HomeMy WebLinkAboutBUSINESS PLAN 8/19/2003 RICK T. GAVIN, D.D.S.
General Dentistry
,._3600 DeSouza PI.
Bakersfield, CA 93309
(661) 831-4533
Fax (661) 831-1920
3600 De Souza Place · Bakersfield, CA 93309:-
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This ~ermit is issued for the followin_.:
[] Hazardous Materials Plan
[] UndergrOund Storage of Hazardous Materials
[] RiSkManagement Program
[] Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002342
DAVID L. WINEGAR, ~.~:: ......
i)"
LOCATION: 3600 DE SOUZA . '~c ,, ,:; CA 93309'
~:,...) ~- ~ ~ ~
· "~ ' ','.", '~:"
1715 Chester Ave., 3rd Floor Approved by: {.. RalpilHuey, D~~) Issue Date
Bakersfield, CA 93301 OmceofEv~Services ~
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: June 30, 2003
DAVID L WIN~GAR, SiteID: 015-021-002342
Manager : BusPhone: (661) 831-4533
Location: 3600 DESOUZA PL.~¢~¢~* Map : 123. Com~az :
City : BAKERSFIELD Grid: liB FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 07 ~v SIC Code:8021
EPA Nu~: ~ DunnBrad:
Emergency Contact /- Title Emergency Contact / Title
RICK T GAVIN / DDS DAVID L WINEGAR / DDS
Business Phone: (661) 831-4533x Business Phone: (661) 831-9595x
24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: React
Contact : Phone: (661) 831-9595x
MailAddr: 3600 DESOUZA PL State: CA
City : BAKERSFIELD Zip : 93309
Owner WINEGAR & GAVIN, DDS Phone: (661) 831-9595x
Address : 3600 DESOUZA PL State: CA
City : BAKERSFIELD Zip : 93309
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
!, '~,..¢,¢~..M_r~¢./~-- Do hereby certify that I have
reviewed the attached h~.za(dous materials manage-
................. ment plan for ~ L~~ and that it along
- ~'~e of eu~) '-
~Y'~ions ~n~itute a complete and corre~
~emem plan tot my,~acility.
1 08/04/2003
1715 Chester Ave., Bakersfield, CA (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
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 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:
LOCATION:
MAILING ADDRESS:
CITY: ~'~ ~5'/c/~
OWNER: ~,,,M/fO ,C &J/~'"~,M4t' PHONE:
MAILING ADDRESS: ~,00 fl,6? ..C. OJ~ /Ac_ ~.~,
EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
~. ,~ce' ci~ ~5 ,v'.r/-4-a-_rs 3~-~~
'l
1,
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:
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION H.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
B. RELEASE CONTAINMENT AND/OR MITIGATION:
C. CLEAN-UP AND RECOVERY PROCEDURES:
UTILITy SHUT-QFF$ (LOCATION OF SHUT-OFFS AT YOUR FACILITY~
SPEC~L: ~ .....
LOCK BOX: YES~ W YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:. bO o
S. WATER AVAILABILITY (FIRE HYDRANT): ' ~)~ '"' /~
ttAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION Iff: TRAINING
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
I, O~JIl~ .I~. ~,c~_~-~ .~r 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.
