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Home My WebLink AboutBUSINESS PLAN 10/7/2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF-PERMIT ON REVERSE SIDE .... ~ '.. This _~ermit is Issued for the followir~; [] Hazardous Materials Plan [] Underground.Storage of Hazardous Materials Permit ID #:: 015-000-000340 [] Risk Management Program PLEASANT CARE BAKERSFI [3 H~rdous WamO~Si~ LOCATION: 730 34TH ST *IELD ~.~' ~,,~ OFFICE OF ENV1R ONMENTAL SER VICES' - ,~' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 OmceofEv~Serviees -o . Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: ~l~l~{} ~O- ~OO~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: =)us Materials Plan ...... · .~! round Storage of Hazardous Materials PERMIT ID# 015-0214)00340 J~il =~, ', ement Program PLEASANT CARE : ~+ "'. ~ '~. ~ ~ ~, ~'~,,;S,. '" ='. " . ~= , '~' '=L~ ~'-.. '. ~ %.... ~, .~..~ , ., ~..~ ~l-:. · ,~- Is~ by: B~ersfield F~e D~a~ment Approv~ by: d ~:~~- ~' 1715 CheAer Ave., 3rd Floor B~e~fiel~ CA 93301 Voice (805) 32~3979 ~ (~0~)~-0~z~ ~xpir~tion~at~: dune 30, 2000 FIRE E VA C,,f,I ATtO N PLA N ,- ¢~X'IT cu-r i__ ~ q Rb-CORO$. B ,c~'FiAF-. OFF= ? ~U~L AL 01~1~6~ 210 I T- TREA?~EN-T SUPPLIES I EXIT p ~TI~ ~T PATt~ Ex t r TN~P~~TO~ C~ CENT~ ~ ~UPPL~ I J PLEASANT CARE BAKER~ SiteID: 015-021-000340 Manager : BusPhone: (661) 327-7687 Location: 730 34TH ST __~% %%%% Map : 103 CommHaz : Minimal City BAKERSFIELD : Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:8051 EPA Numb: DunnBrad:93-102-6009 Emergency Contact / Title Emergency Contact / Title ' ~ ! 4] ~ ~l / ~ ~ -~ ~-~,~4~/ JORGE CHI PRES / MAINTENANCE Business Phone: (661) 327-7687x Business Phone: (661) 327-7687x 24-Hour Phone : ( ) - x 24-Hour Phone : (661) 329-5251x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: (661) 327-7687x MailAddr: 730 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner PLEASANT CARE BAKERSFIELD Phone: (661) 327-7687x Address : 730 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ I, /- ,//u/A ~//~.~,4j.. Do hereby certify that I have '(Ty~e or I:xtnt name) reviewed the attached hazardous materials manage- ment plan for ~.4~..~~''~and that it along with (Name of Busine~) any corrections constitute a complete and correct man- agement plan for my facility. 1 09/26/2003 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~)/.-.~,,~.,d'v-,'Q- ~ ~- INSPECTION DATE ADDRESS -7 ~ ~ '3 ~ 't-~ ~T'- PHONE NO. ~ 2 "7 - FACILITY CONTACT ~',3 p.~e,.~L$oe,.__~ BUSINESS ID NO. 15-210- INSPECTION TIME .... I~ r~ ,,'- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~-Routinc {~ Combined [~ Joint Agency [~ Multi-Agency [..] Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection V Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ~ Yes [~ No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 ,~usiness ~ite Responsibl~ Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: ./~- fi::~ _< ~ t,,,-, / CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ~L(...~$~/.r ~ INSPECTION DATE I/23 ADDRESS '-'/?~ '3~ m 5~ PHONE NO. 3%-7 9~,g7 FACILITY CONTACT. ~¥~t,xc~ gof'.~g BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~.~Routine [~ Combined [~ Joint Agency [~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION C'V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location O~-.V{.~-',.J tZO,.,w~$ (ii, t.,O,,o6- 'if. ~.