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Home My WebLink AboutHAZARDOUS WASTE~- z Q ~~ o: ~W~ ~~ ~~ a w as ~ ~~i ~Z; I WU x ~. j ~~ Uo , ~ ~' ~ -~ V ~~ - ~s - - ~~ --- - - - - (~. ~~ ~ ~~ ~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Permit ID #:: 015-000-000848 COMPREHENSIVE MEDICAL LOCATION: 4000 PHYSICIANS BLVD Issued by: This _~ermit is Issued for the followin_a: El Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program r*l Hazardous Waste On-Site Treatment Bakersfield Fire Department OFFICE OF ENV1R ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-057.6 Approved by: Of~ce of Fvi~m~Servic~s ~ Issue Date Expiration Date: June 30, 2003 / Manager : R Location: 4000 PHYSICIANS BLVD E-101 City : BAKERSFIELD CommC6de: BAKERSFIELD STATION 04 EPA Numb: CAL912693010 'SiteID: 015-0~00848 BusPhone: (805) 395/0~5~ Map : 103 CommHaz/~.- Minimal Grid: 19B -FacUnit's: 1 AOV: %~%IC Code: DunnBrad: Emergency qon~ac~' / Title ~WJ%N~q~-W~U~L~r,g~ADMINISTRATOR Business Phone~ (~~2~q-~g~ .,~--I-!-~ Phone : (~1)~7_~ x~~ ~~ Phone : (~{~ -~O]~x Emergency Contact~ / ~ Title ~ . _ ..... ?~~CLINICAL COORDI Business Ph0ne:- (~5~ 24-Hour Phone : (~'l) g~-q~C~x · Pager Phone : (~) Hazmat. Hazards: '- React Contact : Phone: ( ) - x MailAddr: 4000 PHYSICIANS BLVD E-101 State: CA City : BAKERSFIELD Zip : 93301 Owner Address : .B~B~--6~dqiNO_ DEL' Ri _~q~~ City :~D'I~9~D~~ ¢~¢,~ Zip Phone: ( ) - x State: CA Period : to TotalASTs: = Preparer: TotalUSTs: = Certif'd: RSs: No ParcelNo: Gal Gal Emergency Directives: WASTE TREATMENT SITE: CONTACT 326-3979 FOR JOINT HAZ-MAT INSPECTION revie~ved ~he a~ched hazardous m~rials mem. p'~n for ~~r~K~L~ and ~ha~ R ~en~ ~ith ~y ~~ons ~ns~i~u~s a ~mp~e~s ~n~ ~rr~ man- -I- 08/04/2003 COMPREHENSIVE MEDICAL ~ Hazmat Inventory' -- MCP+DailyMax Order Hazmat Common Name... WASTE FIXER SiteID: 015-021-000848 By Facility~Unit Fixed Containers on Site ISpooHaz EPA HazardsI Frm I DailyMax lunitlMcP R L 15.00 GAL Min -2- 08/04/2003' COMPREHENSIVE MEDICAL GING SiteID: 015-021-000848 -- InYentory Item 0001 Facility Unit: Fixed Containers on Site WASTE FIXER Days On Site 365 Location within this. Facility Unit Map: Grid: INSIDE DARKROOM . CAS# FSTATE TYPE PRESSURE Liquid I Waste Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 10.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 15.00 GAL Daily Average 15.00 GAL %Wt. ISilver HAZARDOUS COMPONENTS N 7440224 ITSecret No HAZARD ASSESSMENTS RSlBioHazI' Radioactive/Amount EPA Hazards No I NoI No/ Curies R NFPA [ USDOT# I MCP / / / Min Treated On Site I CA Code No Treatment UnitID: WASTE DATA US Code I GAL Generated/Mo.I GAL Unit Type: Generated/Yr. Agency-Defined Text Label -3- 08/04/2003 f c~MPREHENSIVE.~ ~ MEDICAL GING SiteID: 015-021-000848 Fast Format = Notif./Evacuation/Medical -- Agency Notification CALL 911 Overall Site Ol/31/ 99o -- Employee Notif./Evacuation PERSONNEL ARE TO IMMEDIATELY NOTIFY THE BFD AND IMMEDIATELY CENTER. 01/31/1990~ EVACUATE THE -- Public Notif./Evacuation ONLY IMMEDIATE ROOM NEED BE EVACUATED 01/31/1990 Emergency Medical Plan 01/31/1990 A SPECIFIC PLAN EXISTS FOR DIFFERENT TYPES OF EMERGENCY AND THE EVACUATION IS ALWAYS TO THE WEST SIDE OF THE BUILDING. IN THE CASE OF INURY, PHYSICIANS AND NURSES ARE ALWAYS ON DUTY. CLOSEST LOCAL HOSPITAL IS THE BAKERSFIELD MEMORIAL HOSPITAL -4- 08/04/2003 coMPREHENSIVE MEDICAL~GING SiteID: 015-021-000848 Fast Format ~ Mitigation/Prevent/Abatemt Release Prevention Overall Site 01/31/1990 CENTER PERSONNEL ARE NOT TO HANDLE THE CRYOGEN APPARATUS. THE TRANSPORT FILLING OF.THE HELIUM AND NITROGEN IS CARRIED OUT BY A TRAINED AND CERTIFIED TECHNICIAN FROM BAKER WELDING SUPPLY. STAFF IS INSTRUCTED THAT IF THE CONCENTRTATIONS FROM THE HELIUM AND NITROGEN WERE TO ELIMINATE ANY OXYGEN FROM THE AIR THE EFFECT WOULD~BE AN IMMEDIATE DANGER AND HAZARD TO THEM. --Release Containment SHUT OFF GAS 01/31/1990 -- Clean Up SPACES CONTAMINATED BY THE hAZARDOUS MATERIAL ARE AIRED OUT 01/31/1990 Other Resource Activation -5- : 08/04/2003 F c6MP~EHENSIVE MEDICAL~GING ~.