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Home My WebLink AboutBUSINESS PLAN 3/21/2007~ ~~EVAN J MCMILLIN-DDS =-- c ~' 4570 -CALIFORNIA AVE #3S0 !' . ~~`~°~ •~r ~---~` ~ Prevention Services = UNIFIED PROGRAM INSPECTION CHECKLIST ~C B E R_s F ,_ _ 0 90o Truxtun Ave., Suite 210 -. _ - - ~` ~ ~- `~`~ `- ~~'~~-~~ -,i Fiee Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program '; "RrM r Tel.: (661) 326-3979 1; ~ Fax: (661) 872-2171 ~\ FACILITY NAME n' \1~ ~~ INSPECT N DAT 3 ~2/~d~ INSPECTION TIME r , ,~ ~ ADDRESS ~ ~ ~ O /~~ f \ ~ ~ ; ~~ ~ ~~ ~ / ~OJ~IEJJO.~~S LL ~' ~' NO OF E PLOYEES ~ n y l .' FACILITY CONTACT USI NE SS ID NUMBER 15-021- ~ /~ ~e~>k~ Section ~1. Business Plan and l~rventary Program ~ ~ ~ ~~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY - ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMMENT S ^ APPROPRIATE PERMIT ON HAND ^ BUSItI@SS 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 AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ENT~D MAR 2 3 2007 ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON ITE? ~fES ^ NO EXPLAIN: ~ ~~~ Q ~, x ~ " QUESTIONS~REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3979 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 r ,~ `w ~c b m .~~ r tf +~~/~~ t FACILITY NAME l~C M~ ~~ CITY ®F BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3`d Floor, Bakersfield, CA 93301 ~D~DS INSPECTION DATE .3~2'~ / ~~ Section 4: Hazardous Waste Generator Program ^ Routine ~ Combined ^ Joint Agency EPA ID # ~~ ~-~a-~- ^ Multi-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~ ,,~ ~~, Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 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 Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line /~ Secondary containment provided t~.~..:.~a.cs~-. ~~,, ~ ~t~~~,,, Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste (I~ Proper management of lead acid batteries including labels (1~/~? Proper management of used oil filters pJ Transports hazardous waste with completed manifest ~- -.,,_ ;s Sends manifest copies to DTSC r( ,( 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 C=Compliance /~ ~V=Violation Inspector: G '1~^~~~-- Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy ~~ Business Site Responsible Party t 11 r MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 Manager LYNN SPRAYBERRY Location: 4570 CALIFORNIA AVE 350 City BAKERSFIELD CommCode: BFD STA 03 EPA Numb: BusPhone: (662) 323-3095 Map 102 CommHaz Minimal Grid: 35A FacUnits: 1 AOV: SIC Code:8621 DunnBrad: Emergency Contact / Title Emergency Contact / Title EVAN J MCMILLIN DDS / PRESIDENT / Business Phone: (661) 323-3095x Business Phone: ( ) - x 24 -Hour Phone (~eu ~) gZ3 -1 ~ S"Sx f 24 -Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact EVAN J MCMILLIN Phone : Vic,( ) 3 Z3 -305 x MailAddr: 4570 CALIFORNIA AVE 350 State: CA City BAKERSFIELD Zip 93309 Owner EVAN J MCMILLIN DDS INC Phone: ~6 ( )3Z3 -3~~~x Address 4570 CALIFORNIA AVE 350 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~~ ~~ ~~~ ~~ ~ Q~~ ~?ased on my inquiry of those individuals respcnsiL7le for ohta.lning the information. 1 certify under penalfyf of lave Yhat I have personally examined and am familiar with the information sul;mitted and `?rlieve the information is true, accurate, and complete. ~~~1 ~ ~ d ~ Signati re D 'e -1- 07/12/2007 F MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 ~ ~ 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 Min -2- 07/12/2007 -3- 07/12/2007 r F MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# Liquid TWaste -~ AmbRent~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL ru~~t~tcLVU~ ~urirviv~ly l~~ ~Wt. RS CAS# Silver No 7440224 riE'~G1~KL 1',JJl"~7b1~11"~1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 F MCMILLIN DDS INC EVAN J SitelD: 015-021-002358 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 06/19/2002 ~ FIRST AID AND 911 Employee Notif./Evacuation 06/19/2002 FIRST AID AND 911 _,_, r .~ t Ui/ 11 ~. 