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HomeMy WebLinkAboutBUSINESS PLAN~~ - it VIVRA RENAL CARE ~~ -- ---- i 4V ~ ~~~~~~ ~~ ~g ~Sn 1 ~~ ~~a~~ ~~ ,~ I TE/FA·C ILI TY FORM AG NORTH DATE: ./ / FACILITY NAME: UNIT s-- ,6- ?7 B/~Ke~_.sF~e-t-'~ . · (CHECK ONE) SITE DIAGRAM '/ .FACILITY DIAGRAM. OF l(Inspect°r' s Comments).: -OFFICIAL USE ONLY- SA - IT.E/FACILITY. FORM NORTH ,SCALE' BUSINESS N~ME: DATE: / / FACILITY NAME: FLOOR: OF ' UNIT ~ ~: OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM, ~505 (Inspector's Comments): -OFFICIAL USE ONLY- Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID# 015-021-000065 VIVRA RENAL CARE LOCATION 5301 OFFICE Issued by: This permit is issued for the following: Materials Plan round Storage of Hazardous Materials ement Program Waste Bakersfield Fire Department OFFICE OF £NVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: ,~ VIVRA RENAL CARE Operator: Location: 5301 OFFICE PARK DR 365 City : BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: ~ SiteID: 215-000-000065 + BusPhone: Map : 102 Grid: 34B (805) 323-2244 OvrlHaz : Minimal FacUnits: 1 AOV: SIC Code:8071 DunnBrad:95-297-7916 Emergency Contact / Title RON NIKKEL / CHIEF TECHNICIA Business Phone: (805) 323-2244x 24-Hour PHone : (805) - x Pager Phone : ( ) - x Emergency Contact Business Phone: 24-Hour PHone : Pager Phone : Hazmat Hazards: - First Response Directives: Fire Press / Title /-- ...... =--=O- (805) 323-2244x (805) ~ ( ) - x ImmHlth += Hazmat Inventory +== MCP+DailyMax Order Hazmat Common Name... One Unified List + Ail Materials at Site + ~ ~ ....... ~ ~ F .... +---+ ISpooHazlEPA HazardsI Frm I DailyMax ]UnitlMCPI F .... +---+ OXYGEN TRAVENOL TABS - HEMODIALYSIS F P IH G 502 FT3 Low L 800 GAL Min I, ~:,,? C~,u~,~,x,,,,, Do hereby certify that ~ have {Ty~ or print name) reviewed the attached ~' ~ ~"~ ~ ~,a~.arm~.~ materials manage- ment plan for v~: ~ &,,,z:~r~:, and that it along with (Name of Business) any corrections constitute a complete and correct man- agernent plan ~or my -1- + VIVRA RENAL CARE += Inventory Item 0001 +== COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit MEDICAL ROOM SiteID: 215-000-000065 + Facility Unit: Fixed Containers on Site + ............. += Days On Site =+ I I 7782-44-7 += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE ..... + [ Gas ] Pure [ Above Ambient I Ambient I PORT. PRESS. CYLINDER [ +=========+ .......... ================================= +== .... AMOUNTS STORED AND IN USE ......................... + q 4 ~ + +~----=~----------------: -I' + ......................... + +=======+ ........... ~-- HAZARDOUS COMPONENTS ~===+ ............... + 100.00 Oxygen, Compressed No 7782447 +=======+===+ ...... + ........... HAZARD ASSESSMENTS ============================= ITSoorotlEHSlBioHazl Radioactive/Amount EPA Hazards [ NFPA I USDOT# I MCP I NO .... [.No..[-No .... ] ....... No/ Curies F P IH / / / Low -I I-----I '1-- '1-- t ! .I- UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? +============== ............. MISC. LOCAL AGENCY DATA ............ + Ag. Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. Defined5: Ag. Defined6: Ag. DefinedT: Ag. DefinedS: Ag. Defined9: Ag.definel0: +- Ag. Definell -- -+ -2- + VIVRA RENAL CARE += Inventory Item 0002 +== COMMON NAME / CHEMICAL NAME TRAVENOL TABS - HEMODIALYSIS Location within this Facility Unit STORE ROOM OUTSIDE SiteID: 215-000-000065 + Facility Unit: Fixed Containers on Site + ~= Days On Site =+ I 365 I +- -+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE I Liquid I Mixture I Ambient I Ambient I ABOVE GROUND TANK ILrgst Cont.this Loc GAL I D ailyMax Stored GAL ============================================================== AMOUNTS STORED AND IN USE ~ ---+ .... .--+ I DailyMax Open Use GAL I DailyMax Closed Use GAL I + ....... + .............. HAZARDOUSCOMPONENTS %Wt. Isodium Chloride ICalcium Chloride IMagnesium Chloride + ..... ==~===+======+= EHS NO No No CAS# 7647145 10043524 7786303 HAZARD ASSESSMENTS ===+ ......... + ........ += .... + ITSecretlEHSlBioHaz No INo No + ~---% UFC Article 80 Radioactive/Amount No/ Curies Control Zone: EPA Hazards I NFPA / / / I USDOT# IMCP Min I ~ + + ~ USDOT Hazards In Cabinet? Sprinklered Area? + ........................... MISC. LOCAL AGENCY DATA Ag.Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag.Defined5: Ag. Defined6: Ag.Defined7: Ag.DefinedS: Ag. Definedg: Ag.definel0: +- Ag. Definell -3- + VIVRA RENAL CARE SiteID: 215-000-000065 + Full Format + += Notif./Evacuation/Medical +== Agency Notification CALL 911 Overall Site + 12/19/1991 + +=== Employee Notif./Evacuation 12/19/1991 + EMERGENCY PHONE NUMBERS POSTED BY TELEPHONES. EXIT LOCATIONS AND ESCAPE ROUTES POSTED IN EACH ROOM AND REVIEWED WITH PATIENTS. SOUND ALARM. REMOVE PATIENTS IN DANGER. +==== Public Notif./Evacuation 12/19/1991 + EVACUATION ROUTES POSTED. PATIENT EVACUATION IS STAFF ASSISTED. EXIT LIGHTS IN PLACE. + ..... Emergency Medical Plan 12/19/1991 + AMBULANCE SERVICE - HALL - 327-4111 SOUTHWEST URGENT CARE - 322-2273 MERCY HOSPITAL EMERGENCY - 327-3371 EMERGENCY MEDICAL SUPPLIES STORED NEAR EXITS. -4- + VIVRA RENAL CARE SiteID: 215-000-000065 + Full Format + += Mitigation/Prevent/Abatemt +== Release Prevention Overall Site + 01/08/1991 + SMALL SPILL COVER WITH SHEETS AND PLACE IN PLASTIC BAG. LARGE SPILL USE FILTER MASK, GOGLES, AND APRON COVER WITH BLANKET AND REMOVE. +=== Release Containment FLUSH WITH WATER 01/08/1991 + .... Clean Up WITH RINSE TO SEWER FLUSH WATER 01/08/1991 + + ..... Other Resource Activation -5- + VIVRA RENAL CARE SiteID: 215-000-000065 + Full Format + += Site Emergency Factors +== Special Hazards Overall Site + +=== Utility Shut-Offs 12/19/1991 + A) GAS - EAST END OF OFFICE COMPLEX B) ELECTRICAL - SOUTH END OF BUILDING #1 C) WATER - IN FRONT OF SUITE 335 D) SPECIAL - EMERGENCY GENERATOR IN BACK D) SPECIAL - EMERGENCY GENERATOR IN BACK OF SUITE 355 E) LOCK BOX - NO ~==== Fire Protec./Avail. Water 12/19/1991 + PRIVATE FIRE PROTECTION - SMOKE DETECTORS MONITORED BY SERVICE, HEAT CENSORS ATTIC AND CEILING SPRINKLER SYSTEM. FIRE HYDRANT - IN FRONT OF PLAZA ON OFFICE PARK DRIVE ...... Building Occupancy Level H OCCUPANCY 12/19/1991 + -6- + VIVRA RENAL CARE SiteID: 215-000-000065 + Full Format + += Training +== Employee Training WE HAVE 19 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: Overall Site + 07/15/1993 + +=== Page 2 -7- 09/19/96 VIVRA RENAL CARE 215-000-000065 Overall Site with 1 Fac. Unit Page General Information Location: 5301 OFFICE PARK DR 365 Map:102 Haz:l Type: 3 City : BAKERSFIELD Grid: 34B F/U: 1 AOV: 0.0 Contact Name Title R%~n~-K~5~I~,z~CHIEF TECHNICIA Business Phone: (805) 323-2244x 24-Hour Phone : (805) - x Pager Phone : ( ) - x Contact Name Title DARLENE BRICKEY / ADMINISTRATOR Business Phone: (805) 323-2244x 24-Hour Phone : (805) 664-9718x Pager Phone : (~) ~z-~lx Administrative Data Mail Addrs: 5301 OFFICE PARK DR 365 City: BAKERSFIELD Con~n Code: 215-011 BAKERSFIELD STATION 11 D&B Number: 95-297-7916 State: CA Zip: 93309- SIC Code: 8071 Owner: JMS CONTE/ROBT GREEN/JMS SMITH Phone: (714) 831-0900 Address:~--M~ffWfB~TIl~ C_~-~ ~_ State: CA City: LAGUNA HILLS ~o v,~ Zip: 92656r Summary !, ~,~.,.~.,,~ '15.:a~,,,., Do hereby certify that I have (Typeor pr~ntname) ' reviewed the attached hazardous materials manage- ment plan for ~,,;.~.~. ~,~,~ C,-~,~ ~ and that it along with (Name ol Business) - any corrections constitute a complete and correct man- agement plan for my facility. 09/19/96 VIVRA RENAL CARE 215-000-000065 Page Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 OXYGEN Gas 502 'Low ~ Fire~, Pressure, Immed Hlth FT3 02-002 ~R~A~NS~--~ - HEMODIALYSIS Liquid 800 Minimal 2 09/1.9/96 VIVRA RENAL CARE 215-000-000065 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-001 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 502 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3502 I Daily Average 502.00FT3 Annual Amount FT3 6,024.00 Storage 7 Press T Temp Location PORT. PRESS. CYLINDER iAbove IAmbientlMEDICAL ROOM -Conc --T 100~0%~Oxygen, Compressed Components MCP ---~uide ILow ! 