~ 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 Any hazardous waste on site?: [~ Yes ~o Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: PLEASANT CARE BAKERSFIELD SiteID: 015-021-000340 Manager: .~C~/~ BusPhone: (805) 327-7687 Location: 730 34TH ST v&-~ i,~.~_ Map : 103 CommHaz : Minimal City : BAKERSFIELD ~1~0~~ ~ Grid: 19D FacUnits: 1 AOV: BAKERSFIELD STATION 04 '~c~/C~~ sic Code:8051 CommCode: EPA Numb: DunnBrad:93-102-6009 Emergency Conta~f / Title Empty. tact / Title ~.~ GF~Z2L~2.~..''~i_~ ~/_PLANT SUPER ~JOI~ ~AL~ ~ / MAINTENANCE Business Phone: (805) 327-7687x Business Phone: (805) 327-7687x 24-Hour Phone : ( ) - x 24-Hour Phone : (805) 329-5251x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: (805) 327-7687x MailAddr: 730 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner GGLDEN~ .......... ~-~.~ PLEASANT CARE- Phone: (805) 327-7687x Address : 730 34TH ST BAKERSFIELD State: CA City : BAKERSFIELD Zip : 93301. Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site ISpeoHazlEPA HazardsI Frm DailyMax Unit MCP Hazmat Common Name... OXYGEN F P IH G 4500.00 FT3 Low I, MARY SUE F _R~_NK__LLI~0 h~reby certify that I have (Type or pdnt reviewed the at~ached hazardous materials manage- PLEASANT CARE-BAKERSF-TE[~n- _an~na~ ~ a g with ment plan for___~m' o, Business) any corrections constitute a complete and correct man- agement plan for my facility. _ _ -1- 08/03/2000 PLEASANT CARE BAKERSFIELD SiteID: 015-021-000340 = Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: ROOM A & B CAS# 7782-44-7 STATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient I Ambient I PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average FT3I 4500.00 FT3I 3370.00 FT3 HAZARDOUS COMPONENTS %Wt. ~S CAS# 100.00 Oxygen, Compressed N 7782447 i TSecret RS BioHazI HAZARD ASSESSMENTS I Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low 2 08/03/2000 ? PLEASANT CARE BAKERSFIELD SiteID: 015-021-000340 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 08/15/1990 CALL 911 -- Employee Notif./Evacuation 08/15/1990 PAGING SYSTEM Public Notif./Evacuation 08/15/1990 PAGING SYSTEM ~ Emergency Medical Plan 08/15/1990 TRANSPORT TO NEAREST HOSPITAL, ALSO DRS AND NURSES ON STAFF -3- 08/03/2000 F PLEASANT CARE BAKERSFIELD SiteID: 015-021-000340 Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 08/15/1990 OXYGEN CYLINDER CHAINED TO WALL --Release Containment 08/15/1990 REGULAR INSPECTION OF OXYGEN CYLINDERS THAT THEY ARE CHAINED, SECURED, AND FREE OF LEAKS. -- Clean Up -- Other Resource Activation 4 08/03/2000 ~LEASANT CARE BAKERSFIELD SiteID: 015-021-000340 Fast Format Site Emergency Factors Overall Site -- Special Hazards 06/11/1997 120-140 SENIORS (MANY DISABLED) -- Utility Shut-Offs 06/11/1997 A) GAS - NEXT TO THE N ENTRANCE ON THE W SIDE OF THE BLDG B) ELECTRICAL - S BULLPEN THE W SIDE OF THE BLDG C) WATER - NEXT TO GAS METER ON THE W SIDE OF THE BLDG D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 06/11/1997 PRIVATE FIRE PROTECTION - FIRE SPRINKLERS, FIRE EXTINGUISHER, PULL BOX, SMOKE DETECTOR. FIRE HYDRANT - CHEVRON STATION AT Q ST. Building Occupancy Level -5- 08/03/2000 i PLEASANT CARE BAKERSFIELD ~/~/~/~/~ SiteID: 015-021-000340 i i~ Training ~~~~~~~~ Overall Site i i~ Employee Training ~5/~/~/~/~/~/~/~/~5/~/~/~~~~ 06/11/1997 i o o o WE HAVE 125 EMPLOYEES AT THIS FACILITY. o o o o WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. o o o o BRIEF SUMMARY OF TRAINING PROGRAM: SAFETY ORIENTATION ON HIRE AND A YEARLY o ° INSERVICE TO ALL STAFF ON SAFETY. ° o o O o O o o o O o o 0 Manager : ~ ~,~usPhone (805) 327-7687 Location: 730 34TH ST 3~ 10~997 ap : 10; : CommHaz Minimal City : BAKERSFIELD ~ '~, frid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATIOI~-0'i'~ ~ SIC Code:8051 EPA Numb: DunnBrad:93-102-6009 Emerqencv Contact / T~e~e Emergency Contact / Title PAI~'~GRAHAM /pHYsICAL PLANT SUPVSR JOHN NEAL /MAINTENANCE Business Phone: (805) 327-7687x Business Phone: (805) 327-7687x 24-Hour Phone : ( ) - x 24-Hour Phone : (805) 329-5251x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Agency-Defined Topic Title ---- Hazmat Inventory One Unified List -- MCP+DailyMax Order Ail Materials at Site ISpecHazlEPA HazardsI Frm DailyMax Unit MCP Hazmat Common Name... OXYGEN F P IH G 4500 FT3 Low I, SEDY DEMESA .r3':;. ,h.o.'®by cerlify that I have materials manage- BAKERSF~I~LD menl p;::=~] '~.::i' PLEASANT CARE- an~rthat it along with any corrections constitute a complete and correct man- agement plan for my facility. 1 05/22/1997 PL-EASANT CARE-BAKERSFIELD SiteID: 215-000-000340 = Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit ROOM A & B CAS# 7782-44-7 Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 4500.00 3370.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHSI CAS# 100.00 Oxygen, Compressed No 7782447 -2- 05/22/1997 f PLEASANT CARE-BAKERSFIELD SiteID: 215-000-000340 Fast Format = Notif./Evacuation/Medical Overall Site -- Agency Notification 08/15/1990 CALL 911 -- Employee Notif./Evacuation 08/15/1990 PAGING SYSTEM Public Notif./Evacuation 08/15/1990 PAGING SYSTEM Emergency Medical Plan 08/15/1990 TRANSPORT TO NEAREST HOSPITAL, ALSO DRS AND NURSES ON STAFF -3- 05/22/1997 PLEASANT CARE-BAKERSFIELD SiteID: 215-000-000340 Fast Format = Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 08/15/1990 OXYGEN CYLINDER CHAINED TO WALL -- Release Containment 08/15/1990 REGULAR INSPECTION OF OXYGEN CYLINDERS THAT THEY ARE CHAINED, SECURED, AND FREE OF LEAKS. -- Clean Up Other Resource Activation -4- 05/22/1997 PLEASANT CARE-BAKERSFIELD SiteID: 215-000-000340 Fast Format Site Emergency Factors Overall Site -- Special Hazards 08/20/1992 120 140 SENIORS (MANY DISABLED) -- Utility Shut-Offs 08/20/1992 A) GAS - NEXT TO THE NORTH ENTRANCE ON THE WEST SIDE OF THE BUILDING B) ELECTRICAL - SOUTH BULLPEN THE WEST SIDE OF THE BUILDING C) WATER - NEST TO GAS METER ON THE WEST SIDE OF THE BUILDING D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 08/20/1992 PRIVATE FIRE PROTECTION - FIRE SPRINKLERS, FIRE EXTINGUISHER, PULL BOX, SMOKE DETECTOR FIRE HYDRANT - CHEVRON STATION AT Q STREET Building Occupancy Level -5- 05/22/1997 PLEASANT CARE-BAKERSFIELD SiteID: 215-000-000340 Fast Format = Training Overall Site -- Employee Training 08/15/1990 WE HAVE 125 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE SAFETY ORIENTATION ON HIRE AND A YEARLY INSERVICE TO ALL STAFF ON SAFETY -- Page 2 -- Held for Future Use Held for Future Use -6- 05/22/1997 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 1 Overall Site with 1 Fac. Unit General Information Location: 730 34TH ST Map: 103 Hazard: Minimal Community: BAKERSFIELD STATION 01 Grid: 19D F/U: 1 AOV: 0.0 Contact Name Title , Business Phone ---[ 24-Hour Phone] ~)~;F~A~r~O ~r~.