1V V V 1 1 ~ .G V 0.l. lA0. L 1 V 11 rJ lllClt~C11C: ~/ l~1C U1Ud1 Yldll -5- 07/12/2007 F MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 2CC1CG1 ~7~C 1.V 111. GL111ILLC1IL .. ~ ~.icaii vN Other Resource Activation -6- 07/12/2007 F MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -~ -,- VL.JGV 10.1 110.40.1 lA0 Utility Shut-Offs ELECTRICAL: SHUT-OFF IN UTILITY CLOSET WATER: REAR OF BLDGS F & B OUTSIDE LOCK BOX: YES BY FRONT ENTR 03/20/2007 Fire Protec./Avail. Water 03/20/2007 FIRE EXTINGUISHERS AND EVACUATION PLAN. FIRE HYDRANT - APPROX 160FT SW OF BLDG. Building Occupancy Level 03/20/2007 7 EMPLOYEES -7- 07/12/2007 F MCMILLIN DDS INC EVAN J SiteID: 015-021-002358 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 03/20/2007 ~ STERICYCLE rayC ~ aiciu ivi rut, utc V.7C nC1U. 1VI ru~ui~ uSe -8- 07/12/2007 EVAN J. McMILLI~I, D.D.S., INC. 4570 CALIFORNIA AVE. SUITE 350 : ' PHONE (661) 323-3095 BAKERSFIELD, CA 9330~ FAX (661) 323-4313 CHOON SU. NG PARK, D.M.D. 4570 CA_LIFORNIA AVE. SUITE 350 PHONE (661) 323-3095 BAKERSFIELD, CA 93309 FAX (661) 323-4313 EVAN J. MCMILLIN, SiteID: 015-021-002358 Manager : ~%~ -- BusPhone: ' (662). 323-3095 Location: 4570 CALIFORNIA AVE 350 Map : 102 CommHaz : City : BAKERSFIELD Grid: 35A FacUnits: 1 AOV: · CommCode: BAKERSFIELD STATION 11 SIC Code:8621 EPA Numb: DunnBrad:' Emergency .Contact / Title Emergency cOntact / Title EVAN J. MCMILLIN / DDS / Business Phone: (661) 323-3095x Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) . - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: ReaCt Contact :'EvAN J. MCMILLIN, DDS., INC' Phone~ ( ) - x MailAddr: 4570 CALIFORNIA AVE 350 State: CA City : BAKERSFIELD Zip : 93309 Owner EVAN J. MCMILLIN, DDS., INC Phone: ( ) - x Address : 4570 CALIFORNIA AVE 350 State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ I, ~, Do hereby certify that I have reviewed the attached hazardous materials manage. ment p/an for~~,,and-~,.-- . . ~ .,at ~t along with any corrsctions Constitu~ a complete and correct man- agem~n~ plan for my facJlib/. -1- 08/05/2003- ' -- 7' ~ CITY OF BAKERSFIELD ~ '~- OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN /02 ~STRUCTIONS: 1. To avoid ~er action, retum this fo~ wi~in 30 days of receipt. 2. T~E~T ANS~RS IN ENGLISH. ~ ~ / f 3. ~swer ~e questions below for ~e business as a whole. ~ ~ ~ [ 4. Be as brief ~d concise as possible. 5. You may also attach Business O~er / Operator Fo~ ~d Chemical Dgscription Fo~(s) to ~e ~ont of~is pl~ ~stead of completing SECTION I. below for initial submission. SECTION I: BUS.SS ~ENTIFICATION DATA Busr~ss N,~E: ~ ~L~G ~DRESS: P~Y ACTIVITY: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. 1, HAZARDOUS MATERIALS MANAGEMENT PLAN ~'~ SECTION II. 1- DISCOVERY AND NOTIFICATIONS.. f A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT': ..-f D. EMERGENCY MEDICAL PLAN: HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION H.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 FACILITY5 NATURAL GAS/PROPANE:../X~ ~ SPECIAL: LOCK BOX: YE~ .... IF YES, LOCATION: 3 PRIVATE FIRE PROTECTION/WATER AVAILABILITY B. WATER AVAILABILITY (FIRE HYDRANT. T):. 6/3~ B-~ SECTION III: TRAINING NUMBER OF EMPLOYEES: ~ATEmAL SA~ DATA S~TS ON BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I, ~_~_.. _ k.. CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION 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 l~T AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 4 ~ CITY OF BAKERSFIELD ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS SECTION I. - BUSINESS IDENTIFICATION DATA: The Business Owner / Operator Form, Chemical Description Form(s) and other Forms (e.g.: underground storage tank information, hazardous waste treatment, etc., as needed) may be submitted as the first section of the Hazardous Materials Management Plan in order to avoid duplication of information for initial submissions. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1 - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDUREs: Describe the procedures and equipment used to detect any release or threatened release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EMPLOYEE AND AGENCY NOTIFICATION: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties? At a minimum, you must call 9-1-1 and the Office of Emergency Services at 1-800- 852-7550 to report any spills that are a threat to life, safety or the environment, or for other non-emergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. ~'~ D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident involving HaZardous Materials used at your business. · HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2 - RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C. CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be imPlemented in case of a release at your business. This should address small spills, as well as a major release of material once the material is contained. Hazardous Waste: Please provide, the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removedl Please keep all disposal receiptS for the last three years available on site for inspection. UTILITY SHUT-OFFS List locations of shut offs using compass points and known or obvious landmarks. If you have a lock box containing keys and maps of the facility for the Fire Department to use, please list its location also. PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. Private Fire Protec. tion: Describe on-site fire protection for your'business or facility unit, ificluding sprinklers, fire extinguishers, alarm systems and private response teams. B. Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the Fire Department in case of an emergency. 2 SECTION III - TRAINING List the number of employees 'that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to be in those areas. Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS must be readily available on site in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a program which provides employees with initial and refresher training in the following areas: 1) Methods for safe handling of the hazardous materials used by your business. 2) The Cal OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4) The preventiOn, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, inventory forms, and map within 30 days of receipt. If you have any questions please call us at (661) 326-3979 Thank you for helping to keep our All America City cleaner and safer. " _ ........... SECTION ~: HEALTH-H~ZARD-~'~IRBT-AID''IN~OEHATION~' ROU~S(S) OF ~T~: Eyes. and Skin Con~ac~ ~n~a~on~ ~n~es~on destruction., possible disco~o~a~i°" oE:.,the con~unc~via. ~Sk~n - Re~den~ng~ swel~ln~ cz burning m~ occur. H~dzoqu~none .~:~ been known~o cause de~a~is. :'~ Ingestion - Corrosion oi tissue may occur. Nausea, vomiting, abdominal pain ~ossible. ~azqe doses of 8ultl~e ~Y cause circulatory dls2u~bances and central ne~voua system depzeaaion. '. Inhalation - Concentrated mists may irritate or da~ge respiratory .~.. tract and lungs. May cause nausea o= vomiting- .~ ~CZN~ITY (N~,I~C, OS~): None'oi the chemicals used In produc~ are lLst~d on NTP, I~C, or OSHA listings o~ carcinogens. ~DZ~ CONDITIONS A~VATED BY E~0S~: Sul~ite~ ~Y cause all~rglc reactions In some asthmatics. FIRST '... Eyes - Flush with water fo= 15 minutes. Obtain medical attention. " Check for co=heal in~ury. Skin - Remove contamina~d clothing. Wash the exposed area ~tho=ouqhly with water. Contact a physician, wash con=aminated CIothing before re-use. Ingestion -"I~ conscious give 2 glasses o~ wa~eI. Do not induce vomiting. Obtain prompt m~dical at~entlon. Inhalation - Remove to fresh air. If adv~rs~ sympto~ develop, contac~ physician. ....... SE~ION 71 SPZ~ Z~FO~TZON' '" ~DLING SPILL~= Use appropItate protective .equipment. Dike the spill and soak up with absorbent mateElal, pzevent liquid entering sewers or waterways. W~TE DISPOSe: Discharge ~o sewer requires approval of permitting authority and may require pretreatment, incineration requires a permitted Incinerator. Landfill disPoas1 requires a permitted land~111. Treatment, Storage, and disposal must be In accordance with Federal, State, and Local =egula~lons. '. ~DLING ~D STORA~ P~IONSI Store in a well ventilated area. Keep container tightly ca~ped when not In use. Do no~ store iood, drink, or