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HomeMy WebLinkAboutBUSINESS PLAN 6/3/2003 Hazardous Materials/Hazardous Waste Unified'Permit CONDITIONS OF .PERMIT ON REVERSE SIDE '.~ * This hermit is issued for the followirm: El H~;.rdous Materials Plan [] Unde~round Storage of H~.~rdous Permit ID #:: 015-000-000190 [] Risk Management Program AUBURN ANIMAL HOSPITAL ~ ,~r~o-. W~.to O.-S,o*r~m~t LOCATION: 3713 AUBURN ST !IEi'D l~ucd by: Baker, field Fire Depa~mcnt -..  OFFICE OF EN~RONMENTAL SER ~CES' 1715 Chester Ave., 3rd Floor A~mvedby: .......Ch~"~'_~J Bakersfield, CA 93301 OfficcofEv~S~ic~~ Voice (661) 326-3979 F~ (661) 326-0576 ExpmtionDate: '~~ ~O~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... ,,,,,,~,~e?'??::?????~?.!ii~,,,~:,,~ ........ This permit is issued for the following: .... ~,,~??'?"/'/V.?).:2,:;~:~i~::;k;k2:;;i:::::,~,':?.;i;;~.~l,~Hazardous 'Materials Plan LOCATION 3713 AUBURN i!'~.. '". 'i' ~?" ~ .i~'l '~"~: ..... ~:...'""' ' "~[~l~iii~ ', '~. i~!~i~iliNii!~i~s,.~'}~~ ~i~ ~-. '""---:i~L  B~er~field Fke D~a~ment Approv~ by: ' O~CE OF E~R O~AL S~ ~CES 1715 Chewer Ave., 3rd Floor B~e~el~ CA 93301 Voice {805) ~2~979 F~ (80S)~2~S76 Expiration Date: ~n~ ~0~ ~000 HM MP P LAIO MAP SITE DIAGRAM ~FACILITY DIAGRAM Area Map ~., c~C Name of Area: 4- OHMM~ PLA~ MAP SITE DIAGRAM FACILITY DIAGRAM ~ North Name o~ Ar~a: Jl~ 2 7 ~ Bakersfield Fire Dept. UNIFIED~~ION CHECKLIS~ _ Entronmentall 715 ChesterServiceSAve SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME ~_~ ~ _~_~__~___~~ ................................... ~'~3-o~ /~ ~,~, ADDRESS PHONE No. No. of Employees ,.~/~ /g~d~_~.~ _~?z-~ ~ ............ FACIL~TYCONTACT Business ID Number KAt~5, oc~F' ~5-021-00o/?12 ': ' SectiOn '1: Business Plan and InVentorY program 4' Routine ~3 Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection C V (c=compliance'~ OPERATION COMMENTS ~. V=Violation - [] APPROPRIATE PERMIT ON HAND J~ [] 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 AVA~LAB~UTYE [] j~ VERIFICATIONOF~I~T--TRAINiN~ ....................................................................................... '~ [~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ [] EMERGENCY PROCEDURES ADEQUATE ,~ [] CONTAINERS PROPERLY L~BELED L [] HOUSEKEEPING ~ ~ FIRE PROTECTION [] ,~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: [] YES ~ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ Inspoctor Badge No. White - Environmenta~ Services Yellow - Station Copy Pink - Business Copy AUBURN ANIMAL HOSPITAL ~a SiteID: 015-021-000190 Manager : ~ ~ ~/~e~ BusPhone: (805) 872-0363 Locati0n:. 3713 AUBURN ST -¢~^---- '~ Map : 103 CommHaz .: Low City : BAKERSFIELD .m. Grid: 15D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 08 u~.~O~_SIC Code:0742 EPA Numb: -~ DunnBrad: Emergency Contact / Title Emergency Co~tact, / Title KRISTY K UTT OWNER Business Phone: ( ) 872-0363x Business Phone: (~C~) 872-0363x 24-Hour Phone : (~J 8~-4~2~ F~2 7~ 2~-Hour Phone : (805 Pa~er Phone : (~"') - x Pager Phone : ( ) ~- Hazmat Hazards: - Fire Press Im~lth Contact : [~ ~ ~ ~% ~ Phone: (&6~) ~-oS~x MailAddr: 3713 A~ ST State: CA City : BAKERSFIELD Zip : 93306 Owner ~ISTY UTT Phone: Address : ~12 M33!LEY AUE ~ ~ Uf~dJ o~ ~{ State: CA City : BAKERSFIELD {~~ ~ Zip : Period : ~ - to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'df RSs: No Emergency Directives: ~ Hazmat One Unified List -- As Designated Order Ail Materials at Site MEDIC~ OXYGEN .... F P IH-- G 251.00 FT3 Low NITROUS OXIDE F P IH G 563.00 FT3 Hi roviowod tho a~ach~ h~~ matodals manage- mom Plan ~or l~~ and ~hm i~ alon~ with (Na~ of ~sino~) any corrections constitute a complete and ~rrect man- agement plan for my facili~. / ~ -1- 09/05/2000 A~URN ~IMAL HOSPIT~ SiteID: 015-021-000190 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~lV~Vl~ ~Vl~ / ~ ~ ~Vl~ MEDIC~ OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: S~GERY ROOM CAS# 7782-44-7 Gas /Pure ~ove A~ient Ambient PORT. PRESS. CYLINDER ~O~TS AT THIS LOCATION I Largest Container ] Daily Maximum Daily Average FT3 251.00 FT3 125.00 FT3 Oxygen, HAZ~DOUS COMPONENTS ~ %Wt. S CAS# 100.00 Compressed N 7782447 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F P IH / / / Low ~ Item 0002 Facility Unit: Fixed Containers on Site ~u~vuv~u~ ~,,Nk-uv~/ ~±~-LL, ~v~ L(~,,V..- Location wi~in this F~ility Unit Map: Grid: SURGERY ROOM ~ / CAS# STATE i TYPE ~RESSURE TEMPERATUREI CONTAINER TYPE Gas Pure Ambient Ambient PORT. PRESS. CYLINDER AT THIS LOCATION Largest Contain~ ~Daily Maximum I Daily Average FT3 563.00 FT3 280.00 FT3 HAZ DOUS COM O TS %Wt. ~ ~S CAS# 100.00 N 10024972 HAZARD ASSESSMENTS TSecret ~S BioHaz Radioactive/Amount EPA HazardsNo N No No/ Curies F P IH NFPA I USDOT# MCP 2 09/05/2000 F Al/BURN ANIMAL HOSPITAL SiteID: 015-021-000190 Fast Format ~ Notif./Evacuati°n/Medical Overall Site --Agency Notification 05/22/1992 CALL 911 -- Employee Notif./Evacuation 05/22/1992 DIAL 911 -- Public Notif./Evacuation 05/22/1992 OWNER OR RECEPTIONIST WILL NOTIFY ANY CUSTOMERS ON PREMISES AND EVACUATE OUT NEAREST EXIT. Emergency Medical Plan 05/22/1992 LOCAL HOSPITAL - KERN MEDICAL CENTER 1830 FLOWER ST BAKERSFIELD, CA. (805) 326-2000 3 09/05/2000 AUBURN ANIMAL HOSPITAL SiteID: 015-021-000190 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --~- Release Prevention 05/22/1992 TANKS ARE CHAINED TO WALL. --Release Containment 05/22/1992 APPROVED PRESSURIZED CYLINDERS. -- Clean Up 05/22/1992 GASSES ONLY AT THIS SITE. Other~Resource Activation 4 09/05/2000 F AUBI/RN ANIMAL HOSPITAL SiteID: 015-021-000190 f Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 05/22/1992 A) GAS - NORTH SIDE SHOPPING CENTER B) ELECTRICAL - NORTH SIDE SHOPPING CENTER C) WATER - EAST SIDE OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 05/22/1992 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON PREMISES FIRE HYDRANT - IN THE PARKING LOT 15FT IN FRONT OF THE NE CORNER OF THE Building Occupancy Level -5- 09/05/2000 Al/BURN ANIMAL HOSPITAL SiteID: 015-021-000190 Fast Format ~ Training Overall Site -- Employee Training 05/22/1992 WE HAVE 6 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: EMPLOYEES INSTRUCTED TO EVACUATE AND DIAL 911 · Page 2 Held for Future Use Held for Future Use 6 09/05/2000 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page 1 Overall Site with 1 Fac. Unit General Information Location: 3713 AUBURN ST Map: 103· Hazard: Low I Community: BAKERSFIELD STATION 08 Grid: 15D F/U: 1AOV: 0.0 ,-- Contact Name ~ Title i Business Phone 24-Hour Phone~ KRISTY K UTT IOWNER 1(805) 872-0363 x (805) 872-4792! ~GWENN OTTO ~RECEPTIONIST ~(805) 872-0363 x (805) 831-5639/ Administrative Data Mail Addrs: 3713 AUBURN ST D&B Number: City: BAKERSFIELD State: CA Zip: 93306- Comm Code: 215-008 BAKERSFIELD STATION 08 SIC Code: 0742 Owner: KRISTY UTT Phone: (805) 872-0363 Address: 1813 MANLEY AV State: CA City: BAKERSFIELD Zip: 93306- Summary RECEIVEO MaY 2 0 1992 ~-r,~ k btam- ~0 hereby certify that I have, r~vi,wed tho a~ached h~ar~us m~er~,ia m~ge- plan fo~.