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HomeMy WebLinkAboutBUSINESS PLANj a f i '~ YE'I'ER 5. BAN:, ll 1405 COMMERCIAL WAY #140 ,~ ,.~ BAE DDS PETER S SiteID: 015-021-002081 Manager DEBORAH ROLAND Location: 1405 COMMERCIAL WY 140 City BAKERSFIELD BusPhone: (661) 328-9993 Map 102 CommHaz Minimal Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title STACEY BAE / OWNERS WIFE DEBORAH ROLAND / MANAGER Business Phone: (661) 328-9993x Business Phone: (661) 328-9993x 24-Hour Phone (661) 664-8278x 24-Hour Phone (661) 809-9173x Pager Phone (213) 500-8868x Pager Phone (661) 889-5188x Hazmat Hazards: React Contact DEBORAH ROLAND Phone: (661) 328-9993x MailAddr: 1405 COMMERCIAL WY 140 State: CA City BAKERSFIELD Zip 93309 Owner PETER S BAE DDS Phone: (661) 328-9993x Address 1405 COMMERCIAL WY 140 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 ENrD JUt~ 2 4 2007 B .sed on my inquiry of those individuals respons.ibiA for obtaining the informati on, I certify under penalty of law that I have pers ll ona y examined and am familiar with the information submitted and believe th i e nformation is true, accurate. ~ ,~ ,, ,;~~ete. gnatu ~ Date -1- 06/29/2007 ,. ~ F BAE DDS PETER S SiteID: 015-021-002081 ~ ~ 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 20.00 GAL Min -2- 06/29/2007 -3- 06/29/2007 F BAE DDS PETER S SiteID: 015-021-002081 ~ ~ 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: X-RAY RM CAS# Liquid TWaste ~ AmbRient~E ~ AmbientT~E ~LASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 20.00 GAL 5.00 GAL nr~~r-ucLVUa 1:V1~lYV1VL"~1V1'S oWt. RS CAS# Silver No 7440224 riHGHKL HJSt5~b1~l~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 06/29/2007 F BAE DDS PETER S SiteID: 015-021-002081 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/22/2007 ~ VISUAL/MONTHLY. ALL OFFICE TEAM TRAINED TO CHECK. DEBORAH TO NOTIFY JIM WARREN X-RAY SOLUTIONS. USE PATTERSON DENTAL ENVIRONMENTAL CARE DIV 800-336-8254 OR 310-426-3100 FAX 310-426-1450 FOR SHARPS DISPOSAL AND ALL DENTAL WASTE. Employee Notif./Evacuation 09/27/2006 DEBORAH TO NOTIFY JIM WARREN. IF HE CANNOT TAKE CARE OF THIS, I WILL CALL YOU. Public Notif./Evacuation DEBORAH TAKES CARE OF THESE MATTERS. STAFF REPORTS TO OWNER. 07/25/2006 Emergency Medical Plan CALL ENVIRONMENTAL SERVICES TO SEE WHAT NEXT STEP WOULD BE. 09/24/2003 -5- 06/29/2007 F BAE DDS PETER S SiteID: 015-021-002081 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/09/2006 ~ STORED IN PLASTIC CLOSE TO GROUND; SEALED WITH SCREW-TYPE LIDS. ALL PPE IS USED AT THIS TIME. WE CALL JIM WARREN SERVICES. Release Containment 03/02/2001 PPE AND CALL JIM WARREN. Clean Up JIM WARREN. 03/02/2001 Other Resource Activation 02/22/2007 BUSINESS NAME WILL BE CHANGING WITHIN 30 DAYS: ENRAGE DENTAL, PETER S BAE PROSTODONTIST WITH THE SAME ADDRESS. -6- 06/29/2007 ., F BAE DDS PETER S SiteID: 015-021-002081 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~1C l~1cl1 naG0.L U.7 Utility Shut-Offs GAS - NEAR STE 120 ELECTRICAL - SUB-METER IN STORAGE RM WATER - NEAR STE 120 03/29/2007 Fire Protec./Avail. Water 01/25/2007 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, 2 FIRE EXTINGUISHERS, ALARM SYSTEM TO FIRE DEPT. NEAREST FIRE HYDRANT - ACROSS ST. Building Occupancy Level 7 EMPLOYEES 05/09/2006 -7- 06/29/2007 :i ~w F BAE DDS PETER S SiteID: 015-021-002081 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/22/2007 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EVERYONE UPDATED EXCEPT LORI, SHE IS ONLY HERE TWO DAYS A WEEK. rayv ~ nC1u tVL rul.utC use nCiu lVl rul.u.LC VAC -8- 06/29/2007 .. '~ :, ,: BAE DDS PETER S SiteID: 015-021-00201 Manager ~2-~7~ {~U(~ ~1 Location: 1405 COMMERCIAL WY 140 City BAKERSFIELD BusPhone: (661} 328-9993 Map 102 CommHaz Minimal Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title STACEY BAE / OWNERS WIFE DEBORAH ROLAND / !