HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This _~ermit is issued for the following:
[] Hazardous Materials Plan
[] Underground Storage of Hazardous Materials
[] Risk Management Program
[3 Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002182
SAN JOAQUIN
LOCATION 2901
Issued by: Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL S ER VICES' a~//~~~ J/~N -3'200,
1715 Chester Ave., 3rd Floor Approved by:
~(~,Ralpl[Huey, D~~i Issue Date
Bakersfield, CA 93301 'Offic¢ofEvironme~aTServic~s
Voice (661) 326-3979
V.~X (661) 326-0576 Expiation V~t~: 'June 30.. 2003
ITE DIAGRAM [
Business Name: 5'/Oo~ .,~-~/>~ t//~' ~//-//2O/o/L/e<2F lC.
Business Address:
SAN JOAQUIN CHIROPRAC SiteID: 015-021-002182
Manager : (661) 861-1000
Location: 2901 F ST ~C~29 2~d% BusPhone:
Map : 102 CommHaz : Minimal
City : BAKERSFIELD Grid: 24D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 01 SIC Code:8041
EPA Numb: DunnBrad:95-324-6262
Emergency Contact / Title Emergency Contact / Title
CRAIG D GUNDERSON,~,/ OWNER --. / ASSOCIATE
Business Phone: (661) 861-1000x Business Phone: (661) 861-1000x
24-Hour Phone : (661) 588-5877x 24-Hour Phone : (661) .9~--7-7~&~-~/.
~ Phone : (661) ~ Pager Phone : (661) ~
Hazmat Hazards: React
Contact : Phone: (661) 861-1000x
MailAddr: 2901 F ST State: CA
City : BAKERSFIELD Zip : 93301
Owner CRAIG D GUNDERSON DC Phone: (661) 861-1000x
Address : 2901 F ST State: CA
City : BAKERSFIELD Zip : 93301
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
-1- 10/17/2003
~ OFI~CE OF ENVIRONMENTAL S~VICES .
~~~r 1715 Chester Ave" CA 93301 (661) 326-3979 5'~,~,
'"'~'~~"~~ESS OWNER/OPE~TOR IDENTIFICATION
"~:~.~ ~ ~ ~[~ ~ ~ ~ ~ Year Beginnng oD ~ Year Ending
~S NAME, Same as FAQILI~ NAME or DBA- Doi~ ausiness ~) 3 ~ B~INESS PHONE ~o~
SITE ADDRESS ~o~
DUN & ~os SIC CODE ~o7
.,=- ~. ~D~7~NET ~ ~- ~ 2 ~ ~-~ ~ ........ = ......... - (4 Digit ~) ~ / / -
COUN~ /~i~ lO8
OPE~TOR ~ME ~, ~~JO~//~ ~ j OPE~TOR PHONE ~/
OWNER NAME ~~ ~, ~~~X~ /~ ¢ '" OWNER PHONE ¢~~ ,,2
OWNE.
ADDRESS ~~ .- ~3
CI~ · ~4 ' STATE ~5 ZIP
116
CONTACT ~ILING 119
ADDRESS ~,~
CI~~ ~2o STATE 121 ZIP ~22
TITLE' ~/~2~ ~25 TITLE ~g~/~ ~3o
BUSINESS PHONE ~/_ ~/__/~ 126 BUSINESS PHONE ~/-- ~/~/~ 13~
Cedification: Based on my inqui~ of those individuals responsible for ob~ining the info~ation, I ~Ai~ under penal~ of law that I have pe~onally examined
and am ~miliar with ~fo~ation submi~ed in this invento~ and believe the information is tree, a~urate, and ~mplete.
~-NA~S~b~OPE~TOR (pdnt) ' - ~36~ TITLE OF OWNE~OPE~TOR 137
UPCF (7/99) S:tCUPAFORMS~OES2730.TV4.wpd
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_ou ~ay also a_tta~c~h ~.us'_m~s_O_wner_/OperatorForm 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
LOCATION: ~ ?O
~L~G ~D~SS:
c~Y:
Pm~Y ACTIVITY:
EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
,. ~,"2. ~,~,,,,;Z-eS~',--,.~ ,~,'---"'e,~ Pd'/-/~Ob ,P¢,e. ov6~-2~'
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1' DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
B. EMPLOYEE AND AGENCY NOTIFicATIoN:
C. E~O~NT~ ~SPONSE ~AGE~NT:
D. EMERGENCY MEDICAL PLAN:
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 11.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
B. RELEASE CONTAINMENT AND/OR MITIGATION:
................ ~ /-T-,~-~ .~Z-~ , .... ~- ~-</'. ./~'. -'~'--~- ~ ~-'~-- -- - ~- . ~ _~ /~,~ ~ _ ~ , ~ ,~-o_ :, . : :_ ~-~ / . __.
C. CLEAN-UP AND RECOVERY PROCEDURES: .,~
(,'~/c..7~/,-~ ff,/~///5' ;.z ~,~ z-o'
~-/ ~.-~ r..o,~ /~z',u ....
UTILITY S~T-OFFS (LOCATION OF S~T-OFFS AT YO~ FACILITY)
NATURAL GAS/PROPANE:
ELECTRICAL: f~'JZ ~ T
WATER: ~_~./--~ :r- 5~//~
SPECIAL:
LOCK BOX: YES/~ IF YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
B. WATER AVAIL~ILITY (F~ ~~T):
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
NUMBER OF EMPLOYEES: ~
MATERIAL SAFETY DATA SHEETS ON FILE: /z:v,/~O'~_~"- ~ ~"'~--~
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
I, /~,d~' ,,/~, ~/~-'~W_-.,q'd~/~,/,O..C._ 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
.~_T__T~_T_..~I'~N'b~..--~ ~--'"?~INFORMATION CONSTITUTES PERJURY.
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