~ .~'~/*'Ah~hat ~ ~0~ w~h ~rmcfions cons~tuls a complote and ~rre~ man- ~oment plan for my ~a~lity. 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page 2 02 - Fixed containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 MEDICAL OXYGEN Gas 251 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 I Annual Amount FT3 251 ~ 125.00. 753.00 Location Storage Press T Temp PORT. PRESS. CYLINDER IAbove /AmbiontlSURGERY ROOM -- Conc ~ ~Components MCP ---rList 100.0% IOxygen, Compressed ILow 02-002 NITROUS OXIDE Gas 563 High · Fire, Pressure, Immed Hlth FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3563I; Daily Average 280.00FT3 I Annual Amount 563.00FT3. Storage r Press T Temp Location PORT. PRESS. CYLINDER lahore [AmBientlsuRGER¥ ROOM -- Conc Components MCP --~List 100.0% INitrous Oxide IHigh 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation DIAL 911 <3> Public Notif./Evacuation NONE LISTED <4> Emergency Medical Plan LOCAL HOSPITAL - KERN MEDICAL CENTER 1830 FLOWER ST BAKERSFIELD, CA. (805) 326-2000 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page~ 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention TANKS ARE CHAINED TO WALL. <2> Release Containment <3> Clean Up <4> Other Resource Activation 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs' A) GAS - NORTH SIDE SHOPPING CENTER B) ELECTRICAL - NORTH SIDE SHOPPING CENTER C) WATER - EAST SIDE OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON PREMISES <4> Building Occupancy Level 04/27/92 AUBURN ANIMAL HOSPITAL 215-000-000190 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE ~ EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: EMPLOYEES INSTRUCTED TO EVACUATE AND DIAL 911 <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Bakersfield Fire Dept. Hazardous Materials Division R~ 2130 "G" Street Bakersfield, CA. 93301 H~. MAT. DIV, HAZARDOIJS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. TO avoid further action, return this form within 30 days of receipt, ~) _ ~<:~.C~ O 2, TYPE/PRINT ANSWERS IN ENGLISH, 3, Answer the questions below for tl3e busiDess as a whole. 4, Be brief and concise as possible, SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: Aubu,,ro AF~lr~l Ho~p~-I-,~,l LOCATION: g-) -'/ 13 ~ JO U v~ I~ MAILING ADDRESS: ~J J~ F~LJ b~rl~ CITY: g-M~Cr%~lff~l~ STATE:.~ ZIP: DUN & BRADSTREET NUMBER: SiC CODE: PRIMARY ACTIVITY' WC-~-,Gr"'t I, qQ, F-t/ ~L-o~--~P r'TLgg I ......... ~ ~o ~ SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE I<,,-~s~-~/ ~. L;+¢ Ou~v~-- b'7~-o~¢-5 Bakersfield 'Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SEeTION '~?'TRAINING: NUMBER OF EMPL©YESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM' SECTION 4: EXEMPTION 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: I, F..rt .fy~_. ~) +.