/I/1(~~t,6t.~°~' Business Phone: (661) 328-9993x Business Phone: (661) 328-g993x 24-Hour Phone (661) 664-8278x 24-Hour Phone (661) 805-7617x Pager Phone (213) 500-8868x Pager Phone (661) 889-5188x Hazmat Hazards: React ............. Contact ~~a~~ ~pIG7~`-~ Phone: (661) 328-9993x MailAddr: 1405 COMMERCIAL WY 140 State: CA City BAKERSFIELD Zip 93309 ............. Owner PETER S BAE DDS Phone: (661) 328-9993x Address 1405 COMMERCIAL WY 140 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs : _ ~r~.l Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN Based on my inquiry of those individuals responsible for obtaining the information, ;certify under penalty of law that I have personally E~ I U F E B ~ 2 2007 examined and am familiar with the information submitted and believe the information is true , accurate, d com te. r Z p gnature ate -1- 01/25/2007 F BAE DDS PETER S SiteID: 015-021-002081 ~ ~ 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 20.00 GAL Min -2- Ol/25/~007 -3- 01/25/2007 F BAE DDS PETER S ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit X-RAY RM Days On Site 365 Map: Grid: CAS# Liquid TWaste ^Tmbient~E ~ AmbientT~E ~PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 20.00 GAL 5.00 GAL t1AG1~tcLVUS L:V1~lYV1VL1V1~ oWt. RS CAS# Silver No 7440224 t11~GHKL 1i77~571~1C~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MGM No No No No/ Curies R / / / Mini SiteID: 015-021-00201 ~ Facility Unit: Fixed Containers at Site ~ -4- 01/25/2007 F BAE DDS PETER S SiteID: 015-021-0020$1 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/25/200b ~ VISUAL/MONTHLY. ALL OFFICE TEAM TRAINED TO CHECK. DEBORAH TO NOTIFY JIM WARREN X-RAY SOLUTIONS. USE SST-~'~' FOR SHARPS DISPOSAL. foA74,c1' D~,~~~ ~~«/~i20~~ciJ~4C. C~2C Oil/~SiO.~/ ~( d) X33 ~ -8'2s y d~ ~3/C~ ~'Z!~ -~3/ d v ~~(~~~ Uz le -/~rsz~ ~~ ~/i O ~~ Employee Notif./Evacuation 09/27/200 DEBORAH TO NOTIFY JIM WARREN. IF HE CANNOT TAKE CARE OF THIS, I WILL CALL YOU. Public Notif./Evacuation DEBORAH TAKES CARE OF THESE MATTERS. STAFF REPORTS TO OWNER. 07/25/2005 Emergency Medical Plan 09/24/2003 CALL ENVIRONMENTAL SERVICES TO SEE WHAT NEXT STEP WOULD BE. -5- 01/25/2007 F BAE DDS PETER S SiteID: 015-021-002081 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 05/09/20(7 STORED IN PLASTIC CLOSE TO GROUND.; SEALED WITH SCREW-TYPE LIDS. ALL PPE IS USED AT THIS TIME. WE CALL JIM WARREN SERVICES. Release Containment 03/02/20171 PPE AND CALL JIM WARREN.. Clean Up JIM WARREN. 03/02/20171 = Other Resource Activation ~~U~iit/E~ ~~/I1E C~u~!