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Home My WebLink AboutBUSINESS PLAN~I -, ; IGAMBRO HEALTH CARE -- _ --' -- - - - - - ALIFORNIA #100A- - - - _ _ - - - - - - - -- - -- - ~~ 4900 C _ __ - --- - - -- -------- -- ------ _ - ._r_ _ _ HazardoUs Materials/Ha~h~dOus' Waste Unified Permit ., CONDITIONS OF ~PERMIT~ON REVERSE SIDE *' ',.: * :.~:';*! ~ !~. '. This _rmrmit is Issued for the followin~j; [] Hazardous Materials Plan Permit ID #:: 015'0~00'001874 E] Underground Storage of HazardOus Materials E] Risk Management Program GAMBRO HEALTHCARE .~,~ ~,~ [] Hazardous Waste On-Site Treatment LOCATION: 4900 CALIFORNIA AVE 100A Bakersfield Fire Department ISSuedby: ' OI~FICE OF ENVIRONMENTAL SER Bakersfield, CA ~330! . ' · ii!~:-','~:'i.-i- . ' Co~}~o"~~i '~"~ 'Voice (661) 326-3979 · ' '. FAX (661) 326-0576 .:.... ,-<.i~,.~i..~iii?~~ii~hiDale::'.' i.'... !'June 30. 2003 Caltwins 4900 California Avenue 647 Parking Places 8 Handicap Places 4.5 Parking Places per 1,000 ~ Dumpster Area Fire Hydrant Fire Landscape Sprinkler Control Main Oaa Shut-off Main Meter Water · Patio Drain Avenue 04/20/98 13:37 8805 326 0576 BFD HAZ MAT DIV ~007 SITE DIAGRAM ~ _ FACHATY DIAGRAM I'-~i Business Name: (-~iC~c,,UD ~CO.f~_ f ' Business Address: t-~O~ Co.t ifcocc~io~ ~ '~. %o.i~ ¢00- ~ r-~ r-~ r-t r-~ I I ~ I I I I I UNIFIED PROGRAM INSPECTION CHECKLISTn SECTION 1: Business Plan and Inventory Program • Prevention Services B E R s F, D 900 Tnixtun Ave., Suite 210 F/RE Bakersfield, CA 93301 ~erM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS ~ ~ y9oo c~-l,t~aQ.rv,,r~ ~~~. PHONE NO. 32z-yq( ~ NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER ~~c.l.lrjlj;A- DbM>,NGt~iz_Z 15-021-QOi$-7N "Section 9: Business Plan and Inventory Program ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ • COMPLAINT ^ RE-INSPECTION I ~J C V ~ C=Compliance OPERATION V=Violation COMMENTS M ^ APPROPRIATE PERMIT ON HAND ~]°J la 1 ~ ®~^- ~j L~f ^ BUSIn2SS PLAN CONTACT INFORMATION ACCURATE ~ /' (1 1. N ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY /~ ~0, l , V W ~ '°r l ^ VERIFICATION OF INVENTORY MATERIALS L7 ^ VERIFICATION OF QUANTITIES ~' ^ VERIFICATION OF LOCATION ~ ^ PROPER SEGREGATION OF MATERIAL GY ^ VERIFICATION OF MSDS AVAILABILITY , LtY ^ VERIFICATION OF HAZ MAT TRAINING G/ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES V V C~ ^ EMERGENCY PROCEDURES ADEQUATE GV ^ CONTAINERS PROPERLY LABELED C~ ^ HOUSEKEEPING L(] / ^ vv FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~ ~ t~ Inspector (Please Print) Fire Prevention / 1~' In /Shift of Site/Station # Business Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy ~ FD 2155 (Rev. 09/05 ^ YES ENO UNIFIED PROGRAM INSPECTION CHECKLIST ~-sY 1 E,'~.'R3S~':~'r~'~ , ..,.a sr~'i~A~ ,~az.,-cns -f...,'._: ,a .z7n.... _-, ;.a~s~..ar;. <-~F= . -.:rs ,.:. , ..,.-:!.^ ... i. SECTION 1: Business Plan and Inventory Program • BAKERSFIELD FIRE DEPT Prevention Services a ari a ~~R~ 900 Truxtun Ave., Suite 210 Ae'f~ r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~n~~sZo ~-}£~~i ~+~~~ INSPECTION DATE 2-- ~ INSPECTION TIME l~v ADDRESS ~{q UD LPrt-t ~o~~~ - ~ ~4U ~ . c ov,~ HONE NO. 322.-`19 ~ 1 O OF EMPLOYEES FACILITY CONTACT f'Y~~i,~i'~~4 Ootml~vvu~2 USINESS ID NUMBER 15-021- OQ 18 7 `~ 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 ~ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS L'~ ^ 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 C4/ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES C9'NO (QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ \ Inspector (Please Print) Fire Prevention ! 1°' In /Shift of Site/Sta~ion ## Business Site/School ite Re ponsible (Please Print) White -Prevention Services Yellow - Station Copy Pink -Business Copy FD2049 (Rev. 02/05) GAMBRO HEALTHCARE -- 'SiteID: 015-021-0018 Manager : V~:~.~CU£ ? BusPhone: (661) 322-4911 Location: 4900 CALIFORNIA AVE 100A Map : 102 CommHaz : Minimal City : BAKERSFIELD ~ Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:8071 EPA Numb: DunnBrad: Emergency Contac~ / Title Emergency Contac% /~.~_~itle Business Phone: 4661) 322-4911x Business Phone: ~9~) 24-Hour Phone : (661) ~4-~n3¥$~-7~7 24-Hour Phone : Pager Phone : ( ) - x Pager Phone : ( ) Hazmat Hazards: RSs Fire Press Im~lth DelHlth. Contact : Phone: (661) 322-4911x MailAddr: 4900 CALIFO~IA AVE 100A State: CA City : BAKERSFIELD Zip : 93309 Owner G~BRO HEALTHCARE PATIENT SERVICE Phone: (949) 831-0900x Address : 115 COL~BiA State: CA City : ALISO VIEJO Zip : 92686 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: ~i;THiA V~%~ERCUS HOME ~~, CELL ~ ~. 1 08/13/2003 CITY OF BAKERSFIELD CLAIM VOUCHER [Vend°r No. 'I I certify that this claim is correct and valid, and isa proper charge against the City Agency and account indicated, CLAIMANT'S NAME AND ADDRESS: Gambro Health Care (AUTHORIZED SIGNATURE OF CITY AGENCY) 4900 California Ave Bakersfield, CA 93309 9-25-00 Initials of Preparer: ED ClT~ DEPARTMENT: . PLEASE PROVIDE SHORT EXPLANATION OF PAYMENT: (Including Contract Number if Applicable) This business made a payment of $159.50 on 8-18-00. Their balance at the time was only $49.50 leaving them with a credit of $110.00. We will refund the $110.00 credit. Dept. Base El I Objt Project # Invoice # Amount Comments on check stub 0000' 123 7900 110.00 VOUCHER TOTAL $110.00 SECTION 72, PENAL CODE . FINANCE DEPT. USE ONLY Section 32, Presenting False Claims. Every person who with intent to defraud, presents for allowance or for payment ~o any state board or officer, or any =ounty, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill; account, voucher, Examined & Approved for Payment Amount or writing, is guilty of a felony. ' ~43~I07 CITY OF BAKERSFIELD 9/21/.00 ~'~'~' sCellaneous Receivables ~iry 09:33:50 Customer ID . . . : · 15517 Name: GAMBRO HEALTH CARE Last statement : 9/01/00 Addr: 4900 CALIFORNIA AVE. Last. invoice : 0/00/00 BAKERSFIELD, CA 93309 Current balance : ll0.00- Pending .. . '. . . : ~00 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail ' 5=Display Chg Bnk G Opt Trans Date Code DescriptiOn Amount Balance Typ Cd L 9/01/00 stmrn Statements Processed .00 110.00- N 8/18/00 PAYMENT 159.50- 110.00- 00 Y 8/01/00 stmrn Statements Processed .00 49.50 N 6/01/.00 stmrn Statements Processed .00 49.50 N 6/01/00 SS001 CA STATE SURCHARGE 10.00 49.50 A N 6/01/00 HM002 HAZ MAT HANDLING FEE 158.00 39.50 A N -- 5/01/00 stmrn Statements Processed .00 118..50- N -- 4/06/00 PAYMENT 110.00- 118.50- 00 Y -- 4/01/00 stmrn.Statements Processed .00 8.50- + F3=Exit F12=Cancel * = Pending GAMBRO H SiteID: 015-021-001874 Locatlon:~900JC~LIFORNIA__~VE 100A Map : 102 CommHaz : Minimal City : 9~~ ~ Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:8071 EPA Numb: ~M~ -- ~ z~H0~:[~i~ ~-3~ DunnBrad: Emergency Contact / Title Emergency Contact ~/~.