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Home My WebLink AboutHAZ-BUSINESS PLAN 3/5/2002 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN 1. To avoid ~her action, return this fo~ within 30 days of receipt. 2. T~E~T ANS~RS m ENGLISH. 5~'60 3. ~swer ~e questions below for the business as a whole. 4. Be as brief ~d concise ~ possible. 5. You may also aRach Business O~er / ~erator Fo~ ~d Chemical Description Fo~(s) to ~e front of~is pl~ instead ofcomplet~g SECTION I. below for initial submission. SECTION~: BUS'SS ~ENTIFICATION DATA ~ ~/0~/ ' BUSINESS NAME: LOCATION: ~L~G ~D~SS: CITY: ~~~~ STATE: zI : SHON : ACTW TY: O~ER: AO SS: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE .24 HR. PHONE 1., HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION H. 1- DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION.~ ............... ,d '" ?~-~-~--~ c~.'//~ ~.~/-,,~x2, c,_.j w//lt c_~-i/ ~..// C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: Office Hours By Appointment Phone: (661) 323-2919 '~ I, SALIN, D.D.S.& ASSOCIATES' · General ~nd Cosmetic Dentistry ,2016 "E" Street Bakersfield, CA 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION H.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: E /~,p /_. o y ~- (.E_-. ~ ,~ ~ ~: 7 £ ,4 ; /,,, ~-_b 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: SPECIAL: ._.. , -LOCK BOX: YE~ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: . B. WATER AVAILABILITY (FIRE HYDRANT): ' HAZARDOUS MATER~LS MANAGEMENT PLAN SECTION Ill: TRAINING NUMBER OF EMPLOYEES: /,~ MATEm~ SAFETY DATA SHEETS ON FraE: /7,/ 7-~- ~'-'/~/---~-- BRIEF SUMMARY OF TRAINING PROGRAM: CERT~ICATION USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CAL~ORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6,95 SEC, 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY, ¢~ ~ ~',~a¢...-~'~..~a-¢- _<-~¢ o ~_.. S IGNAT~I~/RE ~ TITLE DATE 4 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS SECTION I. - BUSINESS IDENTIFICATION DATA: The Business Owner / Operator Form, Chemical Description Form(s) and other Forms (e.g.: underground storage tank information, hazardous waste treatment,, etc., as needed) may be submitted as the first section of the Hazardous Materials Management Plan in order to avoid duplication of information for initial submissions. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1 - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Describe the procedures and equipment used to detect any release or threatened release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EMPLOYEE AND AGENCY NOTIFICATION: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties? At a minimum, you must call 9-1-1 and the Office of Emergency Services at 1-800- 852-7550 to report any spills that are a threat to life, safety or the environment, or for other non-emergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up. companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident involving Hazardous Materials used at your business: 1 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2 - RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that You have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C.- CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be implemented in case ora release at your business. This should address small spills, as well as a major release of material once the material is contained. Hazardous Waste: Please provide the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removedl Please keep all disposal receipts for the last three years available on site for inspection. UTILITY SHUT-OFFS List locations of shut offs using compass points and known or obvious landmarks. If you haVe a lock box containing keys and maps of the facility for the Fire Department to use, please list its location also. PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. Private Fire Protection: Describe on-site fire protection for yourbusiness or facility unit, including sprinklers, fire extinguishers, alarm systems and private response teams. B. Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the Fire DePartment in case of an emergency. SECTION III - TRAINING List the number of employees that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to be in those areas. Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS must be readily available on site in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a program which provides employees with initial and refresher training in the following areas: 1) Methods for safe handling of the hazardous materials used by your business. 2) The Cai OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4) The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, inventory forms, and map within 30 days of receipt. If you have any questions please call us at (661) 326-3979 Thank you for helping to keep our All America City cleaner and safer. 3 OF ENVIRONMENTAL SERVICES 1715 Chester CA 93301 326-3979 * '~* H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ ~er material ~er butlaing or ama) ~EW ~ ADD ~ DELETE ~ REVISE ~ Page __ of __ I. FACI~ INFORMATION BUSINESS ~ME (~e ~ FAClLI~ ~ME ~ D~ - ~ng Busin~ ~) 3 CHEMICAL LO~TIO" ~'~ ~ ~ ~ 201~ CHEMI~L LO~TION D Y. D NO 202 ~ ~NFIDENTIAL (EPC~) ' i '. 1l ~P $ (op~neO ~3 GRID = (op~naO : · 7; II. CHEMICAL IN~O~MA~ON. ~5 T~DE SECRET ~ ~7 ' FIRE ~OE ~D ~SSES (~plme ff ~t~ by I~ fire ~ 2~0 CURIES ~PE ~ p ~RE D m ~RE ~ w WAS~ 211 ~DIOACTNE ~ Y~ D No PHYSICAL STA~ ~ S SOLID ' '~i.]~UID '~ g ~S 2~4 ~RGEST ~AINER 215 FED ~RD ~RIES ~ ~ FIRE ~ 2 ~CT~ D a ~S$U~ REtiE ~ 4 A~ H~L~ ~ 5 CHRONIC H~LTH 2~6 ANNUALWAS~ ~ 2~7 ~I~M ' 2~8 ~ A~Ga ~9 STA~W~OE A~U~ DALLY ~U~ { DALLY A~U~ UNffS* ~ ~ ~L ~ d CU ~ ~ lb LBS ~ m TONS DAYS ON S~ STOOGE ~AINER ~ a ~VEG~UND TANK ~e P~S~N~IC DRUM ~ i FIBER ORUM ~ m G~$S 80~LE ~ q ~IL ( C~eck all ~at ap~) ~ b UNDER~OUND TANK ~ f ~N ~ j ~G ~ n P~STIC BO~E ~ r O~ER ~ c TraK INSIDE BUILDING ~ g ~R~Y ~ k ~X ~ o TOTE BIN ~ d S~EC DRUM ~ h S~CO ~ ~ ~UNDER D p TANK WA~N STO~ P~SSURE ~a ~IE~ ~ ~ ~VE ~IE~ ~ ba BELOW A~IE~ ~4 STOOGE ~M~RE ~ a A~IE~ ~ ~ A~VE ~IE~ ~ ~ BELOW~I~ ~ c CRYOGENIC ~ ~ ~ =7 OY~ DNo 228 '2 ~ ~ 231 OY~ ~N0232 ~ 235 ~Y~O~O ~6 ~ ~7 5 ~ 242 243 ~Y~ ~No 2~ ~ 245 ~U~OR~ED ~C~M~ RE~RE~E~AT~vE SiG~TUEE ~ /~//~ ~ DATE 246 TITLE PRINT NAME & OF UPCF (7199) S:\CUPAFORMS\OES2731 .TV4.wpd i~: ~(~...___.~.~~'-~~~ CITY OF BAKER~I~LI~ !.i:~.~ ~ OF ENVIRONME~ S~VICES ~~ 1715 Chester Ave., CA 93301 (661) 326-3979 H~RDOHS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ per material per ~uilding or ama) ~NEW ~ ADD ~ DELETE ~ REVISE 2~ Page . .. BUSINESS NAME (Same as FACILI~ NAME or DBA - Doing Busin~ ~) FAClLI~ ID ~ ~.~ ~ .~ ~ ~ I~ '~ 1 ~P ~ (op~naO 203 ~ GRID ~ (opt~na~ 205 ~ T~DE SECRET ~ Y~ ~ No 206 CHEMICAL NAME If Subj~ to EPC~. refer to instm~i~s . 