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Home My WebLink AboutBUSINESS PLANBERRY MEDICAL Home Medical Equipment SupPlier (805) 325-7020 815 34TH STREET MANUAL HERNANDEZ BAKERSFIELD, CA 93301 President 02/24/92' BERRY MEDICAL STORE INC 215-000-000262 Page 1 Overall Site with 1 Fac. Unit General Information Location: 815 34TH ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 04 Grid: 19D F/U: 1 AOV: 0.0 Contact Name Title ~ Business Phone 24-Hour Phone] MANUEL HERNANDEZ PRESIDENT/OWNER 1(805) 325-7020 x (805) 399-7093! DOROTHY PHARRIS ASSISTANT MANAGERI (805) 325-7020 x (805) 832-6397/ Administrative Data Mail Addrs: 815 34TH ST D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: Owner: MANUEL G HERNANDEZ Phone: (805) 399-7093 Address: 704 DOUGLAS A State: CA City: BAKERSFIELD Zip: 93308- Summary RECEIVED ~4R 1 6 HA7 M~T. DIV. · I, _/J'/~",'~-< ,x/~ .... ~? Do hereby ce~tt/,,, that t have (Type ~r print name) - reviewed the -,.'.'-- ,, ~ - -, ~,,~., ~,;~. h~?a~'c:'~?~ ~'{a?.erials manage. ment plen 'l~o- ,z3e-,--~y ,,~,,~ .,. ~, ' - .-, ................ ~,...., that it along with any correcti.;,~s c~ns'Iitute a compte'~e and correct man. agement plan for my facility. 02/24/92 BERRY MEDICAL STORE INC 215-000-000262 page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order '02-001 MEDICAL OXYGEN Gas 4880 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 4,880 ~ 3,660.00 · 99,000.00 Storage Press T TempI Location PORT. PRESS. CYLINDER Above ~Below ISOUTHWEST OUTSIDE REAR -- Conc Components MCP List 100.0% IOxygen, Compressed Low I 02324/92 BERRY MEDICAL STORE INC 215-000-000262 Page 3 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 BULDING 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 02~24/92 BERRY MEDICAL STORE INC 215-000-000262 Page 4 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 02324/92 BERRY MEDICAL~STORE INC 215-000-000262 Page 5 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 02~24/92 BERRY MEDICAL STORE INC 215-000-000262 Page 6 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 ClI'Y Of BA'KERSFIELD ; HAZARDOUS MATERIALS INVENTORY Far~ end ADticulture ii' Standard Business [] NON--TRADE sECRETS i Pacje of .... BUSINESS NAHE:]~erry He ±caZ Store OWNER NAME' Hanuel ~e~nan~ez NAHE OF THIS FAC]L~TY:9e~ He~ical ' LOCATION; Rl~g AaYh ~Y ADDRESS; ~'~~ STANDARD IND. CLASS CODE~... CITY. ZIP: BaRe~g¢]~-,~ ~A q~n] CITY. ZIP:'~T~T--~A--~%~h-R . DUN AND'BRADSTREE, T NUMBER PHONE ~: (8~n~) ~_?A~ -, ..... PHONE ~: -- ,, - - , ..... ~, ~ REFER TO~R~~3 ~OR PROP~ CODES, 1tans ~Ne Max Avgrpge: Annual Ngasure I~e Cent Cent Cent Us Location?ecu Code core Act Aec Est units on Type Press Temo Co~e In eacll~ty~t See Instructions Stored ~: · U I P 14880 1366d 199,0oo J FT3I 365 'l 04 12 I 6 127 I SW O]]tgide r~:~r IN3 ICheck ali that apply)~, t, Component 12 Name I C.A.S, Number ire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate Health of Pressure Health Component 13 Name I C.A.S. Number I I I I I I I I I I Physical ,,d Health' UaTard C,A.S. Number Component II Name I C,A,S. Number ~ AU61 41991 (Check al/ that aPP/yJ Health of Pressure i Component 13 Name I C.A.S. Number Physical and Health Hazard : C.A.5. Number Component II Name I C.A.S. Number : ' (Check all that apply) . .~ ~ Fire Hazard /~ Reactivity~ ~ Delayed ~ Sudden Release ~ Immediate Component 12 Name I C.A.S, Number ., Health of Pressure Health Component 13 Name I C.A.S. Number Physical'~od HealtN ~Hard ~ C.A,S, Number Component II Name I C.A.S, Number (Check ali that ap, P~H j ',, . ~ Component 12 Name I C,A,S, Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ lm~i~ · . · ' Health of Pressure ~ : Component 13 Name I C.A.S. Number EMER'GEHCY CONTACTS fll Manuel Hernand~z ~[~ ~~e093 fl2Ra~eorethy Pharris '',rtifi~aLion ~(Read and si~n afCpr '-.