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Home My WebLink AboutBUSINESS PLANI / CHARLES F. WORTISKA, DC 1405 COMMERCIAL WAY #100 - - - - --- 1---------•--------_ -----_ Hazardous Materials/HaZardOus Waste. unified Permit ..~CONDITIONS.. OFPERMIT~.ON~ .. ~.~... .~ ~, REVERSE SIDE ,. , This _~rmit is issued for the followinp: .li~ H~rdoUs Materials P~n ~ Unde~mund Storage of H~ous Mat~s · '.. Permit ID~:: 015~00~01972 D RiskManag~tPr~mm ,..: LOCATION: 1405 COMMERCIAL ~ 100 Issued by: Bakersfield Fire Department · OFFICE OF ENVIRONMENTAL SER VICES: Hazardous Materials/Hazardous Waste Unified Permit IgONDITION$' OF: PI::RMIT ON Ftl::¥1=R$1:: $1Dl::. - This permit is iSsued for the followina: [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-001972 CHARLES ' LOCATION 1405 "' 93309 · '-t~4 -..~ OFFICE OF ENVIRONMENTAL SER VICES'- .' 1715 Chester Ave., 3rd Floor . Approved by: Issue Date Bakersfield, CA 93301 OfliceofEvinmmtml~Services Voice (661) 326-3979 '~.v~ii~.~,, FAX (661) 326-0576 Expiration Date: ' JUNO 30.. 2003 ~ ~`' WORTISKA CHARLES F BusPhone: Map 102 Grid: 34B SiteID: 015-021-001972 Manager CHARLES F WORTISKA Location: 1405 COMMERCIAL WY 100 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: (661) 327-4246 CommHaz Minimal FacUnits: 1 AOV: 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) 587-8061x 24-Hour Phone (661) 637=3224x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact CHARLES F WORTISKA Phone: (661) 327-4246x MailAddr: 1405 COMMERCIAL WY 100 State: CA City BAKERSFIELD Zip 93309 Owner CHARLES F WORTISKA Phone : ( 661) 3~9-~'2~-FsR Address 11811 DELL RAPIDS CT State : CA ~~`i - ~C;C;, ~ City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~''f•"r.~ on !T1 ~ IC1(~1L!Irll 4e tf?!]Se Snt~fb`fiil: !3 `~"`~~'`''ti;i ~,Y ,~r}u~tafning tna i~ifo - rmatiun, !certify an~aw~• tsenaity of laver that I ha~se persona!!y ~varr~ined a; yci am familiar weth the intormatior~ "`hm7t°'d and hel'eve the information is true, ar~:urate, and c,m let p e. ~Nfi S~~ - - - ~/~~ ~ Date I ~ ~ I U ~, ~ 0 X007 -1- 07/16/2007 ~~ F WORTISKA CHARLES F SiteID: 015-021-001972 ~ ~ 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 5.00 GAL Min -2- 07/16/2007 5wc i -3- 07/16/2007 ~.~. a F WORTISKA CHARLES F SiteID: 015-021-001972 ~ ~ 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: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid WasteAmbient ~ Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL t'lE~Y,L-1KLVU5 ~VinrViv~iv'1'~ Silver No 7440224 t1HGAKL A~5L~551~1t;1V'1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/16/2007 s F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 07/24/2006 VERBAL, PHONE, MXR Employee Notif./Evacuation VERBAL . . _. --` v - -- 09/28/1999 Public Notif./Evacuation 09/28/1999 VERBAL. Emergency Medical Plan 09/28/1999 911, MERCY HOSPITAL EMERGENCY ROOM. -5- 07/16/2007 F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/05/2006 ~ WASTE IS CONTAINED IN A 5-GAL CONTAINER. Release Containment - 07/24/2006 TELEPHONE MXR - '- _ ~ - - - - -- - --_-_-_ __, _ _ - _ _ Clean Up 07/24/2006 USE RAGS FOR CLEAN-UP, PUT RAGS IN PLASTIC BAG AND HOLD FOR MXR TO PICK UP AND DISPOSE. V1~11C1 1CC.5'V ULC.:C liCG l.1VdL1CJ11 -6- 07/16/2007 ~... ,~ F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~YC~~.ai nc«aiua Utility Shut-Offs 02/28/2007 ELECTRICAL - DARKROOM WATER - DARKROOM, RESTROOM Fire Protec./Avail. Water 07/24/2006 PRIVATE FIRE PROTECTION - ACE SPRINKLER CO, FIRE EXTINGUISHER IN RECEPTION ANTEROOM. NEAREST FIRE HYDRANT - COMMERCIAL & COMMERCE. Building Occupancy Level 1 EMPLOYEE ~-,,.,, .~- ; n~ ~ 05/05/2006 -7- 07/16/2007 ~,~ r- F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/24/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: REVIEW SPILL PROCEDURE. YdI~C L Held for Future Use Held for Future Use -$- 07/16/2007 - ~ ~~.. - _ X5$2-l UNFE~9E~®~ROGRAM INSPECTION CHECKLIST ___, SECTION 1: Business Plairrand Inventory Program .~°=* ~ Prevention Services B A B e s F •t D 900 'IYuxtun Ave., Suite 210 FIRE Bakersfield, CA 93301- ARTM .Tel.: (661) 326-3979 ~~~y Fax: (661) 872=2171 FACILITY NAME C1naf\ s ~~e ~tskfl ~ INSPECTION g~TE ~ f'z ~ INSPECTION TIME . Q q/ ~ ADDRESS PHONE NO. NO OF EMPLOYEES ~o S Co ~ -~ E czLi A L, w J av 3Z,~- ~Zyb ._~ - FACILITY CONTACT BUSINESS ID NUMBER _ 15-021- o~S-aZ~-ao .Section 1: Business Plan. and Inventory Program ^ ROUTINE ~OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfIeSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~~~•~ --GI ^ VERIFICATION OF INVENTORY MATERIALS ~- - " ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ ~ VERIFICATION OF MSDS AVAILABILITY ~ t ~ ~ u ~~~ ~1~. 1 D S ~ ~4~ ^ 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 19'j Z, ANY HAZARDOUS WASTE ON(S~ITE? -~'~YES ^ NO EXPLAIN: L~~ OLS'-f"2 ~~~~ O QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL us AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1~' In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD-2155 (Rev. 09/05 ~~~~~. UI'~11=~IED PROGRAM INSPECTION CHECKLIST' A ,:.3:, > R s e , n -. ~ F/RE SECTION 1: Business Plan and Inventory Program D'E~ARTM T Prevention Services 9OO'IYuxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: . (661) -872-2171 - FACILITY NAME ~~E INSPEC~Ty°oN DATE `~ INSPECTION TIME JDS - /~S~o ADDRESS 1 ~0 5 ~ C - 0 PHONE NO. ~"~-r191~ NO OF F~IPLOYEES ( ~ oM M E rZLI aL w 1 . a FACILITY CONTACT I BUSINESS ID NUMBER 15-021-OIS-dZ-/-00 P•ZT Cwt i - - --. _ I Section 1: Business Plan and Inventory Program ^ ROUTINE 'I~COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIt1eSS PLAN CONTACT INFORMATION ACCURATE '~'® ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~ ~ ~~0~ ^ 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 vl ^ FIRE PROTECTION ~' ^ SITE DIAGRAM ADEQUATE & ON HAND ~~ ANY HAZARDO`U,S~WASTE ON SITE? -1~ YES ^ NO EXPLAIN: - ya S~C ~\V p y QUESTIONS REGARDING THIS INSPECTION? PueasE cnu us AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # siness Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy - -Pink -Business Copy FD 2155 (Rev. 09/05 ~.