14 02-002 Liquid 800 Minimal GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL800 I Daily Average 500.00 GAL Annual Amount GAL 35,000.00 Storage ABOVE GROUND TANK [Press T Temp Location AmbientlAmbientlSTORE ROOM OUTSIDE -- Conc --I 0.0% ISodium Chloride 0..0% Calcium Chloride 0,,0% Magnesium Chloride Components MCP ---~utde Minimal I 7 Minimal I 60 Minimal I 31 09/19/96 VIVRA RENAL CARE 215-000-000065 Page 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation EMERGENCY PHONE NUMBERS POSTED BY TELEPHONES. EXIT LOCATIONS AND ESCAPE ROUTES POSTED IN EACH ROOM AND REVIEWED WITH PATIENTS. SOUND ALARM. REMOVE PATIENTS I~; DANGER. <3> Public Not£f./Evacuation EVACUATION ROUTES POSTED. LIGHTS IN PLACE. PATIENT EVACUATION IS STAFF ASSISTED. EXIT <4> Emergency Medical Plan AMBULANCE SERVICE - HALL - 327-4111 SOUTHWEST URGENT CARE - 322-2273 MERCY HOSPITAL EMERGENCY - 327-3371 EMERGENCY MEDICAL SUPPLIES STORED NEAR EXITS. 09/19/96 VIVRA RENAL CARE 215-000-000065 Page 00 - Overall Site <E> Mit igation/Prevent/Abatemt 5 <1> Release Prevention SMALL SPILL COVER WITH SHEETS AND PLACE IN PLASTIC BAG. LARGE SPILL USE FILTER MASK, G©GLES, AND APRON COVER WITH BLANKET AND REMOVE. <2> Release Containment FLUSH WITH WATER <3> Clean Up FLUSH WITH WATER RINSE TO SEWER <4> Other Resource Activation 09/19/96 VIVRA RENAL CARE 215-000-000065 Page 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - EAST END OF OFFICE COMPLEX B) ELECTRICAL - SOUTH END OF BUILDING #1 C) WATER - IN FRONT OF SUITE 335 D) SPECIAL - EMERGENCY GENERATOR IN BACK D) SPECIAL - EMERGENCY GENERATOR IN BACK OF SUITE 355 E) LOCK BOX - NO <3> Fire Protec./Avai!. Water PRIVATE FIRE PROTECTION - SMOKE DETECTORS MONITORED BY SERVICE, HEAT CENSORS ATTIC AND CEILING SPRINKLER SYSTEM. FIRE HYDRANT - IN' FRONT OF PLAZA ON OFFICE PARK DRIVE <4> Building Occupancy Level H OCCUPANCY 09/19/96 VIVRA RENAL CARE 215-000-000065 00 - Overall Site <G> Training Page <1> Employee Training WE HAVE 19 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: <2> Page 2 <3> Held for Future Use <4> Held for Future Use WE H,~E CHANGED O~R NAME COMMUNITY ~ ~ IS NOW VIVRA R DIALYSIS CENTERS ,_~,~ b [ L~'~ PLEASE UPDATE YOUR RECORDS TO RECOGNIZE OUR NEW IDENTITY. CARE /COMMUNITY DIALYSIS SERVICES 215-000-000065 Overall Site with 1 Fac; Unit 07/01/93 Page \ General Information Location: 5301 OFFICE PARK DR 365 Map: 102' Hazard: Minimal Community: BAKERSFIELD STATION 11 Grid: 34B F/U: 1 'AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- RON NIKKEL ICHIEF TECHNICIAN (805) (805) 323-2244 x DARLE~[E BRICKIEYf IADMINISTRATOR 323-2244 x~ 805) 664-9718 Administrative Data Mail Addrs: 5301 OFFICE PARK DR 365 D&B Number: 95.'297-7916 City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-011 BAKERSFIELD STATION 11 SIC Code: 8071 Owner: JMS CONTE/ROBT GREEN/JMS SMITH Phone: (714) ~ Address: 2 ~ ~~ ' State: CA ~-~ City: LAGUNA HILLS Zip: 92656- Summary RECEIVED 'JUI` ,~ 9.199~ HAZ. MAT. DIV. I, Darlene Brickey DO hereby certify that ! have reviewed the attached hazardous materials manage- ment plan for CDC B^KF, RSF[]~nDand that it along with (N~ 0f ~si'ne~) any corrections constitute a complete and corm~ man- agement plan for my facility. Sign~lure 07/01/93 Pln-Ref COMMUNITY DIALYSIS SERVICES 215-000-000065 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Name/Hazards Form Max Qt¥ Page MCP 2 02-001 OXYGEN ~ Fire, PressUre, Immed Hlth Gas 502 Low FT3 02-002-mm~'tm~'~T'-'m~m~~.~, ~.,..