tobacco in' areas where contamination could occur with this product. Avoid contact OTHER PRECAUTIONS: Avoid breathing vapors or mists. eyes, skin, and clothing. Wash thoroughly after handling. Do not take in~ernally. Keep out o~ =each o~ children. SECTION 8= CONTROL RESPIRATOR~ PRO~ION: Use a NIOSH a~9~oved cartridge respirator tn poorly ventilated areas. ~ILATION: 10 room volumes per hour is adequate under conditions. PRO~I~ CLO~S: Latex or neoprene gloves EYE PRO~ION= Chemical splash goggles. Eye wash station. PRO~CTI~ ~OTHING= Lab MC CLENNY JR,REESE === ~DS TRACKING INFO~TION === 457~ CALIFORNIA AVE~35~ PID: 6986513 OUST: ~385148-~1 " B~ERSFIELD,CA 93~1 I~G: I:53334 ~ PAGE: ~ of 4 PACKET: 98639-5039 - ;-~ ~ TY OF BA FIELD ., ~-~- OFFICE OF'ENVIRONMENTAL SERVICES~ 1715 Chester Av~,~. Bakersfield,'CA (805) a26-$979 .\ ' ~STRU~IONS SITE'~ FACIL~Y D~G~M~ FOR ~. '.,~, .. .- ~ ~~om ~ ~e ~ of ~e site ~~ md ~e ~ ~. Ho~y, ~ ~d m~ ~ b~~ ~ o~y Mve to ~b~t a ~'~ ~u :~ve ~d~ yo~ b~ ~to ~ ~ ~ of ~e mmpl~ or ~ ~ you ~ ~ mmpl~ ~ rout, to yo~ bu~ it i~ i~ ~ ~ ~ot~ l~on. SITE DIAGRAM INSTRUCTIONS The sit~ diagram is used to show your busin~ and to indicate tho businesses that imm~ surround your property, usually within 300 feet. If'you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout ofthe plant. If you will not be submitting facility diagrams, the site map must include aH of the following information: 1. Check the box on the top lei~ comer of the form provided that indicated "Site Diagram". 2. Print the name of your business, as shown in your I-IMMP, on the top of the 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoffpoints for gas, electric and water services. '5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). ~ap labelin8 musz be lel~bl~i~ ~asily.under$~a~dable. Try to avoi use ot.abbreviatioa~ or ~ ~':~ , symbols. It' you must use them, provide · legend explaining your system. '~ .~, ~ MaPs may be returned t'or correCtion it'you tail to t.ollow these instruction. FACILITY DIAGRAM INSTRUCTIONS Facility distains are supPlemeo~ to the site diasram. Use them to show the subdivision details of a la~e business. 1. Check the box in the upper dsht hand comer of the form provided that indicated "FacUity Diairam". 2. Print the name of your busine~ as shown on your ~. Print the name of the area that this amp represents. This mine should be the same name that you used on this area's inven~ry report 3. Indicate which area ~e dia~rma rel~asems ~ tbe total aumb~ ofihcility diasmnm that you are includins. Ifa map repre~emed the fu'st of four areas, it would be labeled #l of 4. 4. Follow instruction (3 -7) for site diagra~ regardia8 the speci~c details to be included on each facih'ty diasmm. 2 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave.~, Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY INFORMATION INSTRUCTIONS BUSINESS OWNER / OPERATOR FORM I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending).for the facility information. Enter the business name and site address and phone number of your business. Do not use P.O. box numbers. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department, or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and Provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the business. This person may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making authority to call on other resources (such as hazardous waste clean-up companies) as necessary. V. CERTIFICATION: The business owner or operator must sign, date, and also identify the document preparer. 