HomeMy WebLinkAboutBUSINESS PLAN-,~______ ~_J~
~~, Comfort Kids Dental ~_
1900 Brundage Ln__
-- --
~i ~~~
+,F~ T'~'TT'""'" ________________________________________ SiteID: 015-021-002285 +
/ ~OcU
Manager BusPhone : ( 661) 323 -~1'ITr-'
Location: 1900 BRUNDAGE LN Map 102 CommHaz Minimal
City BAKERSFIELD Grid: 36D FacUnits: 1 AOV:
CommCode: BFD STA 06
EPA Numb:
SIC Code:8021
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
/ /
Business Phone: ( ) - x Business Phone: ( ) - x
24-Hour Phone ( ) - x 24-Hour Phone ( ) - x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: React
Contact : -"~'CSTlf `S-~-ephan~-~ `7vhns~t~--, Phone: (661) 323-llllx
MailAddr: 1900 BRUNDAGE LN State: CA 32 3-I~o v
City BAKERSFIELD Zip 93304
Owner SAEKYU OH DMD ~ Phone: (661) 323-llllx
Address 1900 BRUNDAGE LN State: CA
City BAKERSFIELD Zip 93304
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif~d: RSs: No
ParcelNo:
Emergency Directives:
PROG H - HAZ WASTE GEN
ENT's APR ~ ~ zoos
-1- 05/17/2006
t, j
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+= Hazmat Inventory _________________________________________ By Facility Unit +
+_= MCP+DailyMax Order ______________________________ Fixed Containers at Site +
Hazmat Common Name... ~SpecHaz~EPA Hazards Frm ~ DailyMax ~Unit~MCP~
~ WASTE FIXER R L 5.00 GAL Minl
-2- 05/17/2006
-3- 05/17/2006
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+= Inventory Item 0001 _______________ Facility Unit: Fixed Containers at Site +
+_= COMMON NAME / CHEMICAL NAME ______________________________+___=____________+
WASTE FIXER I Days On Site
f 365
Location within this Facility Unit Map: Grid: +----------------+
~ CAS#
+= STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+
Liquid ~ Waste ~ Ambient ~ Ambient', I PLASTIC CONTAINER
+__________________________+ AMOUNTS AT THIS LOCATION =_______________--_______+
Largest Container I Daily Maximum I Daily Average
5.00 GAL 5.00 GAL 5.00 GAL
+_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+
oWt• (Silver INoSI CAS#7440224)
+_______+___+______+__________= HAZARD ASSESSMENTS ==_+_________+________+_____+
ITSecretl RSIBioHazl Radioactive/Amount I EPA Hazards I NFPA I USDOT# I MCP
No No No No/ Curies R / / / Min
-4- 05/17/2006
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+_________________________________________________________________ Fast Format +
+= Notif./Evacuation/Medical ____________________________________ Overall Site +
+_= Agency Notification _______________________________________________________+
+__= Employee Notif./Evacuation _______________________________________________+
+___= Public Notif./Evacuation ________________________________________________+
+____= Emergency Medical Plan _________________________________________________+
-5- 05/17/2006
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+_________________________________________________________________ Fast Format +
+= Mitigation/Prevent/Abatemt =__________________________________ Overall Site +
+_= Release Prevention ________________________________________________________+
+__= Release Containment ______________________________________________________+
±___= Clean Up ________________________________________________________________±
+____= Other Resource Activation ______________________________________________+
-6- 05/17/2006
,~
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+_________________________________________________________________ Fast Format +
+= Site Emergency Factors _______________________________________ Overall Site +
+_= Special Hazards ___________________________________________________________+
+__= Utility Shut-Offs =_______________________________________________________±
+___= Fire Protec./Avail. Water _______________________________________________+
t______________________________________________________________________________*
+____= Building Occupancy Level _______________________________________________+
-7- 05/17/2006
`j.
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
+________________________________________________________________= Fast Format +
+= Training _____________________________________________________ Overall Site +
+_= Employee Training _________________________________________________________+
g -------------------------------------------------------------------
+__= Pa e -------------------------------------------------------------------+
+___= Held for Future Use _____________________________________________________+
+____= Held for Future Use ____________________________________________________+
-8- 05/17/2006
--n Prevention Services
UNI~i~ED PROGRAM. INSPECTION CHECKLIST -e ~ R s e , . „ 90o Truxtun Ave., Suite 210
st;Re Bakersfield, CA 93301
SECTION 1: Business Plan and Inventory Program aRrM t Tel.: (661)_ 326-3979 -
Fax: (661) 872-2171 '
i
FACILITY NAME -
sir -~--~~.~ c~~-~ ~,~ DQ~~ INSPE TION ATE-
-~ ~~ ~~ INSPECTION TIME
i
ADDRESS G
- 1~o 13Q,•~~D~~~ ~ PHONE NO..
