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Home My WebLink AboutBUSINESS PLAN 2/7/1996 01/25/96 PAUL H STEWART DDS INC 215-ooo-ooo:.,~,.FEB ~./~ Overall Site with 1 Fac. Unit General Information ILocation: 4698 AMERICAN AVA Map:123 Haz:2 Type: 3 City : BAKERSFIELD Grid: 02C F/U: 1 AOV: 0.0 Contact Name Title Contact Name Title PAUL H STEWART / CAROLYN MCCAULEY / Business Phone: (805) 834-0911x Business Phone: (805) 834-0911x 24-Hour Phone : (805) 322-2856x 24-Hour Phone : (805) 323-7599x Pager Phone : ( ) - x Pager Phone : ( ) - x Administrative Data Mail Addrs: 4698 AMERICAN AV SUITE A D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-007 BAKERSFIELD STATION 07 SIC Code: 8021 Owner: PAUL H. STEWART Phone: (805) 834-0911 Address: 437 GARNSEY AV ~.~ AState: CA Summary YOLAN~NUNEZ 834-0911 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-002 NITRO~IDE /MO /O~ ~ Gas ~ High · ~Tre, Pressure, Immed Hlth, Delay Hlth _~ 02-001 -OXYGEN Gas [~ CF 5~'~Low · Fire, Pressure, Immed Hlth / 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 NITROUS OXIDE Gas /T~6 High · Fire, Pressure, Immed Hlth, Delay Hlth ~ FT3 CAS #: 10024-97-2 Trade Secret: No ~ . · Form: Gas Type: Pure Days: ~Use: ANESTHETIC ~ Daily Ma~,~ I /~ 1,100.00Y/~verage FT3 --~ Annual Amo~?~9~0 -- Storage ~Press T Temp Location PORT. PRESS. CYLIN~R/IAbove I AmbientlIN CLOSET · -- Conc I - Components MCP ---~uide 100.0%lN s Oxide IHigh ! 14 02-001 OXYGEN Gas 512 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No ~ES.~~~ Form: Gas Type: Pure Days: 365 Use: Daily Max FT3 Daily Average FT3 Annual Amount FT3 512 I 500.00 I 1,,280.00 Storage Press T Temp Location PORT. PRESS. CYLINDER IAbove IAmbientlIN CLOSET -- Conc Components MCP ---~uide 100.0% IOxygen, Compressed ILow ~ 14 -- Notes 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 4 O0 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation OFFICE MANAGER WHO WORKS AT FRONT DESK WOULD CALL 911 AND ALERT STAFF IN BACK THROUGH INTERCOM OF EMERGENCY. DOCTOR AND ASSISTANTS WOULD EVACUATE PATIENTS IN TREATMENT ROOMS. OFFICE MANAGER AND RECEPTIONISTS WOULD EVACUATE PATIENTS IN WAITING ROOM. DOCTOR WOULD TURN OFF NECESSARY UTILITIES IF POSSIBLE. <3> Public Notif./Evacuation IF FIRE, WOULD CALL FIRE DEPARTMENT (911) AND WOULD EVACUATE THE WAITING ROOM <4> Emergency Medical Plan NEAREST HOSPITAL. 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 5 O0 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention TANKS ARE STORED IN CLOSET WITH CHAIN IN FRONT AND PIPED INTO ROOMS. HAVE ONE SMALL MOBILE TANK IN A CART WHICH CAN BE ROLLED FROM ROOM TO ROOM IN CASE OF NEED TO ADMINISTER OXYGEN IN AN EMERGENCY. FITTINGS ARE INSPECTED FREQUENTLY AND WE USE ONLY THOSE DESIGNED FOR DENTAL USE. NEW EMPLOYEES ARE IMMEDIATELY TRAINED CONCERNING THE USE AND SAFETY PRECAUTIONS WITH OXYGEN AND NITROUS OXIDE. PATIENTS ARE NEVER LEFT ALONE IN THE ROOMS WITH THE OXYGEN/NITROUS OXIDE TURNED ON. <2> Release Containment <3> Clean Up <4> Other Resource Activation 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE GARDEN AREA OUTSIDE STAFF ROOM B).ELECTRICAL - NORTH SIDE IN LOCKED GARDEN AREA IN CLOSET C) WATER - SOUTH SIDE IN FRONT