/~j~ . Cclrl~ ~~ C~I~4/,~/~/ j ~tJ~T/~ ~'0 ~ ~ ~vN~~~ D~-~v~~ p~-~2 5. ~G~ . P~ST7~ Ob~I~~S 5~~ ~p~~-mss -6- _ 01/25/007 _- F BAE DDS PETER S SiteID: 015-021-00201 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial riazaras Utility Shut-Offs A) GAS - NEAR STE 120 B) ELECTRICAL - SUB-METER IN STORAGE RM C) WATER - NEAR STE 120 D) SPECIAL - NONE E) LOCK BOX - NO ' 07/25/20(76 Fire Protec./Avail. Water Ol/25/20b`7 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, 2 FIRE EXTINGUISHERS, ALARM SYSTEM TO FIRE DEPT. NEAREST FIRE HYDRANT - ACROSS ST. Building Occupancy Level 05/09/20015 7 EMPLOYEES -7- 01/25/2007 } ' I ~~i F BAE DDS PETER S SiteID: 015-021-0020$1 ~ Fast Format ~ ~ Training Overall Sits ~ ~~~Employee Training 05/09/20175 ~ L MSDS SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: ONLY HERE DAY A WEEK. j W CI Gnr~ EVERYONE UPDATED EXCEPT D~ANELLE, SHE IS ra.y e ~ Held for Future Use ~ nela =or r~uLUre use -8- Ol/25/~007 ~V M7` + BAE DDS PETER S _____________________________________ SiteID: 015-021-002081 + Manager Location: 1405 COMMERCIAL WY 140 City BAKERSFIELD BusPhone: (661) 328-9993 Map 102 CommHaz Minimal Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title STACEY BAE / OWNERS WIFE Business Phone: (661) 328-9993x 24-Hour Phone (661) 6C4-8278x Pager Phone (.~~°~) ~~d - x Hazmat Hazards: Contact MailAddr: 1405 COMMERCIAL WY 140 City BAKERSFIELD Owner PETER S BAE DDS Address 1405 COMMERCIAL WY 140 City BAKERSFIELD Period to Preparers Certif'd: ParcelNo: Emergency Directives: ~~ r PROG H - HAZ WASTE GEN ~~~ Business Phone: (661) 328-9993x 2 4 -Hour Phone r6~63~-8~3 ~ Pager Phone React Phone: (661) 328-9993x State: CA Zip 93309 Phone: (661) 328-9993x State: CA Zip 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No ENT'D J U L 2 5 2006 ~~ ~~~~~ ~~ _ c~~, ~~ 661 ~ ~5 •'7b i~-- P~-~,~ PH~~c ~~ ~ ~g~ ~_ ~ 18~ Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and am familiar with tha information submitted and believe the information is true, accurate, a comp) S ~~ ~~ Si lure Date ~~~~1~1 SS -1- 05/09/2006 Peter S. Bae, DDS ~iEgGE~CY Consultation ~_~ Lobby D~s Office Desk Kitchen Restroom Rctsroom Storage Sterilization X-Ray Opemtory Operator3, Ol~mtmy Opemto~: #1 #2 #3 #4 [] Haz Waste · Fire ExXinguisher [] First Aid Kit J Safety Manual © Water Fountain 4~ Eye Wash Station ~ Smoke Detector ~ Spill Kit F) MSDS Manual ~ Medication []:g Sterilizer ]g~ Fire Alarm ~ Emergency Kit ~ X-Ray 0 Sprinkler : PETER S BAE DDS SiteID: 015-02.1o~'00.20-81 Manager : BusPhone: (661) 328-9993 Location: 1405 COMMERCIAL wY 140 Map : 102 CommHaz : Minimal City · BAKERSFIELD Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD~STATION 11 SIC Code: EPA Numb: DunnBrad: .Emergency Contact /' Title Emergency Contact / Title STACEY BaS / WIFE KRISTI ~,,/~/ / MANAGER Business Phone:~ (661) 328-9993x Business Phone: (661) 328-9993x 24-Hour Phone : (661) 664-8278x 24-Hour Phone : (661) 634-8797x Pager Phone : ( ) - x Pager Phone : (~/)~6~ -~x Hazmat Hazards: React Contact' : Phone: (661) 328-9993x MailAddr: 1405 COMMERCIAL WY 140 State: CA City : BAKERSFIELD Zip : 93309 owner PETER S BAE DDS Phone: (661) 328-9993x Address : 1405 cOMMERCIAL WY 140 State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: Res: No ParcelNo: Emergency Directives: reviewed ~he a~ach~d haza~oUs m~e~a~s mana~®o mom plan ~r and ~ha~ it ~onO any corre~c~ions configure ~ compile ~nd correc~ man- agemem Plan ~r rny f~cili~y. F PETER S BAE'DDS SiteID: 015-021-002081 Fast Format ~Notif./Evacuation/MediCal Overall Site · Agency Notification ~' :~ - 03/02/2001 VIsuAL/MONTHLY. ALL OFFICE TEAM TRAINED TO CHECK. KRISTI TO NOTIFY jIM . WARREN XRAY SOLUTIONS'. USE~STERI