~ Title JULIE TREVINO .L~/_SECRETARY E~F~%~G~~/~fD~EA DIRECTOR B siness Phone: ,Business Phone: 24-Hour Phone ~[~) 834-3553x 24-Hour Phone : Pager Phone : ( ) - x Pager Phone : (~0D)~-~0~x Hazmat Hazards: RSs Fire Press ImmHlth DelHlth Contact : Phone: (805) 322-4911x MailAddr: 4900 CALIFORNIA AVE 100A State: CA City : BAKERSFIELD Zip : 93309~ Owner G/d~IBRO HE~THCJ~E PATIENT SERVICE Phone: ( ~! ~.~.x~--~ Address : 115 COLUMBIA State: CA City : ALISO VIEJO Zip : 92686 Period : to TotalASTs: = Gal PreParer: TotalUSTs: = Gal Certif'd: RSs: Yes Emergency Directives: = Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm DailyMax IUnit[MCP RENALIN E IH L 45.00 GAL Hi BLEACH IH L 9.00 GAL Hi OXYGEN F IH DH G 502.00 FT3 Low NATURALITE DH L 600.00 GAL Low NATURALITE DH L 265.00 GAL Low BI-CART I,~N~ k. ~/~. Do hereby ce~i~that ~ have s 1000 00 LBS Min (Type or print name) reviewed the attached hazardous materials manage- ment plan for ~;fim~/~r_.~l~ ~ and that it along With (Name of Business) any corrections constitute a complete and correct man-, agement plan for my facility. GAMBRO HEALTHCARE SiteID: 015-021-001874 = Inventory Item 0001 Facility Unit: Fixed Containers at Site RENALIN Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM CAS# F STATE TYPE PRESSURE , TEMPERATURE CONTAINER TYPE Liquid Mixture AmbientI Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION %Wt. RS CAS# 24.001Hydrogen Peroxide No 7722841 4.00 Peracetic Acid (EPA) Yes 79210 Acetic Acid Solution No 64196 [TSecret RS BioHazI HAZARD AiSESSMENTB ~ I Radioactive/AmoUnt EPA Hazards NFPA usDoT# MCP No Yes No No/ Curies IH . / / / Hi = Inventory Item 0002 Facility Unit: Fixed Containers at Site BLEACH Days On Site 365 Location within this Facility Unit ~ Map: Grid: STORAGE RM CAS# FLSTATE { TYPE PRES SURE --~ TEMPERATURE CONTAINER TYPE iquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum { Daily Average 1.00 GAL 9.00 GAL 9.00 GAL HAZARDOUS COMPONENTS .25 Bleach N 7681529 HAZARD ASSESSMENTS TSecretNo NoRS Bi°Hazl Radi°active/Am°unt I EPA Hazards[No No/ Curies IH NFPA ./// I' USDOT# {MCpHi 2 08/14/2000 GAMBRO HEALTHCARE SiteID: 015-021-001874 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: IN STOCK AREA ON CARTS CAS# 7782-44-7 F STATE ~ TYPE PRESSURE i TEMPERATETRE I CONTAINER TYPE Gas |Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average. 251.00 FT3 502.00 FT3I 251.00 FT3 HAZARDOUS COMPONENTS wt. I CAS# 100.00 Oxygen,~ Compressed N 7782447 HAZARD ASSESSMENTS TSoorotN~SIBioHaz Radioactive/Amount EPAHazards NFPA IUSDOT# MOP No No No/ Curies F IH DH / / / Low Inventory Item 0004 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME NATURALITE Days On Site 2K 365 Location within this Facility Unit Map: Grid: INSIDE~NW~ORNER OF STORAGE RM CAS# STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE /Mixture Ambient I Ambient /Liquid I Above I ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 300.00 GAL 600.00 GAL I 300.00 GAL HAZARDOUS COMPONENTS %Wt. ~S CAS#. Acetic Acid Solution N 64196 Calcium Chloride No 10043524 HAZARD ASSESSMENTS TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No/ ' Curies DH : / / / Low -3- 08/14/2000 GAMBRO HEALTHCARE ~/~6~~~~ SiteID: 015-021-001874 Inventou Item 0005 ~~~ FaciliW U~t: Fixed Conta~ers at Site i~ COMMON NAME / CHEMICAL NAME NATU~LITE o Days On Site o 1K o 365 o ~cation wi~in ~is Facili~ U~t Map: Grid: INSIDE STOOGE ~ CONTAINMENT A~A o CASg o o o STATE E~E TYPE EEEiEE P~SS~ EEEi TEMPE~TU~ Liquid o Mixture o Ambiem o Ambient o DRUM/BA~L-NONMETAL o Largest Container o Daily Maximum o Daily Average o 55.00GAL o 265.00 GAL o 210.00 GAL %Wt. ~ ~ RS~ CAS~ ~Acetic Acid Solution ~No ~ 6419~~ ~Calci~ C~ofide ONo ~ 1004~24~ ~~~~~ HAZA~ ASSESSMENTS ~TSec~et~ RS~BioH~~ Radioactive/Amour ~ EPA Hazards No ~No ~No ~ No/ Curies° DH ~ /// ~ Inventory Item 0006 ~~6~ Facility Unit: Fixed Containers at Site i~ COMMON NAME / CHEMICAL NAME BI-CART ° Days On Site o o 365 o Location within this Facility Unit Map: Grid: IN STORAGE RM o CAS# o o o STATE ~i~ TYPE ~i~ PRESSURE ~i TEMPERATURE ~i~ CONTAINER TYPE Solid o Pure o Ambient o Ambient o PLASTIC CONTAINER o i~~~~i AMOUNTS 'AT THIS LOCATION Largest Container o Daily Maximum o Daily Average o 12.00 LBS o 1000.00 LBS o 200.00 LBS o i~i~~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS# o °Sodium Bicarbonate ONo o 144558° i~i~i~i~~ HAZARD ASSESSMENTS °TSecret° RS°BioHaz° Radioactive/Amount o EPA Hazards o NFPA o USDOT# o MCP o No ONoONo o No/ Curies° p o /// o OMinO -4- 08/14/2000 GAMBRO HEALTHCARE ~~~~~ SiteID~ 015-021-001874 Notif./Evacuation/Medical ~~~~~~ Overall Site i ~ Agency Notification ~~~~~~~ 05/26/1998 i I o DIALYSIS UNIT TO CALL HAZ MAT 326-3979. o MEDICAL DIRECTOR AND AREA DIRECTOR ALL SO WILL BE NOTIFIED. iE~ Emplojee Notif./Evacuation ~E~EEE~EE~EEEEEE~E~EEE~E~E 05/26/1998 i ALL EMP~LOYEES ON ONE FLOOR. o ~eeee Publlcl Notlf./Evacuat~on/5/5~5/5/5~/~/~~~ 05/26/1998 i i o ALL VISI,TORS ON ONE FLOOR. o ~E~E~EEE~EEE~EEEE~EEEEE~EEEEEE~EEEE~eeeeeee~eeeeeeeeeeeeeeeeeeeee~f i~ Emer~gency Medical Plan ~E~EE~E~E~E~E~EE~E~E~EE~ 05/26/1998 i EMERGENCIES TO GO TO MERCY HOSPITAL - 2215 TRUXTUN AVE - 632-5000. ~eeeeeeeeee~eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee;~eeeeeeeeeeeeeeeeeeeeee~f ? -5- 08/14/2000 GAMBRO HEALTHCARE Mitigatio~Prevent/Abatemt Release Prevention o o i~ Release Conm~ent O o o O iE~60~er Resource Activation EE~EEEEEEEE~EEEEEEEE~EEEEEE~EEE~EEEEEE~EEEEi' O o -6- 08/14/2000 GAMBRO HEALTHCARE 88i~88888888888888888888888~88~ SiteID: 015-021-001874 i f~88~8~8~8~~8~8~888~8~88~8~~8~ Fast Fo~at Site Emergency Factors 888~88~8888888888888888888888~8~ Overall Site i o o i888 Utility Shut-Offs 88888888888888888888888888888888888888888888 05/26/1998 O A) GAS -NW EXTE~OR END OF BLDG, o B) ELECT~CAL - B~A~R PANEL IN CONFE~NCE RM o C) WATER - NW EXTE~OR OF BLDG o D) SPECIAL NONE o - E) LOCK BOX -. YES, IN cOnDOR OUT THE BACK DOOR, W SIDE OF LOBBY (EACH FLOOR ~S ONE) o O i~888 Fire Protec./Avail. Water 88888888888~88888888~8~88888888888 05/26/1998 O P~VATE FI~ PROTECTION - SP~N~ER SYSTEM. o O O o NEA~ST FI~ HYD~NT - HYD~NTS ON SITE (NEA~ST ONE ON NW SIDE OF BLDG). o O -7- 08/14/2000 GAMBRO HEALTHCARE/~/~/~/5/5/5E/~/~/~/~/~/5/~/5~~ SitelD: 015-021-001874 Tra~ng ~~~~~~~~ Overall Site i Employee Tra~g ~~~~~~~ 05/26/1998 i O WE ~VE 17 EMPLOYEES AT THIS FACILITY. o o WE ~VE MSDS SHEETS 'ON FILE. o o B~EF SUM~RY OF T~INING PROG~M: o o 0 0 o 0 0 0 -8- 08/14/2000 _ 04/20/98 1,3:~5 ~805 326 0576 BFD HAZ MAT DIV ~002 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805~326-3979 n~s~uc~io~s: ~¢ ~ '~"--~ 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 condse as'possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSr~SSN~: ~ambro HeatfAec~oa LOCATION: c/q(X~) ~'~ni~ 'A~e, %¢i~ tOO- a ~.~G ~D~SS: ~~ D~ & B~S~ET ~ER: SIC CODE:~ P~Y ACT~: / SI~CTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 1 04/20/98 13:35 8805 326 0576 BFD HAZ MAT DIV ~003 HAZARDOUS MATERIALs MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION R~..OUEST&~l,_l~r 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 TI-IE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, 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 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 04/20/98 13:36 ~805 326 0576 BFD HAZ MAT DIV ~004 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES x ^G . C¥ O n xc^xIONPgOC Si B. EMPLOYEE NOTIFICATION AND EVACUATION: ..~_q.~ (~~ C. PUBLIC EVACUATION: ~ CL'~o,CJ~CO fl-ti ViM-t~ o r~ O~-(2.(oor D. EMERGENCY MEDICAL PLAN: 04/20/98 13:36 ~805 326 0576 BFD HAZ MAT DIV ~005 HAZARDOUS MATERIALS MANAGEMENT PI,AN SECTION 7: MITIOATION, PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/ORMINIMIZATION: ~ C. CLEAN-UP PROCEDLIRES: .~gJL gF. CTION 8: UT_YLITY SHUT-OFFS {LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: M, ~ E)~Jce~( O(' ex'~d ELECTRICAL: P-jeo.~( aOO. CYe-{ t~ SPECIAL: ~dl ~ LOCK BOX: ~/NO IF YES, LOCATION: ~r~ SECTION 9; PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): ~4clf'j n K~L~ r~ oh '~;+c ( ~~ o~ o~ ~,u°. ~;dx. o(' b~ 4 i~RDO US MATERIALS INVENT~ Page of 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Che~k if chemical is a NON Trad~ So:r~ [ ] Trad~ Secret 2) Common Name: O ~f~"~'~ ' 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[~Su~a__,~nReleaseofPressure[~lImmedia~Health(Acute)[ ] Delayed Health (Chronic) [ ~) W~TE cLASsn~c^TION (3-disit code a,,-, DHS ~orm S022) USE CODE 6) PHYSICAL STATE Solidi ] Liquid[ ] Gas [if"] Pure~ Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND TnvIE AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Dail~ Amount ~:;~ ~'O2_ Lbs [ l Gal [ ] fO I'll a) ConUauer. Average Daily Amount Curies [ ] b) Pressure: 7.. Annual Amount c) T .emr, erature # Days on Sit~ Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONEKr CAS// % WT AHM the three most hazardous 1) [ chemical componenm or 2) [ any AHM components 3) [ 10)t. OC^UON ~0,.f ~-r-oCa A.(z~ e,~ 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check ifchemical is a NON Trade Secret [ ]TradeSeoret[ 2) Common Name: ~k//~ T~/~,A(- ' -F ~=~ (g- ~'"'~ 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL ttEALTH Hazard Categories Fire[ ]Reactive[ ]8,_,a_~ReleaseofPressure[ ] lmmediateHealth(Acute)[ ]DelayedHealth(Chroni¢)[ 5) WASTE CLASSIFICATION ' (3-digit code ,%m DI-I8 Form 8022) USE CODE 6)?HYSIC,~STA~ SoUa[ I I, iquia[ I C-as[ ] Pu~[ I ~[ ] Waste[ 7) AMOUNT AND TIME AT FACR, rI~ .,,_~ UNITS OF ~URE 8) STORAGE CODES ' Maximum Daily Amount ~ Lbs[ ]Gal[,_~]ff3[' ] a)Containec. 2-- Average Daily Amount ~d~..9 Curies [ ] b) Pressure: Largest Size Container # Days on Site ~ ~ ~ Circle Which Months: All Year, J, F, Ivl, A, M, $, $, A, S, O, N, D 9) MIXTURE: List -COMPONENT CAS# %.WT AHM the au'ee most hazardous 1) .~C_~-vtc_ Act/~ [ chemical components or 2) ~a-t_c_c v~ -~ co-a,o e. [ any AI-IM components 3) ! certify under penalty of law, that I have personally examined and am familiar with the information on this and all attached docunumts. I believe the submitted infoxmation is true, accurate and complete. ~~ PRINT Name & Title of Authorized Company Representative / Signature - Date' H~RDOUS MATERIALS INVENT(~ Busincss Name' ' ' Address CHEMICAL I)ESCRIPTION I ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Ch~ck if chemical is a NON Trade socret [ ] Trade Secret 2) Common Name: ~TO'('/~S,L'T~ ~ I~'~ 3) DOT # (optional) ChemicalName: -O~A,L~5;,a~T~ '~f.~/b CO~J~C~w~T~ AHM[ ] CAS# 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudckm Release ofPressure [ ] Immediate Health (Acute) [ ] Delayed Health (chronic) 5) WASTE CLASSIFICATION (3-digit code fxom DHS Form 8022) USE CODE · 6) PHYSICAL STATE Solid[] Liquid~] (}es[ ] Pur~[ ] lVlixtwe~] Waste[] Radioactive[ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ' ~_ Fo~*' Lbs [ ] Gal [~] it3 [ ] a) Containen. Average Daily Amount ~ t ~ Curies [ ] b) Pressure: Annual Amount ~ ~ c) Temperature Largest Size Container ~,~ # Days on Site Circle Which Months: All Year, J, F, M, A, M, $, J~ A, S, O, N, D 9) MIXTURE: List COIVIPONt5~ CAS# % WT AHM the three most bo=srdous i) ,/~ ~--C- T, C_. ,~C,1'3 [ chemical components or 2) a&/~o~-~ C~4~-c.