Training 9 PREVENTION PROCEDURES 10 Storage In Containers 10 Welding And Cutting Operations 11 Inspections 12 BAKERSFIELD MEMORIAL HOSPITAL- HAZARDOUS MATERIALS AND WASTE MANAGEMRNT PLAN page HAZ MAT ENVIRONMENTAL EMRRGENCY PLAN 13 Overview 13 Safety officer 13 Facility Description 15 Emergency Contact & Telephone List 16 SHOULD A HAZ MAT EMERGENCY OCCUR 16 Emergency Response Agencies 17 Hazardous Waste Recycling 17 Laboratories For Chemical Analysis 17 Responsibilities 18 Safety Officer Alternates Spill Team Employees At The Scene Emergency Equipment-Location 20 and Maintenance On Site Fire 21 On Site Spill-Inside Building 22 EMRRGENCY RESPONSE PROCEDURES 23 Evacuation Routes and Procedures 23 Appendix A Hazardous Materials & Information Audit B Departmental Monitoring/Inspection Form C Compliance Inspection Problem/Correction Form BAKERSFIELD MEMORIAL HOSPITAL HAZA/~DOUS MATERIALS AND WASTE MANAGEMENT pLAN STATEMENT OF PURPOSE: - The Hazardous Materials and Management Pian has been developed to ensure the health and safety of Bakersfield Memorial Hospital patients, visitors and staff. This program covers all aspects of dealing with hazardous materials and wastes; policies, procedures, handling, storing, using, and disposing of hazardous materials from receipt through use and hazardous wastes from generation to final disposal. REVIEW OF POLICIES AND PROCEDURES: A. POLICY The Hazardous Materials and Waste Management Plan will be reviewed annually by the Haz Mat subcommittee and presented to the Safety Committee and Administration for approval. B. PROCEDURE: 1. The Haz Mat subcommittee will review annually the policies and procedures relating to chemical and physical hazards. 2. The Infection Control Committee will review, annually, the policies and procedures rela~ing to regulated medical waste. Results will be reported to the Hospital Safety Committee. 3. The Radiation Safety Committee will review annually the policies and procedures relating to Radiation hazards. Results will be reported to the Hospital Safety Committee. LAWS AND REGULATIONS: A. The Hazardous Material and Waste Management Plan is established and operated in accordance with applicable laws and regulations. 1. Applicable changes in laws and regulations will be included in the annual review of Hazardous Material and Waste Manage- ment Plan by appropriate committee. 2. A copy of Registered Hazardous Waste Handlers permit will be kept on file by the generating department and the Engineer- ing department. 3. Semi-annual safety inspections will be conducted in the following manner; one fire/life/safety inspection com- pleted in each department by the department manager. 4. Comply with E.P.A., OSPIA, ADA and SB198. · PAGE 2 HAZARDOUS MATERIAL PROGRAM: A. The Haz Mat Committee will ensure that e~ch department identifies all hazardous substances within their area and report the results to the Safety Committee. 1. An inventory of all materials considered~to be hazardous is to be compiled by each department. Substances to be considered for coverage under this program include those substances listed in: a. The Directors list of Hazardous Substances, (29 CFR, Par 1910). b. The Federal Register, 40 CFR, Part 11; Environmental Protection Agency. c. 29 cFR, Part 1910, Subpart Z; Toxic and Hazardous Substances (OSHA). B. Hazardous Materials Policies and Procedures will be maintained by each department. The policies for each department will consist of: 1. Identification of area specific hazards: a. Definition of hazardous substance - any material containing a chemical on the hazardous substances list (or is determined to be hazardous) at a concentration above 1% by weight. The substances may be hazardous -because it is.toxic, corrosive, reactive, or flammable.° For materials that are carcinogenic the concentration is 0.1% by weight. b. Examples of physical hazards - sharps, ladders, egress, etc. 2. Hazardous Material Inventory. a. Should include: Date, Trade name, and Quantity. b. Inventory should be taken periodically so that it is reasonably up-to-date (but no less than quarterly). 3. The Materials Safety Data Sheets (MSDS). a. A MSDS will be maintained on each hazardous substance. b. MSDS's for all identified substances are to be available for study by employees. Any MSDS can be obtained from our national computer system. The computers are located in the following areas. PAGE 3 EMERGENCY ROOM -- ENGINEERING DEPARTMENT PHARMACY ALL OF THESE DEPARTMENTS ARE OPEN 24 HOURS A DAY. Each department will have completed procedures and MSDS's for each hazardous material used in their area readily available to all employees. The MSDS can be obtained from the MSDS computer system. c. Department Managers will update their MSDS,s as warranted. Annual review of departments MSDS's will be by the Haz Mat Committee and approved by the Safety Committee. d. As soon as the department manager becomes aware of a new product he/she will request the MSDS from the MSDS computer system. e. MSDS will be used at all times when a hazardous substances mishap occurs. Labeling procedures. a. Ail hazardous materials will be appropriately labeled. b. Labels are to remain in place at all times from initial receipt of the product through disposal. c. If chemical is transferred from the original container into another container, department managers will ensure that the container is labeled and that labeling is cross referenced with' the appropriate MSDS. d. Labels provided by the manufacturer, on primary container are not to be removed, must be readable, and must contain: MATERIAL NAME CHEMICAL NAME MAIN CHEMICAL HAZARDOUS HAZARD CLASS OR TYPE NAME AND ADDRESS OF MANUFACTURE PRECAUTIONS TARGET ORGANS PAGE 5. Specific policies and procedures which cover the receipt of handling, transfer, segregation/separation and storage. C. The department will annually re-evaluate each Policy and procedure, taking into account, the following factors: 1. New information about the material and it's hazards. 2. New regulations or changes in the regulation. 3. New procedures to reduce the hazard of exposure. 4. Alternative materials as discovered. 5. New procedures available/required for waste disposal. HAZARDOUS WASTE PROGRAM: A. The Safety Committee will ensure that each department identifies all hazardous waste which may be produced/kept in their area. 1. Hazardous waste to be considered for coverage under this program include those listed in: a. The Director's list of hazardous substances (29 CFR part 1910). b. The Federal Register, 40 CFR, Part 1i; Environmental Protection Agency. c. 29 CFR, Part 19i0, subpart Z; Toxic and Hazardous Substances (OSFIA) . B. Hazardous Material Policies and Procedures will be maintained by each department. The policies for each department will consist of: DEFINITION OF H3tZARDOUS WASTE: Any item on the Hazardous substance list or having one of the following characteristics: 1. IGNITkBLE 2. TOXIC 3. CORROSIVE 4. REACTIVE PAGE.5 IN CALIFOP~NIA, MATERIALS THAT ARE BIOACCIIMULATIVE OR THAT CAUSE INCREASE MORTALITY, SERIOUS, IRREVERSIBLE ILLNESS OR .- INCAPACITATING ILLNESS ARE ALSO INCLUDED. a. The department will identify area specific hazardous waste as follows: CHEMICAL WASTE INFECTIOUS WASTE PHYSICAL WASTE CHEMOTHERAPEUTIC WASTE RADIOACTIVE WASTE b. Each of the five types of Waste listed above will have written policies and procedures which includes: IDENTIFICATION (type and location of waste). SEGRAGA- TION and SEPAR3%TION (must keep different types of waste separated). TRANSPORTATION and HANDLING (all containers, bags, boxes, carts, etc., must be labeled and have MSDS's) . DISPOSAL OPTIONS (who to contact for each type of waste disposal). STOR3tGE (where waste is kept until disposed of, inspec- -- .... tion of containers~and storage area, separation, and segregation while in storage). C. The department will annually re-evaluate each policy and procedure, taking into account the following factors: 1. New information about the material and. it's hazards. 2. New regulations of changes in the regulations. 3. New procedures to reduce the hazard of exposure. 4. New procedures available/required for waste disposal. PAGE 6 EMPLOYEE INFORMATION AND TRAINING: All individuals required to handle hazardous materials of wastes are to be provided with appropriate job training. A. POLICY Department managers will explain the Department's Hazardous Materials and Waste Management Plan at the time of orientation to each new employee. This training will be documented and maintained in the Department's employee file. A review of the Hazardous Material and Waste Management Plan will be provided annually during the employee's annual update. Training will include the following: 1. An overview of the hazard Communication Regulation: a. Hazard Communication Regulation requirements. b. Employee Rights under the Regulation. c. A description of Bakersfield Memorial Hospital's Hazardous Materials and Waste Program. d. Location and availability of the regulation, MSDS's and other pertinent information. 2. Training on the reading of labels and MSDS's. 3. Training on identified hazardous materials encountered in the work place and the information found on the hazardous substance policy sheet: a. Common and generic names for the materials. b. Identification of materials by appearance and other properties. c. Nature of hazard including physical and health effects. d. Handling precautions. e. Proper usage. f. Emergency/Spill procedures, including first aid and clean up procedures. g. Disposal procedures. PAGE 7 4. Training on the hazards associated with non-routine duties a. The importance of avoiding contact with of exposure to unfamiliar substances. This includes all materials on which the employee has not received training of is otherwise familiar with it's properties. b. The importance of asking questions of appropriate personnel about hazards before working in a non-routine or unfamiliar area. c. The importance of relaying hazard information to other workers who are'non-routinely performing duties in your own department. d. The importance of sharing exposure to hazardous substances with outside contractors. SPILLS AND LEAKS In the event that a spill or leak of a hazardous substances occurs, reference will be made to the Hazardous Materials Policy and or the MSDS for safe and appropriate clean-up procedures. The Safety Officer will be notified of any such occurrences. A Spill Report will be filled for future references. Employees involved will be sent to the Emergency Department as a precaution and treated as necessary. HAZARDOUS WASTE TR3LNSPORTATION FROM POINT OF USE TO STORAGE SITES Within the facility, hazardous waste will always be separated from non-hazardous waste. Hazardous waste will be collected from point use and transported in a covered, leakproof, labeled cart to the designated locked area, north east of the plant, adjacent to the compactor. WASTE SEGREGATION Refer to Medical Waste Management Plan. HAZARDOUS SUBSTANCES MONITORING Hazardous substances will be monitored to ensure a safe work environment for employees. PAGE 8 A. Wheneve~ possible, less hazardous substances will be - substituted lessening'potential health risk B. All substances will be stored carefully and safely in places where they will not be tampered with and where there is no risk of spilling~ dropping, breaking, or falling. C. All containers will be periodically checked for leaks and other problems. D. Engineering will make sure that there is adequate ventilation in the work place. HAZARD ASSESSMENT This section describes the hazardous substance inventory, facility drainage adjoining land uses, spill potential, fire potential, and Haz Mat information training. A. HAZARDOUS SUBSTANCE INVENTORY 1. Date inventory was taken. 2. Common name and/or chemical name. 3. Maximum quantity on hand aZ any given ~ime. 4 ....Location within.the~department~ .................... B. FACILITY DRAINAGE 1. Street drainage to storm drains. 2.The facility's drains connect to the City Sewage System. 3. City/County storm drains. PAGE 9 C. ADJOINING LAND usES The nearest residential area is located approximately 1/2 block any direction. D. SPILL POTENTIAL 1. Above Ground Oxygen Storage Tank. This facility has two above ground liquid oxygen storage tanks tha~ are located at the north east corner of the lot and are set on a concrete slab. The Engineering Departmen~ is responsible for the tanks and there contents. Visual inspections are made daily to check for leakage. Any Any liquid oxygen leakage would be dissipated into the atmosphere by the Engineering Department. 2. Drum Storage Gallon drums of water treatment chemicals are stored in the plant within the facility. All gallon drums stored and DOT spec 17E drums. 3. chemical Storage Area Possible Spill Occurrence: a. Small spills could occur during transfer of either treat- .................men.t..f-rom a dru~tg .a smaller containe~ ..... A..maximum_of.~. 1/2 gallon could be Spilled. Any water treatment spilled would be contained within the building. b. The largest potential spill would be from the rupture of drum due to overturning during handling (manually or with a forklift). A maximum of 55 gallons of water treatment could be spilled. E. FIRE POTENTIAL Ail hazardous materials and waste are stored in regulation containers. Minimizing the possibility of fire. Ail con- containers are inspected weekly and an inspection log is to be kept. "FIJtMMABLE" and other appropriate signs are posted where combustible of flammable materials or waste are handled, used, or stored. Storage areas, fire fighting water supplies, and sprinkler systems are regularly inspected and comply with all applicable NFPA and local requirements. Responsible facility personnel have been trained in fire prevention techniques and first stage fire suppression. PAGE F. HAZ MAT INFORMATION TRAINING New employees and employees with new Hazardous Waste Management responsibilities shall complete training for each hazardous material job function that they will be performing. This ~raining is completed within one week of the start of their new assignment. Ail employees involved in hazardous waste management participate in annual review sessions pertinent to ~heir responsibilities. Employees may also receive other ~ypes of training in the area of hazardous materials by their department manager. These may include: a. One-on-one or small group training where a supervisor zeros in on specific tasks or activities related to Hazardous materials or Waste Management. b. Monthly department meetings are held in which job-related hazardous materials and waste issues may be discussed. PREVENTION PRocEDURES The following procedures shall be in place at this facility to minimize the possibility of an unplanned release of hazardous substances which would threaten human health or the environment. These.pro.cedures .along wi~h. s~andard policies and~pra'ctices~shall be found in Bakersfield Memorial Hospital Policy manuals. A. STOP~AGE IN CONTAINERS 1. Ail container shall have labels identifying their contents. 2. Ail containers shall be maintained in good condition. Severely rusted containers or those with apparent structural defects shall not be used. 3. The contents of leaking containers shall be immediately transferred into replacement containers and appropriately labeled. 4. The lids of all containers shall be kept closed (hand ~ight) except when materials are being removed from or added ~o them. 5. Drums shall be stored and secured. PAGE 11 6. Containers shall not block exits, stairways, or passageways. 7. Flammable and combustible materials shall be' stored in approved metal cabinets or fire rated storage rooms labeled "FLAMM3LBLE". No more than 55 gallons shall be stored in any cabinet, and not more than three "FLAMM3%BLE" cabinets shall be stored in the same room. 8. Incompatible materials (i.e. corrosives, flammable liquids, reactive materials) shall be separated by aisles or fire walks. 9. Hazardous Wastes shall be stored in designated hazardous waste storage areas. 10. Pesticides and herbicides shall be stored in approved, locked cabinets or storage rooms located at ground level. 11. Wet-acid batteries and other corrosive materials shall be stored approved metal cabinets labeled "CAUTION: CORROSIVE MATERIALS." 12. Compressed gas cylinders shall be stored in designated storage'areas. Ail cylinders, including those in use, shall be secured by chains or other means. B. WELDING AND CUTTING OPERATIONS 1. A fire extinguisher or hose shall be available anywhere a torch is used inside the building. 2. The area surrounding the cutting or welding operation shall be free of all flammable of combustible materials, liquids, vapors, lint or dust. 3. Measures shall be taken to prevent cylinders, piping, valves, regulators, hoses from coming in contact with oil or oily substances. 4. Cylinders in use shall be placed far enough away from welding operations to avoid heat by radiation, sparks, or slag. 5. Ail cylinders in use shall have a pressure regulating device. 6. Hoses shall be regularly inspected for leaks, burns, tears, loose connection, and other defects. Where two hoses are joined by a web, they shall be of different colors or textures. PAGE 12 C. INSPECTIONS 1.The hazardous waste storage-area shall be.inspected weekly by the department storing the waste. 2. Fire extinguishers shall be inspected monthly by ~Security. 3.Emergency response kits shall be inspected monthly by Engineering Department. HAZ MAT ENVIRONMENTAL EMERGENCY PLAN- OVERVIEW The purpose of the Hazardous materials (hereinafter Referred to as "HAZ MAT". Environmental Emergency plan is to provide procedures and other directives to be carried out in the event of an accidental release of hazardous materials or waste due to fire, explosion, earthquake , or any other similar emergency. When such an emergency occurs, the HAZ MAT Environmental Emergency Plan will be implemented by the Safety Officer or his designate. SAFETY OFFICER The Safety Officer shall be the individual who is responsible for coordinating all HAZ MAT Emergency response measures. The Safety Officer shall be available at all times, either at the facility of on an on-basis. This facility shall have one primary safety officer and two or more alternates. They are thoroughly trained and familiar with: 1. The facility's EAZ MAT Environmental Emergency Plan. 2. The facility's operations and activities. 3. The locations and characteristics of hazardous substances. 4. The location of all emergency equipment. 5. The location of inventory and emergency equipment records. 6. The facility's floor Plan. 7.. The applicable local, state, and federal laws regarding the disposal of hazardous waste and debris. In addition, the Safety Officer shall have the authority to utilize the resources necessary to carry out the Plan. The appropriate sections of the Plan will be revised under any of the following conditions: 1. The applicable regulations are revised. 2. The Plan is deemed inadequate and/or fails in an emergency. 3. The facility changes it's design, construction, operations, or maintenance such that it is necessary to modify it's .emergency responses. PAGE 14 4. The Safe~y Officer or alternates changes. 5. The list of emergency equipmen~ supplies changes. 6. The types and/or maximum expected volumes of hazardous sub- stances handled or stored change significantly. 7. The notification procedures change in any way. Changes to the Plan will be made under the direction of the Safety Officer. Copies of the Plan have been submitted to the City of Bakersfield. This agency is on the distribution list to receive each amended version of the Plan. An up-date- version of the Plan will also be located in the Engineering Department. Each individual department will have an update version which will be accessible to all employees. PAGE 15 FACILITY DESCRIPTION A. Facility Name: Bakersfield Memorial Hospital B. Type of Facility: Non-Profit Acute Care Facility C. location of Facility: 420 34th Street Bakersfield, Ca 93301 D. Name and Address of Owner: Bakersfield Memorial Hospital 420 34th Street Bakersfield, Ca 93301 E. Standard Industrial 8060 Classification: F. Facility Chief Operating Mr. Gerald Starr Officer: G. Facility Description: 321 Bed Acute Care Hospital H. Operating Hours: 24 Hours/Daily PAGE 16 BAKERSFIELD MEMORIAL HOSPITAL -. ..... HAZ'MAT EMERGENCY CONTACT AND PHONE LIST 1. In the event of a H AZ MAT Emergency, Monday through Friday: 7:00 am - 4:00 pm, contact the Safety Officer or alternates: SAFETY OFFICER: MIKE WOOD WORK PHONE: 805 327 1792 EXT 1891 PAGER 374 HOME PHONE: 805 871 0592 ALTER/~ATE ~1: ROD TILLERY WORK PHONE: 805 327 1792 EXT 1891 PAGER 348 HOME PHONE: 805 873 1016 ALTERNATE #2: KATHY SMITH WORK PHONE: 805 327 1792 EXT 4546 PAGER 396 HOME PHONE: 805 872 3391 SHOULD A HAZ MAT E~iERGENC¥ OCCUR: 1. CALL THE PBX OPER3tTOR. a. The PBX.will call the Safety'Officer or alternate. 1. The Safety Officer or alternate will evaluate the spill. (a) . If the spill is minor. The evaluator will have ..... PBX contact"'a member'of 'the spill team to:clean up spill. (b) . If the spill is major. The evaluator will have the PBX call code YELLOW. PBX will call all members of the spill team to-clean up spill. The Safety Officer, alternates,and Haz Mat Spill team list are at the PBX operators desk. (c) . If the major spill is to large for the spill team to handle. The evaluator may call other agencies to provide additional resources. (d) . Complete Hazardous Chemical/Cytotoxic Drugs Spill Report (Attachment "A") . PAGE 17 ~ EMERGENCY RESPONS~ AGENCIES: SPILL CLEANUP AND RESPONSE: Name: 911 HAZARDOUS WASTE HAULERS:. Name: M.P. Environmental Service, Inc. (Unusual Waste/Mixes Address: 3400 North Manor City/State: Bakersfield, Ca 93308 Telephone: (805) 393-1151 Name: P.F.S. Waste Control Service (General Waste Disposal) Address: P.O. Box 80101 City/State: Bakersfield, Ca 93380 Telephone: (805) 399-4620 HAZARDOUS WASTE RECYCLING: Name: Cole Service (Recycle oil) Address: City/State: Telephone: (805 322-8258) Namer Jason Marketing (Mercury/Batteries) Address: 5142 Argosy Drive City/State: Huntington Beach, Ca 92649 Telephone: (714) 891-5544 LABOP~ATORIES FOR CHEMICAL ANALYSIS Name: Zalco Lab Address: 4309 Armour Avenue City/State: Bakersfield, Ca 93308 Telephone: (805) 395-0539 John Hatzman PAGE 18 RESPONSIBILITIES 1. SAFETY OFFICER The Safety Officer shall be the individual responsible for coordinating all Haz Mat Emergency response measures. The Safety Officer shall be familiar with all aspects of the Plan, all operations and activities, inventory records, and the facility's layout. This person shall have the responsibility of responding to all Haz Mat emergencies and the authority to utilize the resources needed to carry out the Plan. The Safety Officer's will also have the responsibility of: a. Training employees or directing others in spill response. b. Identifying the hazardous material or waste involved in an unplanned release. c. Determining whether human health and/or the environment will be effected. d. Informing personnel of a incident. e Developing a plan of action to isolate the incident. f Assembling the Haz Mat Emergency Spill Team. Using appropriate emergency response procedures. h Notifying the Manager of Public Relations for media purposes. i Recording incident information on the Spill Report. Following up with reporting, recording, and monitoring review of the incident and responses. k. Revisiting the Plan procedures as necessary. PAGE 19 2. ALTERNATE'S ~' In addition to the Safety officer, there shali~be several -Alternates who are responsible for assisting the Haz Mat Emergency response measures on his/her behalf. The Alternates shall also be familiar with all aspects of the Plan. Should the Safety officer not be present, the Alternates shall have the authority to respond to all Haz Mat Emergencies and to utilize the resources needed to carry out the Plan. SPILL TEAM The Spill Team shall be OHSA qualified and respiratory certified. The Spill Team are the only persons qualified to clean up spills at Bakersfield Memorial Hospital. The Spill Team will use the Hazardous Chemical/Cytotoxic Drugs Spill Report for all Haz Mat spills (see Attachment "A") . EMPLOYEES AT THE SCENE The responsibilities of an employee arriving at the scene of a Haz Mat spill shall: a. Call PBX. 1. Give location of spill. 2. Size of spill. 3. If possible, what type of material was spilled. b. To prevent others from entering the site of the spill until relieved by Safety Officer or Alternate. Barricade the area. c. To initiate action to stop the source of the spill if possible. PAGE 20 EMERGENCY EQUIPMENT-LOCATION AND MAINTENANCE ~' All emergency equipment shall be maintained and inspected regularly according to applicable law. Inspections shall involve checking emergency protection systems and equipment to ensure that they are in place, charged and ready for use in the event of an emergency. Engineering and Spill Team will ensure all equipment will be thoroughly examined. 1. FIRE FIGHTING EQUIPMENT A list of locations and a maintenance scheduled for fire extinguishers and fire fighting equipment, is available in the Engineering Department. 2. SPILL CONTROL AND PERSONAL PROTECTION EQUIPMENT A complete list of spill control and personal protection equipment is kept on the Haz Mat Cart. Other spill kits are located in the Lab. 3. FIRST AID SUPPLIES First aid is available at the Emergency Room. PAGE 21 ON SITE FIRE All fires that involve h~zardous substances, may give off toxic fumes or vapors. 1. Activate the Bakersfield Memorial Hospital Fire Plan. 2. Initiate Haz Mat Emergency Contacts. ~PAGE 22 ON SITE SpILL-INSIDE BUILDING Use this response procedures for hazardous material spills. 1. When a employee finds a spill of a hazardous substance: a. Call the PBX Operator. 1. The PBX Operator will call the Safety Officer or one of the Alternates. 2. The Safety Officer or the Alternate will decide if code yellow is to be called. 3. If the spill is minor. The Safety Officer will have the PBX Operator call for one member of the Spill Team to clean up spill. 4. If the spill is large. The Safety Officer will have the PBX operator call code YELLOW and call all individuals on the Spill Team. 5. If the spill is too large for the Spill Team. The Safety Officer will contact the Bakersfield Fire Department Spill Team by dialing 911. b. Begin to isolate the spill to prevent run off, avoid skin contact. c. Identify source of spill and stop further release. IF THIS CAN BE DONE SAFELY. d. Obtain the MSDS for the hazardous substances. If MSDS is not in the department call the Emergency Room, Engineering or pharmacy with the brand name. This department will enter the name' into the national computer to pu~l. up the MSDS and. 'make a copy for you. e. When Safety Officer or Alternate arrives, assist as needed. f. Complete Hazardous Chemical/Cytotoxic-Drugs Spill Report {Attachment "A") . PAGE 2 3 EMERGENCY RESPONSE PROCEDURES All work and transportation activities shall be handled in a safe and legal manner. In the event of a Hazardous Material Emergency, it is important that appropriate actions be taken by the employees involved to minimize any possible health risk. A Haz Mat Emergency situation may include a spill, leak, fire, explosion, chemical reaction, natural disaster, employee exposure, or any other mishap. EVACUATION ROUTES AND PROCEDURES a. Evacuation of the facility will occur as a response to an incident with known or unknown hazards that could pose a threat to the health and/or safety of patients, visitors, facility personnel and environment. The decision to evacuate is made by the President or Senior Administrator on duty, with the recommendation of the local police/fire department. The President or Senior Administrator on duty will determine the extent of evacuation. b. Incidents that may require evacuation. 1. Hazardous substance spill. 2. Fire or explosion. 3. Any other potentially dangerous situation. c. Evacuation pz~ocedures. Use the evacuation procedures found in the Mass Casualty Plan. d. Evacuation routes. All facility personnel shall be trained in the evacuation routes for their work stations and other areas of the facility. These routes are posted in each unit/area and should be followed. In all cases, at least two routes are shown. ATTACHMENT "A" }akersfield Memorial HosDital ~mzardou$ Materials and Waste Management Plan ~age 25 HAZARDOUS- CHEMIOAL/CY-TOTOXZC DRUGS. SPZLL REPORT q. Where Cid spill occur? Place Da%e T i me 3. Describe how chemical was SDilled and how s~ill could have Deen Was Safe%y Officer (or Alternate) notified? Yes NO DescriDe how sDill was cleaned up 5. DescriDe how soill material was disposed of and :yoe of container use 7. Describe_how staff was Drotected during spill and clean UD How was Darien% protected? How was environment protected? ......... 10. Were any Datients or staff treated for contamimation~ 11. was anyone injured in the spill? Yes NO If Yes, name of injured person(s) 12. ReDort filed wi:h Emergency Room and Human Resources? Yes. No If Yes, at%ac~ cody o~ ~his reDort. 13. Occurrence form filled out and filed wi:h Quality Assessment? Yes No lA. 5PA s~ill form file~? Yes No Signature of Manager making reDor~ D~ CoDy to: Safety Officer Safe:y Committee !1 :-~ .,,-,- ).-.. ,..--,:..~. ? , ....... :_ ..~ .... ~ :..:.. ' ... :: ..>.:._. :-.... :-.. :'.'-.'..-~.' . '"~ . ' .. i~ .:-/ :'~.. ~ .; :~: ,,~ .:! : , ~.": . .-.~.~.., ': .. . .. _ .: . . . .: '"' ..... - - :,e~/ ~,: I --~. -'~'~/ r~ l' i~ g ~'~" ~" · " ._~'~ ::.:.,:>,.:'. :. . .:.:. ..> . ~ . . .' , ,, . · - ::' >.~::}'""'::',i>:: '~ :>.:: - '" ' ~ ' ~ ' '- ·" : ";::¥ .:5.: "~'.-.. . ' " ' :. . · . _,. ~ ::.::..:....., , .': . ,~.-.. - . . ') .~ '.. :c': ' ' ' ."., :'-:. :.::: :,(,. ,:::.. -..: ..... .. . ,, .. :-.. .:-,.: '. ... , ,. : · :. . ': .. . ",., -,.~ .:> . , . ~ ·, .. CA£1FORNIA DF_PARTME.NT OY " TOXIC SUBSTANCES CONTROL OFFICE. OF POLLUTION PREVENTION A~ tD T~CI--]NOLOGY DEV£LOP>/]ENT 5e~te.mber 7 CALIFORNIA DEPARTMENT OF TOXIC SUBSTANCES CONTROL OFFICE OF POLLUTION PREVENTION AND TECHNOLOGY DEVELOPMENT Z. and California Environmental Protection kgenc' Department of Toxic Substances Control isposai Treatment StandardsUnit estrictions ulletin IAn Update on California's Treatment Standards and Land Disposal Restrictions SB 1726 In addition to other requirements, SB 1726 (Chapter 853 of the 1992 Statute) extended the land disposal restrictions prohibition date to January 1, 1995, for three waste groups. SB 1726 also expanded waste reduction plan requirements for · these three waste groups. The three affected waste groups are: (1) RCRA hazardous wastes whose RCRA treatment standards have not yet been developed (2) non-RCRA hazardous wastes whose treatment standards are based on incineration, solvent extraction or biological treatment, and (3) non-RCRA solid hazardous wastes containing metals (wastes subject to the treatment standard in §66268.106 of Title 22, California Code of Regulations). Descriptions of these groups and some examples of wastes that fall into these groups are outlined below. Regulatory Citation Waste Group and Examples Description (CCR, Title 22) 66268.1(i) (~ "Newly listed" or "newly RCRA hazardous waste not listed in 40 CFR §§268.10,268.11 and 268.12. identified" RCRA waste Aqueous and liquid organic Any waste that contains an organic hazardous constituent. For the purposes of66268.29(j) non-RCltA hazardous was{o this paragraph, an aqueous or liquid waste is defined as a waste containing examples include (but are not limited to): water or other liquid, and less than or equal to one percent of nonfilterable · aqueous waste with organic (suspended) solids by weight and an organic hazardous constituent means any constituents hazardous constituent, as defined in section 66260.10, other than those listed in · waste oil and mixed oil Table II of section 66261.24. · pesticide rinse water Solid non-RCP. A hazardous waste Any waste that contains an organic hazardous constituent. For the purposes of 66268.29(k) -.with organic compounds this paragraph, a solid hazardous waste is defined as a hazardous waste that examples include (but are not limited to): contains greater than one percent of nonfilterable (suspended) sol/ds by weight (2) · oil/water separation sludge (from and an organic hazardous constituent means any hazardous constituent, as non-refining sources) deft'ned in section 66260.10, other than those ~sted in Table II of section · tank bottom waste (from non- 66261.24. refining sources) · polymeric resin waste · other organic solids PCB waste Waste containing polychlorinated biphenyls (PCBs). 66268.29(b) Nonwastewater solvent waste A solvent-containing liquid waste containing greater than or equal to one 66268.29(d) percent by weight Total Organic Carbon (TOC). The waste is determined to be liquid or nonliquid at the point of generation with the use of Paint Filter Test (Method 9095 in the U.S. EPA Publication SW-846, 3rd Edition, 1986). -- Metal-containing solid A solid waste that contains any of the metals or metal compounds identified in 66268.29(g) non-RCRA hazardous waste Section 66261.24(a)(2). A solid waste is defined as a waste containing greater examples include (but are not limited to): than one percent of nonfilterable (suspended) solids by weight. (3) · metal sludge · metal dust · FCC catalyst · other spent catalyst · sandblast waste · drilling mud -{ i This document was modeled after the Hazardous Waste Minimization Checklist and t Assessment Manuals developed by the Technology Clearinghouse Unit. ,~-~.