~r~fy under penalh 9[}aW thRtl hav~ pa[sDnH~L~mI~SD..fBLD~ ~ami~ar.v~t6 the information ~u~mittf~ in this.end all ~r I be~eve thai'the .LNched.docgeen[~,:anq tut oasea on.my Inquiry 9T.~nose ]flu~v~uua~a responsible tor obtaining the in~oreacton, uD~lttea iAtoreact~ is [rue, accurate, Rna complete. · ~ ~ Man'el Hernadez Owner/Pres_ ' ' BERRY MEDICAL STORE INC ~ 215 0 000262 Page 1 Overall Site with 1 Fac. Unit Genera i I nformat i on L,-,catior,: .-r~-15 34th St Map: 103 Hazard: Low Ider, t Number:~2~l-5-OOO-000262 Grid: 19D Area of Vul: O. Comtact Name ..... Title Busir, ess Phc, ne . 24 Hc, ur Phc, ne~ MANUEL HERNANDEZ iPres/Owner. Manager ( ) ~25-70~O x ~( )399 '-7093' DOROTHY PHARRIS Assist ( ) 325-7020 x ( ) 832-6397 Admir, istrative Data Mail Addrs: 815 34th St. D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-OO4 BAKERSFIELD SIATION 04 SIC Code: Owner: MANUEL G HERNANDEZ Phone: (805)399 -7093 Address: .~704 Douglas Apt. A State: CA City: Oildale Zip: 93308 ~ S u~l~la~y Hernandez DO b=,~.~b~, C~¢[i~ that I have I, Manuel (Typs er print name) reviewed :,--,.¢. ,:.,,- ,,~, .... ment plan fo~erry Medical ¢;~;~r~a.[ ~l ~:IOR¢ w~th any " , ~ ¢-,." .,., agemen~ plsn ~or my faciJi~y. Signature Date 04/02/91 BERRY MEDICAL STORE INC 215-00(.~F-000262 Page 2 Hazmat Irlventory List ire MCP Order ('-)2 - Fixed Cor~tainers on Site Pln-Ref Name/Hazards Form Quar~t ity MCP .)~-(.)O 1 MEDICAL OXYGEN · . ,-.~ .) Low FTS 04/02/~1 BERRY MEDICAL STORE INC 215-000-000262 Page 3 O0 - Overall Site <D> Notif. /Evacuation/Medical <1> Agency Notification 1. Call Fire Dept. 2. Try to extinquish fire 3. ~Evacuate procedures 4. Medical emergency numbers <2> Employee Notif./Evacuation NONE AVAILABLE FOR PRESSURIZED OXYGEN 'rANKS EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND CALL 911 <3> Public Notif. /Evacuation <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 [)4/[)2/91 BER MEDICAL STORE INC 215-[) [)(:)[)262 Page 4 0(:) - Overall Site <E> Mit igat ior'/Prever't/Abatemt > Release Prever't ion OXYGEN 'rANKS ARE CHAINED AND ARE LOCKED IN AN OPEN AIR AREA. <2> Release Contair.mer.t Approved portable pressurized cylinders <3> Clear' Up <4> Other Resource Activatior. [)4/02/91~ . BERRY MEDICAL STORE INC 215-000-000262 Page 5 O0 - Overall Site <F> Site Emerger, cy Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - West~ide of building, b~hind fence toward front of building B) ELECTRICAL -Inside building, left of south east backdoor C) WATER . Outside south east 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 St. (Mercy Medical Center) <4> Held for Future use 04/02Y91 BE MEDICAL STORE INC 215-0 000262 Page 6 00 - Overall Site <G> Tra ir, ir, g ) Page 1 WE HAVE ?? EMPLOYEES AT '[HIS FACILITY 7 DO YOU HAVE MATERIAL SAFETY DATA sHEETs ON FILE? Xes BRIEF SUMMARY OF TRAINING: 1. Methods for handling of hazardous material 2. Coordinate activites with response agencies 3. Proper use of safety equipment 4. Emergency evacuation procedure <2) Page 2 as r, eeded <3> Held for Future Use <4> Held fc, r Future Use BAKERSFIELD CITY FIRE DEPARTMENT 2130 "O" STREET BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS ~ATERI ALS BUSINESS PLAN AS A WHOLE FOR~ 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 A. BUSINESS NAME: ~Yy ~r-,'"-c, B. LOCATION / STREET ADDRESS: CITY: /~,~.ke..~5~,'~ ZIP: ?330 / BUS.PHONE: (~ 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 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF ~ILI~ S~-OFFS FOR BUSI~SS AS A ~OLE B. ELECTRICAL:__~,~ ~.