CYCLE FOR SHARPS DISPOSAL. --Employee Notif./Evacuation 03/02/2001 KRISTI TO NOTIFY JIM WARREN, IT HE CANT TAKE CAR~OF-THIS I WILL CALL YOU. Public Notif./Evacuation 03/02/2001 KRISTI - I TAKE CA~E OF THESE MATTERS MY STAFF REPORTS TO ME. Emergency Medical Plan 03/02/2001 CALL~YO~OFFICE AND SEE WHAT WOULD BE OUR NEXT STEP. -5- 09/16/2003 + CHARLES F WORTISKA -- = .... '-= SiteID: 015-021-0]0~972 Manager BusPhone: (661) 327-4246 Location: 1405 COMMERCIAL' WY 100 Map : 102 CommHaz : Minimal ~.City : BAKERSFIELD · %%%%~ Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title CHARLES F WORTISKA / OWNER EDWARD SCOTT /'PROPERTY MGR Business Phone: (661) 327-4246x Business Phone: (661) 395-0541x 24-Hour Phone : (661) 58D SGiO~-~c~ 24-Hour Phone .: (661) 637-3224x Pager Phone : (6~rt) ~ Pager Phone : ( ) - x ............ ~ ............. r___L ............. . ........................ Hazmat_Hazards_- .. ~t~_, · _ ~ React. ................................. - -__ -- __. ..... 'iZL_2i~_i .................. Contact : Phone: (661) 327-4246x MailAddr: 1405 COMMERCIAL WY 100 State: CA City : BAKERSFIELD Zip : 93309 ........ 7---~- ........ z ..... ~ ....... .___: .................. , .................. __+ Owner CHARLES ~ WORTISK_A Phone: (661) 327-4246x Address : ~^~ *~, ~ ......... ~ ~ 'll~l ~tll ,~ C~. state: CA City : BAKERSFIELD /~LI Zip : 93312 .................... ~ .............. ~ ~ ~ ........................................ Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: .~ -1- 07/30/2003 + CHARLES F WORTISKA SiteID: 015-021~001972 +-= Fast Format += .N0tif./Evacuation/Medical' Overall Site ~+== Agency Notification ~ = 09/28/1999 'VERBAL,'PHONE, '~IG~'MEDiCAL ii;~GiNG.iNC. + .?+=== Employee Notif./Evacuation ' 09/28/1999 .~VERBAL' · ~-+==== Public Notif./Evacuation 09/28/1999 ~ Emergency Medical Plan 09/28/1999 911, MERCY'HOSPITAL EMERGENCY ROOM. ~ -4- 07/30/200.3 + CHARLES F WORTISKA SiteID: 015-021-001972 ~ Fast Format. += Mitigation/Prevent/Abatemt Overall Site +=~' Release'-Prevention -- 09/28/1999 WASTE IS CONTAINED IN A 5 'GAL CONTAINER. +=== Release Containment 09/28/1999 I PHONE INC. · + .... Clean Up == 09/28/1999 I Other Resource. Activation -5- 07/30/2003 PETER S BAE DDS SiteID: 015-021-002081 Manager : BusPhone: (661) 328-9993 Location: 1405 COMMERCIAL WY 140 Map : 10,2 CommHaz : Minimal City : BAKERSFIELD Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title STACEY BAE / WIFE KRISTI BLAIR / MANAGER Business Phone: (661) 328-9993x Business, Phone: (661) 328-9993x 24-Hour Phone : (661) 664-8278x 24-Hour Phone : (661) .634-8797x Pager Phone : ( ) - x Pager Phone : ( ') - x Hazmat Hazards: React -"---C~-~-~t~-F- .......... ~ ........ ' ........... Phone: .... ~6,6.t~-3~8-9993~ MailAddr: 1405 COMMERCIAL WY 140 State: CA City : BAKERSFIELD Zip : 93309 Owner PETER S BAE DDS Phone: (661) 328-9993x Address : 1405 COMMERCIAL WY 140 State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax IUnitlMCP WASTE FIXER R L 20.00 GAL Min ....... ..... DO -- .............. -- ~ ~y~ or pNnt ~) reviewed ~he a~ached h~ardous mate~als manage- mere plan for~ ~ ~ and ~hm it along with - (Na~ ~ any corre~ions constitute a ~mplete and co~e~ man- agement plan tot my facili~. i 09/10/2002 PETER S BAE DDS SiteID: 015-021-002081 ~ InventorY Item 0001 Facility Unit: Fixed Containers at Site WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE X-RAY RM CAS# STATE i TYPE 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 GAL I 20.00 GAL I 5%00 GAL I~Wt I~e~ zL_ ~ _ HAZARDOUS COMPONENTS. I IRS CAS# r ............................. HO= ........ 