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HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste* Unified Permit' CONDITIONS OF~PERMIT ON REVERSE SIDE This ~ermit is issued for the followin_~: [] Hazardous Materials Plan [] Underground'Storage of Hazardous Materials Permit ID #:: 015-000-000262 ·" [] Risk Management Program · [3 Hazardous Waste On-Site Treatment MEDI STOP HOME MEDICAL LOCATION: 815 34TH ST 'IELD ': OFFICE OF ENVIRONMENTAL SER VICES' ' ~' ~ Bakersfield, CA 93301 omccof£v~S~ices - Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: ..~U... I Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE . ~,~?? ;~;~ ? ??7 ? ?' !~,~ ~,~ This permit is issued for the following: .,,,~,,??i?'?',~'i~%,::i;~ ~i~.:;i,:::;i,~.&;:i;ii:~??.:i:::El~!~Hazardous Materials Plan .=~,~?;"; ~! ~,~!!i:~ ...... *~iiii~,iii!iL ~;~:~[~. ~ ~"~"~'"~ ,~;;;[~;Uhd~[ground Storage of H~rdous Mateflals PERMIT ID~ 015~21e00262 ? ~;~ ;~,;:~4~ ~' ??~ ~ ~ ~?.~?~ ~ ~?:~k~nagement Program ?~%. ~?~'" ~H ': ? ~::: ::~;::~ ~::~::~= ::;~ ':~;:;~::::;~':j~?~:;: ~: ::E= ~a~S Waste ~ ~,, ~. ~'~;~ ~,~? ... ~, .~j ....................... LOCATION 815 ~TH ~=~' '"' ...... ' .... ' .... "=~' ....... ~ .... ' '~ ........ ~e~'C..'" ././,'"/' Issu~ by:  B~er~field Fke D~ment Approv~ by: ~~ ' O~CE OFE~O~L 1715 Chewer Ave., 3rd Floor B~e~fiel~ CA 93301 ~ce of~mml S~i~m Voice (805) ~2~3979 F~ (80S)~26-0S76 ExpkationDate: ~n~ ~O~ ~000 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~ Floor, Bakersfield, CA 93301 FACILITY NAME ]f~'~0l'-Sq-~3 ~0 INSPECTION DATE ADDRESS ~'1.5" "~ ct ~ PHONE NO. FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME t 5' r~ ~/~.,7 NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program -~ Routine {~] Combined ~] Joint Agency ~ Multi-Agency ~l 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 Site Diagram Adequate & On Hand C=Compliance V=Violation AnYExplain:hazardous waste on site?: [~ Yes [~] No ~. , ~ ~~ Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party .,el/] White-Env. Svcs. Yellow-StationColay Pink - Business Copy Inspector: (~-~~'-~ ,90'-3 :~MEDI STOP HOME MEDIC UPPLY SiteID: 015~621£b00262 Manager : BusPhone: (661) 328-9920 Location: 815 34TH ST Map : ~%%%~ 103 CommHaz : Low City : BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:7352 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MANUEL HERNANDEZ / CORP PRES NANCY JACQUE~g / CORP SECRETARY Business Phone: (661) 328-9920x Business Phone: (661) 328-9920x 24-Hour Phone : (661) 978-5560x 24-Hour Phone : (661) 326-1674x Pager Phone : (661) 329-7239x Pager Phone : (661) 978-5562x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: (661) 328-9920x MailAddr: 815 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner MEDI STOP HOME MEDICAL SUPPLIER Phone: (661) 328-9920x Address : PO BOX 40547 State: CA City : BAKERSFIELD Zip : 933841120 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: I, _ _ ./-/~J,~n~'~)&)~_ hereby certify that I have [ Jype o~ I~'fnt name) reviewed the attached hazardous materials manage- ment plan for/-X'/~.- S~/-~ ~ and that it along with (Name of Bu~lneo~ -- any corrections constitute a complete and correct man- a43ement plan for my facility.  -1- 09/09/2003 ~EDI' S%,i~P HOME MEDICAL SUPPL~5~ SiteID: 015-021-000262 Location: 815 34TH ST City : BAKERSFIELD .;~. -~' / Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 ~/ SIC Code:7352 ' EPA Numb:~'~ DunnBrad: Emergency Contact / Title Emergency Contact / Title MANUEL HERNANDEZ,, / MANAGER~ £orp ~$ CrlARL~S HE~AN4D~Z, / Business Phone:~'(~ 328-9920x Business phone:5~/~) 328-9920x 24-Hour Phone :~(~5+ ~3-7--88~8x9~-5~&o 24-Hour Phone :6~1(-805) ~B~-~9~x'3~-~7~ Pager Phone : (~/) 3~?