~zx,
. NO OF EMPLOYEES
~
~3
FACILITY CONTACT BUSINESS ID NUMBER
~~ 15-021- ~ ~-~
i -
Section 1: Business Plan,and Inventory Program
^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ~ C=Compliance OPERATION
V=Violation COMMENTS
APPROPRIATE PERMIT ON HAND ~
e ~,~~,
^ BUSIf12SS PLAN CONTACT INFORMATION ACCURATE ~~~~~
^ VISIBLE ADDRESS
~® ^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
""Q ^ PROPER SEGREGATION OF MATERIAL ~~~/
^ VERIFICATION OF MSDS AVAILABILITY
r ~ ry
~1 ^ VERIFICATION OF HAZ MAT TRAINING
~0 ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY L,4BELED
^ HOUSEKEEPING
^ ~
FIRE PROTECTION.
~~,~ J ~ L~ /~
l ~ ~ ` ~ ~~ ~ ~ t sj,,,, a ~
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ^ YES ~^~VO
EXPLAIN: / ~
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3979
- ~ ~ lv~
Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station #
- White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05
e ,_.-~
~ ~~
~0~~`- ~~~`~ CITI' OF BAKERSFIELD FIRE DEPARTMENT
~~ ~~ OFFICE OF ENVIRONMENTAL SERVICES
~~ , • ~~ UNIFIED PROGRAM INSPECTION CHECKLIST
°-a~ ~~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301
l~ ~--~ kl~s D~r~ a~
FACILITY NAME INSPECTION DATE y ~ ~ ~ ~ d ~
Section 4: Hazardous Waste Generator Program
EPA ID # ~x.~ ~~~
^ Routine [H~ Combined ^ Joint Agency ^Multl-Agency ^ Complaint ^ Re-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made ~
EPA ID Number ~x ~ .~..,-~
Authorized for waste treatment and/or storage
Reported release, fire, or explosion within I S days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames
Containers in good condition and not leaking
Containers are compatible with the hazardous waste ,
Containers are kept closed when not in use
Weekty inspection of storage area
Ignitable/reactive waste located at least 50 feet from property line ~~f ~ ~-b ~la~a
Secondary containment provided v~ Q.i~~- Gt%n,a r del v
Conducts daily inspection of tanks ~ ,.{. ~
t t 1~( 12 n -~
Used oil- not contaminated with other hazardous waste
Proper management of lead acid batteries including labels
Proper management of used oil filters
Transports hazardous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazardous waste analysis for 3 years
Retains copies of used oil receipts for 3 years
Determines if waste is restricted from land disposal
~=~;ompuance v=vtotapon
Inspector: ~ ~~ ~ ws
Office of Environmental Services (661) 326-3979
White -Env. Svcs.
Pink -Business Copy
s ite Responsible Party
~ ~'
+ FIRST DENTAL ________________________________________ SiteID: 015-021-002285 +
Manager [,~L-h` G~ ~ ~-CZ- rv~ i -'-Q Z
Location: 1900 BRUNDAGE LN
City BAKERSFIELD
r
CommCode: BFD STA 06
EPA Numb:
BusPhone: (661) 323-1111
Map 102 CommHaz Minimal
Grid: 36D FacUnits: 1 AOV:
SIC Code:8021
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
1 l.~-h ~~. ~-~ 1 re z / ~~~.~
Business Phone: (L~~I )3a'~ - 111 I x Business Phone: (mv~1 )3~3 - ill I x
24-Hour Phone ( ) - x 24-Hour Phone ( ) - x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: React
12cZ'n'"" reZ
~e-(i~
Contact -
~-- Phone• (661) 323-llllx
MailAddr: 1900 BRUNDAGE LN State: CA
City BAKERSFIELD Zip 93304
Owner SAEKYU OH DMD Phone: (661) 323-llllx
Address 1900 BRUNDAGE LN State: CA
City BAKERSFIELD Zip 93304
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: ~ RSs: No
ParcelNo:
Emergency Directives: ~ ~
PROG H - HAZ WASTE GEN ~~Q
/)
~ ~ ~` ~
~"°~$
5s~
~sr'`iei~ on mY inquiry of those indivicf~131s
ruspansible for obtaining the information, ~ c,es,;;,i
under penalty of law that I have personai~y
~,,.am,nert -:,nd am familiar with the information
s;~iami¢t~.r anra ;,r.,,~,ue the information is true,
accurate, ar currit;e~;te.
Signatur w ' (3 "c'~
Date
ENT ~~~ ~ 4 20
06
-1- 05/17/2006
F~~DENTAL SiteID: 015-021-002285
BusPhone: (661) 323-1111
Manager : '% Map : 123 CommHaz :
Location: 1900 BRUNDAGE LN
BAKERSFIELD ~ Grid: 0lB FacUnits: 1 AOV:
City
:
CommCode: BAKERSFIELD STATION 06 SIC Code:8021
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
/ /
Business Phone: ( ) - x Business Phone: ( ) x
24-Hour Phone : ( ) - x 24-Hour Phone : ( ) x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: React
Contact : RITA Phone: (661) 323-1111x
MailAddr: 1900 BRUNDAGE LN State: CA
City : BAKERSFIELD Zip : 93304
Owner SAEKYU OH, DMD Phone: (661) 323-1111x
Address : 1900 BRUNDAGE LN State: CA
City : BAKERSFIELD Zip : 93304
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
I, ~o,¢ I~,~. ,3 el Do .hereby certify that I have
reviewed the ~ached h~ar~ous mate~ais
merit pan for~~ ~ ~nd t~t it ~ong with
any co~ions ~stitute a
agement plan for my facility.
-1- 08/05/2003