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Home My WebLink AboutHAZ-BUSINESS PLAN 10/27/2000 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This =ermit is issued for the followina_: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials 13 Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002061 COLUMBUS FAMILY LOCATION 505 W 93301 Issued by:~ Bake rs field Fi re D epartme nt " "a~ ~ ' ~"~~~~-~ o~mc~ o~ ~NVT~OtC~ter~. S£~ WC£S' '.' ~ ~ /~.~_~ 1715 Chester Ave., 3rd Floor A~mv~by: . C~IpCHu~'~~) . Issue ~te Bakersfield, CA 93301 OfficeofEv~S~ic~ ~ Voice (661) 326-3979 ~~ F~(661) 326-0576 ExpimtionDate: Ju~8 30~ 2003 505.w. COLUMBUS STREET BAKERSFIELD, CA 93301 . · CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. - OCT g. 7 2300 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. Y: · 5. You maY also attach BUSiness Owner / Operator Form and Chemical Description Form(s)' '~ :' ' to the fi:ont of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA ~L~G ~D~SS: - P~~Y ACT~TY: ..... .... E~G~NfiY NOTiFiCATiON ................... '' "' 6 ~ CONTACT TITLE BUS. PHONF_~ 24 HR. PHONE :\ ,. 1 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: - - B. EMPLOYEE AND ~GENCY NOTIFiCATiONi ' ' C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: · . wATER:. SPECIAL: LOCK BOX: YES~I~ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: <S (om,,,'tcc6rze;D B. WATER AVAILABILITY (FIRE HYDRANT): HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: ~ MATERIAL SA~FETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I, _~~ d.~'-' ,~~'~ 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 rNACCURATE_INFORMATION CONSTITUTES PEPUURY. - 85~" ..... eiTLE .......... DATE ' 4 '. ".." General & cosmetic Dentistry: ' · ,,. ; _ ,' . - ~,~. ,...,. , ~ : R°$;'t°wn Family oenti6try ' ' !' :'c~lunibu~ Family Dentistry' ' 1229 7th Street 505 W. Columbus Street Wasco, CA 93280. ', -~Bakersfield, CA 93301 Telephone (661) 758-5338 "' . ' Telephone (66i) 322-'1300 · Fax (661) 758-81.50 Fax (661) 322-1375 CITY OF BAKERSFIELD FIRE DEPARTMENT ~ OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301f, FACILITY NAME ~_.,ro-a~CS~ ~,~.~ ?X:-~sr~NSPECTiON DATE ADD.SS ~~- ~~oa ~ PHONE NO. FACILITY CONTACT ~ BUS.ESS IDNO. 15-210- ~SPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~l Routine ~LCombined [~1 Joint Agency [~1 Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand /xJCn-~J ~f-~ t T- Business plan contact information accurate ~ ~LC-~3~' f'~t.c Ooer Visible address Correct occupancy Verification of inventory materials // ~__~q'~--t.,,Jtff:at:~ o,,..J Verification of quantities t/ ! t Verification of location p' ~ t ! 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 v,/ Housekeeping Fire Protection Site Diagram Adequate & On Hand ~ ~/_~7'~g~ ~r_3~t?c~r~ C=Compliance V=Violation Questions regarding this inspection? Please call us at (661) 326-3979 Site Responsib e 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 ~ol.o,~g~ f"--o~,~,/ ~t~m~ INSPECTION DATE 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 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 [/'' ~.~t2~_,~ (~]pO~/~c>~'~ 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 t[~.~-- t,~,J r.,~d~gCO Retains hazardous waste analysis for 3 years ~/..~ff IfC'-'~ Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Inspector: ~ t "ff'~'~ Office of Environmental Services (661) 326-3979 Party White - Env. Svcs. Pink - Business Copy CITY OF BAKERS FIEl I ri/ti I OFFICE OF ENVIRONMENTAL SERVICES tn ,n ttrM t r 1715 Chester Ave., CA 93301 (661) 326-3979 "~ ~ ~**~ ~' H~RDOUS MATERIALS INVENTORY Chemi~l Description Form (one ~ per ma~al per building or ama) ~ ADD ~ DELETE ~ R~ISE 200 Page ~ of CHEMI~L LOCATION ..... . ~ 20~l CHEMI~L LO~TION D Y~ ~ No 202 /~ ~ ~ ~ ~1~O~ ~ CONFIDENTIAL (EPC~) FACILI~ ID ~ ~ ~ I ~P" (op~naO 203 GRID ~ (op~naO 2~ 205 T~DE SECRET CHEMICAL NAME ~~ ~~( C ~ <~ If Subj~ tO EPC~. refer to iinstm~ions 207 COMMON ~E EHS* ~ Y~ D No 2~ FIRE ~DE H~RD C~SSES (~plete if r~u~t~ by I~l fire 210 ~PE D p PURE ~ m MI~URE ~ WASTE 211 ~DIOACTtVE D Y~ ~ No 212 CURIES 213 PHYSI~L STATE ~ s SOLID ~LIQUID ~ g ~S 214 ~RGESTCO~AINER ~ 215 FED H~RD CATE~RIES ~ 1 FIRE ~ 2 R~CT~E ~ 3 PRESSURE REL~SE ~ 4 AC~E H~LTH ~ CHRONIC H~LTH 216 (~ all that apply) ANNUAL WASTE ~ 217 ~ ~IMUM 218 AVENGE 219 STATE WASTE CODE ~0 AMOU~ (~ ~ DAILY~U~ DAILYA~U~ UNITS* ~ ~L ~ d CU ~ D lb LBS D tn TONS 221 DAYS ON SITE * If EHS. am~nt must be in lbs. STOOGE ~AINER ~ a ABOVEGROUND TANK ~ e P~STI~NONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~L~ ~ q ~IL ~R 223 (Check afl ~at apply) ~ b UNDERGROUND TANK ~ f CAN ._ Dj BAG ~ P~STIC ~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k ~X ~ o TOTE BIN ~ d STEEL DRUM ~ h SILO D I CYLINDER ~ p TANK WAGON STOOGE PRESSURE ~a AMBIE~ D ~ A~AMBIE~ ~ ba BELOW~BIE~ ~4 STOOGE TEMPE~TURE ~BIE~ D ~ A~VEAMBIE~ ~ ba BELOW AMBIE~ ~ c CRYOGENIC ~5 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE / D,~TE 246 Form 2731(3/~9)