~ ~ _ HEMODIALYSIS Liquid 800 Minimal GAL 07/01/93 COMMUNITY DIALYSIS SERVICES 215-000-000065 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-001 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 502 FT3 Low CAS %:' 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 502 Daily Average FT3 502.00 Annual Amount FT3 -- 6,024.00 Storage ~ORT. PRESS. CYLINDER i. Press T Temp Above ~AmbientlMEDICAL ROOM Location -- Conc , 100.0% IOxygen, Compressed MCP --TGuide CompOnents ILow ~ 14 02-002 -T-P~NOL 'Tan---5-- HEMODIALYSIS Liquid 800 Minimal GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL~ AID OR PROCESS Daily Max GAL 800 Daily Average GAL 500.00 Annual Amount GAL 35,000.00 Storage ABOVE GROUND TANK . Location Press T Temp IAmbient/Ambient I STORE ROOM OUTSIDE -- Conc 0.0% 0.0% 0.0% Sodium Chloride Calcium Chloride Magnesium Chloride Components MCP IMinimal Minimal Unrated -- ui7de 07/01/93 COMMUNITY DIALYSIS SERVICES 215-000-000065 Page ~ ~ 00 - Overall Site · <D> Notif./Evacuation/Medical 4 <1> Agency Notification CALL 911 ~ <2> Employee Notif./Evacuation EMERGENCY PHONE NUMBERS POSTED BY TELEPHONES. EXIT LOCATIONS AND ESCAPE ROUTES POSTED IN EACH ROOM AND REVIEWED WITH PATIENTS. REMOVE PATIENTS IN DANGER~ <3> Public Notif./Evacuation EVACUATION ROUTES POSTED. LIGHTS IN PLACE. PATIENT EVACUATION IS STAFF ASSISTED. EXIT <4> EmergenCy Medical Plan AMBULANCE SERVICE - HALL - 327-4111 SOUTHWEST URGENT CARE - 322-2273 MERCY HOSPITAL EMERGENCY -,327-337! EMERGENCY MEDICAL SUPPLIES STORED NEAR EXITS. 07/01/93 COMMUNITY DIALYSIS SERVICES 215-000-000065 Page ~ '~ 00 - Overall Site <E> Mitigation/Prevent/Abatemt' <1> Release Prevention SMALL SPILL COVER WITH SHEETS AND PLACE IN PLASTIC BAG. LARGE SPILL USE FILTER MASK, GOGLES, AND APRON COVER WITH BLANKET AND REMOVE. <2> Release Containment FLUSH WITH WATER <3> Clean Up FLUSH WITH WATER RINSE TO SEWER <4> Other Resource Activation 07/01/93 COMMUNITY DIALYSIS SERVICES 215-000-000065 Page ~ '~ O0 - Overall Site ~ <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - EAST END OF OFFICE COMPLEX B) ELECTRICAL - SOUTH END OF BUILDING #1 C) WATER - IN FRONT OF SUITE 335 D) SPECIAL - EMERGENCY GENERATOR IN BACK D) SPECIAL - EMERGENCY GENERATOR IN BACK OF SUITE 355 E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SMOKE DETECTORS MONITORED BY SERVICE, HEAT CENSORS ATTIC AND CEILING SPRINKLER SYSTEM. FIRE HYDRANT - IN FRONT OF PLAZA ON OFFICE PARK DRIVE <4> Building Occupancy Level H OCCUPANCY 07/01/93 COMMUNITY DIALYSIS SERVICES 215-000-000.065 00 - Overall Site <G> Training Page <1> Page 1 !~~_ WE HAVE ~'4 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 07/01/93 COMMUNITY DIALYSIS SERVICES ~ 215-000-000065 00 - Overall Site <H> RMPP DATA Page <1> Release Containment <2> Offsite Consequences .<3> In House Capabilities <4> Plant Shutdown Instruction 12/13/90 COMMUNITY DIALYSIS SERVICES 215-000-0C)0065 Overall Site with 1 Fac. Ur, it RECEIVED Page Ger, era 1 I r,f'orrnat i or, HAZ. MAT. DIV. ILc, cati,_-,r,: 5301 OFFICE PARK DR 365 Map: 102 Hazard: Minirnal IIdent Number: 215-000-000065 Grid: 34B Area of Vul: 0.0 Cc, r, tact Name Title Business phc, r~e E'4 F~ ,-,r ,ne ST2VE REESE ~ott~l~.~L CHII=F TECHNICIAN (805) 323-2244 x ~(805) BO~ 0t~/ Admir~istrative Data '~--~ ~-D~ ~rD~.~ Nu~,mer ~-2~779~ Mail Addrs= 5301 OFFICE PARK DR ~3~5 City: BAKERSFIELD State: CA Zip: 93303- Cc, rnm Code: ~l,~-.)li BAKERSFIELD STATION 11 SIC Code= Address: SS01 OFT'IC~ F'~$,RI{ BR ~'3C5 ~ ~ State: CA Surllnlary 12/13/90 COMMUNIT'Y DIALYSIS SERVICES 215-000-000065 Hazmat Inventory List in MCP Order~ 02 - Fixed Containers on Site Pln-Ref Name/Haza~-ds Fo¥~m Quant ity Page MCP 2 02-001 OXYGEN Gas 502 Fire, Pressure, Ir~med Hlth FT2, Low 02-002 TRAVENOL ~ABS - HEMODIALYSIS Liquid 1,000 Minimal 12/13/90 COMMUN DIALYSIS SERVICES 2'15-01~000065 00 - Overall Site <D> Not i f. /Evacuat ir, n/Medical Page 3 <1> Ager, cy Notificatic, r~ CALL 911 <2> E~ployee Notif./Evacuation EMERGENCY PHONE NUMBERS POSTED BY TELEPHONES. EXIT LOCATIONS AND ESCAPE ROUTES POSTED IN EACH ROOM AND REVIEWED WITH PATIENTS. SOUND ALARM. REMOVE PATIENTS IN DANGER. Public Not if. /Evacuatinn <4> E~erger~cy Medical Plar~ AMBULANCE SERVICE - HALL - 327-41ii SOUTHWEST URGENT CARE - 322-2273 MERCY HOSPITAL EMERGENCY - 327-3371 EMERGENCY MEDICAL SUPPLIES STORED NEAR EXITS. 