~ Site Emergency Factors iSpecial Hazards SiteID: 015-021-000848 Fast Format. Overall site -- Utility Shut-Offs 01/31/1990 A) GAS - REAR OF BUILDING B) ,ELECTRICAL - NORTHEAST CORNER NEST TO STAIRS C) WATER - REAR OF BUILDING LOCATED IN ~'~ OF B~ E) LOCK BOX - NO -- Fire Protec./Avail. Water PRIVATE.FIRE PROTECTION - SPRINKLER SYSTEM, FIRE EXTINGUISHERS 01/31/1990 FIRE HYDRANT - ACROSS STREET NORTHWEST SIDE, REAR OF BUILDING Building Occupancy Level -6- 08/04/2003 F~.~OMPREHENSIVE MEDICAL SiteID: 015-021-000848 Fast Format Training --Employee Training WE HAVE~4) EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE STAFF INFORMED ABOUT HAZARDS DURING INSERVICE MEETINGS. Overall Site o11 11 o ~T -- Page 2 Held for Future Use Held for Future Use -?- 08104/2003 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. . Enironmental Service~ ,~/ 1715 Chester Ave }~'~ Bakersfield, CA 93301- ' Tel: (661)326-3979 FACILITY NAME 1 INSPECT. iON D/t/TN INSPECTION TIME ADDRESS ~, [ PHONE No. No, of Employees FACILITYCONTACT - 'Ii ~s i~ ~i ~ - i'~-u-m~' I ~5-o2~- %4~; Section 1: Business Plan and Inventory Program ' Routine ~Combined [] Joint Agency [] Multi-Agency [] Complaint i"1 Re-inspection C V ~' C=Compliance '~ OPERATION COMMENTS ~, v=violation [] ~ APPROPRIATE PERMIT ON HAND ~ [] BUSINESS PLAN CONTACT INFORMATION ACCURATE r"l [] VISIBLE ADDRESS [] ~ CORRECT OCCUPANCY [~ [] VERIFICATION OF INVENTORY MATERIALS [-I [] VERIFICATION OF QUANTITIES {~ [] VERIFICATION OF LOCATION ~ [~ PROPER SEGREGATION OF MATERIAL ~ ~ VERIFICATION OF MSDS AVAILABILITYE [] ~ VERIFICATION OF HAT MAT TRAINING [] i-J VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES [] [] EMERGENCY PROCEDURES ADEQUATE [] ,~L CONTA,NERS PROPER'~ LABELED [] [] HOUSEKEEPING [] [] FIRE PROTECTION {~ [] SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; ~/ES EXPLA,N: C,x. JV~S ~'~- ~'~,~ rl No Inspector ............................Badge Nolo- .................. Pink- ~]-~i~-~'a ~' --' ....... White - Environmental Services Yellow - Station Copy FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 t,~_4'>. ,~. 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 b/~-~-"O.,q t,,.g/k-e,~'~ /..gNfS~--~. 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 ~)/~_h ,q'(~~ Inspector: 6"D'c'~'~ [,[ Office of Environmentai Services (661) 326-3979 Bu~ines~c~te Responsible Party White - Env. Svcs. Pink - Business Copy FACILITY N~ME._~O~ ge~b/~, ~_ ADDRESS FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE ,d~ / PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program. Routine /[~ombined ~]l Joint Agency [~ Multi-Agency [~1 Complaint [~[ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate ~ ~O$. txPt~ Visible address ~ (?'~-~_.K Correct occupancy Verification of inventory materials Verification of quantities .....(,~ - Verification of location --~ Proper segregation of material Verification of MSDS availability ~ C 0 m p I~ e h e i~ $ i v e ,. / medical imaein Verification of Haz Mat training Bakersfie~q~ Verification of abatement supplies and procedures Molly Stugard, R.T. (R) (M) ~' Emergency procedures adequate Chief Technologist Containers properly labeled 4000 Physicians Blvd., Suite E-101 · Bakersfield, CA 93301 .. phone 661.395.0155 ext. 17 · fax 661.395.0102 Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ,~Yes I~ No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE 4/7/~ Section 4: Hazardous Waste Generator Program EPA ID # ~--------~g--- [] Routine )~2._ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous xvaste determination has been made EPA 1D Number (Phone: 916-o_4-1781 to obtain EPA ID/3) Autho,'ized for waste treatment and/or storage Reported release, fire. or explosion within 15 days ofoccurance Established or maintains a contingency plan and training Hazardous waste accumulation time fi'ames 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 S~ec°nd~c°ntainmentpr°vi K qt.v_ xe u, oc - 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 tbr 3 years Retains hazardous waste analysis for 3 years Retains copies of used ()il receipts for 3 years Determines if waste is restricted fi'om land disposal C=Compliance V=Violation Inspector: Office of Environmental Services (805) 326-3979 Business Site Responsible Party \Vhite - Env. Svcs. Pink - Business Copy ~ CITY OF BAKERSFIEJ ' OI~FICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS 'INVENTORY CHEMICAL DESCRIPTION (one form per material l~er building or ama) n NEW kD r-I DELETE n REVISE 200 ' ' . Page __ of BUSINES'S NAME (Sa~IO'as"FACILITY NAME De DBA- D~ng Business ^:Si ' ~ ' ' ' "" ..... ' ..... :" ' ' " 3 _.. 