~ ~ [ · any AHIVI components 3) [ 1) INVENTORY STATUS: Ncw [ ]Addition[ ]Revision[' ]Deletion[ ] Check ff chemical is a NON Trade Secret [ ]Tredesocret[ 2) Common Name: ~ ( - Cz~/L'7-' 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health .PHYSICAL HEALTH Hazard Categories Fire[ ]Rcactive/~/.~:5]-S,addenR¢leaseofPressure[ ] lmmediateHealth(Acute)[ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION . (3-digit caxte from DI-I8 Form 8022) USE CODE 6) PHYSICAL STATE Solid~' Liquid [ ] Gas [ ] Pure ~ Mixture i ] Waste [ ] Radioactive i ] 7) AMOUNT AND TIME AT FACIL~,,~ UN1TS OF MEASURE 8) STORAGE CODES Maximum Daily Amount -z_?~_.~ Lbs[~]Gal[ ]fL3[ ] a)Contai~er: I Average Daily Amount ~ Curies [ ] b) PresSUre: Annual Amount ! ~ c) Tcmpmmture LarSest Size Container ! ~- # Days on Site. ~ 65'- Circle Which Months: All Year, $, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % v~rr AHM the three most hazardous 1) ~c~,~,,.~ ~c/~P~/O,~r~ [ chemical componc~nts or 2) [ any AHM compon~ts 3) [ 10)LOCATION. //,j ~'T'c~-(~. ~ ! certify ~nder penalty of law, that I have personally examined and ~ familiar with thc information on this and all attached documemts. I believe thc submitted information is true, accurate a~d complete. PRINT Name & Title of Authoriz~l Company Repres~tiv¢ Signature Date HAZARD COMMUNICATION PROGRAM FOR VIVRA RENAL CARE ~ The purpose of this program is to ensure that potential hazards and hazard Control measures for chemicals used by Community Dialysis Centers are understood by Company employees and to comply with OSHA Hazard Communication Standard 29 CFR 1910.1200. This written program is available for employees to review at any time. It is located in the Workers' Compensation/Safety b~nder kept in the office of the Unit Administrator. A copy of this program will be provided to any employee upon request. container Labeling The Unit Administrator will verify that all containers received for use-by Community Dialysis Centers have been evaluated for hazards and: 1. Will be clearly labeled, tagged or marked as to the contents. ~,~, 2. Will ensure that labels are not defaced or removed. ,. ,~.3. Will ensure that the labels have the appropriate hazard warnings in the form of pictures, symbols or a combination thereof. 4. Will ensure that labels are in English and in any other language that may be necessary for the employees to read. Materia~ safety Data Sheets The Unit Administrator will maintain a llst of the hazardous chemicals used in the facility. The Unit Administrator will be responsible for requesting Material Safety Data Sheets (MSDS) on all chemicals purchased from the supplier or manufacturers ~that are used in the facility. The Material Safety Data Sheets follow thiS.Program. The Material Safety Data Sheets: 1. Are English and in any Ofhe~ Language that may be necessary for the 9mploy~e~iltoi~ea~. 2. Identifies the product'as described on the labeling. 3. Give the physical and'chemical characteristics of the ~,, product. ,-~.-.~ 4. Give the physical and Chemi~al'~haZards of the produc . 5. Give the health hazards!'ahd'i~adlcal~,Conditions that may be aggravated by the prodUc{~ 6. Give the primary roUte~,'of' en'~Y~. 7. Give the appropriate 'expd~e~iimits. 8. Give the carcinogen indications (if the substance has carcinogenic potential.) 9. Give the precautions for safe handling. 10. Give the control measures. 11. Give emergency first aid procedures. 12. Give the date of the MSDS preparation. 13. Give the name, address and phon~ number of .the chemical manufacturer,~ importer or ~resPor%S~ble party. In~ormation/Traininq for Employees " ~'~'~he unit Administrator at the facility will provide employees with .information and training on hazardous chemicals in their work areas at'the time of their initial assignment and whenever a new chemical hazard is introduced in their work area. iii~~ information/.training requirements of the Hazard Communication ~.~P~ogram is being met through a verbal program. The following information will be addressed during the orientation: 1. The employee will be notified that this orientation is required by the OSHA Hazard Communication Standard. ~ ~ ~ 2. The employee w.ill be informed where the hazardous ~ ...... chemicals are used in the facility. 3. The'employee will be advised of the hazardous chemicals that may be used in his or her routine work area. 4. The employee will be advised of the hazardous chemicals used in his or her work area that may be considered non- ~ routine due to infrequency, location, etc. 5. The.employee will be advised where to find the written Hazard Communication Program and the corresponding Material Safety Data Sheets.. .~. 6. The employee will review the written Hazard Communication Program with the Unit Administrator during this training. 7.The employee will be shown how to use the MSDS. 8. The employee will be advised of the physical and health hazards of chemicals in the workplace. 9. The employee will be instructed in the use of personal protective equipment. - 10. The employee will be instrUcted on emergency/firSt aid procedures including notifying employees of the .~ ~ ~ , industrial physician(s) theY can Use if there is an · ..~ exposure. ,~l~z The employee will be adVised of the methods and obserVations used to detect the presence or release of a hazardous chemical in the work area (such as visual ....~ appearance, odor, etc). 12. The labeling system for haZardoUS chemicals will be explained to the employee. 13. Time will be allowed for any. discussion or questions about the Program. 14..The employee will sign an Employee Inservice Training and Continuing Education Record Verifying that he or she has been orientated on the Hazard 'Communication Program. This Inservice Training Record will be put in the employee's Personnel/Health file. !nforminq Outside Contractors or Worker= The Supervisor will provide outside contractors and workers at the facility with the following information prior to'completion of any Work at the facility: 1. A list of hazardous chemicals to which they may be exposed while working at the facility. 2. Measures they can take to lessen the possibility of exposure. 3. The workers will be informed that the MSDS are kept 'in the Supervisor's office in the Workers' Comp/Safety manual and that the MSDS details the chemicals to which they may be exposed. 4. The workers will be advised of procedures to follow if they are exposed. Rights of Employee Form The right to know of the listed toxic substances present in the work place. The right to obtain a copy of the Material Safety Data Sheets for each listed toxic substance present. The right to refuse to work, under specified circumstances, with a listed toxic substance, if not provided a copy of the Material Safety Data Sheet for that substaKce within 5 working days after submitting a written reques~ to the employer. The right to instruction, within 30 days of employment, on the adverse health, effects of each listed toxic substance with'which they work in the work place, how to use each substance safely and what to 'do in case of emergency. The right to obtain further information on the properties and hazards of listed toxic substances from: Toxic Substance Information Center 2551 Executive Center Circle, West Tallahassee, FL 32301-5014 1-800-367-4378 The right to protection against discrimination, or discharge/discipline for having exercised any of these rights. I have read the above information and understand my rights as listed in the "Right to Know" law. Date Employee Signature Unit Administrator's Signature KBF-7171 CORRECTION NOTICE BAKERSFIELD FIRE DEPARTMENT N°' ~ 012.3 Location Sub Div. Blk. Lot You are hereby required to make the following cor~ctions at the above l~ation: Bakersfield, CA 93309 Compledon Date for Corrections ~{~ ~/ l~ Date ~/fT/~ ~ ~ ~r~*~ Inspector 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE 3/(? ADDRESS ,,4qO0 ~.Po..t~.~tA '.~.,d ~ to0 PHONE NO. <g-o~- - ~2.2.. 4':/t[ FACILITY CONTACT 5o~.t~,0 BUSINESS ID NO. 15-210- · INSPECTION TIME t:;~-oo NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~Routine t~ Combined [] Joint Agency [21 Multi-Agency [] Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand '~ ~/'(:~'-0~ "1'0 ~Olgo* tT' Business plan contact infbrmation accurate /,,/~t,O~t_c ConnPt..E°t'~ ff~,~ Catt,~.7/~lt'4ol-,c~~ 'OtZ.~ Visible address t/ ~ Correct occupancy t,," Verification of inventory materials v,""/~&~ l~C/t~t~6- Verification of quantities i,/"" t ~ Verification of location /,,,' ~ Proper segregation of material ~ ~)?.Mt~ <~-Da.a(~ M~-O.g Verification of MSDS availability x,"'M'~-~t~ ~t~i ~T' Verification of Haz Mat training Verification of abatement supplies and procedures ~' Emergency procedures adequate V/ ~l_~'t~ ..CO~t~n Cf' oJ / g, o s. Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand v; " ~5TTX-~ ,d'~-0 o.t~J i,~P~-:"~ C=Compliance V=Violatlon Questions regarding this inspection.'? Please call us at (805) 326-3979 esponstble Party While- E,w. Svcs. Yellow- Station Cop5' Pink- Business Copy Inspector: "~. ~ HAZA~OUS MATERIALS INVENTORY ~usiness Name Address ,d~°((~ j ('--OX.~U[/3- CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New/~, ] Addition { ] ReviSion [ ] Deletion [ ] Check ffchemical is a NON Trade Secret [ ] Trade Secret 2) Common Name: ' ~-,.~./..~,x/ C_.o~-O <~7-~fv..tt.~x~'r' 3)DOT # (optional) Chemical Name: AHM [ ] CAS # 4)-Physical & Health PHYSICAL HEALTH I-~a?~ Categories Fire [ ] Reactive [~] S~dd_on Release of Pressure [ ] lmmocliate Health(Acute) [ ] Delayed Health (Chruni~ 5) WASTE CLASSIFICATION (3-digR code from OHS Form 8022) USE COVE 6) PHYSICAL STATE Solid [ ] Uiq~d [~] Gas [ ] Pure [ ] Mixture [4] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILrI'Y UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ~ Lbs [ ] Cml [~_~] R3 [ ] a) Containec. Average Daily Amount / ~ Curies [ ] b) Pressure: Annual Amount ¢) Temperature Largest Siz~ Container # Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONEHT CAS# % WT AI-IM the three most hazardous . 1) [ chemical components or 2) [ any AHM componmts 3) [ 10)LOCATION //"'[St O ~ ~_~/~ L ,cO 1) INVENTORY STATUS: New [~"] Addition [ ]Revision[ ]Deletion[ ] CheckifchemicalisaNONTradesoo'et[ ]TradeSec~t[ 2) common 3) not # Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Ha2ard'Categories Fire[ ]Rea~ivc[C~,]$uddenR¢leaseofPressure~ rmmediateHealth(Acute)[ ]DelayedHealth(C~] 5) WASTE CLASSIFICATION (3-digit code fsom DHS Form 8022) USE CODE 6) PHYsicAL sz^TE Solid { ] Liquid [ I C-~ Pure [,~t Mixture { I W~te {. I P.~ioW~ve [ l 7) AMOUNT AND TIME AT FACILITY ~ OF MEASURE 8) STORAGE CODES Maximum Daily Amount _~"-O2- Lbs[ ]Gall ]R3[~] a)Containen.' Average Daily Amount .5'-o"L. Curies [ ] b) Pressure: Annual Amount V'O'7-.- c) Tampexatur¢ Largest $iz~ Container ~- ~ / #.Days on Site 3~'" Circle Which Months: AIl Year, J, F, M, A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ chemical components or 2) [ any AHM components 3) [ ! certify under penalty oflaw, that ! have personally examined and am familiar with the information on this and all attached documents. I believe the submitted infommtion is true, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date HAzARDous MATERIALS INVENTORY , Page ' of- - Business Name Ad~ CHEMICAL Di~SCRIIrrlON l ) ~INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ~ ] Check if chemical is a NON Trade Secret [ ] Trade Se~; [ ] 2) Common Name: ~,T~/X_t-~ ~ 4k7~,r~ ~_O,M~'t~e~-V~ 3) DOT # (optional) ' Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH ' HaTs,~ Categories -' Fire [ ] Reactive [~Sudden Release of Pressure [ ] Immediate Health (Ac.ute) [ ] Delayed Health (Chronic) [ ] 5) WASTE cLASSWICATION (3.digit cod~ fxom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid ~] Oas [ ] Puxe [ I Mixture [~] Waste [ ] Radioa~ve [ ] 7) AMOUNT AND TIME AT FACILI'~Y~x UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ~"~'~ Lb~ [ ] Gal [fi~'] ft3 [ ] a) Container:. ~- Average Daily Amount 700 Curies [ ] b) Pressure: Annual Amount [ ~)OO ¢) T~mperatux~ Largest Siz~ Col~tnlnel' # Days on Site ~<' Circle Which