12/13/90 COMMUNITY DIALYSIS SERVICES 215-000-000065 Page 00 - Overall Site <E> Mit igat ior~/Prever~t/Abate~t 4 <1> Release Prevention SMALL SPILL COVER WITH SHEETS AND PLACE IN PLASTIC BAG. LARGE SPILL USE FILTER MASK~ GOGLES, AND APRON COVER WITH BLANKET AND REMOVE. Release Corot a i r,~er~t Clear~ Up <4> Other Resource Activatior~ 12/13/90 []OMMUN~ DIALYSIS SERVICES 215-00000065 00 - Overall Site <F> Site Emerger~cy Factors Page 5 <1> Spec-~ial Hazards <2> Utility Shut-Offs A) GAS - EAST END OF OFFICE COMPLEX B) ELECTRICAL - SOUTH END OF BUILDING ~1 C) WATER -'IN FRONT OF SUITE 335 D) SPECIAL - EMERGENCY GENERATOR IN BACK D) SPECIAL - EMERGENCY GENERATOR IN BACK OF SUITE 355 E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - SMOKE DETECTORS MONITORED BY SERVICE, HEAT CENSORS ATTIC AND CEILING SPRINKLER SYSTEM. FIRE HYDRANT - IN FRONT OF PLAZA ON OFFICE PARK DRIVE <4> Held for Future use 12/13/90 COMMUNITY DIALYSIS SERVICES 215-000-000065 00 - Overall Site <G> Trairsi rsg Page <1> Page 1 WE HAVE 14 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held fo~~ Futu~e Use <4> Held for Future Use CITY' of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY Farm andAgticulture El Standard Business ~ NON--TRADE. SECRETS Paee 1 of 1 USINESS ttAHF- CBS of Bakersfield 0WNE~_N_AME:_ .~omm~ Dia. lys~s Centers NAME OF THIS FACILITY: CDS of Bakersfield 0CATION: $'~Office ~ark Drive ~3b~ ADDRESS; z~buz ~aci~ic Park Drive . S~ANDARD IND. CLASS CODE~' J[Y. ZIP= Bakersfield, California 9330~ CI~Y. ZlP~na.ull~$..~al~ornza DUN AND BRADS~REE[ NUMBER .... ]IIONE ~: 323-2244 PHO E ~' L/~} ~ol-iloc · - - REFER ~O~N~TR~ON~NOPER COl)ES -- t ~ ~ ~ 5 6 ~ ' , ~ to tt tzt3 irons !yqe HaH AYerage Annual R~a~ure I ys ~ont Cant ~ont Us Location.rheim. shy Hames of VixturelCoFponenCs :ode ' ~oue ~mt mbt Est units on ILe lype Press /emp Cole YL See Instructions Stored ~n ~h~ic~l ~nd ~ellth Hazard ~,~,$, Humber Comlonent II Hame I ~,1,$, )Chect ell that apply| ~e Hazard ~ ReactiYity ]]. Delayed Il(Sudden Release El Immediate Component C.A.$. Humber Health or Pressure Health Component 13 Hame I C.A.S. Number ~hvsical and PealLh Paiard C.X.S. Humber Component I1 Hame I C.A.a. Humber 263g; Dextrose 90g; Calciu3T lCheck 411 that Component I~ Hame I C.A.S. Number Chloride 9.9g; Glacial Acetic 0 Fire Hazard El Reactivity ~ Delayed ~ Sudden Release El lmaediete ~c~ ~.~g; Hagnesium uhiori(e Non Hazardous Health of Pressure Heelth Comp0nen~ I] Hama I C.A.S. Number 3.4g ~hysical and Health Hazard C.A.a. Humber Component II Hame I C.L$. Humber ICheck all that 4pplyJ . Component 12 Hame I C.A.S. Humber El ~ire Hazard ~ Reactiyity ~ Delayed ~ Sudden Release !'1 ]mqedimte Health of Pressure Health O Component 13 Hame I C.A.a. Number :hYsJcll end Health ~alard C.A.$. Hunber Component II Hame I C.l,S. Humber. (Check all that apply) Component I~ Hame I C.A.$. Number U Fire Hazard 0 Reactivity ~ ~layed ~ Sudden Release E) Immediate ., Hem/th of Pressure Health -- Component 19 Name. I C.A.a. Number EMERGENCY CONTACTS #1 Ron Nikkel Chief Tech 821-4702 #2 Darlene Brickey, RN Administrator 664-9718 ff~me Title 2T'ITFF~ Rame Title ?l~r'-F~b-~'~---- ~rti[jcatioq (RepFt ~!Kd.~ign afCf~r cqmpleCi:~g.~ll..~.c~on~) ' certify under penalty olJaF cn~c i flavepersona/py examln~qlqolm lamJlla[yJt~ the jnlormatJ~fl lu~eitt~d in this end all ' , /~ :~ached.dec~menks, and t~at eased on.my inquiry 9f.those In, tv,Duals responsible tar obtaining cna Inrormatton. I believe that~ , ffOmltLed Information is Crum, accurate, aha coBp/ece. · .- RD, NSk~e~, ChSe~ Technologist ~ /~C~ RECEIVED CITY of BAKERSFIELD NOV 0 []HAZARDOUS MATERIALS ~NYENTORY HAZ. MAT. DIV. Farm andAgticulture 0 Standard Business NON--TRADE SECRETS Page 1 I]USI~FSS tlAHE: CDS of Bakersfield O~N~_~AHE: _~omm~ Dialysis Centers NAME OF TH]S FACIL]TY: CDS of Bakersfield LOC^lION: 5301 Office Park Drive #305 ADDRESS: 24buz ~acz~ic Park urlve ST^NDARD IND. CLASS CODE[' CJlY. ZIP~ Bakersfield, California 93309 Cl]Y. ZIPitLaguna~$1i$..cal~fornla DUN AND BRADS]REEl NUHBER N: 325-2244 O E #' L~j' ~1-~1oc ' - - '~F~R YO-~STRL~T~ONS--FOR--PROPER CODES ..... lrans Nax Annual I Us ~¥[y Names of ~ixture/Coeponents Code' cBoe AmC Ami Est units on ItC /ype s /emp Coue Storea.lO taCllity See Instructions u lP I l 2'ey . I "l365I041I IMed Room(Mid. East) Medical Oxygen Physical and Hell[h Xalard C.A,S. Number Coeponen[ II Name I C.R,S. Number IChec~ all [hat ~re Hazard ~ Reactivity ~.0elayed ~Sudden Release ~ Immediate Component Number Hea/~h o~ P[essure Hea I ~h Com~onen~ U Hame I C.A.S. Humber Physical and Pealth Hazard C.l.S. Number Component II Name I C,A.S. Number 263g; Dextrose 90g; Calcim tCheck all that apply) Component 12 Hame I C.A.S. Number Ch[o~de~9.gg; ~[ac~a[ Ace.