~L_ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTANDTHATTHISINFORMATION 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. TITLE DATE 2. FDI500 ~' Dept. ~ , D Bakersfield Fire /, '~, Hazardous Materials Divisior1~' '~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' ~uo ~1~ % ,~ o~ ghvt~?/% /',~..,~ NATURAL ~AS/PROPANE: ELECTRICAL: WATER' ~%~ SPECIAL: LOCK BOX: YES~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: ~"iCC -~ $'~¢5 ~ 1~ B, WATER AVAILABILITY (FIRE HYDRANT): 4. ;Ol5~ Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN. SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION' C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN' CITY .of BAKERSFIELD Farm and Ag[iculture FI Standard Business I~HAZARDOUS..' MATERTALS l' NVENTORY " NON--TRADE SECRETS BUSINESS NAHE: .~Ueurr~ ~'t'l,r~Al ~O~P/+~-~/ OWNER NAME: ~rI5~-l/ L/F~- NAME OF THIS FACILITY: LOCATION; -~2~' ~u~V~ 5~' ADD~ESS', ~1 t~ ~~ ~ STANDARD IND. CLASS CODEf~~~ ] -'- REFER TO~N~TRU~ONS~ROP~ CODES -- I 2 3 4 5 ~ 7 8 . 9 I0 !1 12 Il /3 Trans ,y,e Ne, ,v, ra,e Annual Nee,ute '~e... ~on[ ~on, Con[ Us~ Locetion. Nhe[e. ,u~y_. Names of HixturelComponent, Code ~ooe Amt Amt Esl Un,Is on ~ype ~ress lemp Co~eStored In ~acl~l[y See Instructions Physical end ~e~lth Hazard C.A.S. Humber Component II Name I C.A.S. Humber (Check ~// [hal ~,, Hazard U Reactivity U Delayed ~Sudden Release ~,~i~ComponenL ~2 Hame l C.A.S. Number. Hem lth of Pressure Comp0nen[ 13 Name I C.A.S. Number Physical odd Health Uazard C.A.S. Number ; Componen~ II Name I C.A,S. Number (Check al/ ~haC aPp/yl Component Name Number ~e Hazard ~ Reactivity ~ Delayed ~udden Release Hem ILh of Pressure Component 13 Name I C,A,S. Rumber Physical and Health uazard C.A.S. Number ,~. Component II Name t C.A.S, Number (Check ali that aPP/H Component 12 Name I C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate Hem/Ch of Pressure Hem I Lh t Component 13 Name I C.A,S. Number Physical and Health Uazard C.A.S, Number Component II Name I C.A.S, Number (Check 411 that App/H ComponenL I~ Name I C.A.S. Number U Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ HealCh of Pressure Component 13 Name I C.A,S. Number ~ame i icle 24. Hr Phone Name TITle Cer~lty unoer penalty ot~a~ ~h~c I navepe(sonajly, exaelnQO0floQe famJllaL~ic~cfle/nto{~aClOn Su~ei~t~ in ~his.~nd all a~'~a~ned.dQcyeenT~ an0 t~aC baseo on.my ~nqulry Qt.cnose tnotvlOUalS respofls~Dle for obEainln9 The InformaclOfl, [ believe ChaC ~he s~omltteo IAlorllClOfl IS True, accurate, eno co~p/eTe. ({:~".~e~'-~'e"~ oficlal [fcic of o~ner/operalor oH o~nS/operator s authorized representative5~g~ure ~ ' O Bakersfield Fire Dept. 'HAZARDOUS MATERIALS DIVISION Date Completed Business Name: ./'~'u~ ,., ,-,., .~,.,.,,',.,.,.,,-/ Location: .~'7/,3 .~,,,_~,,-,.,/ Business Identification No. 215-000 ~)oo/?0 (Top of Business Plan) Station No. ~ Shift ~ Inspector .7,.,,,.-/v'~'r-- Adequate Inadequate Verification of Inventory Materials I~ Verification of Quantities ~ Verification of Location ~ Proper Segregation of Material~ Comments: Verification of MSDS Availablity ~] Number of Employees Verification of Haz Mat Training ~ Comments: Verification of Abatement Supplies & Procedures ~ Comments: Emergency Procedures Posted ~ Containers Properly Labeled I~'~ Comments: Verification of Facility Diagram I~"'"'"' Special Hazards Associated with this Facility: Violations: '~ ~ All Items O.K. ~~/,, ~ <~'~._ ~ - ~---~- Correction Needed ', ~usi~'~ O~'-n~ar~er ~ i FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow. Station Copy Pink-Business Copy ~: ,, %.:: ~. :~ t~ ~~..