Months: All year, J, F, M, A, 1~, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# ~ WT AHM the three moSt h-,~nlous 1) ACC--~tC Ac(_-,~ [ ] [ l chemical components or 2) [ ] any AHM components 3) 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] CheckffchemicalisaNONTradeSexxet[ ]TradeS~'~t[ ] 2) Common Name: '~l ~/~rr_Y- 3) DOT # (optional) -ChcrmcalName: .5~O Fo t °e~'l t~ / C /Jrc'~'/~rO ~r-~ AHM [ ] CAS# 4) physical & Health ' ' PHYSICAL HEALTH HmardCategories Fire'[ ]ReaCtive[~]SuddenReless~of~[ ] lmmediateHcalth(Acute)[ ]DclayedHcalth(Chronic)[~'] ~) wAsTE CLAssnnc^r~o~ (3-,u~it ~x~ eom D~ ~orm 8022) USE COD~ 6) PHYSICAL STATE Solid ~ Liquid [ ] Gas [ ] Pur~ [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount /o%~_) Lb~ [~] Gal [ ] ft3 [ ] a) Container:. Average Daily Amount Curies [ ] b) Pressure: Annual Amount c) Tempo~ature Largest Size Container # Days on Site Circle Which Months: All Year, J, F, M, A, M, $, $, A, S, O, bi, D 9) MIXTURE: List COMPONENT CAS# % WT AttM [ l the thr~ most hazardous 1) [ ] chemical components or 2) [ ] any AHM components 3) ! certify under penalty of law, that I have personally examined and am familiar with the information on this and all a~u~ched documents. beli%e the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Repre~mtative Signature Date · - ~ '~APR ~ 'B8 14:17 FR UIURA-BKSFLD PAGE.004 PRODU, C,T_ INFORMATI ON WHAT TO DO IF RENALIN DIALYZER REPROCESSING CONCENTRAtE'SPILLS If Renalin~ (Dialyzer Reprocessing ioncentrate or Cold Sterilant) spills or arrives in a damaged conta inet, be aware of the following precautions and procedures for dlsp)sal: Important: Renalin® can cause perm~.~ent injury to eyes or skin or cause irritation to membranes in t~=~ nose, throat or lungs. *If Renalin~ contacts eyes, imnediately flush eyes with cool .running water for 15 minutes, lifting upper and lower lids intermittently, and then promptly seek medical attention. *In case of skin contact, wash affected area with 'large -amounts of water. If irritatiDn persists, seek medical attent ion. *If breathing discomfort occurs, immediately leave area and seek fresh air. 1. Renalin~ is a corrosive and an oxidizer. In case of a spill, goggles or safety glasses that are designed for splash protection should be used. Lon9 sleeve shirts are recommended. Gloves should be rubber "kitchen variety" strength. Make certain individuals read warnings and precautions printed on the bottles and cases. In tk.e event that the permissible exposure limit (PEL) as measur~.~d by the time weighted average (TWA) is exceeded (10ppm for acetic acid and lppm for hydrogen peroxide)', suitable respiratory protection should be used. 2. After donning protective gear, create a barrier around the spill and sprinkle powdered bsking soda (sodium bicarbonate) or soda ash (sodium carbonate) on the spill to neutralize the solution. a. If a floor drain is ~vailable in the spill area, flush the area of th~ spill thoroughly with water. Then proceed to flusk the drain for 4-5 minutes to clear the line. b. If the spill is large enough that is must be mopped, it is essential that the spilled Renalin~ first be neutralized with baking soda or soda ash. (If this procedure is not foll)wed, the ur~neutralized Renalin~ will damage the mop.)aDO NOT mix the neutralizing agent with Renalinein closed or ~nvented container as this combination ,ill produce a gas that result-~ in high pressures. To neutralize, sprir. [le enough powder to cover the spill thoroughly and ,~ait a few minutes. Using a veryr~ wet mop, carefully ~op up the neutralized Renali~' APR 22 '98 14:18 FROM UIURA-BKSFLD PAGE.BBS /-~ solution, rinsing the mop frequently. When complete, .... flush the neutralized. Renalin~ solution to drain, diluting approximatel, r 1:1 with water. Rinse the mop thoroughly and dry. W~Lsh down the area of spill with detergent and air dry c. Place all Renalin~-so tked cardboard packaging materials in a deep s.nk and thoroughly soak with cold water. After soa:ing in cold water, discard packaging materials ii unsealed, clean plastic trash bags. 3. Renalin~ contains hydrogen per tide and~acetic acid. Safety precautions routinely used for disposal of these compounds should be observed. 4. Immerse any clothing contaminated with Renalin~ in water and wash as soon as possible. 5. .For additional information, contact Renal Systems at 1-800-328-3340. TOTAL PAGE.005 ** In ~e ~vem of a fire or discreet at ~ di~ysis ~r ii ~ ~~ of ~ C~ N~~or of ~ w ~ ~ c~fion d ~ b~ldi~ ~ ~] ~ ~om ~ ~ ~r to ~ ~ or ~ ~t, ~ wt able to w~ on ~e~ o~ ~1 ~ pla~ m w~ or p~a~ ~ a ~ ~ ~ ~o~ twin ~e buiidi~. Hdp ~d ~ ~o~ ~ eye.one h ~ely ~ v~. A ~e~ ~n ~ ~~ W ~ for ~lp. EVACUATION PROCEDURE 1. Discontinue treatment. 2. Clamp and cut blood lines. 3. Evacuate patients, visitors and staff from building. Secure emergency box for supplies to treat hypotemion. 4. Notify thc lru'e department. 5. Secure fire extinguisher if safety permits. 6. Have a staff member stay with thc paticn s at all times. 7. Reassure patients of their safety. Close oors to prevent spread if possible. Leave lights o12. 8. All staff and patients will assemble in bm:', parking lot where the charge nurse will take roll to assure all patients and staff have been evacuated from building. Safety is everybody's responsibility. F..mployees can ~flen prevent accidents and injuries by paying ..,,,-'~.ntion to what is around them and by doing things the right way. All Vivra employees should by dected to remember and follow these basic safety rui-.s at work: APR Z2 '98 14:2G FR( UIURA-BKSFLD PAGE.OOZ ~'-'"~o$s of Power 1. Hand crank blood p~p m p~wm clo~ ng of ~e pareto's blo~. ~is shoed ~ ~o~ for a m~ time ~ of lO (t~) ~inut~. If ~e ~wer is s~H out, r~m ~ patient's bl~. 2. ~~ ~ of ~ ~w~ loss. 3. Nofi~ ~wer ~y ~ ~ M~i~ )~or. 4. If oval 1o~ of ~wer ~ ~~ do at put ~n~ on ~e machi~ ~ffi ~ ~u~ of ~ ~r 1o~ is ~solv~. It ~y ~ ~~ to ~h~Me ~m¢n~ at ~e di~fion of ~ M~I D~tor. TOTAL PAGE.00E ** ~.