-7~3~x I~11t~._. Phone : / Hazmat Hazards: Fire Press ImmHlth Contact : Phone: (805) 328-9920x MailAddr: 815 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner ,JERRY GALLEGOS HE~qi~DEZ-~Q~J;-S,4o~ H°m%ho~e~;(~xJ+ Address : PO BOX ~-1~-2~ ~d~q~ State: CA Zip : 933841120 City : BAKERSFIELD g~ ~c~ ~o~ o~ Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ---- Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA Hazards Frm I DailyMax Unit MOP MEDICAL OXYGEN F P IH G 4880.00 FT3 Low I, r'Qdn/3~/ cer Do hereby certify that I have ~y~ or p~nt name) reviewed the a~ached h~ardous mate~als manage- ment plan ;or ~~- ~o ~nd that it along with (Na~ of Bus~e~) any corrections constitute a complete and corre= man- agement plan for my facili~. m ~'~ 03/16/2001 2236768 SECRETARY OF STATE I, BILL JONES, Secretary of State of the State of California, hereby certify: That the attached transcript of page(s) has been compared with the record on file in this office, of which it purports to be a copy, and that it is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of JUN - 7 2000 Secretary of State Sec/State Form CE-107 (rev, 9/98) ~ OSP 98 13524 2 2 3 - ", ENDORSED- FILED ~' .-' illtbe office ol the Secfeta~/of State o! the Stme of California MAY i 5 2000 ARTICLES OF INCO O TION The name of this corporation is MEDI-STOP HOME ivlEDICAL SUPPLIES II The purpose of the corporation is to engage in any lawi-hl act or activity which a corporation may be organized under the GENERAL ccn~o~'rroN. LAW OF California other than the banking business, the trust company business or the practice of a profession permitted to be incorporated by the California Corporations Code. III The name and address in the State of California of this corporation's initial agent for service of process is: Dells Sehm 9339 Rosedale Hwy Suite D Bakersfield, CA 93312 IV This corporation is authorized to issue only one class of shares of stock; and the total number of shares which this corporation is authorized to issue is ten thousand (10,000). DELLA SEHM, Incor~~ TO WHOM IT MAY CONCERN MEDI-STOP HOME MEDICAL SUPPLIER IS NOW A CORPORATION: THE OFFICERS ARE: MANUEL GALLEGOS HERNANDEZ PRESIDENT JERRY GALLEGOS HERNANDEZ VICE-PRESIDENT NANCY DAWN JACQUES SECRETARY/TREASURER BOARD OF DIRECTORS HAS MARTHA GALLEGOS HERNANDEZ F MEDI ~TOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 ~ Invento~ Item 0001 Facility Unit: Fixed Containers on Site -- CO~ON NME / CHEMICAL NME ~DICAL OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SOUTHWEST O~SIDE REAR CAS# 7782-44-7 · Gas Pure Move Ambient Below A~ient PORT. PRESS. CYLI~ER MOUNTS AT THIS LOCATION Largest Container '1 Daily Maximum Daily Average FT3 I 4880.00 FT3 3660.00 FT3 %Wt. RS ~S# 100.00 O~gen, Compressed No 7782447 TSecret RSIBioHaz Radioactive/~ount . EPA Hazards NFPA USDOT# MCP No IN° I No No/ ~ries F P IH / / / Low 2 03/16/2001 F ~EDI' STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 Fast Format =.Notif./Evacuation/Medical Overall Site --Agency Notification 09/08/1994 CALL 911 TRY TO EXTINGUISH FIRE EVACUATE PROCDURES MEDICAL EMERGENCY NUMBERS --Employee Notif./Evacuation 09/08/1994 EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND CALL 911 Public Notif./Evacuation 09/08/1994 EXIT SIGNS INSIDE OF STORE BLDG. OXYGEN WARNING SIGN OUTSIDE BY OXYGEN TANK Emergency Medical Plan 05/30/1997 MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 SAN JOAQUIN HOSPITAL - 2615 EYE ST - 327-1711 -3- 03/16/2001 F M~D~ STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 