1 COMMON STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODES 0111 Wheat production 0724 Cotton ginning 5821 Eating places 0115 Corn production 0541 Grocery store 5813 Drinking places (Alcohol service) 013 ! Cotton production 1541 Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash '2911 Oil refineries grains 5984 LPG dealers 3441 Welding/fabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes 7532 Auto top, body, 3443 Welding/fabrication - upholstery repair 0173 Tree nuts boiler Auto paint shops 0174 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fruits 4222 Cold ~Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts 4925 Compressed gas supplier 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair crop 5169 Chemical supply 7538 General auto repair 0241 Dairy farms 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs (new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 2851 Paint manufacture 5531 Auto & home supply stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 7-~.: ~,:~ ~ s ~-~'-~~] ~ CITY OF- BAKERSFII~D ~ . ~' FII~E ~ FICE OF ENVIRONMENTA~ERVICES ~4~rM~r 1715 Chester Ave., CA 93301. (661) 326-3979 H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~ (one fo~ per matedal ~er building or a~a) ~W D ADD D DELETE D REVISE' 200 Page B~SINESS ~M~Sa~e~ FACILI~ NAME or DBA - Doing Busings ~) 3 C~AL LOCA~ON J ' ~ 201" CHEMICAL LOCATION ~ Yes /~o 202 F ACiLI~ ID~r { ~;~] [ 1~t ] I ,4~:~;~ [ ~ ~ [ [ ,~ ' ,] 1 ~P~ (op~n~ '203 ~l GRID ~(op~naO 2~ ., .... ~,~ 'E~,~-:~?.q~: ~ ........ ~r: c~':-': ~?.::" =~¢:~, ::-:~,~, ~: .,., ~.~,,~:IL CHEMICAL INEO.MATIO" .~-,... ~ : .? .... . ~ 205 T~DE SECRET ~ Y~ ~o 206 CHEMICAL NAME ~ ~ ~, ~ If Subj~ to EPC~. refer to inst~ions 207 COM~N ~ME EHS* ~ Y~ 208 CAS , .... 209 '~f E.S i~'t~,' ~ FIRE CODE H~RD C~SSES (C~plete if r~u~t~ by I~1 fire ~i~ 210 ~PE ~ p PURE ~ m MIXTURE ~ WASTE 211 [ ~DIOACTIVE ~ Y~ ~ 212 CURIES 213 . 215 PHYSICALSTA~E ~ S SOUD ~LIOUID ~ g ~S 214 ] ~RGEST~AINER~ / ~ ~RE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~L~ ~ 5 CHRONIC HEALTH 216 FED H~RD CATEGORIES (Ch~ all that apply) ~ I ~I~M ~ 218 AVENGE ~ 219 STATE WASTE CODE 220 , DAILYA~Um DAILYA~U~ UNITS' ~ ga ~L ~ d ~ lb LBS ~ tn TONS 221 DAYS ON SITE 222 ' If EHS. amount must ~e in lbs. STOOGE CONTAINER ~ a ABOVEGROUND TANK ~ e P~STIONONMETALLIC DRUM ~ i FISER DRUM ~ m G~SS BO~LE ~ q~lL ~R 223 (Check a/I that apply) ~ ~ UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~STIC BO~LE ~,OTHER . ~d S~ELDRUM ~h SILO ~1 CYLINDER Op TA~WA~N~t ~ _ j , _ STOOGE PRESSUR~ ~ ~ a AMBIE~ ~ aa ABOVEA~IENT ~ ba BELOWAMBIENT 224 : STOOGE TEMPE~TUR ~ ~ aA~IE~ ~ aa ABOVE AMBIENT ~ ba BELOWAMBIENT ~ c CRYOGENIC 225 1 ~ 226 227 ~ Y~ ~ No 228 229 2 i 230 231 ~ Y~ ~ No 232 233 3 'i 234 235 ~ Y~ ~ No ~6 237 4 238 239 ~ Y~ ~ No 2~ 241 5 ] 242 243 ~Y~ ~No 2~ 245 PRINT NAME & TITLE OF AUTHORIZED COMPA~ ~EPRESENTATIVE S GNATURE ~ ~/DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd ~' (~ICE OF ENVIRONMENTAI_~RVICES * '~t~~~ 1715 chester Ave., CA 93301 (661)326-3979 FACILITY INFORMATION :' Page __ Of ,.' ,' '~: ','),:::i: :~(i:':~ i~!}~."; "-:'.i ~ FAcILiTY IDeNTiFicaTION: ~::':. :. i'~':~ ,~.": ' ' FACiLiTY ID * ~ f~';;k; . ~(~: ~ ! I Year Beginning L O0 ~ ' BUSINESS NAMEISame as FACILI~ NAME or DBA- Doing Bus,esha) 3 i~USINESS PHONE ~02 SITE ADDRESS lO3 DUN & ~o6 SiC CODE ~o7 B~DSTREET ~_ ~ I - ~ ~5 ~ (4Oigitg) 108 COUN~ ~.~ ~ OPE~TOR NAME ~ j ~ ~o9 [ OPE~TOR PHONE 1~o OWNER NAME 112 OWNER MAILING CONTACT NAME a~ CONTACT PHONE CONTACT MAILING ~ 19 ADDRESS CI~ 1~ [ STATE 1211 ZIP 122 ''~ >% *~:'~b'~[=:~C/%~:::}:~:~*:~::4~:~r:"~*~"~:h:'7*~*~*'u:~'~.'~::: 4;' ~'~' ~" '~; ~%/j~t~::~:~::~k~y.?"~%~L ~. ,- ..... TITLE I ~ne* 125 TITLE ~5~ OOi ~~ ,30 132 **HOUR*HONE ~: ~. / ~ ~ '*' ~*HOUR PHONE b ~ ~ _ ~ ~ / Ceaification: BasSd on my inqui~ of ~ose individuals responsible for ob~inin0 the info~ation, I ~Ai~ under penal~ of law that I have personally examined and am familiar with the information submiRed in this invento~ and believe the info~ation is tree, accurate, and complete. _~SIGNATURE OF OWNE~OPE~TO~~/~~-- ~ . DAT2/~/~ ~ 1~ NAME OF DOCUMENT PREPARER j~~. ~' ~~ 135 NAMES OF O~E~OPE~TOR (print) 136 TITLE OF ~NE~OPE~TOR 137 UPCF (7/99) S:\CU PAFORMS\OES2730.TV4'wpd STATE WASTE CODE 220 If the hazardous material is a waste, enter the appropriate California 3~digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. A list of.common State Waste Codes are included on page 4 0fthese instructions. 