~ The mention of commercial produc-ts, commercial services, their sources or their use in connection with material reported herein is not to be construed as actual or implied endorsement of such products or services. Introduction ................................................................................................. 1 Background ........................................................................................ 1 Source Reduction and the Waste Minimization Hierarchy .................. 2 Section t' Generator Information ................................................................. 4 Section 2: Compliance Checklist ................................................................. 5 Administrative Steps ........................................................................... 5 Input Changes .................................................................................. 12 Operational Improvements ............................................................... 13 Production Process Changes ............................................................. 17 Product Reformulation ...................................................................... 18 Section 3: Evaluation of Source Reduction Measures ................................ 19 Section 4: Implementation Timetable ......................................................... 20 Section 5: Numerical Goal ............................................. : ............................ 21 Section 6: Certification ................................................................................ 21 Further Information ..................................................................................... 23 In 1989, the Legislature adopted landmark legislation that requires hazardous waste generators consider source reduction as the preferred method of managing hazardous waste. This law, proposed in Senate Bill (SB) 14 as the Hazardous Waste Source Reduction and Management Review Act of 1989 (Act), promotes source reduction over recycling and treatment because it avoids the generation of hazardous wastes and its associated management liability. SB 14 applies to any generator who, by site, routinely produces through ongoing processes and operations, more than 12,000 kilograms of hazardous waste in a calendar year, or "~ more than 12 kilograms of extremely hazardous waste in a calendar year. Once captured by SB 14, a generator must prepare a Source Reduction Evaluation Review and Plan (Plan), Plan Summary, Hazardous Waste Management Performance Report (Report), and Report Summary. The preparation of these documents guides the generator in looking for opportunities to implement source reduction measures. Small businesses, as defined in the Government Code, that are captured by SB 14 could choose to complete the forms contained in any one of the Department's industry-specific "Waste Audit Studies" or "Hazardous Waste Minimization Checklist and Assessment Manuals" as their Source Reduction Evaluation Review and Plan. Small businesses could also choose to use their current Generator's Biennial Report as their Hazardous Waste Management Performance Report. A complete listing of "Waste Audit Studies" and "Hazardous Waste Minimization Checklist and Assessment Manuals" is located at the end of this document. The adoption of Senate Bill 1726, added by Statutes of 1992 as Chapter 853, broadens the applicability of SB 14 to include any generator who routinely generates more than 5,000 kilograms of specified categories of hazardous waste in a calendar year. The categories of hazardous waste include RCRA hazardous waste for which a RCRA treatment standard has not yet been developed, non-RCRA solid hazardous wastes containing metals, and non- RCRA hazardous waste whose treatment standards are based on incineration, solvent extraction, or biological treatment. Generators newly captured by SB 1726 must prepare a Compliance Checklist or a Source Reduction Evaluation Review and Plan by September 1, 1993 and every four years thereafter. The Compliance Checklist is a simple, understandable method for the smaller quantity generator to comply with the requirements of the Act in an inexpensive and convenient manner. The Compliance Checklist guides generators toward opportunities where source reduction measures can be applied. Small businesses also benefit from the adoption of SB 1726. Industries for which a specific Hazardous Waste Minimization Checklist and Assessment Manual is not available may now choose to complete the Compliance Checklist as their Source Reduction Evaluation Review and Plan. SB 1 726 also requires all generators (those previously captured by SB 14 along with those newly captured by SB 1726) to prepare a Progress Report. The Progress Report summarizes the results that the generator has achieved in implementing the source reduction measures identified in the generato'r;s Source Reduction Evaluation Review and Plan or Compliance Checklist. This document establishes the format of the Compliance Checklist and consists of six sections. Section One, "Generator Information," contains basic information about the generator that is completing the Compliance Checklist. Section Two, "Compliance Checklist," helps the generator become aware of the benefits of source reduction and to consider source reduction opportunities at the generator's site. The list of source reduction measures in the Compliance Checklist is by no means a complete listing of all source reduction opportunities. Generators are encouraged to seek and create innovative source reduction ideas that are appropriate for the specific situations at their site. Section Three, "Evaluating Your Source Reduction Measures," provides suggestions to help generators evaluate potential source reduction measures. Section Four, "Implementation Timetable," documents the time frames a generator will establish for implementing selected source reduction measures. Section Five, "Numerical Goal," is the generator's four-year numerical goal that estimates the overall reduction of hazardous waste at the generator's site,'assuming optimum conditions to achieve feasible source reduction measures. Section Six, "Certification," provides the certification language as required by SB 1 4. For more information regarding issues such as additional reporting requirements, · confidentiality of information and the availability of source redcution documents, please 'refer to the "Guidance Manual for the Hazardous Waste Source Reduction and Management Review Act of 1 In its findings and declarations, the Legislature has stated that the intent of SB 1 4 is to promote the reduction of hazardous waste at its source, and wherever source reduction is not feasible or practicable, to encourage recycling. Where it is not feasible to reduce or recycle hazardous waste, the waste should be treated in an environmentally safe manner prior to disposal to minimize the present and future threat to public health and the environment. Source reduction takes its place at the pinnacle of the Waste Minimization Hierarchy, and is preferred to recycling and treatment options because it is likely to pose the lowest environmental risk. Furthermore, source reduction avoids waste management costs and liability while contributing to a company's overall competitiveness. Source reduc~tion is defined as any action which causes a net reduction in the generation of hazardous waste, and may also include any steps taken before a hazardous waste is generated to lessen the properties which cause the waste to be classified as hazardous. The regulations identify five approaches to achieve source reduction. These approaches are presented to help the generator organize strategies toward achieving the maximum benefits from implementing source reduction at the generator's site. There may be some overlap and uncertainty regarding the approach that best describes a specific action. However, we urge the generator to place an emphasis on implementing a plan to maximize source reduction rather than on placing an activity within the most appropriate of the five approaches. The five approaches of source reduction include all of the following: 1 ) Administrative steps include good operating practices that apply to the human aspect of conducting daily operations at the site. These include employee training waste minimization policies, and inventory control. 2) Input changes include changes in raw materials or feedstocks to reduce, avoid, or eliminate the hazardous materials that enter the production process, thereby avoiding the generation of hazardous wastes within the production process. 3) Operational improvements include activities such as loss prevention, waste segregation, production scheduling, maintenance operations and overall site management. 4) Production process changes include process changes, changes 'in production methods or techniques, equipment modifications, changes in process operating conditions, such as temperature, pressure, etc., process or plant automation, or the return of materials or their components for reuse within existing processes. 5) Product reformulations include changes in design, composition or specification of final or intermediate products. Source reduction planning can be particularly beneficial for generators that are taking a look at source reduction for the first time. Often there are simple and inexpensive source reduction measures that can reduce significant quantities of waste. Due to the Iow cost of these measures, the economic benefit of implementing source reduction can be large. The · generator completes the checklist, focusing on identifying the simple measures that can enable significant waste stream reduction and save hazardous waste management costs and reducing future liability. Since this checklist is intended to provide general source reduction guidance to various operations, many of the considerations listed in the checklist may not directly apply to each generator's specific business or process. We urge generators to think about each concept presented in the context of one's own operation to see if the idea can be applied directly, or perhaps in a different way, to secure the benefit discussed at the right side of the page. Remember, the elimination of hazardous waste is good for the environment and can also save you money. [] Company Name: ~ Location Address: [] Street: ~ City: State:~ Zip: i~ Mailing Address: Street: · ~ City: State:~ Zip: Telephone: (__ Contact Person: Quantity of hazardous waste generated in 1992 (total) · , tons Waste Description: California Waste Codes (from the Uniform Hazardous Waste Manifest): Complete the following checklist to determine if you are taking advantage of opportunities to reduce your hazardous waste before it is generated. The preferred answers are in bold print and helpful suggestions or benefit are in the right hand column. I. Do you have a formal policy ~' A formal statement supporting source reduction is or mission statement an important part of encouraging employee source stating your commitment reduction awareness. to source reduction? Yes _-1 No 2. Do you offer an incentive ~,' Incentive programs encourage employees to program to employees to follow good housekeeping practices. Incentive promote good programs do not have to be monetary programs, housekeeping practices? but can involve other incentives such as _3 Yes ,2f/ No recognition or awards. It could be as simple as lunch with the boss. 3. Does your accounting '/ Separate accounting of hazardous waste procedure allocate the management costs by process or costs associated with the production area can be a'valuable tool to management of hazardous prioritize source reduction efforts by wastes to the processes directing initial attention to the most generating the hazardous costly wastes. Somtimes just by ¥ wastes? individualizing the cost of waste ;,~Yes _- No management ways to workers find reduce waste generation. [] I Do you offer employee ,/ Management should make a commitment to [] training on how to avoid develop awareness of source reduction among '! excessive waste generation employees and offer education and trainin[~ ~ through the proper opportunities. You can reduce the amount of ~ handling and storage of hazardous waste generated due to spills if you ~ materials? train your employees to properly handle and store ~ ;-~ Yes :~/No hazardous materials. Some trade associations and - local environmental health agencies sponsor ~ employee t~'ainin§ seminars and some consulting .~ firms offer trainin[~ in handling hazardous materials as part of their package of services.' 2.. Are employees educated in ~/ Introducin§ employees to source reduction source reduction concepts will allow them to develop innovative techniques and encouraged ideas that enable you to reduce disposal costs, to apply them? minimize liability, and protect worker health and .L~v-f/Yes ?_-1 No safety. 3. Do you publicize your ~ Sharing source reduction successes encourages source reduction source reduction awareness among employees. achievements in the form of Successful source reduction activities can make a a newsletter to your good local news story and can help earn and employees and your retain customers and clients. community? _.,~Yes iD No 4. Are periodic sessions held :./ Source reduction training is not a one time to keep employees up-to- exercise. A full time, ongoing commitment must date on source reduction be made by both owners and operators of a measures in the use of business. hazardous materials? -~ Yes _~ No 5. Are job functions defined v' Identifying specific duties for personnel can help or each employee.~ you prevent mishandling hazard_ous waste. ~ Yes _-1 No Communicate to the employees what their job entails and make sure they understand what is expected of them. Make source reduction a part of everyone's job. Provide written guidance, such as a job manual. Encourage workers to offer source reduction suggestions. 6. Are regular meetings held '/ As new developments occur in hazardous to keep personnel current materials management, employees should be kept on hazardous materials informed in order to perform their duties more management policy and efficiently. _~yrOCedures? es ~ No I. Are raw material '/ Inspecting containers before accepting them can containers inspected before prevent the receipt of leaking or damaged being accepted? containers which can lead to a hazardous spill Yes _-I No and expensive clean up and disposal costs. 2. Are all raw materials tested v' Off-specification raw materials, if accepted, can or checked before being become hazardous ~vaste. In addition, the use of accepted from the these materials may generate an off-specification suppliers? product which may then require disposal as a "~ Yes '_.~No hazardous waste. Some off-specification products can be reworked into usable products. 3. Are raw material / A received date is important for keeping track of containers dated as the shelf life of a raw material and preventing received? materiels form becoming obsolete and a ?/Yes ~ No hazardous waste. It also comes in handy when rotating stock. 'I [] 4. Do you use a "first in, first v' Using materials in a "first in, first out" order can · ,i out" materials usage policy? prevent stock from becoming obsolete and a ~ ~ Yes _-1 No hazardous waste. You can easily rotate and [] maintain your stock by labeling, dating, and .::3 [] inspecting new material containers as they are -:i received. Then, use the earliest labeled stock. ~ 5. Do you purchase only ~ Having a minimum supply of raw materials can , enough raw materials and prevent accumulation and eliminate large ~ perishable hazardous amounts of excess materials which may not be ~ materials that will be used used at a later date. Also, overstock of perishable ~:~ before they become materials can contribute to hazardous waste. ':?~ //outdated? '"'~ '~, Yes _-'i No 6. Are material balances y' Performing a material balance for critical performed for the critical processes will allow you to ensure the efficiency .processes your site? of production as well as optimize your source ~/' reduction efforts by knowing the raw materials I Yes _q No entering and the products and wastes leaving your processes. 7. Are material inventories v' Computerizing your inventory will allow you to computerized? Do you track keep track of the materials you use and how much the usage of raw materials? is remaining. This will allow you to keep the · ,~N material levels at a point where you use up your ~ Yes o materials just as new materials are arriving. Personal computers that allow you to computerize your inventory are relatively inexpensive. . I. Are hazardous materials y' Covering individual containers can prevent stored in covered evaporation, contamination by foreign particles, containers? and the frequency of spills. _.~Yes _-_,' No 2. Is your hazardous materials '/' Hazardous materials are best protected in covered storage area covered? areas. Uncovered storage areas allow rainwater to ~/Yes_ ~1_ No contaminate raw materials and can increase the volume of hazardous waste. Sunlight can degrade or change the character of raw materials. Absorbed heat can raise pressure inside containers, creating a potentially dangerous situation. 3. Do you store flammable '/ Reduce fire danger by storing flammable materials materials outdoors? in an outdoor covered, and secured storage /Yes D No facility. Check'the local fire code for more information about storage requirements. Also, if. electrical conduits and equipment are nearby, stringently follow the National Electric Codes (NECs) and local building codes. 4. Are hazardous materials '/ Hazardous materials should be stored separately stored separately from non- from non-hazardous materials to prevent the hazardous materials? creation of larger amounts hazardous waste if a ,~Yes 'D No spill occurs. 5; Are materials stored in v' Storing materials in reusable containers will allow reusable containers? you to return the empty container to the supplier '/Yes _-!. No and reduce the amount of waste you must dispose. Check with your supplier to see if return options are available. 6. Are raw materials stored in :/ Heavy traffic may contaminate raw materials with high traffic areas? dirt or dust and may cause spilled materials to 'q Yes _.O/No become dispersed throughout your site. If yes, can traffic through the storage area be reduced? .7 Yes ~ No 7. Do you store hazardous v' A diked concrete pad will contain spills better materials within a diked than asphalt or dirt. There are also molded plastic concrete pad? pallets available that provide secondary ~ ~Yes i_-1 No containment. ~ 8. Do you store hazardous '/ A secure storage area wil prevent unauthorized :~ wastes and hazardous persons from entering the sto~age area and materials in a secure harming themselves or spilling materials and i'~ storage area? waste. '¥es No 9. Are the proper tools and '~ Powered equipment or hand trucks should be -'! procedures available to used to move drums so as to prevent ctama§e or move drums safely? punctures. Under no circumstances shoulct drums ~ Yes ~ No be tipped or rolled, even when empty. Negligent transport procedures will cause drum damage, particularly to seams, which can lead to leaks or ruptures during future use. Drums should also be capped tightly before they are moved. i. Do you generate hazardous' '? Spills occur mainly because of splashing during wastes due to spills during manual transfer, tank overfilling, and leaks in raw material storage or process equipment and piping. Scoop spills up to during eq,.uipment cleaning? the fullest extent possible, and try to rework tt~em _~ Yes ~/No into product. Remember to keep equipment in good repair anct provide adequate oversight to prevent spilling during manual transfer. 2. Do you have any of the ~ All 'of these safeguards can help you reduce the following safeguards to amount of hazardous waste you generate due to prevent the spillage of spills. liquids while filling storage nks? ~ High level shutdown alarms '- _ . ow.totalizers ,_v~pipeline drainage or purging dikes 3. Do you have a prepared '/ A prompt response helps to minimize health risks plan to respond to to workers, reduce adverse environmental effects, hyazardous materials spills? and reduce potential liability. Furthermore, the es D No law requires a prepared plan to respond to hazardous spills. 4. Do you routinely inspect all / Routine inspections can reduce hazardous spills waste storage tanks, by identifying potential problems such a ieaking drums, and containers for or improperly stored containers. eaks and proper storage? z_ Yes r_q No 5. Do you routinely inspect y' Routine inspections of pumps, valves, pipes and and maintain your processes for leaks can result in prompt equipment and processes replacement of gaskets, packing or the addition of y Crprevent leaks and spills? catch basins to reduce waste. es _-] No 6. If a hazardous waste spill or '/ An immediate response to a hazardous waste spill improper storage of a or improper storage of hazardous waste can waste is discovered during minimize employee exposure, damage to the an inspection, is it dealt environment, liability, and waste disposal costs. ith immediately? Did you know that even a small drippin§ leak can _ Yes ~ No produce several gallons of waste per day? I~ 7. Do you conduct practice ~ Periodic drills can improve the readiness and .drills for major spills?, effectiveness of employees in dealing with z~ Yes -] No emergency situations. You can reduce wastes / - generated from spills and their cleanup with a [] quick response to a spill. ~ I. Have you researched the -'/ Substitution of non-hazardous or less hazardous ~ use of non-hazardous or materials fo~ hazardous materials reduces or ~ less hazardous material eliminates a hazardous waste stream. alternatives? ~;;~j ,Z1/'Y v' Examples of alternatives include the use of soy oil- _ es '_-iNo based printing inks as a substitute for petroleum- based printing inks, using a citrus-based cleaner for a chlorinated solvent, and using trivalent chromium electroplating in place of hexavalent chromium plating. / Non-hazardous and less hazardous alternatives should be fully investigated before making a final decision. 2. Have you considered ~ Aqueous cleaners are nonflammable and are less substituting aqueous likely to give off toxic fumes. In addition, most cleaners for petroleum- aqueous cleaners are less hazardous to the public based or chlorinated and the environment. solvents? :_q Yes '~. J~o ~" Make sure the cleaning is really necessary. Some -~/Do_. es not appl), companies have found that they can completely eliminate some of the cleaning steps with no effect on product quality. 3. If you are using caustic v' One business substituted its caustic cleaning cleaners, have you tried solution with a proprietary alkaline cleaning alternative commercial solution that halved the replacement frequency, cleaning solutions? resulting in less waste requiring disposal. .-_. Yes.~° oes not apply 4. Are biodegradable, film- ',/ Use of biodegradable cleaners could eliminate free detergents a possible hazardous wastes such as solvent contaminated substitution for cleaning rags, waste cleaning solvent, and empty solvent solvents? containers. Biodegradable cleaners have two ,_-1 Yes ?1 No significant environmental benefits over solvents: ~f" Does not apply they will not contribute to photochemical smog as do volatile organic compounds (VOCs), and they do not present a respiratory health hazard to .... workers. 5. Have you considered using ',/ Using Iow VOC paints and coatings can reduce Iow ¥OC paints and hazardous waste and air pollution, as well as coatings? significantly reduce the need for and the use of ,_-I Yes ~ JX~o potentially hazardous materials, such as solvents ~ Does not apply derived from petroleum distillates. Exercise caution when selecting or using low VOC paints since they may still contain toxic metal pigments. I. Do you segregate your v' Segregating wastes will aid in recycling materials v)~aste streams? and eliminate the mixing of non-hazardous wastes f/Yes ,~ No with hazardous wastes. Mixed wastes are more difficult and costly to treat and dispose. .. Do you segregate all empty bags, packages, and containers that contained hazardous materials from those that contained non- _//hyazardous materials? es _'i No 2. Are your hazardous waste '/' Proper labeling is a requirement of federal law. and non-hazardous waste Properly labeled containers may decrease the containers properly likelihood of mixing incompatible wastes which .~w'beled? might cause an explosion, or mixing hazardous _, Yes ~ No wastes with non-hazardous wastes which could increase your volume of hazardous waste. I~ 3. Are liquid materials ~,' Transporting liquids using pumps and piping can .i transferred using pumps help you reduce the amount of chemicals spilled :-~ and piping? during transfer. q OYes '~Dc~ [] _ es not apply ~ 4. Are the materials stored ~ Storing materials near the processing areas where ] close to the process areas they are used will reduce the distance you need to ~ ~ where they are used? transport them and therefore reduce your handling and spillage. ~ ,~.' Yes '_~ No ~ 5. Do you maintain and ~" You may generate unnecessary hazardous waste if 'ii enforce a clear policy of you use supplies for purposes other than their using raw materials only for intended uses. For example, don't use equipment /,~eir intended uses? cleaning solvents to clean your floors. ;D Yes ~ No 6. Do you plan your production schedule to '~' Plan your production schedule in a way thaL reduce the generation of reduces the need for intermediate storage and . ,~yeZardous waste? excessive cleaning. For example when blending s m No paints, do you schedule the tint mixing from light -' - to dark to avoid excessive cleaning, or mix only those paints having a common base at one time? 7. Have you attempted to :~' Additives may be available in pre-weighed soluble purchase pre-weighed bags, which do not require container disposal. materials in soluble bags? '-' Yes ~ 8. Do you plan your mixing '/ Planning is the key to efficiency. Plan your operations so that you will mixing so that you use only the necessary only use the necessary raw components. A properly sized container will also ~ ,~y.aterials? reduce waste. __, Yes _q No 9. Do you test your products ~' Accurate lab scale tests can eliminate the in your quality control production of off-specification products, which laboratory before can become hazardous waste. attempting full scale pr°ducti~3~ -1 Yes ~ No 10. The solvent waste ~' Maximize your benefits from the solvents you do generated from equipment use. Reusing solvents as much as is practicable cleaning is can significantly reduce your total solvent waste generation. For example can you reuse a solvent _-t drummed for disposal from a process cleaning operates as a product thinner or ingredient? _~ drummed for disposal after being used ~ times :_-'1 drummed for use in a subsequent process sent to a holding tank _~d0es not apply I I. Is the piping to and from ,/' Use a plastic or foam pig to clean pipes. The pig raw material or product (slug) is forced throug.h the pipe ~:rom the tank. tanks pigged before The pig pushes ahead any product left clinging to flushing? the walls of the pipe. This increases yield and reduces the degree of pipe cleaning required. _!. Yes ~ _ es not apply s/ The equipment (launcher and catcher) must be carefully designed so as to prevent spills, sprays, and potential injuries, and the piping runs are free of obstructions so that the pig does not become stuck or lost in the system. [] 12. What is the cleaning s,' To reduce the amount of product left clinging to q method used for cleaning the walls of a raw material or product storage .~] raw material and product tank, use rubber wipers to scrape the tank sides. storage tanks? ~ :D manually scraped v' Mechanization or automation of this step should ! be considered to increase raw material yield and i~1 reduce the quantity of waste produced from tank i _-1 washed with high pressure ' [] spray system using caustic cleaning. ~ then solvent rinsed Other _~does not apply 13. Have you established '/ Equipment should be cleaned immediately in procedures for cleaning order to reduce the amount of solvent that will be process equipment? Are necessary to clean it. they cleaned immediately after completing the task? '/ In some instances, having a scheduled Is there a scheduled maintenance and cleaning program for process maintenance and cleaning equipment and parts can have a profound impact program? on reducing hazardous wastes. Yes _~ ~oes not apply 14. is there an established ~? Proper coordination between production and procedure for cleaning crews can prevent such things a.s product communication between drying in tanks. cleaning and production crews? ~ Yes ~. No 15. Have you considered a high ~/ High pressure spray systems can be used to clean pressure spray system for equipment and tanks and reduce water use by 80 cleaning parts or to 90 percent. In addition, high,pressure sprays equipment? can remove partially dried product so that the need for caustic cleaners is reduced. Yes ~_.-K"'Does not apply _-: o 1 6. Do you capture unused raw ~/ The method for saving unused raw material or material or product prior product will be process specific. In general, to cleaning process capturing as much material as possible before quipmen.,c? cleaning is important because it saves on the use ~1' Yes ~ No of cleaning solvent. - 17. Do you follow the ~' It is important to follow the manufacturer's manufacturer's suggested suggested procedures. They are intended to methods for cleaning and maximize efficiency and minimize waste. using your process ,~//eyqUipment? es ~ No i 8. Can you install counter .'/ Counter current rinsing can reduce waste current rinsing processes? generation especially if the most concentrated bath becomes makeup for the process solution. :_~ Yes ~-~ ~'"1 o es not apply i I. Do you use automated ~' Automated feeding systems can help reduce : feeding systems to feed raw spillage. Switching from numerous small :. materials into your containers to one larger container can help reduce i . processes? cleaning waste. For large scale dedicated :~"Yes '_q No equipment, clean-in-place systems are effective in reducing cleaning waste. 