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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Thi; oermit is issued for the followin=_: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program [3 Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002060 ARUN KENI MD INC LOCATION 511 W 93301 OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 O~ceofE'~im~uenta'~ices''''~' Issue Date Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: J[i~ 30.. 2003 JUL 3 ~ ~7~ ~ ~ ARM KENI MD INC SiteID: 015-021-002060 Manager : BusPhone: (661) 395-1085 Location: 511 W COL~BUS AVE Map : 103 Com~az : Minimal City : BAKERSFIELD Grid: 18C FacUnitS: 1 AOV: CommCode:, BAKERSFIELD STATION 04 SIC Code: EPA Nu~: DunnBrad: Emergency Contact / Title Emergency Contact~ ~j/~_ Title ARUN KENI / MD Business Phone: (661) 395-1085x Business Phone: (661) 395-1085x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: React Contact : Phone: (661) 395-1085x MailAddr: 511 W COL~BUS AVE State: CA City : BA~RSFIELD Zip : 93301 Owner AR~ KENI MD INC Phone: (661) 395-1085x Address : 511 W COL~BUS AVE State: CA City : BAKERSFIELD Zip : 93301 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No ParcelNo: Emergency Directives: ~ewed ~he a~ache~ n~ar~ous mmeri~ls manag~ ment plan for .,and that it ~ong with {Name of any corrosions constitute a complete and ~ffe~ man- ~ement plan for my facility. -1- 06/16/2003 ARUN KENI MD INC SiteID: 015-021-002060 ~ Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers at Site Hazmat Common Name... ISpecHazlEPA Hazards} Frm DailyMax IUnitlMcP WASTE FIXER R L 15.00 GAL Min ARUN KENI MD INC SiteID: 015-021-002060 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~lV~Vl~ ~vl~ / ~ · ~ ~Vl~ WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF DARKROOM CAS# STATE TYPE PRES SURE --~ TEMPERATURE I CONTAINER TYPE Liquid WasteI~ Ambient Ambient PLASTIC CONTAINER Largest Container Daily Maximum Daily Average 5.00 GAL 15.00 GAL 5.00 GAL %Wt. S CAS# Silver N 7440224 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies R / / / Min MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag. DefinedT: Ag.Defined8: Ag.Definedg: Ag.Definel0: -- Ag.Definell 3 06/16/2003 ARUN KENI MD INC SiteID: 015-021-002060 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site Treated On Site CA Code US Code GAL Generated/Mo. GAL Generated/Yr. No Treatment UnitID: Unit Type: Agency-Defined Text Label -4- 06/16/2003 F ARUN KENI MD INC SiteID: 015-021-002060 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 11/15/2000 INSPECTED EVERYDAY, I WILL BE NOTIFIED IMMEDIATELY IF THERE IS ANY LEAK. -- Employee Notif./Evacuation Public Notif./Evacuation 11/15/2000 WILL PUT TOWELS AND DYKES IMMEDIATELY, WILL NOTIFY SMI INC OUR SERVICING PEOPLE. Emergency Medical Plan 11/15/2000 CONTAIN SPILL IMMEDIATELY AND CALL SMI INC FOR CLEANING. -5- 06/16/2003 ARUN KENI MD INC SiteID: 015-021-002060 Fast Format = Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 11/15/2000 INSPECTED EVERYDAY FOR LEAKING AND OVERFLOW. WASTE CONTAINER IS SECONDARILY CONTAINED. -- Release Containment 11/15/2000 WILL CALL SMI INC WHO ARE OUR SERVICING PEOPLE. WILL PUT TOWELS & DYKES TO CONTAIN SPREAD. -- Clean Up 11/15/2000 SMI INC WILL DO THIS (OUR REGULAR SERVICING AGENCY.) Other Resource Activation -6- 06/16/2003 F ARUN KENI MD INC SiteID: 015-021-002060 Fast Format F Site Emergency Factors Overall Site [~ Special Hazards --Utility Shut-Offs 11/15/2000 A) GAS - N/A B) ELECTRICAL - IN THE HALLWAY C) WATER OUTSIDE OF BLDG IN R CORNER D) SPECIAL - N/A E) LOCK BOX - NO -- Fire Protec./Avail. Water 11/15/2000 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER IN HALLWAY. NEAREST FIRE HYDRANT - JUST OUTSIDE BLDG. Building Occupancy Level -7- 06/16/2003 ARUN KENI MD INC SiteID: 015-021-002060 Fast Format ~ Training Overall Site -- Employee Training 11/15/2000 WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM; ALL OF THE EMPLOYEES ARE AWARE OF AND HAVE BEEN INFORMED AND TRAINED IN CASE OF SPILL. Page 2 Held f°r Future Use I Held for Future Use I 8 06/16/2003 ARUNKENI MD INC ' ' SiteID: 015-021-002060 Manager : t / BusPhone: (661) 395-1085 Location: 511 W COLUMBUS AVE - Map : 103 CommHaz : Minimal City : BAKERSFIELD Grid: 18C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ARUN KENI / MD GENEVA SOUTHARD / Business Phone: (661) 395-1085x Business Phone: (661) 395-1085x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: React Contact : Phone: (661) 395-1085x MailAddr: 511 W COLUMBUS AVE State: CA City : BAKERSFIELD ~f~.