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Home My WebLink AboutBUSINESS PLAN 4/29/2002 MAN$OOR M. GILANI~ D.D.S. GENERAL DENTIST 602 - 3,~TH STREET BAKERSFIELD, CALIFC)RNIA 93301 (805) 323-2929 TELEPHONE ¢805) 323'2929 ~ SAN DIMAS FAMILY DENTISTRY MANSOOR M. GILANI 602 - 34TH STREET GENERAL DENTIST SAKEREFIELCI. CALIFORNIA 93301 CITY OFBAKEI IELD O OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZ OUS MATE ALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, retum this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DAT~4 LOCATION: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: .UTILITY SHUT-OFF8 (LOCATION OF SHUT-OFFS AT YOUR FACILITY)_ NATURAL GAS/PROPANE: ELECTRICAL:. WATER: SPECIAL: ,- LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILrrY (FIRE HYDRANT): ' HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III; TRAtN~G NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION INFORMATION IS A~CURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~IGNATORE TITLE ' '' TE 4 CITY OF BAKEI~JELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS SECTION I. - BUSINESS IDENTIFICATION DATA: The Business Owner / Operator Form, Chemical Description Form(s) and other Forms (e.g.: underground storage tank information, hazardous waste treatment, etc., as needed) may be submitted as the first section of the Hazardous Materials Management Plan in order to avoid duplication of information for initial submissions. HAZARDOUS MATER/ALS MANAGEMENT PLAN SECTION II. 1 - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Describe the procedures and equipment used to detect any release or threatened release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EMPLOYEE AND AGENCY NOTIFICATION: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties? At a minimum, you must call 9-1-1 and the Office of Emergency Services at 1-800- 852,7550 to report any spills that are a threat to life, safety or the environment, or for other non-emergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident involving Hazardous Materials used at your business. 1 HAZARDOUS MATERIALS MANAGEMENT PLA SECTION II.2 - RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C. CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be implemented in case of a release at your business. This should address small spills, as well as a major release of material once the material is contained. Hazardous Waste: Please provide the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removedl Please keep all disposal receipts for the last three years available on site for inspection. UTILITY SHUT-OFFS List locations of shut offs using compass points and known or obvious landmarks. If you have a lock box containing keys and maps of the facility for the Fire~ Department to use, please list its location also. PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. Private Fire Protection: Describe on-site fire protection for yourbusiness or facility unit, including sprinklers, fire extinguishers, alarm systems and private response teams. B. Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the Fire Department in case of an emergency. 2 SECTION III List the number of employees that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to be in those areas. Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS must be readily available on site in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a program which provides employees with initial and refresher training in the following areas: 1) Methods for safe handling of the hazardous materials used by your business. 2) The Cal OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4) The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, inventory forms, and map within 30 days of receipt. If you have any questions please call us at (661) 326-3979 Thank you for helping to keep our All America City cleaner and safer. 