2. If you are planning any '/ More efficient equipment.can reduce your total future plant hazardous waste volumes while meeting or modernizations, do you exceeding current production rates. consider replacing existing equipment with more efficient ones which generate less hazardous _~Yesste? _~ ~o [] 3. Have you investigated the '/ Unnecessary cleaning of equipment increases the :~ effect of reduced cleaning amount of cleaning wastes generated. The ~ on produc.,t-quality? feasibility of eliminating cleaning steps between ~ ~D Yes ~/No subsequent production steps should be explored. ]~ Conduct experiments on a small scale in the ~ laboratory to measure the degree of contamination [] due to the elimination of cleaning. If ~ contamination of the products is within quality control standards, then the clean up step can be ~ eliminated. ~ I. Can you modify the specifications, design or '/ If your product results in a hazardous waste at the composition of your end of its service life, it may be costly to manage product so that less as a hazardous waste and may be a long term hazardous waste is liability to you and your customers. generated? *es ._ es not apply After completing the checklist and identifying potential source reduction opportunities, you must evaluate your options to select those you wish to implement. Source reduction is defined in the law as any action which causes a net reduction of the generation of hazardous waste, or any action taken before the hazardous waste is generated that results in the lessening of the properties which cause it to be classified as a hazardous waste. There are five source reduction approaches under which specific source reduction measures may be grouped: · input change · operational improvement · production process change · product reformulation · administrative steps However, source reduction measures are none of the following: · any action taken after a hazardous waste is generated · any action that concentrates the constituents of a hazardous waste to reduce its volume or that dilutes the hazardous waste to reduce its hazardous characteristics · any action that shifts hazardous wastes from one environmental medium to another environmental medium · treatment There are a variety of different factors to consider when evaluating potential source reduction measures. These factors include: · expected change in the amount of hazardous waste generated; · technical feasibility; · economic feasibility; · effect on product quality; · employee health and safety considerations; · requirements for permits, variances, and compliance schedules of applicable agencies; and · releases and discharges to all media. You are not limited to the factors listed above. You may develop additional factors that you feel are important in developing a successful source reduction program at your site. Examples of additional factors you may consider include: · reduction in the hazardous characteristic of the waste; · previous success of the measure within your organization; · previous success of the measure in other industries; · length of implementation period; · ease of implementation. [] Source reduction measures you The dates when you plan to begin implementing each [] have chosen to implement at measure and the date when the measure will be i your site operational l k Every generator who is subject to SB 14 and SB 1726 must prepare a four-year numerical source reduction goal. The goal is included in a generator's compliance checklist (or Plan, if applicable). The ~oal is not simply a reflection of your intended source reduction under SB 14 or SB ~ 726, rather it is vour estimate of the source reduction that your site could optimally strive to achieve over tt~e next four y'ears. The goal, a sin§le numerical percentage, would reflect your organization's source reduction vision and commitment. The goal must reflect your company's waste stream reductions due only to source reduction and would exclude effects due to production variation or economic influences. For example, Source Reduction Goal (%) = Total hazardous waste generation reduced by optimizing source reduction practices x 100 Total hazardous waste senecation i~ source reduction measures were not considered a~ your site The four-year numerical source reduction goal for this site is: % for the years to __ (your four-year planning period). There are two certifications required by regulations - a technical certification and a ~inanciaJ certification. (Section 67~ 00.10 Tittle 22 California Code of Regulations). TECHNICAL CERTIFICATION: The compiiance checklist must be reviewed and certified by any one of the fol owing persons for technical c°mpieteness' Check the appropriate box and provide the information below: _ o o' o who is registered as a professional engineer pursuant to section 6762 Of the Business and Professions Code ._-I an environmental assessor ~vho is registered pursuant to section 23.570 of the Health and Safety Code ~ an individual ~vho is responsio e for the processes and operations of the site Please print the name of the person certifying this compliance checklist: Name: Title: Sionature: Date: " ; FINANCIAL CERTIFICATION: The compliance checklist must be reviewed and certified that the reviewer is made aware of the checklist contents and resour'ce commitment. Financial certification shall be made by any one of the following persons able to commit company finances. Check the appropriate box and provide the information below: the owner the operator the responsible corporate officer of the site an authorized individual capable of committing financial resources necessary to ' ' implement selected source reduction measures. "1 certify that this document and all attachments were prepared under my direction or supervision in accordance with a system designed tO assure that qualified personnel properly §ather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or the persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for making false statements or representations to the Department, including the possibility of fines for criminal violations. Please print the name of the person certifying this compliance checklist: Name: Title: Signature: Date: / / The Technology Clearinghouse within the Office of Pollution Prevention and Technology Development has prepared Waste Audit Studies which are full scale assessments for specific industries that show examples where waste minimization is implemented. The specific industries include: · Automotive Paint Shops · Marineyards for Maintenance and ° Automotive Repair Repair · Building and Construction Industry · Mechanical Equipment Repair · Commercial Printing Industry Shops · Drug Manufacturing and Processing · Metal Finishing Industry Industry · Nonagricultural Pesticide · Fabricated metal Products Industry Application Industry · Fiberglas-Reinforced and · Paint Manufacturing Industry Composite Plastic Products · Pesticide Formulating Industry · General Medical and Surgical · Printed Circuit Board Industry Hospitals · Research and Educational · Gold, Silver, Platinum, and other Institutions Precious Metals Product and · Stone, Clay, Glass, and Concrete Reclamation Products Industries · Thermal Metal Working Industry The following Hazardous Waste Minimization Checklists and Assessment Manuals are available from the Department to assist manufacturers in evaluating their shops for waste minimization opportunities. · Automotive Repair Shops · Marine Ship and Pleasure Vessel · Auto Paint Shops Boat Yards · Building Construction · Paint Formulators · Ceramic Products · Pesticide Formulators · Metal Finishing Industry · Printed Circuit Board Manufacturers [] To obtain a copy of any of the publications listed above, or for a list of other publications :~ available from the Department, contact the Office of Pollution Prevention and Technology .:,~ Development: ...! Department of Toxic Substances Control ~ Office of Pollution Prevention and Technology Development ~1 400 P Street Fourth Floor i P.O. Box 806 ~ Sacramento, CA 9581 2-0806 ~ (916) 322-3670 · ,~ Region I Sacramento (91 6) 255-3545 z;2;, Fresno (209) 297-3901 .....Region 2 - Berkeley (510) 540-2122 : Region 3 - Glendale (818) 551-2800 ..... ~ . Region 4 ~ng. Beach (3]0) 590-4868 KBF-7171 CORRECTION NOTICE BAKERSFIELD FIRE DEPARTMENT N°- Location/VI ~L~r~' Sub Div. [/,4/3~./,./G ~,- ('~A?' Blk. Lot You are hereby required to make the following corrections at the above location: Cot. No Completion Date fox' Corrections I(/t6/,st Date lO/[6/0! ~,,V~U~ ~/~,J,,v~ InspectOr 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME /v/C-'v~ ~t.b,o~?,-r~- INSPECTION DATE / O [/¢/'tOt Section 4: Hazardous Waste Generator Program EPA ID # C zg c_ O00 0 z{ "~ ~-4-- [] Routine j2~ 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 kep~ closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment 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=Complianee V=Violation Inspector: Office of Environmental Services (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy ~ rATE ~F CALIFORNIA--CALIFORNIA ENVlRONM~Y~.AL PROTECTION AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC acJBSTANCES CONTROL 400 P STREET, 4TH FLOOR P.O. BOX 806 SACRAMENTO. CA 95812-0806 (916) 323-587[ February 2]., 1996 EPA. ID: CAL000021756 BAKERSFIELD MEMORIAL HOSPITAL GARY STEVENS Initial Authorization: 09/03/93 420 34TH ST Amendment Date: 12/21/95 BAKERSFIELD, CA 93301 For facility located at: 420 36TH ST BAKERSFIELD, CA 93301 Dear Onsite Treatment Facility: The Department of Toxic Substances Control (DTSC) has received your facility specific Amended notification (form DTSC 1772). Your notification is administratively complete, but has not been reviewed for technical adequacy. A technical review of your notification will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws. or regulations are found. The Department acknowledses receipt Of. your completed Amended notification for the treatment unit(s) listed on the last page of this letter. These units are authorized by California law without additional Department action. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). DTSC has revised its database records to reflect your status and has notified the Board of Equalization (BOE). You will be billed annual fees by BOE calculated on a calendar year basis for each year you operate and/or have not notified DTSC that the units have been closed. If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this 'office at the letterhead address or telephone number. Sincerely, ~ief Tiered Permitting. Compliance Section State Regulatory Program Division cc: See next page. BAKERSFIELD MEMORIAL HOSPITAL EPA ID: CAL000021754 Page 2 cc= ASTRID JOHNSON MR STEVE MCCALLE¥ DTSC REGION 1 KERN COUNTY STATE REGULATORY PROGRAM ENV HEALTH SERVICES DEPT 1515 TOLLHOUSE 2700 M ST ~300 CLOVIS, CA 93611 BAKERSFIELD, CA 93301 STATE BOARD OF EQUALIZATION STEPHEN R. RUDD, ADMINISTRATOR ENVIRONMENTAL FEES DIVISION P.O. BOX 942879 SACRAMENTO, CA 94279-0001 Units authorized to operate at this location: UNDER CONDITIONAL'EXEMPTION: PROCESSOR #2 , UNDER CONDITIONAL EXEMPTION: 1 UNDER CONDITIONAL EXEMPTION: 3 UNDER CONDITIONAL EXEMPTION: 4 UNDER CONDITIONAL EXEMPTION: 5 UNDER CONDITIONAL EXEMPTION: 6 UNDER CONDITIONAL EXEMPTION: 7 UNDER CONDITIONAL EXEMPTION: 8 sT~OF C.:~IFORNIA--CALIFORNIA ENVIRON8 PETE WILSON, Governor ~,.o.DEPARTMENT,,oxso~ OF TOXIC SUBSTANCES CONTROL_\,. 400 P STREET, 4TH FLOOR ..//~ ~ ~ SACRAMENTO, CA 95812-0806 ~ ~x * ~ ~ (916) 323-5871 ~ :... /~: ., ~ ~ "~ :?' May 15, 1995 .:( ~.. x. ~ ~ . ;~. EPA ID: C~21754 B~RSFIELD MEMO~ HOSPIT~ xx~' Forfac~ ~ted at: G~Y STEVENS 420 34TH ST 420 34~ ST B~RSFIELD, CA 93303-1888 B~RSFIELD, CA 93303-1888 Authorization Date: 09/03/93 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DTSC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for technical adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additioualDepartment action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). You will be charged annual fees calcnlated on a calendar year basis for each year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature space on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this year. Print~l on Recycled Paper, Page 2 EPA ID: CAL000021754 If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this office at the letterhead'address or phone number. Michael S. Homer, Chief Ousite Hazardous Waste Treatment Unit Permit Streamlining Branch Hazardous Waste Management Program Enclosure cc: ASTRID JOHNSON DTSC REGION 1 STATE REGULATORY PROGRAM 1515 TOLLHOUSE CLOVIS, CA 93611 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2700 M STREET, SUITE 300 BAKERSFIELD, CA 93301 Page 3. EPA ID: CAL000021754 ENCLOSURE 1 Units authorized to operate at this location: UNDER CONDITIONAL AUTHORIZATION: UNDER CONDITIONAL EXEMPTION: 1 3 4 5 6 7 8 C. Larry Carr, President Board of Directors: Gordon K, Faster, Chairman Joel D. Mack. M.D., Vice Chai~m~n Bakersfield Memorial Hospital Edward H. Shuler, Secretary-Treasurer · Charles S. Ashmore, M.D, John M, Brock, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Larry Carr Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R. Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W, Smith February 15, 1995 Kern County Environmental Health C/O Dan Starkey 2700 M Street, Ste. 300 Bakersfield, CA 93301 Dear Dan: Upon completion of our State inspection of our silver recovery treatment units by Larry Shumate, State Inspector, we were advised to supply you with updated information. Enclosed, you will find documenation of the closing down of Treatment Unit #2 and the opening of Treatment Unit #8 to be effective April 1, 1995. Thank you for your time and consideration in this matter. Res/~ec t ful l ]~¥,/submi t t ed , .:bhry StF~ns z DirectOry of Imaging GS/aa encl . VH-~I~ Affiliate of Voluntary Hospitals of America, Inc.® C. Lar~ CarT, President Board of Directors: Gordon K. Foster, Chairman Joel D. Mock, M.D., Vice Chairman Bakersfield Memorial Hospital Edward H. Sh~,er. ~oreto~-rreasurer Charles S. Ashmore, M.D. John M. Brock, Jr. ACCREDI~D BY THE 3OINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Lam/Cart Stephen T. Clifford Mailing Address: PO. Box 1888 / Bakersfield, CA 93303-1888 John R. Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W. Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID # CAL 000021754 BOE # HAHQ22107432 SIC Code: 8062 Dear Sirs: This letter is to inform you of the application for the silver recovery cartridge treatment devices that are to service our new film processor scheduled to be installed April 1, 1995. It was recommended by State Inspector 'David L. Shumate that you be notified that this treatment unit is located at the same'~ facility address as our other six units. Resl~ct fully /~bmitt e~, Director of Imaging GS/aa V~=~A Affiliate of Voluntary Hospitals of America, Inc.® C. Larry Carr, President Board of Directors: Gordon K, Foster, Chairman Jael D. Mack, M.D.. Vice Chairman Bakersfield Memorial Hospital Eclwara H, Snu~er.Seorerary-Trecsurer Charles S. Ashmore, M.D. John M. Brock, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Larry Cart · Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 Jahn R. Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thamas W. Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID # CAL 000021754 BOE # HAHQ22107432 SIC Code: 8062 Dear Sirs: This letter is a notification of the closing down of unit #2 Treatment Unit at our facility. Our Emergency Room was relocated in July of 1994; and, at that time, the X-Ray Department and the Darkroom Facility were closed down. The silver recovery cartridge treatment device that was attached to processor #2 was also closed down at that time. ! . Re sp~.~c t ful 1Z/.~submzt ted, 'Gary St e.4ehs . Director of Imaging GS/aa VU"~l~ Affiliate of Voluntary Hospitals of America, Inc.® C. Larry Cart, President Board of Directors: Gordon K. Foster. Chairman Joel D. Mack. M.D.. Vice Chairma~ Edward H. Shufer, Secretary-Treasurer Bakersfield Memorial Hospital cho,es s. A~hmo,e, M.D. John M. Brock, Jr, ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALIHCARE ORGANIZATIONS C. Lorry Carr Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R. Findley, M.D. ' 420 34th Street / Telephone (805) 327-t792 Thomas W. Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID # CAL 000021754 BOE ~ HAHQ22107432 SIC Code: 8062 Dear Sirs: The enclosed documents are in response to the inspection report filed by David L. Shumate, Hazardous Substance Scientist, Department of Toxic Substance Control, on January 25, 1995. Enclosed is our facilities response to the violations and also the Certification of Return to Compliance document. I hope the enclosed documentation meets all Return to Compliance specifications; and, if any further information ms required, please contact me immediately. RespeCtfully s~/~mitted, ' ~irecto~/of Imaging GS/aa encl. VH,'A Affiliate of Voluntary Hospitals of America, Inc.® STAT.~. OF CALIFORNIA-ENVIRONMENTAL PRQ.YECTION AGENCY ____~ ..... ~ .... ==~===:= PETE WILSON, Governor DEPARTMENT OF ~ ~-~~E-~' ~'~'NTROL '" TIERED PERMITTING ' CERTIFICATION OF RETURN TO COMPLIANCE For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers In the matter of the Violation cited on' ,~- A~s Identified in the Inspection Report dated /. I certify under penalty of law that: 1. Respondent has corrected the violations specified in the notice of violation cited above. 2. I have personally examined any documentation amched to the certification to establish that the violations have been corrected. 3. Based on my examination of th~ attached documentation and inquiry of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete. 4. I am authorized to file this certification on behalf of the Respondent. 5. I am aware that there are significant penalties for submitting false information, including, the possibility of frae and imprisonment for knowing violations. GARY STEVENS':' ' ....... - DIRECTOR OF IMAGING Name~J~Print or Type) ~ Title Date Signed BAKERSFIELD MEMORIAL HOSPITAL EPA #000021754 Company Name EPA ID. Number DTSC-RETCOMP.CRT (8/94) P~ge 1 o~ ONSITE NOT CA ON FA~ ~PEC~C N~CA~ON - For U~ by H~ W~ Un~ ~fio~ ~e~on ~d ~n~ Auto--on, ~ R~ ~d by P~e rff~ to t~ ~ta~ I~~ b~ore ~ing t~ fo~ You ~ ~t~ for ~re t~ o~ ~ing t~ ~ ~g th~ ~t~c~ion fo~, D~C 1~. You m~ ~a~ a ~e di~e~ ~a ~fic ~tific~ion fo~ for ~ ~'x). You o~ ~'to x~ fo~ for ~ t~(x) t~ ~ ~ ~(~). D~ or re~c~ t~ ~ ~ fo~.- N~ ea~ page or,ur comp~ ~t~ion ~ge ~ i~c~e t~ total n~ of pag~ ~ t~ top of e~ ~ge ~ t~ 'Page ~ of__~ P~ your EPA ~ N~ on ea~ pag~ comp~ed ~c~t t~e t~ ~e '~ di~e~' or a~a~e~. ~ not~c~ionfe~ ~e ~x~z~ on the b~ of t~ n~ff of ti~ the ~tifi~ will oper~e ~, ~ will ~ ~1~ ~ t~ Stye Board of Eq~l~iom DO N~ ~ YO~ ~ ~ ~S N~~ON FO~. L NOT'CATION CA~GO~ [~ic~e t~ n~ of uni~ you op~e in ea~ tiff. ~ will a~o be t~ n~er of unit spe~fc ~t~c~ion fo~ you m~ ~a~ ~~ ~ ~ Q~ Tr~ o~ N~ o~ ~ ~d qt~ch~ u~t sp~fic no~o~ far ~ ~ re~. A. Conditio~ly Exempt-$~l Q~ti~ Tr~t~at D. Pe~t by Rule B. ~ Conditionally Exempt-5~i~ W~t~tr~m E. Co~erci~ C. Con&tio~ly Au~o~ F. Va~ce (~fion ~ 143) EPA ID NUMBER CA~ ~ ~ ~ ~ PHYSIC~ L~A~QN ~G ~D~, ~ D~~: COMPLY N~E [For DTSC U~ ~y ST~ I R~gion _ CI~ $TA~ ZIP COU~RY (o~y co~l~ i~ ~ USA) CO~A~ PERSON PHO~ ~t Nama) ~ Namc) DTSC 1772 (1/95) Page CONDITIONALLY EXF~UT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION - . (pursuant to He, al~ and Safety Code Section 25201.5(¢)) - The Tier-Specific Fact Sheets cootn;- a summary of the operatl.g requirements for this category. Please review those requirements carefully before completing or submittino~ ~ notification package. ~ER OF TREATMENT DEVICES: 0 Tank(s) / Container(s)/Conta/ner Tr~tment Ar~(s) NU1V[BER OF STORAGE DEVICF~:. Tank(s) E=Ch =.it mt=t be deart~ ld~nt~ed a~ Iabeted on the pl~t plan =tacl~d to Fo,m 1772. ,~=fg. your o~n ,..iq~e .umb~ to eac~ ,,nit. The .umber ca. be =eq~ntial (I, 2, 3) or t=ing a~, ~yste., ]ou choose. Enter the estimated monthly total vol'.trae of hazardou.~ waste treated by this unit. This should ba the max~n: um or highe, rt amount treated in any month. Indicate in the narrative (Section II) if yo. ur operations hove seasonal variations. L W~ AND TREA~ Estimated Monthly Total Volume Treated: pounds and/or c,~- gallons Estimated Monthly Total Volume Stored: pounds and/or gallons YES NO ['~ [~ Is the waste treated in tkis mt radioactive? ['"] [~ Is the waste treated in this unit a bio-b~nml/infectionslmedical waste? [--] l~ Is remotely generated ha?nrdoas waste (H$C 25110.10) treated ia this unit? The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: [~! I. Treats resins mixed or cured in accordance with the manufacturer's instructions (indudlng one-part pre-impregnated, materials). ['~ 2. Treat containers of 110 gallons 'or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. [""l 3. Drying special wastes, as dassifled by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. ['~ 4. Magnetic separation or screening to remove components from special waste, as classified by the depar~ent pursuant to Title 22, CCR, Section 66261.124. a:NOTE:a 5. NO AUTllORIZATION IS NEEDED to neatrallze acidic or alkaline (base) wastes from regeaemtion of ion exchange media used to demlnerallze water, crlais waste cannot contain more ,h.,n 10 perceat acid or base by weight to be eligible for this exemption.) ['-] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. [~ 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. *NOTE* Recovery of 10 gallons or less per month of silver from photofinishing completely exempt from permitting; this form need not be submitted. DT$C 1772B (I/95) Page I0 CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per Title 22, Califoi-nia Code of Regulations (CCR) Section 66270.11). 312 three copier mart have original xigm. . Wa$te Minimization I certify that I have a program ia place to reduce the volume, quantity, and toxicity of waste geaerated to the degree [ have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal curvmtly available to me which minimizes the present aad furur~ threat to human health and the ~nvirotmamat. Tiered Permitting Certification I certify that the unit or units described ia th~ docam~nts meet the eligibility md operating r~quir~ments of state statutes and regulations for the indicated permitting tier, including geaerator md secondary eon~t requir~meats. I tmderataad that i~f any of the units operate under Permit by Rule or Conditional Authorization, I will also b~ r~qui~ to provide r~quir~i fi. aaacial a.aauraace for closu~ of the treatm~at unit by lanuary 1, 1995. I certify under penalty of law that this document and all attachmenm were prepared under my dir~:tion or supervision in _~ccordaac~ with a system desigued to assur~ that qualified per, heel properly gather and evaluate the information submitted. Ba..~ on my iaquL,'y of the per, on or per, ns who manage the system, or those directly resp~ibl¢ for gathcriag the ia£ormation, the iaformation is, to the be~t of my knowledge and belief, true, accurate, aad complete. I am aware that thar~ ar~ substantial penaltiea for submitting fal.~ iaformation,, iac!udiag the l~saibility of fia~ and impr~-m~at for knowing violations. D:ue Signed OPERATING REQUI1LEMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the ~T~er-$peci. fic Fact Sheets available.from t,% Department's regional and headquarters o.~ces. SUBI~LISSION PROCEDURES: You must xu~mlt two copie:t of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section 400 P. Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must also submit one copy of the notification and attachments to the local regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part af your operating record. All three forms ~tst have original, signatures, not photocopies. DTSC 1772 (I/95) Page 3 ' ~,; ~;~, .__~..~_ DP-. ..... -- i, ....... 'i ~ ~ I 12 SPACES ~4 SPACES 34TH STREET ONSITE WASTE T1LEA NOTIFiCA2- ION FORM FA~ SPE~C NO~CA~ON ' Un~ ~do~ ~c~don ~d ~n~d~ Auto--on, ~ R~ ~d by P~t By R~c F~{Ii~ iV~ ea~ page or.ur comp~ ~t~ion ~ge ~ i~'c~e t~ ford n~ of pag~ ~ t~ top of 'Page ~ of ~'. P~ yo~ ~A ~ N~ on ea~ pag~ P~t pro~ ~ of tb~ info--ion ~q~. ~ notific~ion fe~ ~e ~s~s~ on t~t b~L- of t~ n~2~ of :i~ the ~tifier will opine ~, ~ will ~ NOT.CATION CA~GO~ I~ic~e t~ n~ of unt~ you opine in ea~ ti~. Tn~ will a~o be t~ n~er of unit ~edfic ~tific~ion fo~ you m~ A. Caadirio~ly Exempt-S~l Q~ti~ Trmt~at D. Pemt by Rule B. ~' Coaditio~lly Exempt-~ifi~ W~t~trmm E. Commerd~ C. Coa~tio~ly Au~od~ F. Vafi~ce (~tioa ~143) PHYSIC~ L~A~ON ST~ [Region CI~ STA~ ZIP COU~Y (o~y ~o~1~ if ~ USA) C0~A~ PERSON PHO~ ~t Nama) ~a Mama) DTSC 1772 (1/95) Page 1 P~ge~ ~T~CA~ONS: ~ fo~ m~t be ~i~ ~ a, a':~ calorie o~c~ or h~ op~a~iona~ con~ol a~ F~o~ de~ion-m~n~L '.n~ior~ :~ go*~ option of the fa~li~ (p~ ~:~ 22, C~ifo~ C~e of Regu~'io~ (CCR) 8e~ion ~270. I1). ~ a~:.,~ ~p~ ~ ~ oHg~ Mg~. _ Tiered Pe~itting Ce~mtlon I caai~ ~t ~a ~t or ~= d~ ~ ~ d~m~ m~ ~a e~b~ mdo~g ~ui~menm of smta s~mt~ ~d ~latio~ for ~e ~t~ ~ttmg fi~t, ~ctu~g g~e~tor ~d ~n~ ~uigm~m. i ~d~d ~t if my of ~e ~ o~ ~d~ P~t by Rule or Cen~6o~ Auto--on, I m pmvid~ ~ 5-~ci~ ~ca for cte~ of ~a a~t ~t by ~ I, 1995. I ca~Pl ~der ~ of law ~t ~his d~um~t ~d ~I at~&q~ we~ p~p~ ~dar my of ~e ~n or ~ who maga tha sys:em, or ~a~ dimity ~ibla for ga~a~g I ~ aw~ ~t ~em ~ ~bs~ti~ ~nalti~ for ~b~tt~g f~ ~fomfiom- ~clud~g ~a ~ibility of for ~o~g Date OFE~T~G ~Q~~S: Pleat note that generators treating h~ardo~ w~te ot~ite are required :o comply with a n~ber of operating requir~en~ whi~ di~er depe~ing on the tier(s). ~e operating requirements are set fonh in the statut~ a~ regu~io~, some of whi~ are referenc~ in the ~er-~pec~c Fa~ Sheets available ~om the Depanment's regional a~ he~q~rs o~c~. S~NHSSION PROCED~S: You m~: s~it ~ ~pi~ of this completed not,cation by csn~ed mail, return receipt requited, to: Depa~ment of Toxic Substanc~ Con:rol Progr~ D~a Management 2e~ion ~ ~ Street, 4th F~oor, Room ~53 {wa& h only) P.O. Box ~6 Sa~ento, CA 95812~6.' You m~t a~o s~mit o~ ~ of the not,cation a~ attachments to the local regulazo~f agen~f in your ju~ion ~ l~t~ in Appe~k 2 of :~e ~:ru~ion material. You m~t a~o retain a copy ~ pa~ of your oper~ing record. All thres fo~ ~t ~ oHg~r~l sig~, ~t DTSC 1772 (i/95) Page - . ~1 to E~ ad Safe~ C~e S~on ~201.5(c)) _ - ~e ~~c Fa~ Sh~ con~ a ~ of ~e o~ng ~m~m for m~ew ~ ~menm ~y ~fo~ completing or ~b~ '~ no~3mfion ~e. Ea~ unit m~t be c~Q ~nt~ ~ ~e~d on the p~t p~ mrad~d to Fo~ 1 ~. ~,ign your own uniq~ n~ to ea~ unit. ~e n~ ~ be seq~ial (I, 2, 3) or ~ing ~ ~ ~u ~ated Mon~ly To~ Vol~e T~t~: ~ ~er g~lo~ ~timat~ Money To~ Volme Stored: ~ ~dlor gallom YES NO ~ ~ ~e w~te tr~t~ ~ ~s ~t radioactive? ~ Is remotely geaemt~ ~do~ w~te (HSC ~ i 10.10) ~mt~ ~ ~s ~t? ~e fol~wing are the eligible w~r~tre~ a~ tre~ment proca~s~. Ple~e ~eck all applic~le boxy: ~ 1. Trmm r~i~ mked or c~ in accor~nce with ~e manufacturer's i~cfio~ (indu~ on,pm ~d · ' pr~impr~nated matlab). ~ 2. Trmt conmin~ of 110 gallo~ .or 1~ ~padty L~t conmlned h~rdom rote by ~ing or physi~ pr~, su~ ~ ~hing, shredding, gdndlng, or p~ct~. ~ 3. D~ing sp~ wat~; ~ dai~d by ae depma~i~t pmmt to Title *2, CCR, ~fion ~261.~, by prying or by p~ive or h~t-aided evaporation to r~ove wat~. ~ 4. ' Magnetic separation or s~ng to remove componen~ from sp~al w~te, ~ d~i~ by ~e depaanent pum~nt to Title ~, CCR, S~fion 66261.124. =NO~a 5. NO A~OR~A~ON IS ~ m ~li~ ad~c or t~nn 10 ~t a~d or ~ by w~ht m ~ ~ble for ~ ~ 6. Neuml~ a~dic or ~ine (b=e) w~t~ from the f~d proofing indm~. '~ 7. R<ov~ of silver from photofinhhing. The volme limit for condifion~ ~x~pfion generator (at the s~e lo~fion) in any mlendar mon~. =NO~* R~oVery of 10 g~ons or l~s ~r month of s~ver from photofinishing ~mpietety exempt from ~r~ing; this form aced not be submit. DTSC i772B (1/95) Page Y c _ · .... ' * * '12 SPACIE8 __. . \ ~t $ PAC_~ $ r-- \ · 126 SP~ --~. . __ ~ * ~.~ 34TH STREET ONSI NO CA ON FA~ SPE 2~C N~CA~ON ~d by pm: By R~ F~tifi~ ~ P~t r~ m t~ ~ ;~~ b~ore m~g t~ fo~ You ~ ~ti~ for ~re t~ o~ ~ing t~ ~ diff~em ~it $~fic ~t~cm{on fo~ for e~ of :~ fo~ ~ego~ ~ ~ ~dir~ ~tifi~ion fo~ for m~n~M ~ ~'~). ~o~ o~ ~'to ~ fo~ for ~ t~) ~ m~ ~ ~(~). D~d or rtq~ t~ ~ m~ fo~. N~ ea~ page of your mmp~ ~tifi~on ~ge ~ i~cme ~ total n~ of pag~ ~ t~ top of e~ ~ge 'Page__ of __[ Pm yo~ EPA ~ N~ on ~ paga fkme pro~ ~ of t~ info--ion req~' aH fie~ comf~d ~qt t~t t~ g~t '~ &~e~' or '~ avai~ 5 P~e ~e ~ info~n pm~ on th~ fo~ atta~e~. ~ not~cmianfe~ ~e ~,~ on the b~ of:?~ n~ ofti~ the ~tifi~ wiiI op~me ~, ~ MH ~ ml~ L NOT'CATION CA~GO~ IMic~e :b~ n~r of uni~ you op~e in ea~ ti~. ~ wilI a~o be t~ n~er of una ,pedfic ~t~c~ion fo~ you m~ Nm~ o~ ~ ~d gt~ch~ ~t sp~fic no6fi~fio~ for m~ ~er re~m~. A. Coaditio~Iy Exempt-S~l Q~ti~ Tr~t~at D. Pe~t by Rule B. Xv' Coaditioaatly Exempt-S~ifi~ W~t~trmm E. Comme~i~ C. Coa~tio~ly Au~od~ F. V~ca (~tioa ~143) ~. G~N~T OR ~EN~CATION EPA ID NUMBER CA L 0 ~2 Z ( q ~ ~ BOENUMBER(ifavaiIable) H~HQ~ ( 0 7 PHYSlC~ L~A~ON l~ - COMPLY N&ME [~or DTSC I S~ [Region STA~ ZIP COU~Y (o~y co~le~ if ~ USA) CO~A~ PERSON PHO~ ~ER~ (~t Name) ~a Name) DTSC 1772 (1/95) Page 1 CXz. oooo C~I~T~-ICATIONS: 7'ais form must be sig~ ~ ~ c:~:?~ co,erie o~c~ or C~e of Regu~ior~ (CCR) Seaion ~270.11). ~ ~.~ ~p~ ~ 7~ offg~ Mg~. . di~ e~y av~able to me which ~~ ~e p~nt ~d ~am~ ~ ~ui~m~m. I ~de~d ~t i~y of ~ ~a o~te ~d~ ?a~fit by Rule ar I cem~ ~der ~ of law ~t ~s d~um~t ~d ~1 at~a were pre~a~ ~der my di~on or ~ a ~stem d~i~ to ~ ~t q~ifi~ ~el pm~rty ga&er ~d ev~e of ~e ~n or ~ who ~age the system, or ~o~ di~:iy ~ible for gate.ag ae ~t of my ~owt~ge ~d Miler, Wae, ~umte, ad for ~o~g violation. N~e (P~T~) OPE~T~G ~Q~~S: ~e~e note that generatom treating h~ardo~ w~te ot~ite are required 1o comply with a n~ber of operating requir~nm which differ depe~Zng on the tier(s). ~a~e operating requirements are set forth in the s~atut~ a~ regu~io~, some of whi~ are referenc~ in the ~er-~pec~c Fa~ $heetx available ~om the Depamment's regional a~ he~q~ne~ o~c~. ~SSION PROCED~S: - You m~t s~it ~ ~pi~ of this completed not,cation by cen~ed mail. return receipt requited, to: ~epanment of ToMc Substanc~ Control Progr~ Data Mat~gement $egion ~ ~ S~eet. 4th ~Zoor, Room ~53 (wa& in only) P.O. Box ~6 Sa~ento, CA 95812~6. You m~t a~o s~mit o~ ~ of the not,cation a~ attachmen~ to the local regulato~ agen~/ in your ju~di~ion ~ l~t~ in Appe~ 2 of ;he i~trugion material. You m~t a~o retain a copy ~ pan of your oper~ing record. DTSC 1772 (1/95) Page CONDITIONALLY EXE~Grr (pm-suaa£ to Heal~ and Safer/Code Section 2-5201.$(¢)) _ The Tier-Specific Fac~ Sheets contain a surnrnu? of the operating requirements for th~ category.' l~.eas~ review those requiremen~ carefully be£ore complet~ug or submitting this notit~cafion package. NUlVl]3E~ OF TREATMENT DEVICES: O Tank(s) ~ Conminer(s)/eanra/ner Treaanent ,~a(s) ~'~:[ OF STORAGE DEVIl. S: Tank(s) Each unit must be cfzar~, identifir, d ar~t label~ on &e plot plan attacJted to Form 1772. A~sign your own unique number to each unit. 73¢ number can be sequential (1, 2, 3) or using any. ~srern you choose. Enter the estimared monthly total volurr~ of ht~dous wmvte trearsd by this unit. This should be the nmMmum or highest amount trea,.ed in any mom& indicaxe in the na~'ative ($eczion If) if yo. ur operazions /~ve seasonal variations. L WAS'rE~fRE~MS ~ND TREA~ Estimated Monthly Total Volume Treated: t~uads md/ar /~--..~-"" gallons Estimated Monthly Total 'Volume Stored: tmuads and/or, gallons YES NO [-] [~ Is tha wasta treated in '.his unit radioac:ive? ['-] [~ Ia tiaa wa~ta treated ia this unit a bio-hazard/infectiousLmedical waste? [] [~ Is remotely generated hazardous wazta (HSC 25110. I0) treated ia this unit? The following are the eligible wctstestrearns and treatment processes. Please check all applicable boxes: [~] 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part .and pre-impr~nated materials). [-'] 2. Treat containers ~ of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such az crushing, shredding, grinding, or puncturing. 1-"] 3. DrTing spec. lal wastes, as-cta~ifled by the depa~nt~ent pursuant to Title 2.2, CCR, Section 66261.12A, by pressing or by passive or heat-aided evaporation to remove water. ['~ 4. Magnetic separation or screening to remove components from special waste, az classified by the depaxtment pursuant to Title 22, CCR, Section 66261.124. 'NOTE" s. No AUTFIORFZATION IS ,NEEDED to ne~la-nl;7~ acidic or alkaline (base) wns~ from the regeaeration of ion exchange media used to dem;neraiize water. (This waste ~nnot contain more th.an 10 perceat acid or ~ by weight to be etL~ble for this exemption_) ~ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. [~// 7. Recovery of silver from photofinlshing. The volume limit for conditional exemption i.s 500 gallons per generator (at the same location) in any calendar month. =NOTE= Recovery of 10 gallons or hms per month of silver from photofinlshlng completely exempt ,"rom permitting; tMs form need not be submitted. DTSC 1772B (I/95) Page 10 of - ON$ITE I-IA~ZARDOUS WASTE ..REATMENT NOTIFICA~ON FOIL, VI FACYLi~f $?.' ~C N~CA~ON _ For U~ by ~~ W~ ~ G~emm~ P~o~g T~t ~d by P~'2c By R~ F~ilifi~ P~e r~ m t~ ~ Ia~ b(ore m~ing t~ fo~ You ~/ ~ti~ for ~re ~tifi~ion fom. D~C I~ ~oa m~ ~a~ a ~me ~ ~dfic ~tific~n fo~ for e~ u~ N~ ea~ page or,ur ~mp~ ~tifi~ion ~ge ~ i~'cme t~ wml n~ of pag~ 'Page ~ of ~'. P~ yo~ ~nA ~ N~ on ~ pag~ P~t pro~ ~ of t~ info--ion req~' a~ fie~ ana~e~. ~ notificmion fe~ ~e ~,~ on t~ b~ of t~ n~ of ri~ the ~tifi~ will oper~e ~, ~ wiH ~ ml~ ~ t~ NOT'CATION CA~GO~ I~icme t~ n~ o~uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of unit spedfic ~t~cmion fo~ you m~ ~a~ Nm~ ot ~ ~d ~t~ched uffit sp~flc nofifl~fio~ tar m~ tier A. Condkio~ly Exempt-S~l Q~ti~ Tritest D. Peru; by Rui¢ B. ~' Conditionall7 ~empt-S~ifi~ W~t~tr~m E. Co~erciM C. Con~tio~ly Au~od~ F. ... V~ce (~tion ~143) H. G~TOR ~E~CATION EPA ID N~BER CA~ ~ ~ ~ ~ Z ( ~ ~ ~ BOE NUMBER (if available) H~HQ~ .. z ~G ~D~, ~ D~RE~: COMPLY N~E ST~ {R:~ion CI~ STA~ ZIP COU~Y (o~y co~1¢~ il ~ USA) C0~A~ PERSON PHO~ ~m[ Name) ~ Name) DTSC 1772 (1/95) page 1 ~f]2t. CERTL-rICATIONS: ThL~/or~ mas: be :igned by. an au:?.ariz~ cc~. orcce offic~ or ~ other per, on in the company has operational control and performs decision-majdng fun~:ionx that govern operation of ~he I'aciliry (per TuI~ 22, Ca!~?oinia Code of Regukuionx (OCR) 3eoion 66270.11). AIl thr~ c~pi~ mart ~ original ~g~-.=-~._ Waste Minlmimtion I ceriify that I have a pmgra.m La plac, s to reduce the volume, quandry, and to.'rdcity of waste generated tO tee degree I have determl-ed to be economically prac:icabl¢ and that [ have selected the practicable toe'-heal of treatment~ storage, or di .s-~sal cm'rendy available to me which minimizes the present and ~rure threat to hunm~ health and thc enviro~m~ac T:ered Permitting Cer~ifi~tion I certify [hat the unit or ur. icz described La &es~ dcx:uments meet the eligfoLli~ and mauirem~nts of state statutes and reg,aiaticns for the indica.,ea Ferm~tthag ~er. inctudLiag generator and secondary. requirements. I tmderstand that i.f may of the traits operate under ?er'mit by Rule or Conditional Au~oriT~6on, I wiil also be mquLr~ tO provide req ;uired Financial a~m-ance for clca'u.r~ of the tmatm~t unit by Jan,.szry I, 1995. I certify under penalty of law that 'd~is document and all attach, re<ts were prepared trader my direction or supervision La acc~rdanc~ with a system designed to assure that qualified personnel preperiy gather and evaluate the information submitt, ed. Based on my of the person or persons who ,'m.nage the system, or those directly rexponsibIe for gatherLag the information, thc Laformadon is, tO the be. st of my knowledge and belief, true, accurate, and comple:e. I ax= aware th,at ',hem are substantial penalties for submitting false ia£or'mation,- Lactuding the p~ssibiilty of fiaes and irnpr4_Sonrr~£ for knowLag violations. $i=maa.~ ~ Date Si~maed OPERATING REQUIR. EMZENTS: ?t. eaxe note that generator, treating hazardous waste ot~ite are required to comply with a number of operating requirements which differ depending on the tier(x). 