201 CHEMICAL LOCATION [] Yes [] No 202 CHEMICAL LOCATION I~ //~ ~" ~t~._,~.~.~...~<~.,)/¥'~ CONFIDENTIAL (EPC~) FAClLI~ ID = ~ ~ 1 ~ = (op~na~ ~3 GRID = (op~na~ · CHEMICAL NAME COMMON NAME CAS # FIRE CODE HAZARD CLAS~ES (Complete if requested hy IOCaJ fire chie0 205 I TRADE SECRET []Yes [] No 206 i If Subject to EPCRA. tepee to inslrucfions 207 : I EHS° []Yes []No 208 ~., ~;~,. ... ~¢:,~.~.~.~,. ~: ;%,:? >:.:~ ,:;~'!? (': ~,~- 210 TYPE r-] p puRE r-] m 'MIXTURE ~w WASTE 211 I RADIOACTIVE [] Yes ~,,No 212 I CURIES 213 ' i PHYSICAL STATE [] $ SOLID ~;~LIQUID [] g GAS 214 LARGEST CONTAINER I O 215 FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELE/~E [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 ' (Check all t~at apply) 219 STATE WASTE CODE ^..UAL W^STE I MAX,MUM 2~8 I ^VERAC-E UNITS* ,,,~ga GAL [] c~ CU FT [] lb LBS [] tn TONS '"'If EHS. amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK ~ PLASTI~NMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) []b UNDERGROUND TANK '[]f CAN []j BAG r-In PLASTIC BOTFLE []r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER ' [] p TANK WAGON S'I:ORAGE PRESSURE [] · AMBIENT [] aa ABOVEAIdBIENT [] ba BELOWAIVlBIENT 224 ! STORAGE TEMPERATURE [] -.AMBIENT [] aa ABOVE AMBIENT [] be BELOWAMBIENT [] c CRYOGENIC 225 i DYes DNo ~2s 235 [] Yes [] No 236 237 239 [] Yes [] No 240 241 243 [] Yes [] No 244 245 ' 238 PRINT NAME & TITLE OF AUTHORIZED ( DATE UPCF (7~99) I S:~CUPAFORMS\OES273i .TV4.wixI DEP~RTMENT OF TOXICou~_~,~l~.=.. CONTROL REGION 1-1515 Tollhouse 8oad Clovis. CA 93612 CHECI~J-qT AND INSPECTION REPORT FOR Permit by Rule, Conditionnlly Authorized, and Conditionnlly Exempt Notifiers FACIL1TY NAME: PHYSICAL ADDRESS: C OU1WrY /irt. INSPECTION DATE: ~.~r;/,~, /e~'- # of VIOLATIONS: Minor __ Class 1 VIOLATION TYPE: ~ Onslte treatment Generator Waste min.' Recycling NOTICE to COMPLY ISSlJED (y/n): ,(/o Local Agency # e: PETE WILSON,' Governor ~-f_?~ f This diecklist and inspection report idemity violations of'state law reglmting onsite treaters of hazardous waste, operating under an onsite permitting tier. T'n~s ~n verifi~s tile information provided on form ~ 177~. It also covers generator r~qtl~entq, salthoIzgJ3 a separa/~ chec~ my be ~ for those requirements. A checlanark indicates violation of the law, which are explained in more detail on the attached note sheets and Notice to Comply. The governing laws are the Health and Safety Code (HSC) and Titla 22 of the California Code of Regulations (22 CC:R). Generator Standards: ~ Each in~ection agency may age their own generator inspection checkl~t or protocols, which are summarized below. A full evaluation of each item or document ir not comtucted during the lnspection, unless serious defidenc~ are ~ected. 1. ~ Contingency plan has been Prepared (adequately minimize releases, has alarm/communication system, lists emergency equipment and phone numbers for emergency coordinators). Written training docnments and records prepared for employees handling hazardous waste. Meet container management standards (storage time limits, closed, labelled, compatibility, inspected weekly, in good condition, with-ignitable.~/reactives 50 feet frompropeny line). 4./V/~ Meet tank management standards (either secondary containment or integrity assessments, plus storage time limits, labelled, compatibility,' inspected daily, in good condition, with ignitables/re, actives 50 feet from property line). 5.0 ~ All wastes are properly identified. Treatment Items-Facility Wide: (Facitity mu= submit a reused Form 1772 to correct error~ or omissions.) 6. ~ ~ All units under PBR, CA, and CE are properly indicated on Form DTSC 1772. units with unit sheets or correct tier on the unit sheet.) (Add any new 7. ~& All generator identification information on Form DTSC 1772 is correct. 8. ~r -The submitted plot plan/map adequately shows the location of all regulated units. · 9.0 t( There are records documenting compliance with sewer agency pretreatment standards and industrial waste discharge requirements, where applicable. 10./hq Generator has prepared/maintained source reduction documents requirements (SB 14/SB 1726). FOr many wastes, a checklist Or plan is required only if annual hazardous waste volume is over 5,000 kilograms (approx 11,000 pounds or 1,350 gallons). HSC 25244.1'5, 25244.19-.21 For CA or PBR notifiers: 11./[/fl The generator has an annual waste minimization certification. (PBR submit with renewals.) Onsite Checklist (A) Page 1 of / January 1, 1995 STATE OF CA LIFORNIA:ENVlRONMENTA_L PROTECTION AGENCY DE~ARTI~,IENT ~"~~~SUBS~ICES ~T"~'~ ~ REGION 1-1515 Tollhouse Road Clovis, CA 93612 PETE WILSON, Governor CHECKLIST 'AND INITIAL VERIFICATION INSPECTION REPORT FOR - Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers UNIT SHEET Complete one unit sheet fOr each unit either listed in the notification or identified during the inspection. Unit Number: Notified Tier: Unit Name: Correct Tier: Notified Device Count: Correct Device Count: Containers Containers For each Unit: 12.v(~. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22 23. All hazardous wastes treated are generated onsite. The unit notification is accurate as to the number of tank(s) and/or container(s). The estimated notification monthly treatment volume is appropriate for the indicated tier. The waste identification/evaluation is appropriate for the tier indicated. The wastestream(s) given on 'the notification form are appropriate for the tier. The treatment process(es) given on the notification form are appropriate for the tier. The residuals management"information on the form is correct and documented for the unit. The indicated basis for not needing a federal permit on the notification form is correct. There are written operating instructions and a record of the dates, volumes, residual management, and types of wastes treated in the unit. There is a written inspection schedule (containers-weekly and tanks-daily). There is a written inspection log maintained of the inspections conducted. If the unit has been closed, the generator has notified DTSC and the local agency of the clOSUre. For each CA or PBR unit: 24. j/# The generator has secondary containment for treatment in containers. For each PBR unit: 25. There is a waste analysis plan 26. ~/~ There are waste analysis records. 27. There is a closure plan for the unit. Unit Comments/Observations: (If this is a unit tttat was not included on the notification form, the violatton is operating without a permit-HSC 25201(a). Also note if the activity is currendy ineligible for onsite authorization.) Onsite Checklist (B) page/' of f January 1, 1995 CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally ExemPt Notifiers SIGNATURE SHEET PETE WILSON, Governor Onsite Recycling: Only answer,if this facility recycles more than I00 Idlograms/month of hazardous waste on,ire. ,NO 28. 29fl/~ Releases: yES' 30. 31. The appropriate local agency has been notified. HSC 25143.10 Activit!es claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. If there has been a release, prOvide the following information., number of releases, date(s), type(s) and quantity of materials/waste, and the 'cause(s). Use unit sheet or attach additional pages. Within the last three years, were there any unauthorized or accidental releases to the 'environment of hazardous waste or hazardous waste constituents from onsite treatment units? Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from any location at this facility? For purposes of a Tiered Permitting inspection, an unauthorized and/or accidental release to the environment does not include spills contained within containment systems. This. report may identify conditions observed this date that are alleged to be Violations of one or more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in more .detail on the attached note sheets. If any viOlations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 60 days, unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the facility will submit a revised notification within 30 days to the'Department of-Toxic Substances Control 'with a copy to the local enforcement agency. Inspector(s): Lead Inspector: Print Name: z,r~a,.,/~ A. 3"-jw~,, ~-,.. Title: //,~, . ~.g ~_/~,~,.,..~ ~ ~:.~,4,.~ Phone Number: 20?) .2 e ~'-J'gSo Other Inspector: Signature: Print Name:' Title: Agency: Phone Number: Facility Representative: Your signature Signature.~/~ Title: ~t~' Onsite C acknow}edges 'receipt of this report and does not imply agreement with the findings. ~tp_~' _~~ ~'~rint Name: ~c~ist (C) Page~ of/ Au~st 2, 1994 Depnrtmmt of Toxic ~b.s~m~ees Control Page I of _~ TREATMENT NOTIFICATION FORM' [] Initial [] Revised FACILITY SPECIFIC NOTIFICATION For Use by Hazardous Waste Generators Performing Treatment Under Conditional Exemption and Conditional AuthOrization, and by Permit By Rule Facilitie~s Please refer to the attached b~tructions before completing this form. You may notify for more than one permitting tier by using.this notification form, DT~C 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit SPecific notification forms for each of the four categories 'and an additional notification form for transportable treatment ' units (TTU's).. You only have to submit forms for the tier(O that cover your unit(s).' Discardor recycle, the other Unused forms. Number each page of your completed notification package atut imticate the total mtmber of pages at the top of each page at the ~'. 'Page ' of__'. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'if diffcrent' or"if available'. Please type the information proVided on this form atu~ any~ 'attachments. The notification will not be considered complete without payment of the appropriate fee for each tier ututer which you are operating. (Please note that the fee is per TIER not pcr UNIT. For e. rample, if you operate 5 units but they. are all Conditionally Authorized, you Only owe $1,140, NOT5 timex $1,140. If you operate any Permit by Rule units and any units under Conditional Authorization you owe $2,280.) Checks shouM be made payable to the Department cf ?bxic Substances ContrOl and be stapled to the'top of this fomt. Please write 3'our EP/t ID Number on the checL'. Fill ~'n the check number in the box above, t NOTIFICATION CATEGORIES Indicate the number of units you operate 'itt each tier. Condltionally ~t Small Quantity Treatment operatior, r may not operate ttnit, r under any other tier. This will also be the number of unit specific notification forms you must attach. Number of units and attached unit specific notifications Conditionally Exempt-Small Quantity Treatment A. B. 1 Conditionally Exempt-Specified Wastestream ConditionallY Authorized D. Permit by Rule 1 Total Number of Units GENERATOR IDENTIFICATION (Form DTSC 1772A) (Form DTSC 1772B) (Form DTSC 1772C) (Form DTSC 1772D) Fee per Tier (not per unit) $ 100 $ I00 $1,140 $I, 140 Total Fee Attached $ 100.00 EPA' ID NUMBER CA L NAME (Company or Facility) (DBA-Doing Business As) PHYSICAL LOCATION cOUNTY. CONTACT PERSON DTSC 1772 (1/93) 0. O 00._7._280 5 __ BOE NUMBER (it available) ~FHQ__3__8 0 0 1' 0 1 4 Physicians Plaza Medical Imaging Center 4000 Physicians Blvd. , Suite 101. Bakersfield CA Kern Greg Harmon (First Name) Harmon (Last Name) [ For DTSC U.~ Only ZIP....93301 - [Region' I PHONE NUMBER(B05 ) 395 -.0155 Page 1 ,. EPA ID NUMBER CAL 000072805 MAILING ADDRESS, IF DIFFERENT: COMPANY NAME (DBA) sTREET _ Physicians Plaza Medical Imaging Center 4000 Physicians Blvd,, Suite 101 . Page 2 of _7.. CITY COUNTRY · CONTACT PERSON Bakersfield .. STATE .CA ZIP 93301 (only complet~ if not USA) Greq Harmon PHONE NUMBER( 805 ) 39'5 -0155 Name) (Last Name) .III.. TYPE OF COMPANY: STANDARD EYDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes fa four digit number) that best describe your company's products, services, or itMustrial activity. E~cample: 7384 ~g_._~__~ ~3672 Printed circuit boards · .