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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified ~Permit ..~ ~CONDITIONS OFPERMIT ONREVERSE SIDE · · ~ ~ H~ous M~e~als D Unde~rou~ Stom~ of N~Ous M~Is Permit ID ~:: 015~00~02023 ,, D RiskManage~tP~mm PIERCE ROAD CHIR = .~ous Was~OmS.eT~t ' LOCATION: 3012 BUCK OWENS BLVD Issued by: Bakersfield Fire Department , '= * ' OFFICE OF £NVIRONM£NTAL SER VICES~ · Approved by: · Bakersfield, CA 93301 ~ ' ~'~ Office of I~ i~ma~T-~vie~ Voice (661) 326-3979 ·; '-, i,. . .~: ,=* , FAX (661) 326-0576 . i'EXpii~ti0ri;iDate:.~:' ~June 30. 2003 usinesS Name: Pierce Road Chiropractic / Linda Ann Hansen, D. C. Business Address: .............. 301.2 Buck Owens Blvd. :~P~ERCE ROAD CHIROPRACTIC SiteID: 015-021-002023 Manager : %%%%% BusPhone: (661) 322-9480 Location: 3012 BUCK OWENS BLVD ~ Map : 102 CommHaz .: Minimal City : BAKERSFIELD Grid: 23B FacUnits: 1 AOV: CommCode: ~SEiELD~S-T-A-T-i~~_~ SIC Code-:8041 EPA Numb: DunnBrad:537-42-9575 Emergency Contact / Title Emergency Contact / Title LINDA ANN HANSEN / OWNER SHIRLEY KELLER / FRIEND Business Phone: (661) 322-9480x Business Phone: (661) 322-0442x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x ) - x Pager Phone : ( ) - x H~zmat Hazards: DelHlth C~ntact : Phone: (661) 322-9480x M~ilAddr: 3012 BUCK OWENS BLVD State: CA C.ty : BAKERSFIELD Zip : 93308 O~'ner LINDA ANN HAMSEN, D.C. . Phone: (661) 322-9480x Adldress : 3012 BUCK OWENS BLVD State: CA C~y : BAKERSFIELD Zip : 93308 Pc ~iod : to TotalASTs: = Gal P~parer: · TotalUSTs: = Gal C~r~if ' d: RSs: No P~.r~elNo: 'Emergency Directives: atmche_d hazardous ma~sriais -. ~ /r//q// reviewed the ~ ~/~.~ ~ ' an~ ~rm~ions ~ns~i~u~s e~mPle~ ~d ~rr~ man- '~ agemem plan ~or my facili~. 1 09~26/2003 P~ERCE ~ROAD CHIROPRACTIC SiteID: 015-021-002023 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~UtV~v~u~ ~vl~ / ~ £ ~ ~vl~ WASTE PHOTOGRAPHIC FIXER & DEVELOPER Days On Site 365 Location within this Facility Unit Map: Grid: ?????????????? CAS# STATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~ Ambient I Ambient DRUM / BARREL- NONI~ETAL Waste Liquid AMOUNTS AT THIS LOCATION I Largest Container I Daily Maximum Daily Average . 5.00 GALI 5.00 GAL 5.00 GAL TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies DH / / / UnR -~- 09/26/2003 F~'~ERCE ~'ROAD CHIROPRACTIC SiteID: 015-021-002023 r Fast Format ~ Site Emergency Factors Overall Site special Hazards -- Utility Shut-Offs 05/03/2000 GIVE THE LOCATION OF YOUR UTILITY SHUT OFFS???????????? ~ // D) SPECIAL - ///'~/' // - - ~ ~/ / E) LOCK BOX - / ~ /.~ ' · -- Fire Protec./Avail. Water 05/03/2000 Building Occupancy Level 7 09/26/2003 SITE DIAGRAM I X FACILITY DIAGRAM Business Name: Pierce Road Chiropractic / Linda ^nn Hm~sen, D. C. Business Address: 3012. Buck Owens Blvd. Don Keith Trucking Office Entr,~ce 3012 Buck Owens Blvd. Block Wall Fke Hydmt O N -- P~ERCE ~ROAD CHIROPRACTIC SiteID: 015-021-002023 ~ Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers at Site Hazmat Comr~on Name... I SpooHazlEPA Hazards] Frm I DailyMax l UnitlMCP WASTE PHOTOGRAPHIC FIXER & DEVE DH L 5.00 GAL UnR -2- 09/26/2003 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~OtC'cdr-& 0-D Cl4'~OIO(~,O~r-.- INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~l~[.~ Combined [] Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection OPE~TION C V COMMENTS H~ardous w~te dete~ination h~ been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID ~) Authorized for w~te treatment ancot storage Reported rele~e, fire, or explosion within 15 days of occu~ence Established or maintains a contingency plan and training H~ardous w~te accumulation time frames Conmine~ in good condition and not le~ing Confiners are compatible with the h~ardous w~te Confiners ~e kep~ closed when not in use Weekly inspection of storage ~ea Ignitable/reactive w~te located at le~t 50 feet from prope~ line Second~ con~inment provided ~ Conduc~ daily inspection of inks Used oil not contaminated with other h~ardous w~te Proper m~agement of lead acid batteries including labels Proper management of used oil filters T~spo~ h~dous w~te with completed m~ifest Sends m~ifest copies to DTSC Retains m~ifes~ for 3 ye~s Retains h~dous w~te analysis for 3 yearn Retains copies of used oil receip~ for 3 yearn Detemines ifw~te is res~icted from land disposal C=Compliance V=Violation Inspector: ~~ Office of Environmental' Se~ices (661) 326-3979 ~usin[ss ~ it~ Responsible P~y White - Env. Svcs. Pink - Business Copy · ___ __~,~. ~ s ~ :--~. "1 ~'~-~OFF[CE OF ENVIRONMENTAL SE'I~VICES .~4,r~r F 1715 Chester Ave., CA 93301 (661~-~~D · '~ ~ ~' H~RDoUs MATERIALS INVENT~ 1:9 ~ CHEMICAL. DESCRIPTION '~nVlCEg,ga ef ~ NETM ~ ADD D REVISE 2~ BUSINESS NAME (Same as FACILITY NAME er DBA - Doing Business As) 3 PIERCE ROAD CHIROPRACTIC 201 ' CHEMICAL LOCATION [] Yes [] No 202 CHEMICAL LOCATION30i2 Buck Owens Blvd. CONFIDENTIAL(EPCRA) FACILITY ID # ~ ~ .::~ · 1 MAP # (optional) 203 GRID # (optional) 204 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME .,~~ If Subject to EPCRA. refer to instructions ( ' 207 COUUONNA y. F±xer and .D~o..veloper E.S' []Y~ []No ~ CAS # ....... 209 ~.~lf:EHS;is~Ye~iidI ~;boio~:~:bem:lt~;/ FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE [] m MIXTURE ' [] w WASTE 211 RADIOACTIVE [] Y~s '['-] No '212' CURIES 213 LARGEST CONTAINER ' 215 'PHYSICAL STATE [] s SOLID []1 LIQUID [] g GAS 214 5 9a 1 FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HF..~LTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217I MAxiMUM ' 218 I AVERAGE 219 STATE WASTE CODE 220 AMOUNT 60 gaI --+ I DAILY AMOUNT I DAILY AMOUNT DAYS ON SITE 222 UNITS* [] ga GAL [] cf CU FT ' [] ih*LBS [] tn TONS '221 · If EHS, amount must be in lbs, STORAGE CONTAINER [] a ABOVEGROUND TANK [~e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM' [] m GLASS BOTYLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC Bo'VrLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] 0 TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CU PAFORMS\OES2731 .TV4.wpd -~ ~ CITY OF BAKERSFIELI~ · OFFYCE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301(661) 326-3979 BUSINESs owNER I OPERATOR IDENTIFICATION FACILITY INFORMATION ' Page Of FAC!