3 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805)326-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATERIALS MANAGEMENT PLANS These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diasmn, for each of these areas. Include instructions that show tho route to your business it it is in a remote location. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your busine~ and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include aH of the following information: 1. Check the box on the top leR comer of the form provided that indicated "Site Diagram". 2. Print the name of your business, as shown/n your HMMP, on the top of the diagranx 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive sol/d). 4. Label the location ofutil/ty shutoff`points for gas, electric and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). symbols. Ir'you must u~e'Tllem, provra-e a lesend explaiain8 your system. Maps may be returned For correction it'you t'a~l to t'ollow these instruction. FACIT.ITy DIAGRAM [NSTRUC'I~ON$ Facility diasrams are supplements to the site diasram. Use them to show the subdivision details ofa larse business. 1. Check the box ia the upper right band comer of'the form provided that indicated "FacUlty Diagram". 2. Print the name ofyour business az shown on your HMMP. Print the name or'the area that tl~ map represents. 'EMs name sbould be the same name that you used on rids atea's iaveatory report. 3. L'~dicate wbi~ area the diaszam mpresem and the total number ot'~ diaszama tl~ you are including. Zf a map rep~ the ~u'st ot'tbur are~ it would be labeled #! or'4. 4. Follow instruction (3 -7) ~or site diasrams regarding the speci~c deta3s to be included on each ~acib'ty diagram. .. 2 Bu,iae~ Name: FRONT PARKING LOT (34T' STREET) ~ ~/I"0 JlC:: ~" Window Window ~ u.., ~ IMOpU,MI 0 ,",' m X ' m 0 m 0 · 0 OJ 0 o CITY OF BAKERSFIELD FIRE DEPARTMENT .~\ ~ OFFICE OF ENVIRONMENTAL SERVICES ~x ~ ~.~, UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~" Floor, Bakersfield, CA 93301 FACILITY NAME ~ D,~5 ~ O~~SPECTION DATE 4 ADD'SS ~O~-34~ ~ PHONENO. 3~3- Z~ FACILITY CONTACT BUSINESS ID NO. 15-210- ~SPECTION TIME NUMBER OF EMPLOYEES i -D Section 1: Business Plan and invento~ Program ~ Routine ~ombincd ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate pe~it on hand ~ ~t~ Business plan contact info~ation accurate Visible address Co~ect occupancy Verification of invento~ materials ~ Verification of quantities ~ Verification of location t~,o~ D~ ~ Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Explain:Any hazardous waste o~ site?:~~ ~ ~Ye~ ~No Questions reg~ding ~is ins~cfion? Pl~a~ call u~ at {661) 326-3979 ~siness Site Responsible Party White - Env. Svcs. Yellow- Station Cop~ Pink - Business Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ D,.~a4 ~.,~..cg oc.,tr,¥~sd INSPECTION DATE ~Ael/O-Z. Section 4: Hazardous Waste Generator Program EPA ID # ~(~ CE;K) ! 3'7 ~-6(~ [] Routine ~-- Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use ~6o<,C-o D~dco~a- t~oSPE:a~?,~ Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided ~/ ~9LC, O4~_. ff-r.3.~ O~ Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal o=t~ ..... ~a: .... xr-x,:A,ation ~ ~~----'-~ Inspector: ~ t'~l~ ~ Office of Environmental Services (661) 326-3979 Site Responsible Party White - Env. Svcs. Pink - Business Copy SITE/FACILITY D I AGR~k~4 FORM 5 · FLOOR: OF NORTH SCALE: B~SINESS ~A~E:~ ~,~0~ ~O.r~'~/,A (CHECK ONE) SITE DIAGRAM ~ FACILITY DIAGR.&~ ~- . ~ ........ .~ ~ ~ , (Inspector's Comments): -OFFICIAL USE ONLY- - SA - SITE DIAGRAM (Requi [tens) 1. Address: Identify he 9. Lock (key) Box principle buildings by the Street numbers. 10. }{SDS Storage Box 2. Street(s), Alleys. ~l. Railroad Tracks Driveways. and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Mire street names. · b. Masonry 3. Storm Drains. Culverts. Vard Drains c. Wood 4. Draina{e Canal{. Ditches. d. Dates Creeks. 