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Home My WebLink AboutBUSINESS PLAN p.! To: Betty Wilson From: LaVeme Hailer Fax: 661.326.0576 Pages: 8 Phone: 661.326.3642 Date: 3/27/02 Re: Hazardous Materials Management Plan CC: I-I Urgent [] For Review ~ Please Comment [] Please Reply [] Please Recycle Ms. Wilson: The Hazardous Materials Management Plan for Alliance Surgery Center has been reviewed. The corrections have been made on the plan, which I am faxing with this packet. Since the corrections have been made, do you still want me to complete the detailed plan for the Hazardous Materials Management Plan. I will hold the detailed plan until further notice. Thank you for your assistance in this matter. Sincerely, LaVeme Hal~er 562.446.2234 562.743.2539 (cell phone) p.Z AMER.BIOMED.$ERV.CO..~095991177 03/25 '02 N0.796 02/08 03./2~/02 15,57 AI, L, IP. NC~ SURGERY CENTER ............--' Manaqer : RI~i~TE MITCHEi,I. RusPhone: (661} City ; ~K~R~T~I,D Grid: 3OA adc'On.itg; 1 AOV: CO~COde; BA~RSFI~LD ST~'I'ION 0 1 SIC Cod-: 80 1 l g~gencY Co~%act / Title ~ma.,-9~ncy Co~tac~ / 24-H~Ur Phon~ : (661) 765.,~95]~. 24-Rout Phono : (TKO))79 2748x pa~cr Phon~ : { } x Pager Phone : ( ) - .......................... Phone: L661) 127-54.12X Con,aCt : R~ATE NITC~LL City t B~SFIELD Zip : 933'01 City : BA~RSFIE~ Zip : 93301 ................. .......................... TO~ alA~TO: = Period : co Tor. a I liSTs: ~ Gal preparer: RS&: No Emergency Dire~ i veo- ..... ~2 c ~evlswed th~ arlach~ h~arO~ m~eda~ man~e- any ~n~ionS ~n~itute a ~mp~te and ~e~ man- agemem plan for my ~li~. o~/2~/~oo2 p.3 AMER.BiOHEO.SERV.¢O. ~095991177 03~25 '02 :02 N0.796 03108 P-:, 03/22/02 l.~'.:la '~'O01 0g~ 0~ ~FD #AZ H~T ~iV ~Jou3 . _. --- ..... $i r.e[D: 01S-021-0004ql site NITROU~ O'XT~ Day~ On Site Largest. C0nt. ainer [ Daily Maximu- , D~&', ~ver°~' ~ ....................... ~XYCEN S~ ~ ~R OF BL~ 7782 .44-7 STATE =+- TYP= .... +-,= P~SE~E -=-* T~RA~E ~*='=~= CO~AIN~R Ca~ I PUA'o { A'~,ve A~.,ent { Amble/lT. I PORT. P~SS. CYLI~R 'l %Wt,0O. O0 lOxygen, Co~r,ur, ed tN:'[ ............ ASSES S~S ~ + ..... ' No [No [ No No/ Curie~ F P IH / / / Low 2 o'~/22/200Z AMER.BIOflED.SERV.CO. ~095991177 0~/25 '02 N0,796 04/08 ~,-~ ALLIANCE SURGERY CENTRE .... -=--= ........... - .... ~fteIP: ._ ~ . . . - /2001 = Agei~Cy Notification - - ---' -; '- '' '=~ ...... = ...... FOR ETN~LE PATIg~' PROBLEM: NOT;WY N~g~ ~D/OR ~CTOR. IF PATI~'r ~ESPO~ ~ ~DS 'I'~SPOR~ATXON TO ~OSPl'r~, DIAl, 911 ~0~ ~[I~NC~: SERVIC~ TO T~EPORT. OR P~RTI~MT C~T rNE~'I'ION. ~loy ./E = ....... - ~= -.== Em ee Not. if ~aC~ation ..... ~= =~ :==~-~==~-' IT IS THE RE~PONSTBII~I'I'Y OF ~'Y ~YVIt)U~ W~O NOTiCeS A FIRE To ACTIVATE T~E FI~ AlUM SYSTRN ~Y USING 'n~Y ~V~ P~T, ~TATION WAITING ROOM O~ BX 'l'~E G~CENCY EXIT. CHI~S ~ILL BE H~ IN THE EUITE AND ACTIVATED IT A~O~TIC~I~Y SIG~$ TEE FIRE OEPT WHX~ 5~5 A FIK~ TRUCE TO TH~ C~TER. ~ OPE~T~VE PROCED~K C~R~bY IN PR~R~fi~ WrLL T~T~AT~5. 'I'~ ~R ~ TI[E CIRCUI~TING ~SE wl~ CONC~LY EITHER PnXli~ ~N Ti~ R~O~RY R~M AR~. THE RCRI$ ~RSR ~ 'r~K ~STHEglOL~IST DI~ 80 ON ~ FH0~ ~ ~O~C~ NKRD FOR G~ACO~'rzO~. ~K~ To ~o ~L OkSE~TI~ ROOM EXTENSION 258 O~ 270 RF.~IISR ~ $YGT~ I~ N~ H~ THE~. .= .... Eme~ncy Medical Pla~ .,.=;=.-.~=~ ":-===~=~'===~=====- ....... 12/15/19~9 NOTIFY ~NFI ~/OR ~OR. EVAbUA'I'E: UETR~I~ NEKD FOR TRIAGE. -3' 03/22/2002 p.5 AMER.BIOMED.SERV.CO. ~9095991177 03/25 '02 :02 N0.796 05/08 __= .... . ....... ==_~... ~= =. = ==~== .=n~ Past Rmle Pre ........... , = ]1/28/1990 ~NI FOL, D~ ~D .......... 09/1~/2001 ~VACUA'I'iON ~:' TH~ ~ AR A 9RECA~I'Io~. - . - ~/~8/ CLF~ UP WOULD BE LIMITED TO ~ECKING T~KS ~R ST~ILITY ~ TO B~ V~S WER~ ~NED OFF. 4- 03/~2/2002 p.G AMER.BiOMED.SERV.CO., 09095991177 03/25 ' 03 N0.796 06/08 +~=~ Utilit~ Shut Offs .................................... ~ ....... A) ~s SE CORNER & W SIDE C) ~AT~ - W SIDE OF 8LDG hPPROXf~TELY 15 ~ E) ~K sOX - NO . ... 09/16/2001 PKZVATE F1HY; ~OTE~ION -' FZRE EXT1NOUISHERG AR~ LOCATED FL~RS OF E~TI~E oFFICE ~'~ ~{~ ~OU~P~ED WIT~ SPHINCter. ~]T OFF V~S F'IRE IIYDRANT - NW C01~NRR OF PROPERTY, CORNER OF EYE ST ~ Z6TIi ST. 03/22/2002 p.7 AMER.BIOMED.SERV.CO. ~095991177 03/25 '02 03 N0.796 07/08 ~., + ALLI~NCE SUitL;EU~ CI~NTER =-=,====a==-~= ......... = ....... W~ i~ ~T~RIAI. SA~TY DATA SIIE~:T~ ON ~RIEV ~U~Y OF T~AINING~ WE }~V'~ A ~AFKTY C~I~E~ CONS.~STYNG OP O~ ~ER FROM t;aC.{,i PERT. TR~Y IDE~IFY THOSE ITEMS MSDS EN~KTS ~ i~5'i'K0CT THE ~P~Y~EU ~ecnn~nT,v. ~o~ ':z~S ~ Y~R AT OUR GENE~ DT~F M~TINGS TiiEI~ tS AN ~ ON SAFETY ON THE AG~, t::::';;~i"};;%;;~e"~;;':,.~:::: "" ........ :"' ...... :"':" .-=~== Held [or Fut'ur~ Uae ==~-~:--.-~=~ ............... -6 0~/22/200~ AMER.BIOMED,SERV.CO. )5991177 03/25 '02 03 N0.796 08/08 ROBERTS 1~/05/]994 OK u'l/os/19s~ oK {Reterenc~ uaces SummarY DOecrJption MJAM~ ~0/25/~3 oK UPDATE EMERGENCY CONTACTS. ALLIANCE SURGERY CEN Sir_elD: 015-(]2L.000471 Manager : RENATE MITCHELL " BusPhone: (6ql.) 327-5412 Lo,zat Lon: 252S EYE ST ~TE A Map : L0 3 CommHaz : Low ,Z[~_':' : BAKERSFIELD Grid: 30A FacUni~s: L AOV: CommCode: BAKERSFIELD STAT[ON 0l SIC Code: 8011 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title BETTY DEWOODY / CH3kRGE NI/RSE RENATE V MITCHELE / Business Phone: (66!) 327-5412 X254 Business Phone: (661) 327-5412;X303 2~-Hour Phone : (66!) 765~4963x 2q-Hour Phone : (760) 379-2~48 x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImraHlth Contact : RENATE MITCHELL Phone: (661) 327-5412 MailAddr: 2525 EYE ST STE A State: CA City : B~_KERSFIELD Zip : 93301 Owner : WEST COAST SURGERY MANAGEMENT Phone: (562) 803-~22 Address : 2525 EYE ST State: CA City : BAKERSFIELD Zip : 93301 Period : to TotalASTs: = Ga! Preparer: TotalUSTs: = Ga! Certif'd: RSs: No Emergency Directives: Hazmat Inventory One Unified List Alphabetical Order Ail Materials at Site NITROUg OXIDE P P IH G 13~0.00 PT3 Hi I, '~8i~ ¢ / 0 h~re0y ca~%P,, _, IH,._., G 1300.00 FT3 Lo~ revla',v~d the a~ached h~ardcus maleda~s a~y cocre~ions constitute a ~mplete and csrrec~ agement plsn for my faciii~. -1- 07/17/20 ALLIANCE SURGERY CENTE'~ Site[D: 0LS-02L-000471 ~ [~vencory rCem 00u2 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site i 365 Location within this FackliCy Unit Map: Grid: STORAGE RM REAR OF BLDG l CAS~ L0024 -97-2 ~ STATE -- TYPE PRESSURE I TEMPERATURE ~ CONTAINER TYPE Above Ambient I Below 'Ambien~ I PORT PRESS [Gas Pure . . CYLINDER AMOUNTS AT THIS LOCATION I Largest Container I Daily Maximum Daily Average 1350.00. FT3t 1350.00 FT3 1350.00 FT3 HAZARDOUS COMPONENTS 100.00 Nitrous Oxide N 10024972 HAZARD ASSESSMENTS TSecretl RoSIBi°Hazl Radi°active/AmduntNo N No No/ Curies EPA HazardsF P IH NFPA/// USDOT# I MCPHi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM REAR OF BLDG CAS~ 7782 -44-7 Ambient PRESS CYLINDER Pure Above Ambient . [Gas PORT. AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 1300.00 FT3I 1300.00 FT3 1300.00 FT3 HAZARDOUS COMPONENTS !00.00 Oxygen, Compressed N 77824~-7 ecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F P IH / / / Low -2- 0~/17/20~ ALLItANCE SURGERY CEN' Site[D: 0LS-02L-000471 Fast Format -- Notif./Evacuation/Medical Overall Site -- Agency Notification FOR SINGLE PATIENT PROBLEM: NOTIFY NURSE AND/OR DOCTOR. 57 PATIENT RESPONDS BUT NEEDS TRANSPORTATION TO HOSPITAL. DIAL 911 FOR AMBULANCE SERVICE TO TRANSPORT. REMEMBER TO SEND A COPY OF PATIENT'S INSURANCE INFORMATION AND ANY MEDICINES OR PERTINENT CHART INFORMATION. ' Employee Notif./Evacuation IT IS THE RESPONSIBILITY OF ANY INDIVIDUAL WHO NOTICES A FIRE TO IMMEDIATELY ACTIVATE THE FIRE AIJLRM SYSTEM BY USING THE MANUAL PULL STATION IN THE WAITING ROOM OR BY THE EMERGENCY EXIT. CHIMES WILL BE HEARD IN THE SUITE AND THE FIRE BELL WILL SOUND IN THE OUTSIDE CORRIDOR. WHEN THE ALARM SYSTEM IS ACTIVATED IT AUTOMATICALLY SIGNALS THE FIRE DEPT WHICH SENDS A FIRE TRUCK TO THE CENTER. ANY OPERATIVE PROCEDURE CtTR/~ENTLY IN PROGRESS WILL BE TERMINATED. THE DOCTOR AND THE CIRCULATING NTJRSE WILL CONCLTRRENTLY EITHER ASSIST EVACUATION OF THE PATIENT IN THE OPERATING ROOM OR WILL EVACUATE ANY PATIENT IN THE RECOVERY ROOM AREA. THE SCRUB NURSE AND THE ANESTHESIOLOGIST WILL EVACUATE THE PATIENT FROM THE OPERATING ROOM ON A GURNEY TO THE Public Notif./Evacuation DIAL 80 ON ANY PHONE AND ANNOUNCE NEED FOR EVACUATION. REMEMBER TO ALSO CALL OPERATING ROOM EXTENSION 258 OR 270 BECAUSE CALL SYSTEM IS NOT HEARD THERE. -- Emergency Medical Plan NOTIFY NURSE AND/OR DOCTOR. EVALUATE: DETERMINE NEED FOR TRIAGE. TREAT IF IN OUR AREA OF EXPERTISE. IF YOU NEED PATIENT(S) TRANSFERRED, DIAL 9'I~AND FOLLOW OUTLINE TO TRANSPORT PATIENT(S) TO HOSPITAL EMERGENCY ROOM. -3- 07/17/20 ALLIANCE SURGERY CENTER SitefD: 015-021-000471 " Fast Format Mi t igat ion/Prevent/Abatemt Overall Site Release Prevent fon MEDICAL GASES BEHIND LOCKED DOORS IN APPROVED CONTAINERS WITH APPROVED MANIFOLDS AND CONTROLS. -- Release Containment OXYGEN AND NITROUS OXIDE ARE USED ON ANESTHESIA AND MEDICAL EQIUPMENT IN THE OPERATING ROOMS. EXTRA TANKS ARE STORED IN SEPARATE ROOM IN RACKS OR BEHIND CHAIN. IN THE EVENT GAS WAS LEAKING FROM TANK, BOTH GASES WOULD DISSIPATE INTO THE AIR RAPIDLY WITHOUT INJURY OR HARM. EVACUATION OF THE AREA AS A PRECAUTION. CleanUp CLEAN UP WOULD BE LIMITED TO CHECKING TANKS FOR STABILITY AND TO BE SURE VALVES WERE TURNED OFF. Other Resource Activation -4- 07/17/20C ALLIANCE SURGERY C Site~D: 015-021-000471 Fast Format -- Site Emergency Factors Overall Site -- Special Hazards RADIOISATOPES ON HAND RADIATION HAZARD. -- Utility Shut-Offs A) GAS - SE CORNER & W SIDE ' B) ELECTRICAL - NW CORNER & W SIDE MIDWAY C) WATER - W SIDE OF BLDG APPROXIMATELY 15 FT D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water -- PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ARE LOCATED IN REQUIRED AREAS AND ROUTINELY CHECKED FOR REQUIRED MAINTAINANCE. PARKING STRUCTURE AND BOTH FLOORS OF ENTIRE OFFICE BLDG ARE EQUIPPED WITH SPRINKLERS. SHUT OFF VALVES ARE CHECKED ANNUALLY. FIRE hYDRANT - NW CORNER OF PROPERTY, CORNER OF EYE ST AND 26TH ST. Building Occupancy Level -5- 07/17/20Ci ALLIANCE SURGERY CENTER SiteID: 0~5-021-000471 Fast Format -- Training Overall Site --- Employee Training WE HAVE '25 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TPd%INING: WE HAVE A SAFETY COMMITTEE CONSISTING OF ONE MEMBER FROM EACH DEPARTMENT. THEY IDENTIFY THOSE ITEMS IN THEIR AREA THAT REQUIRE MSDS SHEETS AND INSTRUCT THE EMPLOYEES ACCORDINGLY. FOUR TIMES A YEAR AT OUR GENER3LL STAFF MEETINGS THERE IS AN AREA ON SAFETY ON THE AGENDA. -- Page 2 Held for Future Use Held for Future Use -6- 07/17/20£