~,~ ,, · .x - . . ~' ~ ~ ., ~ ,,'~ ",,"',.c-'.~,..-, · ' ~,~ O ' ~k:J ,:.>~t':", ,~ J~ ~ ~ Do hereb~~ cert~ _ze that I have revie~ed the A,~'~ ............ attached Hazardous ~laterials business plan name of business and that it along with the attached additions. or corrections constitute a comDlete and correct Business Plan for mM facilit>-. signature date BUSINESS NAME AUBURN ANIMAL HOSPITAL ID NUMBER 215-000-000190 LOCATION 3713 AUBURN ST HIGH HAZARD RATING 2 '1 o OVEX~V ~- EW LAST CHANGE 11/09/87 BY ESTER JURIS CODE 215-008 JURIS BAKERSFIELD STATION 08 MAP PAGE 103 GRID lSD FACILITY UNITS 1 HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC 2) DAVID A. PACE - OWNER 872-0363 OR 392-0237 SkLER~ IIUGii~S ~CR. 392 1213 O~ 53~-2573 D~. ~$~ ~T~ $~.o~ UTILITY SHUTOFFS 2A SEC 3) A) GAS - NORTH SIDE SHOP CENTER B) ELECTRICAL - NORTH SIDE SHOP CENTER ~) ~AY~ = ~Afl~ flID~ OF ~UILDI~ D) ~A~ = 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 12/13/88 16:18 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME AUBURN ANIMAL HOSPITAL ID NUMBER 215-000-000190 LOCATION 3713 AUBURN ST HIGH HAZARD RATING 2 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 o LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 09/01/87 BY ESTER 2A SEC 5) LOCAL HOSPITAL PAGE 2 12/13/88 16:18 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME AUBURN ANIMAL HOSPITAL ID NUMBER 215-000-000190 LOCATION 3713 AUBURN ST HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 09/01/87 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE MEDICAL OXYGEN 251 FT3 HIGH SURGERY ROOM PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LISTS 2359.00 100.0 OXYGEN, COMPRESSED HIGH 2 PURE NITROUS OXIDE 563 FT3 MODERATE SURGERY ROOM PORTABLE PRESS. CYL. ANESTHETIC ID PERCENT COMPONENTS HAZARD LISTS 2345.00 100.0 NITROUS OXIDE MODERATE B . FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 09/01/87 BY ESTER 3A SEC 4) FIRE EXTINGUISHERS ON PREMISES 3A SEC 5) IqV-THE ALL~¥ DETW5~N OREGON & PACIFIC, ST N_A~_~__ON ROBINSON ON THE .J~!~_.~T ~TD~ ~w THE ~EET. PAGE 3 12/13/88 16:18 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME AUBURN ANIMAL HOSPITAL ID NUMBER 215-000-000190 LOCATION 3713 AUBURN ST HIGH HAZARD RATING 2 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 09/01/87 BY ESTER 3A SEC 2) DIAL 911 E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 09/01/87 BY ESTER 3A SEC 1) TANKS ARE CHAINED TO WALL. PAGE 4 12/13/88 16:18 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 ~ . BAKERSFIELD CITY FIRE DEPARTMENT : ~ 2130 "G" STREET RECEIVED BAKERSFIELD, CA 93301 (805) 326-3979 JUN 1 1 1987 Ans'd ............ OFFICIAL USE ONCY USiNESS NAME I 0 BUSINESS PLAN AS A WHOLE 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 8. LOCATION / STREET ADDRESS:Iq 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 p / DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: /~O~ ~;~:~ ~"~L~?