~ ~PR ~ ~8 15:43 ~ UIURA-BKS~LD~ PAGE.001 MODULE 3 THE REPROCESS1NG PI ,OCEDURE Section 2. Preparation of21% Renal~ Solution PURPOSE: Preparation of 21% Renalin s ~lution from Renalin concentrate Equipment Needed: ~, PPE, i.e., waterproof long sleeve go~ n, full face protection faceshield, "kitchen-grade" robber utility gloves and robber boo! ~ · Renalin concentrate in pm-fflled 2.5 [allon container · An indelible marking pen i!~:i~?: ~~ ~ ~ii~~[!i~~.':~'~'~'5' wi'i' ~:' :.z. :~, ~.; :;:[ ::::::::::::::::::::::::::::::: :::: ;:~ ;::::::j:: zz~!~;:::~r.; ~:ii ~;~;:~ ~:~',:~;~YJ:~:::~!~:r,::~ ~ii .!! i}::[ RATIONALE PROCEDURE ....... 1. Don PPE including Ion§ sleeve water Step 1. Renalin concentrate is a strong proof gown, full face protection oxidizing agent. Appropriate ~ faceshield, "kitchen-grade" robber glo, es must be worn when handling Renalin and robber boots, concentrate to prevent chemical exposure. 2. Verify that Renalin concentrate has no Step 2. Outdated concentrate must not be reached thc expiration date. .~' used. Use of outdated concentrate may cause incomplete sterilization of r~processed dialyzers and result in patient infection(s). 3. Remove one 2.5 gallon ~hipping Step 3. Cartons are delivered two (2) per container from the carton, carton. 4. Verify that the container is £tlled with he Step 4. Renalin is shipped with 2 liters of proper volume of Rcnalin concentrate, concentrate in a translucent container. Do not use if liquid level is not within /~ Using containers with insufficient inch of the crown below the lower Renalin concentrate may result in shoulder of the shipping container (see improper sterilization of dialyzers. figure next page). Revised May 1997 · APR ~ ~8 15:44 FR UIURA-BKSFLD PAGE.002 MODULE 3 THE REPROCESSING PROC'ED JRE Section 2. Preparation of 2][%, Renalin Solutl m (continued) Dilution Level Lower Shoulder Crown .~--~ Renalin Concen~ te Container 5. Flush purified water in fill hose for ' Step 5. Flushing removes any stagnant water approximately thirty (30) seconds, which may contain bacteria and/or endotoxin. 6. Remove vented cap from concentrate Steps 6-7. Be careful not to spill concentrate container and set aside, open side up, and/or contaminate cap. 7. Insert water hose just inside the open container. Do not touch inside of conta/ner or concentrate. 8. Wrap a damp wipe mound the neck of Step 8. Limits fume formation. the container and the water hose. 9. Open the water valve until a gentle Step 9. Splashing Renalin can cause severe stream is produced, chemical bums. 10. Close water valve when the liquid level .Step 10. Assure proper concentration of reaches the top depression on the Renalin solution. shipping container (see figure on ~ previous page). Revised May 1997 ~.~ 'APR ~ '~ 15:44 F UIURA-BKSFLD PAGE,00~ MODULE 3 THE REPROCESSING PROCED LIRE , Section 2. Preparation of 21% Renalin Solut on (cor, I#med) 11. Securely replace the vented cap. Step 1 I. Renalin conccntratc is heavier Thoroughly mix thc Rcnalin ~olution y water. Active mixing of the rotating the container with a circular solution assures even distribution motion for approximately one (1) throughout the tank. minute. NOTE: IF CONTAINER IS ASSURES PROPER CONCENTRATION OVERFILLED, DISCARD OF SOLUTION. SOLUTION AND REMIX. 12. Label container, using indelible mat'kc: Step 12. The container must be labeled with preparation date, expiration date a ad with the date of preparation and Technician's initials, expiration. 13. Place freshly prepared Renalin solutio= Steps 13-I4. Allows proper flow of next to empty or outdated container, solution through uptake hose and assures Remove and discard vented cap. accurate proportioning of solution. 14. Remove the Renatron uptake hose from the empty or outdated container and pl; Ge into the freshly prepared Renalin soluti m container. Securely tighten the cap and verify the vent hole in the uptake tube i clear. 15. Place the Renalin solution container a,~ y Step 15. Renalin® is direct mmlight from direct sunlight, sensitive. 16. In preparation for dis~carding outdated Step 16. Minimizes Renalin fumes and Renalin, turn on cold water to the sink. splashing of concentrate. 17. Slowly and carefully pour the outdated Step 17. Splashing Renalin solution can Renalin down the drain being careful t¢ cause chemic, al bums. avoid spills or splashes. NOTE: AVOID INTRODUCTION OF AVOID MIXING OTHER CHEMICALS OTHER THAN INCOMPATIBLE MATERIALS ' RENALIN INTO DISPOSAL AREA SINKS. Revised May I997 '98 15:45 UIURA-BKSFLD PAGE.004 MODULE 3 THE REPROCESSING PROCE£ URE Section 2. Preparation of 21% Rcna[in Solu! on (continued) 18. Rinse the emptied Renalin container v ith Step 18. Rinsing the container protects cold tap water to remove all traces of 1~ ae waste handlers from accidental solution, exposure. 19. Rinse sink with cold tap water to remo ve Step 19. Removes Renalin from surfaces residual Renalin solution from the and sink trap. surfaces for a minimum of two (2) minutes. 20. Discard the empty and timed Renalin Step 20. Renalin containers must not be container in a waste receptacle or set mused. aside for recycling: Do not use containers for other than Renalin use. 21. Record data on Reuse Daily Log Shee~ Step 21. Provides preparation of solution documentation. Revi~ed May 1997 ** TOTAL PAGE.004 ** APR 22 'S8 14:12 F UIVRA-BKSFLD PAGE.001 8 List of Hazardous Chemicals The following is a list of all known Hazardous Chemicals used by employees of vivra Renal Care. ~rther information on each noted chemical can be obtained by revie~,ing Material Safety Data Sheets located at the Nurses Station. _~azardous __C~ic~l s Work Proc. e_ss~ Should additional hazardous subs :ances be put into use at any facility, the Unit Administrator ~ill be responsible for obtainin~ the Material Safety Data Sheet("M~DS") and notifying the e~loyees of the presence of the chemical,.~.nstructing them in its actions, etC., and documenting said trainl:Lg. Rev. 1996 TOTAL PAGE.001 ** APR P~ ~8 14:1~ FR UIURA-BKSFLD PAGE.001 1345 To--ark' Dr., suite B ~ee~ OH 43537 · mergency Telephone # '.1-800-831-2292 Nights, Weekende, Holiday Telephone wil,lia~ Griswold late Prepared ....... May .19~9_2 ..... Prepared by: _ Colon Na~ie: · B'lea.