09/08/1994 AIR OUT OXYGEN TANKS ARE CHAINED AND ARE LOCKED IN AN OPEN AIR AREA. --Release Containment 09/08/1994 NONE APPROVED PORTABLE PRESSURIZED CYLINDERS -- Clean Up 09/08/1994 NOT APPLICABLE Other Resource Activation 4 03/16/2001 MED~ STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 Fast Format Site Emergency Factors Overall Site Special Hazards ~ Utility Shut-Offs 09/08/1994 A) GAS - WEST SIDE OF BUILDING, BEHIND FENCE TOWARD FRONT OF BUILDING B) ELECTRICAL - INSIDE BUILDING, LEFT OF SOUTHEAST BACK DOOR C) WATER - OUTSIDE SOUTHEAST BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 09/08/1994 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS (HALON #1211) FIRE HYDRANT - ACROSS THE STREET AT 820 34TH STREET (MERCY MEDICAL CENTER) Building Occupancy Level -5- 03/16/2001 M~I' STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 Fast Format ~ Training Overall Site -- Employee Training 05/30/1997 WE HAVE~ EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: METHODS FOR HANDLING OF HAZARDOUS MATERIAL; COORDINATE ACTIVITIES WITH RESPONSE AGENCIES; PROPER USE OF SAFETY EQUIPMENT; EMERGENCY EVACUATION PROCEDURE. Page 2 Held for Future Use I Held fOr Future Use I 6 03/16/2001 MEDI STOP HOME MEDICAL SUPPLY ' SiteID: 215-000-000262 Manager : ~¥ 2 9 1997 ~ usPhone: (805) 328-9920 Location: 815 34TH ST lap : 103 CommHaz : Low City : BAKERSFIELD 8y~ Irid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:7352 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MANUEL HERNANDEZ / MANAGER CHARLES HERNANDEZ / ASSISTANT MANAG Business Phone: (805) 328-9920x Business Phone: (805) 328-9920x 24-Hour Phone : (805) 837-8850x 24-Hour Phone : (805) 836-8493x 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 Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax Unit MCP MEDICAL OXYGEN F P IH G 4880 FT3 Low I, ~,~ez //¢'~',,~ ~,,~-Do hereby certify that I have (TyI~ ~ I~nt name) reviewed the ~'imched !:.?.';.,?:~'~.?..,~.~ ~'~aterials ma~'~ge- mere plan fcr /Ue~l ;.- ~-/o ? and ~hs~ it along with · ' ,~'a~nnlr3~'~ and correct man- any corrections consti~u~ agement plan for my facility. 1 05/22/1997 MEDI STOP HOME MEDICAL SUPPLY SiteID: 215-000-000262 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME MEDICAL OXYGEN Days On Site 365 Location within this Facility Unit SOUTHWEST OUTSIDE REAR CAS# 7782-44-7 rSTATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient I Below Ambient PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 4880.00 3660.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS[ CAS# 100.00 Oxygen, Compressed ~ 7782447 -2- 05/22/1997 MEDI STOP HOME MEDICAL SUPPLY SiteID: 215-000-000262 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 09/08/1994 CALL 911 TRY TO EXTINGUISH FIRE EVACUATE PROCDURES MEDICAL EMERGENCY NUMBERS -- Employee Notif./Evacuation 09/08/1994 EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND CALL 911 -- Public Notif./Evacuation 09/08/1994 EXIT SIGNS INSIDE OF STORE BLDG. OXYGEN WARNING SIGN OUTSIDE BY OXYGEN TANK AREA. Emergency Medical Plan 09/08/1994 MERCY HOSPITAL MEMORIAL HOSPITAL 2215 TRUXTUN AV 420 - 34TH ST 327-3371 327-1792 SAN JOAQUIN HOSPITAL 2615 EYE ST 327-1711 -3- 05/22/1997 MEDI STOP HOME MEDICAL SUPPLY SiteID: 215-000-000262 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 09/08/1994 AIR OUT OXYGEN TANKS ARE CHAINED AND ARE LOCKED IN AN OPEN AIR AREA. -- Release Containment 09/08/1994 NONE APPROVED PORTABLE PRESSURIZED CYLINDERS -- Clean Up 09/08/1994 NOT APPLICABLE Other Resource Activation -4- 05/22/1997 MEDI STOP HOME MEDICAL SUPPLY SiteID: 215-000-000262 