OF BUILDING IN GARDEN D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - ACROSS STREET WEST ON VALHALLA <4> Building Occupancy Level 01/25/96 PAUL H STEWART DDS INC 215-000-000367 Page 7 00 - Overall Site <G> Training <1> Employee Training WE HAVE 8 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE HAD TRAINING MEETING AFTER ALL PRODUCTS IN OUR FACILITY WERE LABELED ON SHELVES AND ON EACH INDIVIDUAL CONTAINERS. DISCUSSED EMERGENCY EVACUATION PROCEDURE. <2> Page 2 <3> Held for Future Use <4> Held for Future Use 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 1 Overall Site with 1 Fac. Unit General Information Location: 4698 AMERICAN AVA Map: 123 . Hazard: Low I Community: BAKERSFIELD STATION: 07 Grid: 02C F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- -[ PAUL H STEWART (805) 834-0911 x (805) 322-2856 CAROLYN MCCAULEY (805)-834-0911 x (805) 323-7599 Administrativ~ Data Mail Addrs: 4698 AMERICAN AV SUITE A / D&B Number: City: : BAKERSFIELD /' State CA Zip: 93309- ooze: ooze: Owner: pAuL H. STEWART . ¢ ~/ Phone: (805) 834-0911 Address: 43~ GARNSEY AV \~ State: CA City: BAKERSFIELD · %./ Zip: 93309- Summary YOLAND NUNEZ 834-0911 REOE~VEO $£P 0 1199~ HAZ M,AT. D~V. ~~d ID® ~ached hazardous mmeriaLs manage- , . - ~d ~ha~ i~ ~lon~.~ith- ~.~rrs~o~s ~nsti~ut~ ~ complete and correc~ man~ ,, ~m p~ for my ~. 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN Gas 512 Low · Fire, PreSsure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: 'No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC~ Daily Max FT3I Daily Average FT3 1 Annual Amount FT3 512 I 500.00, 1,280.00 Storage Press T Temp Location PORT. PRESS. C~LINDER IAbove /AmbientllN CLOSET -- Conc Components MCP LiSt 100.0% Ioxygen, Compressed IL°w I ' -- Notes 02-002 NITROUS oXIDE Gas 1126 High W Fire, Pressure, Immed Hlth, Delay Hlth FT3 CAS #: 10024-97-2 Trade Secret: No · Form: Gas 'Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 Daily Average FT3 I Annual Amount FT3 1,126 I 1,100.00 1,894.00 Storage' ·.Press T Temp Location PORT. PRESS. CYLINDER IAbove ~AmbientlIN CLOSET -- Conc Components ~ MCP List 100.0% INitrous.~xide '- ..... I'High I .... -- Notes 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 3 00 - Overall Site ~~ <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation ·. OFFICE MANAGER WHO WORKS AT FRONT DESK WOULD CALL 911 AND ALERT STAFF IN BACK THROUGH INTERCOM OF EMERGENCY DOCTOR AND ASSISTANTSWOULD EVACUATE PATIENTS IN TREATMENT ROOMS. OFFICE MANAGER AND RECEPTIONISTS WOULD EVACUATE PATIENTS IN WAITING ROOM. DOCTOR WOULD TURN OFF NECESSARY UTILITIES IF POSSIBLE. <3> Public Notif./Evacuation IF FIRE, WOULD CALL FIRE DEPARTMENT (911) AND WOULD EVACUATE THE WAITING ROOM <4> Emergency Medical Plan. NEAREST HOSPITAL. 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 4 · 00 - Overall Site <E> Mitigation/Prevent/Abatemt , <1~ Release Prevention ~ . TANKS ARE STORED' IN CLOSET wITH CHAIN IN.FRONT AND PIPED INTO ROOMS. HAVE ONE SMALL MOBILE TANK IN A CART WHICH CAN BE ROLLED FROM ROOM TO ROOM IN CASE OF NEED TO ADMINISTER OXYGEN IN AN EMERGENCY. FITTINGS ARE INSPECTED FREQUENTLY~AND WE USE ONLY THOSE DESIGNED FOR DENTAL USE. NEW EMPLOYEES ARE IMMEDIATELY TRAINED CONCERNI-NG THE USE'AND SAFETY PRECAUTIONS WITH OXYGEN AND NITROUS OXIDE~ PATIENTS ARE NEVER LEFT ALONE IN THE ROOMS WITH THE OXYGEN/NITROUS OXIDE TURNED ON. <2> Release Containment <3> Clean Up <4> Othe~ ResOurce Activation 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 5 00 - Overall .Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE GARDEN AREA OUTSIDE STAFF-RoOM B) ELECTRICAL -.NORTH SIDE 'IN LOCKED GARDEN AREA IN cLOSET· C) WATER - SOUTH SIDE IN FRONT OF BUILDING IN GARDEN D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water 'pRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT -.ACROSS STREET WEST ON'VALHALLA '<4> Building Occupancy Level 08/05/92 PAUL H STEWART DDS INC 215-000-000367 Page 6 O0 - Overall. Site' <G> Training .. <1> Page 1 WE HAVE 8 EMPLOYEES AT THIS FACILITY· ~ WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE HAD TRAINING MEETING AFTER ALL ~RODUCTS IN OUR FACILITY WERE LABELED ON SHELVES AND ON EACH INDIVIDUAL CONTAINERS. DISCUSSED EMERGENCY EVACUATION PROCEDURE. ~ <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ,,Paul H. Stewar~- nn.q ,, LS'D~ or ~n~ name) ' RECEIV£D Do hereby: oert~=-- 1~89 _~., that I have reviewed the ............ attached Hazardous Materials business ~lan for Paul H. Stewart, DDS,.Inc' [name of business) and that it along with the attached additions er corrections constitute a comDtete and correct Business Plan for my facility. '~ o~na~ure date'- CITY of BAKERSFIELD NON--~I?RADE SECRE - S , ' Page _/___ of .... % E~ 'InCOJ~NER NAME: Paul H. Stewart NAME OF T~ FACILITY: BUSINESS NA ~ul H, Stewart, DDS, . . LOCATION: . ~A ADDRESS: .:~:7::..Ga~,n-~:~:Y:..::~:~::~ ,., 84 American Ave . S~A~DARD IND. CLASS crYY, ZIP: Bakersfield 93309 .CITY,' ZI~ : ~~o]dr 'q3~-- DUN AND BRADSTRggT PHONE ,: 834--0911 PHONE ,: 322-2856~ ~/~_ -__ _ - Iran, T~ ~x i~,~ ~1 Msu~ I ~ Cmt ~t ~t. ~ L~tJm ~ %~ i of ntxt~l~ts C~e C~ ~t ~t Est Un'ts ~S~tet T~ ~l T~ ~ St~ ~n FKtltty '~' : ~ I~t~ti~ .................. =u =u :t ~t~~~~~2~o~.~r ~z ~'..~~ ....... Ph~ic/} ~ ~)th ~z4~ C.I.5. ~ 7 7 8 2- 4 4- 7 ~t ~} ~ & CJ.S. ~ ~ ~lth of P~ ~lth ~'~xl ~12~ ~00., ~94~ ~t3/365 1"04 I b~ I 0~'1 0'4 le&oset./~ns~de ,~.d~ ;~-.~ , ~ous oxide'" p~i~,~ ~ ~th H~,,~ C.A.S. ~ 0024-97-2 ~t ~ ~ & C.A.S. ~ . ~t 13 ~&C.A.S~ ~ .; _L_L L .......... 1 _.[ '1 ..... [ I' i 1" I .... ....... : ' .... (~k all t~t a~ly) ~ ~t II ~ & C.I.S. ~ _ [ ~ Fire Hazard ~--~ RHctivity ~--~ ~1~ ~--~ ~ Reline ~--~ I~Jite H~lth of P~ ~lth. ~, / , ~t 13 ~&C.A.S. ~ , P~Jcal ~ HHlth ~tl~ C.A.S. ~ ~t II h & C.l.S. ~ (C~k all t~t ~ly) ~-~ r--~ r--~ ~--~ r--~ C~t 12 ~&C.A.S. ~ c J Fire Hazard ~-~ ~tJvJty ~- J ~le~ J ~ Relic ~--J I~Jltl H~lth of Pr~sure ~ Health .... ~ ~t l] ~&C.A.S. ~r ,~,,~,c,c,,,clS ,, Paul .. Stewart. President 8'~4-6911 ,,Carolyn Mc Cauley' Receptionist 323~99 ~ Ri~': ................................... ~Tli ....................... ?l-~;'P~i ........ ~ ~II ~-~! ...... Cer'tificatJ~ (Read and s~ after coMpJetJnE all sectJon~) ~' ~-~tH~i~-~it];'~V~i~'o~-~iU~q'i~'~i~ti~]~i ~'~i~F ......... r ............ t--~ ............. [- ~ti'Si~g ........................... BUSINESS NAME PAUL H STEWART DDS INC ID NUMBER Z15-000-000367 LOCF~TION 4698-R AMERICAN AV HIGH HAZARD RATING Z t. OVERVIEW LAST CHANGE 08/30/88 BY ESTER JURIS CODE Z1S-007 JURIS BAKERSFIELD sTATION 07 MAP PAGE tZ3 GRID OZC FACILITY 'UNITS I HAZARD RATING Z RESPONSE SUMMARY ZA SEC 4> NO PRIVATE RESPONSE TEAM. " EMERGENCY CONTACTS ZA SEC Z) PAUL H STEWART - 834-0911 OR 3ZZ-ZAS6 CAROLYN MCCAULEY - 834-0911 OR 323-7599 UTILITY SHUTOFFS 2A SEC A) GAS - W S10E GARDEN AREA OUTSIDE STAFF ROOM 8) ELECTRICAL - N SIDE IN LOCKED GARDEN AREA IN CLOSET C) WATER - S SIDE IN FRONT OF BL[~ IN GARDEN O) SPECIAL - NONE ,E) LOCK 80X - NO NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE I IZ/Z3/88 13:17 MATERIAL. SAFETY DATA SYSTEMS, INC. (805) G48-GB(~B BUS'INESS NAME PAUL H STEWART ODS INC I0 NUMBER Z15.-080-000~67 LOCATION 4898'-Ft AMERICAN AV ' HIGH HAZARD RAT-INO Z ~. HAZ M~T TRRiNING SUMM~RY < NO INFORmaTION RECORDED FOR THIS SECTION > ' 4. LOCAL EMERGENCY MEDICAL ASSiSTaNCE LAST CHANGE 08138/88 BY ESTER SEC S) NEAREST HOSPITAL. PAGE Z MATERIAL SAFETY DATA SYSTEMS, INC. (805) B48-G800 .BUSINESS NAME PAUL H STEWART ODS INC ID NUMBER Z15-000-0~367 LOC~TION 4698-R AMERICAN AV H'IGH H~Z~RO'RATING Z FACIEITY UNIT 01 A. OVERALL H~ZARDOUS MATERIALS INVENTORY LAST CHANGE 08/30/B8 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTRINME'NT' USE 1 PURE OXYGEN 512 FT3 HiGH IN CLOSET PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LIS'T' Z359.00 100.0 OXYGEN, COMPRESSED HIGH Z PURE NITROUS OXIDE 1-12G FT3 MODERATE IN CLOSET PORTABLE PRESS. CYL. ANESTHETIC 'ID PERCENT COMPONENTS HAZ'~RD LIST Z345,00 100.0 NITROUS OXIDE MODERATE FIRE PROTECTION / WATER SUPPLIES LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 3 1Z/Z3/B8 13:17 MATERIAL SAFETY DATA SYSTEMS, INC. (805) G48-G80~. 'i BUSINESS NAME PAUL H STEWART DDS INC ID NUMBER Z1S-000-OO03G?' LOCATION '4GB8-A AMERICAN AV HIGH HAZARD RATING 2 O. EMPLOYEE NOTIFICATION / EVACUATION LF~ST CHANGE 08/30/88 BY ESTER SEC Z) OFFICE MANAGER WHO WORKS AT FRONT DESK wouLD CALL Bl) AND ALERT STAFF IN BACK THROUGH INTERCOM OF EMERGENCY. DOCTOR AND ASSISTANTS WOULD EVACUATE PATIENTS IN TREATMENT ROOMS. 'OFFICE MANAGER AND RECEPTIONISTS WOUI_O EVACUATE PATIENTS IN WAITING ROOM. DOCTOR WOULD TURN OFF NECESSARY UTILITIES IF POSSIBLE. E. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 08/30/88 BY ESTER 3R SEC t) TANKS ARE STORED IN CLOSET .WITH CHAIN IN FRONT AND PIPED INTO ROOMS. HAVE ONE SMALL MOBILE TANK IN A CART WHICH CAN BE ROLLED FROM ROOM 1'0 ROOM IN CASE OF NEED TO ADMINISTER OXYGEN IN AN EMERGENCY. FITTINGS ARE INSPECTED FREQUENTLY AND WE USE ONLY THOSE OESIGNED FOR OENTAL USE. NEW EMPLOYEES ARE IMMEDIATELY TRAINED CONCERNING THE USE AND SAFETY PRECAUTIONS WITH OXYGEN AND NITROUS OXIOE~ PATIENTS ARE NEVER LEFT ALONE IN THE ROOMS WITH THE OXYGEN/NITROUS OXIDE TURNED ON. PAGE 4 12-/23/88 13: i'7, MATERIAL SAFETY DATA SYSTEMS, INC. (805) G48-G800 '- J RECEIYED BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" .STREET JUL t 1987 BAKERSFIELD, CA 93301 (805) 326-3979 A~8°~ ............ OFFICIAL USE ONLY Paul H. Stewart, DDS, Inc. ID# {9 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 belo~ ~or the business as a ~hole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: Pa~ H. Stewa~v~, DDS, Inc. B. LOCATION / STREET ADDRESS: 469g AM~i~n Avenue, Sa~e A CITY: Bak~y~6~ie~!d, ZIP: 953d9 BUS.PHONE: (Ed5) 834-~9f~ SECTION 2: EMERGENCY NOTIFICATIONS In case of an ~mergency involving the release or threatened release of a hazardous material, call 911 and 1-800-8~2-7~0 or 1-916-427-4341. This will not2fy your local fire department and the State Office-of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NA~E AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Paul H. Stew~, DPS, Pr~iden~ Ph# g34-0911 Ph~ ~22-285~ B'. C~olyn Mc Cagey; recep~o~ Ph~ 834-0911 Ph~ 323-7599 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~_.3~ side ~a/tden d/'c2a oa./i/~ide's~ ~oom B. ELECTRICAL: No~h' side ~n'locked qarden are~ in c~Oset C. ~ATER: So~th side in front of budldinq in qa~den 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 TEAM FOR BUSINESS AS A WHOLE None SECTION~5: LOCAL EMERGENCY MEDICAL.ASSISTANCE,FOR YOUR ~USINESS'AS A:-WHOLE Ne~est hospital 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 FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...' .................................... ~ NO ._~.~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ES~ NO _~E-~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. NO ~E[~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~' NO ~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~ NO ~ NO SECTION 7: RAZARDOUS MATERIAL CIRCLEC S R .NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES'LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... ~ NO I, Pa~l H. St~c~, DDS , certify that the above information is accurate. ~o~ 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. SIGNATURE~ DATE iTLEz President 6/S0/g7 / 'BAKERSF~IELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE. ONLY ID# BUS INESS 'NAME: . BUS I NESS PLAN SINGLE FACILITY UNIT 'FORM SA INSTRUCTIONS · 1. To.,avoid further action,~ this form must ,be retur, ned bY: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE'FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as .possible. 'FACILITY UNIT# FACILITY UNIT ?NAME: Paul .H. St~a~t, DDS, SECTION !: MITIGATION, PREVENTION, ABATEMENT PROCEDURES Tanks ~e stored in ~oset with chain in fron~, and piped into rooms. Have one small mobile tank in a cart which can be rolled from room ta ~room in case of need to administer oxygen in an emergency. Fdttings are inspected frequently and we u~e only those designed for dental ~se. ~ New employees are immediately trained concerning 'the use and safety precautions .... with Oxygen and nitrous oxide. Patients are never left alone in the rooms with the oxygen/nitrous oxide turned on. SECTION Z: NOTIFICATION AND EVACUATION PROCEDb*RES AT THIS b~IT ONLY Office manager w~ho wor~ at front desk wou~d ~ 911. and alert staff in back through intercom~ o~f~ e~rgency. Doctor and assistants would evacuate patients in treatment rooms. Office manager and receptionists would evacuate p~atients in waiting room. Doctor would turn off necessary ~b~ties if possible~ - 3A - SECTION 3: HAZARDOUS ,.MATERIALS FOR THIS UNIT ONLY Ay 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 