~-13 a_ ~` ~~z- CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ OFFICE OF ENVIRONMENTAL SERVICES b~ •y UNIFIED PROGRAM INSPECTION CHECKLIST ~w ~4ti ~~ 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 FACILITY NAME Cti R ~~ Q s ~ ° Q-~ t S K~ INSPECTION DATE ~ ~~ ~~° 7 Section 4: Hazardous Waste Generator Program EPA ID # ~x Fi• ~^rf' ~' ^ Routine -~l Combined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~x ~^ ~- 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 Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste N//~ Proper management of lead acid batteries including labels N ~ Proper management of used oil filters ,g Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years t`^' x ~- Retains hazardous waste analysis for 3 years ~QG ~ /vo Retains copies of used oil receipts for 3 years i~ Determines if waste is restricted from land disposal c;=c:ompt~ance v=vtotat~on Inspector: C~ ~' `f Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy Business Site Responsible Party w. ;fir ]~"<- - -"'~~` CITY OF BAKERSFIELD FIRE DEPARTMENT ~a OFFICE OF ENVIRONMENTAL SERVICES • • ~~ UNIFIED PROGRAM INSPECTION CHECKLIST _wE'' Ag~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~'bP~ ~~ 5 Sectaon 4: Hazardous Waste Generator Program INSPECTION DATE ~ / z'~/~'~ EPA ID # ~x~ ~~'~ ^ Routine ~, Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~' iv. ~ ~ 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 ~y LG cu d-~ , Cantainers 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 N Secondary containment provided (~e, ~~ a. S ~ Ge ^ d~ r Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste /ll Proper management of lead acid batteries including labels (1/ ~ Proper management of used oil filters N ~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years }~~r.~- 5 Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years N/.~ Determines if waste is restricted from land disposal ~=~ompt~ance ~v=v~ltot/a~cwn Inspector: ~~ l v ~`~"f'°l "`-s Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy Business Site Responsible Party j h~"V WORTISKA CHARLES F Manager CHARLES F WORTISKA Location: 1405 COMMERCIAL WY 100 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: BusPhone: Map 102 Grid: 34B SIC Code: DunnBrad: SiteID: 015-021-001972 (661) 327-4246 CommHaz Minimal FacUnits: 1 AOV: 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) 587-8061x 24-Hour Phone (661) 637-3224x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React __ Contact- ~: _ CHARLES F WORTISKA ~~` ~ ' ` "-- -`~ ~~ - Phoriecy`(66-1 )'" 327=`42.4"6x°- - - MailAddr: 1405 COMMERCIAL WY 100 State: CA City BAKERSFIELD Zip 93309 Owner CHARLES F WORTISKA Phone: (661) 327-4246x Address 11811 DELL RAPIDS CT State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~Q~'~ E?ased ©a rray i"r~uiry of those individuals respcsrs,i~~€~ ;rir c~~i?Mirtinc~ the information, I certify under pen, ity eat la~ae ttl,^,t I have personally _ _ _ _ - _ exa~;;ined and ~m famiilar with the information - ~ ' - - ` _ ~ ~uiimitte-d a r~ ;;~iil~v~he irifiormatio'n is true; J - ~"- ~-'- -- -- - ~- - - _ - - - ac,~,rat~ and rarnplete. -- -1- 02/20/2007 -~ F WORTISKA CHARLES F SiteID: 015-021-001972 ~ ~ 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 5.00 GAL Min -2- 02/20/2007 ~ooz/oz/zo -E- F WORTISKA CHARLES F~ SiteID: 015-021-001972 ~ ~ 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: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL HAZARDOUS COMPONENTS ..- Silver '~~ riti4riRL 1ii J .7 P~J~Jl"1r+1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/20/2007 _j F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/24/2006 ~ VERBAL, PHONE, MXR = Employee Notif./Evacuation 09/28/1999 VERBAL .. _ "- ~_ ~ - - _- -,-~~=~:~.~-=~=------~-_ --- - _ ---~_ _ _ _~ - - ~ -~ -,_ _ -- ~~ _._ __ Public Notif./Evacuation 09/28/1999 VERBAL. Emergency Medical Plan 09/28/1999 911, MERCY HOSPITAL EMERGENCY ROOM. -5- 02/20/2007 F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/05/2006 ~ WASTE IS CONTAINED IN A 5-GAL CONTAINER.. = Release Containment 07/24/2006 - ----_~__v~ __ - - ____ TELEPHONE MXR- -!-"'--'`~- Clean Up 07/24/2006 USE RAGS FOR CLEAN-UP, PUT RAGS IN PLASTIC BAG AND HOLD FOR MXR TO PICK UP AND DISPOSE. VL11Ci 1CCSVUIC:C HUl.1VdL1CJI1 -6- 02/20/2007 F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~la~: nac.ct.[.u~ Utility Shut-Offs 05/05/2006 A) GAS - -- - --- B) ELECTRICAL - DARKROOM C) WATER - DARKROOM, RESTROOM D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/24/2006 PRIVATE FIRE PROTECTION - ACE SPRINKLER CO, FIRE EXTINGUISHER IN RECEPTION ANTEROOM. ' NEAREST FIRE HYDRANT - COMMERCIAL & COMMERCE. Building Occupancy Level 05/05/2006 1 EMPLOYEE -7- 02/20/2007 ... ~~ . ~ - F WORTISKA CHARLES F SiteID: 015-021-001972 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/24/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: REVIEtnT SPILL PROCEDURE. Page 2 Held for Future Use _, r_ azctu ivt i' u~utc v.~c -8- 02/20/2007 iU ;7 + WORTISKA C ES F __________________________________ SiteID: 015-021-001972 + Manager BusPhone: (661) 327-4246 Location. C MMER AL WY 100 Map 102 CommHaz Minimal City BAKERSFIELD ~ Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: 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) 587-8061x 24-Hour Phone (661) 637-3224x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat ^Hazards : _ _ _ _ _ _ _ _ _ React _ , Contact Phone: (661) 327-4246x MailAddr: 1405 COMMERCIAL WY 100 State: CA City BAKERSFIELD Zip :-93309 Owner CHARLES F WORTI~SKA Phone: (661) 327-4246x Address 11811 DELL RAPIDS CT State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: /~ PROG H - HAZ WASTE GEN ~~ ~ ` EN 1 C T'D J U L 2 4 2006 ~~ has®d on my inquiry of thos® individuals re~pon~Ibia f®r obtainin® th® information, I certify examined anld m 9aml lara w4th the information submitted and believe the Information Is true, accurate, and complete. Signature Date -1- 05/05/2006 RECEP~ON REOT'- OFFICE. II ROOM & . ; ~ . OFFICE -OFFICE' OFFICE CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r" Floor, Bakersfield, CA 93301 FACILITY NAME C. HY~E~cfc~ t,s00~L"fl~tC~a, INSPECTION DATE ADDRESS lq 0 ~ c2or~' ~z~ff-.,~L ~,.r ~'/~ PHONE NO. ~z-7~ qT_.