Fast Format Site Emergency Factors Overall Site iSpecial Hazards -- Utility Shut-Offs 09/08/1994 A) GAS - WEST SIDE OF BUILDING, BEHIND FENCE TOWARD FRONT OF BUILDING B) ELECTRICAL - INSIDE BUILDING, LEFT OF SOUTHEAST BACK DOOR C) WATER - OUTSIDE SOUTHEAST BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 09/08/1994 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS (HALON #1211) FIRE HYDRANT - ACROSS THE STREET AT 820 34TH STREET (MERCY MEDICAL CENTER) Building Occupancy Level -5- 05/22/1997 MEDI STOP HOME MEDICAL SUPPLY SiteID: 215-000-000262 Fast Format Training Overall Site -- Employee Training 08/28/1991 WE HAVE, EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: METHODS FOR HANDLING OF HAZARDOUS MATERIAL; COORDINATE ACTIVITIES WITH RESPONSE AGENCIES; PROPER USE OF SAFETY EQUIPMENT; EMERGENCY EVACUATION PROCEDURE. Page 2 -- Held for Future Use Held for Future Use 6 05/22/1997 ~ ~ Bakersfield Fire Dept. ~ ....... ' HAZARDOUS MATERIALS DIVISION Date Completed Business Name: //~-~/~/' ~ ,-~"~p Location: ~,/~"' ~ff/~ ~'~, Business Identification No. 215-000 . c~ ~, (Top of1 Business Plan) Station No. L.~ Shift..-~ Inspector ~ .~~ Adequate Inadequate Verification of Inventory Materials 51 ~ ~ RECEIVED Verification of Quantities r~ ~' o 5 ,t994 Verification of Location r~ r~ HAZ. M4 T. DIV. Proper Segregation of Material~/' I~] Comments: Number of Employees Verificat~..~of MSDS Availablity ~ I~] Verification of Haz Mat Training ~ ~ Comments: ,' f Verification of Abatement Supplies & Procedures ~ Comments: Emergency Procedures Posted ~ ~ Containers Properly Labeled ~ ~ Comments: 7~OF-~~-) '~},,[~ '~)~),~t~O~O 1 Verification of Facility Diagram ~ ~ Special Hazards Associated with this Facility: ~ Violations: All Items O.K. ~-- "~-~-'--"--z, ~'"' Correction Needed Business Owner/Manager FD 1652 (Rev, 1-90) White-Haz Mat Div, Yellow-Station Copy Pink-Business Copy BAKERSFIELD CITY FIRE DEPARTMENT H/~.ARDOUS MATERIALS DIVISION ~ 1715-CHESTER AVE~ BAKERSFIELD, CA. 93301 ,- HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: ~ i. To avoid further action, return this form within 30 days of receiDt. July 30, 1994 · 2. ~PE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the Dusiness cs a whole. ~,~ 1"7o ~ SECTION 1' BUSINESS IDENTIFICATION DATA ',~ BUSINESS NAME: [V~E D T - S rl'O ~D '[-I O ]~V] F~, ~D~ C~ ~~ ~A ~ ~C~ ' ~~ LOCATION: 8i5 34th/ ~treet Bksf MAILING ADDRESS: P.O. Box .][]~][~ 40547 -~" . 93384 C;IY. Bakersfield ~TA~,-. CA ZIP: x~g~ PHONE'. (805) 328-9920 DUN & BRADSTRE'ET NUMBER: SIC CODE: PRIMARY ACTIVITY' Sales and Rental of Medical Equipment OWNER: Jerry. Gallegos Hernandez MAltING ADDRESS' Same as Above SECTION 2: EMERGENCY NOTIFICATION' CONTACT TITL= BUS. PHONE 24 HR. PHONE l. Manuel G. Hernandez Manager 328-9920 837-8850 2. Charles Hernandez Assistant 328-9920 836-8493 · : .. ~Bakersfield Fire Dept. " ?fazardous 1V~aterials Division :.. HAZARDOUS MATERIALS MANAGEMENT PLAN -- , SECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFE~ DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: " SECT[ON 4: EXEMPTION REQ. UEST: I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAF ~'Z r_.Y CODE" FOR THE FOLLOWING REASONS' WE OD NOT HANDLE HAZARDOUS MATERIALS. WEOO HANDLE HAZARDOUS MATERIALS, BUT THE C3UANTiTIES AT NO TiMEEXCEEO THE MINIMUM REPORTING GUANTFTIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, Jerry Hernandez 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 CHAP'TER 6.95 SEC. 255,00 ET AL..) AND THAT INACCURATE INFORMATION. CONSTITUTES PERJURY. /' TITLE DATE ..... B akersEeid Fire Dept. l Hazardous