/o ~ D. SPECIAL: E. LOCK BOX: YES / NO 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 TE~ FOR BUSINESS AS A mOLE LOCAL EIWERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6i 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 YES ~ B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO ~N~ C. PROPER USE OF SAFETY EQUIPMENT: .................. NO NO D EMERGENCY EVACUATION PROCEDURES: ................. ~ · E DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YESN~ YES N~ SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES ~ES$ THAN 500 POUND,~F,,~ SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... ~~,9/ I, '~)~%q~ ~- ~~ , 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 2~30 "G" STREET BAKERSFIELD, CA 93301 OFFiCiAL USE ONLY' ID# BUSINESS NAME: BUSI NESS PLAN SINGLE FACILITY UNiT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be retul-ned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions be].ow for THE FACILITY UNIT LISTED BELOW 4. Be as BRI'~iF and~ CONCISE as possible. FACILITY %~IT# FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMEN~ PROCEDO]IES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... Y~ NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide'Trade Secret YES ~ If No, complete a separate hazardous materials 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 #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 0F WATER SUPPLY F0R USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. D. SPECIAL: E. LOCK BOX: YES IF YES, LOCATIOS: IF YES, SITE PLANS? YES / NO HSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - SB - BAKERSFIELD CITY FIRE DEPARTMENT '.T' I.D. { FORM 4A-1 Page 'of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY o ADDRESS: 3-7 ~ .,~,~,~-v~. S~c. ADDRESS: ~[( O~V~ ~ FACILITY UNIT NAME: PHONE ~: ~ ~0 '~ PHONE ~: %q~ ~37 [OFFICIAL USE CF[RS COOE { ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T ,.,CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIQAL OR COMMON NAME CODE GUIDE EMERGENCY CONTACT: ~~ TITLE: PHONE ~ BUS HOURS: 8~ ~ 0~ ~ AFTER BUS HRS: ~9~ O~ ~7 E~EROENCY CONTACT:~~~ ~LE: .. PHONE ~ BUS HOURS: iqo In,p, ~ NORTH SCALE: BUSINESS NAME: OF DAT~;~ /~'/I~'7 FAC;~,~T¥ ~'~E; UNiT ~; OF ~CH~,C~ ONE~ $~T~. DIAOR~,~ ~ ~AC~LIT¥ DIAOR.~ (Inspector's Comments); -OFFICIAL USE ONLY- SITE DIAGRAM (Required items) ~-.~ 1. Address: Identify the 9. Lock (key) Box principle buildings "..~ by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals. Ditches, d. Gates Creeks, 13. Powerlines 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 7. Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Five Standpipe 20. Outside Hazardous Connections Material Storsge d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pu~p 22. Type of Hazardous Material/Waete Stored 8. Fire Department Access or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid R = Radlological C - Corrosive 0 - Oxidizer O = Gas P - Poison Water Reactive T = Toxic S = Solid H = Cryogenic D t Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAGRAM (Required Items la addition to the. abo~e) 1. Rtsez's for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12, Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside. Hazardous ° Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets 7. Skyl!~hts