'UNITS 221 Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be ?eported in pounds. If material is a mixture containing an EHS, report the units that the material is stOred in (gallons, pounds, cubic feet, or t6ns). DAYS ON SiTE 222 List the total number of days during'the year that the material is on site. STORAGE CONTAINER 223 Check all boxes that describe the type of storage containers in which the hazardous material is stored. · NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT I - 5 (% by weight) 226, 230, 234, 238,242 If a range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1 - 5 Name 227, 231,235,239, 243 When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT i- 5 EHS 228,'232,236, 240, 244 Check "Y" for yes if the component of the mixture is considered an Ext/remely Hazardous Substance as defined in 40 CFR, Part 355, or."N" for no, if it is not. HAZARDOUS COMPONENT 1 .- 5 CAS 229, 233,237, 241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. IlL SIGNATURE: 246 Please print name, title, sign and date each chemical description form. If you have any questions please call us at (661) 326-3979 3 '..-'" CALIFORNIA WASTE CODES Cod~ Description Code Description Inorganics . 241 Tank bottom waste 111 Acid solution 2 < pH < 7 with metals . 251 Still bottoms with halogenated organics (antimony, arsenic, barium, beryllium,' 252 Other still bottom Waste cadmium, Chromium, cobalt, copper, .lead, 261 PCB's and material containing PCB's mercury, molybdenum, nickel, selenium, silver, 271 Organic monomer waste (includes unreacted thallium, vanadium and zinc) resins) ! 12' Acid solution without metals 272 Polymeric resin waste · 113. Unspecified acid solution 281 .Adhesives 121 Alkaline solution pH >12.5 with metals (see 291 Latex waste 111) 311 . Pharmaceutical waste 122' 'Alkaline soiution without metals 321 ' Sewage sludge 123 Unspecified alkaline solution 322 Biological waste other than sewage sludge 131 Aqueous solution (2 < pH < 12.5) ~ontaining 331 Off-spec, aged or surplus organics reactive anoins (azide, bromate, chlorate, 341 Organic liquids (nonsolvents) with halogens cyanide, fluoride, hypochl0rite, nitrite, 343 Unspecified organic liquid mixture perchlorate and sulfide anions) 351 Organic solids with halogens 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues Sludges 10% or more 411 Alum and gypsum sludge 134 Aqueous solution with total organic residues 421 Lime sludge less than 10% 431 Phosphate sludge 135 Unspecified aqueous solution 441 Sulfur sludge 141. Off-spec, aged, or surplus in0rganics 451 Degreasing sludge 151 Asbestos.containing waste 461 Paint sludge 161 FCC Waste 471 Paper sludge/pulp 162 Other spent catalyst 481 Tetraethyl lead sludge 171 Metal sludge (see 111) ' 491 Unspecified Sludge waste 172 '. Metal dust and machining waste (see 111) 181 Other inorganic sOlid ,waste Miscellaneous 511 Empty pesticide containers 30 gal or more Organics ' 512 Other empty container 30 gal or more 211 Halogenated solvents (methylene chloride, 513 Empty containers less than' 30 gal chloroform, TCE, TCA) 521 Drilling mud 212 Oxygenated solvents (acetone, butanol, MEK) 53 l· Chemical toilet waste 213 Hydrocarbon solvents (stoddard solvent, 541 Photo chemical/photo processing waste xylene) 551 Laboratory waste chemicals 214 Unspecified solvent mixture 561 Detergent and soap.' 221 Waste oil and mixed oil 571 Fly ash, bottom ash, and retort ash 222 Oil/water separation sludge 581 Gas scrubber waste 223 Unspecified oil - containing waste 591 Baghouse waste 231 Pesticide rinse water 611 Contaminated soil from site clean-ups 232 Pesticide and other waste assOciated with 612 Household wastes pesticide production. , ~o j'~' CITY OF BAKERSFIEL '~' · ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS CHEMICAL' DESCRIPTION FORM Make as many copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet ora gas. Report any amount of any hazardous waste being generated or handled on site. I. FACILITY INFORMATION: Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Enter the business name at the top of the form. Enter the page number in the right hand corner. Describe the exact location of the hazardous waste or material being reported. NOTE: Chemical location information is