7'~exe operating requirements are set forth in the statuter and regul~,eiortr, xome of which are referenced in the 2~er~pecific Fac~ Sheet, available from the Department's regional and headquarrelv office. SUB~vLISSION PROCEDU'tLES: You mast ~ub~it tw~ copier of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substanc~ Control Program Data Ma~u~gernent Section 409 P. ~treet, 4th Floor, Room 4453 (waLk tn only) P.O. Box 806 Sacramento, CA 95812-0806. You mast alto smbmit oru~ coov of the notificazion and attachments to th~ local regulazorf agency in your jurixdi~ion ax listeaf in Appendi. r 2 of the instruction materials. You mast aL~o retain a copy as par~ of your operating record. All thre~.form~ muat hav~ original signatures, not ~tmtocopiex. DTSC 1772 (1/95) Page C©NDIT~©NALL¥ EX~~ - $?EC~LED WASTES~A~'vIS UNTI' SPEC~C NO~iCA~ON . ~t to H~ ~d Safe~/C~ S~oa ~201.5(c)) _ ~e ~-S~c Fa~'Sh~ cont~{n a ~ of ~e o~~ ~~ for m~ew ~ ~men~ ~y ~fo~ comple~ng or mb~ ~ noOn,on ~e. 0 / E=~ unit m~t be c&~ ~ ~ ~e&d on the p~t p~ ~ta~ to Fo~ 1~. ~sign your own uniq~ unit. The n~ ~ be ~eq~miai (1, 2, 3) or ~ing ~ ~ ~u En:~ the ~t~ ~mhly total ~l~ of ~~ w~, ~e~ ~ th~ unit. ~ s~uM ~e~ in ~ ~ IMic~e in t~ ~ive (Se~ion II) ~ ~yr op~io~ ~ ~e~o~ ~o~. ~ated Mon~ly To~ Vol~e T~t~: ~ ~d/or ~ ~timat~ Mon~ly To~ Vol~e Stored: ~ ~d/or gallo~ YES NO ~ Is ~ w~te tr~t~ ~ ~s ~t radioactive? ~ ' ~ Is remotely geaemt~ ha~nrdo~ w~te (HSC ~ 110.10) ~t~ ~ ~s ~t? Tae fol~wing are the eligible w~t~tre~ a~ tre~ment process. Plebe ~e~ ali applic~le boxy: ~ 1. Tr~ r~i~ raked or c~ in accor~nce with ~e manufactureFs im~cfiom (indu~ on~p~ ~d pr~impr~ted matlab). ~ 2. Trot conmln~ of 110 g~Iom or 1~ ~pa6ty ~t contained ~rdo~ ~te by H~ing or physi~ pr~, suah ~ ~ng, shred~ng, gHnding, or p~c~. ~ 3. D~ing sp~ w~t~, ~ d~i~ by ~e dep~t~t p~t to Title ~, CCR, ~fion ~261.~, by prying or by p~ive or h~t-aided evaporation to r~ove ~t~. ~ 4. ' Magnetic sepam6on or ~ng to r~ove componen~ from spool w~te, ~ d~i~ by ~e dep~ent pu~nt to Ti~e ~, CCR, S~fion 66261.124. ~NO~~ 5. NO A~OR~A~ON ~ ~~ ~ ~]i~ a6~c or ~fion of ion ~ckn~e m~ ~ m d~;~li~- ~. ~ ~ ~t ~n~ mo~ tko, 10 ~t a6d or ~ by w~ht ~ ~ ~ble for ~ ~ 6. Neu~li~ a6dic or ~ine (b~e) w~t~ from the f~d pinching ind~. ~ 7. R~ov~ of silver from photo~hing. The vol~e limit for condi~on~ ax~p~on generator (at the s~e lo~Hon) in any ~lendar month. =NOTE= Recovery of 10 gallons or less per month of silver from photofinishing is completely exempt from permit'dng; this form nc. cd not be submitted. DTSC 1772B (1195) Pag~ i0 ONSITE HAZARDOUS WASTE TI ATMENT NOTIi CATION FORM FACIJ=_ri'Y SPECI~C NOTIFICATION _ For Usa by H~,~,-d~ua Wast~ Geaeramrs Performing Treatment [] Initial Under Conditional Exemption and Conditional Authorization, ~ and by P~amait By Rule Fa~iliti~s [] P~age refer to tI, e attachext Insrruc~ior~ before campl~ing thi~ form. Yo- may notify for more than one permixting tier by aring thi~ notification form, DT~C 277'2. You must arrant a ,eparat~ ,.mit .~ecific notification form for each unit at ~ location. There are different unit specific notificaxion forrn~ for each of tht four categori~ ~ an m4d;rioruxl ru~tificaxion forrn for trana~rtable treatment u~x (TT~'x}. You on2y have'to ~ubmit forrn~ for t~ tier(s) thax cover your unit(s). Discard or rea'ycle the other Number each page of your campleted notification pa~ge and in&'cate the tatal number of page~ at the top of east page ar the 'Page __ of__'. P:a your F_PA 1D Number on each page_ Pleare provide ail of the information requtrted; all fiet. d~ mart be completed eccctpt tho.,¢ that ~axe 'if different' or 'if available'. Plea. re type the informaxion provided on thi~ form and any artachrnent~. The notification fee., are axse.~sed on the basi.~ of the num3er of tierz the notifitr will operate under, ancl will be catIeaed by tht State Board of Equalization. DO NOT SEND YOLrR F~ WITFI 7-F[IS NO77FTC. A ~'JTON FORM. NOTIFICATION CATEGORIES Indicate :he number of unit. r you operate in each tier. Thi~ will a~o be the number of unit ~'pecific notification formx you mart attach. Condixionalty ~ Small Qua~ Treatrntnt aperaxiar~ may not apo'axe ~ ant~ any otht~ tier. Number or' uni~ and ~ttached unit specific notiflcation~ far each tier reported. A. Conditionally Exempt-Small Quaati~ Tr~atmeat D. .... Permit by Rule B. Ny Coaditioaally Exempt-Specified Wa~te~tream E. Commercial Latmdry C. Conditionally Authorized F. Variaace (Section 25143) 11. GEaN-ERAT OR IDEN'rlYlCATION EPA ID NUMBER CAL- 0.9_ .0_ O_. O 2. ( "1 ~' ~3t BOE NUMBER (if available) H~_..HQ.~_ L [ O 7 ~ 5 2-- PHYSICAL LOCATION M. AIZING ADDRESS, IF DrlrFERE,XU': COMPANY NAME IFor DTSC U. Only ] ST'XR.E _---'T [R~gion _ CITY STATE ZIP - COUNTRY (only complete it' tax USA) CONTACT PERSON PHONE NLrMBER( ] - CFirzl ,"lam~) CLeat Nam,') DTSC 1772 (1/95) Page 1 YIn. CERTIFICATIONS: i'nis ~orm mu~t be signed by, an a~:/'u~rized corporate o.~c~' or ~ ot~ p~on in t~ ~mp~ w~ d{~ curdy av~hblc to me which ~~ ~e p~nt ~d ~m~ ~t to hu~ h~ ~d ~e ~v~t. . .. o~ uhc ~u or ~ who ~agc th~ ~stam, or nfio~ di~:ty ~ible for ga~=~g ~e ~fo~don, ~ ~fo~don ~, m for ~o~g viol~io~. OPE~T~G ~Qb~N~S: ~NHSSION PROCED~S: - You m~t s~'it ~ ~pi~ of this completed not,cation by cen~ed mail, return receipt requited, ~o: Depanment of To~ic Substanc~ Control Progr~ D~a Mm~gement Se~ion ~ ~ Street, 4th Floor, Room ~53 (wa& in only) P.O. Box ~6 Sa~ento, CA 95812~6. You m~t a~o s~mit o~ ~ of the notifcation a~ attachments to the local regu~to~ agen~ in your ju~df~ion ~ l~ in ~ 2 of ~ i~tr~fo~ ~at~Ha~. ~o~ m~t a~o retain a copy ~ pa~ of your oper~ing record. DTSC 1772 (I195) Page 3 CONDITIONALLY EXEblYT - 5PECI~"IED WASTES_'!T~.AMS UNIT SPEGr~=!C >~OTI2riCATION . (purmmat to HeaPh a.~d Safer,,' C~xl~ Se*:fion %5201.$(¢)) - The Tier-Spee. ific Fact Sh~s eontni- a s'ummar3r of t'~e o.veratlng ~rnents for this mtegory. Please review thase requirements car~y before completing or submi~ng thi~ nothScation NIO,"M~EIt OF TI~EATI~'-'N~ DEVI~_v,S: O Tank(s) __ Coutainer(s)tContainer Tr~t Ar~(s) " ?~.'qVEBER OF STORAGE DEVICES: Each unit mu~t b~ ¢~ar?y idaneifie~l ~ lWo~e~l on t~ ~ ~ =m~d to Fo~ 1 ~. ~timnt~ ~on~ly To~ Volme S~ored: ~ ~d/or gallo~ ~S NO ~ Is re=oteiy genemt~ ~,,,,do~ w~t~ (HSC ~tlO. lO) tr=t~ N ~s ~t? Tae fol~wing are the eligiM¢ ~r~tre~ aM tre~ment proc~aes. Plebe ~e~ ali applic~le boxy: ~ 1. Trm~ r~i~ mhed or c~ in accor~nce with ~e m~actur~s i~c~o~ (indu~ on~p~ ' pr~impr~nated mariaN). ~ 2. Trmt conminm of I10 gallo~ or 1~ mpadt7 ~t contained ~rdo~ ~te by N~ng or ph~ pr~, su~ ~ ~hing, shredding, gdnding, or p~ct~. ~ 3. D~ing sp~ w~t~, =~&~ifi~ by ~e depmhnent pm~t to Title ~, CCR, ~fion ~26I.~, by prying or by p~ive or hint-aided evapo~on to r~ove wat~. ~ 4. ' Magnetic sepa~fion or ~Mng to rmmove componen~ Dom sp~al w=le, = d~ifi~ by ~e dep~mt pu~nt to Title 9~, CCR, S<~on 66261.124. tknn 10 ~t add or ~ by w~ht ~ ~ ~ble for ~ ~ 6. Neu~li~ addle or ~ine (b=e) w=tm Dom the r~d proc~ing ind~. ~ 7. R<ov~ of silver Dom photofi~hing. The volme limit for condi~on~ &x~p~on gene~tor (at the s~e lom~on) in any mlendar month. =NOTE= Recovery of 10 gallons or less per month of silver from photofinishing is completely exempt Dom permit-ting; this form need not be submitted. DT$C 1772B (i/95) Page I0 ONSITE HAZA.RDOUS WASTE TREATMENT NO--CATION FOI:~M FACILEi'~ SPECIFIC N~CATION For Us~ by F~m~..~ua Wa~t~ ~a¢:mora P~.~orml,,g T~ Un~ ~o~ Exe~dan md ~~ Auto--on, ~ R~ md by P~t By R~e F~ilifi~ P~e r~ m t~ ~ I~~ b~ore m~ing t~ fo~ You ~ ~ti~ for ~re ~t~cmion fo~. D~C 1~. You m~ ~a~ a ,~e ~ ~fic ~r~c~n fom for diff~e~ ~it ,~dfic ~tificmion fo~ for e~ of t~ fo~ ~ego~ ~ ~ N~ ea~ page or,ur comp~ ~tifi~ion ~ge ~ i~t t~ 'Page ~ of ~5 P~ your ~A ~ N~ on ea~ pag~ Pk~e pro~ comp~ ~c~t t~e t~ ~me '[ differ' or '~ avai~ [ Pkme a~a~e~. T~ not~c~ian fe~ ~ ~s~s~ on t~ b~ of :~ n~ of :i~ the ~t(a~ wi~ oper~t NOT,CATION CA~GO~ IMic~t thz n~r of uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of una ~e~fic ~t~c~ionfo~ you m~ ~a~ ~~ ~ ~ Q~ Tr~ o~ ~ ,~ o~ Nm~ o~ ~ ~d gt~qh~ u~t sp~fic nofi~fio~ for m~ ~ re~m~. A. Conditio~ly Exempt-S~l Q~ti~ Tr~t~at D. Pe~t by Rule B. ~:' Canditioaally Exemp~-S~ifi~ W~t~tr~m E. Co~erc~M C. Coa~tio~ly Au~od~ F. V~ca (~tiea ~143) u. G~TOR mE~CATION EPA ID NUMBER CAL 0 ~ ~ ~ L ( ~ ~ ~ BGE NUMBER (if available) H~HQ~ PHY51C~ L~A~ON / ' COMPanY N~E ST~ R~gion ,. CI~ STA~ ZIP COU~Y (o~y co.leto if r~ USA) CONWA~ PERSON ~mZ Name) ~t Name) DTSC I772 (1/95) Page " '-' 7'7 " Z. 2... ~"~C.-kTION$: 7'nix.form must be signed by, an .' ':'.orized corporcae officer or any. otter ,~ercon in rl~ comt~an~ ha, operational control and performs dec;.sion-maJa'ng~.......':.ions :hat govern opera:~on of the fa&..lity ('per T~tle 22, ~ai~o~ia Code of Regulations (CC2~) Seaion 66270.11). All tb..~..x ~pit~ mart ]'.ave original ~ig~. . Waste Minimlza~on I cerfif'y that I I:tava a program La piac.~ to ,-~duca the volume, quantity,, a.nd toxici .ty of wa.sm generated degre~ [ have dete.?nlned to be economically prae:icabi¢ and th~ I Mve seiec:ed the practicable method of treatment, storage, or di .~posal curt'early available to me which minimizes the pre~en£ md ~rum threat to human health and the envh'~nment. .. Tiered Permitting Cer~i~c:ntion I csmify that the uait or ur. ia d~_~cdbed in ~.hee~ documents meet the etigibit'tr/ and requi~ments of state stamte~ and regulafio~ for the indicated ~.-mitting tie~', including generator :md see~ndary~ con ;minmen~ :~uirements. I under~mnd that i~f any of the units operam under Permit by Rule or Condi~onal Au~orizaxion, I will aL~ be to provide require~ S~nc~al aasuran~ for clomzre of the ~v~.ent unit by .tatum.fy I, 1995. I certify under per, dry of law tha~ this document and all aV. aekme:~a wer~ prepared under my direction or supervision ,.'n ac.z. ordanc~ with a sy. stem designed to a.xsure that quaiiied personnel pm~riy gat,her and evai ,uate the Lnformation s~abmitted. Based on my inquiry of the person or pe,-morm who manage the ~ys:em, or thos~ direcdy re~-~.~nsible for gathering the information, the information L% the best of my knowledge and belief, true, accurate, and comple~.e. I am aware that the~ aze substantial penalde~ for submitting false information,, including the po=ibilky of fmcs and for knowing violations. ' "--"'-' -'777 /7, q"i-' Si~aaturv/ ~/ - / '~' ' Date Signed OPERATING REQ~M2ENTS: ?!ease note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the 7~er-$pecific Fac~ Sheets available from the Department's regional and headquar:ers offices. SUBMXSStON PROCEDURES: You must subinlt two c'ooie~ of this. completed notification by certified mail, return receipt requested, to: Department of Toxic Substances COntrol Program Data Management Section 400 P. Street, 4th Fbor, R3om 4.453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must also cubmit on~ cowry of the notification and attachments to the local regulato~ agen~/ ~n your jurisdic:.ion ar listed in Appendix 2 of the instruc:ion materials. You must also retain a copy ar para of your operating record. All three forms trivet have original signatures, not photocopies. DTSC 1772 (1/95) page 3 CONDITIONALLY E~-"~~ SPECI~ED WASTES~A~."VlS UNTT SPEC~"i(': No'rIFiCATION . (pm'xtm~t to Healfla and Saf~ Code S~don Z5201.5(c)) _ T'ne Tier~Spee. gie Fact She~t.s contain a s~mm.r'~ of ~e Ol~l'~l~llg ~e~.~.S for ~ entegorir. review ~nse reqairv, ments c=.ret'-tly before completing or sabmi~ng rials notitimtion NTIN[BEI% OF TREAx~-NfE..'NT DEVICES: 0 Tank(s) / Container(s)/Conmin~-. T."c~sr~n: Ax~a(s) : NIJSfBER OF STORAGE DEVICES: __ Tank(s) Each ,,=i~ ~usz b~ ct~ar~y i~m~i~d and labeled on ~h~ t~lot i~l~m axrarJ~.d to Form 1772. Xs~ig~ ?o~r ow, u=lq~ number ~ =ni~. 7'n~ ,umber c~ be ~¢que~iai (I. 2.3) or ~in~ arty sy~vam 7ou choosz. £n:~ ~h~ as~in,~ed mo,uhly total ~ol=r,u~ of h~---~,rdo~ w~ rre=ad by. :hi~ uni:. 7~is ;houkt be rh, rr~a~m .=n or higher: ~ated Mon~ly To~ Vol~e T~t~: ~ ~or ~ g~lo~ ~t~at~ Mon~ly To~ Volme Stored: ~=~ md/or gallo~ YES NO ~ ~ Is remotely genent~ ha~=rdo~ w=te (HSC ~10.10) tr~t~ M ~s ~e fol~ing are the eligible w~r~tre~ ~ tremment process. Ple=e ~eci all applic~le boxy: ~ 1. Tr~ r~i~ tuned or c~ in aceor~nce with ~e m=~acturer~s im~cfio~ (indu~ on,pm : pr~impr~ted mariaN). ~ 2. Trmt conminm of 110 g~lo~ .or 1~ mpadty ~t contained ~rdo~ ~te by fi~ing or physi~ pr~m, su~ ~ ~hing, shred~ng, grinding, or p~ct~. prying or by p~ive or hint-aided evapo~fion ~ r~ove wat~. · ~ 4. Magnetic sepa~fion or ~Nng to r~ove componen~ from sp~al ~te, = d~ifi~ by ~e dep~ent pu~nt to Tire ~, CCR, S<~on 66261.124. ~Nn~ 10 ~t add or ~ by w~ht m ~ ~ble for ~ ~ 6. Neu~li~ addle or ~ine (b=e) w=t~ Dom the f~d proc~ing ind~. ~ 7. R<ov~ of silver from photofi~hing. The volme limit for condifion~ ~x~pfion ~ ~00 g~Iom gene=tot (at the sine lomtion) in any mlendar mon~. =NO~= R<ove~ of 10 gallons or l~s ~r mon~ of s~ver from photofinishing ~mpletety exempt from ~rmi~g; ~ ~orm n~ not be submit. DTSC 1772B (i/95) Page i0 ONSiTE HXZ OUS WASTE 2" LEA 'I2'vlE N"r NOTIFICATION FORM FACII-WY SPEC'P-lC N~CATION For Use by Ham~taua 'h'asw. Geaeramm Perfor~;~g Tmatm~a£ [] Init/al " Under Conditional F. xemp. dan md Conditional Authorimi~on, [] and by Pe,~t By Rui~ F~ilitiea Pleas, refer to the attached Irtsrructio~ before compl~ing thi~ form. You may )ratify for rnore than one pertaining tier by uMng thi~ notification form, DTSC I772. You must attach a stlmratt attit rpecifi¢ notification form for different unit specific notificaIi.on form~ for each of:he four c~tgorie~ and an additionai notification form for tranaportable rre. atrnt~ uni~ (TTEI'x). Yott onfy have'to xabmit formt for the tierfs) that cav~r your anix(s). DJ, caM or recyc~,e the other anu~ed forrnx. Number each page of your complied notificaxion pa~cage a~ irC'cate the total number of page~ at the top of each page ax :he 'Page -- of ~" Put your F_PA ID Num3er on eaah page_ P~ease provide afl of tP~ information requ~e&' all fiet. d~ minx be completed ~xcgpt tho~e that ~tare 'if different' or 'if available'. Please type the information provided on thi~ form and any a~achment~. Toe notification fee.~ are assessed on the basix of the nurr~er of tier~ the notifier will operaxe unger, and will be colfeaed by the Sta:e i~oard of Equalization. DO NOT SEND YOUR F~ WFFFf TFtI$ NOT'~.C~TfON FOl~. I. NOTIRrlCATION CATEGORIES Ir, dicate the number of uni~ you operate in each tier. ~7~ix will afro be the number of unit specific notificaxion forrn~ you mu~ attach. ConditionalIy F_a2mpt Small Quara'ay Treatment olx, ratio~ may not op~r~.e ~ and~ any other tier. Number of' units and attached unit specific notifications for tach tier reported. A. Conditionally Exempt-Small Qumatiry Treatment D. Permit by Rule B. ~' Conditionally Exempt-Specified Wmteztream E. Commercial Lau.udry 'C. Conditionally Authodz~ F. Variance (Section 25143) 17. GENERATOR IDENTIFICATION EPAID NUMBER CA/..- 0 .O_O_Q__Q_) ( '-I ~' ~_. BOE NUMBER (if avaitable) H~_..HQ~2-' PHYSICAL LOCATION ~-~} ~' 7 ~ co ^cT PERSON ~ ' x PHONE NUMBER(~I C/) ) ? ?,,'] ( 7_.. COMPANY NAME For DTSC U~ (>aly '] STREET Region __ CITY STATE ZIP COUNTRY (ordy ¢ompl,'~ it' no~ USA) CONTACT PERSON PHONE NLrMBER(______)_._._--' C~r~t Name) (I~t Nam¢) DTSC i772 (1795) Page i CERTu~--vICATIONS: This form mm: be xig~,~l by. ~ aur.~ co~or~, offic~ or h~ op~affonai con~ol arm p~o~ deckion-m~n~a.naio~ th~ go~ option of thz fa~li~ (p~ ~ 22, C~fo~ C~e of Regu~io~ (CCR) 5e~ion ~2 70. I 1). ~ ~ ~p~ ~ b~ oHg~ ~g~. . _ W~te Minimi~fion I ce~ ~t I ~v¢ a pm~ ~ pl~ to ~a ~c volume, ~, de~ [ ~ve dete~in~ to ~ ~ono~mtly p~ti~ble ~d ~t I Mve ~t~t~ ~e p~fi~le ~ of ~~ ~mge; or Tier~ Pemltfinl Cemifimtlon I ceni~ ~t ~e mt or ~m d~fi~ ~ ~ d~ ~ui~meam of state s~mt~ ~d m~latio~ ~r ~e ~t~ ~tt~g tier, ~u~g g~emtor ~d ~uimmmm. I ~de~md ~t i[ ~y of ~e mm o~e md~ Pe~t by Rule er Co~fio~ ~ provide ~ ~ci~ ~m~e for clo~ of ~e mint mt by J~ I, 1995. I ce~ ~der ~ of law ~at ~his d~um~t ~d ~I atm~enm were prep~ '~er my diction or ~ a ~s~m d~i~ to ~m ~at q~ifi~ ~el pm~rty ga~er ~d ev~e ~e ~fomfion ~b~t~ B~ on my ~q~ of ~e ~n or ~ who ~age the system, or ~o~ dimity ~ible for ga~emg · e ~t of my ~owl~ge ~d ~lief, tree, ~umte, ~d mmplete. for ~o~g violation, j . 0PE~T~G ~Q~~S: P~e~t nott that generators treating h~ardo~ w~t~ o2~ir, are r~quired to comply with a n~ber of operating requir~n~ whi~ differ dep~ing on th~ tier(~). Tn~ operating r~quirement, are :er fo~h in the ,tatut~ referenc~ in the ~,r~pec¢~c Fa~ She~t, available ~om rh, Deganment's regional a~ he~er, o~c~. ~ffSSION PROCED~S: - You m~t x~it ~ ~i~ of this completed not,cation by ce~ed mail. return r~c, ipt requited, to: Depanment of Toxic Substanc~ Control Progr~ Data Mmmgement Se~ion - ~ ~ S~,~t. 4th Ftoor. Room ~53 (wa~ in only) ~. O. Box ~6 Sa~ento. CA 958~2~6. You m~r a~o ,~mit o~ ~ of the not,cation ~ attachments to the local r~gulato~ agen~ in your ju~di~ion ~ l~t~ in Appe~ 2 of the i~rru~ion materiaH. You m~t a&o retain a copy ~ pan of your oper~ing record. DTSC 1772 (1/95) page CONDITIONA-LLY EiCE~fiF~' SPECIi=IED WA~STESTILE~%fS LrNTT SPECi:. ' NOT~iCAT!ON . (pursuan~ to Health ~nd ' .%~ Cod~ Section %5201.5(c)) - The Tier-._qpecific Fact.Sheets contM- a ~mmmar7 c .' the operatff~g requirements for this entegor7. review those requi~ments carefl~y before comple~ug or submittln~ this notit'~cation l:mcknge. NIYM~ER. OF TREATMENT DEVICES: .... T=.k(s) _ '. NUM]BER OF STORAGE DEVICES: __ T=.k(s) Each ,,nj: m~t be ctzar~y idamifiad ~ labe!ed on zhe fio~ plan az:ach~d m Form I772. A~sign 7o,,r ow= ~,iqzm n=rn&,r m ~nin 2'n~ numb~ m be ~equenziM (1, 2. 3) or =ing any $=e~,, 70~ choose. Emer :he eszimazed momhly total volmn~ of h~a:rd~= waste memed by. rhi= 'anit. Tai= shoubt be ~he rr~mum or hi~he~ treated in any mom& Indiccae in the narrative (Section II) if your operations have ceasonal variationc. Estimated Monthly Total Volume Treated: ~ua~ and/or q0 galloas Estimated Monthly Total Volume Stored: rounds =d/or gallons YES NO [~l ~ La .the waste treated in this unit radloac:ive? [~] ~ I$ the waste treated in t.b.is unit a bio-hn,arclJinfeedouslmedical waste? [-'] [~ la remotely generated hazardous waste (HSC 25110.10) treated in this unit? T'ne following are the eligible wastestrearas and treatment processes. Plea. re check ali applicable boxes: ["'1 I. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part and ' pre-impr~nated materials). {--] 2. Treat containers of 110 gallons or less capacity that contained hn:mrdous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. [--I 3. DtTing special wastes, 'as'klassifled by the depa~,ixent pursuant to Title 22, CCR, Seztion 66261.124, by pressing or by passive or heat-aided evaporation to remove water. [--'{ 4. ' Magnetic separation or screening to remove components from spedal waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. =NOTE* S- NO AI/THORIZATION IS NEEDED to neutralize addle or alkaline (Imse) waxtes from ~ regeneration of ion ex,-h-nge media used to d~-~nineral;7~ water. (This was~ cannot c~nl'aln more th~,n 10 percent acid or base by weight to be eLLgible for thi~ exemption.) F'~ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry.. [~ 7. Recovery of silver from photofinishing. The volume limi~ for conditional exemption is 500 gallons generator (at the same location) in any calendar month. ~NOTE* Recovery of 10 gallons or less per month of silver from photofinishing completely exempt from ~rmitfing; this form nc. ed not be submit~acl. DT$C 1772B (l/95) p:gc . Stax~ or C.atil*or~a - C..alirorala ~.av~az~l l"~6oa Pag~ l of ONSI NO CA ON FA~ SPE~C NO~CA~ON For U~ by Under ~o~ Exe~on ~d ~n~ Au~o~oa, ~ R~ PM~e r~ to t~ ~ta~ Im~ b~ore ~g t~ fo~ You ~ ~ti~ for ~re ~ o~ ~ing t~ ~ ~g th~ ~t~c~ion fo~, D~C 1~. You m~t di~e~ ~a *~fic ~t~c~ion fo~ for N~ ea~ page of ~ur ~mp~ ~tifi~ion ~ge 'Page~ of ~[ P~ yo~ EPA ~ N~ on ea~ pag~ comp~ ~c~t t~,e t~ ~e '~ d~e~' or ~ta~e~. ~ not~c~ion fe~ ~e ~s~z~ on t~ b~ of t~ n~ of ti~ the ~t~ will oper~e ~, ~ wi~ ~ ~l~a~ ~ t~ Stye Board of Eq~l~iom DO N~ ~ ~0~ ~ ~ ~S NOOn,ON FO~. NOT'CATION CA~GO~ IMic~e t~ n~r of uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of una spedfic ~t~c~ion fo~ you m~ ~a~ Nm~ o~ ~ ~d gt~ch~ uffit sp~c nofifi~o~ for m~ tier re~. A. Coaditio~ly Exempt-S~l Q~ti~ Trmt~at D. Pemt by Rule B. ~ Conditio~lly Exempt-S~ifi~ W~t~trmm E. Commemi~ C. Condkio~ly Au~o'd~ F. Vafi~ce (~tion ~ 143) n. G~TOR mE~CATION EPAID NUMBER CA~ ~ 0 ~ ~ ~G ~D~, ~ D~~: COMPLY N~E Pot OTSC I CI~ STA~ ZIP COU~Y (o~y co~ta~ if ~ USA) CO~A~ PERSON PHO~ ~BER( DTSC 1772 (1/95) Page , EPA ID NUMBER Page ~ of..~} 1TI. RADIOACTIVE MATERIALS OR WASTE YES NO F-] '~] Does the facility use, store or treat radioactive materia/s or radioactive waste? IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSII~ICATION (SIC) CODE: Use either one or two SIC codes (a four digit number) that best describe your company's products, services, or industrial aaiv~ot, F'zample: .7384 ". Ph~to~nishing lab 7218 Indalrrial ~ V. PRIOR PER3ilT STATUS: atci yes or no to tach question: x~]S NO = [='=1 1. Did you file a PBR Notice of Intent to Operate (DT$C Form 8462) in 1992 for this location7 [~] ~ 2. Do you now have or have you ever held a state or federal haza~o~ waste facilit~ f~ll permit or interim stares for any of ~ese tre=tment units7 '[~! [="! ~. Do you now have or have you ever held a state or federal full permit or interim stems for any other hazardous waste activities at this location7 \1~] i'-'] 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you are now notifying for at this location? x~ ['-1 5. Has this location ever been inspected by the state or any local agency aa a hazardous waste generator? VI. PRIOR ENFORCE,MEN'r HISTORY: Not required from generators only notifying as co ~nditionalIy ~ or a: a YES ['-] Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders resultifig from an action by any local, state, or federal environmental, hazardous waste, or public health e~forcement agency? (For'-the purposes of this form. a notice of violation does not constitute an order and need not be reported it was not corrected and became a final order.) [-'[ If you answered Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) VII. A'ITA CI-I~ENTS: Attachnum~ are not required for Commercial Laundry facilities. 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. x ~ 2. A unit specific notification form for each unit to be covered at this location. DTSC 1772 (1/95) Page 2 VIII. CERTIFICATIONS: Th/~form must be signed by an authorized corporate officer or any other person in the company who has operational control and perform.r decision-making functions that govern operation of the facility (per Title 22, CalifoPnia Code of Re_gulations (CCR) Section 66270.11). All thre~ capit~ mt=t have original ~ignatttr~. . Waste Minimization I certify that I have a program i. place to reduce the volume, quantity, and toxicity of waste generated to the degree [ have determined to be economically practicable and that I have selected the practicable method of treatment, storage; or disposal currently available to me which minimizes the prec~nt and future threat to human health and the environment. Tiered Permitting CertiHcation I certify that the unit or units descriI:~ ia thes~ documents meet the eligibility and op~-atiag requirem(mts of state statutes and regulations for the indicated permitting tier, including generator and s(w. ondary containment requiremeats. I understand that i.f any of the units operate under Permit by Rule or Conditional Authorization, I will also be required to provide r~uimi financial assurance for ¢losu~ of the treatment unit by January I, 1995. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision ia accordance with a system designed to assure that qualified personnel properly gather and evaluate the iaformation submitted. Based on my inquiry of the person or persons who manage the system, or those directly m-s'ponsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there ar~ substantial penalties for submitting false information, iacludiag thc possibility of fines and impriso,,-~n£ for knowing violations. OPERATING REQUIREM2ENTS: Pleaxe note that generators treating ha~.ardou~ waxte ot~ite are required to comply with a number of operating requirement.; which diffkr depending on the tier(s). Thexe operating requir,ment., are .~et forth in the statute~ and regulations, some of which are referenced in the ~er-$p¢cific Fact Sheet.~ available from the Department ', regional and headquarters officex. SUBMISSION PROCEDURES: You maxt submit two copie.~ of this completed notification by ct-,rtified mail, return receipt requexted, to: Department of Toxic Substanc~x Control Program Data Matu~gernent Section 400 P. Street, 4th Floor, Room 44§$ (walk in only) P. O. 'Box 806 Sacramento, CA 95812-0806. You must al~o submit or~ co~:~ of the notification and attachment* to the local regulatory agency tn your jurixdiction ax l~ted in ~'tppendix 2 of thg in~tru~ion materialx. You must also retain a copy ax part of your operating record. .All three form~ rtu~t hav~ origirml signature. L not photocopie.~. DTSC 1772 (1/95) page 3 CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION _ - (pursuant to HeaRh and Safe~y Ccxie Section 25201.5(c)) - . The Tier-Specie Fact Sheets contain a summary of the operating requiremems for this category. 'Please review those requirements carefully before completing or submi_~ng this notification package. NUMBER OF TRE&~ DEVIC-I~: c~ Tank(s) Conmi~er~s)/¢ontain~ Treatment Ama(s) NUMBER OF STORAGE DEVICES: Tank(s) Each unit mu.~t be clearly Mentified and la~eled on the plot plan attached to Form 1772. As.~ign your own uniqu~ number to each unit. Th. number can bt .requ~ntial (1.2, $) or uMng any system you choose. Enter th. estimated monthly total volun~ of ha~rdou., wast, treated by thi~ unit. Thi~ ,hould be th. ~. '~ um or highe, rt amount treated in any month. Indicate in th~ narrative (Section II) if your operatior~ hav~ seasonal variations. Estimated Monthly Total Volume Treated: ~ound~ and/or/~) galloas Estimated Monthly Total Volume Stored: pound~ and/or gallons YES .~ 1--] Is the waste treated in this unit radioactive? [--1 Xx[~ Is the waste treated in tkis unit a bio-ba~,~rd/infectious/medical waste7 [--] x[~ Is remotely generated haTardous waste (HSC 25110.10) treated in this trait? The following are the eligible wastestream~ and treatment processes. Please check all applicable boxes: [--1 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part ,and pre-impregnated materials). [~] 2. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. [-] 3. Drying special wastes, as 'dlassified by the deparUnent pursuant to Tiff, 22, CCR, Section 66261.12~, by pressing or by passive or heat-aided evaporation to remove water. [-'l 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. ~:NOTE* 5. NO AI. Yr~oRIZATION IS NEEDED ~ mmtrnl;?~_ acidic or regexaeration of ion exeh.qnge media used to d~minernli~- water. ('rhis waste ennnot contain more than 10 percent acid or base by weight to be eligible for this exemption.) XX~ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. 7. Recovery of silver from photofinishing. The Volume limit for conditional ~xempfion is 500 gallons per generator (at the saxne location) in any calendar month. =NOTE= Recovery of 10 gallons or less per month of silver from photofinishing is completely exempt from permitting; this form need not be submitted. DTSC 1772B (I/95) Page 10 CONDITIONALLY EXEMFr - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to H~lth sad Safety Code Section 25201.5(c)) 8. Gravity .%eparafion of the following, induding the use of flocculanta and demulsifier~ if l--] a. The settling of solids from the waste where the resulting aqueous/liquid stream i~ not hayardous. [] b. The separation of oil/water mixtures sad separation sludges, if the average oil recovered per mon~ is leas than 25 barrels (42 gallons per barrel). [--] 9. Neutralizing ~cidie or alkaline (base) material by a state ce..,Mfied laboratory or a laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) ['"] 10. Hazardous waSte treatment is carried out in quality control or quality assurance laboratory at a facility that is not an offcite hn?nrdous waste facility. l'-] 11. A wastestream and treatment technology combination certified by the De. partment pursuant to Section 25200.1.5 of the Health and Safety Code. Hesse enter certification number:. ['"] 12. The treatment of formaldehyde or glutaraldehyde by a healthcare facility using a technology combination certified by the Department pursuant to section 25200.1.5 of the Health and Safety Code. Please enter certification number: II. NARRATI%CE DESCRIFI'IONS: Provide a brief description of the specific waste treated and the treatment procexs axed. / 3. SPECIFIC WASTE TYPES STORED: - III. RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit. G S NO . ,. l-'i 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? [-'] '~-'] 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? "'"~ l'-'] 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler? '~]If you do, where is the waste sent? Check all that apply. a. Offsite recycling [--] b. Thermal treatment I--'[ c. Disposal to land '--] d. Further treatment [-] '~ 4. Do you dispose of non-hazardous solid waste residues at an offsite location? [--1 'X[~l 5. Other method of disposal. Specify: DT$C 1772B (1/95) Page 11 CONDITIONALLY EXEMi:T - SPECIFrED WASTESTREA.MS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code S<tion 25201.5(c)) IV. BASIS FOR NOT' NEEDING A FEDERAL PERMIT: In order to dern°nstrate eligibility for one of the onsite treatment tiers, faciliti~ are required to provide the basis for determining that a hazardous waste permit ix not required under the federal Re. source Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA {~tle 40, Code of Federal Regulations (CFR)). Choase th~ reason(x) that dexcribe the operation of your onsite treatment units:' ' [-'] I. The hn~rdous waste being treated is not a hazardous waste under federal law although it is regulated as a ha~rdous waste under california state law. 1'"'1 :2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly orated treatment works (POTW}/sewering agency or under an NPDES permit. 40 CFR' 264.1(g)(6) and 40 CFR 270.2. ['-] 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260. I0, and discharged to a POTW/s~wering agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. ['-[ 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260. I0; 40 CFR 264.1 (g)(5). ["'] 5. Thc company gcncrate, s no mort than 100 kg (approximately 27 gallons) of ba:mrdous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR. 261.5. r"]' 6. The waste is treated in an accumulation tank or container within 90 days for over 1003 kg/month generators and 180 or 270 days for generators of 1130 to 10130 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 ..Federal Register. 7. R~cyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv). 40 CFR 264. l(g)(2), and 40 CFR 266.70. ['"'] 8. Empty container rinsing and/or treatment. 40 CFR 261.7. [-'1 9. Other. Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YEXNi~TiS NO [-'1 Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. DTSC 1772B (I/95) Page 12 BAKERSFIELD HEMORIAL HOSPITAL EPA ID: CAL000021754 Page 2 cc: ASTRID JOHNSON MR STEVE MCCALLEY DTSC REGION 1 KERN COUNTY STATE REGULATORY PROGRAH ENV HEALTH SERVICES DEPT 1515 TOLLHOUSE 2700 M ST ~300 CLOVIS, CA 93611 BAKERSFIELD, CA 93301 STATE BOARD OF EQUALIZATION STEPHEN R. RUDD, ADMINISTRATOR ENVIRONMENTAL FEES DIVISION P.O. BOX 942879 SACRAMENTO, CA 94279-0001 Units authorized to operate at this location: UNDER CONDITIONAL EXEMPTION: PROCESSOR UNDER CONDITIONAL EXEMPTION: 1 UNDER CONDITIONAL EXEMPTION: 3 UNDER CONDITIONAL EXEMPTION: 4 ~_ UNDER CONDITIONAL EXEMPTION: 5 UNDER CONDITIONAL EXEMPTION: 6 UNDER CONDITIONAL EXEMPTION: ? UNDER CONDITIONAL EXEMPTION: 8 'oNsITE I-IAZ OUS WASTE TREATMENT NOTIFICA ON FOtLM For Us~ by Hazatdo~ Wast~ O~eratora P~fforming Tt~atmeu£ [] Initial P~ r~ to t~ ~t~ f~~ b~ore ~g t~ fo~ Yoa ~ ~ti~ for ~re t~ o~ ~ing t~ ~ ~ing ~tificmion fo~, D~C l ~. YOU m~ ~a~ a ,~e ~ ~fic ~tific~on fo~ for e~ u~ ~ :h~ ~m ~e di~e~ ~a ,~fic ~tific~ian fo~ for e~ of t~ fo~ ~ego~ ~ ~ ~~ ~tifi~ion fo~ for ~n~ ~ ~'~). ~o~ on0 ~ve'to ~ fo~ for ~ t~) ~ ~ ~ ~a(,). D~d or re~c~ t~ ~ m~ fo~. N~ ea~ page or,ur comp~ ~tifi~ion ~ge ~ i~c~e t~ total n~ of pag~ ~ t~ top of e~ ~ge 'Page __ of__'. P~ yo~ ~A ~ N~ on ea~ pagm P~e pro~ Ml of t~ info--ion req~; aa fie~ m~ a~a~e~. ~ notific~ionfe~ ~e ~s~s~ on the b~ o/t~ n~ o/ti~ the ~tifi~ will oF~e ~, ~ wi~ ~ ~l~a~ ~ Board of Eq~l~iom DO N~ ~.~ ~0~ ~ ~ ~S N~O~O~ FO~. L NOT'CATION CA~GO~ f~ic~e t~ n~ of uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of uflit spe~fic ~tific~ion fo~ you m~ ~~ ~ ~ Q~ Tr~ o~ ~ ~ o~ ~ ~ ~ o~ ~. Nm~ o~ ~ ~d gt~ch~ uffit sp~fic nofifimfio~ for ~h tier re~m~. A. Coadi~o~ly Exempt-S~l Qmti~ Tr~t~at D. Paint by Rule B. ~: Conditio~lly Exempt-S~ifi~ W~t~tr~m E. Commemi~ C. Coa~tio~ly Au~od~ F. Vad~ca (~tioa ~143) ~. G~TOR ~E~CATION EPAID NUMBERCA~~L' ( q ? ~ ' BOE NUMBER (if available) H~H~ { 0 7 PHYSIC~ L~AnON ¢~0 -" I ~G ~D~, ~ D~~: ST~ {Region C~ STA~ ZIP COU~Y (oMy co.lam if ~ USA) CO~A~ PERSON PHO~ ~t Nam) ~ DTSC 1772 (1195) Page I · ?IXL ".C'E~. TI~C.ATION$: 7'his form must be zig~ ~ ~ auffw~ calorie ,, &~.op~atio~l consol a~ p~o~ de~ion-m~ng~io~ :~ go~ option of t~ fa~li~ (p~ ~t~ 22, C~o~ia C~e of Regu~io~ (CCR) Seaion ~270.~1). .~ a~ ~p~ ~ ~ W~te Minlmi~tlan I ce~ ~ I ~ve a pm~ ~ pl~ to ~e ~e value, q~fi~, ~d de~ I ~ve dere~in~ t0 ~ ~ono~cally p~ti~ble ~d ~t I Mve ~t~t~ ~e p~le me~ of ~ ~mge, or di~ curtly av~hble to me which ~~ ~e p~at ~d ~mm ~t to hu~ h~ ~d Tier~ Pe~itfing Ce~ifl~tion I ce~i~ ~t ~e ~t or ~m d~d~ ~ ~. ~ui~m~m of smta smmt~ ~d m~iatio~ for ~e ~t~ ~tt~g der, ~clu~g ~mm~m. I ~de~md ~t i~y of~e ~m o~ ~d~ Pe~t by Rule or Con~6o~ ~ pmvid~ ~ ~c~ ~ca for c!o~ of ~e ~t ~t by Jm~ I, 1995. I ce~ ~der ~ of law ~t ~s d~u~t md ~1 a~um were prep~ ~der my of ~e ~n or ~ who ~age the ~stam, or ~o~ di~fly ~ible for ga~e~g · e ~t of my ~owl~ge md ~lief, tree, ~umte, md I ~ aw~ ~t ~em ~ ~bsmti~ ~lti~ for ~b~t/~g f~ ~fo~on,- ~ctud~g OPERATING REQUII~M:ENTS: Pteaxe note that generators treating ha~.ardous wuste on$ite are required to comply with a number of ol~erating requiremen~ which dlr~er ffepcndlng on the tier(s). Th~e operating requirements are ~¢t forth in the statutex atwl regu~zrion$, some of which are referenced in the ~er-~peci. flc Fact Sheets available from the Department '$ regional and headquarters offices. SUBI~LIS$ION PROCEDURES: - .... . ,.:.'