~ _ MAINTENANCE SUPERI (805) 327-7687 x ~(805) ~~6 ~'----~/~'">-~]~7-~'w ~,~ ~?~t~ HOUSEKEEPING SUPER (805) 327-7687~~jx l(805) '~o~~ Administrative Data Mail Addrs: 730 34TH ST D&B Number: 93-102-6009 City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 8051 Owner: MAR~E ~ZF Rg~ERTSON ~/~/~/ ~ ~ Phone: ( 805 ) ~ Address: 370~Q S~ 1~ ~. ~/~_z-.~¢. State: CA' Summary RECEIVED HA7. M~T. DIV. I, ~7~)~,~,Z~;~ ~. C//~,~/~/-~ Do hereby certify that l have reviewed the attached hazardous materials manage- ment plan ~'or,~,~,,v,~__~.,~.. ?,~:~ and that it along with any corrections c~ns~u~e a complete and ~rma man- agement plan for my faci!i~. 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN Gas 4500 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3I Daily Average FT3 I Annual Amount FT3 -- 4,500 ~ 3,370.00 40,500.00 StorageI Press T TempI Location PORT. PRESS. CYLINDER Iabove ~ambientlROOM a & B -- Conc Components MCP List 100.0% IOxygen, Compressed ILow I 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation PAGING SYSTEM <3> Public Notif./Evacuation PAGING SYSTEM <4> Emergency Medical Plan TRANSPORT TO NEAREST HOSPITAL, ALSO DRS AND NURSES ON STAFF 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention OXYGEN CYLINDER CHAINED TO WALL <2> Release Containment REGULAR INSPECTION OF OXYGEN CYLINDERS THAT THEY ARE CHAINED, SECURED, AND FREE OF LEAKS. <3> Clean Up <4> Other Resource Activation 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NEXT TO THE NORTH ENTRANCE ON THE WEST SIDE OF THE BUILDING B) ELECTRICAL - SOUTH BULLPEN THE WEST SIDE OF THE BUILDING C) WATER - NEST TO GAS METER ON THE WEST SIDE OF THE BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE SPRINKLERS, FIRE EXTINGUISHER, PULL BOX, SMOKE DETECTOR FIRE HYDRANT - CHEVRON STATION AT Q STREET <4> Building Occupancy Level 02/20/92 BAKERSFIELD CONVALESCENT HOSPITAL 215-000-000340 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 120 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE SAFETY ORIENTATION ON HIRE AND A YEARLY INSERVICE TO ALL STAFF ON SAFETY <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 02/12/91 BAKERSFIELD~ONVALESCENT HOSPITAL 21 D00340 Page Overall Site with 1 Fac. Ur, it Ger, era I I nfr, rmat i on ILocation: 730 34TH ST Map: 103 Hazard: Minimal l ldent Number: 215-000-000340 Grid: 19D Area of Vul: 0.0 Contact Name I Title I Business Phone ---1-24 Hour Phone] ,'JO$~=~l~WkI~O IMAINTENANCE SUPER I (805)327-7~87x Administrative Data Mail Addrs: 730 34TH ST D&B Number: 93-102-6009 City: BAKERSFIELD State: CA Zip: 93301- Comrn Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 8051 Owner: MARLENE Z. ROBERTSON Phone: (805> 327-7687 Address: 3700 Q ST 12 State: CA City: BAKERSFIELD Zip: 93301- Summary RECEIVED FEB ! 5 199! / Ans*d ............ .~ ~,~,~.s~e. z. ~ss~T~lC)o heFeby c~)~ that l have ~ ....