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity in gal, a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas 16, Diking or Berm b. Electricity 17. EvacuaTion Route c. Water 18. Evacuation Area: - Identify the Firm Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Masts Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous For protection systems Material Use/Handling e. Fire Pump 22. ~ype of Hazardous Water iai/Mas te Stored 8. Fire Department Access or Used (See TYPE OF HAZARDOUS MATERIAL F - Flammable ~ - Explosive L - Llquid R - Radlologlcel C - Corrosive 0 - Ox/dAzer O - Gao P - Poison M - Mater Reactive T - Toxic S - Solid H - Cryogenic D - Waste B - Etiological Example: Flamble Liquid - FL FAC[LI~ DIAGRA~ (Required irene in additAon to the ab~e) 1, Rtsore for Sprinklers a. Fire Escapee 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10, Windows levels served ErDa highest to lowest, 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served fron 12. Inside Hazardous hi{heat to lamest. M~tarials Storage $. Elevator 13. Inside Hazardous hterials Use/Handling S. Attic Access 14. Sewer Drain Inlets ?. Skylights ff BAKERSFIELDBAKERSFiELD.2130(805)CITY,,G.326_3979FIREsTREETcA DEPARTNENT93301 /~~~5' ~ D OFFICIAL USE ONLY BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: CITY: [~ ()c~ ~-qo~, ~ IC~ ZIP: SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-4~7-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME 6~p TITLE , DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A W~OLE A. NAT. GAS/PROPANE: B. ELECTRICAL: D. SPECIAL: E. LOCK BOX: YES / IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO 2A- SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE SEGTIO~ ~: BOGAB E~RgE~GY ~DIgAB ASSIST~GE POR YO~ BUSINESS AS A ~OL~ SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS F0R SAFE HANDLING OF HAZARDOUS ,MATERIALS:.... .................................... ~ NO ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO .~NO C. PROPER USE OF SAFETY EQUIPMENT: .................. NO NO D. EMERGENCY EVACUATION PROCEDURES: ................. NO NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES (~ YES (~ SECTION 7: HAZARDOUS NATERIAL cC ' DOES Y(Tb'KrBUSINESS HANDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THA~N 500 POUNDS SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES~NO~J I, '~OD&C)OC~ (~'1 !0~'1 J~J~, certify that the above information is accurate. I u6derstand that thi~information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUS I NESS pLAN SINGLE FACILITY UNIT F 0 R~v~ 3A INSTRUCTIONS 1. To avoid further action, thSs form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions belo~ for THE FACILITY UNIT LISTED BELO~ 4. Be as BRIEF and COSt[SE as .possible. SECTION 1: ~ITIGATION~ PRE~NTION~ ABATE~E~ PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS b~':'IT ONLY- - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... YES NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No,.complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form ~4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS,,"PROPAN~ B. ELECTRICAL: C. WATER: D. SPECIAL: . ~ NO IF YES LOCATION: ELOCK BOX: YES ,, , IF YES ,.~_ , S~TE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO -' 3B - · BAKERSFIELD CITY FIRE DEPARTMENT BUSINESS NAME: S/I_.~ ~'~,mO.~ F&m,l~ ~ 5~Y,a}%OWNER NAME: FACILITY UNIT /O0~3~ ~¢. ADDRESS: FACILITY UNIT NAME: ADDRESS: CITY, ZIP:-~f~e&~','~(C3 q.3~50~ CITY,ZIP7 ~o~n ~: ~-,~a3-a~ PnON~ ~: O~CIA~ US~ C~S COD~ 1 2 3 4 5 6 ~ 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T .CO~E A~OUNT AMOUNT UNIT CODE C09E FACILITY UNIT ~T. CHEMICAL 0R COMMON NAME CODE GUIDE N~ME:~%oOc ~..,C'%'~%0~'~ 5D~ TITLE: SIGNATURE: DATE: E~kRGENCY CONTACT: ~~7~1~ ~C~ff_C - TITLE: PHONE * BUS HOURS: ..-~ ~, ' AFTER BUS HRS: ~-~ EM,ERGENCY CONTACT:~m~[~ ~~ TITHE ~¢~ ~~~ P"ON~ ~ BUS PRINCIPAL BUSINESS ACTIVITY: ' ~* a~&5~ AFTER BUS HRS: .5~--l~l - 4A-1 - ! t,v~e or ~rin~ name ) JAN ~9 1989 Do hereb7 eerti~z that I have reviews'ed the attached Hazardous Materials business ~lan (name of business) and that. it along with the attached additions or corrections constitute a complete and correct Business Plan for mM facilit.v. l~na~ur.e - date CITY of BAKERSFIELD NON--'I?RAI) E SECRETS . , LOCATION: ~O~ ~ ~ ~ o ADDRESS: ~O~ ~~- ~ . STANDARD I~D. CLASS CODE CITY, ZIP: ~~l~L~x {~. ~ ~ CITY, ZIP: ~&~ZcA~'lq.