~ G, FACILITY CONTACT c.~}~.~ s ~t~o~-r~s<,a BUSINESS ID NO. 15-210- INSPECTION TIME .~ , ,~ O NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~ Routine ~(..Combined [~ Joint Agency l~l Multi-Agency [_~ Complaint I~l Re-inspection 1' OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address X Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability /~ ~~ ,'ac~Cfl /~'//S'[~ c::>~C) ~['7~'~...1 Verification of Haz Mat training /~ k,~/E. ~.~q/ a~n.e rc. qt,(~', ..,,/ Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled ~.~ Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste~on site?: ~LYes [~No/~f¥,~/z/'~) (~ ~P'~ Explain! ~//c,.~'~---~ f'"l.~-/~ ' Questions regarding this inspection? Please call us at (661) 326-3979 lousiness Site ResponsiVe P~rty White - Envl Svcs. Yellow - Station Copy Pink - Business Copy Inspector CHARLES F WORTISKA SiteID: .015-021-001972 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 EPA Numb: DunnBrad: Emergency Contact / Title Iency Contact / Title CHARLES F WORTISKA / / PROPER Business.Phone: (66 Business : -9985x 24-Hour Phone : ) 589-861 24-Hour Phone : (661) 637-3224x Pager Phone : ) ~g~-~Tx Pager Phone : ( ) - x Hazmat Hazards: React Contact : Phone: (661) 327-4246x MailAddr: 1405 COMMERCIAL WY 100 State: .CA City : BAKERSFIELD Zip : 93309 Owner CHARLES F WORTISKA Phone: (661) 327-4246x Address : 1608 LONGREACH DR State: CA City : BAKERSFIELD Zip : 93312 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: Res: No Emergency Directives: ~ Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat COmmon Name... ISpooHazlEPA HazardsI Frm D~ilyMax lUnit[MCP WASTE FIXER R L 5.00 GAL Min -1- 06/24/2002 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: -'-~ Y°u~may also:attach BusinesS:OwneW~Operator~Fo~m~and~Chemical:Description:Form(s) .... - to the from of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA I ~L~G ~D~SS: ~t .. P~~Y ACT~TY: ~ ~[~o~ c ....... _ -~iE~G-ADD~SST~ ~ .... ~ ....... ~ _- ~- ..~_ ~ .... 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!' '~7 ";~ ~/;;' . ' , "'".-...~'-:-.;. ~ '-~.,, .' '::--~;i..~ .... - ...' "'., ': . B. EMpNOYEE AND-AGENcY. NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: :~ ' :' ' · HAZARDOUS MATERIALS MANAGEMENT PLAN ' ~mER .OF EmLoYEES:.."I;'.'~'., .,' ': :' '.. ~TE~L S~ETY' DATA SHEETS ON FILE:· ' ¢ ~'; ~ ,. B~EF S~Y OF T~~G pRoG~: _~~ .'~ . CERTIFICATION I, ('"~exc. o\,.,, t3i',':~ 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 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. ,. HAZARD AS~E~-~E~N'I~A~q-D~??~'TE~TI_QN~_MEASURES: C. CLEAN-UP AND RECOVERY PROCEDURES: .'~ UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR .FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: WATER: I2)ad:,~--, ...... SPECIAL: ....... LOCK BOX:,', YES.../NO IF YES, LOCATI. QN: . PRIVATE FIRE PROTECTION/WATER AVAILABILITY B. 