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Home My WebLink AboutBUSINESS PLAN 12/30/1998Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........ ,,,,,;~,,~¢,~,,,,~,~,~,~,,,~,,,,,,,~,,,,, ......... This permit is issued for the following: ..... ~ ~ ,~'??'i:~',!ii! i:~ii:::~;:ii::i~i::i;ii;:i~:ii:ii:/:::::??iii~!Hazardous Materials-Plan :~,?i??i'..~i~;:i::~'':~'~::~'~*~:~::~';i :i~i!i ! ii', ii[:::'.::: i?~ii~iiB~emround Storage of Hazardous Materials ~:'~,-."4 ~= '-'---. ~ ,~ ......... ~. , % ..... 1..~ Cy ~ . ,, ~ '":'~EL.:.." ..:' ...,, c" .:" /' ," ,' ? .{ ¢ ~:.,4~¢";~=' · Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL 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 HALL AMBULANCE " SERVICE: INCORPORATED 1001-21st STREET BAKERSFIELD, CA 93301-4792 (805) 322-8741 FAX (805) 334-i 541 ~- December 30, 1998 Ralph E. Huey, Direbtor Office of Environmer~tal Services Bakersfield Fire Department 1715 Chester Ave. ' Bakersfield CA 93301 Dear Mr. Huey: Please be advised treat Hall Ambulance Service, Inc. no longer occupies the premises at 6201 Schirra Court, Bakersfield CA for which Hazardous Materials Permit 015-021-001370 was issued. Thank you for your c~onsideration of this advisory, and should you have questions or need fu'rther on this matter please contact me at 322-8741. Sincerely .... ~ Louis Cox Operations Manager "WE CARE. EVERY HOUR. EVERY DAY." HALL AMBULANCE SERVICE INC #~l,~~.~,~{ SiteID: 215-000-001370 Manager : II~' II~sPhone: (805) 322-8741 Location: 6201 SCHIRRA CT IIi ~A¥ 91997 I~p : 123 CommHaz : Low City : Bakersfield [~_ ' ~id: 15C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION[~. r~ -~-~C Code:4119 EPA Numb: DunnBrad: Emergency Contact / Title LOUIS COX / OPERATIONS MGR Business Phone: (805) 322-8741x 24-Hour Phone : (805) 836-1936x Pager Phone : ( ) - x Emergency Contact / Title KEN GARBER / ASST OPERATIONS Business Phone: (805) 322-8741x 24-Hour Phone : (805) 327-4111x Pager Phone : ( ) - x Hazmat Hazards: Fire Press Agency-Defined Topic Titlle : Hazmat Inventory -- MCP+DailyMax Order Hazmat Common Name... MEDICAL OXYGEN One Unified List Ail Materials at Site IspecHazlEPA HazardsI Frm DailyMax UnitlMcP F P G 244 FT3 Low !,/~,r.e.,".O . ~--~'0~ ..... Do hereby cerU~y ~h~t (T~ or prin[ rev)~t~ed ~.h~ "'~'~' :' "'"" ........ '~ materials manage- ment pi~n ~oi~g_~_~~a~ that i~ along wi~h any correctio~)s constitute ~ complet~ and cormcl man- agemont plan for my facili~. 1 04/25/1997 HALL AMBULANCE SERVICE INC #918 SiteID: 215-000-001370 ---- Inventory Item 0001 Facility Unit: Mobile Containers on Site MEDICAL OXYGEN Days On Site 365 Location within this Facility Unit ON BOARD AMUBLANCE CAS# 7782-44-7 STATE I TYPE Gas Pure PRESSURE TEMPERATURE 1 Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Lrgst Cont.this Loc FT3 AMOUNTS STORED AND IN USE DailyMax this Loc FT3 244.00 DailyAvg this Loc FT3 244.