SIGNA'~/RE. - ~' TITLE ' DATE
4
. EYE WASH STATION
2. 02 TANK
3. FIRST AID KIT
4. FIRE EXTIN~'UISHER
5. OS~ ~S
6. FI~ ~ITS
7. B~LETIN BO~
8~'. ~. sn~ ~
· SITE DIAGRAM [ ] FACILITY DIAGRAM
Business Name:
~ Business Address:
S:\PROCEDURE MANUAL\diagraminst.wpd
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661)~326-3979
BUSINESS OWNER / OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page Of
?~i~i!l ~?~ I I I ' i ' ' YearB ,oo YearEnding
BUSINESS NAME (8~me ag FAOILI~ NAME or DBA- Doin~ Buginegg ~) 3 BUSINEg8 PHONE ~o~
SITE ADDRESS ~o3
CI~ ~~r~f~ '~ j CA ZIP ~y~? ',05
DUN & ~06 SIC CODE ~,]~ ~07
B~DSTREET (4 Digit ~)
COUNW ~M ,08
OPE~TOR NAME ~)~ ~ ~/~~ 109 OPE~TOR PHONE ~]/~~ ~o
OWNER NAME ~1~ L ~~ ~ ,,, ! OWNER pHONE ~/~¢~-- 112
OWNER MAILING
ADDRESS ~00 ~ ~ ~ a~3
CONTACT NAME ~lp C ~/-~~ ~7I! CONTACT PHONE '~I ~ ~8
CONTACT ~ILING
CITY' ' ~4/( ~r~/~ ,20 STATE ~.,2, ] ZIP ¢~3G~ ,22
NAME ~ [L~ ~1~ ~¢ 123 NAME ~&~ ~ld 129
TITLE ~ I '~ ~25 TITLE ~ ~ ~ 130
BUSINESS PHONE ~] -- ~ 126 BUSINESS PHONE ~~ d~ 131
24-HOUR PHONE ~ ~ ],~ 127 24-HOUR PHONE ~ -- /)~ ~ 132
PAGER ~ ~28 PAGER ~ 133
· : "?;:
Ce~i[oation: Based on my inqui~ of tho~e bdividu~ls responsible for ob~inin~ the info~atiom I oe~i~ under p~n~l~ of I~w that I have personally ex, mined
and am familiar with the info~ation submi~ed in this invento~ and believe th~ info~ation i~ true, aocurate, and ~mpl~te.
SI6NATU~E OF OWNE~OPE~TOR DATE ~34 NAME OF DOCUMENT PREPARER
NA~ES OF OWNE~OPE~T~ (print) 136 TITLE OF OWNE~OPE~TOR 137
UPCF (7~99) .. S:\CUPAFORMS\OES2730.TV4.wpd
/~'~'~--'~ · CITY OF BAKERSFIEL
~ OFFICE OF ENVIRONMENTAL SERVICES
~/"~~r 1715 Chester Ave., CA 93301 (661)326-3979
'~"¢~~'"~' HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
/ ~ (one form per material per building or area)
,~EW [] ADD [] DELETE [] REVISE
20O
Page
of
BUSINESS ~ME (Same as FACILI~ NAME or DBA - O~ng Busin~ ~) 3
2os ~ T~DESECRET ~Y~ ~ 206
CHEMICAL ~ME ~/A ~ If Subj~ tO EPC~, refer to inst~ions
Fl~E ~Dfi H~RO C~SS~S (C~plet~ if ~u~t~ by I~l fire ~i~ 210
WPE ~ p PURE ~ m MI~URE ~WASTE 211 ~ ~DIOACTIVE ~V~ ~o 212 ~ CURIES 213
.
PHYSaC~LSTATE D, SOUD ~UaD D g ~S 2,4 i ~RGESTCONT~INER ~ ~ 2,5
FED H~RD ~TEGORIES ~IRE ~ ~CTI~ ~ 3 PRESSURE REL~SE ~ACUTE H~L~ ~ CHRONIC H~LTH 216
(Ch~ all that apply)
ANNUAL WASTE 217 ~I~M 218 AVENGE 'q '219 STA~ WAS~ CODE ~0
~ * ff EHS, am~nt must ~e in lbs.