~c ~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ lmqpdi~.~e Health of PressureHealth Acid 5.4g; ~.'iagnes~ Ch~o~< e Non Hazardous Component 13 Hame I C.A.S, Number 5.4g Physical lnd Health Hazard C.A.S. Number Component II Name I C.A.S. Number ICheck a]l that applyJ Component I~ Name I C.A.S. Number  ire Hazard ~ Reactivity ~ Delayed ~ Sudden flelease ~ Immediate Health of Pressure HealthComponent I~ Name I C.A.S. Number 'phvsicll ~nd Hellth UHard C.A.S. Number Component II Name I C.A.S. Number [Check 411 that App/H ' Component U Name I C.A.S. Number U Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release Hem/~h of Pressure Component I~ Name I C.A.S. Number EHERGEHCY COIaTACTS ~1 goo N~kge[ CMef Tach 8g[-470g ~2 Da~[ene B~c~e~, ~ Adm~Ms:~a~o~ b54-9718 'ortificati0n (Repf~ g!t.d.~ign af~pr compleCi(~g..all..~c~(on~) ['~ertlfy under penalty 9l)a~ tnqt I nave personajly, exemln~glfld lm lamllleL¥1tgtne !nlocmaupn Su~miktp~ la this.end all ]aa~he,d dQcvment~! an~ tplc masco on. my Inquiry qr. tnose InOlYlUUalS responsible for obtaiNINg toe InfOrmation. [ believe ~ubmltted Information IS true, accurate, and complete. . Ron Nikkel, Chief Technologist 10/26/89 RECEIVED CITY' of HAZARDOUS MATERIALS Farm and Agriculture [] Standard Business I~USI[JESS NAHE; CDS of Bakersfield LOCA[ION: S30Z Office Park Drive #365 [J[Y. ZIPs' Bakersfield, California 95309 ~IIONE #: 325-2244 Irans bin Innuel )f.e.a$.ur e I ys ICode ' Coca Est units on Ire BAKERSFIELD NOV 011989 1 NVENTORY HAZ. MAT. DIV. NON--TRADE SECRETS Page 1 OWNER NAHE: Comm. Dialysis Centers NAME OF THIS FACILITY: CDS of Bakersfield ADDRESS: 245u2 Pacific YarK urive STANDARD IND. CLASS CODE.= .......... CITY. ZlP:~na~ulll$..cal~forn~a DUN AMD BRADSIREET NUMBER ............................... p~HONO E fl' L~*3 oo~-~lOC RE~ER YO~STR~nONS hUH PROPER CODES -- /ype{°nt s /emp~°nt UScole Loceltjon.¥he[e. ~¥~y NameSseeOf ,ixturelCoeponentSlnstructlons StoreD. Ill taCllll;y Of Hex Average 502 PhYsical end Pealth Hazard I(;heck ali that apply) ~l~re Hazard [] Reactivity C.A.S. Humber Delayed I~Sudden Release Health of Pressure Component II Med Room (Mid. East) Hame I C.A,S. Humber Immediate Health Component I~ Hame I C.A.S. Number Component 13 Hame I C.A.S. Number Physical and Health .Hazard {Check all that applyl [J Fire Hazard [] Reactivity Non Hazardous C.A.S. Number Component II Component 12 [] Delayed [] Sudden Release 11 lmq~di~_~e Health of Pressure Health Component I3 ~hy$ical and ~lealth Hazard ICheck all that apply) C.A.S. Humber Fire Hazard [] ReactiYity [] Delayed [] Sudden Release ~ lmmediaLe Health of Pressure Health Component II Component 12 Component 13 PhYSiCal end Health .Halard C.A.S. Humber {Check all that app/yl [] Fire Hazard [] Reactivity [] Delayed I~ Sudden Release [] lmmHeedailat[h~ flea ICh of Pressure Component II Component I~ Component 13 EHERGENCY CONTACTS ffl Ron Nikkel Chief Tech 821-4702 ll~ne TI{ I~ 2T-ItFPIiOh~ Hame t C.A.S. Number Name I C.A.S. Number Rime I C.A.S. Number //~,~ Name I C.A.$. Number Hame I C.A.S. Number NAme I C.A.S. Number Name I C.A.S. Number Hame I C.A.S. Number Name I C.A.S. Number #2 Darlene Brickey, RN H~me Medical Oxygen Potassium 2.0g;. Sodium Chlo~ 263g; Dextrose 90g; Administrator TI[Il 664-9718 ~I -I:iFTli~---' :ertifj~atioq .(Rej~! p!t.cl.oign afCpr I ~ertlly under penelt~ ~l!a~ tnqt I nave pe(sonalq, examln~qlqo Im lamlllaE. Vltgtne !nlo(natJpn ]aache.d.dqcvmeflt~, an~ cpc cased on. ny Inquiry ti.those InOlylOuals responsible Ior obcnlnmg cna ~ubmltte~ InlormaLIofl Is true, accurate, and complete, Ron Nikkel, Chief Technologist ,;;~e-~3,~-~H~Tt-rlr/~-0f ov~ri~F~or o~ o~d~r!opermt~r'S authorized teoresent~[IY~ ~ulmitt.e4 in this.end all . InFormation.. ! believe thlt~ 10/26/89 akersfield Fire ~..