ma%erials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form 14A-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,MERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS,/PROPAN~5' B. EbECTRICAL: 'C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS7 YES / NO MSDSs? YES / NO · FLOOR PLANS? YES / NO KEYS? YES / NO - 3B ~ BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 . Page of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: Pa~ H. St~, ~S, Inc. OWNER NAME: Pa~ H. St~ FACILITY UNIT ~:__ ADDRESS: 4698 Amain.Ave., S~e A ADDRESS: 4J/ G~ey Ava. FACILITY UNIT NAME: CITY, ZIP: Bak~fi~d, 93309 CITY,ZIP: Bak~i~d, 93309 PHONE ~: ~34-0911 PHONE ~: 322-2~5~ [OFFICIAL USE CFIRS CODE { ,ONLY , 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS g BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE /~[e ~512~a" 12~0 cu ~t3 04' 04 O~ygen ~ ~'~ F.kOS ,'. ~i'~6>~ 894~ 'f¢cu ft3 04 04. :N~o~ O~de ,~¢~' ~ME: Pr~,~ H. q~r~Z TITLE:...p~Zd~.~ .. S ONATURE:~ ~ ~' EMERGENCY CONTACT: Pc~,~ ~- -q~,,:~ TITLE: pj,.~id~.~ -' P~&ffE · B~ HOORS: ~ AFTER BUS HRS: .~-~5~ '~' C~olgn Mc Cagey .. PHONE ~ BUS HOURS:,,, ~4-flOll EMERGENcy CONTACT: ' TITLE: R~a~p~o~ · ~RIN'CIPAL BUSINESS ACTIVITY: 'D~ or,ia2 AFTER BUS HRS: - 4A-1 - SITE/FACILITY D I AG R.A/¥I FORM 5 NORTH SCALE: BUSINESS NAME:p~cccc~.~H._. S£~a,~, DDS, Ina. FLOOR: OF DATE: / / FACILITY N~'~E: . UNIT ~: OF (CHECK ONE) SITE DIAGRAm! ',FACILITY DIAGR.~ l-/ attac~[ec i(Inspector's Comments): -OFFICIAL USE ONLY- - SA - SiTE DiAORA~ (Require ems) I. Address: Identify the '.9 Lock (key) Box principle buildings by the Street numbers. 10. MSDS'Storage Box 2. Street(s), AlLeys, ti, Raliroad Tracks Driveways, and Parking Areas adjacent to the 12, Fence or Barrier property. Include the a. Wire street noses. b. Masonry 3. Storm Drains. Culverts. Yard Drains c. Hood 4. Drainage Canals, Ditches, d. Gates Creeks, .- 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Sis[ion b.'Masonry construction 15. Storage Tanks: '~- Identify the c. Metal construction capacity tn gal. a. Above ground d. Access Door b. Underground 6. Utility Controls e. Gas 16. Diking or Bern b. Electricity 17. Evacuation Route c. #stet 18. Evacuation Area: Identify the 7. Fire Suppression Systeas: location where a. Fire Hydrants ewployeea will neat. 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 ayateas Material Use/Handling e. Fir~ Pu~p ~2. Type of Hazardous Naterlal/#aote Stored 8. ~lre Department Access or Osed'(See ~1o~) TyPE oF HAZARDOUS NATERIAL F - Flammable g - Explosive L - Liquid R - Radlologlcal Corrosive 0 · Oxidizer G - Gas P - Poison ~ater Reactlve T - ~oxtc g - Solid H - Cryogenic O · #ante B · Etiological Example: Flammable Liquid - FL FACILITY. DI,~GRA~ (Required tress tn addition to the-above) 1. Risers for Sprinklers 8. Fire gscapea a. Partitions 9. Air Conditioning Units 3. Stairways: Indicate {he 10. ~lndo~s levels served from ' highest to lo.est. 11. Inside Hazardous ~aate ~ Storage 4. Escalator: Indicate the ]eveIa served from 12. Inside Hazardous highest to lowest. - #atartala Storage 5. E1evator i3. Inside Hmzardous l~atarlalm Uae/Handling 6. Attic Access ]4. Se~r Orain Inlets ?. Skylights