considered confidential unless you check "no." Ifa site map is being submitted, you may refer to the map number and grid coordinates for the approximate location of the material, as shown on the map. II. CHEMICAL INFORMATION: Each of the instructions below correspond to the entry field with the same number on the chemical description form. CHEMICAL NAME 205 Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture or a hazardous waste, do not complete this field; complete the "common name" field instead. TRADE SECRET 206 · Check "Y" for yes if the information in this section is declared a trade secret, or "N" for n.o, if it is not. State requirement: Ifyes~ and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by Health and Safety Code, Section 25511. Federal Requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by Title 40 Code of Federal Regulations (CFR) and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. coMMoN NAME 207 Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. EHS 208 Check "Y" for yes if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. CAS # 209 ~-~.~ · Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been ass.igned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the section below. FIRE CODE HAZARD CLASSES (Please leave blank) 210 HAZARDOUS MATERIAL TYPE 211 Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, Complete hazardous components section. RADIOACTIVE 212 Check "Y" for yes if the hazardous material is radioactive or "N" for no, if it is not. CURIES 213 If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. PHYSICAL STATE 214 Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gaseous (gas). LARGEST CONTAINER 215 Enter the total capacity of the largest container in which the material is stored. FEDERAL HAZARD CATEGORIES 216 Check all the physical and health hazards associated with the hazardous material: PHYSICAL HAZARDS: Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers · Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents HEALTH HAZARDS: . Acute Health (Immediate): Highly Toxic, Toxic, kritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short term exposure. Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with long term exposure. ANNUAL WASTE AMOUNT 217 If the hazardous material being inventoried is a waste, provide an estimate of the annual/~mount handled. MAXIMUM DAILY AMOUNT 218 Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. AVERAGE DAILY AMOUNT 219 Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be .............. consistent with~ the units-reported in box- 221 and ~should not.exceed that of maximum dai.lyamount. Dear Business Owner: This packet contains important information regarding your business and k~ ~0' \~" the requirements of Hazardous Materials Inventory Regulations. Both State and Federal laws may require that your business complete a Hazardous Materials x- ~\\9y Management Plan (HMMP). Please read all the enclosed ~information C,~EF carefully, failure to comply with any portion of the Business Plan requirements RON m~ZE may result in Civil Liabilities of up to $2,000 for each day in which the violation ADMINISTRATIVE SERVICES occurs. 2101 'H:' Street Bakersfield, CA 93301 VOICE (805) 326-3941 WHAT BUSINESSES MUST COMPLY FAX (805) 395-1349 SUPPRESSION SERVICES If you handle, use, store or dispose of Hazardous Substances at any time 2101 'H' Street Bakersfield. CA 93301 during the year in excess of the minimum reporting quantities you must submit VOICE (805) 326-3941 a Plan. FAX (805) 305-1349 PREVENTION SERVICES Typical everyday Hazardous Materials you may find in your facility may 1715 Chester Ave. Bakersfield. CA 93301 include, but are not limited to: compressed gasses; fuels - all types including VOICE (805) 326-3051 FAX (805) 326-0576 propane; solvents - most solvents would be Hazardous Materials; oils - new and. waste; thinners; caustic or c0rrosive-matevials;.poisonous._, or toxic materials, and ENVIRONMENTAL SERVICES radioactive materials.