( yp~ or ~int 02/12/91 BAKE RSF I ELDeONVALESCENT HOSPITAL 215e)0-000340 Page Hazmat Ir, ventory List ir, MCP Order 02 - Fixed Cor, tair, ers c,r, Site Pln-Ref Name/Hazards Form Quar, t ity MCP 02-001 OXYGEN Gas 4, 5o0 Low Fire, Pressure, Irl~r,~ed Hlth FT3 C)2/12/91 BAKERSFIELD~ONVALESCENT HOSPITAL 21 ~)C)C)34C) Page 3 O0 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuatiorl PAGING SYSTEM <3> Public Notif./Evacuatior~ PAGING SYSTEM <4> Emergency Medical Plan TRANSPORT TO NEAREST HOSPITAL, ALSO DRS AND NURSES ON STAFF 02/12/91 BAKERSFI )NVALESCENT HOSPITAL 00-000340 Page 4 O0 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention OXYGEN CYLINDER CHAINED TO WALL <2> Release Containr~ent REGULAR INSPECTION OF OXYGEN CYLINDERS THAT '[HEY ARE CHAINED, SECURED, AND FREE OF LEAKS. <3> Clear, Up <4> Other Resource Activation 02/12/91 BAKERSF IIEL ONVALESCENT HOSPITAL 21 000340 Page 5 00 - Overall Site <F> Site Er,~ergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NEXT TO THE NORTH ENTRANCE ON THE WEST SIDE OF THE BUILDING B) ELECTRICAL - SOUTH BULLPEN THE WEST SIDE OF 'THE BUILDING C) WATER - NEST TO GAS METER ON THE WEST SIDE OF THE BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE SPRINKLERS, FIRE EXTINGUISHER, PULL BOX, SMOKE DETECTOR FIRE HYDRANT - CHEVRON STATION AT Q STREET <4> Held for Future use .,-/1~/91 BAKERSF IEL ONVALESCENT HOSPITAL ~ :')-000340 page 6 O0 - Overall Site <G> Trair~ir, g > Page 1 WE HAVE 120 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE SAFETY ORIENTATION ON HIRE AND A YEARLY INSERVICE TO ALL STAFF ON SAFETY <2> Page 2 as r~eeded <3> Held for Future Use <4> Held for Future Use ...' CITY of BAKERSFIELD - "H,'E C,4 RE" ~"'~ -.~,: NEEDHAM BAKERSFIELD 9330~ CHIEF 326-391 Dear Business'O~ner: This notice is meant to act as a reminder that the California Health and Safety Code, ChaDter 6.9§, requires an), handler of hazardous materials to revise their hazardous materials business Dlan within 30 days of any one of the following events: (1) A 100 Der cent or more increase in the quantit~ of a ~reviousl¥-disclos~ed material. (2) Any handling of a ~reviously-undisclosed hazardous material, subject to the inventory requirements of Cha~ter 6.95. (3) Change in business ownership. (4) Change in business address. (5) Change of business name. Any questions regarding these required revisions, Dlease call the Hazardous Materials Division at (805) 326-3979. Sincerely yours, ~rdo~s Materials Coordinator REH/d Bakersfield Fire Dept. ~ Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 iUG 0 3 199D · -¢' HAZ~ MAT. DIV. HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days ot receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH, 3. Answer the questions ~elow for the business as a whole. 4. Be brief and"~oncise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: MAILING ADDRESS' CITY: P,'_~Er~R$~'_TRT.n STATE: CA ZIP: q'~'~n] PHONE: 327-7687 D'UN & BRADSTREET NUMBER: ~391026009 SIC CODE: ~'~--~ PRIMARY ACTIVITY: cSKILLED NURSING FACILITY OWNER: MARLENE Z. ROBERTSON MAILING ADDRESS: 3700 Q STREET APT.~:.,I2 93301 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. ELTON NEAL MAINTENANCE SUPERVISOR - 327-7687 323-2915 2. FRANK SANCHEZ HOUSEKEEPING SUPERVISOR -327-768~ 326gD143~ FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION $: TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: Yes BRIEF SUMMARY OF TRAINING PROGRAM: Safety orientation on hire and a yearly inservice to ail staff on safety SECTION 4: EXEMI~TION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: F'h I, MARLENE Z. ROBERTSON CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. 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. ~ -~z~.~ ~W-~ PRESIDENT AUGUST 1,1990. _~ SIGNATURE TITLE DATE FD15~0 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: RAIEF, RF, FTIqT.D C.n~VAT.