~?~ ~ ~o~ D. SPECIAL: ~.~ ~e~; ~ ~> E. LOCK BOX: YES / NO IF YES LOCATION: ~~ ~~; f~ IF YES, DOES IT CONTAIN SITE PLANS? YES / NO ~SDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / N0 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A h~rlOLE /. zo fl. SECTION 5: ~OCAL E~R6ENCY ~DICAL ASSIST~CE FOR YO~ BUSINESS AS A ~O~E SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGR~ WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS ¥~ATERIALS:...- .................................... Q 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: ....... NO NO SECTION ?: HAZ~d~I)OUS NATERIA~L CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUND~F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... (YES) NO I,/~,~/~-'~ ~. ~~/~.v-- , certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 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 BUSINESS NAME: ~9~'F7 '/~('C--a~ ID# 7'2- ~/Z/~fg7.. BUS I NESS PLAN SINGLE FACILITY UN'IT FORM SA INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACII, ITY UNIT LISTED BELOW 4. Be as BRIEF and C0NCISE as .possible. / SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDbqRES SECTION Z: NOTIFICATION ~ EVACUATION PROCEDURES AT THIS b~IT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... ~ NO If YES, see B. If NO, continue with SECTION 4. any of the hazardous materials a bona fide Trade Secret YES~ B. Are If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-I) 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 E~ERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPAN[J'2 D, SPECIAL: E. LOCK BOX: YES ,I NO IF YES, LOCATION: iF YES, SITE PLANS? YES / NO ASDSs. YES ./ NO FLOOR PLANS? YES / NO KEYS? YES ./ NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # 7~-~2>/~/~22)y~ 7 FORM AA-! Page NON--TRADE SECRETS HAZARDOUS I~IATE R ]' ALS INVENTORY ~f~' : ~~< ~. ~~~ FACILITY UNIT BUSINESS NA~E: ~'~ ~,'<~r ~~ ~, ~ NAME ADDRESS:_.707 3~/y4 ~[. ADDRESS: 3~5'0 ~ 3~ ~i FACILITY UNIT NAME: CITY, ZIP: J~k~}/e{Y ~ &. ~J~o[ CITY,ZIP: ~{X~/~/d/ l, PHONE ~: <~05-~ ~?2,~'-~Ot~O PHONE 1: (~o~} Ji?-JyoZ OFFICIAL USE CFIRS CODE .... - I ONLY 1 2 3 4 5 6 7 8 9 10 TYPE ~AX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T .CODE AMOUNT A~OUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIQAL OR COMMON'NAME CODE OOIDE. F ~o~ ?qooo ~.z o~ ~7 ~,~. o~.,'~ /~ ~,'~c o<~7~~ E~ERO~NCV CONTACT: ~//~o ~ ~.~~z TITLe: ~:~ ~, ~ ~' P~ ~US HOURS(~/~Y E~EROENCY CONTACT: ~oFly ~~,'S TITLE: ~~ ~;*~.. PHONE ' BUS P-)~*NC*PAL BUS*NESS ACT]V,TV: AFTER BUS HRS:(~) - AA-1 - ST T]~/FAC'r LT TY D'r AG I~.AI~I ITY _N~: / UNIT e: OF '..~ (CHECK ONE) SITE DIAGR~ ~ FACILI~ DIAGR~ (Inspector's Comments): -OFFICIAL USE ONLY- - SA - SITE/FACILITY' D T AG R.,~d~I FORM FLOOR: NORTH SCALE: BUSINESS NAME: ~_nC ¥ DATE: / FACILITY N~ME: ~ UNIT ~: OF (CHECK ONE) SITE DIAGRAM FAClLI~ DrA6R~ - .S~(n Dim o~s (Inspector's Comments): -OFFICIAL USE ONLY- September 5, 1990 Mr. Manuel Hernandez Berry Medical Store Inc. 707 34th Street Bakersfield, Cs. 93301 Dear Mr. Hernandez: Enclosed you will find a computer printout of the Hszardous Materials Management Plan that is currently in our computer, we have highlighted the areas that need to be revised. Also due to a change in the law that went into effect January~ 1989, we need tc have a new inventory form (enclosed} filled out. These forms must be filled out and returned to our office by September 28, 1990. If you have any questions please don't hesitate to contact us at (805) 326-3979. Sincerely Yours, Ralph E. Huey Hazardous Materials Coordinator REH:vp Enclosures