~.: 1715 Chester Ave. Bakersfield, CA 93301 _ VOICEFAX (805)(805)326-0576326-3979 . M~ni:~'~m State Ret~orting quantities"for all h~ardous materials are: /// ' \,,, / · · mUN,NO D,V,S,ON ,-x,~'x'' ~.'/ 55 gallons for hqmds . ] i / 5642 Victor Ave. ~['~J .'X,~,ff.' 500 P0~nds for solids / Bakersfield, CA 93308 !/'/ VOICEFAx (805)(805)399-5763390'4697 '_~ XX'/,(~ ' ' 200 cub, ic feet (at standard te~¢perature and pressure, W '~,,""... ., for gasses) /3/ . F~)"~-ai}~.ac.ut-elyc.H~O~ffs~Matenals the mm]mum reporting quantities are found on the list of Extremely Hazardous Substances on the current EPA List (Vol 52 No 77 of the Federal Register.) This list is available at the Hazardous Materials Division of the Bakersfield Fire Department, 1715 Chester Ave., Bakersfield, Ca. 93301. Your reporting requirements are either the State quantities or the Federal (threshold planning quantity) -- W H I C H E V E R I S L O W E R ! If your facility is exempt or handles Hazardous Materials in-quantities less than the minimum..reporting quantities please .fill out. and return to this office Section (1) one, (4)' four, and (5) five of the Hazardous Materials Management Plan. Page 2 HAZ MAT BUSINESS PLAN WHAT BUSINESSES ARE EXEMPT If you do not handle Hazardous Materials or if the quantities of Hazardous Materials are below the minimum reporting quantities at all times during the year, you are exempt. Hazardous Materials which are stored in transit or temporarily maintained in a fixed facility for less than (30) thirty days during the course of transportation' are exempt from the inventory requirements of the law. -- NOTE -- (Hazardous Materials contained solely in a consumer product for direct. distribution to, and use by, the general public are N O T exempt'from the reporting requirements of the law per this Administering Agency.) HOW DO BUSINESSES COMPLY Businesses that are required to comply with requirements of Chapter 6.95 Of California Health and Safety Code must submit a Plan. This Business Plan consists off 1) Emergency Response Plans and Procedures. 2) Inventory of Hazardous Materials. 3) Training Program for Employees. The forms for completing the Hazardous Materials Management Plan are attached to this letter. By correctly filling this Business Plan in you satisfy both the Federal Requirements (Tier I and Tier II Inventory Requirements of SARA Title III) as well as the Califomia Requirements of Chapter 6.95 of the California Health and Safety Code. Business owners are urged to read and become familiar with Chapter 6.95 of the Califomia Health and Safety Code. 'Copies are available at the Hazardous Materials Division of the Bakersfield Fire Department, 1715 Chester Ave., Bakersfield, Ca. 93301 (805) 326-3979. The completed Business Plans or Exemption Request Form are required to be submitted within 30 DAYS of receipt of this letter. On-site inspections are required to insure compliance with the law. If you have any questions or need assistance with completing the Business Plan please call 326-3979. Sincerely, Ralph E. Huey Director, Office of Environmental Services REI-Bed CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~V~M .L ~col,cctM 005 ,'~C'INSPECTION DATE ~"-/'Z. /,0 2.. ADDRESS Z~'~c) c./~,~e.~,~ 0~ 35'0 PHONE NO. FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~ Routine [~l~Combined [~ Joint Agency [~ Multi-Agency ~ Complaint OPERATION C V COMMENTS Appropriate permit on hand 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 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?: ~Yes [~]No . 'N~-/~/L~ ,Explain: L~t~'3 q"~ ~t~,O. Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield,' CA 93301 FACILITY NAME ,,C-~/,t~ .L ~c~cct^l ~)0 ~ t'~c~ INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~]C~.Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, Or explosion within 15 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 kepi closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks 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 C=Compliancebn,.) V=Violationr4t~ N~ t~ /1 Inspector: ! - Office of Environmental Services (66 l) 326-3979 Business Site Responsible Party White - Env. Sves. Pink - Business Copy