~.~C~_~!? HOSP!TAT SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: Notify ~MERICAIR- 805-485-1999 800-g52-8881 B. EMPLOYEE NOTIFICATION AND EVACUATION: Through paging system C. PUBLIC EVACUATION: THrough paging system D. EMERGENCY MEDICAL.PLAN: Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: Oxygen cylinder chained to wall B. RELEASE CONTAINMENT AND/OR MINIMIZATION: Regular inspection of oxygen cylinders that the~ are c~ained, sec~med, and free of leaks C. CLEAN-UP PROCEDURES: NONE SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: located next to the north of the building ELECTRICAL: ~'lec~tical breaker switch is located in the south bullpen the west side of the building SPECIAL: none LOCK BOX: YES/NO IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: fire sp~nkle~:; fire extinquisher, pn~-~' box, smo~e detector B. WATER AVAILABILITY (FIRE HYDRANT)' located at Chevron Station at Q STREE~~ 4. FD159o CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY Farm and Agriculture ri Standard Business [] NON--TRADE SECRETS Page of __ BUSINESS NAME- DBA.:;'SUNTOAK CORP. :' "' OWNER NAME: MARLENE Z. ROBERTSON ~Ne.H,E,~O.~F~T,HI.$~ FA~,CI.L.L~ITY.]~A.g_~FIRT,T) o.(3~DZ .__~(~qp LOCATION: 73~ 34th STREET ADDRESS; ~7~---~--~---~p-~q~--~---~--{--~- ~/ANUAI~I) INU. ULAbb LJUDI-: CITY, ZIP:navpoepTp, n nqqnl - CITY. ZIPFDAEKRSEIEED; g330T~ DUN AND BRADSTREE) NUMBER-~j~--~)-~'~'O9- PHONE It: ~77~7~R7 ........ :': PHONE ~: ~oZo ' - - - REFER TO~NS'/R~C'IIONS h'UN HNOP~ CODES '1 2 3 4 S ~ 1 8 9 10 I1' 12 13 lrans [y~e Nax Average Annual Measure I ~y~ Cont Con: Cont Us~ Locatton. Whece. ~wbyt Naees of Code cooe AeC Aa: Est Un]:s on 5t:e Type Press Temp CoueStored ;n eacl/~:y 5me NIP la, tiff 1''.7~ko, oo1365 Io~ I= I~ 12~ bxvgen roodA+B lOi} P,,re oxygen Physical and Health Hazard C.A.S. Number Co=ponent II Name I C.A.S. Hu~ber (Check a]~ that apply) ~ire Hazard 0 Reactivity D Delayed ~udden Release ~ Immediate ' / CoeponenC Number ~eal:h of Pressure HealCh Component 13 ~a~e I :,A,~, Number I I I I I I I I I I I Physical and Health ~a~ard C,A.S. Number Component I1 Naee& C.A,S. Number (Check al/ that app/yJ Component 12 Hame & C.A,S, Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ I~aediate Health of Pressure Health Component 13 Na~e I C.A.S. Hu=ber Physical and Health Hazard C.A.S. Number Co~ponent II Hame t C,A.S. Number (Check all that apply) Coeponent 12 Hame & C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ I~ediate ~ Health of Pressure Health Component 13 Hame & C.A.S. Humber (Check al/ that apply) Component 12 Name $ C.A.S. Number ~ Fire Hazard 0 Reactivity 0 Delayed ~ Sudden Release ~ Immediate Health of Pressure Health Component 13 Name S C.A.S. Number EMERGENCY CONTACTS ~1 ELTON NEAL MAINT. SUP. 323-2915 ~2 FRANK SANCHES HSKPNG SUP. 3260143 Name m ltle z4 Hr Phone Name TlCle :erti[i{~tioq ,(Re~ ~,n~.~ign af~pr compl~tiog,mll sectipnq) ,certify unoer penalty oFja~ ~n~c I navepe(sonal~y examlnqolqo)m tamim~aLvitb the jntormacIpn ~u~mitt~d in this And all C~acned.dOcwment), mnO tUac oaseo on.my Inquiry 9f.those inOlVlOUa/s responsible Tot obtaining the information. I believe that the uomltteo information Is true, accurate, ano complete. .MARLENE Z. ROBERTSON, PRESIDENT ~~~ ~e end oficfal fi~le ot own~ttooer~tor u~ owner/ooerator;s authorized reoresentat~ve ~