. : ...... You must sub, it ~ co~i~r of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control ., Program Data Ma~ungement Section _:. 400 P. Street, 4th Floor, Room 4453 (walk in only) P. O. Box 806 : Sacramento, CA 95812-0806. You must also submit one cooy of the notification and attachments to the local regulator'~ agency in your jurisdlction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. All three fornu nu~ ~ original ~ignatures, not photocopies. DTSC 1772 (1/95) Page 3 '- ooo0 ' '-'f'ff ,. ' .'~CO~ITION.~LY E~~ - SPECI~ED W~S~~MS .. ' ~ SPEC~C NO~ICA~ON ~t to H~ ~d Safe~ C~¢ S~6oa ~201.5(c)) - ~e ~~c Fa~ Sh~ con~ a ~ of ~e o~ng ~~ for ~~ OF ~O~GE DE~: T~(s) E=~ u,it ~ b~ c~ ~i~ ~ ~ o, ~ ~ ~ ~r=~d to Fo~ I~. ~ign 7our o~ u~iq~ ~nin ~n~ ~ ~ b~ ~q~ial (1.2.3) or ~ing ~ ~ ~ ~s~. ~r,~ in ~ ~ I~c~ i= ~ ~i~ (&cio, fi) f ~r of~io~ ~ ~,~o~ ~at~ Mon~ly T o~ Vol~e T~t~: ~=~ ~dlor ~0 g~lo= ~timat~ Money To~ Volme Stored: ~ md/or gMlo~ NO ~ ~ ~e w~te tr~t~ ~ ~s ~t mdio~tiv¢? ~ ~ Is remotely geae=t~ b-=~-do~ w~te (H3C ~ 110.10) tr~t~ ~ ~s ~t? ~ae fol~wing are the eligible w~t~tre~ a~ =emment proc~ses. Pte~e &e& all applic~le boxy: ~ 1. Tr~m rmlm mNed or c~ in aceor~nce Mth~e m~utactur~s im~cfiom (indu~ on,pm ~d prwimpr~ted matlab). ~ 2. Trmt conmin~ of 110 gallom or 1~ mpadty ~t contained bamrdo~ ~te by fi~ng or physi~ pr~m, ~ m ~Nng, shred~ng, grinding, or p~ct~. ~ 3. D~ng s~ ~tm, ~ d~ifi~ by ~e depm a,,~t p~t {o Title ~, CCR, ~fion ~261.~, by prying or by p~ive or hint-aided evapbmfion to r~ove ~t~. ~ 4. Magnetic sepa~fion or ~ng to r~ove componen~ from spcaI ~te, ~ d~ifi~ by ~e flep~an~t puget to Title ~, CCR, S~fion 66261.~4. ~NO~~ 5. NO A~OR~A~ON ~ ~~ ~ ~11~ ad~c or ~fion of ion ~e m~ ~ ~ d~{~li~e m~. ~ ~ ~-~t mn~ mom ~kn. 10 ~t a6d or ~ by w~ht ~ ~ ~%le for ~ ~ 6. Neumli~ a6dlc or ~ine (b~e) w~t~ from the f~d proc~ing indm~. '~ 7. R~ov~ of silv~ from photo~ng. The volme limit for condifio~ ax~pfion generator (at the sine lo~fion) in any mlendar monffi. =NO~~ R~ove~ of 10 g~ons or 1~ ~r mon~ of s~ver from photofin~shlng ~mpletely exempt from ~r~ing; this form n~ not be submit. DTSC 1772B (I/95) Page 10 8. Gravity separation of the following, including the use of flocculants and demulsifiers if [~] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not hazardous. l-"] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). i~I 9. Neutralizing acidic or alkaline (base) material by a state certified' laboratory or a laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by. weight.) [~] 10. Ha?ardous waste treatment is carried out in quality control or quality assurance laboratory at a facility that . _ is not an offsite hazardous waste facility. [~1 11. A wastestream and treatment technology combination certified by the Department pursuant to Section 25200.1.5 of the Health and Safety Code. Please enter ce~2tifieation number: [-] 12. The treatment of formaldehyde or glutaraldehyde by a healthcare facility using a technology combination certified by the Department pursuant to section 25200.1.5 of the Health and Safety Code. Please enter certification number: II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used. I. SPECIFIC WASTE TYPES TREATED: X RAY FIXER SOLUTION 2. TREATMENT PROCESS(ES)USED: X RAY SOLUTIONS COLLECTED AND SENT THROUGH SILVER RECOVERY CARTRIDGES 3. SPECIFIC WASTE TYPES STORED: III. RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit. YES NO -" ~ l'-] - I. D0 you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? [-'] [] 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? i~ ["] 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler? If 7ou do, where is the waste sent? Check all that apply. ~X a. Offsite recycling ['-] b. Thermal treatment l-"l ¢. Disposal to land l-"i d. Further treatment [-'] [] 4. Do you dispose of non-hazardous solid waste residues at an offsite location? [~] [] 5. Other method of disposal. Specify: DTSC 1772B (1/95) Page 11 ? .~.PA ID NUMBER CAL00~ 754 Page of CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION -. '(pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardou~ waste pet?nit is not required under the'federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (Title 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: I'-I 1. The hazardous waste being treated is not a hazardous waste under federal law'although it is regulated as a hazardous waste under California state law. [-'l 2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. ['-] 3. The.waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [] 4. The waste is treated in a totally enclosed' treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264. l(g)(5). ['"! 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally .exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. I~! 6. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. [] 7. Recyctable materials are reclaimed to recover economically significant amounts of silver or other precious metals. ~ 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. 1--'i 8. Empty container rinsing and/or treatment. 40 CFR 261.7. ~l 9. Other: Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer.to, the Instructions for more information. YES NO I~ ~! Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. DTSC 1772B (1/95) Page 12 · .. Page __ of__ · .. r'' NOTIFICATION FORM TRANSPORTABI.~/,. TREATMENT UNITS [] Iaitial '~ OPERATING AT CONDITIONALLY EXEMPT ii]ix Renewal OR CONDITIONALLY AUTHORIZED GE~TORS [] Amendment GENERATOR EPA ID NUMBER CAL000021754 GENERATOR UNIT ID NUMBER PROCESSOR #2 I. TTU INFORMATION: TTU EPA ID NUMBER CA__L920235089 TTU SERIAL NUMBER CA 87757 BUSINESS NAME X RAY SOLUTTON SERVICE TI'I) OWNER JIM WARREN TTU OI3$NI~R'S 9104 THURBER LANE ADDRESS CITY BAKERSFIELD STATE CALIF ZIP 93311 . COUNTRY USA TTU OPERATOR (if differ~ni from Owner) TTU OPERATOR'S ADDRESS CITY STATE__ ZIP COUNTRY· "f'YU CONTACT PERSON JIM WARREN PHONE NUMBER ( 805 ) 664 7760 '(first name) (last name) II. PROJECTED WORK SCHEDULE': Indici~te the normal weekday, working hours arm the dates during this calendar year. Normal Hours of Work - From 0000 to 2359 Dates on Site - From 1/1/96 to 12/31/96 Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to [--'[ If you plan on more dates, attach a Continuation Sheet showing the additional dates and check this box. DTSC 1772E (1/95) Page 24 ~ Sl'~E'(~ CALIFORNIA ENVIRONMENT~ii~ROTECTION AGENCY PETE wILSON, Governor ~ ~ ~ ~~~ST~~-~ ~ONTROL ~ ~ P STRE~,'4~ FLOOR P.O. 8OX 8~ SAC~ME~O, ~ 95812-08~ (9[6) 323-587[ February 21, 1996 EPA ID:'CAL00002175'4 BAKERSFIELD MEMORIAL HOSPITAL GARY STEVENS Initial Authorization: 09/03/93 420 34TH ST Amendment Date: 12/21/95 BAKERSFIELD, CA 93301 For facility located at: 420 34TH ST BAKERSFIELD, CA 93301 Dear Onsite Treatment Facility: The Department of Toxic Substances Control (DTSC) has received your facility specific Amended notification (form DTSC 1772). Your notification is administratively complete, but has not been reviewed for technical adequacy. A technical review of your notification will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The DePartment. acknowledges receipt of your completed Amended notification for the treatment unit(s) listed on the last page of this letter. These units are authorized by California law without additional Department action. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). DTSC has revised its database records to reflect your status and has notified the Board of Equalization (BOE). You will be billed annual fees by BOE calculated on a calendar year basis for each year you operate and/or have not notified DTSC that the units have been closed. If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this office at the letterhead address or telephone number. Sincerely, ~ief Tiered Permitting Compliance Section '' State Regulatory Program Division cc: See next page. TREA~T UNIT LOG MONTH: FEBRUARY Y~AR: 1995 ***THIS LOG PROVIDES DOCUb~NTATION THAT ESTABLISHED TREATMENT UNITS HAVE BEEN INSPECTED FOR LEAKS, SPILLAGE, CORROSION AND CONDITION OF FITTINGS ON A WEEKLY BASIS. 2111195 2/12/95 TO 2/18/95 2/19/95 TO 2/25/95 2/26/95 TO 3/4/95 BAKERSFIELD MEMORIAL HOSPITAL DIAGNOSTIC IMAGING QUALITY CONTROL FREQUENCY ACTIVITY Initiall¥1Dail¥1Weekl¥1Monthl¥1Quarterl¥1annuallall¥ IState* JCAH0 Lead Apron Check X I I I X I I I XX XX ma/ky in fluoro I I X I I I I I XX XX Physicist Evaluation I I I I I I X I XX XX Repeat ~alysis I I I x I I [ I xx xx Processor Statistics } I I X I ] ] ] XX XX Fixer Retention I ] ] [ X I I I XX XX safe~iqht Test I I I I { x I } xx xx Base ~oq Test I I I I { x I I xx xx Darkroom Cleaninq ] X ] [ ] I [ XX XX Cassette Cleaninq I I t X I I I I XX XX crash Cart I I x I I I I I xx I xx Equipment Problems I X I I I I J I XX I XX Equipment PM I I I I [ X I I XX I XX Ii~inators I ' I I I I I X I XX I XX Technolqoist License Updates I I I X I I I I XX I XX MD Fluoro License Updates I I I X I t I I XX XX Product Reca~ I X I I I I I I XX XX ChemicaX Levels I I X I I I I I XX XX Processor Temperature I I X I I I I I XX XX Fixer Cartridqe Inspection I X I I I I I XX XX *California Radiation Control Regulations Title 17. Health Subchapter 4. Radiation Sections 30100-30570 IMAGING DEPARTMENT DAILY FIXER USA GE MONTH: JANUARY YEAR 1995 3/IO N TttL Y NUMBER DAILY PROCESSOR FIXER OF FIXER USED WORKING DA YS USED #1 17.5 gal 22 days .80 gal/day #2 closed closed closed #3 136.3 gal 31 days 4.4 gaL/day ~4 121.3 gal 31 days 3.9 gal/day ~5 121.3 gal 31 days 3.9 gal/day #6 ~ gal 22 days 0.2 gal/day ~7 40 gal 22 days 1.8 gal/day #$ :, #9 #10 IMAGING o ~to~rI~t ~ FIXE R/I~EL OPER LOG 1995 PROCESSOR PROCESSOR PROCESSOR PROCESSOR PROCESSOR PROCESSOR PROCESSOR PROCESSOR #1 , #2 #3 #4 #5 #-6 #7 ,#8 APPLICATIO] J~L~vYf~Y 17.5 gal CLOSED 136.3 gal 121.3 gal 121.3 gal 5 gal 40 gal IN PROCESS FEBRUARY MARCH APRIL JUNE JULY AUGUST .' SEPTEMBE:~ OCTOBER NOVEMBER DECEMBER RA LOGY DA I LY OG 5 a.m. 5 p.m. 1.MAIN PROCESSOR TEMPERATURE 2. U/S PROCESSOR TEMPERATURE 3. CHEST ROOM - PROCESSOR TEMPERATURE 4. FLASHER TIME - MAIN PROCESSOR 5. FLASHER TIME - U/S PROCESSOR 6. C~MICAL LEVELS - CLOSET 7. C~ECK SILVER RECOVERY CANISTER - ALL PROCESSORS 8. CHEST ROOM DATE 9. LOCATION OF PORTABLES A. OLD GE B. NEW GE C. I/NIT D. NURSERY E. OPERATING ROOM 10. LOCATION OF C-ARMS A. OEC B. PHILIPS C. OLD C-ARM 11. LOCATION OF BLUE FLUORO TABLE 12. LINEN CART INVENTORY 13. RADIOLOGY ROOMS - STATUS A. ROOM ONE B. ROOM TWO C. ROOM THREE D. CHEST ROOM F. TOMOGRAPHY ROOM 14. REQUISITION REVIEW XR/CT/US/NM/MULTIPLE EXAMS 15. TRANSPORTATION CALL TIME 16. E.R. FILM COLLECTION 17. D-FIB CRASH CART (BATTERY CHECK) 18. CHECK E-MAIL REPAIRS NEEDED / ADDITIONAL COMMENTS TRANSPORT 1. 2. 3. 4. DATE: kersfield ollege November 22, 1993 Angle Wheeler' Memorial Hospital Engineering Dept. 420 34th St. Bakersfield, CA 93301 Dear Angie: The following staff members of Memorial Hospital attended and success~u!ly completed the Annual 8 Hour Refresher held Nov. 18,1993 at Bakersfield College. Liz Oiivarez 561-90-9999 Robert Liburdy 570-41-8607 Larry Laballister 367-40-'9048 Don Hynds 563-64-6257 Felix Ortiz 573-74-9786 Peggy Gordon 553-84-7640 The cost for this course is $45.00 per person. Please submit check payable to Bakersfield College for $270.00. Please send this check as soon as possible in the addressed envelope provided. Thank You. Sincerely, Bakersfield College 1801 Panorama Dr. Bakersfield, CA 93305 1801 Penormrne Orive, I~ekersfielc~. CA ~!3305 · Cci: [1~05] 39~-4011 · Kern Community College Oistrict ~ purifying RespiratoryEquipmen~i~ Fitting' and 'Training Session Log ~ Air supplied_ INSTRUCTOR(S) LOCATION NAME PAYROLL / EMpLoYEE NAM~ -- I / (PRINT) SOCIAL SECURITY NUMSER RESPIRATOR ~ TEST (LAST. FIRST. MIDDLE INITIAl_) I (BRAND. SIZE, MODEL) ATMOS- PHERE ' ] ~ ~ ~ - ~ , :.i,~~-+~;,.,~c~/- ~1 - ~~ ~b, COPY DISTRIBUTION: OriginaI--LOCalion RETENTION: Douglas J. Davis & Asaoclatas Cooy--Occup. Satety and Health Consultant Original ~ location 2 years. Training Attendance Log /- / Instructor Time 0~06 -- / ~O 0 ~~ ~ ~ ~ ~t~ ~ Location ~ ~ ~ (~T. ~I~T. MIDDLE INITIAU S I G N A T U R · ~IAL SECURITy NUMB ~R ~.~~ ~¢ ~g-~r7 Oouglal J. DII|i I Al~ocllltl CO~Y DI~-rRIBUTION Or,g, nlI--L.l:X:ll,O~ BAKERSFIELD MEMORIAL HOSPITAL Inter-Office Memorandum DATE : September 2, 1992 TO : Managers of: Environmental Services Emergency Room Clinical Engineering Plant Operations/Maintenance LabLaundry Pharmacy Purchasing FROM - Mike SUBJECT: Haz Ha~ Spill Response Team The following personnel have completed the OSHA approved 40-hour Haz Mat Response Team Training' '~ Jane Murray, Env. Serv. Fr~rfl(~Gutierrez, Env. Karen Darter, E.R. f~. ¢~¢~ ¢,~e "- "' -, . ,. ,,~. Larry Laballister, Env Serv -?c:-;7'-Rober% Liburdy Clinical Eng ¢'0 ' z Don Hynds, Plan% Oper. ";'~'~¢Ar~hur Dorado, En~..., Serv. , ~ Ed Hough%aling, Plan% Main~. Barbara Gee¢;'"~L*' ~4. -r'¢'-¢¢¢"¢-Peggy Gordon, Laundry s~*-,~:...',~ .... .~Michelle Torres, Lab ¢% ~'E~¢ -Alfred Garza, Env. Serv.~P¢' Todd WhO%e, Pharmacy .~¢;~.. ~ Liz Ol ivarez, Purchasing ~.'.-"~-~'- /~¢~. %.,~,~. Please highlight your personnel and file %his memo in ~he RED BINDER behind %he "Safe~y Meeting" divider. You may also wan~ %o documen~ %his %raining for %he employee's personnel file. Thank you. BAKERSFIELD MEMORIAL HOSPITAL RADIOLOGY DAILY LOG INVENTORY ANALYSIS In our effort to improve and maintain quality service, we now have a Radiology Daily Log that must be completed twice daily, at 5:00 a.m. and 5:00 p.m. This list must be completed, in a joint effort, by the day and night shifts. This inventory analysis is provided for clarification and to maintain quality and consistency. 1. Main Processor Temperature: Check at 5:00 a.m. and again at 5:00 p.m. 2. U/S Processor Temperature: Check at 5:00 a.m. and 5:00 p.m. ~ 3. Chest Room - Processor Temperature: Check at 5:00 a.m. and at 5:00 p.m. 4. Flasher Time - Main Processor: Check at 5:00 a.m. and at 5:00 p.m. 5. Flasher Time - U/S Processor: Check at 5:00 a.m. and at 5:00 p.m. 6. Chemical Levels - Closet: Check at 5:00 a.m. and 5:00 p.m. 7. Silver Recovery Cannister - Ail Processors: Check for leaks and spills, corrosion and fittings; if necessary, report as hazardous material spill (reporting instructions located by cannister). 8. Chest Room Date: Check at 5:00 a.m. and again at 5:00 p.m. 9. Location of Portables: Self-explanatory; notify shift supervisor to relate any mechanical problems. 10. Location of C-arms: Self-explanatory. 11. Location of Blue Fluoro Table: Blue table is to be stored in old E.P. Room. 12. Linen Cart Inventory: Check linen cart in a.m. located outside employees' lounge. If linen supply is iow, notify the Laundry Department. 13. Radiology Rooms - Status: Be sure rooms are clean and stocked; note any repairs that need to be done. Supervisor will arrange needed repairs. 14. Requisition Review: Check the following: (1) exam name; (2) exam date; (3) indication for exam; {4) prep needed? (5) patient having exams elsewhere - U/S, CT, N/M? 15. Transportation Call Time: Regards early morning call-downs; do not call if patient is also having exams in other areas U/S, CT, N/M. 16. ER Film Collection: Collect loose films, sort, put in jacket and take to the Film Room. 17. D-Fib. Crash Cart (Battery Check): Check at 5:00 a.m. and at 5:00 p.m. 18. Check E-Mail: Ail staff members to check E-Mail for important communications. Each day, one technologist from each shift will be responsible for completing the Radiology Daily Log Inventory. Hazardous. M 'aterial Spill What To Do? 1. Call PBX Operator. 2. Clear Area Where Spill is Located. 3. Locate MSDS For Spill. ~. 16 BAKERSFIELD MEMORIAL HOSPITAL " HAZ'MAT EMERGENCY CONTACT AND PHONE LIST 1. In the event of a HAZ MAT Emergency, Monday through Friday: 7:00 am - 4:00 pm, contact the Safety Officer or alternates: SAFETY OFFICER: MIKE WOOD WORK PHONE: 805' 327 !792 EXT 1891 PAGER 374 HOME PHONE: 805 871 0592 ALTERNATE ~1: ROD TILLERY WORK PHONE: 805 327 1792 EXT 1891 PAGER 348 HOME PHONE: 805 873 1016 ALTERNATE ~2: KATHY SMITH WORK PHONE: 805 327 1792 EXT 4546 PAGER 396 HOME PHONE: 805 872 3391 SHOULD A H3%Z t~AT EMERGENCY OCCUR: 1. CALL THE PBX OPEP~ATOR. a. The PBX will call the Safety'Officer. or alternate. 1. The Safety Officer or alternate will evaluate the spill. (a) . If the spill is minor. The evaluator will have · - PBX contact-'a member'of 'the spill team to'clean up spill. (b) . If the spill is major. The-evaluator will have the PBX call code YELLOW. PBX will call all members of the spill team to clean up spill. The Safety Officer, alternates,and Haz Mat Spill team list are at the PBX operators desk. (c) . If the major spill is to large for the spill team to handle. The eva!uator may call other agencies to provide additional resources. (d) . Complete Hazardous Chemica!/Cytotoxic Drugs Spill Report (Attachment "k") . C. Lar~y Cart, President Board of Directors: Gordon K. Foster, Chairman Jael D. Mack. M.D., Vice Chairman Edward H. Shuler, Secretary-Treasurer Bakersfield Memorial Hospital Charles S. Ashmore, M.D. Jahn M. Brack, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Larry Carr Stephen f. Clifford Mailing Ad,dress: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R, Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W, Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID # CAL 000021754 BOE # HAHQ22107432 SIC Code: 8062 Dear Sirs: The enclosed documents are in response to the inspection report filed by David L. Shumate, Hazardous Substance Scientist, Department of Toxic Substance Control, on January 25, 1995. Enclosed is our facilities response to the violations and also the Certification of Return to Compliance document. I hope the enclosed documentation meets all Return to Compliance specifications; and, if any further information is required, please contact me immediately. sDeMtfull s~mztted, Re ~. - y ~ _ '-f., ..G~ry Stevens ' Director/of Imaging GS/aa ' enci. V~'A Affiliate of Voluntary Hospitals of America, Inc.® C. Lorry Carr, President Board of Directors: Gordon K. Foster. Chairman Jaei D. Mack, M.D..Vice Chairman Edward H. Shuler, Secretary-Treasurer Bakersfield Memorial Hospital Charles S, Ashmore, M,D. John M. Brock, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS C. Lam/Corr Stephen T. Clifford Mailing Address: RO. Box 1888 / Bakersfield, CA 93303-1888 John R. Findiey, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W. Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID ~ CAL 000021754 BOE # HAHQ22107432 SIC Code: 8062 Dear Sirs: This letter is a notification of the closing down of unit ~2 Treatment Unit at our facility. Our Emergency Room was relocated in July of 1994; and, at that time, the X-Ray Department and the Darkroom Facility were closed down. The silver recovery cartridge treatment device that was attached to processor #2 was also closed down at that time. Resp¢ctfully,'~ubmitted, i .,,Gary St~ens Director of Imaging GS/aa Affiliate of Voluntary Hos~,tals of Amenca, Inc'3 C. Larry Carr, President Boa~d of Directors: Gordon K. Foster, Chairman Joel D, Mack, M.D., Vice Chairman Bakersfield Memorial Hospital Edward H. Shuler, Secretary-Treasurer Charles S. Ashmore, M.D. John M. Brock, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZAI'IONS C. Larry Carr Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R, Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W. Smith February 6, 1995 State of California Environmental Protection Agency Department of Toxic Substances Control Form 1772 On Site Treatment Unit P.O. Box 806 Sacramento, CA 95812-0806 Re: Bakersfield Memorial Hospital EPA ID # CAL 000021754 BOE # HAHQ22107432 SIC Code: 8062 Dear Sirs: This letter is to inform you of the application for the silver recovery cartridge treatment devices that are to service our new film processor scheduled to be installed April 1, 1995. It was recommended by State Inspector David L. Shumate that you be notified that this treatment unit is located at the same'' facility address as our other six units. Re~ctfully/~bmitted, 'Director of Imaging GS/aa VH~A Affiliate of Voluntary Hospitals of America, Inc.® TIERED PERMITTING CERTItlCATION OF RETURN TO COMPLIANCE For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers In the matter of the Violation cited on · As Identified in the Inspection Report dated/-' I certify under penalty of law that: 1. Respondent has corrected the violations specified in the notice of violation cited above. 2. I have personally examined any documentation attached to the certification to establish that the violations have been corrected. 3. Based on my examination of the attached documentation and inquiry of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete. 4. I am authorized to fil.e this certification on behalf of the Respondent. 5. I am aware that there are significant penalties for submitting false information, including, the possibility of frae and imprisonment for knowing violations. GARY STEVENS':.' " ..... ' DIRECTOR OF IMAGING Nam?j,~rint or Type),,_~ Title /g~'~nature / ~' - Date Signed BAKERSFIELD MEHORIAL HOSPITAL EPA ~/00002175/4 Company Name EPA ID. Number DT$C-RETCOMP.CRT (8/94) C. Lorry Carl President Board of Directors: ' Gordon K. Foster, Chairman Joel D. Mock, M.D., Vice Chairman Bakersfield Memorial Hospital Edward H. Shul~r,S~¢r~*or~-Tre~surer Charles S. Ashmore, M.D. John M. Brock, Jr. ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEAUHCARE ORGANIZATIONS C. Larry Ca~r Stephen T. Clifford Mailing Address: P.O. Box 1888 / Bakersfield, CA 93303-1888 John R, Findley, M.D. 420 34th Street / Telephone (805) 327-1792 Thomas W. Smith February 15, 1995 Kern County Environmental Health C/O Dan Starkey 2700 M Street, Ste. 300 Bakersfield, CA 93301 Dear Dan: Upon completion of our State inspection of our silver recovery treatment units by Larry Shumate, State Inspector, we were advised to supply you with updated information. Enclosed, you will find documenation of the closing down of Treatment Unit #2 and the opening of Treatment Unit #8 to be effective April 1, 1995. Thank you for your time and consideration in this matter. Rem~ct ful1 ~submi t t ed , ,/ Directdr of Imaging GS/aa ' ' encl . VH~A Affiliate of Voluntary Hospitals of America, Inc.® Ob'SITE tEAZ, RJDOUS 'WASTE TR.EA NT NOTIFICATION FACILITY SPECIFIC NOTtlqCATION - For Us~ by t4.~:mrd~ Wasa Generamr~ p~orml-g Trmtmeut ~d by P~t By R~e F=ilifi~ P~e r~ to t~ ~ I~~ b~ore ~g t~ fo~ You ~ ~t~ for ~re t~ o~ ~ng t~ diff~em ~ ~fic ~tificmion fo~ for e~ of t~ fo~ ~egoH~ ~ ~ ~lr~ ~t~ion fora for ~n~ ,~ ea~ ~age of your ~mp~ ~tifi~on ~ge ~ i~cme t~ rural n~ of pag~ ~ t~ w~ of e~ 'Page ~ of ~[ P~ your ~A ~ N~ on e~ pag~ P~e pro~ ~ of t~ ~fo~ion req~' ~ notific~ion fe~ ~e ~s~s~ on the b~ of :~ n~ of ti~ the ~t~ will oper~e ~, ~ will ~ ~l~ ~ t~ Stye Board of Eq~l~iom DO N~ ~ FO~ ~ ~ ~S N~~O~ FO~. NO--CATION I~ic~e t~ nmr of uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of una wedfic ~t~c~ion fo~ you m~ ~a~ Nm~ of ~ ~d gt~ghed uNt sp~c nofi~mfio~ for ~ ff~ re~m~. A. Coaditio~Iy Exempt-S~l Q~ti~ Trmt~at D. Pemt by Rule B. ~' Conditio~lly E.xempt-S~ifi~ W~t~trmm E. Co~e~i~ C. Coa~tio~ly Au~od~ F. V~c= (~tion ~143) ~. G~TOR ~E~CATION PRYSIC~ L~A~ON / CO~A~ PERSON ~f ~ ,~7' ~"r~'>X.~ PHO~ ~BER( . - , C OMP,~NY N~ME I ST~ [R=gion CI~ STA~ ZIP - COUNTY (ody zo~le~ if ~ USA) CO~A~ PERSON PHO~ ~t Na~) ~t Name) DTSC I772 (I/95) Page OZ~TD"ICATION$: 7'~.?orm must be signed ~ ~ c. '~w~M co~orge o~cer or ~ ot~ ?~on in the eo~ C~e of Regu~io~ (CCR) Se~ion ~270.11). ~ ~w ~p~ ~ ?~ odg~ ~g~. _ _ deg~ [ Mve de~e~in~ to ~ ~ono~lly p~li~ble ~d ~ ! Mve ~t~:~ ~e p~le me~ of ~~ ~mge, or ~ui~m~ of s~:~ smmt~ ~d m~latio~ for ~e ~t~ ~tt~g tier. ~ctud~g g~e~tor ~d ~n~/ ~n~t · I c~ ~der ~ of law ~at ~s d~u~t md fll a~mnm we= p~pm~ ~der my di~on or m~oa N ~ a ~stem dmi~ to ~m ~t q~ifi~ ~et pm~rty gaper ~d ev~e ~e Nfomfion ~b~t~. B~ on my of ~e ~n or ~ who ~age the ~stem, or ~og dimity ~ible for ga~e~g ~e Nfomdon, ~e Nfo~on · e ~t of my ~owt~ge md ~!ief, tree, ~umte, ~d ~mpte=e. I m awm ~t ~== ~ ~bsmti~ ~natti~ for ~b~ttNg f~ Nfomdon,. NcludNg ~e ~ibility of ~ ~d for ~o~g violafio~ ~ OPE~T~G P~e~e note that generato~ treating h~ardo~ ~te otuite are required to comply with a n~ber of operating requir~en~ whi~ differ depe~ing on the tier(s). ~e operating requirement$ are set forth in the statut~ a~ regu~io~, some of whi~ are referenc~ in the ~er-~pec~c Fao Sheets avai~ble ~om the Depanment'$ regional a~ he~q~ners o~c~. ~SION PROCED~S: You m~t $~it ~ ~oi~ of this,completed not,cation by cen~ed mail, return receipt requited, to: Depamment of Toxic Substanc~ COntrol Progr~ D~a Management Se~ion ~ ~ S~eet, 4th Floor, Rhom ~53 (wa& in only) P.O. Box ~6 Sa~mento, CA 95812~6. You m~t a~o s~mlt o~ ~ of the notification a~ attachments to the local regulato~ agen~ in yourju~digion ~ l~t~ in Appe~ 2 of the i~truoion material.. You m~t a~o retain a copy ~ pan of your oper~ing record. DTSC 1772 (1/95) Page 3 CONDITIONALLY E~M2rr SPECIYlED WASTESTR~AMS UNiT SP£CL~iC NoTr3- iCATION - . ~t to H~ ~d Saf~ C~e S~don ~201.5(e)) - ~e ~er~c Fa~ Sh~ con~ a ~mma~ of ~e o~Hng ~~ for m~ew ~ ~m~m ~y ~fom compl~ or ~b~ng ~ no~fion ~e. / ~~ OF ~O~GE DE~: __ T~-k(s) Ea~ unit m~ be c~ ~tifi~ ~ ~e~d on the p~t p~ ~ta~ to Fo~ 1~. unit. ~e n~ ~ be ,eq~mial (I. 2, 3) or ~ing ~ ~ ~u trem~ in ~ ~mk Idicme in t~ ~mive (Secion II) ~ ~ur op~io~ ~ stmo~i ~ated Mon~y To~ golme T~t~: ~ ~or ~ g~lo~ ~at~ Mon~ly To~ Volme Stood: ~ ~dlor gallom NO ~ Is ~e w~te tmt~ ~ ~s ~t mdio~tive? ~ Is remotely geaemt~ hn-n~do~ w~te (HSC ~II0.10) trmt~ N ~s ~e fol~wing are the eligible w~t~tre~ ~ tremment process. Ple~e &eck ali applic~le boxy: ~ 1. Trmm r~i~ m~ed or c~ in accor~nce with ~e m~acturer~s im~cfio~ (indu~ on,pm ~d : pr~impr~mted mariaN). ~ 2. Trmt conminm of 110 g~lo~ .or 1~ mpa~ty ~t contained ~rdom ~te by Nming or physi~ pr~, su~ ~ ~Nng, ahred~ng, grinding, or p~ct~..- ~ 3. D~ing s~ w~tm, ~'d~ifi~ by ~e depmhn~t prat to Title ~, CCR, ~fion ~261.~, by prying or by p~ive or hint-aided evapo~fion to r~ove mt~. ~ 4. Magnetic sepa~fion or ~ng to rmove comgonen~ from sp~al ~te, ~ d~i~ by ~e dep~ent pum~nt to Title ~, CCR, S~fion 66261.124. ~ 10 ~t add or ~ by w~ht m ~ ~ble for ~ ~ 6. Neumli~ addic or ~ine (b~e) w~tm from the f~d proc~i~ indm~. ~ 7. R~ov~ of silver from photofi~Nng. The volme limit for condifion~ ~x~pfion generator (at the sine lomtion) in any mlendar mon~. =NO~= R~ove~ of 10 g~lons or 1~ ~r mon~ of s~ver from photofinishing, ~mpletety exempt from ~rmi~g; ~ form need not be submit. DTSC 1772B (I/95) Page 10 FA~ SPEC'~C N~~ON - ~d by ?~t By R~e F~ilifi~ ~ N~ ea~ page of ~ur comp~ ~tifi~on ~ge ~ i~c~e t~ total n~ of pag~ ~ t~ top of ~ ~ge 'Page -- of __[ ~ yo~ ~A ~ N~ on to& pag~ P~e pm~ ~I of t~ info--an req~' ~ fie~ ~a~e~. ~ notificmian fe~ ~e ~s~s~ on tht bm~ of t~ n~ of ti~ the ~tifi~ will opine ~, ~ MH ~ mt~ ~ ~oard of Eq~l~iom DO N~ ~ ~0~ ~ ~ ~X N~O~O~ L NOT'CATION CA~GO~ I~icme r~ n~r of uni~ you opine in e~ ti~. ~ will ~o be t~ n~er of unit ~e~fic ~tificmion fo~ you m~ Nm~ o~ ~ ~d ~t~ch~ u~t ~fic nofifi~fiom for m~ ~ A. Coadkio~ly Exempt-5~l Q~ti~ Trmt~at D. Pemt by Rule B. ~; Conditionally ~empt-S~ifi~ W~t~trmm E. COmmemi~ C. Coa~tio~ly Au~od~ F. Vah~ce (~tioa G. G~TOR ~EN~CATION EPAIDN~BERCA~ 0 ~L r ~ ~ ~ BOE NUMBER (if available) H~H~L ~ ~ (DaA-~na PHYSIC~ L~A~ON COMPLY N~ME ~or DTSC ST~ Raglon _ CI~ STA~ ZIP COU~Y (o~y co~le~ if m USA) CO~A~ PERSON PEO~ ~mt Name) ~t Name) DTSC 1772 (1/95) page CE~T~rlCATIONS: 7~nis form m~t be sig~ ~ ~ amrmd~ co~orme offic~ or ~/ ot~ p~on h t~ compm~ h~ op~a:ionat conxol arm ;~o~ dec~icn-m~ngfia~aiam t~ go~ opem~on cf r~e fac~li~ (p~ ~ 22, C~e of Regu~iom (CCR) Seaian ~270.11). ~ ~ mp~ ~ ~ odg~ de~ [ ~ve dete~in~ to ~ <ono~lly p~ti~ble =d ~t I ~ve ~1<1~ ~e pmd~le ~ of ~~ ~mge; or di~ cu~y ayah]able to me wMch ~M~ ~e p~nt md ~m~ ~t to human h~ ~d ~ ~uimm<m of s~t~ s~mt~ md ~iatio~ tbr ~e M~t~ ~tt~g tier, M~u~g g=emtor =d ~n~ ~mm=~. I =d~d ~t i~=y of ~ ~a o~e =d~ Pe~t by Rule or ~n~fio~ Au~od=fion, I ~ ~ ~ m pmvid~ ~ ~ ~mc: for clo~ of ~e ~t m~ by J=~ I, 1995. I ce~O =der ~ of law ~t ~is d~t =d ~1 at~enm were p~p~ =der my diction or ~ion h ~ a ~smm d~i~ to ~m ~t q~ifi~ ~=et pm~rty ga~er ~d ev~me ~ hfomfioa mb~t~ B~ on my ~q~ o( ~e ~n or ~ who ~age the ~stem, or [5o~ dimity ~ible for ga~e~g ~e ~fomfion, ~e ~fomfion · e ~t of my ~owl~g¢ =d ~lief, tree, ~umte, =d for ~o~g violation. ] .. OPE~T~G P~e~e note that generators treating h~ardo~ w~te ot~ite are required to compQ with a nmber of operating requir~n~ differ depe~ing on the tier(r). ~e o~erating requirementx are get fo~h in the ,tatut~ a~ regu~iom, ~ome of wfii~ are referenc~ in the ~er~pec~c Fa~ ~heem avaitable fiom the Depanment'~ regional a~ he~er, ~SION PROCED~S: You m~t s~it ~ ~ni~ of this completed not~cmion by ce~ed mail, return receipt requited, to: Depa~ment of Toxic ~ubstanc~ Control Progrm Data Mmmgement $e~ion - ' ~ ~ S~eet, 4th F~oor, Room ~53 (~a~ in only) P. O. Box ~6 Sa~ento, CA 95812~6. You m~t a&o s~mlt o~ ~ of the notification a~ attachmentc to the local regulatom~ agen~ in your ju~di~ion ~ ApFe~ 2 of'the i~tru~ion material. You m~t a&o retain a copy ~ ga~ of your oper~ing record. DTSC 1772 (1/95) page 3 o CONDITIONALLY ENd. MIr( SPECIFI.~ED WASTESTREA~%fS b~ SPECi.. ' NO~iCA~ON ~E~ OF ~AT~ DE~: 0 T~s) / Con~s)/Ccn~ T~: ,~s) ~~ OF ~O~GE DE~: , T~(s) Em~ the ~:~ ~mhly total ~l~ of ~~ w~e ~em~ ~ th~ unit. ~n~ s~u~ be the ~m~ or hig~ ~timat~ Money To~ Volme Stood: ~ ~dlor gallo~ YES NO ~ Is remotely geae~t~ ha:nrdom w~te (HSC ~110.10) ~mt~ ~ ~s ~ne fol~wing are the eligible w~t~tre~ ~ ~e~ment proc~ses. Ple~e ~eck all applic~le boxy: ~ I. Tr~ r~i~ m~ed or c~ in accor~nce with ~e man~actur~'s i~cfio~ (indu~ on~p~ ~d ' pr~impr~ted mariaN). ~ 2. Trot conmin~ of 110 gallo~ or I~ ~padty ~t contained bn~rdo~ ~te by ~i~ or physi~ pr~, ~ ~ ~Mng, shred~ng, grinding, or p~cl~. prying or by p~ive or h~t-aided evapo~on to r~ove wat~. ~ 4. Magne~c sepa~on or s~ng to r~move componen5 ~rom spiel w~te, ~ d~i~ by ~e dep~ent pu~nt to Title ~, CCR, S~fion 66261.124. t~nn 10 ~t add or ~ by w~ht m ~ ~le for ~ ~ 6. Neu~Ii~ addic or ~ine (b~e) w~t~ from the f~d proc~ing ind~. ~ 7. R<ov~ of silver from photofi~hing. The volme limit Mr condi~on~ ~x~p~on gen~toc (at the s~e lo~tion) in any ~lendar mon~. *NO~= ~overy of 10 gallons or 1~ .~r mon~ of shyer from photoffnlshlng ~mpletely exempt from ~rmi~g; ~ form n~ not be DTSC 1772B (1/95) Page . . ~ ot ~ond~. ~lLrornLa F~LFomn Pago 1 of ONSITE NO CA ON FA~ SPEC~C NO~CA~ON - For U~ by ~d by P~e r~ m t~ ~ta~ I~~ b~ore ~t~cmion fo~, D~C I~ You m~ ~a~ a diff~e~ ~a ~fic ~t~c~ion fo~ for e~ of t~ fo~ ~ego~ N~ ea~ page or.ur ~mp~ ~t~ion ~ge 'Page~ of ~[ P~ your EPA ~ N~ on comp~ ~c~t t~e t~ ~e '~ ~ta~en~. ~ not~c~ionfe~ ~e ~$~*~ on t~ b~ of t~ n~ ofri~ the ~tifi~ wile oper~e ~, ~ wi~ ~ ~l~ ~ t~ Board of Eq~l~iom DO ~ ~ YO~ ~ ~ ~S ~0~0~ FO~. NOT'CATION CA~GO~ I~ic~e t~ n~r of uni~ you opine in ea~ ti~. ~ will a~o be t~ n~er of unit spe~fic ~t~c~ion fo~ you m~t ~a& Nm~ of ~ ~d gt~qh~ uffit sp~Uc nofifi~fio~ for m~ fief re~. A. Condifio~ly Exempt-Stall Q~ti~ Trmt~at D. Pemt by Rulo B. ~ Coaditio~lly Exemgt-S~ifi~ W~t~trmm E. Comme~i~ C. Conditio~ly Au~od~ F. Vad~ca (~tioa ~ 143) n. (DBA-~ing ~ ~) COMPLY N~E For DTSC U~ ST~ R~gioa CI~ STA~ ZIP COUNTY (o~y co~la~ if ~ USA) CO~A~ PERSON PHO~ ~BER( ) ' ~t Name) ~st Name) DTSC 1772 (1/95) Page 1 ]III. RADIOACTIVE MATERIALS OR WASTE . YES NO - Doe, a the facility use, stor~ or treat radioactive materials or radioactive waste? IV. TYPE OF COMPANY: STANDARD IINDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes (a four digit number) that best dexcribe your compa~. 's products, services, or industriai Example: 7384 ". Photofinishing lab 7218 Indartrial lmmder~ " V. PRIOR PERMIT STATUS: Check ye..v or no to each question: r-] 1. Did you file a PBR Notice of Intent to O!~rate (DTSC Form 8462) ia 1992 for this location? l'-] t~ 2. Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim status for any of these treatment urdta? '[~ [] 3. Do you now have or have you ever held a state or federal full p~rmit or interim status for any other ba:mrdous waste activitie~ at this location? X~ l-"] 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you am now notifying for at this location? x[~] ['-] 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? VI. PRIOR ENFORCEMENT HISTORY: Not required from generators only notifying as condizionally ~ or as a YES NO l'"'] Within the last thre~ years, has this facility been the subject of any convictions, judgments, settlements, or final ordem resulting from aa action by any local, state, or federal environmental, hazardous waste, or public health enforcement agency? (For'-the purposes of this form, a notice of violation does not constitute an order and need not I:~ reported toeless it was not corrected and became a final order.) If you answered Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) VII. ATTACHMENTS: Attachments are not required for Commercial Laundry facilities. x,l~ 1. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. '[~! 