~'~i;!:~~. ~ 'i Year Beginning ,oo Year Ending BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE PIERCE' ROAD CHIROPRACTIC 661-322-9480 S~TEADDRESS3012 BUCK OWENS BLVD. DUN & los SIC CODE · -. _=5_3.7~T42-95g_5 ......... . .... :_ _:.:._- _ _l_(_4'' Oigit~#) .... ~ .... _ _ BRADSTREET COUNTY KERN . . . ...... ,o~ LINDA ANN HANSEN, D.C. - OPERATOR PHONE 6 61- 32 2- 94 80 110 OWNERNAME b~DA A~N ~ANSgN, 'D.C. m OWNERPHONE 661-322-9480 ~]2 O~ER~ILING 3012 BUCK O~ENS B~VD. ADDRESS . CI~ BAKERSfiElD . ~4 STATE CA ~ 'ZIP 93308 CONTACT NAME L~NDA ANN ~ANSgN, D.C. ~ CONTACT PHONE 661-322-9480 CONTACT~ILING 3012 BUCK OWENS BLVD. ADDRESS CI~ BAKERSFIELD 'm STATE CA ~2~ ZIP 93308 ~ME SHXRLEY KELLER ~2a NAME FRXEND TITLE .......... ~2s _TITLE~_ BUSINESS PHONE ~26 BUSINESS PHONE ~3~ 24-HOUR PHONE 66 i_:S 2'2~0~A 2 127 24-HOUR PHONE " 132 PAGER ~ ~2e PAGER ~ ~33 Ce~fi~on: Based on my inqui~ of ~ose individuals responsible for ob~inin9 ~e info~a~on, I ~Ai~ under penal~ of law ~at Ihave pe~onally examin~ and am ~millar with the infomaiion submi~ed in ~is invento~ and believe ~e info~aGon is line, a~u~, and ~mplete. SIGNATURE OF OWN~OPE~O~ DATE ~34 NAME OF DOCUMENT PREPARER . N~ES OF OWN~OPE~OR (print) ~36 TITLE OF O~E~OPE~TOR LINDA ANN HANSON Doctor of Chiropractic UPCF (7/99) S:\cu PAFORMS\OES2730.TV4.wpd CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS; 1. To avoid further action, return this form within 30 days of receipt. 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. 5.' ~ ~_ You may also_attach B .usin~s Owner / Opera~tor.~orm _and Chemic~ D~s. criptj0n~ F?rm(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAIVIE: pIERCE ROAD CHIROPRACTIC LOCATION: 3012 BUCK OWENS BLVD. MAH]NGADDKESS: 30]2BUCK OWENS BT,VD, CITY: BAKERSFIELD STATE: CA Z~:93308pHONE:661-322-9480 CHIROPRACTOR PRIA4ARY ACTMTY: OWNER: LINDA ANN HANSEN, D.C. PHON~:661-322-9480 3012 BUCK OWENS BLVD., BAKERSFIELD, CA 99~08 -MAILING-ADDRESS: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. Shirley Keller Friend 661-322{}442 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 11.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)_ NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: ...................................... LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME/-- t,qc0~. ~,~dl g4t~,t:~c~ ~ r3 -ct., INSPECTION DATE t c3 ADDRESS ZO ~ 7.. ~E.4z. CE. ~,'3.0..~,') PHONE NO. FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ine [] Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand /VYk%/ t~__,2~'~ ~-~O g, Business plan contact information accurate ~. t.~/X-% ~ (9(-~') ~c-~L Visible address C.)od ,_.q' ~ 'c-~.. 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 Any hazardous waste on site?: [] No Explain: ~:~.J~ C~ Questions regarding this inspection? Please call us at (805) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: