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HomeMy WebLinkAboutBUSINESS PLANHazardous Materials/Hazardous Waste Unified Permit Permit ID#:: 015-000-O00731 CUNNINGHAMiVETERIN -~-~ CONDITIONS'~OFPERMIT ON REVERSE SIDE · · ' This _Permit is issued for the followin?, [] Hazardous Materials Plan [3 Underground Storage of Hazardous Materials [3 Risk Management Program n Hazardous Waste On-Site Treatment LOCATION: 2703 M ST Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: · E~p~iion Date: · Oflic¢ofEv~Services ~ 'June 30; 2003 issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... ,,~.~,,~,'~;~'?m,',~,,,~,~,~ ........ This permit is issued for the following: PERMIT ID# 015-0214)00731 .d~i~i ~i. !,,,[[!!:i~:!!iiiiii? 'i !!!['~i~.!?!!!!!::::!![!!i ,,.,,,! ~ ~'~k ~anagement Program ~i%*". 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Issued by: Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: June 30, 2000 ITE/FACILITY D I~AG R~%1~4 4 NORTH (CHECK ONE) SITE DIAGR.~M FLOOR: / OF / ~. ~,~.. · ' ~NIT ~:/OF / FACILITY DIAGR.~M Inspector's Comments): -OFFICIAL USE ONLY- Manager : Location: 2703 M ST city : BAKERSFIELD BusPhone: Map : 103 AUG12 ~0~ Grid: 30 CommCode: BAKERSFIELD STATION 04 EPA Numb: ~L u ~ ~6"On~O&~/ SIC Code: DunnBrad: SiteID: 015-021-000731 (661) 327-9614 CommHaz : Low FacUnits: 1 AOV: Emergency Contact / Title CATALINA B PARAYNO / Business Phone: (661) 327-9614x 24-Hour Phone. : (~/~.~) SJ7-1i3-Sx Pager Phone '~.- (44~) ~ ~zg~x Emergency Contact / Title DR OVIDIO PARAYNO / Business Phone: (661) 327-9614x 24-Hour Phone~ _~ ~01 5177x Pager Phone Hazmat Hazards: Fire Press ImmHlth Contact : OVlPI~ ~ ~-~T~[~A MailAddr: 2703 M ST City : BAKERSFIELD Phone: (661) 327-9614x State: CA Zip : 93301 Owner Address City OVIDIO ~CATALINA PARAYNO ::~2'~ ~( Phone: (661) 327-9614x State: CA Zip : ~-3~ ~O~ Period : to TotalASTs: = Preparer: TotalUSTs: = Certif'd: RSs: No ParcelNo: Gal Gal Emergency Directives: 01-10-01 PER WILLIAM NAREZ, BUSINESS SOLD 8/00 SEND BILL TO 2703 M ST. I, OV'~f~l~A-. PA-I%~tJ 0. Do hereby certify that t have ffype or ~n~ ~) reviewed the a~ached h~ous ment plan for Y~, I~FtT~ and that ~t ~cn~ w~h ~y ~e~i0ns ~nmi~ute a ~mp~e~e and ~rr~ man- agement plan for my faciiityo -1- 08/04/2003 CUNNINGHAM VETERINARY HOSPITAL Manager : Location: 2703 M ST City :.BAKERSFIELD CommCode: BAKERSFIELD STATION 04 EPA Numb: BusPhone: Map : 103 Grid: 30 SIC Code: DunnBrad: SiteID: 015-021-000731 (805) 327-9614 CommHaz : Low FacUnits: 1 AOV: Emergency Contact / Title C.A~ Cr~-E,ii}!CY~i / ~7~%J~ Business Phone: (805) 327-9614x ,,2~-Hcur Ph3~ : (~05) 322~0'D58~ Pager Phone : (~9) G~q -l~x Emergency Contact / Title ....... N~J~n'vl /'~. 6~p~ F~lz,~~c Business Phone: (805) 327-9614x 2~-, Phone : ~ou~ 3~-o~oo~ Pager Phone : (~o(--~1~$ x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: ( ) - x MailAddr: 2703 M ST State: CA City : BAKERSFIELD Zip : 93301 Address : 541 NORD AVE City : BAKERSFIELD Phone: (805) State: CA Zip : 93312 Emergency Directives: 327-9614x Period : to ~v~D TotalASTs: = Gal Preparer: Gal Certif d: ~ ~ 5 ~otalUSTs: = ' RS s: No ~ Hazmat Inventory --As Designated Order One Unified List Ail Materials at Site DailyMax Unit MCP 1686.00 FT3 Low OXYGEN F P IH G ~C~0~D)~fl~-- --F--~L- IH G -- ~, 6JV'lo~u~ ~'or~^'zA~/~op..t..~) Do hsreby ce~i~ lhat ] have reviewed ~h~ a~achod h~ardous ma~e~a,s mm :~ge. '/~ ~' men~ plan fo~.~u~ Y~land ~ha~ R along wi~h (Na~ of ~o~e~) -- any corre~ions ~ns~i~u~ a complete and correc~ man- agement plan ~or r~y ~aciMyo 09/05/2000 CUNNINGHAMVETERINARY HOSPITAL = Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit OUTSIDE WALL SURGERY SiteID: 015-021-000731 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 7782-44-7 F STATE TYPE Gas Pure PRESSURE TEMPERATURE I Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest ContainerFT3 AMOUNTS AT THIS LOCATION Daily Maximum I 1686.00 FT3 Daily Average 843.00 FT3 HAZARDOUS COMPONENTS %Wt. I 100.00 Oxygen, Compressed  S CAS# N 7782447 ~Secret N~SIBioHaz No No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F P IH NFPA /// USDOT# I MCP Low = Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit SURGERY O/S WALL Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# STATE ~ TYPE Gas ~Pure PRESSURE TEMPERATURE Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 326.00 FT3 Daily Average 250.00 FT3 %Wt. ~0 O0 Nitrous HAZARDOUS COMPONENTS CAS# TSecretNo N~SIBi°HaZNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F P IH NFPA /// USDOT# MCP Hi 2 09/05/2000 F CUNNINGHAM VETERINARY HOSPITAL SiteID: 015-021-000731 Fast Format ~ Notif./Evacuation/Medical --Agency Notification CALL 911 Overall Site 03/23/1990 -- Employee Notif./Evacuation ROUTINE FIRE SAFETY PROCEDURES. ACCESSABLE. 03/23/1990 6 EXITS, ALL CLEARLY VISIBLE AND EASILY -- Public Notif./Evacuation 03/23/1990 IN THE EVENT OF AN EMERGENCY, PUBLIC WILL BE DIRECTED OUT THE FRONT EXIT OF THE BUILDING. THIS WILL PUT AT LEAST 3 WALLS AND CONSIDERABLE DISTANCE BETWEEN THE PUBLIC AND THE COMPRESSED GAS CONTAINERS. EMPLOYEES WILL NOTIFY THE PUBLIC OF THE NATURE OF THE SITUATION, AND KEEP PEOPLE CLEAR OF THE Emergency Medical Plan EMERGENCY ROOM AT SAN JOAQUIN - 2615 EYE ST - 327-1711 03/23/1990 -3- 09/05/2000 F CUNNINGHAM VETERINARY HOSPITAL SiteID: 015-021-000731 Fast Format = Mitigation/Prevent/Abatemt --Release Prevention Overall Site 04/17/1992 02 TANKS SECURED TO WALL WITH CHAINS TOP AND BOTTOM. NO OIL USED ON 02 EQUIPMENT. NO SPARKS OR OPEN FLAME NEAR ANY 02 EQUIPMENT OR LINES. FIRE EXTINGUISHERS AT FRONT AND BACK DOORS. 3 OUTDOOR WATER HOSES. -- Release Containment CONTAINERS ARE OUTSIDE OF BUILDING, GAS ONLY. ATMOSPHERE. 04/17/1992 RELEASE WILL BE INTO OPEN -- Clean Up GAS ONLY 04/17/1992 -- Other Resource Activation -4- 09/05/2000 F CUNNINGHAM VETERINARY HOSPITAL SiteID: 015-021-000731 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - FRONT OF BUILDING B) ELECTRICAL - SOUTHWEST CORNER OF BUILDING C) WATER - FRONT OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO 04/17/1992 -- Fire Protec./Avail. Water 04/17/1992 PRIVATE FIRE PROTECTION - TWO WATER OUTLETS WITH ATTACHED HOSES ON EITHER SIDE OF THE OXYGEN AND NITROUS OXIDE TANKS FIRE HYDRANT - CORNER OF M ST AND GOLDEN STATE HWY Building Occupancy Level -5- 09/05/2000 F CUNNINGHAM VETERINARY HOSPITAL SiteID: 015-021-000731 Fast Format Training -- Employee Training WE HAVE.~EMpLOYEES__ AT THIS FACILITY Overall Site 09/10/1991 WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE EMPLOYEES TRAINED AND REVIEWED ON THE PROPER HANDLING AND EMERGENCY PROCEDURES ASSOICATED WITH COMPRESSED OXYGEN AND NITROUS OXIDE GASSES Page --Held for Future Use Held for Future Use 6 09/05/2000 CITY OF BAKERSFIELD CLAIM VOUCHER Vendor No. CLAIMANT'S NAME AND ADDRESS: Cunningham Veterinary Hospital 431 W Los Feliz Road Glendale, CA 91204 I certify that this claim is correct and valid, and is a proper charge against the City Agency and account indicated. (AUTHORIZED SIGNATURE OF CITY AGENCY Date: 04-01-99 Initials of Preparer CITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This customer made a duplicate payment on this years Haz Mat bill in the amount of $128.50. We have since made an adjustment to the California State surcharge in the amount of $8.50 leaving them with a credit of $137.00. Dept. 0000 El/Objt 7900 Pr~ect# VOUCHER TOTAL Invoice # Amount Date of Invoice $137.00 $137.00 SECTION 72, PENAL CODE Section 72, Presenting False Claims. Every person who with intent to defraud, 'presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or wdting, is guilty of a felony. FINANCE DEPT. USE ONLY Examined & Approved for Payment Amount STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-5201 TO: (805> 32&-397~ CUNNINGHAM VETERINARY HOSPITAL LOS FELiZ RD OLENDALE, CA 91~04 DATE: 4/01/99 CUSTOMER NO: 3080 CUSTOMER TYPE: ES/ 3080 CHAROE SSO01 DATE DESCRIPTION 3/01/99 BEGINNING BALANCE 2/04/99 PAYMENT 3/31/99 Charge adjustment CA STATE SURCHARGE REF-NUMBER DUE DATE 4/30/99 TOTAL AMOUNT .00 128.50- 8. 50- FOR GUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 8. 50- DUE DATE: 5/03/99 PAYMENT DUE: TOTAL DUE: 137.00-- $137.00-- DATE: PLEASE' DETA:CH AND"/S~ND THIS COPY WITH REMITTANCE 4/01/99 DUE:"DATE: 5/03/99 REMIT AND HAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD CA 93303-2057 (805) CUSTOMER NO: 3080 CUSTOMER TYPE: ES/ TOTAL DUE: 3080 $137. 00- CUS~~NO. ~ ~C)~ MISCELLANEOUS RECEIVABLES ADJUSTMENT CUSTOMER NAME MAILING ADDRESS SITE ADDRESS STATE NEWACCOUNT i ADDRESS CHANGE ~ CLOSE ACCT j ~ ' FINANCE CHARGE I ,I OTHER ADJ i~_1 PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT CHG DATE CHARGE CODE ADJUSTMENT AMOUNT REMARKS: '~--~ ~, / APPROVED BY STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA ~3301-520i TO: (805.) 32&-3~79 CUNNINGHAM VETERINARY HOSPITAL 431W LOS FELIZ RD GLENDALE, CA 91204 DATE' 9/01/98 CUSTOMER NO' 3080 CUSTOMER TYPE: ES/ 3080 CHARQE DATE DESCRIPTION REFND S/01/98 BEGINNING BALANCE b/24/98 PAYMENT 8/19/98 MR INT REFUND VCHRS REF-NUMBER DUE DATE TOTAL AMOUNT 110.00 128. 50- 18. 50 FOR QUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 90 DUE DATE: 10/01/98 PAYMENT DUE: TOTAL DUE: 18. 50- $18. 50- BAKERSFIELD. TO: THIS COPY WITH 'REMITTANCE CUSTOMER NO: 3080 CUSTOMER TYPE: ES/ TOTAL DUE: 3080 $18.50- CITY OF BAKERSFIELD CLAIM VOUCHER Ivendor No. I CLAIMANT'S NAME AND ADDRESS: Cunningham Veterinary Hospital 431 W. Los Feliz Rd. Glendale, CA 91204 I certify that this claim is correct and valid, and is a proper charge against the City Agency and account indicated. (AUTHORIZED SIGNATURE OF CITY AGENCY) Date: 08-12-98 initials of Preparer: ;ITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This business overpaid their Hazardous Materials bill by $18.50. For that reason they now have a credit of $18.50 which we will be refunding. Dept. 0000 El / Obit Project # Invoice # Amount Date of Invoice 79OO VOUCHER TOTAL $18.50 $18.50 SECTION 72, PENAL CODE 'Section 72, Presenting False Claims. Every person who with intent to defraud, ~ presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. FINANCE DEPT. USE ONLY Examined & Approved for Payment Amount BAKERSFIELD FIRE DEPARTMENT MEMORANDUM DATE: July 30, 1998 TO: Susan Chichester FROM: Esther Duran SUBJECT: Claim Voucher Please issue a Claim Voucher to refund over payment of $18.50 made by Cunningham Veterinary Hospital. They made a payment of $18.50 on 6/15/98 and then sent a payment of $128.50 on 6/24/98. The second payment caused them to have a credit of $18.50. Please send a refund of $18.50 to: Thank you, Cunningham Veterinary Hospital 431 W Los Feliz Rd Glendale, CA 91204 /ed STATEMENT OF,.**,'""',.]UN]"..,.. CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD., CA 9330!-:5201 (805~ ~6.-~9,,9 CUNNiNGHAM VETERINARY HOSPITAL 43i W LOS FELiZ RD GLENDALE, CA 91204 DATE: 6,;30/98 CUSTOMER NO: 3080 CUSTOMER TYPE: ES/ 3080 CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT 6/11/98 BEGINNINg BALANCE 6/15/98 PAYMENT 6/'~.4/98 PAYMENT 28. 50 18. 50- 28. 50- FOR QUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THiS STATEMENT. CURRENT OVER R ~0 OVER 60 OVER 90 DUE DATE' 7/30/98 PAYMENT DUE' TOTAL DUE' 18. 50- $18. 50- DATE' PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE 6/30/98 DUE DATE: 7/30/98 REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO' 3080 CUSTOMER TYPE: ES/ TOTAL DUE: 3080 $i~.50- CITY OF BAKERSFIELD ellaneous Receivables In 7/31/98 L6:34:39 Custome L' ID : Last invoice : Current balance : Pending ..... : 3080 6/30/98 o/oo/oo 18.50- .00 Name: CUNNINGHAM VETERINARY HOSPITAL Addr: 431 W LOS FELIZ RD GLENDALE, CA 91204 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail 5=Display Opt Trans Date Code Description 6/30/98 stmrn Statements Processed 6/24/98 PAYMENT 6/15/98 PAYMENT 6/11/98 stmrn Statements Processed 6/10/98 HM0.05 HAZ MAT HANDLING FEE 6/01/98 stmrn Statements Processed 6/01/98 SS001 CA STATE SURCHARGE 5/01/98 stmrn Statements Processed 4/01/98 stmrn Statements Processed Amount 0O 128 50- 18 50- 00 110 00 00 18 50 .00 .00 Chg Bnk G Balance Typ Cd L 18 50- 18 110 128 128 18 18 50 - 00 Y 00 00 Y 5O 5O 5O 50 A 00 00 + F3=Exit F12=Cancel * = Pending STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-5~0i (805) 326-3~79 TO: CUNNINQHAM VETERINARY HOSPITAL 431 W LOS FELIZ .RD OLENDALE, CA 9~04 CUSTOMER NO: . 3080 DATE' cuSTOMER TYPE: ES/ 8/01/98 3080 CHARQE DATE DEsCRIpTION 6/30/98 BE~INNIN~ BALANCE REF-NUMBER DUE DATE TOTAL AMOUNT 18. 50-- FOR OUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER DUE DATE: 8/31/98 PAYMENT DUE: TOTAL DUE: 18.50-- $18.50- ITH =REMITTANCE CUSTOMER NO: ~C'A-"~3303'2057 3080 CUSTOMER TYPE: ES/ TOTAL DUE: 3080 $18. 50- 02/24/92 ~"/RECEIVED CUNNINGHAM VETERINARY HOSPITAL 215-000-00073~AR 2 199~age Overall Site with 1 Fac. Unit ARs'd ............ General Information Location: 2703 M ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 01 Grid: 30 F/U: 1AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- C.A. CUNNINGHAM (805) 327-9614 x (805) 322-8958 D.R. CUNNINGHAM (805) 327-9614 x (805) 322-8958 Administrative Data Mail Addrs: 2703 M ST D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 8980 Owner: N$~;;AN E. CU::~iNC:IAM ~ ~ ~ ~-~~tPhone: (805) 327-9614 ..... /v,.,( Address: ~I .... ~ ~ '~ State: CA City: BAKERSFIELD Zip:J~3_3~ q~/~ Summary reviewed th.,. ~.ti~c?~.~d ~:az ,a~:lous ma!~rials, m~nage-' merit .plan tot ~ ~6 that ,t along with any corrosions oonstitut~ a complete and ~rr~ man- ~emem plan for my facUi~. 02/24/92 CUNNINGHAM VETERINARY HOSPITAL 215-000-000731 .02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order Page 2 02-001 OXYGEN · Fire, Pressure, Immed Hlth Gas 1686 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max1,686FT3 I Daily Average 843.00FT3 Annual Amount FT3 -- 6,744.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Above ~AmbientlOUTSIDE WALL SURGERY -- Conc 100.0% IOxygen, Compressed Components MCP Low iList 02-002 NITROUS OXIDE · Fire, Pressure, Immed Hlth Gas 326 High FT3 CAS #: Form: Gas Type: Pure Daily Max FT3 326 I Trade Secret: No Days: 365 Use: ANESTHETIC Daily Average FT3 ~ Annual Amount FT3 250.00! 652.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Above IAmbientlSURGERY O/S WALL -- Conc Components I MCP 100.0% INitrous Oxide IHigh iList 02/24/92 CUNNINGHAM VETERINARY HOSPITAL 215-000-000731 00 - Overall Site <D> Notif../Evacuation/Medical Page <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation ROUTINE FIRE SAFETY PROCEDURES. ACCESSABLE. 6 EXITS, ALL CLEARLy VISIBLE AND EASILY <3> Public Notif./Evacuation IN THE EVENT OF AN EMERGENCY, PUBLIC WILL BE DIRECTED OUT THE FRONT EXIT OF THE BUILDING. THIS WILL PUT AT LEAST 3 WALLS AND CONSIDERABLE DISTANCE BETWEEN THE PUBLIC AND THE COMPRESSED GAS CONTAINERS. EMPLOYEES WILL NOTIFY THE PUBLIC OF THE NATURE OF THE SITUATION, AND KEEP PEOPLE CLEAR OF THE AREA. <4> Emergency Medical Plan EMERGENCY ROOM AT SAN JOAQUIN - 2615 EYE ST - 327-1711 02/24/92 CUNNINGHAM VETERINARY HOSPITAL 215-000-000731 Page 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention 02 TANKS SECURED TO WALL WITH CHAINS TOP AND BOTTOM. NO OIL USED ON 02 EQUIPMENT. NO SPARKS OR OPEN FLAME NEAR ANY 02 EQUIPMENT OR LINES. FIRE EXTINGUISHERS AT FRONT AND BACK DOORS. 3 OUTDOOR WATER HOSES. <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/24/92 CUNNINGHAM VETERINARY HOSPITAL 215-000-000731 00 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2'> Utility Shut-Offs A) GAS - FRONT OF BUILDING B) ELECTRICAL - SOUTHWEST CORNER OF BUILDING C) WATER - FRONT OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - TWO WATER OUTLETS WITH ATTACHED HOSES ON EITHER SIDE OF THE OXYGEN AND NITROUS OXIDE TANKS FIRE HYDRANT - ???????????? <4> Building Occupancy Level 02/24/92' CUNNINGHAM VETERINARY HOSPITAL 00 - Overall Site <G> Training 215-000-000731 Page <1> Page 1 'WE HAVE 6 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE EMPLOYEES TRAINED AND REVIEWED ON THE PROPER HANDLING AND EMERGENCY PROCEDURES ASSOICATED WITH COMPRESSED OXYGEN AND NITROUS OXIDE GASSES SEMI-MONTHLY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY of BAKERSFIELD ( ~5'De or ~,~q n; name Do hereby certify that I have reviewed the RECEIVED JAN 1 9 I989 A,~?i ............ attached Hazardous Materials business plan for . o~ business ) and that it along with the attached additions or corrections constitute a comDlete and correct Business Plan for my facility. CITY of BAKERSFIELD NO N-- T RAD E S E C RE TS ' P~ge.~__of_[._ LOCATION: ~l.?~-q ~ d~--.~ ....... [ .... v ADDRESS: Q-~/~-e~c-t~--~i-~-~°' ....... STANDARD CITY, ZIP: ~C~~ ~/ CITY, ZIP: ~F~e~ ~,35~ DUN AND BRADSTREET NUMBER PHONE ~: ~--~--~t~ PHONE ~: ~ ~~,~ __ - - ~ ~ f~U~fO~ ~R ~OP~ COD~ t~ C~e ~t Mt Est Un~ts m Stte I~ ~. TM ~ St~ tn FKtJfty~" ~ltk of P~ ~lth ........ ' ..... ,P~icll ~ ~lth fllzl~ C.l.S. ~ ~t II ~ b C.l.S. ~ (C~k ell t~t ~pply) - r--~ r--~~~ r--~ ~t I~ ~&C.A.5. ~ ~lth of P~ ~lth ..... L_I L_.i2 ..... l ['1 l:: ! ! I_ ! ............ P~lcal ~ ~lth ~zaH C.A.S. ~ ~t I1 h i C.A.S. ~ (C~k ~11 t~t a~ly) H~l~h of P~su~ N. Ith ' ' ~.__~__t ......... ,L ........... ~ .......... ] ..... j. ....... t ].~~ ...... ! ....................... H~lth of Prflsuee Health .... - ...... ~t 13 ~&C.A.S. ~ ................. Certification (Read and sign after completing ali sections) I c~rt*fy onder ~lty of law that I have oerso~allyexamined a~d aB f~iliar vith the tnformtio~ submtted in this aed all etjt~ehed docue~ts. ~d that based on ay in*lutry of the~e fndtvtd,els e~pensible for obtainin9 the jOtoeeatton. I believe that the suheitte~ intoeeation is true. accurate, ~d~r, lealeta. /~ / / OUNNINGHAM VETERINARY HOSPITAL DOGS CATS CAGE PETS 2703 M Street Bakersfield, California 93301 (805) 327-9614 SIC #: 8980 I B~SINESS NAME CUNNIN~m~M VETERINARY HOSPITAL LOC~TION Z703 M ST ID Nu~R 21S-~OO--O(~O73! HIGH HAZARD RrSTING Z 1. OVERVIEW JURIS CODE Z!5-OO1 MAP PAGE 103 GRID LAST CHANGE 10/20/88 BY SURIS BAKERSFIELD STATION FACILITY UNITS 1 HRZARO RATING RESPONSE SUMMARY Z~ SEC ~) NO PRIg~TE RESPONSE 'rEaM. EMERGENCY CONTACTS ZA SEC C.A. CUNNINGHRM - 3Z?-9~14 OR D.A. CUNNINGHRM - 3Z?-9614 OR ~22-8958 UTILITY SHUTOFFS ~ SEC A) GAS - FRONT OF BLDG B) ELECTRICAL - S~ CORNER OF BLDG C) ~ATER - FRONT OF BLDG D) SPECIAL - NONE E) LOCK'BOX - NO RECEIVED JAN 2 1989 ....... 2. NOTIFICATION / PUBLIC EVGCUATION LAST CHA~E Z / 20 89 BY )]on C'%~J_qgheLm In the event, of an emergency, public will be directed out the front exit of the building. This will put at least 3 walls and considerable distance between the public and the cc~pressedgas COntainers. Employees will notify the public of' the nature of the situation, and keep people clear of the area. < NO INFORMATION RECORDED FOR THiS SECTION PRGE I 12/2'7/88 17:ZG MATERIAL. S~FETY DATA SYSTEMS, INC. (805) G48-G800 BUSINESS NRME CUNNINGHAM VETERINARY HOSPITAL LOCATION 2703 M ST ID NUMBER ZlS-~00-000731 HIGH HAZARD RATING 2 -~. H~Z MAT TRAINING SUMMARY LAST CHANGE 1 / 20/89 BY Don Cunningham 8 employees trained and reviewed on the proper handling and emergency procedures associated with compressed oxygen and. nitrous o~Jde gasses semi-r~Dnthly. < NO INFORMATION RECORDED FOR THIS SECTION > 4. LOCGL EMERGENCY MEDICAL ASSIST~tNCE LAST CHANGE 08/30188 BY ESTER SEC 5) EMERGENCY ROOM AT SAN JOAQUIN - 2$1S EYE ST - 327-171t PAGE Z 1Z/27/88 17:28 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 848-8800 BUSINESS NAME CUNNI~ LOCATION 270~ M ST FACILITY UNIT 9ETERINA~Y HOSPITAL ID HiGH HAZARO RATING Z OVERALL HAZAROOUS MATERIALS INVENTORY LAST CHANGE 10/28188 BY UAL. ID TYPE NAME MAX AHl' UNIT HAZARD LOCATION CONTAINMENT USE PURE OXYGEN OUTSIDE WALL SURGERY PORTABLE PRESS. CYL. ID PERCENT COMPONENTS 235B.~ 100.0 OXYGEN, COMPRESSED SG2 PT3 HIGH MEDICAL AID OR PROCESS HAZARD LIST HIGH PURE NITROUS OXIDE SURGERY O/S WALL PORT6BLE PRESS. CYL, ID PERCENT COMPONENTS '~4S.~ l e,~.~ NITROUS OXIDE 326 FT3 MODERRI~ ANESTHETIC HRZARO LIST MODERATE FIRE PROTECTION / WATER SUPPLIES L~ST CHANGE 1 /20/89 BY DonC oDDingham Two water outlets wi~h attached hoses on either.side of' the oRygen and nitrous oxide tanks. < NO INFORMATION RECORDED FOR THIS SECTION PAGE 3 IZ/ZT/88 17:ZG MATERIAL SAFETY DATA SYSTEMS, INC. (885) 648-6800 BUSINESS NAME CUNNINGHAM VETERINARY HOSPITAL LOCATION 2703 M ST ID NUMBER Z!5-0~-~7~1 HIGH HAZARD RATING D. EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 06/30/88 BY ESTER SEC Z) ROUTINE FIRE SAFETY PROCEDURES. G EXITS, ALL CLEARLY VISIBLE ~ND EASILY ACCESSABLE. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 0G/30/88 BY ESTER SEC 1) 0% TANKS SECURED TO WALL YITH -CHAINS TOP AND BOTTOM. NO OIL USED ON OZ EQUIPMENT. NO SPARKS OR OPEN FLAME NEAR ANY 02 EQUIPMENT OR LINES, FIRE EXTINGUISHERS RT FRONT AND BACK DOORS, 3 OUTDOOR UAl'ER HOSES, P~qGE 4 12/27./88 17:26 MATERIAL SAFETY D~tTA SYSTEMS, INC. <B05) G48-G800 Business Name: Location: Hazardous Materials Inspection Date Completed ~' 1~ '~ C~,J,~,d~t~ V~'~,~/~/ ~~, RECEIVED JUt 0 3 1909 Plan ID # 215-000 Station No. ZT/ Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: HAZ. MAT. DIV. (Top right comer Business Plan) Inadequate Verification of MSDS Availability Number of Employees /[ Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow*Station Copy Pink-Business Office BAKERSFIELD Ci~[ FIRE DEPARTMENT 2120 "S" S%2REET BAKERSFIELD. CA 98301 (805) 326-39T9 S E P 3 1988 A s'd ............ IXESS NAME OFFICIAL USE ONLY ID= i-i/.-'kZ .~i~ ~ 0 U S ~E~ ~-kLS BUSINESS PLAN AS A WHOLE FORM 2A 1. To avoid further action, return this form by 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. SECTION 1: BUSINESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: ~, ~ SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call g!! and t-800-852-75S0 or 1-916-427-4341. This will notify your local fire department and the State Office of EmerLency Services as required by law. - EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: N~XE AND TITLE DURING BUS. HRS. SE~!ON S: LOCATION OF I~ILI~ S~-OFFS FOR BUSI~SS AS A r~OLE AFTER BUS. HRS. A. NAT. GAS/4~4~grN~5: B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN S~TE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSS? YES ./ NO KEYS? YES / NO SECTION ~t: PRIVATE RESPC3NSE TE~LM _"OR FJUSI.YESS AS A WHOLE SECTION ~: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOI~ BUSINESS AS A WHOLF SECTION 8: EMPSO%rEE TRAINING E}!PLCS~RS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPL0'~2ES WITH REFRESHER TRAiXiNG iN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS >~TER!ALS: ....................................... YES N0 YES B. PROCEDURES FOR COORDiNATiNG ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES ~0 YES X0 C. PROPER USE OF SAFET~f EQUIPMENT: .................. YES ~0 YES 'NO D. E?,!EEGE:'~CV EVACUATION PROCEDURES: ................. - YES XO YES E DO YOU .~INT~IN EMPLOYEE TRAI~I~G RECORDS: ....... YES NO YES ~0 REFRESHER SECTION T: FAZARDOUS MATERIAL CIRCLE YES - NO - NONE DOES YOUR BUSI)~ESS HANDLE HAZARDOUS ~,~TERIAL IN QUANTITIES ~r ~ ~,S~ THAX 500 POUYDS OF A SOLID, $5 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I, certify that the above information is accurate. r 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 Sec. 2~500 Et Al.) and that inaccurate information constitutes perjury. 'SIGNATURE TITLE DATE BAKERSFIELD CI/~' FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS OFFICIAL USE ONLY ID# BUSINESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS 1. To avoid further action, this form must be returned 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. ' SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES ' '~ '~ I' , ~ ' ; --~ -- '~" SECTION 2: NOTIFICATION .~YD EVACUATION PROCEDL-R. ES AT THIS 5~IT ONLY SECTION 4: PRI,,VATE., RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION ~: LOCAL EMERGENCY MEDICAL ASSIST~YCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE ~RAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGP~I WHICH PROVIDES ~MPLOYEES WITH INITIAL REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS .MATERIALS: ....................................... B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~E~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES E. DO YOU ,MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES REFRESHER gO YES ~ YES SECTION "f: F, AZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THAN 500 ?0L~I1S-DF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC" FEET OF A COMPRESSED G~S: ...... Y~_S" NO I, /~ i~ ~'~9 ¢. , certify that the above information is accurate' I understand that this infg~mation will be used to fuifiiI my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. ZO Chapter ~.95 Sec. 2~$00 Et Al.) and that inaccurnte information constitutes per3ury. DATE - 2B - BAKERSFIELD CITY FIRE DEPARTMENT . I .D. # FORM 4A-I Page ..... .,~ HAZARDOUS ADDRESS zip: NON--TRADE SECRETS IVlATER I ALS I I~{VE NTORY ADDRESS: ~ ~~ I/~ ~ F~CILITY DNiT NAt. IE:__ PIIONE ~: ~~ %~~. [OFFICIAl, USE CFIR~ I ON[,Y ... FACII, ITV UNIT ~: I 2 3 4 5 6 7 8 9 10 TYPE HAX ANNUAL CONT USE LOCATION IN TillS ~; BY IIAZAtllJ CODE____~ASJ_OUNT AMOUNT UNIT CODE __C_O~_E._ FACILITY UNIT kiT. CHE_MI__~AL OR COM~ION NAA_IE COl)l: ,HA~IE: TITLE: ~0~ ~ SIONATURE: ,~ DATE:. '~HERGEHCV CONTACT: TITLE: PHONE : AFTER BUS HRS: ~~.~ ~MERGENCV CONTACT: ~0~ _~.~n_~.~.~ TITLE; P~INCIPAL BUSINESS ACTIVITY: IUSINESS BAKERSFIELD CITY FIRE DEPARTMENT 2130 "$" STREET BAKERSFIELD, CA 93301 (805) 326-3979 RECEIVED .2A)SP ~ JUN 3 0 1987 Ans'd ............ NAME OFFICIAL USE ONLY ID# HAZARDOUS MATERIALS USINESS PLAN AS A WHOLE FORM 2A INSTRUCT IONS: 1. To avoid further n, return this form by 2. TYPE/PRINT ANSWERS iNGLISH. 3. Answer the questions b~ .ow for the business as a whole. 4. Be as brief and concise s possible. SECTION 1: BUSINESS DATA A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: ~ CITY: /~z~er~'ze, id ziP: o/ BUS.P~ONE: (2~ o=.2 7- ?g/~z SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the lease or threatened release of a hazardous material, call 911 and 0 or 1-916-427-4341. This will notify your local fire department and the State Offi, of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE , , .... BUS. HRS. AFTER ~US. HRS. SgCTIO~ 8: BOC~TI0~ OF ~I~I~ S~-OFFS ~OR BUSI~SS OBg ~. E~CTRrCAn: .~. D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANSP YES / NO .DSS? YES / NO FLOOR PLANS? YES / NO KEYS9 YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE EMPLOYERS ARE REQUIRED TO REFRESHER TRAINING IN THE A PROG ,LOWING AR! WHICH PROVIDES EMPLOYEES WITH INITIAL AND CIRCLE YES OR NO A. METHODS FOR SAFE HANDLING MATERIALS. B. PROCEDURES FOR COORDINATING AC' WITH RESPONSE AGENCIES: ....... C. PROPER USE OF SAFETY EQUIPMENT D. EMERGENCY EVACUATION PROCEDURi E. DO YOU MAINTAIN EMPLOYEE TRA] 'ITIES INITIAL REFRESHER (~ NO (~ NO  NO (~ NO NO (~ NO : ....... YES YES SECTION 7: HAZARDOUS MATER] CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE SOLID 55 GALLONS OF A LIQ{ MATER: OR 200 CUBIC certify IN QUANTITIES LESS THAN 500 POUF A OF A COMPRESSED GAS: ...... ~ NO the above information is accurate. SIG lnac~ - 2B - l SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION $: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGR~M WHICH PROVIDES k-MPLOYEES WITH INITIAL .~\~ REFRESHER TRAINING IN THE FOLLOWING AR~4S. CIRCLE YES OR NO INITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS .MATERIALS:...- .................................... B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES E. O0 YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES REFRESHER YES ~ YES SECTION ?: MAZARDOUS ~ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS ~T~RIAL IN QUANTITIES LESS THAN ~00 POL~J~F A SOLID, 55 GALLONS OF A LIQUID~OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... Y~ MO I, ~ ' ~,~9 /~,~ , certify that the above information is accurate' I understand that this infg~mation will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. Z0 Chapter 6.95 Sec. 25~00 Et Al.) and that inaccurate information constitutes per3ur¥. DATE - 2B - BAKERSFIELD CITY FIRE DEPARTM~E~ 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 IUSINESS NAME OFFICIAL USE ONLY ID: INSTRUCTIONS: HAZARDOUS MATERIALS ,USINESS PLAN AS a W~OLE FORM 2A / 1. To avoid further n, return this form by 2. TYPE/PRINT ANSWERS IN ISH. 3. Answer the questions for the busines~ 4. Be as brief and concise possible. whole. SECTION 1: BUSINESS IDENTIFI A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: CITY: ZIP: BUS.PHONE: ( ) SECTION 2: EMERGENCY NOTI g the tel or threatened release of a r 1-916-427-4341. This will notify Emersency Services as required by In case of an emerMency hazardous material, call 911/~ 1-8C fire depar--~me.n~d the State Office local your ,E,~PLOYEES TO NOTIFY IN ~ASE OF EMERGENCY: B. / Ph~ Ph~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A ~LE, A. NAT. GAS/PROPANE: B. ELECTRICAL: AFTER BUS. HRS. Ph~ C. WATER: D. SPECIAL: E. LOCK BOX: YES ." NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? FLOOR PLANS? YES ./ N0 MSDSS? YES / NO YES / ~0 KEYS? YES / NO BAKERSFIELD CITY FIRE DEPARTMENT 2~30 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAME: OFFICIAL USE ONLY ID# BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned 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. SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION .~%~ EVACUATION PROCEDb~ES AT THIS 5~'IT ONLY NON--TRADE SECRETS ', HAZARDOUS MATERI ALS . I NVENTORY ., BI/SINESS NAME: ~INGH~ERINARY HOSPI~N~ OWNER NAME: ~ ~(~ ~ ,,FACILITY UNIT ~: ~ Al}DRESS: 2703~,,.~,,~t~ ~, ADDRESS: ~)~/ ~~ ~ ~C~LITY UNIT NAME: CITY, ZIP: ~A<E~SFiELD. ~,r~ ..... ~ CITY,ZIP: ~~reF~ PIIONE ~: ~ ?--~ ~Z~ PIlONE ~: -~--~ap [6FFIciAL USE CFIRS co~g ' - -- I ONLY 1 2 3 4 5 6 7 8 9 1 0 oYPE MAX ANNIIAL CONT USE LOCATION IN THIS % BY }lAZARD D.O.T DE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT {qT. CHEMIi~AL OR COMMON NAME CODE GUIDE NAME: /~/~//.f~, ,~- , TITLE: SIGNATURE: EMERGE~dY- CONT/~CT: t- TITI, E: · t. PIIONE BUS ROUR$: ~o AFTER BUS HRS: EHE~R.ENCY CONTACT: ~d~ ~&&'- ~ TITHE: PHONE ~ BUS ROURS: PRINCIPAL BUSINESS ~C~IVITY: ~ogt~e~& ~.~~ ~/)d~ ~ ~ AFTER ~OS,