% First: 8~] ] orris, ms and Clinics Second: 7384 of Medical ·Doctors pRIOR PERMIT STATUS: Check yes or no to each question.. NO i"'i I. I:] [-'i [] S. Ph°tofinishinq Lab Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim status for any of these treatment units? Do you now have or have you ever held a state or federal full permit or interim Status for any other hazardous waste activities at this location? Have you ever held a variance issued by the Department of Toxic Substances Control for thetreatment you are now notifying for at this location? ' Has this location ever been inspected by the state or any local agency as a hazardous waste generator? PRIOR ENFORCEMENT ttlSTORY: Not required from generators only notij~ing a~ conditiona~. ~ tm~mpt [] Within the last three years, has this facility been the subject of any convictions, judgments, settlements, .or final orders resulting from an action by any local, state, or federal environmental, haZardous.waste, or public .health enforcement agency? (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a final order.) . If you answered Yes, check this box and attach a listing ofconvictions, judgments~ settlements, or orders and a copy of the cover sheet from each document. (See the Instructions for more information) DTSC 1772 (1/9:3) ' Page 2 EPA ID NUMBER CAL 000072805 ATTACHMENTS: Page 3 A plot plan/map detailing the location(s)' of the cover~ unit(s) in relation to the facility boundaries. A unit specific notification form for each unit to be covered at this location. 7 VII. CERTIFICATIONs: Thls form tnt~st be signed by att authori:.ed corporate o2~cer or any other pers°n in the company who .has operational control ami performs decision-making functiot~r that govern.operation of the facility (per title 22, California . .Code of Regulatioas (CCR) section 66270.11). Ail three copies must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated tO the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. .Tiered Permitting Certification I certify that the. unit or units described in these documents meet the eligibility aad operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional AuthoriZation, I will also be required .'. to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January 1, 1995. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my 'knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility' of fines and imprisonment for knowing violations. ' ' ' Gregory J. Harmon Name (Pti t or Type) i ' Administrative Director Title Date Signed OPERATING REQUIREMENTS: " Please note that generators treating hazardoux wca'te om'itc are required to comply with a number of operating requirements which differ depending on the tier(s) tinder which one operates. These operating requirements' are set forth itt the statutes artd regulations, some'of which are referenced in the 77er-Specific Factsheets. · suBMIsSION PROCEDURES: YOu must submit two copies of this completed notification by certified mail, return receipt requestqd~ .to: Department of Toxic Substances Control Form' 1772 ~ " ' Onsite Hazardoas Waste Treatment Uni. t ~ " 400 P Street, 4th Floor (walk in only) P.O. Box 806 .... Sacramento. CA 95812-0806. You must also submit one colD' of the noti. fication atwl attachments to the local regulatory agency in your jurisdiction as listed in the instruction materials. You must also retain a copy as part of your operating record, All three forras must have original signatures, not photocopies, DT$c 1772 (1/93) Page 3 ,. EPA ID NUMBER Chi, 000072805 4 7 Page __ of CONDmtONALt.¥ EXEMm' - SPECIHED WASTEsTREAMs UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) UNIT NAME. A UNIT ID NU3~ER NUMBER OF TREATMENT DEVICES: ... Tank(s) ,3 Container(s) Each unit must be clearly identified and labeled on the plot plan attached to Form 1772. Assign your own unique nutnber to each unit. The number can be sequential (1, 2, 3) or using arty system you choose. Enter the est#nated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount' treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. 'WASTESTREAMS AND TREATMENT PROCESSES: [3 Estimated Monthly Total Volume Treated: pounds :md/or =.. 60 gallons 7J~e following are the eligible wastestreams arm treatment processes. Please check all applicable boxes: I. Treats resins nfixed in accordance with the n'hanufacturer's instructions. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical proces~s,. such ~ crushing, shredding, gr/nding, or Puncturing. o 4. 