~ ~. ~3~( ,,, DUN AND BRADSTR~ET NUNB~R {~e C~e Mt ~ Est ~ts m Site I~ ~ Im ~ St~ in FKtllty , ~ ~ I~t~tt~ ~ltk of P~ ~lth ~_._[ .... 1 ............ 1 .............. 1 I .... ~1 ...... 1 I ! _~. I ' ~lth of ~ Mlth Wt 13 ~&C.A.S. P~tcll ~ Mlth ~z4~ C.A.S. ~ Wt II h i C.A.S. (C~k iii t~t i~ly) ~-~ -- -- r--~ -- ~t~ ~ & C.A.S. ~ blth of P~q Mlth Wt 13 M &C.A.S. __t ........... k ............ ~ .......... J ~ ~1 .... !_~!~.[ .... ! .............. F~ical ~ Mlth ~ C.A.S. ~ Wt II ~ & C.A.S. (C~k ill t~t Mly) ,. ~- . . ~.. - r--~ r-~ -- r--~ Cwt 12 ~&C.A.S. ~ ~ Fire Huard ~--~ ~ttv~ty ~--a ~leM ~-~ ~ ~lme ~--~ I~tite ....... H~lth of Prflsure ~lth 12 M[~GENCY C~TACTS lING.: ................................... ~[li ....................... ~I-8F'P~ ....... G R~II ~?'~! ....... Cert~ficati~ (Read and sign after co.pJ~tinK all sections)~ certify ~dtr wlty of 1~ ~t,I ~ve. wrs~e11yexami.n~.~ N fNiliir vlth t~ infor~~ this ~ oll itt . ,;~g~T~i[li~(i~7~;;T~OR-~F76~;;T~;';';GT~Fli~';~;~T;Tl;i S;~; ................................................. Ti'SI ........... BUSINESS NAME SAN DIMAS FAMILY DENTISTRY ID NUMBER 215-000-000020 LOCATION 602 34TH ST HIGH HAZARD RATING 2 1. OVERVIEW LAST CHANGE 05/13/88 BY ESTER JURIS CODE 215-004 JURIS BAKERSFIELD STATION 04 MAP PAGE 103 GRID 19D FACILITY UNITS 1 HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) PT IN OPERATORY 1 & WAITING ROOM EXIT BY FRONT DOOR "SOUTH". PT~S IN OPERATORY 2, 3, & BOTH LABS EXIT REAR DOOR "NORTH". FRONT OFFICE PERSONAL PHONE "911" AND IMMEDIATELY LEAVE BY FRONT DOOR "SOUTH". ALL EMPLOYEES & PT'S TO MEET IN FRONT OF THE BLDG "SOUTH" & WAIT FOR EMERGENCY HELP TO ARRIVE. EMERGENCY CONTACTS 2A SEC 2) KIMBERLEE BOWMAN -'~-~9~4~OR 328-1371-5a)-~ KIMBERLEE HICKS -~-2~---2-9-2-~OR 326-8198 3~$-~q UTILITY SHUTOFFS 2A 'SEC 3) A) GAS - SE CORNER OF BLDG B) ELECTRICAL - N SIDE OF BLDG BY REAR DOOR C) WATER - SE CORNER OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO 2 . NOT I F I CAT I ON / PUBL I C EVACUAT I ON LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 12/12/88 14:32 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME SAN DIMAS FAMILY DENTISTRY ID NUMBER 215-000-000020 LOCATION 602 $4TH ST HIGH HAZARD RATING 2 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 05/13/88 BY ESTER 2A SEC 5) DETERMINE THE EXTENT OF THE EMERGENCY. TO CALL THE APPROPRIATE AUTHORITIES FOR THIS EMERGENCY "911". TO ASSIST T~E INJURED PERSON BY "CPR, FIRST AIDE OR SHOCK". TO WAIT FOR MEDICAL HELP TO ARRIVE. PAGE 2 12/12/88 14:32 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME SAN DIMAS FAMILY DENTISTRY ID NUMBER 215-000-000020 LOCATION 602 34TH ST HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 05/13/88 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE OXYGEN 256 FT3 HIGH NW CLOSED IN FRONT LAB PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LISTS 2359.00 100.0 OXYGEN, COMPRESSED HIGH 2 PURE NITROUS OXIDE 244 FT3 MODERATE NW CLOSET FRONT LAB PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LISTS 2345.00 100.0 NITROUS OXIDE MODERATE B . FIRE PROTECTION / WATER SUPPLIES LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 3 12/12/88 14:32 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME SAN DIMAS FAMILY DENTISTRY ID NUMBER 215-000-000020 LOCATION 602 34TH ST HIGH HAZARD RATING 2 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 05/13/88 BY ESTER 3A SEC 2) NON-TOXIC GAS TO BE RELEASED INTO THE AIR. E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 05/13/88 BY ESTER 3A SEC 1) NITROUS OXIDE & OXYGEN ARE CHAINED TO THE WALL. VOICE COMMUNICATION TO EVACUATE THE PREMISES. PAGE 4 12/12/88 14:32 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800