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. ] 100.00 Oxygen, Compressed EHS CAS# No 7782447 -2- 04/25/1997 HALL AMBULANCE SERVICE INC #918 SiteID: 215-000-001370 Fast Format Notif./Evacuation/Medical Agency Notification THE PROPER AGENCY WILL BE NOTIFIED Overall Site 03/20/1992 -- Employee Notif./Evacuation 03/20/1992 IN THE EVENT OF A SPILL OR INCIDENT, AND DEPENDING ON THE NATURE, DAMAGE AND THREAT POTENTIAL, AN ORDERLY EVACUATION OF THE FACILITY WILL BE ORDERED, AND IF INDICATED, THE PROPER AGENCY NOTIFIED. -- Public Notif./Evacuation 03/20/1992 IN THE EVENT OF A SPILL OR INCIDENT, AND DEPENDING UPON THE NATURE OF THE INCIDENT, DAMAGE AND THERAT POTENTIAL, THE APPROPRIATE AGENCY WILL BE NOTIFIED TO DETERMINE IF PUBLIC NOTIFICATION AND OR EVACUATION WOULD BE Emergency Medical P~an INDUSTRIAL PHYSICIAN: WILLARD CHRSITIANSEN 2021 22ND STREET BAKERSFIELD, CA. 03/20/1992 MEMORIAL HOSPITAL 420 34TH ST BAKERSFIELD, CA. (805) 327-1792 -3- 04/25/1997 HALL AMBULANCE SERVICE INC #918 SiteID: 215-000-001370 Fast Format Mitigation/Prevent/Abatemt Release Prevention THE MATERIALS WILL BE STORED IN THE PROPER LOCATION Overall Site 03/20/1992 Release Containment IN THE EVENT OF A RELEASE, APPLICABLE MSDA STANDARDS. 03/20/1992 CONTAINMENT WILL BE CONDUCTED WITH CURRENT -- Clean Up ' 03/20/1992 THE ON DUTY FIELD SUPERVIISOR AND OPERATIONS MANAGER WILL BE NOTIFIED IN THE EVENT OF AN INCIDENT, AND WILL RESPOND TO THE SITE. THIS FACILITY CONTAINS A NORMAL HOUSEHOLD SUPPL~ OF HOUSEHOLD CLEANING MATERIAL. THE MATERIAL WILL BE STORED IN THE PROPER LOCATION. Other Resource Acti~vation -4- 04/25/1997 F HALL AMBULANCE SERVICE INC #918 SiteID: 215-000-001370 Fast Format Site Emergency Factors Special Hazards Overall Site -- Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - NORTHEAST BOX IN FRONT OF COMPLEX C) WATER - FRONT LAWN BOX D) SPECIAL - NONE E) LOCK BOX - NO 01/07/1990 -- Fire Protec./Avail. Water 01/07/1990 THIS FACILITY IS EQUIPPED WITH A,B,C FIRE EXTINGUISHERS AND AUTOMATIC SPRINKLERS FIRE HYDRANT - IN BUSHES WEST OF THE STAND PIPE Building Occupancy Level -5- 04/25/1997 HALL AMBULANCE SERVICE INC #918 SiteID: 215-000-001370 Fast Format Training -- Employee Training Overall Site 01/07/1990 ONLY 2 EMPLOYEES AT A TIME WE DO HAVE MSDS SHEETS ON FILE THE OUTLINE PROCEDURES FOR HANDLING HAZARDOUS MATERIALS IS OUTLINED IN THE EMPLOYEE MANUAL. EACH EMPLOYEE IS RESPONSIBLE FOR KNOWING THE INFORMATION CONTAINED INi THE MANUAL, AS EACH EMPLOYEE SIGNS A LETTER OF ACKNOWLEDGEMENT AND UNDE,RSTANDING. -- Page 2 -- Held for Future Use Held for Future Use -6- 04/25/1997 02/27/92 HALL AMBULANCE SERVICE INC #918 215-000-001370 Overall Site with 1 Fac. Unit General Information Page Location: 6201 SCHIRRA CT Map: 123 Hazard: Low Community: BAKERSFIELD STATION 09 Grid: 15C F/U: 1AOV.: 0.0 Contact Name LOUIS COX JJ~~ Ken Garber Title OPERATIONS MGR ASST OPERATIONS MGR Business Phone ----F 24-Ho~ Phone] (805) 322-8741 x/(805) (805) 322-8741 x (805) Administrative Data Mail Addrs: 1001 21ST sT City: BAKERSFIELD Comm Code: 215-009 BAKERSFIELD STATION 09 D&B'Number: State: CA Zip: 93301- SIC Code: 4119 Owner: HARVEY HALL Phone: (F~§)~F~-//// Address: 1001 21ST ST State: CA City: BAKERSFIELD Zip: 93301- Summary Do hereby certify that ! have reviewed 'the atJached h.