6.' Drying special 'wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. Magnetic separation or screening to remove compoaents from special waste, ,'ks classified by the department pursuant to title 22, CCR, section 66261.124. Neutralize acidic or alkaline (b~e) wastes from the regeneration of ion exchange media used to demin_eralize water. (This waste cannot contain more than I0 percent acid or ba~ by weight to be eligible for conditional exemption.) Neutralize acidic or alkaline (base) wastes from the food processing industry. Recovery of silver from photofinishing.· The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. ' El o Gravity separation of the following, including the use of flocculants and demulsi~fie/s if a. The settling of solids from the waste where the resuiting aqueous/liqUid stream is not hazardous. b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month<is les.q than 25 barrels '(42 gallons per barrel). ' ... %. 'Neutralizing acidic or alkaline (base) material .by a state certified laboratory or a lalmratory operated by an 'educational institution. (To be eligible for conditional exemption, this waste cannot cOntain more than I0 percent acid or base by weight.) DTSC 1772B (I/93) Page 9 II. ..EPA. ID NUMBER CkL 000072805 Page 5 'of ' 7 ' CONDITIONt~J.~LY EXq~MPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatnlent process used. SPECIFIC WASTE TYPES TREATED:. eont. a in~nq silver TREATMENT PROCESS(ES) USED: Spent photographic fixer solution Electrolytic and ion exchange RES[DUAL MANAGEMENT: Check Yes or No to each question as it applies to all residualx from this treatment unit. NO ["] 1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (PoTW)Isewer? N b. Thermal treatment ["] e. Disposal to land [] d. Further treatment 2. Do you discharge non-hazardous aqueous waste under an NPDES Permit? 3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler.'? If you do, where is the waste sent? Check all that apply. a. Offsite recycling 4. Do you dispose of non-hazardous solid waste residues at an offsite location?' 5. Other method of dispor, al. Specify: IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demot~rtrate'elig ibili~, for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste per,nit is not required under the federal Resource Conservation and Recove~Act (RCIGt) and the federal regulations adopted under RCRA (Title 40, Code of Federal Regulatiot~ (CFR)). " Choose the reason(s) that describe the operation of your om'ire treatment units: ["l 1. The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a h~as'd6us waste under California skate law. 1-'] 2. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly oumed treatment works (POTW)/sewedng agency or under an NPDES Permit..40 CFR 264. l(g)(6) and · 40 CFR 270.2. DTSC i772B (I/93) Pago 10 [3 [3 [3 EPA ID NUMBER CAL 000072805 Page 6 of 7 CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAblS . UNIT SPECIFIC NOTIFICATION (pursuant to Health ,'md Safety Code Section 25201.5(c)) BASIS FOR NOT NEEDING A FEDERAL PERMIT: (continued) The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/~wering agency or'under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. The waste is treated in a totally enclosed treatment facility :xs defined in 40 CFR part 260.10; 40 CFR 264. !(g)(5). The company generates no more than 100 kg (approximately 27 galloas) of hazardous waste in a calendar month and is eligible as a federal conditionally exe~mpt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5; The waste is treated in an accumulation tank or container within 90 days for over 10ft) kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. Recyclable materials are reclaimed to recover economically significant amounts of silvetr or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. Empty container rinsing and/or treatment. 40 CFR 261.7. Other:. Specify: TRANSPORTABLE TREATI~fENT UNIT: Check Yes or No. Please refer to the Instructions fOr more information. NO .v. Is this unit a Transportable Treatment Unit? If you answered yes, you mttst also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification Package. DTSC 1772B (1/93) Page 1 .