~ ..])] azardous Materials Inspection ~ Date Completed Business Name: Location: Plan ID # 215-000 tgO~ 3- (Top right comer Business Plan) Station No. (~(' Shift //r~ Inspector .5~7,'o,/,'- ~' RECE!VED HAZ. MAT. DIV. Verification of Location Proper Segregation of Material Adequate Inadequate Verification of Inventory Materials ~ 0 ~ d Verification of Haz Mat Training CornlTtert~: Verification of Abatement Supplies & Procedures Comlnents: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram Spe. cial Ha~ard~ Ass,ociat~d with this Facility: -¢';f~ ~ .~/~. FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office FIRE DEPARTMENT O. S. NEEDHAM .FIRE CHIEF CITY of BAKERSFIELD "WE CARE" 210! H STREET BAKERSFIELD. 93301 326-391'1 DECEMBER 20, 1990 DEAR MR. NI~{EL, NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS, COMMUNITY DIALYSIS SERVICE LOCATED AT 5301 OFFICE PARK DRIVE #355, BAK]IRSFIELD, CA 93309 ON DECEMBER 18, 1990, THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED: 1. Hazardous materials inventory is incomplete. Use the attached inventory form to identify the contents of the tank in the storage room. VIOLATION· OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(A)(1-4) The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (1) A listing of the chemical name and common names of every hazardous substance or chemical product handled by-the business. (2) The category of waste, including the general chemical and mineral composition'of the waste listed by probable maximum.and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing.a hazardous material handled by the business which is not otherwise listed pursuant to 'paragraph (1) or (2). (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at any one time by the business over the course of the year. 2. Employees must be trained in the use of material safety data sheets. Material safety data sheets must be available to employees for use in their work areas. VIOLATION OF OSHA 1910.1200 (g) The employer shall maintain copies of'the required material safety data sheets for each hazardous chemical in the workplace, and shall ensure that they are readily accessible during each work shift to employees when they are in their work area(s) (h)(1) INFORMATION. Employees shall be informed of: (i)The requirements of this section (ii)Any operations in their work area where hazardous chemicals are present; and, (iii)The location and availability of the written hazard communication program, including the required list(s) of hazardous Chemicals, and material safety data sheets required by this section. 3. Storage of incompatible hazardous materials,, hydrogen peroxide and acetic acid, must be separated. VIOLATION OF UNIFORM FIRE CODE SECTION 80.301 (n) Separation from' Incompatible Hazardous Materials. Storage in excess of the exempt amounts specified in Sections 80.302.. through 80.315 shall either be: 1. Segregated from incompatible hazardous materials storage by a distance of not less than 20 feet, or 2. Isolated from incompatible hazardous materials'storage by a noncombustible partition extending not less than '18 inches above and to the sides of the stored material, or 3. Stored in hazardous materials storage cabinets or gas cabinets. Materials which are incompatible shall not be stored within the same cabinet. The above violations must be corrected bY January 18, 1991. The department will schedule a re-inspection of your facility to verify compliance. Please send me a copy of the material safety data sheets for the acetic acid and acetate dialysis solutions. If you have any questions regarding this notice, please contact Barbara Brenner at 3Z6-3979. Sincerely, Barbara Brenner Hazardous Materials Planning Technician I..D. # BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 'Page NON--TRADE SECRETS HAZARDOUS MATERI ALS' INVENTORY ADDRESS: ~.~C) I ~{~=, (-k~ F~K ~ .12_ ~'~o.