--~za~'d0us materials manage- merit p~al~ for_~_//~ ,4~ &,,Z~,~' and that it along with (Name ~1 Busir~s~) any corrections constitute a compJeJe and correct man- agement plan for my facility. RECEIVED HAT~ I~1~'1-. DIV. 02"/27/92 HALL AMBULANCE SERVICE INC #918 215-000-001370 01 - Mobile Containers on Site Hazmat Inventory Detail in Reference Number Order Page 01-001 MEDICAL OXYGEN ~ Fire, Pressure Gas 244 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas TyPe: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3 244 Daily Average FT3 244.00 Annual Amount FT3 1,365.00 Storage PORT. PRESS. CYLINDER Press T Temp Location IAbove ~AmbientlON BOARD AMUBLANCE -- Conc 100.0% IOxygen, Compressed Components MCP List 0~/27/92 HALL AMBULANCE SERVICE INC #918 00 - Overall Site 215-000-001370 <D> Notif./Evacuation/Medical Page 3 <1> Agency Notification THE PROPER AGENCY WILL .BE NOTIFIED <2> Employee Notif./Evacuation IN THE EVENT OF A SPILL OR INCIDENT, AND DEPENDING ON THE NATURE, DAMAGE AND THREAT POTENTIAL; AN ORDERLY EVACUATION OF THE FACILITY WILL BE ORDERED, AND IF INDICATED, THE PROPER AGENCY NOTIFIED. <3> Public Notif./EvacuatiOn IN THE EVENT 'OF A SPILL OR INCIDENT, AND DEPENDING UPON THE NATURE OF THAT INCIDENT, DAMAGE AND THREAT POTENTIAL, THE APPROPRIATE AGENCY WILL BE NOTIFIED TO DETERMINE IF PUBLIC NOTIFICATION AND OR EVACUATION WOULD BE WARRANTED. <4> Emergency Medical Plan INDUSTRIAL PHYSICIAN: WiILLARD CHRSITIANSEN 2!021 22ND STREET B~KERSFIELD, CA. MEMORIAL HOSPITAL 420 34TH ST BAKERSFIELD, CA. (805) 327-1792 '0~/27/92 HALL AMBULANCE SERVICE INC #918 00 - Overall Site 215-000-001370 <E> Mitigation/Prevent/Abatemt Page 4 <1> Release Prevention THE MATERIALS WILL BE STORED IN THE PROPER LOCATION <2> Release Containment IN THE EVENT OF A RELEASE, CONTAINMENT WILL BE CONDUCTED WITH CURRENT APPLICABLE MSDA STANDARDS. <3> Clean Up THE ON DUTY FIELD SUPERV!ISOR AND OPERATIONS MANAGER WILL BE NOTIFIED IN THE EVENT OF AN INCIDENT, AND WILL RESPOND TO THE SITE. THIS FACILITY CONTAINS A NORMAL HOUSEHOLD SUPPLY OF HOUSEHOLD CLEANING MATERIAL. THE MATERIAL WILL BE STORED IN THE PROPER LOCATION. <4> Other Resource Activation 02~/27/92 HALL AMBULANCE SERVICE INC #918 00 - Overall Site 215-000-001370 <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - NORTHEAST BOx IN FRONT OF COMPLEX C) WATER - FRONT LAWN BOX D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water THIS FACILITY IS EQUIPPED WITH A,B,C FIRE EXTINGUISHERS AND AUTOMATIC SPRINKLERS FIRE HYDRANT - IN BUSHES WEST OF THE STAND PIPE <4> Building Occupancy Level '02/27/92 HALL AMBULANCE SERVICE INC #918 00 - Overall Site <G> Training 215-000-001370 Page 6 <1> Page 1 ONLY 2 EMPLOYEES AT A TIME WE DO HAVE MSDS SHEETS ON FILE THE OUTLINE PROCEDURES FOR HANDLING HAZARDOUS MATERIALS IS OUTLINED IN THE EMPLOYEE MANUAL. EACH EMPLOYEE IS RESPONSIBLE FOR KNOWING THE INFORMATION CONTAINED IN THE MANUAL, AS EACH EMPLOYEE SIGNS A LETTER'OF ACKNOWLEDGEMENT AND UNDERSTANDING. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ! ~ , RECEIVED ~,"c"; ~,~ ~ , WAY 2 6 1991 ~OR A PERMIT ACTIVITY AT a US T FAO ILI TY I N BAKERSFIELD ~ITY / ! APPLICATION SUBMITTED FOR WORK TO BE COMPLETED AT THE FACILITY L~OTED a:~nra- FACILITY ADDRESS: ~~/ ~V~ 1' ~~ ~Ur~ DESCRIPTIONS OF WORK FOR WHICH PERMIT APPLICATION HAS BEEN SUBMITTED: SPECIALIST GI!VEN THE APPLICATION: DATE GIVEN I TO, THE SPECIALIST: BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREVENTION APFLICATION Application regulations, application 'L'is--cna~ In conformity with provisions of p~inent