STOOGE CONTAINER ~ a ABOVEGROUND TANK ~STI~NONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR
(Check att that apply)
~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r OTHER
~ T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BiN
~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON
STOOGE PRESSURE ~BIE~ ~ ~ ABOVE A~IE~ ~ ba BELOW A~IE~ 224
STOOGE TEMPE~TURE ~BIENT ~ aa ABOVE AMBIE~ ~ ba BELOWAMBIE~ ~ c CRYOGENIC ~5
2 230 231 ~ Y~ ~ No 232 233
3 234 235 ~ Y~ ~ NO 236 231
4 ' 238 239 ~ Y~ ~ NO 240 241
5 242 243 ~ Y~ ~ No 2~ 245
PRINI NAME & lilLE OF AU~ORIZED COMPANY REPRESENIATIVE SIGNATURE OAIE 246
UPCF (7/99) , S:\CUPAFORMS\OES2731.TV4.wpd
MATERIAL SAFETY DATA SHEET
This form may be used fo comply wilh OSHA's I-la;:a~d Communication Standard, 29 CFR 192.0.1200. To
be valid, all information required by § 1910.1200(g) of the Standard must appear on this form. Consult the
~ Standard for specific requirements. Note: Blank spaces are not permitted. If any item is not applicable, or
'" no information is available, lhe space must be marked to indicate thai.
IDENTITY (As u~ed on Label and List/ Fixer _. . Label: Corrosive
Section I
Manufacturer's name Emergency Telephone Number
Address (number, street, city, s~H-ZlP'code) Telept~one Number for Information
Date Prepared
~/88
Signature of Preparer (option-~)
Section II - Hazardous Inaredients/ld_entity InfojmaJ!on
Hazardous Components (Specific Chemical Identity/Common Name(s) OSHA PEL ACGIH TLV Other limits %
Reoornmended
Acetic Acid TWA lO ppm TWA 10 ppm
Vinegar Acid
Section III- Phvsical/Cl~emical Characterlstlc~
- . 244° F 1.0
Vapor Pressure (mm Hg.) Itl'mm [[]~Talting PointRate ( Butyl Acetatel = 1)
Vapor Density (AIR = 1') 62° F
· Sol'ubility in Water · 12.07 IEvap°rati°n
Unk
miscible
Appearance and Odor
clear~.co~orless liquid, pungent Odor
_Section IV.(-. F~_r-e/and Explosion Hazard Data Rating/~P
Extinguishing Media ' ~, 4%
Use ('0-, dry ~.t~em~(.,~~ ..... 1_ foam, foam and mist
· .~ .............. :_.. -- '~_ :..::' ,
Special Fire Fighting Proced~
NA
Unusual Fire and Explosion Hazards
Moderate fire and explosion hazard when exposed rio heat of flame.
Based on Draft of OSHA 174, Seph:rnber 1985.
Replaces obsolete OSHA form 20 MSDS
Form no. 042 1988 ttCI,S
Section V- ,-3eactlvltv Data t~ ....... 1
Stability - Unstable Conditions to Avoid
Stable
x
Incompatibility (Materials to Avoid) chromic acid ethylene ].mine, .~ --~'~c ........ ~", ~'"'~; .....
peroxide, nitric acid~ acetaldehyde~ 2-amino-thanol
Hazardous Decomposition or Byproducts
When heated to decomposition emits irritating fumes.
Hazardous May Occur Conditions to Avoid
Polymerization
Unk Wi Not Oo~ur
Section VI - Health Hazard Dat~ R a t i n g: 2.
Routes of Entry: Inhalation? yes Skin? yes Ingestion? yes
Target Or.qans; Respiratory system~ skin~ eyes', teeth
H6alth HazardJ' (Acute and Chronic)
Caustic~ can cause burns~ lachrymation and conjunctivitis, Inhalation causes
irritatzon of mucous membranes. Common air contaminant.
. Carcinogenicity: NTP? no IARC Monographs? Unk OSHA Regulated? yes
"Signs and Symptoms of Exposure
conjunctivitis, irritates nose, throat, chronic bronchitis,' burns eyes and skin,
.skin sensitivity, dental eros].on, black skin, pharyngeal edema, hyperkera£osis
Medical Conditions Generally Aggravated by Exposure
Unk
Emergency and First Aid Procedures
ey¢~; ir,ri~ate immediately skin: flush with water immediately
b~eath: artificial respiration
swallow: seek medical attent].on ].mmediately - see first aid secnion
· .Section VII - Precautton~ for Safe Handling ~nd
Steps to Be Taken in Case Material is Released or Spilled .
protect skin, eyes, clean up immediately,
Waste Disposal Method
see section on waste management~ consult manufacturer.