~ADDRES S: CITY,.. Z I P: ~~,~O' C~ ~0 q .CITY,ZIP: ~-~~ /~ed~'~v~, ' FACILITY UNIT #: FACILITY UNIT NAME: OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 · 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~; BY HAZARD D..O.T .CODE' AMOUNT AMOUNT UNIT CODE CODE FACILITY U.NIT WT. CHEMICAL OR COMMON NAME CODE GUIDE ~u~~ /eootr, -  · II N&ME: -- TITLE:~'t~I~:~'- ~(_d4 SIGNATURE: ~, DATE: E~gROENCY CONTACT: ~~~~ TITLE: ~{~~ PHONE ~ BUS HOURS: .~-~q~ .~.. ... AFTER BUS HRS: 'P~(~IPAL B'UglNESS ACTIVITY: M~~i~ 0{/ ~/.~ /~n~-~ ] ~~~~ 1~ ~TFU nll~ I.D. # CITY,,. ZIP: ~g~~O <~ ~~ CITY, ZIP: BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON--TRADE SECRETS HAZARDOUS HATERI ALS INVENTORY FACILITY PaEe~ of~ FACiLiTY ---uNiT UNIT NAME: PHONE #: .[OFFICIAL USE CFIRS CODE 1' 2 3 4 5 6 · 7 8 9 10 TYPE MAX- ANNUAL CONT USE LOCATION IN THIS '~; BY HAZARD D.O.' CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUID NAME:' ~-7'-~'~t'~ .~'-~E . TITLE :~/~:~"- 'T~...t'( S GNATURE: ~ ~ · OATE: ~--4 EMERGENCY CONTAb~: .~~~~ TITLE: ~{~~ - PHONE { BUS HOURS:, .32~-ZZq~ '-,. ~. ' AFTER BUS HRS: .,~q~-~l~ ' B_~GENd}~.CONTACT:~O~ ~1~~ TIT~E:,~mi~I$~~ ... PHoN~ ~ B0S HOURS:' ~'-~-'~O~ ~ BAKERSFIELD CITY FIRE DEPART~iENT 2130 "O" STREET BAKERSFIELD, CA 93301 (805) 326-3979 tUSINESS NAME OFFICIAL USE ONLY ID# HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: / 1. To avoid further action, return this form by , 2. TYPE/PRINT ANSWERS IN ENGLISH. S. Answer the questions below for the business 'as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: BUS.P.ONE: 25-z Z4 SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. ? 5z- 4 (,, fro SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT'. GAS/PROPANE: B. ELECTRICAL: f~)fD(~-f~ ~--/~//O ~,C c. WATER: D. SPECIAL: E. LOCK BOX: YES /~I~ YES, LOCATION IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO MSDSS? YES / NO YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE LOCAL EMERGENCY MEDICAL ASSIST~CE FOR YO~ BUSINESS AS A WHOLE EMPLOYERS ARE REQUIRED TO HAVE A PROGR~M WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...- .................................... ~NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... (~E~NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO SECTION 7: HAZARDOUS MATERIAL REFRESHER NO SO NO CIRCLE YES OR NO. DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUND/S~F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... (Y~ NO I, , certify that the above'information is accurate. I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. DATE - 2B - BAKERSFIELD CITY FIRE DEPARTMENT 2~30 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSINESS NAME: ID# BUS I NESS PLAN SINGLE 'FACILITY UNIT FORM 3A INSTRUCTIONS FACILITY UNIT# FACILITY UNIT NAM'E: ~O/OB~%~ SECTION I: MITIGATION, PREVENTION, ABATEMENT PROCEDURES 1. To.avoid further action, this form must be retnrned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as .possible. 'D' SECTION 2: NOTIFICATION AND EVACUATION PROCEDb~ES AT THIS UNIT ONLY SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A, Does this Facility Unit contain Hazardous Materials? ...... If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous'materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2)in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION ~ SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E~RGENCY RESPO~ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPAN~] B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES /~tF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSs? YES / NO KEYS? YES / NO - 3B - Bakersfield Fire D ePt' Hazardous Materials Inspection Date Completed Plan ID # 215-000 Station No. Il 1989 (Top right comer Business Plan) Shift ~ Inspector /~ns'[t ............ Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Cortlm~m: Verification of MSDS Availability Number of Employees i J~ Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Emergency Procedures Posted Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office