~,~,_ Zip : 93301 ~f0~ Phone: (661) 395-1085x Owner ARUN KENI MD INC / ~ State: CA Address : 511 W COLUMBUS AVE ~ City : BAKERSFIELD ~,,,,~,, Zip : 93301 Period : to W~ TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: INVENTORY OBTAINED ON INSPECTION - NEED TO COMPLETE A HAZARDOUS MATERIALS MANAGEMENT PLAN AND SITE/FACILITY DIAGRAM. = Hazmat Inventory One Unified List --As Designated Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax Unit MCP WASTE FIXER R L 15.00 GAL Min (Type or pr~n~ aame~; merit pt~an for ~.~ ~h~ ~ a~ ~h any ~ons ~n~e a ~mpl~e ~ ~ ~Q~ agement plan for my fadJi~. ~ ~///_~~ 1 // /U/~0 10/18/2000 Sight.re ~(e ~ARUNKENI MD INC SiteID: 015-021-002060 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site 'WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF DARKROOM CAS# ~ STATE ~ TYPE i PRESSURE i TEMPERATURE I CONTAINER TYPE Liquid /Waste Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 5.00 GALI 15.00 GALI 5.00 GAL HAZARDOUS COMPONENTS Silver 7440224 RS BioHaz I HAZARD ASSESSMENTS I TSecret Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min 2 10/18/2000 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: ~' 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach BUsiness Owner /Operator Form and ChemiC'al 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: /5] 0'~ ~rV' )<'~.. n/'~' r'q.D /tV'ti .) CITY: g/Offl~f---f~'/eL-9 "STATE: ~ ZIP.'~yo! PHONE: ~( 10ts'-- EMERGENCY NOTIFICATION CONTACT, TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: EMPLOYEE ANDAGENQY NO)'I~FiCATION: 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: ' e,q,x,~,,4~L~ v-'~. ~ .~t,~ ~ .~. SPECIAL: ~ 14'~ · LOCK BOX: YES(~I~O ) IF YES, LOCATION: --~ PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN .SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SA~FETY DATA SHEETS ON FILE: BRIEF SUMMARY OF rv~O VROORAM: CERTIFICATION I, /~'/~ (AtV }~tV} CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION XVILL 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 INACCUR~TE_n~_..O .R~TION CONS~TUTESpEmURY. SIGNATURE -. TITLE ... DATE 4 ARuNKENI M.D., I Internal Medicine 511 West Columbus (661) 395-1085 Bakersfield, CA 93301 Fax: (661) 395-1158 OFFICE OF ENVIRONMENTAL " r 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVE ORY CHEMICAL DESCRIPTIO~-~ ~ ADD D DELVE 0 R~ISE ~ ~ X [ -- Page of BUS~NESS ~E (~e ~ FAC~C~ ~E ~ 9~: ~n6 e~'~ .................. CHEM~L LO~T~ON ~ S~ b~ ~ G ~ ~ ~~ ~N~DE~L(EPC~) CHEUI~L ~E COU~N ~ EHS' FIRE ~OE ~ ~ES (~e ~ ~ by ~ tim ~ ~PE ~ p PU~ ~ m ~ ~ WAS~ 211 I ~D~A~ ~ Y~ ~ ~ 212 CURIES ~3 PHYSI~ STA~ ~ s ~LID ~L~UID D g ~S 214] ~GEST~NER ~ ~5 FED ~D ~ES D 1 FI~ · ~ 2 ~ O 3 ~S~ ~E D 4 A~ H~L~ (~ all ~at app.) ANNU~ WA~ ] ~ 217 ~I~M 218 A~m~ 219 STA~ W~ ~DE A~U~ , ~ILY ~U~ * DAILY ~U~ ~ Ducu~ D~s D~ro.s ' ~ EHS, ~nt mu~ ~ In I~. STOOGE ~AINER ~ a ~G~UND T~K ~ P~TI~NM~IC DRUM ~ i FIBER DRUM (Check aB ~at apply) ~ b UNDER~UND T~K D f ~ ~ j ~G D n P~C BO~LE D r O~ER ~ c T~K INSIDE BUi~I~ ~ g ~R~Y ~ k BOX ~ o TO~ BiN ~ d S~ DRUM ~ h SILO D I CYLINDER ~ p T~K WA~N STOOGE P~SSU~ ~a ~IE~ D ~ ~VE~IE~ D be BELOWA~IE~ ~4 STOOGE ~~ ~1~ ~ ~ A~VE~I~ ~ ~ BELOW~IE~ ~ ~9 ~ Y~ D ~ 2~ 24~ 242 2~ 0 Y~ 0 ~ 2~ 2~ SIGNATURE 246 UPCF: (7/99) S:\CUPAFORMS\OES2731 .T¥4.Wl:Xl CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME /~tt2~d K~'~t r~.t),, Iasc_.. 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 kep~ 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{ ~,--~ t~J V=Violation ~:;~ Inspector: ~ Office of Environmental'Services (661) 326-3979 Business Site Responsible Party White - Env. Sves. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME ]X, t2.on/ l~l m,~,. ~c INSPECTION DATE ADDRESS K-it oo~ c_~,.,~o~ PHONENO. ~3~/g''-- (O FACILITY CONTACT~C,.n/~ ..~0o~4~o BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~l Routine ~ Combined [~ Joint Agency ~ Multi-Agency [~l Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand 3dZ2---r.O ~-,~o~,~- ~ Business plan contact information accurate ~LC--a~: C_CgnnP~ ~ Visible address Correct occupancy Verification of inventory materials ~ ~-r~.~,~-.o o~/ !~g4 Verification of quantities I ~ Verification of location 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 Housekeeping Fire Protection Site Diagram Adequate & On Hand ~ t.~,~ ~ff' <~o~pt.¢-~-~ C=Compliance V=Violation Any hazardous waste on site?: ~Yes [~]No Explain: {.,O~Ag~r-(~ f~"O~le~ Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- ~u~ine~ Copy Inspector: GO