~h S. 25% ......................... __ C~em/oal Na~&: '$ .o~ium .Rv~ochlorite_5~.25_.%' ' . Formula: ..~aOg!L - CLHO. N_a ..... Principal Hazar~c, us Component(s) (cb mica1 & ~:ommon name(e)) .... S~i~ HVDochlo~e - 5,25 % ************************ sz 'os -- p,Y' TC ...OA A ********************** 8o£1ing Poi~ decomuoses Specific Gravity n/a ... Vapor Pressure ._: , i' ~la- ' _ .. Percent' volatile _. , ,/a .. Vapor Density ti .. , n/a , _._ Evaporation Rate n/a _ Soluabili~y in wa~er ~.00% _soluabl e in wa=er ..... App~ar&n:=e an~ o~tor Yellow lizzu .d-' wi~_~_~ona disagreeable' odor., APR ~ ~8 14:P0 F .R~ UIURA-BKSFLD ~ PAGE.00~ *************~'*** .,' giON IV -- F!~E AND EXPLO~ Flash Poin~ , nl.a . ._ FI~ ~ble Limi=~ n/.a .... ~&n~ishing M~ia w~er ~orav or fo~. co~ .... ',, - ........ ~ni~er for chlorine or 8elf con~a~ ned breathin= aD. fa=us. qR~bu~able_ mater~al. MaY. iD!ti~te or promote _combustion.. A~id a~ heat accelerate decomDosi=ton ..... ,, ,, ************************ SECTION V =~ MEALTH HAZARD '~ATA ********************* .Effe~-~S O~ Overexposure:_ V,erv ..irrititin~ to all_Joodv._surfa_ce$ includina l~a-~, and mucus membrane-~. -~ay _Dfc dUc~_~vere b~onChia1 irritation and D~l~onaz'V edema, ' ..... IBgeS~iO~: ___ If '¢0~s¢i.ous. dr_ink, la~ ue ~uantitle~ o~ m~lk or w~er- , - V ******************: Stabili=y: unstable lcondi=ions ~o Avoid: , , Incom~a=abil~ySta~le ~._~~iVe Hazardous De¢0mpo~i~ . _ Hazardous Polymerization- Will ~o= ~¢=ur A , 'Other Conditions =o Avoid ~ ° 'SS 14:20 FR ' ~ APR 2~ UIURA-BKSFLD PAGE 003 'S~eps ~o J:)o T~en i { with a dike dilute with water ..... Ua_ no=..release x~te natural wa=e~avs. ,~. ~eu~alize wi~. s~ium bi~ulfate an~, ~isuose o~ ma_~erial a~cor~in= to all. s~a~a & ~e~eral re~la~ions .......... ,. WaSte Disp=aal Me.od , Re~e= to-.re~ ula~io~s ...... - *****~&.'~***~' ~ECTIONVITI -- SPEC] LL PR~'-C-YiON_._IN__FOR~ATION *******~.***' Respiratory prote==ion ,None . ,, : Ven~ila~ion: Lo=al EXhaus= - ' _ X ; Mechani=al , ,, O~her ..... -~e~u~ion~ ~o ~e T~ in Handling and S~uring for. a par=i, cular purpose c~r ~o information or the .prod~: which information re~er~. TOTAL PAGE.003 ~ ~ ~ gPR ~ '~8 1~:16 ~I UIURA-BKSFLD PAGE.001 ,~.,. MATERIAL SAFETY DATA SHEET RENALIN~ COLD .S~,ER] 5ANT/24~ H202 Renal Systems P~eparation Date: April 25,1997 Division of Minntech Corporation R!~vlsion: E 14605 28th Avenue North ~ lformation Phone Number: Minneapolis, MN 55447 712) 553-3300 (800) 328-3340 ClemtrecEmergency Phone Numbers: (703) 527-3887 (800) 424-9300 NFPA Hazard Ratings Health: (Blue) 2 Flammability: (Red) 0 Reactivity: (Yellow) I Special Hazard~: Corrosive ~,E~P~uL INFO~.MATION: Ca:alog Number: 78253/78335 E~k Reg. Number: 52252-1 T~ade Name: Renalin 'Cold --~ Sterilant for Dialysis Use HAZA~D. OUS iN~REDTRNT/IDENTITY INFO~ATION~ Ingredient CAS No. Percent TLV PEL Hydrogen Peroxide 7722-84-1 24.0% 1 ppm lppm Peracetic Acid 79-21-0 4.0% N/E N/E Acetic Acid 64-19-7 10 ppm 10 ppm Wa~er 7732-18-5 N/E N/E N/E= None Established 50095-002/E GCO~ 7208 (DO27) Page 1 of 3 'aPR aa '98 14:16 F UIURA-BKSFLD PAGE.00a .-~, Renalin~ Cold Sterilant/24% H202 50095-002 E Page 2 of 3 PHYSICAL DAT~.% Boiling Point ("C @ 60 m~g): N/A Melting Point (°C): N/A Vapor Pressure (mm~g): N/A Vapor Density (AIR=l): N/A Specific Gravity {H20=1): 1.090 - 1.140 Evaporation Rate: N/A Solubility In Water: Complete pH as Concentrate: 0.6 - 1.2 Appearance and Odor: Clear, Colorless Liquid, Pungent Odor FIRE AND EXPLOSIQN HAZARD DATA: Flash Point: N/A Flammable Limits; N/A Extinguishing Media: water, Foam, C02, Dry Chemicals Fire Fighting Procedures Wear self-contained breathing apparatus and full protection equipment. Unusual Fire and Explosi, n Hazards: ,N/D · r~aJuTH HAZARD INFORMATION: Symptoms of Exposure: Can cause burns, as evidenced by a temporary whitening of the skin, irritation to eyes, skin, and muc¢ us membranes. Carcinogenicity: Not listed as a cancer causing ageEt. EMERgEnCY FIRST AID: 'EYES AND SKIN- Flush with exce~s water at least 15 minute~. If .burn or irritation has occurred., see physician immediately. If clothing is contaminated, remove clothing, wash skin and wash clothing before reusing. INGESTION- If swallowed, drink large amounts of water. Do not attempt to induce vomiting N/A= Not Applicable N/D~ None Determined 'APR ~ '98 14:17 F UIURA-BKSFLD PAGE.003 Renali~ Cold Sterilant/24% H202 50095-002/E '~'~ Page 3 of 3 ~ACTIV,ITY INFORMATION: Stability: Pro~iuct is stable. Conditions to Avoid: Hot storage Hazardous Polymerization: WillL not occur. Materials to Avoid: ~ea'ry metals including iron, cop])er, copper alloys, brass and alu~ninum, salts, flammable org.~nics, alkalis, caustics, chL)rine and formaldehyde. Hazardous Decomposition: Oxy,~e~ and heat. Do not mix with chl. Dr~nated products as this could liberate toxic corrosive chlorine gas BAFE,p~%NDLINGAND USE:. Spill Response: Wash. ~own area thoroughly with water, mop thoroughly. Do not use adsorbent to soak up spill. Waste Disposal: To be performed in compliance with all c~irrent local, state, and federal regulations. Do not contaminate water food, or feed. Waste resulting .,-,~ from ihe use of this product may be dispc~ed of on site by diluting in a sanitary sewer or at an approved wast~ disposal facility. Handling and Storing: Keep container closed, but vented, when not in use. Store in a cool, dry area (below 75~F). Do not transfer prod%ct from original container and once )roduct has been removed, do not retuz~ to original container. CONTROL MEASURES: Respiratory Protection: Use ~ocal exhaust. If air cont4mination is above permitted levels, use suitable respiratory protection. Protective Covering: Eyes. Glasses, goggles or face shie]d should be worn. Skin-Rubber or plastic gloves should be w<rn when handling concentrate. Protractive aprons should be worn when spla::hes or spills are likely. Rubber boot: should be worn for spills.