'WATER AVAILABILITY (FIRE HYDRANT): 3 OF~CE OF ENVIRONMENTAL ;ERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '~'~"~~'""~'-' BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION '- Page Of ~ ~l~ t .~ Year Beginning ~oo Year Ending BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE 102 SITE ADDRESS lO3 ~o~ SIC CODE DUN & ~o? COUNTY ~ f~, OPERATOR NAME ~o9 OPERATOR PHONE ~1o OWNER NAME OWNER MAILING ADDRESS . . . .... 113 CITY - 114 STATE ~s ZIP~ 116 CONTACT NAME . 117 CONTACT PHONE ~8 CONTACT MAILING ~9 ADDRESS CITY ~20 STATE ~2~ ZIP 122 ' BUSINESS PHONE 126 BUSINESS PHONE ...~,,~, _ .~::~__~_ _,~.,~ 131 24-HOUR PHONE 127 24-HOUR PHONE (_...C~ ',.~'~-~"'( 132 PAGER # ~2s PAGER # 133 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. ' SIGNATURE OF OWNER/OPERATOR DATE 1~, NAME OF DOCUMENT PREPARER . ~35 NAMES OF 0-"WNEI~OPERA-TOR (print) 136 TITt'E OF OWNER/OPERATOR 137 UPCF (7~99) S:\CUPAFORMS\OES2730.TV4.wpd -. ~.~. ~ ~'?!i:', CiTY OFBAKERS ,:~., ~ .. , OFFiCE OF ENVIRONMENTAL RVIC ,'. :.~!; ~::';;i i715 CheSter A~'e. (661) 326~3979 ~:~:?C: ' ~. -: *. "' '~ ~ ~ * ~'~ ::' ~- ~ '"'**"~'""?'~7~;~''~ ~: ~: '~;~ ':",~(one~permam alperbu~dingorama):,~* ADO ': . .*~* ~flELET~;' ' ~.REVISE.' ' ':~. * ~ : ~NFIDE~IAL (EPC~) . .... ' * ' : .'-;~;':..~' : ' = .' .... - ,,, .... , _ *, ,: ,,:,..., ; ,:':~_". ', .~Y~. . ~. No' ~. ,~.. ~ ' '' ' ' ~ ~':2211 ~ ~ ~-~' , . ~ . ..~ ' ~ p PURE ' ~ m ~RE ~ w WASTE ~DIOA~NE ~::'..; ;: "~ Y~': ~ No Y ' * 21.2 CURIES ' 213:. '. ~2 ~C~ ,./ D'3'PREssuRE~SE:~:}~'- ~4 A~H~LTM FiRE '.~. : , ~:,...:.,..~ ~:...' · " ' ' ': :'r ' ~' ~ ~ DAILYA~U~?*" -' :'~..' '. :" 'ffEHS. am~ntmustbelnlbs.:.': ' -. ...~ ,. :::::,' :~' 7/ i* . .:;~-::~, ~o.ou.b,."~ ".-' ~. ~,,~o.~.~[,c ~,~ I~::..~ ~, ~,~. ~ '~ ~b ~NDERGRouNDTANK' ';' ~f"~N' ' -'*'- ~ "" ~":: '}:~;'"~J BAG ?'" :( ??::: :',:':i~}} :'~: ? Od S~ELDRUM'- ' .:* - ' Oh SILO .',..':: '.:* ' :' ~',' · ::,,O! ~LINDER ,)'7 * '~'~*~.~"O~ TANKWA~N :, ,' "::.'::~' .. :, . -* -.. ~.: ¥~;.,::*','. · ' ': D ~ A~VEA~IE~."'.' -~'', , ~ b~ BELOw~IE~ ' ~IE~ - ..... .<'.':~ ~ 'AUTHORIZEDCOMPANY~ .. . . SIGNATURE . ;,::, ,:: ~:. :.,.. ,- . . DATE. 246 i :.. -~::' .. "~- · . .' :.'. -' '* /-' * ~:,,.:-,: .... ~*:'~:,',.~.' '..:~.: ,:?'i~'~'~'-':'v''~/ ' ' / ." ' * * ' '::'~C:.- ! -,~*, "',';'-*'"~' '" -. 'i: ,::~:, ,'-*/: ':'?' ':'~ ?i:':'-~:::'' :..~:'::':i~i:::'::'! '/.'. '"-.:'ii:'?::,i'::'i~.':~: ' :' S:\cuPAFORMS\OES2731'TV4'wpd '[ ~,~,(:~],RV~I3! SiteID: 215-000-001972 CHARLES F WORTISKA S£~P 2~ 1999 Manager : /// BusPhone: (661) 327-4246 Location: 1405 COMMERCIAL W~~)/.. Map : 102 CommHaz : Grid: 34B FacUnits: 1 AOV: City : BAKERSFIELD CommCode,: BAKERSFIELD STATION 11 SIC Code: EPA Numb: DunnBrad: Emergency Contact. / Title Emergency Contact / Title CHARLES F WORTISKA / OWNER SHARON ETCHECHURY / CO-TENANT Business Phone: (661) 327-4246x Business Phone: (661) 869-2639x 24-Hour Phone : (661) 589-8610x 24-Hour'Phone : (661) 862-2238x Pager Phone : ( ) - x Pager Phone : ( ) - x Hanmar Hazards: React I Con.tact ?.hone._.