z~Iaterials Division ...... HAZARDOUS MAIERIAL$ MANAGEMENI PLAN Medi-Stop Home Medical Supplier SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. Rc_~,~c PREVENTI©N STEPS: Air out Oxygen Tanks are chained and are locked in an open air area. B. RELEASE. CONTAINMENT AND/OR MINIMIZATION: None Approved portable pressurized cylinders CLEAN-UP PROCEDURES: Not applicable SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): West side of building, behine fence toward front of NATURAL GAS/?RO?ANE: building. ELECTRICAL; Inside of building, left of southeast back door. 'WATER: "Outside south east back door. t~one SFECIAL'. LCCKBOX: YES/NO I';o iF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: Fire extinguisher (Halon #1211) B. WATER AVAILABILITY (FIRE HYDRANt' Accrose the street at 820 34th St. (Mercy Medi-Center F~re De~t. ~'~-Iazardous ~aterials Di~sion HAZARDOUS MATERIALS MANAGEME~qT PLAN Fac{lib/Unit Name: Medi-Stop Medical Supplier SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: " AGENCY NOTiFiCATION ? ~OCEOURES: TRY TO EXTINGUISH FIRE EVACUATE PROCEDURES MEDICAL EMERGENCY PHONE NUMBERS :_MFLOYEE NQTIFiCATICN AND :'/,-,,~,,AiION. EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND'CALL ~%! 911 C. ?UBLIC EVACUATION' exit signs inside of store building Oxygen warning signs outside by oxygen tank area EMERGENCY MEDICAL ?LAN: ~rdy HoSpital' ~enorial tiospital 2215 T~uxtun Ave'. 420 34th St. 327-337! 327-1792 San Joaquin Hospital 2615 Eye St. 327-1711 , ~F_¢ ~ ¢,~¢N% HAZARDOUS MATERIALS DIVISION ~'~ ~,~ ~[~ 1715 CHESTER AVE. ~' ~ .'~¢~ BAKERSFIELD, CA. 93301 '~_~' " (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK ':F BUSINESS IS A FARM [ ] BUSINESS NAME Medi-St0p Horae Medical Supplier FAC;L':~f NAME Same as above , ~ ~ 815 34th Street SiTE ACD~E.S CiT~, Bakersfield, STATE Ca. ZiP e.33m Sales and Rental of medical supplies NATURE CF BUSINESS SIC CCDE DUN & BRADSTREET NUMBER Manuel G. Hernandez / Manager (805)837-8850 OWNE.=,/CpEp, ATCR Jerry G. Hernandez / Owner PHONE (619)353-2275 MAILING ADDRESS P.O. Box 40547 CII-~ Bakersfield, STATE Ca. Z!P 93384 EMERGENCY CONTACTS NAME Manuel G. Hernandez TITLE Manager BUSINESS FHONE 328-9920 24-HOUR PHONE 837-8850 NAME Charles Hernandez TITLE Assist. Manager BUSINESS PHONE 328-9920 24-HOUR PHONE 836-8493 BAKERSFII D CIT FIRE DEPAFJVlENT HAZARDOUS MATERIALS INVENTORY 0f__ smess Name Address CHEMICAL DESCRIPTION INVENTORY STATUS: New { ] Addition [ ] Revision ( ] Deletion ( ] Check if chemica~ is · NON TRADE SECRET [ ] TRADE SECRET Common Name: 3) DOT # (optmnaJ) Chemical Name: AHM [ ] CAS # PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES ~ire ( ] ~eactlve { ] Sudden Release of Pressure WASTE CLASSIFICATION t3-digit code from OHS Form 8022) USE CODE PHYSICAL STATE. Solid [ I L~clutd [ ] Gas [ ] Pure ( ] Mixture [ ] Waste [ ] Radioactive [ ] AMOUNT AND TIME AT FACILITY UNITS OF MEAsuRE 8) STORAGE CODES Ma.~mum OaJiy Amount: :bs [ ] ga [ ] ~3 [ ] a) Contmner: Average Deity Amount: curies [ ] b) Pressure: Annua~ Amount: c) Temperature: L.a.rgest Size Container: # _mays On Site CircteWhich Months: Ail Yesr, J. F, M, A, M, J. J, A, S, O, N, D MIXTURE: List COMPONENT CAS # % WT AHM :he three most hat.alDUS 1) [ ] chemlca~ comoonents or any AHM ccml:x:inents 2) [ 3) [ 0) Location CHEMICAL DESCRIPTION INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET Common Name: 3) DOT # (optmnai) ChemiceJ Name: AHM [ ] CAS # PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive { ] Sudden Release of Pressure [ ] [mmedia/e Hesith (Acute) [ ] Delayed Health (Chronic) WASTE CLASSIFICAT;CN (3-dig~t code from OHS Form 80221 USE CODE 6) PHYSICAL STATE Solid [ ] gc~uid [ ] Ga.