2. A unit specific notification form ~br each unit to be covered at this location. DTSC 1772 (1/95) Page 2 VIII. CERTIYICATIONS: Th/s form must be signed by an authorized corporate officer or any other person in the company who has operational control and perforrn.v decision-meriting functions that govern operation of the facility (per T'ttle 22, California Code of Re_gulations (CCR) Section 66270.11}. All three capitx mart have original ~ignatm~ . Waste Minimization ! certify that I have a program ia place to reduce the volume, quantity, and toxicity of waste generated to the degree [ have determined to be economically practicable and that I have selected the practicable method of treatment, storage; or disposal currently available to me which minimizes the pre, eat aad futura threat to human health and the eavironment. Tiered Permitting Certification I certify that the unit or units described in thes~ documents meet the eligfbility md .operating requirements of state statutes and regulations for the indicated permitting tier, iacluding g~aerator and secondary contalnm~t requirameats. I uadersmad that if any of the units operate uader Permit by Ruie or Conditional Authorization, I will also be requir~ to provide required financial ass~-anc~ for clnsura of the treatment unit by January I, 1995. I certify under penalty of taw that this documemt and all attacLments were prepared under my direction or supervision ia accordanc~ with a system d~sigaed to assure that qualified l:~rsonael properiy gather and evaluate the information submitted. Based on my inquiry of the per,on or persons who manage the system, or those directly r~fmnsible for gathering the information, the information is, to the best of my knowledge and belief, true, ac.~:urate, aad complete. I am awara that there ara substantial penalti~ for submitting fal~ information, iacludiag the possibility of fin~ and impriso,,mm~x for kaowing violations. ~-' OPERATING REQLrlI~MENTS: Please note that g,nerator.~ treating har. ardous waste ot~ite are required to comply with a number of operating requirements which differ depending on the tier(x). Thexe operating requirements are set forth in the ,tatute.~ and regulation.,, .~ome of which are referenced in the ~er-$pecifi¢ Fact Sheet~ available from the Department '.~ regional and hcndquarter, SUBMISSION PROCEDURES: You mu~t .~ubmit two copies of this completed notification by certified mail, return receipt requexted, to: Depamment of Toxic Substanc~ Control .~rogram Data Matmgement Section 400 P. Street, 4th Floor, Room 4457 (walk in onlyJ P. O. 'Box 806 Sacramento, CA 95812-0806. You muxt al.~o submit or~ cot~ of the notification and attachments to the local regulatory agency in your jurixdiction a~ l~ted in Appendix 2 of the ir~truction materials. You muxt also retain a copy a~ part of your operating record. All three form.~ must ~ original .~ignature~, not photoco£ies. DT$C 1772 (1/95) Page 3 CONDITIONALLY EXEMFF - SPECIFIED WASTESTREAMS ~'' UNIT SPECIFIC NOTIFICATION _ - (purmmnt to H~alth and SafeXy Code Secfioa 25201.$(e)) - The Tier-Specific Fact Sheets contv,;- a summm7 of the operating requh'ements for tiffs category. Pleas~ review those requlrem~-ts carff,,lly before completing or submj~ng this notification package. NUMBER OF TREATMENT DEVICF_.$: c~. Tank(s) Conrainer(s)/Container Treannent Area(S) NUMBER OF STORAGE DEVICF_.S: Tank(s) Each unit must be clearly identified and la~eled on the plot plan attached to Form 1772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or u~ing any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This shauld be the ~. '~ um or highest amount treated in any month. Indicate in the narrative (Section II) if yo. ur operations have seasonal variaHons. . Estimated Monthly Total Volume Treated: pounds and/or/~,,) gallons Estimated Monthly Total Volume Stored: pounds and/or gallons YES ["] i~ the waste treated in ttfis unit radioactive? [~ ,xx~ Is the waste treated in this unit a bio-hazard/infections/medical waste? [.._] x~ Is remotely generated hagardons waste (HSG 25110. I0) treated in The following are the eligible wastestrearns and treatment processes. Please check all applicable boxex: [~] 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part ,and pre-imprgnated materials). ~l 2. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. i-'l 3. Drying special wastes, as ~assified by the degarh,ient pursuant to Title 22, CCR, Section 66261.12A, by pressing or by passive or heat-aided evaporation to remove water. ['-1 4. Magnetic separation or screening to remove components from special waste, as daasifled by the depaxhnent pursuant to Title 22, CCR, Section 66261.124. *NOTE* 5. NO AUTHORIZATION IS NEEDED to neutralize acidic or ail,al;ne 0rose) wastes from the regeneration of ion exchange media used to dominernl;?o_ water. (This waste cannot contain more th.a, 10 peax:ent acid or base by weight to be eligible for this exemption.) x~ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. 7. Recovery of silver from photofinishing. The Volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. ' ~:NOTE* Recovery of 10 gallons or less per month of silver from photofinishing is completely exempt from permitting; this form need not be submitted. DTSC 1772B (I/95) Page 10 CONDITIONALLY EXEMFr - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 2520 I.$(c)) 8. Gravity ieparatlon of the following, indudlng the use of flocculants and demulsifiers if I~l a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ha~ntons. [~ b. The separation of oil/water mixtures and separation sludges, if the average oil recover~l per month is leas than 25 barrels (42 gallons per barrel). r-] 9. Neutralizing iddic or alkaline (base) material by a state certified laboratory or a laboratory operated by an educational institution. {To be eligible ['or conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) ["'[ I0. H-~rdous waste treatment is carried out in quality control or quallty assurance laboratory at a facility that is not an offsite hazardous waste facility. ['-] 11. A wastestrenm and treatment technology comb/nation certified by the De. partment pursuant to Section 25200.1.$ of the Health and Safety Code. Please enter certification nmber= ['"] 12. The treatment of formaldehyde or glutaraldehyde by a healthcare facility ming a technology combination certified by the Department pursuant to section 25200.1.$ of the Health and Safety Code. Please enter certification number:. II. NARRATIYE DE$CRIFrlONS: Provide a brief description of the specific waste treated and the treatment process ased. 2. / 3. SPECIFIC WASTE TYPES STORED: III. RESIDUAL MANAGEM~ENT: Check Yes or No to each question as it applies to all residuals.from this treatment unit. G S NO . ., [-'1 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? [-] 'X[~"! 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? ~ [] 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler? x~If you do, where is the waste sent? Check all that apply. a. Offsite recycling l--] b. Thermal treatment I~! c. Disposal to land ~ d. Further treatment [---] 'x[~---] 4. Do you dispose of non-hazardous solid waste residues at an offsite location? ['--] ~['~ 5. Other method of disposal. Specify: DTSC 1772B (1/95) Page I1 CONDITIONALLY EXEMFT - SPECIFieD WASTESYREAM~ UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) _ IV. BASIS FOR NOT' NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (7~tle 40, Code of Federal Regulations (CFR)}. Choose the reason(s) that describe the operation of your onsite treatment units:' ' l-'! 1. The hazardous waste being treated is not a bn~'-nrdous waste under federal law although it is regulated as a h.~rdous waste under California state law. F"] 2. The waste is treated in wastewater treatment units (tanks), as defined ha 40 CFR Part 260. I0, md discharged to a publicly owned treatment works (POTW)/seweriag agency or under aa NPDES permit. 40 CFR' 264.1(g)(6) and 40 CFR 270.2. F"] 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a PO'I'WlseweHng agency or under an NPDE$ permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. ['-'l 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260. I0; 40 CFR 264. l(g)(5). [--[ 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. [--] 6. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generatom and 180 or 270 days for generators of I00 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 _F~eral Register. ~] 7. Recyclable materials are reclaimed to recover economically si~nificant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [~l 8. Empty container rinsing and/or treatment. 40 CFR 261.7. V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Ir,~vtructions for more information. ["'[ Is this unit a Transporlable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. Page 12 DTSC 1772B (1/95) /J ONSITE HAZ. RDOUS W..ASTE ..PxEATMENT NOTIFICATION FORM FACI~TY S?!' ::&'iC NOTIFICATION _ For Use by 14.~rdoua Wa~'~ Geaerator~ P~orming Treamaent [] Initial Under Cam:t.itional Exem[:. Con aad ConcLifional Authorization, [] Renearal amd by Pein'it By Rule Fac/lit/es [] Ameadmeat Please refer to the attached Inaxrmxior~ before c~mpl~ing thief otto. You may. n°ti. fy for more than orae perrnitling tie~ by using notification form, DTSC 177'2. You muxt attach a separaxe unit cpecific notification form for eaah unix at thi~ location.' There are different u.nit specific notificat(on form~ for each of the four categories and an ~4~tional notification form for rransponaJJle unitx f27[l's). ~ou ordy have'to submit fot'n~ for the tier(s) that cover your ~nit(s). Discard or recycle the other uno. form&. Number each page of your' compl~ecl notification paa~.age and indicate the total number of pages at the top of each page ax the 'Page -- of __% Pat your F_~A 1D Number on ea~ page.. ?lease provide ail of the information reque~ed; all fie~= mart be complied exc.~t tho~e that ~rate 'if different' or 'if available'. ?lease type the information prove__4 on thi~ form and any at~aahrnent& 7fine notificalion fees are asse_rse, d on the basix of the Number of tier~ the notifier will operate ~, and will be colle~ed by t,~e State Board of Equalization- DO 3107' SEND YOU~R r~ WtTF!r Ti775 NO771qrcA770N / L NOTIFICATION CATEGOR/ES Indicate the numb~ o£uni~ you operaxt in ,ach tier. ~ir ~ill airo be the number of,nit specific notification forrr~ you mart Number of uni~ and :Ittached unit specific notiSc:ltions ['or each tier reported. .-%. Condkionally Exempt-$rm,!! Quanti:y Treatment D. Permit by RUl~ B. 'X/ Conditionally Exempt-Spec{fled Waste.stream E. Commercial Laundry C. Conditionally Authorized F. Variance (Section 25143) II. GF~NERAT O R IDENTIFICATION EPAID NUMBERCA/L- 0 0 O_.O- 2. ( q f' t~t BOE NUMBER (if available) Hfl_~..HQ 2- .L [ ~ '] 7 ~ PHYSICAL LOCATiON MARLING ADDRESS, IF DI'FFERENT: COMPANY NAME [For OTSC ts..,- o~:, I ST ~, ~'~'T /R~gion -- CITY STATS ZIP COUNTRY (only cormplet~ if no~ USA) COl'Or, ACT PERSON PHONE NI3MBER(_____) ' C~r~l Name) (12..~ Name) DTSC 1772 (1/95) Page I CERTI~"ICATION$: 7'hie'form must be signed by. an au:b~rizezi corporate o~czr or a.,ry other ye'/son in the company has operational control and perfbrms decision-maJdng funcriottt that govern operation ofthe f'aci~iry (per I'~tle 22, Cata;?oinia Code of Regulations (CCR) Seaion 66270. I1). All tfl. r~ copi~ mart have original aignm=ar~t. . Waste Minimization I cariify that I have a program in place to reduce the volume, qtmafity, and ~xicity of waste geaerated to the deg~ [ have determined to b~ economically practicable and ~aat [ have selecteci the prac~ca~le me~cx:t of ~x~a:~eat, ~rage, or di .sposal currently available to me which m/nim/zes the present and future threat to human bee/th and the env/ro=~eat. T~ered Permitting Cer'tifl~tion I certify that the un;t or units desc,-ibed in &ese documents meet the eLig~n/lity and' ope:-,a/ng c~quirements of state statutes and ,~guta.'ians for the ind/cated Fermitt/ng tie:% inciuding generator and secondary requirements. I understand that i.f any of the un/ts operam ,under ?e:-m/t by Rule ar Cand/t/onat AuthoriT_~Oon, I wLLI also be ,'~qu/red to provide required 5.aaaci~ a.~uranc= for cica-ute of the treatm~t uait by ~aauary l, 1995. [ certify under penalty of law that =his documeat and all attackments were prepared ttuder my direction or supervidon ia accardanc~ with a system designed to a.~ure that qualified per-.~nne! prcpe:iy gather md evaluate tiao informatiea submitted. Based on my [uqui~-'y of the person or persons who n-aanage the system, or those directly res~nsible for gathering the ia£ormation, the informatioa i~, to the beat of my knowied§e and belief, true, accurate, aad eomple.'e. I am aware that there a.re substantial penalties for submittiag fal.~ information,- inciudin~ the possibility of 5.ues and i. mpr~nn'~ut for knowing violations. Title ' Name (Prfia~.~Type) . ,f/ Sig-na.~,t~ ~ / ~ Date Si~aed OPERAT~'NG R.E QUIR~'v[ENTS: P!ease note that generators treating ha:.ardous waste onsite are required to comply with a nm'nber of operating requirement~ which di~er depending on the tier(s}. 7'aese operating requirements are set forth in the statutes and regulations, some of which are referenced in the ~er-~Specific Facx Sheet. v available from the Department's regional and headquarters o. Orices. SUBMISSION PROCEDURES: You must sabl;nit two c~pies of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Ma~mgement So,ion 400 P.. Street, 4th F~oor, Room 44.53 (waLk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must also s:tbmit one c'oe~v of the notification and a:tachment.~ w the local regulator/agency in your jurisdiction us listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. All three, fot-m.v must have ori.giru~l signatures, not photocopies. DTSC 1772 (1/95) page 3 ~ SPECIFIC MO~iCATION . (pura'aan£ to He~th and Safe,",! Cod~ S~ct~on %~201.5(c)) - The Tier-Specie Fact'Sheets contain a summar7 of the operating requirements for this category.. review those ~ents carefully before completing or submi~ng this notification package. ,NI~--R OF STORAGE DE¥ICES: Tank(~) E~ch unit must be clear~ identical and labeled on the plot plan attacb~_d to Form 1772. Assign your own unique number to each unit. The number can be sequential (I, 2, 3) or asing any. system, you choose. Erxer the estimated monxhly total volume of bx~aa'dous waste treated by. this unit. This should be the maximum or highest, amount treated in any rnorah. Indicate in the narrative (Semion II)ifyo. ur operations have seasonal variations. Estimated Monthly Total Volume Treated: pounds mad/or ~'"~_) gallons Estimated Monthly Total Volume Stored: pouads and/or gallons YES NO ["-] [~ Ia the waste treated ia this un.it radioactive7 ["-] []~ Is the waste treated ia dais unit a.bio-hazard/Lafectiotm/medical waste? ['--] [~ Ia remate!y generated bnz,nrdous waste (H$C 25110.10) treated La this ,uak? ~ne following are the eligible wastestreams and treatment processes. Please check all applicable boxes: [~] 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part mad pre-impr~nated materials). [-'] 2. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. [-] 3. Drying special wastes, as classified by the depaxh~ent pursuant to Title Z2, CCR, Section 66261.12A, by pre~ing or by passive or heat-aided evaporation to remove water. [--] 4. Magnetic separation or screening to remove components t'rom speclal waste, as classified by the depaxtauent pursuant to Title 22, CCR, Section 66261.124. a:NOTE~: 5. NO ALrI~ORYZATION IS NEEDED to neutrnllTe_ acidic or alkaline (base) was~ fr~n /he regeneration of ion exdmnge media used to demlnexnllv~- water. Cl'his waste ~nnot contain more than 10 percent acid or base by w6ght to be etigfible for this exemption.) [--] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. [3~ 7. Recovery. of silver from photofinishing. The volume limit for conditional ~xemption is 500 galIons per generator (at the same location) in any calendar month. :~NOTE= Recovery of 10 gallons or less per month of silver from photofinishing completely exempt from permitti.g; this form nccd not be submitted. DTSC 1772B (I/95) Page I0 ONSITE 'HAZ OUS WASTE TREATMENT NOTIFICATION FOl ,4 FACII_rI'Y SPECI~C N~CATION For U~ by I4~mIaua Waste G~emtot~ P~rforming Tmattmmt [] In/t/al Uader CandifiotmI ExertS. ti~n and Conditional Authorization, r-[ axM by Pemmit By Rule Facilities [] Amendment Please r~.'er :o the attached Insrrucsions before compltring this form. 7on may n°tify for more than one penai~ng tier by using this notification form, DT~C 1772. You mast attach a separate ~ specific notification form for each unit at this location. There are different unit specific notificax~on forrr~.for each of the foot categori~ and an ~'t;tionad notification form .for tranxpo, gable treatrr~ unitg (TT~'.r). Yon only ]rove'to submit forms for iht tiff(s) th~ cover your unit(s). Di. xcard or rtcyc~e the other anased form~. Number each page of your completed notification pat:~age and in&cate the total number of pag~ at the top of each page at the 'Page ~ of ~'. ?~ your E.DA 1D Number on each page. Please providt all of the information requested; all fief. dr mart be complesed except those that ~tazt 'if different' or 'if available'. Please type th~ information provided on thit form and any attachments. ~.e notification fe~s are asxt'.sxed on tht basis of the nurn3er of riem the natifier wilI operatt under, and will be colle~ed by the State zToard of Equalization. DO NOT SEND YOUR F~ grITFl 77TI$ NO77FtCA770iV FORM. NOTifICATION CATEGORIES Indicate the number of units you operate in each tier. This '.ill alxo be the number of unit specific notification for'rn~ you mast attach. CondixionaJdy F_z2mtx &r~lt Qmznriry Tre. mm~ operations nmy not or. rate ~ andtr any othtr tier. Number of tm/ts and qttached unit specific notifications for each tier reported. A. Conditionally Exempt-Small Qumatity Treatment D. Permit by Rule B. 'v Conditionally Exempt-Specified Waste~tream E. Commercial I~tmda-! C. Conditionally Author/zed F. Var/aace (Section 25143) II. GENERATOR 12DENTEFICATION EPA ID NUMBER CA/L- 00 O__Q_ 2. t "] ~' t{ BOE NUMBER (if available) Hr~HQ.~_.2-- [ (7 '~ ~ 3 2.- PHYSICAL LOCATION COMPANY NAME [For STR.E~--'T [Region CITY STATE ZIP - COUNTRY (only ¢orr~l,'ta it' not lISA) CONTACT PERSON PHONE N'UMBER(...__~~' (F~mt Name) ['Lag Name) DTSC 1772 (1/95) Page 1 CERTIFICATIONS: ~ir form mu.*t be ~ig~ ~ ~ au:~ co~r~e h~ op~mionat consol a~ p~o~ de~ion-m~n~fi~a~io~ rinm go~ oR.reich of'rh~ fa~li~ (p~ ~t~ 22, CMifo~ C~e of Regu~io~ (CC,~) Se~ion ~270. I1). ~ ~ mp~ ~ ~ o~g~ W~te Minlmim~on I ¢e~O ~t I ~ve a pm~ ~ pl~ m ~e ~a voium~, deg~ [ Mve dete~in~ to ~ ~ono~ly p~fi~ble ~ ~t i Mve ~t~ ~e p~fi~te ~ of ~ ~mge~ or di~ cumdy arable to me w~ch ~~ ~e p~at ad ~mm ~t to ~er~ P~itfinl Cemifimtion I ceni~ ~ ~e m~ or ~m d~d~ ~ a~ ~ui~m~m of s~:~ s~mt~ ~d ~ahtio~ for ~e ~mt~ ~tt~g tier, ~ctu~g g~emtor ~d ~ui~m~m. [ mdeamd ~ i~ my of ~a ~m o~m~a md~ Paint by Rule or Con~fio~ m provide ~ ~ci~ ~ce for cto~ of ~a ~: mt by J~ 1. 1995. I ce~ ~der ~ of law ~t ~s d~a~t ~d MI a~m~m were prep~ ~der my diction or ~sioa ~ a ~stem d~i~ to ~ ~t q~ifi~ ~el pm~rty ga~er md evMxmte of use ~n or ~ who ~age the system, or ~o~ di~tly ~ible for ga~e~g ~e ~t of my ~owl~ge md ~tief, tree, ~umte, ~d ~mple~e. Pte~, not~ that gsnera*o~ tr,ating h~ardo~ w~ts ot~i~, ars rsquirsd to com?y with a n~b~r of operating requir~en~ whi& di~ dep~ing on tbs tier(si. ~ operating rsquir,msnt= ars =~ fonh in the =tatut~ a~ rsgu~io~. =om, of whi& ar, ~SSION PROCED~S: ~o~ m~r =~'it ~ ~pi~ of this completed not,cation by csn~ed mail. return r,c~ipt requited, to: Depanm~nt of Toxic Subxt~c~ Control ~ ~ ~. 4th Ftoor. Room ~5~ (wa~ in only~ ~ou m~t ~o =~mit o~ ~ of the notification a~ a=tachment= to the local r,gulato~ agsn~ in your ju~d~ion ~ l~t~ in Appe~ 2 of the i~rru~ion material. You m~t a~o retain a copy ~ pa~ of your oper~ing record. DTSC 1772 (1/95) Page .CONDITIONALLY EXEI-'vEFT - ~SPECitrtED WASTESTREAMS ~ SPEC~C iqO~tCA~ON * - U=4~c FaC Sh~ con~ a ~ of ~e o~~ ~it m~t be c~0 ~t~M ~ ~e~d on &e p~t p~ ~za~d to Fo~ 1 the ~t~ ~hly total ~l~ of ~~ w~e ~e~ ~ ~at~ Mon~ly To~ Vol~e S~ored: ~ ~d/or gallo~ NO ~ ~ ~e w~te tr~t~ ~ ~s ~t mdio~:ive? ~ Is remotely geae~t~ ~,~do~ w~te (~SC ~ I ~0. I0) tr~t~ ~ ~s ~t? ~e fol~wing are the eligible w~r~tre~ ~ :re~ment proc~ses. Ple~e ~e~ all applic~le boxy: 1. Tr~ r~i~ raked or c~ in accor~nce with ~e m~acmr~s i~c~o~ (indu~ on~p~ ~d pr~imprgnated matlab). 2. Trmt conmin~ of 110 gallo~ or 1~ mpad~ ~t contained ~rdo~ ~te by dining or phy~ pr~, su~ ~ ~hing, shredding, grinding, or p~c~. prying or by p~ive or h~t-aided evapom~on ~ r~ove wat~. 4. Magne~e sepa~Mon or ~ng to r~ove componen~ Dom sp~al w~te, ~ d~i~ by ~e deg~mt pu~nt to Title ~, CCR, S~on 66261.124. ~ 10 ~t add or ~ by w~ht ~ ~ ~ble for ~ ~pfiom) 6. Neu~li~ addle or ~ine (b~e) w~t~ ~rom the ~d proc~ing ind~. '~ 7. R~ov~ of silver Dom photo~hing. The vol~e limit ~or condi~o~ gen~tor (at the s~e lo~fion) in any ~lendar mon~. =NO~~ ,R~overy of 10 gallons or 1~ ~r mon~ ~mpletely exempt from ~rmi~g; ~ ~orm n~ not be ~ubmi~. DTSC ~772B (I/95) Page 10 ~ ...... 12SPACES I tx*T --' '3 ' , ~ SPA~S i ~ . · · 126 SP, 34TH STREET Page ~ of ~.~- ONSITE ItAZ OUS NO CA ON FA~ SPE~C NO~CA~ON _ For U~ by ~n~ ~ G~ ~¢ r~ m t~ ~ I~~ b~or~ m~ing t~ fo~ Yoa ~ ~ti~ for ~r¢ t~ o~ ~ing t~ ~ ~ th& ~tifi~ion fo~, D~C 1~. You m~ ~a~ a *~e ~ ~fic ~tifi~ion fo~ for diff~e~ ~a ~fl~ ~tific~ion fo~ for ~ of t~ fo~ ~ego~ ~ ~ ~'a). You OhO ~ve'm a~ fo~ for ~ ~s) ~ m~ ~ ~(,). D~d or r¢~c~ t~ m~ ~ fo~.- ~V~ ea~ page or,ur ~mp~ ~tifi~ion ~ge ~ i~'cme 'Page ~ of ~'. Pm your ~A ~ N~ on ea~ pag~ P~e pm~ ~ ~tificmion fe~ ~e ~s~s~ on the bm~ of t~ n~ of ri~ the ~tifi~ Board of Eq~l~iom DO N~ ~.~ ~0~ ~ ~ ~S N~G4WON FO~. I. NOT'CATION IMicme t~ n~ of uni~ you op~me in ea& ti~. ~ will a~o be t~ n~er of unit ~e~fic ~t~cmion fo~ you m~ ~a~ Nm~ of ~ ~d gt~ch~ u~t sp~fic nofifi~fio~ for m~h ~er A. Coaditio~ly Exempt-S~l Q~ti~ Trmt~at D. Pemt by Rule B. ~/ Coaditio=lly E.xempt-S~ifi~ W=t~trmm E. Com~emi~ C. Con~tio~ly Au~od~ F. ~. G~TOR ~E~CATION EPA ID NUMBER CA~ ~ ~ ~ ~ ~ ~ ~ ~ BOE NUMBER (if available) H~H~ PHYSIC~ L~A~ON ~ t CO~A~ PERSON ~/~ , ~G ~~, W COMPANY N~ME S~ -- [Region CI~ STA~ ZIP COU~Y (ody ~o~1,~ if ~ USA) DTSC I772 (1/95) Page 1 VIII. CERTI}"ICAT~ONS: 7nir form mus: be ~igned by c.. :~'~'koriz~ corporate or~cm' or any other per=on in tb~e aampany who has operational control arm ~er~brtv~s ded~ion-medffng_ '::-~.."tior.: :hat govern o.o~,raxion of t.~ facili~ (per ~:Ze 22, Califoi-nia Code of Regulations (CCR) Sec:ion 66270. II). All .:,,:~>'~ aa.vier mart have original a'ig~ _ Waste Minimization ! cersi,'f'y ttmt [ have a program ia piac~ t,~ :~xt ,mt= the ¥oium~, quantity, and toxicity of wa.~ geaerauxt to the degree [ have determine~t to be ~onomically prac'.icabie and ~t.~ [ have seleca=t the pm:icable method of Wean:neat, storage, or di .sposal c=rreat.ty available to me wkich minimizes tho present ~d future threat to human health and the eav~a'~n~eztt. Tiered Permitting Cer~iflcation I certify that the unit or uaim de..~,-ibed ia t~e~ docm:neats meet the eligibili.'3' and ~uiremeata of state statutes and regulaticn.s for the in~i~te~ permitt'.'.-~g ties, including generator and second,sty eontain.w~-mt r'vctuirememts. I madersmnd that if any of the tmit.s operat, a under Pa,'mi, 't by Rule or Conditional Authorization, I w/il .also be ~ provide r,'~quired financial a.szumnc= for ciczure of the k'"~'~'~'~'~'~'~'~'~:.~i unit by January I, 1995. I csrtiP/under penalty of law that t,':is document and all atmkme.nm were prepaxe~t trader my direction or au.vm"~isioa ia with a system designed to assure that qualified personnel pr~periy gather and evaluate the iaformation rabmitted. Based on my i.aquiry of the person or persons Who manage the sys:em, or those directly :'expo. msible for gathering the information, the information is, to the best of my ~owiedge and belief, true, accurate, and complete. I am awe.re ttmt them are subsm.nfial penalties for submitting faL.~ information,, including the ix~ssibility of fines and impr~nmemt OPERATING REQUIR.EM~NTS: ?!eas~ note that generatorz tr,ating haz. ardou~, wa. rte onxite are required to com?y with a number of operating requirements which differ de~ending on the tier(s). 7~e operating requirements are xet forth in the statutes and regul~ionx, .rome of which are referenced in the ~er-$pecific Fact Sheets available from the Department's regional and headquarters o. lfices. SUBMISSION PROCEDLrR.ES: You mu. st srdffnit two copier of this completed notification by cer:i, fied mail, return receipt requested, to: Depat'r, ment of Toxic Substanc~ Control Program Data Matkagement Section 400 P. Street, 4th F~oor, Room 4453 (walk in only) P. O. Box 806 Sacramento, CA 95812-0806. You mttst also su3mit one coo~, of the notification and attachments to the local regulatory agent? in your jurixdiction as lixted in Appendix 2 of :he in. rtruction materials. You mast also retaia a copy ax part of yotar operating recora. All three forrn~ tniart have oHgir, al signatures, not photocopies. DTSC 1772 (1/95) CONDITIONALLY EX]E~fFr -,SPECIFIED WA~STESTREAMS bqqtT SPE~C ~ ~ O~.CA; ~ON ~t to H~ ~d Safc~ C~c S~on ~201.5(¢)) _ ~e ~-S~c Fa~ Sh~ con~ a ~ of ~e o~-g ~~~ for ~ew ~ ~enm ~y ~%~ comple~ or ~b~ng ~~ OF ~~ DE~: T~(s) ~ ,,. Con~e~s)lCon~ T~: ~(s) Ea~ unit m~t be c~ ~t~ ~ ~e~d on the p~e p~ ~md~d m Fo~ 1 ~. ~xign your own uniq~ n~ m ea~ unit. ~e n~ ~ be seq~ial (I, 2.3) or ~ing ~ ~ ~u ~se. Ent~ the ~'~ ~hly fatal ~l~ of ~~ w~e ~e~ ~ th~ uni:. ~n~ tre~ in ~ ~ I~ic~e in t~ r~ive (Se~ion Il) ~ yo~r op~io~ ~ se~o~l v~o~. ~at~ Mon~ly To~ Vot~e T~t~: ~ ~or g~lo~ ~timat~ Money To~ Volme Stored: ~ md/or gallo~ YES NO ~ Is ~a w~te tr~t~ ~ ~s ~t a bio-b~--~f~tio~lm~i~ w~ta? ~ Is remotely geae~t~ hn,nrdo~ w~t~ (HSC ~ 110.10) ~t~ ~ ~s ~e fol~wing are the ~ligibte w~t~tre~ a~ ~e~ment proc~ses. P~e ~ec~ all applicable boxy: ~ 1. Tr~ r~i~ m~ed or c~ in accor~nce with ~e manufactures i~c~o~ (indu~ on~p~ ~d " pr~impr~nated matlab). ~ 2. Trot conmin~ o~ 1!0 gallo~ 0r 1~ ~padty ~t contained h~rdo~ ~te by fi~ng or physi~ pr~, su~ ~ ~hing, shredding, grinding, or p~ct~. ~ 3. D~ing sp~ ~ ~ d~i~ by ~e dep~t p~t to Title o~, CCR, ~fion ~261.~, by prying or by p~ive 0r hot-aided evapo~on ~ r~ove wat~. ~ 4. ' Magne~c sepa~on or s~ng to r~move compon~ ~rom spiel ~te, pu~nt to Tide ~, CCR, S~on 66261.124. =NO~~ 5. NO A~OR~A~ON IS ~~ ~ ~i;~ ad~c or ~fion of ion ~n~e m~ ~ ~ ~mi~liy~ ~. ~ ~ ~n~t mn~ mom t~an 10 ~t a~d or ~ by w~ht m ~ ~ble for ~ ~ 6. Neu~li~ a~dic or ~ine (b~e) w~t~ from the f~d proc~ing ind~. ~ 7. R<ov~ of silver from photofi~hing. The volme limit ~or con~fionM ~x~pfion generator (at the s~e lo~tion) in any ~endar mon~. =NO~* R<oVery of 10 g~ons or I~s ~r month of s~ver from photofinishing ~mpietety exempt from ~rmi~g; this form need not be sub~. DTSC ~772B (I/95) Page -' ONSt.TE It ZARDOUS WASTE "?,ZATME.NT NOTIFICATION FORM FACr2.ITT $?E L~C NOTI~CATION For Us~ by H~mmioua Wa~-'~ 6~nacramta Perfcrmi-g Tmattmmt [] Initial Lrad~r Condit/orml Exe~C~..~n and Conditional Authori~5on, [] and by P~rm/., By Rule Facilit/,~ [] Pteaxe refer to the attached [r. rtr~i~n~ before complming thi~ form. Yott may n~ti. fy for more than one perusing tier by ua-lng thi~ notification form, DT~C J77'2. You mu.rt attach a separate unit rpeaific notification form for each unit at ~ location. 'Th~'e ar~ different unit ~?ecific notificaxion forrn~ for each of the four categot-i~ an~ an n~4~4~tionai notification form for tranrportable tr~rntnt una~ t'2TO'O. ¥o~ ordy have'to ,abmit forrn~ for the titr(s) t~ cover your one(s). Discard or recycle th~ other anu~ed forrn~. Number each page of your completed notifiaaxion pac~ge and indicate the total number of page~ at the top of each page at the 'Page m of__: Put your EPA 1D Number on e. ach page. ?~eaxe provide ail of the informaxion reque_rted; aa fie~.d~ mart be complexed exc~,pt tho.re that maxt 'if different' or 'if available'. Please .type the information provided on thix form and any attachment& ~ notification fee~ are asse. rs,cl on the basi~ of the numben' of tier~ the notifier will operate under, and will be colle~ed by the State 2~oard of Equalizaxion. DO NOT 6'END YOUT~ ~ ~ T'~I$ NO77~CA770N FORM. I. NOTIFICATION CATEGORrI:$ Indicate tb~ num3er of uni~ you operate in eac~ tier. T'ni~ will a~ro be tht num3er of uno specific notification forrn~ you mart al'tach. Number or' units and ~ttached unit specific notifications for each tier reported. A. Conditionally Exempt-Sm,all Quanti~t Treatment D. Permit by Rule B. Nv' Conditionally Exempt-Specified W~te~tream E. Commercial I.~uadry C. Conditionally Au~odzed F. Variance (Section 25143) II. G~N-ERATOR IDEN'rIlrlCATION EPA ID NUMBER CA L- 00 O__. O 2. ~ -1 ~' ~7t BOE NUMBER (if available) Hfi~_HQ?_ PHYSICAL LOCATION C,b'lm Na~t~) COMPANY NAME ~or OTSC u~ omy j CITY STATE ZIP - COUNTRY (only ¢on'~ple~ if' m:x USA) CONTACT PEKSON PHONE NTj~'MBERC.__~ L'F~rst Name) (Laa Name) DTSC 1772 (1/95) Page VIII. Cv~.~,'rI~CATIONS: ~i'nis form must be sig~ ~ ~ a:~ co~r~e o~c~ or ~ o~b~ p~on in t~ comp~ .~ h~ op~ionai consol arm p~o~ de~ion-m~n~f~aio~ :h~ go,~ option o~:~ fa~a~ (p~ ~ 22, C~e ofRegu~io~ (CC~) Semion ~270. I1). ~-~ ~p~ i~o~g~Mg~. . W~te Minimi~don l ce~/~t I ~ve a pm~ ~ pl~ to :~e ~a volume, ~d~, ~d ~ of w~ g~ de~ [ ~ve de~e~in~ to ~ ~ono~Ily p~:i~ble ~d ~ I ~ve ~l~d ~e p~ie ~ of ~ ~ge, or di~ curtly av~abI~ to me w~ch ~~ ~e p~nt ad ~m~ ~ to hu~ h~ ad ae ~v~~ Tler~ Pe~itffng Ce~ifl~tion I ce~i~ ~t ~ ~: or ~Ja d~fi~ ~ ~ d~ m~t ae ~o~r/ md ~uimm~m of ~mta smmt~ ~d m~la/io~ for ~a ~t~ ~tt~g tier, ~ctu~g g~tor ~d s~n~-f m provide ~ 5~ci~ ~u~ca for cte~ of aa ~mt ~ by ~ 1, 1995. I ce~ ~der ~ of law ~t ~s d~um~t md ~1 at~a were prepa~ ~der my di~on or ~on ~ ~ a ~stem d~i~ to ~m ~t q~ifi~ ~ei pm~rty gaper ~d av~ ~ ~fomdon mb~t~. B~ on my of ~e ~n or ~ who ~age the system, or ~o~ di~:ly ~ible for ga~e~g ~e ~[emdon, ~e ~fo~den aa ~t of my ~owi~ge ~d M!ief, tree, ~umte, ~d I ~ aw~ ~t ~e~ ~ ~bs~ti~ ~natti~ for ~b~tt~g f~ ~fomtion,. ~clud~g ~ ~ibility of Pm~ ~d for ~o~g violation. } /9 .~ / Si ~ Date ~PE~T~G ~Q~b~S: P~e~e note that generato~ treating h~ardo~ w~te or.ire are required ~o comply with a n~ber of operaring requir~n~ which. d~ depe~ing on the tier(s). ~e operating requirements are set forth in the ~tatut~ a~ regu~io~, some of whi~ are referenc~ in the ~er-Spec~c Fa~ Sheets avai~ble ~om the Department's regional a~ he~e~ o~c~. ~5~SSION PROCED~S: You m~t s~it ~ ~pi~ of this completed not,cation by cen~ed ~ail, return receipt requited, to: Department of Toxic Substanc~ Control Progr~ Data M~gement Se~ion ~ ~ S~eet, 4th ~loor, Room ~53 (wa& in only) P. O. Box ~6 Sa~ento, CA 95812~6. You m~t a~o ~mlt o~ ~ of the not,cation a~ attachments to the local regulato~ agen~ in your ju~di~ion ~ l~t~ in Appe~ 2 of the i~tru~ion material. You m~t a~o retain a copy ~ pan of your oper~ing record. All three fo~ ~ ~ o~gf~l sig~, ~t p~to~pi~. DTSC 1772 (1/95) page 3 CONDITIOMALL¥ F,,'~CEMl:rr - ~.~ ECIFIED WASTE~TRE,A~MS ~ SP5~C N'O~!CA~ON ~e ~er-S~c Fa~ Sh~ con)~;- a ~,mm~ of ~e o~d~ ~~m for T~ ~~R OF ~O~GE DE~: T~(s) ~tlmat~ Mon~ly To~ Vol~e Stored: ~ ~d/or YES NO ~ Is ~e w~te tr~t~ ~ ~s ~t mdio~:ive? ~ ~ Is ~motelF gene~t~ ~zn~do~ w~te (ESC ~IlO. IO) tr~t~ ~ ~s ~t? ~e fol~wing are the eligible w~t~tre~ a~ ~e~ment process. Plebe ~eck all applicab~ boxy: ~ 1. Trm~ r~im m~ed or c~ in accor~nce with ~e man~actur~s i~c~om (indu~ on~p~ .~d pr~impr~ted matlab). ~ 2. Trmt containS'of 110 gallom or 1~ ~padty ~t contained N~mrdom ~te by d~ing or physi~ pr~, su~ ~ ~ng, shred~ng, g~nding, or p~ct~. prying or by p~ive or h~t-aided evapo~on to r~ove wat~. ~ 4. ' Magnetic sepa~on or ~ffing to r~ove componen~ from sp~al w~te, ~ d~ifi~ by ~e dep~hnent pum~nt to Ti~e ~, CCR, S~fion 66261.124. t~nn 10 ~t add or ~ by w~ m ~ ~ble for ~ ~ 6. Neu~li~ addic or ~ine (b~e) w~:~ from the f~d proc~ing ind~. ~ 7. R~ov~ of silver from photofi~hing. The vol~e limit for cond/fion~ ~x~pfion gene~tor (at the s~e lo~fion) in any ~lend~ mon~. =NO~~ R~overy of 10 g~ons or l~s ~r mon~ of shyer from photofin]shing ~mpletety exempt from ~rmi~g; ~ form n~ not be DTSC 1772B (I/95) Page i0 / ? ~-STATE GF CALIFORNIA--CALIFORNIA ENVIRONME PROTECTION AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL 400 P STREET, 4TH FLOOR P.O. BOX 806 SACRAMENTO, CA 95812-0806 (916) 323-5571 May 15, 1995 EPA ID: CAL000021754 BAKERSFIELD MEMORIAL HOSPITAL For facEity located at: GARY STEVENS 420 34TH ST 420 34TH ST BAKERSFIELD, CA 93303-1888 BAKERSFIELD, CA 93303-1888 Authorization Date: 09/03/~3 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DTSC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for technical adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). You will be charged annual fees calculated on a calendar year basis for each year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature space on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this year. Page 2 EPA ID: CAL000021754 If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this office at the letterhead address or phone number. Michael $. Homer, Chief Onsite Hazardous Waste Treatment Unit Permit Streamlining Branch Hazardous Waste Management Program Enclosure cc: ASTRID JOHNSON DTSC REGION 1 STATE REGULATORY PROGRAM 1515 TOLLHOUSE CLOVIS, CA 93611 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2700 M STREET, SUITE 300 BAKERSFIELD, CA 93301 Page 3 EPA ID: CAL000021754 ENCLOSURE 1 Units authorized to operate at this location: UNDER CONDITIONAL AUTHORIZATION: UNDER CONDITIONAL EXEMPTION: 1 3 4 5 6 7 8 ~ ~ ON~ ~~OUS W~ ~A~~ NO~CA~ON FO~ ~c~c~ion rom, D~C 1 ~ Yo~ diff~e~ ~ ~fic ~tific~i~n fo~ for ~ ~'~). You o~ ~'to $~ fo~ for N~ ea~ page or.ur ~mp~ ~t~ion ~ge ~ i~c~e t~ total n~ of pag~ ~ t~ top of e~ ~ge ~ t~ 'Page__ of ~'. P~ your EPA comp~ed ~c~t t~e t~ ~e atta~e~. ~ not~c~ion fe~ ~e ~x~x~ on t~ b~ oft~ n~ff ofti~ the ~t~ wile °Perle ~, ~ will ~ ~l~ ~ t~ Stye Board of Eq~l~iom DO ~ ~ YO~ ~ ~ ~S ~~0~ FO~. L NOT.CATION CA~GO~ I~ic~e t~ n~ of uni~ you opine in ea~ tiff. ~ will a~o be t~ n~er of unit spe~fic ~t~c~ion fo~ you m~ ~a~ ~~ ~ ~ Q~ Tr~ Nm~ of ~ ~d at~ched uMt sp~fic nofifimfiom for ~ tier re~m~. A. Conditio~ly Excmpt-S~l Q~ti~ Tr~t~at D. Pe~t by Rule B. N4 Conditionally Exempt-S~ifi~ W~t~tr~m E. C. C0n&tio~ly Au~od~ F. V~=ce (~tion ~ 143) H. G~TOR ~E~CATION EPA ID NUMBER CA~ 0 ~L PHYSIC~ L~A~ON .. ¢ ,. ~G ~D~, ~ D~~: COMPLY N~E I CI~ STA~ ZIP COU~Y (o~y ~o~1~ if ~ USA) CO~A~ PERSON PHO~ ~BER~ ~t Na~) ~g Name) DTSC 1772 (1/95) Page CONDITIONALLY E~MFr - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION . (pursuant to Health and Safety Codo $~tiou 2~201.5(¢)) _ The Tier-Sper. iflc Fact Sheets contain a stmunary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. NUMBER OF TREA~ DEVICF~: 0 Tank(s) ] Contaiaer(s)/Contalner Treatment Area(s) NUMBER OF STORAGE DEVICES: Tank(s) Each unit must be clearly identified and labeled on the plot plan attached to Form I772. A~$ign your own unique number to each unit. 7'he number can be sequential (I, 2, 3) or using any ~'ystem you choose. Enter the estimated monthly total volum~ of hazar~us waste treated by this unit. This should be the ma~mum or high~ amount treated in any month. Indicate in the narrative ($ecxion II) if your operations have seusonal var/atdotm L WA~TEST!