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Home My WebLink AboutBUSINESS PLAN ~I ~ j MASS CHIROPRACTIC ____ i~ 4750 COFFEE ROAD, #107 :'~• UNIFIED PROGRAM INSPECTION CHECKLIST<<' ~~~~ SECTION 1: Business Plan and Inventory Program ': ~ BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPECTION DATE INSPECTION TIME ~ ADDRESS HONE NO. O OF EMPLOYEES G ~~ 7-Q'~ FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliance` OPERATION V=Violation l COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIII2SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ~i ^ VERIFICATION OF MSDS AVAILABILITY y ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ~~~ /// ~ ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? YES ^ NO EXPLAIN: ~~ 7 `~ _~ e• ___ __ QUESTIONS REGA//RDI,,NG THIS INSPECTION? PLEASE CALL US AT (861) 326-3979 ~i~QN ~ ~~ Inspector (Please Print) Fire Prevention / 1" In / Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink - Buainesa Copy FD2049 (Rev. 02/05) Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _he.it is issued for the followina: [] Hazardous Materials Plan ri Underground StorageOf H-=,:~ous Materials - . [] Risk Management Program. ~' " 13 Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002067 · ; .: MASS ~ .. .... LOCATION 4750 .'" "' . ' , . .:' t4 .' IA 1715 Chester Ave., 3rd Floor "' APPr°vedby: · (,~ Ralp~Huey, ~) Issue Date Bakersfield, CA 93301 OmceofEv~Services '~ Voice (661) 326-3979 FAX(661) 326-0576 Expiration Date: 'June 30=. 2003 ITE DIAGRAM FACI~I~ DIAGRAM ! Business Name: ' ~ /v-~, ,' - Business Address: R ~T~,HAET. MA2S. D.C.~ ~750 COFFEE 1~).. STE. 107 PH: 587-9741 ~MASS CHIROPRACTIC SiteID: 015-021-002067 Manager : BusPhone: (661) 587-9741 Location: 4750 COFFEE RD 107 Map : 102 CommHaz : Minimal City : BAKERSFIELD Grid: 16C FacUnits: 1 AOV: CommCode: COUNTY STATION 66 ~'%~ SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MICHAEL MASS / OWNER MARTHA MASS / OWNER Business Phone: (661) 587-9741x Business Phone: (661) 687-9741x 24-Hour Phone : (661) 588-1710xCELL 24-Hour Phone : (661) 747-4378xCELL Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: React Contact : Phone: (661) 587-9741x MailAddr: 4750 COFFEE RD 107 State: CA City : BAKERSFIELD Zip : 93308 Owner MICHAEL & MARTHA MASS Phone: (661) 587-9741x Address : 4750 COFFEE RD 107 State: CA City : BAKERSFIELD Zip : 93308 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: · ' ' (TYI~e o~ p~nt reviewed the attached hazardous materials manage- ment plan for/'~'~,,~ t;~t't it along with r- ~ (Name~Busima~) any corrections constitute a complete and correct man- agement plan for my facility. -1- 09/09/2003 Bakersfield Fire Dept. Enironmental Services~ 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: {661)326-3979 FAC L TY NAME _ INSPEC.TION DATE INSPECTION TIME '%6'~S-~ .................................................................................... ~ PHONg-~i;,7 ............ l-h~;-0i ~;bTb-~e;- ..... ....... cor %?2 ............................................ _[ .............. 1 Section 1: Business Plan and Inven~W Pr~mm ~ ROutine ~ombin~ ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection O V {C=C°m¢i*n°el OPE~TION OOMMENT8 [ V=Violation ~ ~ APPROPRIATE PERMIT ON HAND ~ f ~ ~ ~ BUSINESS PLAN CONTACT INFORMATION ACCU~TE ~ ~ VISIBLE ADDRESS ~ ~ CORRECT OCCUPANCY ~ ~ VERIFICATION OF INVENTORY ~TERIALS ~ ~ VERIFICATION OF QUANTITIES ~ ~ VERIFICATION OF LOCATION ~ ~ PROPER SEGREGATION OF MATERIAL ~ ~ VERIFICATION OF MSDS AVA~LABILI~E ~ ~ VERIFICATION OF HAT MAT TRAINING ~ ~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ~ EMERGENCY PROCEDURES ADEQUATE ~ ~ CONTAINERS PROPERLY ~BELED ~ ~ HOUSEKEEPING ~ ~ F~RE PROTECTION ~ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; ~,~ES ~ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECT)ON? PLEASE CALL US AT (661) 326-3979 ......... ---~'4~-~ ~Inspector ........................... Badge - -~?