7440224 HAZARD ASSESSMENTS TSecretINO N~S I Bi°HasINO Radioactive/AmountNo/ Curies EPA HazardsR NFPA//./ USDOT# MinMCP 2 09/10/2002 PETER S BAE DDS SiteID: 015-021'002081 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 03/02/2001 VISUAL/MONTHLY. ALL OFFICE TEAM TRAINED TO CHECK. KRISTI TO NOTIFY JIM WARREN XRAY SOLUTIONS. USE STERI CYCLE FOR SHARPS, DISPOSAL. -- Employee Notif./Evacuation 03/02/2001 KRISTI TO NOTIFy JIM WARREN~ IT HE CANT TAKE CAR OF THIS I WILL CALL YOU. -- Public Notif./Evacuation 03/02/2001 KRISTI - I TAKE CASE OF THESE MATTERS MY STAFF REPORTS TO ME. Emergency Medical Plan 03/02/2001 CALL YOU OFFICE AND SEE WHAT WOULD BE OUR NEXT STEP. -3- 09/10/2002 PETER S BAE DDS SiteID: 015-021-002081,~ Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 03/02/2001 STORED IN PLASTIC CLOSE TO GROUND SEALED WITH SCREW TYPE LIDS. ALL PPE IS USED AT THIS TIME. WE CALL JIM WARREN SERVICES. -- Release Containment 03/02/2001 PPE AND CALL JIM WARREN. ~ Clean Up 03/02/2001 JIM WARREN. Other Resource Activation 4 09/10/2002 F PETER~S BAE DDS SiteID: 015-021-002081 Fast Format F Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 03/02/2001 ALL OUTSIDE OF SUITE BROUGHT IN AT 1 CENTP~AL POINT NEAR SUITE 120. A) GAS - NEAR SUITE 120 B) ELECTRICAL - SUBMETER IN STORAGE ROOMS C) WATER - OUTSIDE NEAR SUITE 120 D) SPECIAL - NONE E) LOCK BOX - NO -- Eirg_~9~e.¢~,~A~a~l. Wate~.~_ _ ..... _~__= .~ ....... 03/02/2001 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, 2 FIRE EXTINGUISHERS, ALARM SYSTEM TO FIRE DEPT. NEAREST FIRE HYDRANT ACROSS STREET. Building Occupancy Level -5- 09/10/2002 PETER S BAE DDS SiteID: 015-021-002081 Fast Format ~ Training Overall Site -- Employee Training 03/02/2001 WE ~VE 7 EMPLOYEES AT THIS FACILITY. WE DO ~VE MSDS SHEETS ON FILE. ~~ BRIEF S~RY OF T~INING PROGRAM: EVERYONE UPDATED EXCEPT --.SHES ONLY HERE 1 DAY A WEEK. Page 2 ~Hel~fp~EutDre_U~e.._ ...... - ~ Held for Future Use -6- 09/10/2002 OFFICE OF ENVIRONMENTAL SERVICES ~. 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS' MATERIALS MANAGEMENT PLAN INSTRUCTIONS: · '1~ To avoid further action, remm 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 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: ~[' ~°~er ~ l~Ot~L CITY: bak STATE: C~q ziP: q32eHONE:. P~Y ACTIVITY: ,PffbS4h~~ [~ EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 0 C HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1' DISCOVERY AND NOTIFICATIONS A. 'LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: - - HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 11.2: 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: N (a') l ~ ELECTRICAL: ~J'O-m~ Lib WATER: SPECIAL: LOCK.BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: ~lgF,rq~Lf.