Precautions to Be Taken in Handling and Storing
protect skin and eyes
"Other Precautions
Section VIII - Control Measures
Respiratory Protection (SpeCify T~pes.)
use any supp~].e~-a].r respirator operated in a continuous flow mode at 250 ppm >
I iSpr~ciaI
Ventilation Ih°oC(~ldEXc~ ~tu s t .......... NA
Mechanical (Gener~l~ ........... IOther
I Do not use in confined area
Protective Gloves ..... f~_~-~ P--~e~ -T-. ~.' - '-~ -- --
use rubber, vinly, or latex I~f any poss].b].l~ty o~ exposure
Other Protective Clothing or Equipment
ch~n~e clothes with 10% or more contaminant
Work/Hygie~'e/Maintenance Practices
provide eyewash
HATERZAL SAFETY DATA SHEET
EASTMAN KODAK COMPANY
~$ State Street
Rochester, New York 14650
For Emergency Health, Safety, and Environments1 Infor=ation, call 716 722-5151
For other purposes, call the Marketing and Distribution Center in your area.
Date of Preparation= 04/6/88 Kodak Accession Number= 427771
SECTION I. IDENTIFICATION
- Product Name= KODAK READYMATIC Dental~~ Replenisher
(Ready-To-Use - ~orking ~~ .....
- Formula: Aqueous M2xture
- Kodak Photographic Chemicals Catalog Number(s)~ CAT ~02 8869 -
1 ~al~on; CAT lOZ 8885 - I/Z Gallon; CAT 106 6406 - 1/Z Gallon
Salution Number: 4814
- Kodak Hazard Rating Codes= R; ! S= 2 F= 0 C= 0
SECTION II. PRODUCT AND COMPONENT HAZARD DATA
AC$[H Kodak
A. COMPONENT(S): Percent TL¥(R) Accession No. CAS Reg. No.
~atar 80-90 .--- 055290 7752-18-5
Sodium me~abisu~f~te 5-10 5 mo/mS 905498 7681-57-4
xHydroqugnone 1-5 2 mg/m$~x 90055&
xPrincipa! Hazardous Cam;anent(s)
~XSee Section ~I-A for additional information on exposure limits.
B.' PRECAUTIOHARY LA~EL STATEMENT(S)~
CONTAINS= hydroqu~none
~ARNING!
CAUSES SKiN AND EYE ]RRZTATION
CAN CAUSE ALLERGIC SKIN REACTION
Avoid contact ~th ayes, skin, and
~ash thoroughly after handling.
First'A~d: In case of aye contact, ~mmediately flush
~ater for at ~ssst 1S minutes. Get medical attention.
skin contact, ~mmed~ately ~ash ~th soap and plenty of
C-0124.000B
8Z-~$12
WINEGAR,DAVI --- MSDS TRACKING INFORMATION
MID: 1052362 READYMATIC FIX & DEVEL
3600 DE SOUZA PL PID: 1115178 OUST: 0167228-001
BAKERSFEILD,CA 95309-5194pACKET: 16521-4029IMG: I:52562_1 PAGE: ¢~~% ..........
q
2
SECTION III. PHYSICAL DATA
- Appearance end Odor: Clear colorless solution; odorless
Boil/nD Points eT lO0 C CDT 212 F) · 760 mmHg
Vapor PrassuraI approx 18 mmHg · 20 C
Evaporation Rate (n-bury! acetate f l)= Not AYailable
Vapor Density (Air - 1): 0.6
-Volatile Fraction by Ioioht~ approx 90 Z
Specific Gravity (HZO = 1): ~.09
- pN: approx 10.0
- Solubility in Water (by Weight): Complete
SECTION XV. FIRE AND EXPLOSION HAZARD DATA
- Flash Point: None, noncombustible
- Extinguishing Ned/a= Use appropriat~ agent for aurrounding fire.
- Special Fire Fightlng Procedures: Wear selF-contained breathing
apparatus and protective clothing.
- Unusual Fire and Explosion Hazards: Fire or excessive heat may
cause production o~ hazardous decomposition products.