-. !66_1) 327-4246x MailAddr 1405 CoMMERcIAL WY 100 State: CA City BAKERSFIELD Zip : 93309 Owner CHARLES F WORTISKA Phone: (661) - 32x74246 Address : 1608 LONGREACH DR State: CA City : BAKERSFIELD Zip : 93312 Period : to TotalASTs: = Gal Preparer : TotalUSTs: = Gal Certif ' d: RSs: No Emergenc,~ Directives: ~ Hazmat Inven~tory One Unified List -- Alphabetical Order All Materials at Site Hazm~atl Common Name... ISpooHazlEPA HazardsI Frm DailyMax IUnitlMCP I WASTE FI,XER R L 5 GAL Min ~, C.J,~,l¢~ /_.~~ Do hereby certify ~hat ~ ha~e reviewed the attachsd ~azardous mate,a,s manage- ~"~"'L ~°"rd-'r-F~/ O-~L merit plan for,(~g~~h~~ that it any corremions c~nstitu~e a c~mpl~t~ ~nd correct man- ,--T-~r~-~-~o q~_ ~ ~,~. ,_,.~_ ..... -1- 08/02/199,. ~HARLES F WORTIS~ SiteID: 215-000-001972 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site -- CO~ON N~E / CHEMIC~ N~E WASTE FIXER Days On Site WASTE PHOTO FIXER 365 Location within this Facility Unit Map: Grid: CAS# Liquid[ / Waste I A~ient A~ient P~STIC CONTAINER ~O~TS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 G~ 5.00 G~ 5.00 G~ ~Z~DOUS COMPONENTS Silver .... 7440224 ~Z~D ~SESSMENTS ITSecret' RS BioHaz' Radioactive/Amount ' EPA Hazards NFPA USDOT# MCP IIIINo No No No/ Curies R / / / Min 2 08/02/1999 F .~HARLES F WORTISKA SiteID: 215-000-001972 Fast Format F Notif./Evacuation/Medical Overall Site Agency Notification Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan 3 08/02/1999 F fH~RLES F WORTISKA SiteID: 215-000-001972 f Fast Format F Mitigation/Prevent/J~batemt Overall Site Release Prevention --Release Containment P~,~ ,,%m~ -- Other Resource Activation -4- 08/02/1999 cHaRLES F WORTISKA SiteID: 215-000-001972 Fast Format Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 08/02/1999 A) GAS- B) C) WATER - D) SPECIAL- E) LOCK BOX - Fire Protec./Avail. Water 08/02/1999 NEWEST FIRE HYD~T - -- Building Occupancy Level -5- 08/02/1999 / ~HARLES F WORTISKA SiteID: 215-000-001972 I/'f ? Fast Format ,~ Training Overall Site -- Employee Training 08/02/1999 HOW MANY EMPLOYEES DO YOU HAVE AT THIS FACILITY??????? DO YOU HAVE MSDS SHEETS ON FILE???????? · SIVE A BRIEF S~Y OF YOUR TRAINING PROSRB~M: ~X~I~'~JD~:,~,¢ -- Page 2 Held for Future Use --Held for Future Use 6 08/02/1999 Chemical Description Form . (one ~ oer matenal per ~ud~ing or ama) ~ Page ~ I, FAClM~ INFORMATION II. CHEMICAL INFORMA~ON T~OE SECRET ~7 COM~N ~ EHS' ~PE ~ p ~ ~ m M~URE ~ w WASTE 211 ~IOACT~ ~Y~ ~No 212 ~ CURIES 213 FED H~RD ~TE~RIES ~ 1 FI~ ~2 R~CT~ ~ 3 ~URE ~L~SE ~ 4 AC~E H~ ~ 5 CHRONIC H~L~ 216 (~ aU ~t ~) WAS~ 2,7 ~I~M 218 I A~~, ~. 