~ [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] AMOUNT AND T;ME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Ma. xlmum Ca~ly Amount: lbs [ ] ga [ ] ,~3 [ ] a) Cont~Uner: Average Da~iy Amount: curies [ ] b) Pressure: AnnuaJ Amount: c) Temperature: i_a~ges~ Size Container: ~. gays On Site C[rcteW~ich Months: All YeeJ', J, F, M, A. M, J, J, A, S. O, N, O 9) MIXTURE: L/st COMPONENT CAS # % w'r AHM the three most he. za~cous 1) [ cnemtca~ comoonen~s or [ any AHM components 2) [ O) Loca~on cerofy under ~en~u~y ct ~aw. u~a~ i nave Dersona.y examined and am mrnma~ w~rn me uDrntrted inforrna=on is z~ue. accurate, eno cornptete. RINT Name & Title or Au~onzea Cornoany ~eoresenmnve Signature Date BAKERSJELD CITY FIRE DEP/ TMENT HAZARDOUS MATERIALS INVENTORY Page_of_ ~.usiness Name Address CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New { ] Addition { ] Revision { ] Deletion [ ] Chec~ if chemical is & NON TRADE SECRET .r ] TRADE SECRET [ ] . 2) Common Name: 3) DOT # (ol3tienal) ChemicaJ Name: AHM { ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive{ ] Sudden Release of Pressure [ ] Immediate HeeJth (Acute) [ ] Delaye¢t Health (Chronic) [ ] ' 5) WASTE CLASSIFICATION (3-digit code f~om OHS Form 8022) USE CODE 6) PHYSICAL STATE. Solid [ ] Liquid [ ] Gas { ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum oaJiy Amount: lbs [ ] gal [ ] ft3 [ ] a.) Container: Average Daily Amount: cunes{ ] b) Pressure: AnnuaJ Amount: c) Temperature: Largest Size'Container: ~ Days On Site Circle Which Months: All Ye=. J, F, M, A, M, J, J, A, S, O, N. D 9) MIXTURE: Dst COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemic~ comoonents or any AHM components 2} [ ] 3) [ ] 10) Locatmn CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive { ] Suclden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed HeaJth (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT ;,ND TiME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Omly Amount: lbs [ ] gaJ [ ] E3 [ ] a) Cont~,ner: Average Daily Amount: cunes[ ] b) Pressure: AnnuaJ Amount: c) Teml~erature: L~-gest Size Container: # Days On Site Circle Which Months: AJI Yea~, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chem~ca~ components or any Al-tM components '2) [ ] 3) [ ] 10) Lo¢~iqn cer~ty unaer !~en~ury or law, ~at I nave ~ersonally exarnlneo aha am familiar wl~h ~e inromaDon suDmllZe~ on ~i$ anct alt aiZacl3ect documenl~. I believe ;ubmittect information is true, accurate, anct complete. 3RINT Name & Title of Au~onzecl Cornoany t~epresentaOve Signature Date HAZAR US MATERIALS INVENT( IIY Page__of__ ~siness Name Address CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New { ] Addition [ ] ReWS~On [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optionat) ChemicaJ Name: AHM [ ] CAS 1) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Re~ct~ve( ] Sudclen Release of Pressure ~) WASTE CLASSIFICATION (3-digit code fi.om DHS Form 8022) USE CODE 5) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TiME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum oaJly Amount: lbs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: !