}, 5"'~~, ~ ~.lCe. e~4lt~/U8/~~t)' B. WATER AVAIL~ILITY (FI~ H~NT): 3 HAzARDous MATERIALS MANAGEMENT PLAN SECTION III'. TRAINING · NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: '. BRIEF SUMMARY OF 'TRAINING PROGRAM: CERTIFICATION I, j~."i~'~i' ~ i ~ 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 ' ~//J TITLE (/ DATE PETER S BAE DDS SiteID: 015-021-002081 Manager : ~/~/l' ~/~/~ BusPhone: (661) 328-9993 Location: 1405 COMMERCIAL WY 140 Map : 102 CommHaz : Minimal City : BAKERSFIELD Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title PETER S BAE / DDS Business Phone: (661) 328-9993x Business Phone: ( ) ~ -~x 24-Hour Phone : ( ) - x 24-Hour Phone : ( )~q ~x Pager Phone : ( ) - x Pager Phone : ( ) ,, - .. x Hazmat Hazards: React Contact : ~/~1'5~;' ~}~,'~ Phone: (661) 328-9993x MailAddr: 1405 COMMERCIAL WY 140 State: CA City : BAKERSFIELD Zip : 93309 Owner PETER S BAE DDS Phone: (661) 328-9993x Address : 1405 COMMERCIAL WY 140 State: CA City : BAKERSFIELD , Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... SpecHazlEPA HazardsI Frm I DailyMax UnitlMcP WASTE FIXER R L 20.00 GAL Min -(Type or print name) reviewed the attached hazardous materials manage- ment plan for/~ t~:~ .~nd that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. PETER S BAE DDS SiteID: 015-021-002081 = 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: INSIDE X-RAY RM CAS# FSTATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 5.00 GALI 20.00 GAL 5.00 GAL HAZARDOUS COMPONENTS I Silver N 7440224 HAZARD ASSESSMENTS ITsecret[ oRSlBioHazI Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No N No No/ Curies R / / / Min -2- 11/09/2000 CITY OF BAKERSFIELD FIRE DEPARTI~-F~'T~ OFFICE OF ENVIRONMENTAL SERVICERS UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3fa Floor, Bakersfield, CA 93301 FACILITY NAME pC~ ~- ~ez ODS ~SPECTIONDATE ADD'SS ~ ~ ~~.~ ~ ~l~ PHONE NO. FACILITY CONTACT4~t~ ~tM BUS'ESS IDNO. 15-210- ~SPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine ,~ombined [~l Joint Agency [~l Multi-Agency [] Complaint ~l Re-inspection OPERATION C,~~ ~'I COMMENTS. Appropriate permit on hand c~/,.c~-~a.g~- ~7.~,n{'at.C.m.~ l~-"Oo~,T Business plan contact information accurate -I-I Ill Visible address Correct occupancy Verification of inventory materials . .. <.. Verification of quantities ~,' Verification of location '~ Proper segregation of material Peter S. Bae D.D.S. ~ Prosthodontics ! ~ Verification of MSDS availability " 1405 COMMERCIAL WAY #140, BAKERSEIELD, CA 93309. ' BUSINESS PHONE. 805 328-9993 ~.'~ Verification of Haz Mat training . ~, - Verification of abatement supplies and procedures .... Emergency procedures adequate Containers properly labeled ~Li~-&~ Z_Ag~'~.- ~a,-%T Housekeeping Fire Protection Site Diagram Adequate & On Hand ~.Od~lS~,O ~-'~0_,~(.-_ C=Compliance V=Violation hazardous waste on site?: ~J~Y. es [] No Any Explain: LO~-~q'~ ,~dO~d,c._ f~,~.~'0~. ~sines~ Questions regarding this inspection? Please call us at (661) 326-3979 s 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 ~-~-Z2-q.-. ~-~, ~,a~-.t ~)~L INSPECTION DATE {0/"5,/'7_cac,3 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 ~ ~'p~ff~,-5'~ ~'/Et. Xftf"o~: *'T'O--~d" 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: ~) r/',,f~ /~ ,10,j~ ~;~0~yh Office of Environmental Services (661) 326-3979 ~siness Site Responsible Party White - Env. Svcs. Pink - Business Copy .' ' r ~1~CITY OF BAKERSFIEL~i~ OFI"I~E OF ENVIRONMENTAL S~"RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (o~ ~ ~r mammal per bu~ging or a~a)  NEW ~ ADD ~ OE~E * ~ REVISE ~ Page BUSINESS ~ (~e ~ FACILI~ ~E ~ D~ - ~ng B~n~ ~} 3 ~ ~NFIDE~L (EPC=) FACIL~ ID = ~ ~ . 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