ordLnan~:es, codes and/or Na~ of C~ny / ~dre~ to display, store, install, use, o~rate, sell or handle materials or pr~esses involving or creating con- ditions deemed hazardous to life or property as follows: RESOURCE MANAGEMENT AGENCY RANDALL L. ABBOTT DIRECTOR DAVID PRICE III ASSISTANT DIRECTOR Environmental Health ServW-e~ Department STEVE McCA! Il:y, REHS, DIRECTOR Air Pollution Control D~tr~t WILLIAM J. RODDY, APCO Planning & Development Se~ice,~ Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT FOR PERMANENT~ OF UNDERO~OUND HAZAKDOUS SUBSTANCES STORAGE FACILITY PERMIT NUMBER A 1497-3' FACILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: CONTRACTOR: Royce Asset Property 6201 Schirra Court Bakersfield, CA 93313 Royce Asset Managing Group 23901 Calabasas #1010 Calabasas, GA 91302 Phone: (818) 592-6687 Kern Environmental Services P. O. Box 5337 Bakersfield, CA 93388 License #432732 Phone: (805) 589-5220 PERMIT FOR CLOSURE OF PERMIT EXPIRES August 23, 1991 2 TANK(S) AT ABOVE LOCATION APPROVAL DATE APPROVED BY May 23, 1991 Laurel Funk Hazardous Materials Specialist ......................................................................................... } ..... Post ON PREMISES ............................................................................................... CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fire and Bulldir Departments). 2. Permittee must notify the Hazardous Materials Management Program at (805) 861-3636 two working days prior to tank removal or abandonment in place arrange for required inspections(s). 3. Tank closure activities must be per Kern County Environmental Health and Fire Department approved methods aa described in Handbook. UT-30. 4. It is the contractor's responsibility to lmow and adhere to all applicable laws regarding the handling, transportation or treatment of ha?ardoua materials. 5. The tank removal contractor must have a qualified company employee on site supervising the rank removal. The employee must have tank removal experien prior to working unsupemSed. 6. If any contractors other than those idsted on permit and permit application are to be utilized, prior appcoval must be granted by the specialist, listed on t. permit. DeWation from the submitted application is not allowed. 7. Soil Sampling: a. Tang ,qze leas than or equal to 1,000 gallons - a minimum of two samples must be retrieved from beneath the center of the tank at depths approximately two feet and:six feet. b. Tank size gr~atex than 1,000 to 10,000 gallons - a minimum of four samples must be retrieved one-third of the way in from the ends of each ta at depths of apprOXamately .two feet and six feet. c. Tang siz~ greater than 10,000 gallons - a minimum of six samples must be retrieved one-fourth of the way in from the ends of each lank and bene:_ the center of each tank. at depths of apprommately two feet and six feet. 8. Soil Sampling (piping area): A minimum of two samples must be retrieved at depths of appraximately two feet and six feet for every 15 linear feet of pipe run and under the dispenser ar 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 £RMIT FOR PERMANENT CaL--'~!i~b~l~' OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY PERMIT NUMBER A 