2,9 STA~W~OE ~ DAYS ON sTOOGE ~AINER ~ a ~UND T~K ~e ~STI~NM~LIC DRUM ~ i FIBER ORUM ~ m G~SS ~E ~ q ~IL (Cbeck a8 ~at app.) ~ ~ UNeER~OUND T~K ~'f ~ ~ j ~G ~ n ~STlC ~LE D r O~HER O C T~K INSIDE BUILDING ~ g ~Y ~ k ~X D o TO~ BIN . ~ d STEEL DRUM ~ ~ SILO ~ I ~INDER ~ p T~K WA~N STOOGE ~ESSURE ~ ~1~ ~ ~ A~VEA~IE~ ~ ~a BELOW~BIE~ ~4 STOOGE TE~ ~ a ~1~ ~ ~ ~VE ~BIE~ ~ ~ ~ BELOW~IE~ ~ c ~YOGENIC ~8 2~9 ~ Y~ ~ No 240 241 245 III. SIGNATURE" DATE 2~ OES FORM 2731 (7/98) P:~OES2731.TV4.wpd CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROG~RAM INSPECTION CHECKLIST - ', 1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301 FACILITYNAMI~.~__..~ 1~'. O'&~Sff-4 , I'3-F...- INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~i~Cornbined [] 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 ohtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, tat' explosion within 15 days ofoccurance / Established or maintains a contingency plan and training Hazardous wastie accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed ~vhen not in use~x,,% 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 1,/ Sends manifest copies to DTSC Retains manifests [br 3 years Retains hazardous waste analysis fi)r 3 years Retains copies of used <)il receipts for 3 years' 4 Determines if waste is restricted fi'om land disposal C=Compliance V=Violation . Office 6f Environmental Services (805) 326-3979 Business Site Responsible Party · \Vhite - Env. Svcs. · 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 NAMECC,~,r~t..C'-'5' Ut U'.O~?~SK,~- INSPECTION DATE FACILITY CONTACT ~f2__ (~O~'~St~ BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES i Section 1: Business Plan and Inventory Program [21 Routine ~ Combined [21 Joint Agency l~l Multi-Agency l~] Complaint 121 Re-inspection OPERATION C V: COMMENTS Appropriate permit on hand Business plan contact intbrmation accurate / Visible address Correct occupancy ) A~.. t"~.~ ~:~/~.~_ 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 . C=Compliance V=Violation Any hazardous waste on sitef: ~'Yes [2]No /~ -~/.~x '~'~' Explain: ~kJ'/X'e>T~ {)~'-0 ()c-(Ogf) .~)t'l~'(.. Questions regarding this inspection? Please call tis at (805) 326-3979 ~~qtmsmes~ Sitek'A'~~Res~nsible Party White- Env. Svcs. Yello,,,- Statio,, CopyPi,~- ~,~i~ Copy Inspector: CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 'Chester Ave., Bakersfield, CA 93301 (805) 326-3979 FACILITY INFORMATION Page __ Of __ F^Cl~.l'?'.,~ ~ I ~ ~ .? Year Beginning ,00 Year Ending BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE · 103 S~TEADDRESS i405- ~,~e~-,~c t~ ~ DUN & ~os SIC CODE ~oz B~DSTREET (4 Digit g) 108 COUN~ - ' 1 OWNER NAME ~ OWNER PHONE OWNER MAILING. .~ ~ - - ~~+ ~ 113 AgD~ESS (~ ~ ' '1 CI~ ~4 STATE ~1~ ZIP CONTACT NAME 117 CONTACT PHONE lie CONTACT MAILING ADDRESS CITY 120 STATE 121 ZIP 122 TITLE ~~ ~25 TITLE ~ ~ ~~ 130 us,.ESS..O.E 2~-.ou...O.E Ce~ification: Based on my inqui~ of those individuals responsible for ob~ining the information, I ce~i~ under penal~ of law that I have personally examined and am familiar with the info~ation submiEed in this invento~ and believe the info~ation is tree, accurate, and complete. /~O~T F O PE OR DATE 134 ~ME OF DOCUMENT PREPARER 135 ~OF OWNE~OPE~TO~ (pdnl) 136 TITLE OF OWNE~OPE~TOR 137 OE5 FO~M 27'50 (7/96) P:\OES2730.TV4.wpd