_arcJest Size Container: ~ Oavs On Site Circle Which Months: All Yea~, J, F, M, A, M, J, J. A. S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazaraous 1) [ ] chemical components or any AHM comOonents 2) [ ] 10) .oca~,on CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive { ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-dicjit code from DHS Form 8022) USE CODE 5) PHYSICAL STATE Solid [ ] Liquid { ] Gas [ ] Pure [ ] Mixture [ ] Waste 7) AMOUNT AND TIME AT FACIMTY UNITS CF MEASURE 8) STORAGE CODES Msximum Daily Amount: lbs [ ] ga { ] fl:3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Contn'ner: # Days On Site Circle Which Months: All Yea~. J, F, M, A, M, J, J, A. 9) MIXTURE: Ust COMPONENT CAS # % WT AHM the three most haz~rclous 1 ) chemical components or ~ny AHM components 2). [ ] [ ] 1 O) Location erDfy unaer ~enalty or law, flnat J have Dersonafiy examme° eno am fam~iiar wi~ ~he mromauon suom~rte~ on ~i~ ar~ a~i a~acne~ aocumen~s. I oelrave' mu ,~mitte¢~ inforrna~on is Due. accurate, and compiere. 'INT Name & Title of Au~honZect Come,shy Representative Signature Date (store front) Medi-Stop Home Medical Supplier Exit Accounts Receivable Dept. Show Room Accounts Pay. IRoom ales Offices Exit Warehouse (Outside back lot) Large Warehouse Door (Locked at Nigth) (Open during Store hours) ire Hydrant ~ ~ Martins Market~ Import Smog _i Medi'-stop Fast'rip Auto.Repair ;I Medical Deli Mart Supply h~ ~:~ Complex Berry Medical ..... Fire Hydrant MEDICAL August 16 1994 To: Bakersfield Fire Dept 1715 34th St. Bakersfield, Ca. 93301 Please update your records with our New Store Address be]ow- New Store Address · 3316 Panama St., Ste. #B. Bakersfield, Ca. 93301 Mailing Address - P.O. Box 41120 (Remains the same) Bakersfield, Ca. 93384-tt20 Telephone remains the same- (805) 325-7020 Sincerely Manuel G. Hernandez Presi dent/Owner Your Complete Hospital Equipment Supplier 3316 Panama Street, Suite A · Bakersfield, CA 93301 · (805) 325-7020 CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT 1715 CHESTER AVENUE Mo R. KELLY BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Dear Business Owner: This notice is meant to act as a reminder that the California Health and Safety Code, Chapter 6.95, requires any handler of hazardous materials to revise their hazardous materials business plan within 30 days of any one of the following events: (1) A 100 per cent or more increase in the quantity of a previously-disclosed material. (2) Any handling of a previously-undisclosed hazardous material, subject to ; ~ the inventory requirements of Chapter 6.95. (3) Change in business ownership..~ Change in business address. ~ (5) Change of business name. Any questions regarding these required revisions, please call the Hazardous Materials . Division at (805) 326-3979. Sincerely. yours, .. ~Ralph~.'. Huey~ H~r'~dous Materials' Coordinv c, CITY of BAKERSFIELD "WE CARE" F,RE DEPA.TME.. I M T A N T ,71~. C.ES*ERAVE.UE M. R. KELLY BAKERSFIELD, 93301 FIRE CHIEF 326-3911 DO NOT DISCARD *Dear Business Owner: California Law requires that all Businesses, which at any time during the year handle reportable quantities of hazardous materials, file a Hazardous Materials Business plan, including inventory of hazardous materials, with the local administering agency. Your business has filed such a plan. This same regulation requires that these businesses review the business plan submitted to determine if revisions are needed, and to certify to the administering agencies that the review was made and that any necessary changes were made to the plan. To facilitate this review we have enclosed a computer print-out of the plan you . have submitted. Please review this plan in its entirety and make any necessary revisions on the print-out. When the review and revisions are completed sign the first page of the plan in the appropriate space certifying that the plan is complete and correct. Return the business. plan along with any revisions to this office within 30 days of