SECTXON V. REACTIVITY DATA
- Incompatibility: Strong acids
- Hazardous Decomposition Products: Thermal decomposition may produce
oxides of sulfur.
- Hazardous Polymerizations W~11 not occur.
SECT/ON V~. TOX[C~TY AND HEALTH HAZARD DATA
A. EXPOSURE L~HZTS:
See Section II
OSHA Permissible Exposure Limit (PEL)= 2 mD/mS (hydroquinone)
~. EXPOSURE EFFECTS=
Inhalation= Lo~ hazard for recommended handling.
Eyess Causes ~rr$~a~$on..
Skin= Hay cause irritation. Hey ceuae allergic skin reaction.
C. FZRST AXDs
Eyes= Xmmed~a~ely ~lush eyea ~ith plenty of ~ater and get medical
attention.
C-01Z~.O00}
8Z-1S12
WINEGAR,DAVID MSDS TR6CKING INFORMATION
MID: 1052562 READYMATIC FIX & DEVEL
3600 DE SOUZA PL' PID: 111~178 CUST: 0167228-001
BAKERSFEILD,CA 93509-519¢ IMG: I :52562 2 PAGE: ~~~
PACKET: 16521-4029 -
$
Skin: Flush skin with plenty of water. If skin irritation or an
allergic skin reaction develops, get medics1 attention.
Ingestion: Drink 1-2 glasses of water. Seek medical advice.
SECTION VII. PERSONAL PROTECTION AND CONTROLS
A. VENTILATION: Good general vent/alt/on should be sufficient,
B. SKIN AND EYE PROTECTION:
Safety glasses with side shields are recommended.
Impervious gloves should be worn.
The routine use of a non-alkaline (acid) type of hand cleaner will
help minimize the possibility of aIlergic skin reaction.
SECTION VIII. SPECIAL STORAGE AND HANDLING PRECAUTIONS
Jeep container tightly closed and away from acids.
SECTION IX. SPILL, LEAK, AND DISPOSAL PROCEDURES
Flush to an acid-free sewer with large amounts of water.
Discharge, treatment, or disposal may be subject to federal, stats, or
local laws.
SECTION X. ENVIRONHENTAL EFFECTS DATA
This chemical formulation has not been tested for environmental effects.
Some laboratory test data and published data are available for the major
components of this chemical formulation, and these data have been used to
provide the following estimate of environmental impact: (1-7)
This chemical formulation has a-moderate biological oxygen demand, and it
is expected to cause some oxygen depletion in aquatic systems. It is
expected to have a high potential to affect a;uatic organisms. It is
expected to have a moderate potential to affect secondary waste treatment
microorganisms. It is expected to have a low potential to affect the
germination of some plants. The components of this chemicsl formulation
are biodegradable and are not likely to bioconcentrate. The direct
instantaneous discharge to a receiving body of water of an amount' of this
chemical formulation which will rapidly produce, by diIution, a final
concentration of 0.02 mg/L er less is not expected to cause an adverse
environmental sffac~. After dilution with a large amount of water,
followed by secondary waste treatment, the chemicals in this formulation
are not expected to have any adverse environmental impact.
8Z-i~IZ
WINEGAR,DAVID MSDS TBACKING INFORMATION
MID: 10~2~62*.READYMATIC FIX & DEVEL
5600 DE SOUZA PL PID: 111~178 CUST: 0167228-001
BAKERSFEILD,CA 95509-S19~ IMG: I:S2562 5 PAGE: ~~,,
PACKET: 16521-4029 -
SECTION XI. TRAHSPORTATZON
For transportation in~ormatlon regarding this product, please phone the
Eastman Kodak Distribution Center nearest you; Rochester, NY (716)
ZSq-I$OOj Oak Brook, ZL ($]2) 654-5500; Chamblee, GA (404)
Dallas, TX (214) 241-1611; Whittier, CA (215) 945-1Z55; Honolulu, HZ
(808) 855-1&61.