207 ~ EHS* ~Y~ ~No CAS ~ 209 ':' If EHS is"Y~ "~ ~ ~w ~st ~ ~ ~ ':~: FIRE CODE H~RD C~SSES (~plete if r~u~t~ by I~1 fire ~i~ 210 I CURIES 213 ~PE . ~ p PURE ~m MITRE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 ~ ~ ~RGEST CONTAINER 215 PHYSICAL STATE ~ s SOLID ~1 LIQUID ~ g ~S 214 FED H~RD ~TEGORIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACU~ H~L~ ~ 5 CHRONIC HEALTH 216 (Ch~ all that a~ply) ANNUAL WASTE~. 217 ~I~M/--/~ 218 , DAILY A~uNTAVE~GE__~ 219 ~[STATE WASTE CODE UNITS* ~ga ~L ~ ~ CU ~ ~ lb LBS ~ t~ TONS 221 DAYS ON SITE ~2 ' ' E EHS, amount must be in lbs. STOOGE CONTAINER ~ a ABOVEGROUND T~NK ~ P~STI~ONM~ALLIC DRUM ' ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (Check a//that app/y) ~ b UNDERGROUND TANK~ f CAN ~ j BAG ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN ~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON STOOGE PRESSURE a AMBIENT ~ ~ ABOVEA~IE~ ~ ba BELOW AMBIENT 224 ~ a AMBIENT ~ aa A~VE AMBIENT ~ ba BELOWAMBIE~ ~ c STOOGE TEMPE~TURE CRYOGENIC 225 I ~ 226 227 ~Y~ ~ NO 228 229 I 2 [ 230~ 231 ~Y~ ~No 232 233 ~ i 237 3 ~ · ~ 235 ~ Y~ ~ No 236 4 ~ Y~ ~ NO 240 239 241 238 ~ 242 , 243 ~ ~y~ ~No 244 i 245 PRINT NAME & TITLE OF AU~ORIZED COMPANY REPRESENTATIVE SIGNATURE DA~ 2~6 · / UPCF (7/99) S:\CUPAFORMS\OES2731 .'l¥4.wpd 1. Salin, DDS EMERGENCY EVACUATION ./ · ~- Dark Storasc Exam ~ -~ ~_~_~.. i B~8 ~ ~2 ; . -~ ~ / ~ : ~3 ~m ir/~o~ I ,0 ~ --. ' R~ : i - , I I : ~ FROM :N FAX NO. :661323495? 29 2002 04:30PM Pi I. SALIN, D.D.S., Inc, General $~d Cosmetic Dentistry 2016 'E' Street Bakersfield, California 93301 Telephone: ~ 323-29]9 o~,/ FAC$1M!,LE, ,COVER PAGE DATE: ~'- ~- O~ TIME: ~'' FROM: ~0 TI. IlS DOCUMENT, INCLUDING TttIS COVER SHEET IS ~ PAGES(S) LONG. THE ATTATCHED PAGE(S) MAY CONTAIN INFORMATION THAT CONFIDENTIAL IN NATURE AND EXEMPT FROM DISCl,OSURE BY CALIFORNIA LAW. Therefore, if you are not thc intended rccipient, demand is hereby made that you do not view the attached pages but, instead, deliver it to thc intended recipient. If delivery is not immediately possible picasc notify this office by lelephone. PLEASE DELIVER TO: NAME: OFFICE:__ M SSAOE: IF ANY OF THESE PAGES ARE NOT LEGIBLE OR YOU DO NOT RECEIVE ALL OF THE PAGES. PI.F. ASE CALL AT (661) 323-2919 OR FAX AT (661) 323 4957~ crrv OF BAKERSFIELD FIRE DEPARTMENT ~ OFFICE OF ENVmO M NTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ADDRESS ;7-.0 ! 6 "t~" '5 ~ PHONE NO. ~2-3 - 2a/l'9 FACILITY CONTACT_~x~xc.-~Ec-t--E ~.O~_' BUSINESS ID NO. 15-210- ~ INSPECTION TlME NUMBER OF EMPLOYEES /O2 ~.~/5 ! Section 1: Business Plan and Inventory Program ~ Routine ~Combined [~ Joint Agency [~ Multi-Agency · ~ Complaint OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials 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 site?: ~[~Yes [~ No ~ ~O.~.~L{~,.~.~.~ , Explain: {.~,J~T'~ {~:~7~ XC~ ~~ , ~,~, Questions reg~ding ~is inspection? Please call Us at (661) 326-3979 ' Business Site Responsibl~y White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: · ~ ~ ~g CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ~, 5~'t-'~a bO$ ~t .~5C. 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 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 v/' 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 Inspector: ~~)'t M'~'5 \ ~ x., Office of Environmental' Services (661) 326-3979 Business Site Responsi_LbJ~ Party White - Env. Svcs. Pink - Business Copy