~- '---~-- No,, ...... ~~ White. Environmental Services Yellow - S~ation Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ C~tz'OP~ INSPECTION DATE ~'"t/~ Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~ 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=Compliance V=Violation Inspector: {~N.) ! ~ Office of Environmental Services (661) 326-3979 Busm ss S~te Respq~ns~ble Party White - Env. Sves. Pink - Business Copy R. MICHAEL MASS, D.C. 4750 Coffee Rd. Ste. 107 Phone (805} 587-9741 Bakersfield. Ca. 93308 Fax (805) 587-9750 ' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN L~STRUC S_.' 2.1. TYPE/PRINTT° avoid furtherANSWERsaCtion, remmiN ENGLISH.this form within 30 days of receipt · ' 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner /Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: /0Q ~ ~ 7, C7.~'//C~ fr~, 'c.~ R. MIC~L ~SS, D.C.. · LOCATION: ,.~ ~~ ~ ~ ~ ........... B~RSFIELD, CA .933~ .... - ~L~G ~D~SS:' · ' ' PH: 587-974L ' CITY: STATE: ZIP: PHONE: PRIMARY ACTIVITY: .. OWNER:R_ M' o~.~ ~ ~b~I,¥~' ~'~"~._L_ .~MA$$, D.C. PHONE: : .. ~' ~r'l~LD, CA 93308 · ' ~IL~G ~D~SS: PH: 687-9741 EMERGENCY NOTIFICATION ........... CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.l' DISCOVERY AND NOTIFICATIONS . '. A. LEAK DETECTION'AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NoTIFICATIONi D. EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLANt' i._'/'-f "'.'-'.. '.d.. i' , 7/' ;'.,'.';' ;~., '..'.'.,i'.'?( ~:.. ,.. :'::" A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLE~-~ ~ ~CO~RY PROCED~S: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL OAS/PROPANE: ' WATER:' ~r - ~.,~ SPEC~: LOCK BOX: ~S~O IF ~S; LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: ~ B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRA/NING NUMBER OF EMPLOYEES: MATERIAL SA~FETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: ~11 . d~l~, : ~. ....... /-~~-,'~h~__ . ..~ ~ ~,'~ ................... ~ o~. ~i~u~~ ........ ._ - .... ., CERTIFICATION I., l)q~ '~Y/~~ 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. - '- .- ~" .' .~.'7 ~'-..:.~C~'".7 ..... ~-..-~'C...~ -"-.. -.:.d' ~:. ~¥.:~ '- .- ~.~- ' :._ :-- ->':-~'"~'~-':. ~' :-' . ................ TITLE .......... DATE_ 4 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME/~ ,a,-$5 E?l..~,a~?r,a¢~¢ INSPECTION DATE ~ / ADDRESS 4-?s'-'O Cog'g'E-~. t~o-it--(O'? PHONE NO. FACILITY CONTACT 'De. r~,,,x$5 BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program l~l Routine l~l Combined [~ Joint Agency I~l Multi-Agency [~] Complaint l~l Re-inspection OPERATION C V COMMENTS Appropriate permit on hand /x/'~_-n,.j Business plan contact information accurate ~t.¢Ax;~ ~a~P~er~ 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 [>L~-3C- CC..J,,tPcE-~ q( t,,t~¢. /sd C=Compliance V=Violation Any hazardous waste on site?: · ~Yes [~lNo ~~,~ Explain: b~t/~'U~ ~~~tG ~ '~ Questions regarding this inspection? Please call us at (661) 326-3979 ~us~ne~s Site Responsib'fe 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., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME /14/~ ~/4~/~d~q'-tC, INSPECTION DATE <~/t~ /ZaYre) Section 4: ttazardous Waste Generator Program EPA ID # [] Routine ~ 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 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 I~' '~ ~CC4~E: f/~J~tt~' <~i~tcc Tt'e~¥ 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 P~2~cco O~° ~ ~_~A.. innaG,.4o ~o"cta~ 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 Office of Environmental'Services (661) 326-3979 ~usine~s Site Respon~il~le Party White - Env. Svcs. Pink - Business Copy OF ENVIRONMENTAL SE'I VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORy CHEMICAL DESCRIPTION (one form per materializer building or area) r-] NEW I-1 ADD r-) DELETE [] REVISE 200 Page __ of __ BUSINESS ~E (~me ~ FACIL~ ~ME ~ ~ - ~ng Bu~n~ ~) 3 CHEMI~L LO~TION ~1~NFIDE~LCHE~L LO~TION(EPC~) ~ Y~ ~ No ~2 FACILI~ID~~ ~ I . , ~ I I~ 11 ~,(op~naO , ~ ~ GRlD,(op~naO~ CHEMI~L ~E COM~N ~ EHS' FIRE ~DE ~D C~ES (~e ~ ~ by I~ tim ~ ~0 PHYSI~STAm ~ s ~LID ~UID ~ g ~S 214 ~GEST~N~R (~FED ~RDal ~at ~RIESap~) ~ 1 FIRE · ~ 2 ~ ~ 3 P~SSU~ ~E D 4 A~ H~L~__~NIC H~ . UNffS* ~ ffi ~L ~ d CU~ ~ lb ~S ~ m TONS · ~ EHS, ~t m~ ~ In I~. 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