% ~. · Physicians Plaza Med.i. Ca_l~I,m~g Center PAGE ~ of 7 · 4000 Physicians Blvd., 000072805 ~. Suite 101, Bakersf~eldI[".j~ // ' PLOT/PLAN MAP [!;i ~ 1' . .(' ...... ~_ .... . ,.,-, -",- , w,,//z ////_Zz.'/_// ( /, UNIT A, NO 1 N STATE CALIFORNIA-ENVIRONMENTAL PROai~CTiON AGENCY - · OF DEPARTMENT OF TOXIC ~E$ CONTROL REGION 1~1515 Tollhous~ Road Clovis. CA 93612 PETE WILSON, Governor CHEC~T AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers NOTE SHI~ET This sheet includes inspector Observations and expands upon the violations identified on the checklist (by number). In some ' cases, it indicates how the facility should correct the violations. It also includes the names of any others participating in this inspection. Onsite Checldist (D) Page - - of August 2, 1994 ~ STATE OF CAUFCRNIA-ENVIRONMENTAL PROTECTION AGENCY · D~PAI~TMENT OP TOXICSUB~ NCES CONTROL REGION 1-1515 TolRtouse Road CIov~. CA 9'J612 CHECgT.IST AND INITIAL VERIFICATION INSPECTION REPORT. FOR Permit by Rule, Conditionally' Authorized, and Conditionally Exempt Notifiers NOTE SHEET PETE Wff. SON, Governor 27tis sheet includes inspector observa~ons and ~cpands upon the violations identified on the c. heclclLst (by number). In some ca~es, it indicates how the facility should correct the violatiottr. It al~o includes the names of any others participating in ~ inspection. Onsite Checklist (D) Page of AUgust 2, 1994 '~STATE OF CALIFORNIA-F. NVlR~NMENTAI. PRpTECTION AGENCY DEPARTMENT OF TOXIc SU PEG[ON t-tSt5 Toilho~'Road ~ovis. CA 93612 CES CONTROL TIERED PERMI'rTI~G ' CERTIFICA~ON OF RETURN TO COMPLIANCE P~.~ WILSON,. Gov~n~r · For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers 'In the matter of the' Violadon cited on: As Identified in .the inspection Report dated Conducted bY: (a§ency~)) I certify under pemlty of law that: Respondent has corrected the violations specified in the nodce of violation cited above. I have personally exnmined any documentation attached to the certification to establish that the violations have been corrected. Based on my examL'mdon of the at'ached documentation and inquiry of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete.·' '4~' I am authorized to file this certification on behalf of the Respondent. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name (Print or TyPe) Title Signature Date Signed Company Name EPA ID. Number DT$c-RfiTcoMP.CRT (8/94.) PETE WILSON GoVernor 0, C. UFOR,,^--CAU ORN,A ENV,"ONM NCV 400 P STREET, 4TH FLOOR P.O. BOX 806 SACRAMENTO, CA 95812-0806 (916) 323-5871 06/29/94 EPA ID: CAL000072805 PHYSICIANS PLAZA MEDICAL IMAGING CTR GREG HARMON 4000 PHYSICIANS BLVD STE 101 BAKERSFIELD, CA 93301. Forfac~/ty/oaattz/at: 4000 PHYSICIANS BLVD STE 101 BAKERSFIELD, CA 93301 Authorization Date: 06129194 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility 'specific notification (form DTSC '1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DTSC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for-technical adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification' for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have stopped treating Waste and have fully closed the unit(s). You~will be charged annual fees calculated on a calendar year basis for each year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating haTardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature?pace on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to Properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this year. Printed on Recycled Pa~er Page 2 EPA ID: CAL000072805 If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this office at the letterhead address or phone number. Enclosure Michael S. Homer, Chief Onsite Hazardous .Waste Treatment Unit 'Permit Streamlining Branch Hazardous Waste Management Program SUSAN LANEY DTSC REGION 1 SURVEILLANCE & ENFORCEMENT BR. 10151 CROYDON WAY, 'SUITE 3 SACRAMENTO, CA 95827 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2700 M STREET, SUITE 300 B~ERSFIELD, CA 93301 ENCLOSURE 1 · · Units authorir~ to operate at O~ ioauioa: UNDER CONDITIONAL AUTHORIZATION: EPA ID: CAL000072805 UNDER CONDITIONAL EXEMPTION: 1