receiving these forms. If you have any questions or if we can be of any assistance please do not hesitate to call 326- Sincerely yours, s Materials Coordinator 08j08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 1 Overall Site with 1 Fac. Unit General Information Location: 3316 Panama St.,'Ste. B. Map:103 Haz:2 Type: 3 City : Grid: 19D F/U: 1 AOV: 0.0 Contact Name Title Contact Name Title MANUEL HERNANDEZ / PRESIDENT/OWNER L ~- .... -i~ / ASSISTANT MANAG Business Phone: (805) 3'25-7020 ix Business Phone: (805) ~_ 24-Hour Phone : (805) 837-8850 .x 24-Hour Phone : (805) - Pager Phone : ( ) - x Pager Phone : ( ) - x Administrative Data Mail Addrs: -3316_Panamg~..~t. Ste, B. D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: Owner: MANUEL G HERNANDEZ Phone: (805) 837=8850 Address: 7405 ~enal~ State: CA City: BAKERSFIELD Zip: 93313 Summary Information Updated I, ~Ty~,.~,t"' ~,~'- Do hereby certify that I have reviewed the a~/ched hazardous materials manage- ment plan for_.,_~m~o~,~,~,,,,~ .... and that it along with any corrections constitute a complete and correct man- agement plan for my facility. 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 2 Hazmat Inventory List in MCP Order ' 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 MEDICAL OXYGEN~ Gas 4880 Low · Fire, Pressur~J~~2~ --~--~ FT3 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-001 MEDICAL OXYGEN Gas 4880 Low ~ Fire, Pressure, Immed ~lth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type:/~Re Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 ~ i~Daily Average FT~ ~ Annual Amount FT3 Storage I~. ~es~~emp ~ Location PORT. PRESS. CYLINDE~~¢o'~B;r;w ISOUTHWEST OUTSIDE REAR -- Conc Components MCP ---~uide 100.0% IOxygen, Compressed Low ! 14 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 TRY TO EXTINGUISH FIRE EVACUATE PROCDURES MEDICAL EMERGENCY NUMBERS <2> Employee Notif./Evacuation NONE AVAILABLE FOR PRESSURIZED OXYGEN TANKS EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND CALL 911 <3> Public Notif./Evacuation EXIT SIGNs INSIDE OF STORE BLDG. OXYGEN WARNING SIGN OUTSIDE BY OXYGEN TANK AREA. <4> Emergency Medical Plan MERCY HOSPITAL MEMORIAL HOSPITAL 2215 TRUXTUN AV 420 - 34TH ST 327-3371 327-1792 SAN JOAQUIN HOSPITAL 2615 EYE ST 327-1711 08}08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention OXYGEN TANKS ARE CHAINED AND .ARE LOCKED IN AN OPEN AIR AREA. <2> Release Containment APPROVED PORTABLE PRESSURIZED'CYLINDERS <3> Clean Up <4> Other Resource Activation 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE OF BUILDING, BEHIND FENCE TOWARD FRONT OF BUILDING B) ELECTRICAL . INSIDE BUILDING, LEFT OF SOUTHEAST BACK DOOR C) WATER - OUTSIDE SOUTHEAST BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS (HALON #1211) FIRE HYDRANT - ACROSS THE STREET AT 820 34TH STREET (MERCY MEDICAL CENTER) <4> Building Occupancy Level 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 7 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: METHODS FOR HANDLING OF HAZARDOUS MATERIAL; COORDINATE ACTIVITIES WITH RESPONSE AGENCIES; PROPER USE OF SAFETY EQUIPMENT; EMERGENCY EVACUATION PROCEDURE. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 08~08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 8 00 - Overall Site <H> RMPP DATA <1> Release Containment <2> Offsite Consequences <3> In House Capabilities <4> Plant Shutdown Instruction 08>08/94 BERRY MEDICAL STORE INC 215-000-000262 Page 9 00 - Overall Site <I> Underground Storage Tanks <1> Leak Monitoring Methods <2> Leak/Spill Response Plans <3> Financial Responsibility <4> Tank Test/Service Company