SECTION XZZ. REFERENCES
Toxicity results are from unpubl/shed data, Health, Safety, sad Human
Factors Laboratory, Eastman Kodak Company, Rochester, Ne~ York.
Verachuaren, K., Handbook of Environmental Data on Organic Chemicals,
Van Nostrand Reinhold Company, Ne~ York, N.Y., 1977.
$. Battelle~s Columbus Laboratories, ~eter Quality Critical Data Book -
Vol. $ - Effects of Chemicals on Aquatic L~fa - Selected Data from
the Literature Through 1968, for the U.S. Environmental Protoct~on
Agency, Pro,act Ho. 180SO G~V, Contrac~ No. 68-01-007, Hay
4. Nat$onal AsSociation of Photographic Hanufacturers, [nC. 'and
Hydroscienca, Znc., Environmental Effects of Photoprocoss~ng
Chemicals, Nat~ona~ Association of Photographic Manufacturers,
Harrison, HeN York, 1974, 2 ¥o2s.
5. Kodak Publicatlon J-41, "BOOS end COD o~ Photograph$c Chomicals",
Eastman Kodak Co., 1981.
6. Bringmann, G. and Kuehn, R., 'Results of Toxic Action of Mater
Pollutants on Dophnia magna (Straus) Tested by an ~mproved
Standard/zed Procedure,w Z~ Massar AbMaaaar Forsch., 15(1),
(1982) (in German).
7. Juhnke, Z. and Luadomann, D., "Results of the Study of ZOO Chemical
Compounds on Acute F~ah Toxicity Using the Golden Orfe Zest," Z.
Wasser Ab~aaser Forsch., lite), 161-4 (1978) (in German).
The information contained herein ia furnished ~thout warranty of any
k~nd. Users shouZd consider those data only as a supplemen~ to other
~nformat~on gathered by ~hem and mus~ make independent detarm~nattons of
the suitability and completeness of ~nformation from all sources to assure
proper uae and d~sposa~ of these materials end the safety and health of
employees and customers.
C-O1Zq. OOOB
WINEGAR,DAVID ---MSDS TR4CKING INFORMATION ---
MID: 1052362 READYMATIC FIX & DEVEL
3800 DE SOUZA PL PID: 111~178 OUST: 0167228-0.01
BAKERSFEILD,CA 93309-5194 .... IMG: 1:52362 4 PAGE. ~r~:~~~
PACKET: 16521-4029 - '
~i?~k j~¢~'~ CITY OF BAKERSFIELD FIRE DEPARTMENT
~ ~ /~,~ UNIFIED PROG~M INSPECTION CHECKLIST
~~2~¢~ 1715 Chester Ave., 3~a Floor, Bakersfield, CA 9330I
FACILITY NAME'~ ~,c< ~ 6~v,d ~b5 ~SPECTION DATE Z ( {4
ADD.SS ~$~ ~ ~oo~ e~ PHONE NO. ~ ~'{ -&S-~ ~
FACILITY CONTACT BUSINESS ID NO. 15-210-
~SPECTION TIME NUMBER OF EMPLOYEES
Section 1: Business Plan and Invento~ Program
~ Routine ~Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection
OPERATION C V COMMENTS
Appropriate pe~it on hand ~ P~ ~'~ ~
Business plan contact info~ation accurate
Visible address
Co~ect occupancy
Verification of invento~ materials
Verification of quantities ~~ ~ ~C~ ~
Verification of location I ~ 51 fi& ~
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--~;4~LC~ e~"~ ~-,O~:~
Site Diagram Adequate & On Hand
C=Compliance V=Violation
Any hazardou~ waste on ~ite?: ~Ye~ ~ No
Explain: ~~ ff,X~
Questions reg~ding ~is inspection? Pl~s~ call u~ at (661) 326-3979 ~ ~usmess S~teons~ble Pa~y
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 ~ ~t,,d { C.~,,~.~' INSPECTION DATE .'~/~4/Oz..
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 /
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: {~} t ~.~ ~-~
Office of Environmental'Services (661) 326-3979 Business Site Respo/fisible Party
White - Env. Svcs. Pink - Business Copy