~AMS AND TREATMENT Estimated Monthly Total Volume Treated: pounds and/or o~ ~'~ gallons Estimated Monthly Total Volume Stored: pounds and/or gallons YES NO [-'] [~ Is the waste treated ia' this unit radioactive? ]-'] [~ Is the waste treated ia this unit a.bio-hn?n,'d/iafectiouMmedical w~te? ['~ [~ Is remotely generated h~rdous waste (H$C 25110.10) treated ia this unit? The following are the eligible waste, streams and treatment processes. Please check all applicable boxes: [~! 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part .and pre-impregnated materials). l--] 2. Treat containers of 110 gallons 'or less opacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. [] 3. Drying special wastes, as classified by the depa~a~ent pursuant to Title 22, CCR, Section 66261.12A, by pre~sing or by passive or heat-aided evaporation to remove water. [-"] 4. Magnetic separation or screening to remove components from special waste, as classified by the deparmlent pursuant to Title 22, CCR, Section 66261.124. *NOTE~' 5. NO AUTHORIZATION IS NEEDED to mmtrai;~_ acidic or ~il~iln~ (base) wasf~ from the regeneration of ion exchange media used to demineraliTe wa~zr, frhls wa~ ~nnot contain more th~a. 10 percent acid or base by weight to be eligible for this exemption.) [~ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. '[]~ ' 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. *NOTE* Recovery of 10 gallons or less per ,month of silver from photofinishing is completely exempt from permit-ting; this form need not be submitted. DTSC 1772B (I/95) Page 10 VIII. CERTII~ICATIONS: Th/s form must be signed by an authorized corporate officer or any other person in the company who her operational control and performs decision-maldng function~ that govern operation of the facility (per T'ttle 22, Califoi'nia Code of Regulations (CCR) Section 66270. I1). All three copie~ mart have original ~ignatm-e~ _ Waste Minimization I certify that I have a program in plac~ to reduce the volume, quantity, and toxicity of wast~ generated to the degree [ have determined to b~ ~conomically practicable and that I have sel~ted the practicable method of treatment, storage, or disposal currently available to me which minimizes the pr~ent sad futura threat to human health and the environment. .. Tiered Permlttinf Certification I certify that the uait or units described in these documents meet the eligibility and operating requirements of state stat'utes and regulations for the inclicat~ permitting tier, including generator and secondary enntainm~t requirements. I undersmad that if any of the units operam under Permit by Rule or Conditional Authorization, I will also Im mqttired to provide required ffuartcial asa~-anc~ for closure of the trestmmt unit by lanuary I, 1995. I certify under penalty of law that this document and all attachments wer~ prepared uader my direction or supervision ia ac~:ordanc~ with a system desigaed to assure that qualified per~oanel properly gather and evaluate the information submitted. Based on my inquiry of the person or tmrsons who manage the system, or those directly r~l:~asible for gathering the information, the information is, to the best of my knowledge and b~lief, true, accurate, and complete. I am awar~ that them am substantial penalti~ for submitting fals~ information,~ including the possibility of fine~ sad impriso-,~-at for knowing violations. /-~ / Tkle OPERATING REQUIREMENTS: Please note that xenerator~ treating ha~.ardo~ w~te onsize are required to comply with ~ number of operating rcq,,iremenz~ which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the ~er-Speci. fic Fact Sheets available from the Department's regional and headquarters offices. SUBMISSION PROCEDURES: You must st~bmit two copie~, of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section 400 t~. Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must also submit one copy. of the notification and attachments to the local regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. All three forms must have original, signature.v, not photocopies. DTSC 1772 (1/95) Page 3 ST. ATE OF ~ALIFORNI~,-ENVIRC AGENCY PETE WILSON, Governor ~ .,. ~ ~ __._ DEPARTMENT OF TOXIC SUBSTANCES CONTROL CI-[ECKLIST AND INITIAL VERIFICATION INSPECTION REPORT-FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers FACILITY NAME: ~t~[rers J~/~ll9 /~e/~r/~ I /-[o.~f,; f,~ ( EPA ID NUMBER: PHYSICAL ADDRESS: z/oZ~ 3¥f~ ~f~er~ d3~er~'lcr~/~ , CFi, 93 3o FACILITY CONTACT-NAME: ~ar~. J1M, eu~s ' PHONE: ~¢o0- ) 32 7 SIC CODE(S): ~O,g : INSPECTION DATE: ~. ,~Jf; t,es' Local # NOTIFIED LrNIT COUNT: PBR CA CESW ? CESQT ~ TOTAL '7 · CORRECT UmT COUNT: PBR .. CA CESW ~; CESQT TOTAL This checklist and inspection report identify violatiOns'of state law regarding onsite treaters of h~ardous waste, operating under an onsite permitting tier. This inspection verifies the information provided on form DTSC 1772. It also covers generator requirements, although a separate checklist may be used for those requirements. A checkmark indicates violation of the law, which are explained in more detail on the attached note sheets. The governing laws are the ltealth and Safety Code (HSC) and Title 22 of the California Code of Regulations (22 CCR). Generator Standards: Each inspection agency may use their own generator inspection checklist or protocols, which are suramarized below. A full evaluation of each item or document is not conducted during the Verification Inspection, unless serious defici, e, ncies are suspected. NO 1. tTP, Contingency plan has been prepared (adequately minimize releases, has alarrrdcommunication system, lists emergency equipment and phone numbers for emergency coordinators). 2.0/~ Written training documents and records prepared for employees handling hazardous waste. 3. {)l~ Meet container management standards (storage time limits, closed, labelled, compatibility, inspected weekly, in good condition, with ignitables/reactives 50 feet from Property line). 4. N/I Meet tank management standards (either secondary containment or integrity assessments, plus storage time limits, labelled, compatibility, inspected daily, in good condition, with ignitables/reactives 50 feet from property line). 5.0g All wastes are properly identified. Treatment Items-Facility Wide: (Facility must submit a revised Form 1772 to correct errors or omissions.) ¢'~ 6. ~ Ail units under PBR, CA, and CE are properly indicated on Form DTSC 1772. (Add any new units with unit sheets or correct tier on the unit sheet.) 7. og All generator identification information on Form DTSC 1772 is correct. 8. ott The submitted plot plan/map adequately shows the location of all regulated units. 9. o r~ There are records documenting compliance with sewer agency pretreatment standards and industrial waste discharge requirements, where applicable. /' 10. Generator has prepared/maintained source reduction documents requirements (SB 14/SB 1726). For many wastes, a checklist or plan is required onBt if annual hazardous waste volume is over 5,000 kilograms (approx 11,000 pounds or 1,350 gallons). HSC 25244.15, 25244.19-.21 For CA or PBR notifiers: 11./l/~ The generator has an annual waste minimization certificatic~n. (PBR submit with renewals.) Onsite Checklist (A) Page 1 of [ . August 2, 1994 STATE OF CALIFORtliA*ENVIRONk,U:.NTAL PROTECTION AGENCY Pffi'E WIL~OtC Gtvern°, ~ra~, CA 9~27 CII~K~T AND ~ITIAI. V~IFICATION INSPECTION RE~RT FOR ~it by Rule, Cuuditio~Uy Authm'~d. and Coaditio~Hy UNIT SIIEET Cotnplete ot~ w~it ~et for e~h mtit eiti~r list~ in the not~c~ion Or Met~t~ d. dng ti~ it~pection. Notified Tics': C ~ ~ ~ Cos's~ Tier: Not~ed ~v~ Count: Ta~ ~ _ Coulaiuem 7 For all Uuits: 12. o~ All hazardou:i wastes treated afc generated m~ite. t/ 13. Thc unit notification infos'mation is accurate as tu thc nunlL~r of tank(s) or cuntaiai:r(s). " 14.o~ Thc ¢:itimated notification monthly lrealment volumi: is appropriate for Ilia is'ldicateA tint. " 15.l Thc w~te identification/evaluation is appropriate for tha tier indicatcA. 16. Thc wa.,te:,trcamis) give,l on Ilia notification forin ara appropriate for the tier. 17. Th¢ lre. atmcnl pruci:ss(~) givan on thc notification form are appropriate for the tint. "' 18. Thc reaiduala mauagcmi:,st information on thc form is correct al~d docusncntczl for the unit. 19. Thc indicatc, d ba~i.s for not net:ding a fi:dj:s-al permit oa thc notification torm is correct. .t.d'. 20. There ara wrillcu operalhig is~tructioas and a r~ord of thc dates, volumas, residual inaaagesnalit, and typ~s of wastes treated in thc unit. e/ 21. "l'hcs'¢ is a writteq h~pectiou schedule (containers-weekly and tanks-daily). ~/' 22 There ia a writlcu inspection log of flit: inspections conductr. M. ~23.0t, If the unit has bcca cloacA, thc generator has nolificd DTSC and the local agency of the For each CA or PBR uuit: 24. ;vz/Tha generator has secoud'.ary contaimueut for tr~tmeut iu contaiaes~. For ~ch PBR uuR: 25. There is a w~te analys~ plan and was~ m~ysis r~or~. 26.~ There is a ci~m~ plats for the unit. IJnil Comments/Ob~awalioa~: (g tha. ~' a unit th~ ~v~ not incl~ on Iht uot~c~iot~ fortn, the vio~ion ~ oper~ing wi#to~ a p~ttnit..tlSC ~201 (a).) Otisite Checklist (B) Page / of ~.,_ February 10, 1994 PETE WIL.501'i, Geve[n~ ,STATE OF CAL.iFORI. IIA-ENVII:IQhlIv~NTAL pflOTl:.CTION AG~NC.¥ R~OION i-JOJ5J Croyd~- W~y, Sd~ 3 ~ ~ra~, CA 95827 . CII~K~T A~ ~ITIAI, V~IFICATION INSPECTION RE~RT FGR ~it by Rule, Cuaditio~RY Authored, and Coaditio~Ry ~~ Not~c~ UNIT SIIEET Cotnpl~t~ otg ~it s~t for ~h m~it ~iOgr list~ in the not~c~ion Or Met~t~ d,ring dg im'p~ction. ~ ~ Udt Name:~e Unit N~ber: Nolified Tier: _C~ . NotWled ~v~ Count: Ta~ ~ Containe~ 7 Coc~t ~vi~ Count: Tau~--& ~ Coata~es~ ~ clv~ o ~ /v,~ For all U~its: ~ 12.~ All hazardous wastes treated axe generated oasite. _~ 13A/~ The milt notifi~tion information is a~umg as ~ ~ numar of tank(s} or container(s}. ~ 14. The ~stima~ nofifi~fion monthly tr~tment volmng is appropdag for the indica~ tier. ~ 15. Thg w~t~ identifi~tio~gvaluation is appropfia~ for fl~c tier indi~. ~ 16. ~t~ w~tr~n(s} giwn on the nofifi~tion form are appropriag for file tier. ~ 17. 'l'h¢ tr~tmeat pt'~(~) given on fl~e no~fi~tion form ar~ appropcia~ for the tier. ~ 18. Tim ~iduah nmuagcment information on ~ form is ~rf~t and d~umcn~ for thc unit. 19. Thc indi~ b~h for no{ needing a federal ~nait on tim notifi~tioa form is ~rr~t. ~ 20. There are written o~rating i~tructio~ and a r~urd of tim dates, volumes, reaiduM ~ m~xagement, ~d ty~s of wasms U~ in fl~e unit. ~ 21. There is a written is~tiou ~hedule (~n~ners-w~kly ~d ranks-daily). ~ 22 There is a written i~cfion log of tim inactions ~nduc~. ~ 23. If the milt has b~n clo~, the gene~tor h~ notified DTSC and the i~ai agency of the cJ~ut'e. For each CA or PBR unit: 24.///4 The generator has secondary contaimnent for treatment in containers. For ~ch PBR unit: 25.~ There is a w~te analys~ plan and wasm ~ysis r~or~. ~ 26. There ia a ci~m'e plan for the milt. [hill Comments/Ob~watim~: (~ thh. fi' a unit th~ ~v~ t~ot inc'l~ un th~ not~c~ion furm, tt~ vio~ion ~ oper~ing withom a p~tmit..llSC ~201 (a).) Onsim Clwxkliat (B) Page ~ of _-7 Febnary 10, 1994 STATE Oi: CALiFO6IqlA-ENVii~ON~NTAL Pf~OTECTION AGENCY PETE Wi~Otl, Geve~ ~OJON j-JOlSl C~y~u Way, S~ ~ CII~K~T ~N~ ~ITIAI, V~IFICATION INSPECTION RE~RT ~t by RuLe, Couditio~Uy Authored, and Couditio~Uy ~~ UNIT SIIEET Compic~c o~g ~i~ shcc~ for c~h ~dt cidgr lis~ in ~hc nog~c~ion Or ~c~ during dg Uait Nm-bev: ~ 3 U~t N~e: 3~'~,,~ ~f c~c/~, 7 ~ ~ ~f' ~ ~ ~ Notified Tier; C E3 ~ Cor~ tier: ~g ~ Not,ed ~v~ Count; Ta~ ~ Coutaiue~ ~ Corr~t ~vi~ Count: Taa~ ~ Coata~el~ ~ For aU U~its: 12. All hazardous wastes tre. ated arc generated ol~site. t....'13. Thc unit notification information is accurate as la ~c number of tank(s) or contaim:r(s). "' 14. Thc cstimaw, d nofifi~fon monthly tr~tment volume is appropfiag for th~ indica~ 15. Th¢ w~te idemifi~tio~gvaluatioa is appropfia~ for ~¢ tier indi~. 16. Th~ w~tr~n(fi) given on th~ nofifi~tion form arC appropria~ for fl~ tier. 17. Thc tr~tmcat pc~(~) given on fl~c nofifi~fioa form arc appcopria~ for thc tier. 18. Thc ~idua~ umuagcmcnt information on ~c form is ~rc~t ~d d~umcn~ for thc unit. 19. Thc indi~ b~ for ual needing a federal ~nui/on fl~c notifi~tion form is ~rr~t. ~ 20. There are wrillga o~ralhig i~mlructio~ and a r~urd of tim dates, volumes, reaidu~ mmtagement, mid ty~s of wasps ~ in file unit. ~ 21. Thm'c ia a written i~tioa ~hedule (~n~ncra-w~kly ~d ranks-daily). ~ 22 There ia a written i~ctiou log of die ins~tiona ~nduc~. 23.M~ If thc unit has b~n clo~, thc gcnc~lar h~ notified DTSC and the I~ai agency of ci~ut'~. For each CA or PBR uuii: 24.~]0 Thc generator has secoudary contaimueut for treatmeut ia containei's. For each PBR uuR; 25.///7. There is a waste analysis plau and waste analysis records. 26. There is a ci~ace plan for thc unit. Unit CommentMObscawalioats: (l/this. is' a unit that wag t~ot included on thc not~c~ion furm, thc vio~ion ~ oper~ing wixho~ a pctmit..tlSC ~201(a).) Oasitc Checklist (B) Page.-? of"/ February 10, 1994 STATE Oi= CALIFOSI'JIA-ENViSONIv~NTAL PBOTECTION AGENCY PETE Wl~Ot4. Gever~, :DEPAR~ROL , ~GION 1-10151 Cmy~u W~y, S~ 3 ~ ~~. CA 95827 ~ CII~[~T A~ ~ITIAI. V~IFICATION INSPECTION EE~RT FOR ~i~ by ~ule, Coa~lio~Uy Aulhor~d, and Coudilio~Hy ~~ Nol~=m UNIT SIIEET Con,plet~ ot~ ~,~t ~h~et for ~h ~it eider l~st~ in the not~c~ion Or Me~t~ during t/~ it~'pection. Notified l'i~r; C~5 ¢ Con~ Tier: _ t .... ( Nolffied ~v~ Count: 'ra~ ~ Coulaiuem 7 Cor~t ~vi~ Count: Tau~ ~ Coaia~e~ ~ For all Units: 12. All hazardous wastes treated ar~ generated mksite. t.-'-13. The unit notification information is accurate aa to thc number of lank(s} or container(s}. - 14. 'The estimate, xl notification monthly treatment voimue is appropriate for the indicatrxl tier. " 15. The waqe identification/evaluation is appropriate for thc tier indicated. 16. The waz, a~tream(s} given on the notification form are appropriate for the tier. 17. 'l'h~ treatment process(e.s} given on the notification form are appropriate for the tier. 18. Th~ re..siduala ntanagcment informatiOn on the form is correct and documentr, xl for tile unit. 19. The indicated basis for not needing a federal permit on th~ notification form is correct. t/ 20. There are ws-itlcu operati, g is~trucliou-$ a,sd a re. curd of tile dates, volumes, residual management, m~d types of wastes treated in the unit. ~-' 21. There is a written lsuspection schedule (containers-weekly and tab)ks-daily). t./ 22 Ther~ is a writl/:u iscspeclion log of tile ilsspc, ctions conducted. ~ 23. If the unit has be. ch cio:sc.d, thc generator has nolified I)TSC and lhe local agency of lhe closure. For each CA or PBR unit: 24./1/// Tim generator has secondary containment for treatment iu containes~. For ~cls PBR uuit: 25. l'im'e is a w~te aualysN plan and wasm ~ysis 26~ There is a ci~us'c plan for the unit. Unil Comments/Ob~walios~: (~ thh. ~ a unit th~ sv~ not i,,cl~ on th~ uot~c~ion funn, thc vio~ion ~ opcr~ing wi~hom a p~,mit..tlSC ~201(a).) Onsite Checklist (B) Page P' of 7 Febnuiry 10, 1994 STATE OF CALAFORIilA-ENVIRONMiiNTAL PROTECTION AGI~NCY PETE WiL~Otl, Govemo, D£PARTMENT,Oi: TOXIC 6UB$'~CES CONTROL ~. . ]~F-GJON 1-10151 Croydon W,,y, Sui~ 3 ClIECKLIST ,,tNT) INITIAl, YERIFICATION INSPECTION REPORT FOE Permit by R~Ig, CouditiouaUy Authorized, and Coudiliou~Uy F..xe. mpl Notificra UNIT $11EET Complel¢ ot~ unit sheet for each unit cittu::r listed in the noto~cation Or id~t~t~fied during tim ina'pection. Unit Number: e/-3-' Unit No_re_c: .5;/c, er- aP~ co,:~,/ Notified l~vic.¢ Count; 'l'aUk.s "._..3 Containers Corcect l~vic~ Count; TaLks 6;~ Coatainer~ wTs . For all Units: NO 12.bi; All hazardoua waatea treated arc generated mksite. t/ 13. The milt notification information ia accurate aa to the numix:r of tank(a) or container(a). 14.e', Thc c:itimated notification monthly treatment volume ia appropriate for thc indicate, d tier. 15. Thc w~ie ideutificatimdcvaluation ia appropria~ for the tier indicate.& 16. Thc wa.sleatrcam(s) given on thc notification form are appropriate for the tier. 17. Th~ treatment pct~ce_s.s(~) given on thc notification focm ace appcopciat~ for the tier. " 18. Thc re.:siduai.~ management information on thc form is corccct, and documcntr, d for th~ unit. 19. Thc indicatc. A basis loc not needing a federal permit on tim notification form is correct. ~ 20. There are written operathig i~h-uctioas and a record of thc datca, volumes, ceaidual management, mid types of wastes treated in the unit. e/ 21. There is a written ls~pectioa schedule (container?weekly and tanks-daily). ,/ 22 There ia a written inspection log of Ibc inspections 'conductcM. 23./t//~ If thc unit has b~n cloned, thc generator h~ notified DTSC ami the local agency of tl~e cimmre. For each CA or PBR unit: 24./yff Thc generator has secondary contaimuent for trealmeut in cmdaiuers. For each PBR uuit: 25..,/~ Tim'¢ is a waste analysis plan and wast~ analysis rexo,'ds. 26/.'/t 'l'hcr¢ is a ciosur~ plan for thc unit. l[Jnil Comnlenl:i/Obsetwaliottq; ([f thi~. h' a utlJt that svo~ riot included on the uoti. li.'ation form; the viob. uion i~ operating wid;out a p~:mit..ll$C 25201(a).) Onsitc Checklist (B) Page ..5- of 7 Fcbn~ary 10, 1994 STATE O.F CALIFORNIA-ENVIRONMENTAL PROTOZOON AGENCY ,~ , ~====~ PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers UNIT SHEET Complete one unit sheet for each unit either listed in the notification or identified during the inspection. UnitNmnber: ~6 UnitName: .5; A, e,. ~eco c, e~? Notified Tier: .... c 6--J ~o ' Correct Tier: c Notified Device Count: Tanks O Containers Correct Device Count: Tanks e~' Containers / For each Unit: NO 12.be All hazardous wastes treated are generated onsite. ~.- 13. The unit notification is accurate as to the number of tank(s) and/or container(s). ... 14.0 The estimated notification monthly treatment volume is appropriate for the indicated tier. 15. The waste identification/evaluation is appropriate for the tier indicated. 16. The waste, stream(s) given on the notification form are appropriate for the tier. 17. The treatment process(es) given on the 'notification form are appropriate for the tier. 18. The residuals management information on the form is correct and documented for the unit. 19.' The indicated basis for not needing a federal permit on the notification form is correct. ~.- 20. There are written operating instructions and a record of the dates, volumes, residual management, and types of wastes treated in the unit. v/ 21. There is a written inspection schedule (contaifiers-weekly and tanks-daily). // 22 There is a written inspection log maintained of the inspections conducted. 23;/y/~ If the unit has been closed, the generator has notified DTSC and the local agency of the 'closure. For each CA or PBR unit: 24./y/? The generator has secondary containment for treatment in containers. For each PBR unit: 25. There is a waste analysis plan 26. ~'f/There are waste analysis records. 27. There is a closure plan for the unit. Unit Comments/Observations: (If this is a unit that was not included on ~he notification form, the violation is operating without a perrnit-HSC 25201 (a). Also note if the activity is currently ineligible for onsite authorization.) Onsite Checklist (B) Page ~ of '7 August 2, 1994 STATE OF CALIFORIqlA-ENVIRONM~NTAL Pi~OTECTION AGENCY PETE W~Q~I, Gave~. .D'EPAR~MENT OF TOXIC SUB5 REGION 1-10151 Cwy~u W~y. S~ 3 ~~, CA 95827 CIIECKI IST A~ ~ITl~l, V~IFIC~TION INSPECTION RE~RT ~t by Rule, Cuu~tio~Uy Auibor~d, aud Coudi~ia~Uy ~~ Not~c~ UNIT SIIEET Complg~g o~g ~i~ s~g~ for c~*h ~dt cidgr l~:~ in ~ no~c~ion Or ~cz~ during dg image,ion. Notified Tier: ~ff~ ~ Cen~ Tier: c~5 ~ Nai~ed ~v~ C~uat: Ta~ ~ Coulaine~ Cor~t ~vi~ Couui; Tau~ ~ Cuuia~e~ / For aU Uuits; HO 12.0 g Ali hazardous wastes treated arc geuer~ted onsite. ~ 13. Tim unit notifi~tion informution }a a~ura~ aa ~ ~c numar of tank(s) or cuntaincr(s}. 14. Tha cstima~ nofifi~fion umuthiy lr~lmeut volume is appropdum for thc indica~ fiat. i5. Tim w~le ideutifi~tiu~cvaiuatiou is appropfiam for ~m tier indi~. 16. ~{a w~tr~(s) given on tim nofifi~tion form ar~ appropria~ for tim tier. 17. Tha h-~tmcul pc~(~) given on ~ia nonfiction form arc appmpria~ for the ticr. ' 18. Thc ~idua~ umuagcmcnt information on ~ form is ~r~t m{d d~umm~ for th~ unit. i9~ ~ Tim indi~ b~ for ual ueediug a federal ~nuit on ~m notifi~tion form is ~rr~t. ~ 20. There ~c writt~u o~:-aling i~lructio~ and a r~ucd of flic daica, volumca, rc~idu~ m~agcmeni, ~d ty~s of wasps ~ in fl~c unit. / 21. -Thcrc is a writlcu is~tiou ~hedule (~n~ncrs-w~kly ~d ranks-daily). ~ 22 There ia a writleu il~ction log of tim inactions ~nduc~. 23.~ If tim unit haa b~n cloud, thc gentler h~ notified DTSC and the l~al agency of the ci~ure. Fur each CA or PBR uuil: 24./~7 "rh¢ generator has secoudary contaimueu& for tr~lmeai ia conlaiu~:~. For ~cls PBR uuil: 25.~ There ia · w~te aualys~ plaa and was~ ~ysis r~or~. 26. Timre ia a cl~us~ plau for die unit. Unil Comments/Ob~swalioi~; (~ ~hh. ~ a unit ~h~ w~ not incl~ on th~ .ot~cmion funa. th~ vio~ion ~ °P~r~ing wid, oma p~nsit-ilSC ~l (a).) Oasit~ Checklist (B) Page ~. of 7. Fcbn~ary I0, 1994 STATE O.F CALIFORNIA-ENVIRONMENTAL ON AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL CI-IECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers SIGNATURE S}IEET Onsite Recycling: Onty atzrwer.if this facility recycles more than 100 kilogramx/rnonth o[ hazardou$ waste onsite. NO 28. The appropriate local agency has been notified. HSC 25143.10 '29./v't$ Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. Releases: If there has been a release, provide the following information: number of releases, date(s), type(s) and quantity of materials/waste, and the cause(s). Use unit sheet or attach a~_ditional pages. YES' 30. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from onsite treatment units? 31. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from any location at this facility? For purposes of a Tiered Permitting inspection, an unauthorized and/or accidental release to the environment does not include spills containedwithin containment systems. This report may identify conditions observed this date that are alleged to be violations of one or more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in more detail on the attached note sheets.-' If any violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 60 days, unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the facility will submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy to the local enforcement agency. Inspector(s): Lead Inspector: Other Inspector: Signature: ,~.?....~Z~ a.~"/-~6z- Signature: Print Name:29,~,,t2~ ~. ~d,-,~ ~tc Print Name: Title: _/-2~- '//~_~,~,~,,, ~ .-;~,/;_~ f~ .... ~ ,;,~ /,.~ /- Tide: Agency :/~cw/. ~,; ~<,, g~ lc,~ ~c~ Co ~ ~.~ I Agency: Phone Number: .roe') ;s?,_~s~ Phone Number: Facility Representative: Your signature,~cknowledg~yeceipt of this report and does not imply agreement with the findings. Signature:,/~5~r~g~/7 ~ k PrintN e: ff~'7 Onsite Checldist (C) Page / of [ August 2, 1994 ' STATE OF CALIFORNIA-ENVIRONMENTAL PRO~ ION AGENCY -' } ~' PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL CIEECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers NOTE SIEEET This sheet includes inspector observations and expand~ upon the violations identified on the checklist fay number). In some cases, it indicates how the facility should correct the violations. It also includes the names of any others participating in this inspection. Onsite Checklist (D) Page / of ..,9 August 2, 1994 STATE OF CALIFORNIA-ENVIRONMENTAl. PRO AGENCY - ~ - ' DEPAFITMENT OF TOXIC SUgSTANCES CONTFIOL CHECKLIST AND INITI3~L VERIFICATIO~ INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, ~nd Conditionally Exempt Notifiers NOTE SHEET Thi~ sheet inc!ud~ inspector, observations and e. rpand~ upon the violations identified on the checklist (by number). In some car~. it indicate~ how the facility should correct the violations. It alxo includex the nam~ of any otherz partidpating in this inspection. Onsite Checklist (D) Page ~ or ,~ Au.wast 2, 1994 DEPARTMEN9~ OF TOXIC SU~E'~ ~-NT~OL TIERED PEIhMITTING CERT~CATIOM OF ~~ TO COOL.CE For Pe~ by Rule, Cond~on~1y Au~or~ed, ~d Cond~on~y Exemp~ In the matter of the Violation cited on · '" As Identified in the Inspection Report daied/- ~ ~"~/'-- certify under permlty of law that: 1. Respondent has corrected the violations specified in the notice of violation cited above. 2. I have personally examined any documentation art. ached to the certification to establish that the violations have been corrected. 3. Based on my examination of th~ attached documentation and inquiry, of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete. 4. I am authorized to file this certification on behalf of the Respondent. 5. I am aware that there are significant penalties for submitting false information, '" including, the possibility of frae and imprisonment for knowing violations. GARY STEVENS',.' ..... DIRECTOR OF IMAGING Name~.(.?rint or Type)~ Title ,/Signature / Date Signed BAKERSFIELD MEMORIAL HOSPITAL EPA #000021754 Company Name EPA ID. Number DTSC-RETCOMP.CRT (8/94) DEPART;.¢E ~? ,,, OF 70XtC SUgST,~.}~CES 'CONTROL RECIOt~ I - CLOVIS FILE INPUT FACILITY t~zT cotu~y ~--E~_~ ~/ · ADDRESS STATE ZIP CODE EPA TD FILE TYPE OTHER REMARKS PETE WILSON, Governor STATE OF CALIFORNIA--~:NVIRON..__~M~E NCY ~ ~)EPARTMENT OF TOXIC SUBSTANCES CONTROL - 400 P Street, 4th Floor P.O. Box 806 Sacramento, CA 95812-0806 (916) 323-5871 09/03/93 EPA ID: CAL000021754 BAKERSFIELD MEMORIAL HOSPITAL For facility located at: RICK STEWART 420 34TH STREET 420 34TH STREET BAKERSFIELD, CA 93303-1888 BAKERSFIELD, CA 93303-1888 Authorization Date: 09/03/93 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DTSC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for technical adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). You will be charged annual fees calculated on a calendar year basis for each year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature space on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this year. Pag~ 2 EPA ID: CAL000021754 If you have any questions regarding this letter, or have questions on operating requirements for your facility, plea.so contact the nearest DTSC regional office, or this office at the letterhead address or phone number. Sincerely, Michael $. Homer, Chief Onsite Hazardous Waste Treatment Unit Permit Streamlining Branch Hazardous Waste Management Program Enclosure cc: SUSAN LANEY DTSC REOION 1 SURVEILLANCE & ENFORCEMENT BR. 10151 CROYDON WAY, SUITE 3 SACRAMENTO, CA 95827 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2700 M STREET, SUITE 300 BAKERSFIELD, CA 93301 Page 3 EPA ID: CAL000021754 ENCLOSURE 1 //~/t~ author/zed to operate at th/s/ocat/on.' UNDER CONDITIONAL AUTHORIZATION: UNDER CONDITIONAL EXEMPTION: 1 2 3 4 5 6 7 Department of Toxic Control kb }t 0 ; O0 0 1 8 Pagelof__ ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM FACILITY SPECIFIC NOTIFICATION For Use by Hazardous Waste Generators Performing Treatment [] Initial Under Conditional Exemption and Conditional Authorization, 1~ Revised and by Permit By Rule Facilities Please refer to the attached Instructions before completing this form. ¥ot~ may notify for more than one permitting tier by using this notifcation form, DTSC 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit specific notifcation forrns for each of the four categories and an additional notifcation form for transportable treatment units (TTU's). You only have to submit fortns for the tier(s) that cover your unit(s). Discard or recycle the other unused forms. Number each page of your completed notification package and indicate the total number of pages at the top of each page at the 'Page __ of__ '. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'if different' or 'if available'. Please type the information provided on this form and any attachments. The notifification will not be considered complete without payment of the appropriate fee for each tier under which you are operating. (Please note that the fee is per TIER not per UNIT. For example, if you operate 5 units but they are all Conditionally Authorized, you only owe $1,140, NOT5 time~ $1,140. lf you operate any Permit by Rule units and any units under Conditional Authorization you owe $2,280.) Checks should be made payable' to the Department of Toxic Substances Control and be stapled to the top of this form. Please write your EPA 1l) Number on the check. Fill in the check number in the box above· I. NOTIFICATION CATEGORIES In&cate the number of umts you operate tn each tter. Thts wall also be the number of unit specific notifcatio, n f6 ~rt~ns_ yqu must attach. Condiuonally Exempt Senall Quantuy Treatment operatwns may not operate umts under any other t.t~r. Number of units and attached unit specific notifications ' - ~-~-~ " ' ' ~ '~'i 'F~e per Tier .-, · ~ , c, ~ ~ il(not per uni0 A. Conditionally Exempt-Small Quantity Treatment (Form DTSC 1772A) ..... -- ,... !/ $ lOO C. Conditionally Authorized (Form DTSC 1772C) -- '/ $1,140 D. Permit by Rule (Form DTSC 1772D) $1,140 _/_ PHYSICAL LOCATION L~. ? ~ ~, L~,~.. ~ IFor DTSC Us~ Only (Fi (~ Na~) DTSC 1772 (1/93) Page MAILING ADDRESS, IF DIFFERENT: COMPANY NAME (DBA) STREET CITY STATE ZIP - COUNTRY (only ¢omplet~ if not' USA) CONTACT PERSON PHONE NUMBER(__),__- (First Name) (Last Name) III. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes (a four digit number) that best describe your comPany's products, services, or industrial activity. Example: 7384 Photofinishing lab 3672 Printed circuit boards IV. PRIOR PERMYF STATUS: Check yes or no to each question: YES NO --[~ F-] 1. Did you file a PBR Notice of Intent to Operate' (DTSC Form 8462) in 1992 for this location? [--[ [~ 2. Do you now have or have you ever held a state or federal hazardous waste facility full p~rmit or interim status for any of these treatment units? [~ ['"] 3. Do ~ou now have or have you ever held a state or federal full permit or interim status for any other haTardous waste activities at this location? [~ ~ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you are now notifying for at this location? ['-! ~ 5. Has this location ever been inspected by the state or any local agency as a haTardous waste generator? V. PRIOR ENFORCEMENT HISTORY: Not required from generaton only notifying as wnditionally ~xempt. YES NO F-] l~] Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health enforcement agency? (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a final order.) F-I If you answered Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) DTSC 1772 (1/93) Page 2 . Page 3 VI.. ATTACHMENTS: !--] 1. A plot plan/map detailing the location(s) of the covered mt(s) in relation to the facility boundaries. ['"] 2. ' A unit specific notification form for each unit to be covered at this location. VII. CERTIFICATIONS: This forrn must be signed by an authorized corporate oJ~cer or any other person in the company who has operational control and pecforms decision-making functions that govern operation of the facility (per title 22, California Code of Regulations (CCR) section 66270.11). All three copies mast have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, qUantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permitting Certification I certify that the unit or umts described, in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I'understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January 1, 1995. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fmcs and imprisonment for kn~ violations. Name ~ or Ta/pe) Title Signatifre . Date Signed OPERATING REQUIREMENTS: Please note that generators treating hazardous waSte onsite are required to comply with a number of operating requirements which differ depending on the tier(s) under which one operates. These operating requirements are set forth in the statutes and regulations, some of which are referenced in the 27er-Specific Factsheets. SUBMISSION PROCEDURES: You must submit two copie~ of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Form 1772 Onsite Hazardous Waste Treatment Unit 400 P Street, 4th Floor (walk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must al~o submit one oopy of the notification and attachments to the local regulatory agency in your jurisdiction as listed in the instruction materials. You must also retain a copy as part of your operating record. All three forms must have original signatures, not photocopies. DTSC 1772 (1/93) Page 3 251 SPACES 12 ~ SPA~S 126 SPA~ 34TH STREET ',E. PA ID NUMBER ~ Page~e-'-of__ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) NUS~ER OF TREATMENT DEVICES: Tank(s) 7 Container(s) Each unit must be clearly identified and labeled on the plot plan attached to Forra ,~ 772., Assign your own unique number to each unit. The number can be sequential (I, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations hove seasonal variations. I. WASTESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or ~2,,.~ gallons The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: [~l I. Treats resins mixed in accordance with the manufacturer's instructions. ["'] ~. Treat containers of 110 gallons or less capacity that contained haTardons waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ["'] 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. ['"l 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to title 22, CCR, section 66261.124. [~ 5. Neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for conditional exemption.) [-'] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. < . 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 8. Gravity separation of the following, including the use of flocculants and demulsifiers if ['"] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ba?urdons. ['-'] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). [-'1 9. Neutralizing acidic or alkaline (base) material by a state certified laboratory or a laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) DTSC 1772B (1/93) Page 9 Page..b CONDITIONALLY.EX~I~tPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) II. NARRATIVE DESCRIlrrrlONS: Provide a brief description of the specific waste treated and the treatment process used. 1. SPECIFIC WASTE TYPES TREATED: ,""l ' .. , ,- 2. T~^T~ENT PROCESS~ES) USEr>: ~ - .~ v .<~ / ~. ~ b r/~ ~ ~, ' ' 111. RESIDUAL MANAG£MENT: Check Yes or 3Io to each question as it applies to all residual~ pom this treatment unit. ,~ 1-'1 i. r>o you discharge non-hazardous, aqueous waste to a publicly owned treatment works (POTW)/sewer? [--] [~J 2. Do you discharge non-hazardous aqueous waste under an $?r>ES permit? ~ [--! 3. r>o you have your residual h*~rdous waste hauled offsite by a registered ba?arrlous waste hauler? If you do, where is the waste sent? Check all that apply. ~l a. Offsite recycling I~ b. Thermal treatment r"'l c. Disposal to land l'"] d. Further treatment ["'! [~L 4. Do you dispose of non-hazardous solid waste residues at an offsite location? i-'l [~1 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardou~ waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (7~tle 40, Code of Federal Regulations (CFR}). Choose the reason(s) that describe the operation of your onsite treatment units: [--1 i. The ba?ardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous waste under Califorma state law. ~'[ 2. The waste is treated ia wastewater treatment units (tanks), as defined ia 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewermg agency or under aa NPDES permit. 40 CFR 264.1 (g)(6) and 40 CFR 270.2. DTSC 1772B (I/93) Page 10 CONDITIO LY EXEMI~ - SPECIFIED WASTEST biS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) I-"] 3. The waste is treated in elementary neutralization traits, as defined in 40 CFR Part 260.10, and discharged to a POTW/s~wering agency or under aa NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [~] 4. The waste is treated in a totally enclosed treatment facility as defin~l in 40 CFR Part 260.10; 40 CFR 264.1 (g)(5). i'-! 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. I'"! 6. The waste is-treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. ~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. i-'] 8. Empty container rinsing and/or treatment. 40 CFR 261.7. ~l 9. Other. Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO [~] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. Pa~,e 11 DTSC 1772B (1/93) ~ Page ~k of ATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONDITIONALLY EXEMPT OR CONDITIONALLY AUTHORIZED GENERATORS I. ~U ~ORMATION: ~UEPAIDNUMBERCA~g~~~3 29 m SERIAL NUMBER C~ '~9 ~q ~D~SS ,, ~U OPERATOR (if different f~m ~ner) ~U OPE~TOR'S ~D~SS CITY STA~ ZIP COUNTY (fi~t mine) (l~st nnme) II. PRO~CTED WORK SC~D~E: l~icate the no~al wee~ working hours a~ the dates during this calet~ar year. Dat~ on Site- From t ' [~ to ~-~[--qg Dat~ on Site - From to Dat~ on Site - From to Dates on Site - From to Dat~ on Site - From to Dat~ on Site - From to Dat~ on Site - F~m to Dat~ on Site - F~m to If you pl~ on more ~t~, attach a ~pa~te pi~e of pa~r showing the additional ~t~ m ~e ~ fo~t ~d ch~k ~s ~x. DTSC 1772E (I/93) Page 22 Page/~of__ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(e)) NU3,fl~ER OF TREAT~ENT DEVICES: Tank(s) 7 :-- container(s) Each unit must be clearly identified and labeled on the plot plan attached to Forrtl 1~772.. Assign your own unique number to each unit. The number can be sequential (1,' 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. WASTESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or ... ~"fl~"~ gallons The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: [-'[ 1. Treats resins mixed in accordance with the manufacturer's instructions. ['-! 2. Treat containers of 110 gallons or less capacity that contained baTardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ["'l 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. ['-] 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to title 22, CCR, section 66261.124. ["l 5. Neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for conditional exemption.) ['"] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 8. Gravity separation of' the following, including the use of flocculants and demulsifiers if ['-] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ha?urdous. [-] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 ga:lions per barrel). ['-'] 9. Neutralizing acidic or alkaline (base) material by a state certified laboratory or a laboratory operated by an educational restitution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) DTSC 1772B (1/93) Page 9 CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used. 1. SPECIFIC WASTE TYPES TREATED: t Ill. RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit. YES NO ~ ['-i 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? [--] ~] 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? J~ ['"] 3. Do you have your residual baTardous waste hauled offsite by a registered ha?ardous waste hauler? If you do, where is the waste sent? Check all that apply. ~ . a. Offsite recycling l~! b. Thermal treatment ["l c. Disposal to land r'l d. Fur~2mr treatment r'l ~ 4. Do you dispose of non-haTardous solid waste residues at an offsite location? r-i ~ 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basix for determining that a hazardous waste permit ix not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (~tle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the: operation of your onsite treatment units: D -1. The haTardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous waste under Califorma state law. FI 2. The waste is treated ia wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewermg agency or under an NPDES permit. 40 CFR 264.1(g)(6) and 40 CFR 270.2. DTSC 1772B (1/93) Page 10 'spA ID NUMBER ~ I Paget,.of__ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) ~I 3. The waste is treated ia elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES permit. 40 CFR 264~. l(g)(6) and 40 CFR 270.2. I-"! 4. The waste is treated ia a totally enclosed treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264.1 (g)(5). ['"'i 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. ["! 6. The waste is-treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. J~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [~i 8. Empty contaiaer rinsing and/or treatment. 40 CFR 261.7. l-'! 9. Other. Specify:. V. TRANSPORTABLE TREATM~ENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO tr~ [-1 Is this unit Transportable Treatment Unit? a If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. Page ~_ of __ ·' ~TIFICATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONDITIONALLY EXEMPT OR CONDITIONALLY AUTHORIZED GENERATORS C _SE TO EP^IDNUMB -R C -000o2/TS-V% -NERATORUNIT D UMB a 22- I. T'rU INFORMATION: ~D~SS TTU OPERATOR (if difl'¢rcnt from TTU OPERATOR'S ADDRESS CITY STATE ZIP~ __ COUNTRY (fi~ ~mc) (last name) II. PRO~CTED WORK SC~D~E: l~icate the no~al weeM~ working hours aM the dates during this calendar year. No~ Hou~ of Work- From ~ 0 ~O. .... - to '~ q~, ~ Dat~ on Site - From to Dat~ on Site - From to Dates on Site - From to Dat~ on Site - From to Dat~ on Site - From to Dat~ on Site - From to Dat~ on Site - From to [--] If you plan on more dates, attach a separate piece of paper showing the additional dates in the same format and check this box. Page 22 DTSC 1772E (1/93) ,~PA ID NUMBER ~ paEe/~'of__ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) NUMBER OF TREATRtENT DEVICES: Tank(s) -7-- Container(s) Each unit must be clearly identified and labeled on the plot plan attached to Fornl d 772.. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This shouM be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. WASTESTREAM$ AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or ! ~"~' gallons The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: 1'-] 1. Treats resins mixed in accordance with the manufacturer's instructions. ["] ~. Treat containers of 1 I0 gallons or less capacity that contained baTardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ['"1 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. ['-] 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to title 22, CCR, section 66261.124. /-'] 5. Neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more than 10 percent acid or base by weight to be ehgible for conditional exemption.) [-'] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. · 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 8. Gravity separation of the following, including the use of flocculants and demulsifiers if ["] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ha?ardous. ["'] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). 1-'] 9. Neutralizing acidic or alkaline (base) material by a state certified laboratory or a laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) DTSC 1772B (1/93) Page 9 CONDITIONALLY.EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section Z5201.5(c)) II. NARRATIVE DESCRIIyrIONS: Provide a brief description of the specific waste trecaed and the treatment process used. 1. SPECIFIC WASTE TYPES TREATED: · , ;: . 2. P OCESS(ES) USEI):,)( - ¢0 / III. RESIDUAL MANAGEMENT; Check Yes or No to each question as it applie~ to all residuals from this treatment unit. YSS NO ~ ~l 1. Do you discharge non-hazardous, aqueous waste to a publicly owned treatment works (POTW)/sewer? [~ [~ 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? J ~ [~] 3. Do you have your residual ha~a'dous waste hauled offsite by a registered h~¢~rdous waste hauler? If you do, where is the waste sent? Check ali that apply. a. Offsite recycling ['~ b. Thermal treatment [~ c. Disposal to land [~1 d. Further treatment ['-I ~ 4. Do you dispose of non-hazardous solid waste residues at aa offsite location? I'-[ [~ 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers,facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA ('i~tle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: [-'! -1. The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a b~Tardous waste under Califorma state law. ["] 2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. Page 10 DTSC 1772B (1/93) CONDITIONALLY EXEMFr - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) ["] 3. The waste is treated in elementary, neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewermg agency or under an NPDES permit. 40 CFR 264-1(g)(6) and 40 CFR 270.2. [] 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264. l(g)(5). [~i 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. [-] 6. The waste is.treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. J~[ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [--] 8. Empty container rinsing and/or treatment. 40 CFR 261.7. ["] 9. Other. Specify: V. TRANSPORTABLE TREAT1V[ENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO ['-1 Is this unit a Traasportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Ptease review those requirements carefully before completing or submitting this notification package. Page 11 Page J_~of m )TIFICATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONr mONALL¥ EXtort OR CONmTIONALL¥ *UT OmZm GENE~TOR EPA ID NUMBER C~ O00 o~ ~ 7r~S~*O~ U~ ~ ~UM~ ~ I. ~U ~oRMATION: ~U O~ER ~ '~ ~ ~ ~ ~M ~D~SS TTU OPER3,TOR (if diffcr~m from Owner) TTU oPERAToR's ADDRESS CITY STATE ZIP ,~ COUNTRY (first name) (last name) II. PROJECTED WORK SCHEDULE: Indicate the normal weekday working hours and the dates during this calendar year. Normal Hours of Work- From ~ O ~0 O___ c to '~, q',~ ~- Dates on Site- From t "' t '~ '~ to I ;2 - ~ f "q ~ Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to If you plan on more dates, attach a separate piece of paper showing the additional dates in the same format and check this box. Page 22 DTSC 1772E (1/93) : . · ,,,.,,,,~..,.o.. ...... I~$ 251 SPACES I 126 SPA~ i 34TH STREET CO ITION LY - SPECI ED W TEST S UN~ SPECIFIC NO~FICA~ON (puget to H~ ~d Safety C~e S~tion ~201.5(c)) ~'~ER OF T~AT~ DE~CES: ~ T~(s) ~_ Con.efts) Each unit m~t be clearly ident~ a~ ~bel~ on the plot plan attach~ to Fo~ 1772., ~sign your own unique numb~ to each unit. ~e number can be sequential (l, 2, 3) or ~ing any ~stem you c~ose. Enter the estimated monthly total volume of ~ar~ w~te tre~ ~ th~ unit. ~ shouM be t~ ~imum or high~t mount treated in any month, l~icate in the namati~ (Seaion II) ~ your op~atio~ ~ se~o~l variation. I. WASTEST~A~ ~ T~AT~ PROCES~S: Estimat~ Money To~ Vol~e Tr~t~: ~ ~d/or ~ g~lons ~e following are the eligible w~t~tre~ a~ tre~ment proc~ses. Plebe check all applicab~ boxy: ~ 1. Tr~ res~ ~x~ m aeeor~ce with ~e ~ufaem~r's ~tmctio~. ~ ~. Trot con~e~ of 110 gallons or 1~ rapacity t~t ~n~ ha~ardo~ w~te by ~s~g or physi~ pr~, such ~ c~g, s~d~g, grading, or p~cm~g. ~ 3. D~g ~ial w~tes, ~ cl~sifi~ by ~e department puget to title 22, CCR, ~tion ~261.124, by pr~s~g or by p~ive or h~t-hd~ eva~tion to ~move water. ~ 4. Ma~etic ~pmtion or ~r~mg to remove com~nenm from ~i~ w~te, ~ el~ifi~ by ~e dep~ment pu~t to title 22, CCR, ~tion 66261.124. ~ 5. Neut~i~ ~idic or a~me ~) w~t~ from ~e regeneration of ion exe~ge ~ia ~ to demine~i~ water. ~s w~te mnnot ~n~ more ~ 10 ~nt ~id or b~ by weight ~ ~ ehgible for mn&tio~ exemption.) ~ 6. Neutmli~ acidic or ~Ime ~) w~t~ from ~e f~ prong ~d~t~. ~ 7. R~ove~ of silver from photo~s~ng. ~e volume li~t for mnditio~ exemption is 5~ g~lo~ ~r g~emtor (at ~e ~e l~tion) m ~y ~en~r month. 8. Gravity ~pamtion of ~e following, ~clud~g ~e ~ of fl~ul~m ~d demulsifie~ if ~ a. ~e ~ttl~g of mli~ from ~e w~te where ~e r~ultmg ~u~/liquid str~ is not ba~ardo~. ~ b. ~e ~pmtion of oil/water mxmr~ ~d ~pmtion sludg~, if ~e avenge oil r~ver~ ~r mn~ is ~ 9. Neut~i~g acidic or ~me ~) mteh~ by a state ~ffifi~ la~mto~ or a la~mtoW o~m~ by ~umtio~ ~timtion. ~o ~ eligible for conditio~ exemption, ~s w~ ~ot ~n~ ~re ~ 10 ~nt ~id or b~ by weight.) DTSC 1772B (1/93) Page 9 CONDITIONALLY EXEMI:rr - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used. 1. SPECIFIC WASTE TYPES TREATED: i f I~. RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all residuals from this treatment unit. YES NO ~ r-I 1. Do you discharge non-hazardous, aqueous waste to a publicly owned treatment works (POTW)/sewer? [--] ~] 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? [~i 3. Do you have your residual baTardous waste hauled offsite by a registered b~Tardous waste hauler? If you do, where is the waste sent? Check all that apply. ~l a. Offsite recycling i""] b. Thermal treatment D c. Disposal to land D d. Further treatment ['-i I~. 4. Do you dispose of non-hazardous solid waste residues at aa offsite location? l--] [~ 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA ('litle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: [--! i. The hazardous waste being treated is not a ba:,ardous waste under federal law although it is regulated as a ba7ardous waste under California state law. l'-] 2. The waste is treated ia wastewater treatment traits (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewermg agency or under aa NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. DTSC 1772B (1/93) Page 10 J3'*SUMNER ovaO Vage of_ CONDITIONALLY EXtlMI~ - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) ['-i 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/seweriag agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. ["'] 4. The waste is treated ia a totally enclosed treatment facility as defined ia 40 CFR Part 260.10; 40 CFR 264. l(g)(5). ~! 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. [--] 6. The waste is-treated ia an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. J~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(ivi,' 40 CFR 264. l(g)(2), and 40 CFR 266.70. [~3 8. Empty container rinsing and/or treatment. 40 CFR 261.7. I-'] 9. Other. Specify: V. TRANSPORTABLE TREATMENT UNIT : Check Yes or No. Please refer to the Instructions for more information. YES NO ['"i Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. Page DTSC 1772B (1/93) . ~ .. . · . ~ Page~2-of __ OTIFICATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONDITIONALLY EXEMPT OR CONDITIONALLY AUTHORIZED GENERATORS OENERATOR EP^ :D NUMB~-R C tqt-- o o0 02 t 7£~O~_NERATOR UNiT ~D NUMBER I. 'I'WU INFORMATION: O- TTU OPERATOR (if different from Owner) 'ITU OPERATOR'S ADDRESS CITY STATE ZIP - COUNTRY (tim name) (last namc) II. PROJECTED WORK SCHEDULE: Indicate the normal weekday working hours and the dates during this caletutar year. Normal Hours ofWork - From ~0~.O.....~. ~ ,.- to I ~ q~ ~ l Dates on Site- From [ ' ./'~ ~ to } ~, - ~. l "' q ~ Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to F'! if you plan on more dates, attach a separate piece of paper showing the additional dates in the same format and check this box. DTSC 1772E (1/93) Page 22 251 SPACES ~-~ ~ ..... ...~ ~ ', ~ ~- ~ · ':~-: h~ .....~ :~ ' 12 SPA~S .... ~_~ ...... I I I 34TH STREET CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) NUMBER OF TREATMENT DEVICES: __ Tank(s) 7 Container(s) Each unit must be clearly identified and labeled on the plot.plan attached to Forth j 772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. WASTESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or ~ 0 gallons The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: [--] 1. Treats resins mixed in accordance with the manufacturer's instructions. 2. Treat containers of 110 gallons or less capacity that contained ba:'ardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. i-'! 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. I~l 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to title 22, CCR, section 66261.124. i'"] 5. Neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. Cliffs waste cannot contain more than 10 percent acid or base by weight to be eligible for conditional exemption.) ["-I 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 8. Gravity separation of the following, including the use of flocculants and demulsifiers if ["1 a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ba?ardous. ["'] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). ['-[ 9. Neutralizing acidic or alkaline (base) material by a state certified laboratory or a laboratory operated by au educational institution. (To be eligible for conditional exemption, this waste cannot contain more than I0 percent acid or base by weight.) DTSC 1772B (1/93) Page 9 Pagt. ~ CO~ION~LY-E~ - SPEC~D UNIT SPECIFIC NOTIFICA~ON (pum~t to H~l~ ~d Safety C~e S~fion ~201.S(e)) N~AT~ DESC~IONS: ProvMe a brief d~iption of the spec~c w~te treat~ a~ the treatme~ pro~s ~ 1. SPECIFIC WAS~ ~PES T~ATED: m. ~S~U~ ~AGE~: Che& Y~ or No to ca& question ~ it applies to all resM~ pom this tremment unit. YES NO ~ ~ I. Do you di~harg~ non-ha~rdous, aqu~us w~te to a publioly o~ tr~tm~nt wor~ (PO~/~wer? ~ ~ 2. Do you diverge non-h~rdous aqu~us w~te ~der ~ NPDES ~t? J~ ['-I 3. Do you have your residual hazardous waste hauled offsite by a registered ha?ardous waste hauler9. If you do, where is the waste sent? Check all that apply. ~ a. Offsite recycling [-1 b. Thermal treatment I~! c. Disposal to land r-'! d. Further treatment ['"l [~ 4. Do you dispose of non-hazardous solid waste residues at aa offsite location? l~l [] 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrcae eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA little 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: D '1. The haTardous waste being treated is not a ha?ardous waste under federal law although it is regulated as a hazardous waste under California state law. r-] 2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under aa NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. DTSC 1772B (1/93) Page 10 · ,e^ NUM Ea 17 3"q VageMo°f __ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) [~! 3. The waste is treated in elementary neutralization units, as deft.ned in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under aa NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. ["'] 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264. l(g)(5). i'"'! 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5· [~! 6. The waste is-treated in an accumulation tank.or container within 90 days for over 10013 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. J~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [-'l 8. Empty container rinsing and/or treatment. 40 CFR 261.7. [~] 9. Other. Specify: V. TRANSPORTABLE TREATb~ENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO g~ ["'l Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. DTSC 1772B (1/93) Page Page~....~ f '' ' ~qOTIFICATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONDITIONALLY EXEMPT OR CONDITIONALLY AUTHORIZED GENERATORS GENERATOR EPA ID NUMBER .C ~ tv oo o2 / 7'~C//GENERATOR UNIT ID NUMBER c~ I. TTU INFORMATION: TTUEPAIDNUMBERCA/-_r~R._~..aQ~._~"~OO9 TTU SERIAL NUMBER Cf) ,~t~ ~n~ ~^~. Y- ?~. 7_,,/~ 4-; ~ ,~ et ~ ,'~ v_ ADDRESS (~;t. STATE TTU OPERATOR (if diffcrcm from Owner) 'ITU oPERAToR'S ADDRESS CITY STATE ZIP COUNTRY ~u co~^~ ~_~o~ ~', ~ ~%,v~-, ~.o~~.~ (tim mmc) (last namc) II. PRO~CTED WORK SC~D~E: I~icate the nomal wee~ working hours a~ the dates during this cale~Mar year. No~ Houm of Work - From ~O~O_~_ ..... -- ,o ~ ~0P Dat~ on Site - From t ' [~ to )2-~t--~g Dat~ on Site - From to Dat~ on Site - From to Dates on Site - From to Dat~ on Site - From to Dat~ on Site - From to Dat~ on Site - Fwm to Dates on Site - From to I'-! L_i If you plan on more dates, attach a separate piece of paper showing the additional dates m the same format and check this box. DTSC 1772E (1/93) Page 22 ./ c ~ ."~ .... wsrron I~ 251 SPA~S ._ ...., :~ ~ ~- ~ I 126 SPA~ 34TH STREET CO ITION LY - SPECI ED W TEST S UN~ SPECIFIC NO~FICA~ON (puget to H~ md Safety C~e S~tion ~201.5(c)) ~ER OF T~ATb~ DE~CES: ~ T~(s) _~_ Con~e~s) Each unit m~t be clearly ident~M aM ~beiM on the plot plan ~tac~ to Fo~ 1772.~ ~sign your own unique numb~ to each unit. ~e number can be sequential (1, 2, 3) or ~ing any ~stem you c~ose. Enter the estimat~ monthly total volume of ~ar~ w~te tre~ ~ th~ unit. ~ s~uM be t~ ~imum or highest mount treated in a~ month. I~icate in the namati~ (Seaion II) ~your op~atio~ ~ se~o~l vacation. I. WA~EST~A~ ~ T~AT~ PROCES~S: Estimat~ Mon~iy To~ Vol~e Tr~t~: ~ ~d/or ~g~lons ~e following are the eligible w~t~tre~ a~ tre~ment process. Ple~e check all applicab~ bo~: ~ I. Tr~ res~ ~x~ m accor~ee wi~ the ~ufacmrer's ~tmctio~. ~ 2. Trot conm~e~ of 110 gallons or l~s ~pacity t~t ~n~ ba~atdo~ w~te by ~s~g or physi~ pr~, such ~ c~g, s~dmg, g~ding, or p~cm~g. ~ 3. D~mg ~i~ w~tes, ~ cl~sifi~ by ~e dep~ment pu~t to title 22, CCR, ~tion ~261.124, by pr~s~g or by p~ive or h~t-~d~ eva~mtion to remove water. ~ 4. Ma~etic ~p~tion or ~r~g to ~move com~nen~ from ~i~ w~te, ~ cl~ifi~ by ~e dep~ment pu~t to title 22, CCR, ~tion 66261.124. ~ 5. Neut~i~ ~idic or a~me ~) w~t~ from ~e ~genemtion of ion exc~ge ~a ~ to demine~i~ water. ~s w~te ~nnot ~n~ more ~ 10 ~nt ~id or b~ by weight ~ ~ eligible for ~n~tio~ exemption.) ~ 6~ Neut~li~ acidic or ~al~e ~) w~t~ from ~e f~ prong md~t~. · 7. R~ove~ of silver from photo~s~ng. ~e volume limt for ~nditio~ exemption is 5~ gdlom ~r g~e~tor (at ~e ~e l~tion) m ~y ~en~ month. 8. G~vity ~pa~tion of ~e following, &elud&g ~e ~ of fl~ul~ ~d demulsifie~ if ~ a. ~e mttl~g of mli& from ~e w~te where ~e ~ult~g ~u~m/liquid str~ is not ~dom. ~ b. ~e mpmtion of oil/water mxmr~ ~d ~pmtion sludg~, if ~e average oil r~ove~ ~r mn~ is · ~ ~ b~els (42 g~lom ~r b~l). ~ 9. Neut~img ~idic or ~me ~) mted~ by a state ~ffifi~ la~mto~ or a la~mto~ o~m~ by ~umtio~ ~timtion. ~o ~ eligible for ~nditio~ exemption, ~s wrote ~ot ~id or b~ by weight.) DTSC 1772B (i/93) Page 9 " '.,NUMBER CONDITIONALLY EXEMZPT - SPECIFIED WASTESTREA~Lq UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) II. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatmerg process used. 1. SPECIFIC WASTE TYPES TREATED: 1TI. RESIDUAL MANAGEMENT: Check Yes or No to each question as it applies to all resid.als ~rom this tremment unit. Y¥.$ NO ~ ['"] 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? ['-[ [~l 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? [] 3. Do you have your residual hazardous waste hauled offsite by a registered hayardous waste hauler? If you do, where is the waste sent? Check all that apply. ~] a. Offsite recycling ['-! b. Thermal treatment [-'] c. Disposal to land ['"] d. Further treatment ['"l [~ 4. Do you dispose of non-hazardous solid waste residues at an offsite location? l-'! [~1 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA} and the federal regulations adopted under RCRA ('27tie 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: ['--! -1. The bayardous waste being treated is not a hazardous waste under federal law although it is regulated as a buyurdous waste under California state law. ['-[ 2. The waste is treated in wasteWater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewermg agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. Page 10 DTSC1772B (1/93) .. ID NUMBER t~tt~ d) O~90 ~7S--17/ Vage~_3of__ CO~ION~LY E~ - SPEC~D WASTE A~ UNIT SPECIFIC NOTIFICA~ON ~u~t to H~I~ ~d Safety C~e S~tion ~201.5(c)) BASIS FOR NOT ~ED~G A ~DE~L PE~: (confinu~) 3. ~e w~te is tr~t~ ~ elemenm~ neutmli~tion ~, ~ de~ ~ 40 CFR Pa~ 260.10, ~d di~harg~ to a PO~/~we~g agency or ~der ~ NPDES ~mt. 40 CFR 264. l(g)(6) ~d 40 CFR 270.2. 4. ~e w~te is tr~t~ ~ a totally enclo~ tr~tment facility ~ de~ ~ ~ CFR Pa~ 260.10; 40 CFR 264. l(g)(5). l"'[ 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. ~l 6. The waste is.treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24., 1986 Federal Register. J~ 7. Recyclable materials are reclaimed .to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. ~l 8. Empty container rinsing and/or treatment. 40 CFR 261.7. 1-] 9. Other. Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. YES NO ["'l Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. DTSC 1772B (1/93) Page 11 tOTIFICATION FORM FOR TRANSPORTABLE TREATMENT UNITS OPERATING AT CONDITIONALLY EXEMPT OR CONDITIONALLY AUTHORIZED GENERATORS I. TTU INFORMATION: 'vru EPA ID NUMBER CA/- _~,,~ __~_~..__~'~ o© ~ TTU SERIAL NUMBER C ADDRESS ,. ~U OPERATOR (if differ*hr from ~n~r) ~U OPE~TOR'S ~D~SS CIT~ STATE ZIP COUNTRY (tim name) (last name) II. PROJECTED WORK SCHEDULE: Indicate the normal weekday working hours and the dates during this calendar year. Normal Hours of Work- From ~ O .D_ f.~'_ .... -- to -~ L.~) g Dates on Site- From t ~" t '~'~ to I ~ -~a- t -- ~ ~ Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to [-'[ If you plan on more dates, attach a separate piece of paPer showing the additional dates in the same format and check this box. DTSC 1772E (1/93) Page 22 CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) NLrMBER OF TREATI~tENT DEVICES: Tank(s) -7'--' Container(s) Each unit must be clearly identified and labeled on the plot plan attached to Forra i772.. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. WASTESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or /~ gallons The following are the eligible wastestreams and tretument processes. Please check all applicable boxes: ["-] 1. Treats resins mixed in accordance with the manufacturer's instructions. ['-] ~. Treat containers of 110 gallons or less capacity that contained ha:,ardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ['-! 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. [--[ 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to title 22, CCR, section 66261.124. [--] 5. Neutralize acidic or alkaline ('base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for conditional exemption.) [-'] 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. · 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. · 8. Gravity separation of the following, including the use of flocculants and demulsifiers if 1--'] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not hazardous. l~ b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). ['-] 9. Neutralizing acidic or alkaline (base) material by a state certified laboratory or a laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) DTSC 1772B (1/93) Page 9 CONDITIONALLY ,EXEMI~r - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) II. NARRATIVE DESCRIFrlONS: Provide a brief description of the specific waste treated and the treatmenI process used. 1. SPECIFIC WASTE TYPES TREATED: Ill. R. ESIDUAI., ]V~AGEI~NT: Check Yex or No to each question ax it applies to all residual~ from thi.._.~s treatment unit. Y:%q NO ~ r"'i 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? ["'[ [~] 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? [~I [-'l 3. Do you have your residual hazardous waste hauled offsite by a registered ba:,ardous waste hauler? If you do, where is the waste sent? Check all that apply. ,~] a. Offsite recycling [--] b. Thermal treatment F'! c. Disposal to land 1'"] d. Further treatment ~ 4. Do you dispose of non-hayardous solid waste residues at an offsite location? I'"l ~ 5. Other method of disposal. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardo~ waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA (7~tle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that dexcribe the operation of your onsite treatment units: ['"! '1. The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a ha7ardous waste under California state law. [-'] 2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewermg agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. DTSC 1772B (1/93) Page 10 . ^ iD NUMBER Page,of__ CONDITIONALLY EXElV[tq' - SPECIFIED WHSTESTKEHMS UNIT SPECIFIC NOTIFICATION (pursmmt to Health and Safety Code Section Z5201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) [~3 3. The waste is treated in elementary neutralization traits, as defined ia 40 CFR Part 260.10, and discharged to a POTW/sewermg agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [~1 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264. l(g)(5). [~ 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible ~ a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. ["'! 6. The waste is.treated in an accumulation tank or container within 90 days for over 1003 kg/month generators and 180 or 270 days for generators of 1130 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. J~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv),. 40 CFR 264. l(g)(2), and 40 CFR 266.70. I'-'] 8. Empty container rinsing and/or treatment. 40 CFR 261.7. [~] 9. Other. Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Pleaxe refer to the Instructions for more information. YES NO ["l Is this unit a Transportable Treatment Unit? If you am'wered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. Page 11 DTSC 1772B (1/93) ,, . ~OTIFICATION FORM FOR ~, ' TRANSPOR'lnS~LE TREATMENT UNITS OPER~PING AT CONDITIONALLY EXEMFT OR CONDITIONALLY AUTHORIZED GENERATORS I. TTU INFORMATION: 'I'rU EPA ID NUMBER CA/-..._~ g ~._~..__~'~ o© ¢ TTU SERIAL NUMBER ~D~SS CI~ TTU OPERATOR (if different from Owner) TTU oPERAToR's ADDRESS CITY STATE ZIP__ COUNTRY WU CONTACT PERSON '~c~ 'x ¢m ~a./~-~'X : PHONE NUMBER (~;>0~"~ g~? 77~ ~ ./ (tim ~mc) (lest name) II. PRO~CTED WORK SC~D~E: l~icate the nomal wee~ working hours a~ the dates during this calet~ar year. No~ Hou~ of Work- From ~O~O____.. ,. ,-- to '~ ~ Dat~ on Site- From t ' t~ to 12-~{--q~ Dat~ on Site - From to Dat~ on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to Dates on Site - From to [--I If you plan on more dates, attach a separate piece of paper showing the additional dates in the same format and check this box. DTSC 1772E (1/93) Page 22 I?.~ 2,51 SPA~S ' 12 SPA~S _ ~- - · ~ ~ SPA~S