14~7-31 ' ADDENDU~ Soil Sample anal.vsls: a. All soil samples retrieved from beneath gasoline (leaded3anleaded) tangs and appurtenances must be analyzed for benzene, toluene, xylene, and total petroleum hydrocarbons (for gasoline). b. All soil samples retrieved from beneath diesel tan~ and appurtenances must be analyzed for total petroleum hydrocarbons (for diesel) and benzene. c. Ail soil samples retrieved from beneath waste oil tanks and appurtenances must be analyzed for total organic halides, lead, oil and grease. d. Ail soil samples retrieved from beneath crude oil tanks and appurtenances must be analyzed for oil and grease. e. All soil samples retrieved from ibeneath tan~ and appurtenances that contain unknown substances must be anal~ed.for a full range of substances that may have been stored within the tank. 10. The following timetable lists pre- and post-tank removal requirements: ACTIVYrY DEADLINE Complete permit application submitted to Hazardous Materials Management Program Notification to inspector listed on permit :of date and time of closure and soil sampling At least two ween prior to closure Two working days Trfinsportation and tracking forms sent to Hazardous Materials Management Program. All haz~a~ rdous waste manifests must be signed by the receiver Of the hazardous waste No later than 5 worlfing days for transportation and 14 working days for the tracking form after tank removal Sample analysis to Hazardous Materials Management Program No later than 3 working days after completion of analysis 11. Purginganening Conditions: a. Liquid shall be pumped from tfink prior to purging such that less than 8 gallons of liquid remain in tank. (CSH&SC 41700) b. Tank shall be purged through vent pipe discharging at least 10 feet above ground level. (CSH&SC 41700) c. No emission shall result in odors detectable at or beyond property line. (Rule 419) d. No emission shall endanger the health, safety, comfort or repose of any person. (CSH&SC 41700) e. Vent lines shall remain attached to tank until the inspector arrives to authorize removal. RECOMMENDATIONS/OUIDELINE$ FOR REMOVAL OF UNDEROROUND STORAGE TANI~ This department is responsible for enforcing ihe Kern County Ordinance Code, Division 8 and state regulations pertaining to underground storage tanks. Representatives from this department respond to~ job sites during tank removals to ensure that the tanks are safe to remove/close and that the overall job performance is consistent with permit requirements, applicable laws and safety standards. The following guidelines are offered to clarify the interests and ea'pectations'for this department. .lob site safety is one of'our primary concerns. ExcavatiOns are inherent~ dangerous. It is the contractor's responsibility to know and abide by CAL-OSHA regulations. The job foreman is responsible for the crew and any subcontractors on the job. As a general rule, workers are not permitted in improperly sloped excavations or when unsafe conditions exist in the hole. Tools and equipment are to be used only for their designed function. For example, backhoe buckets are never substituted for ladders. Properly licensed contractors are assumed to understand the requirements of the permit issued. The job foreman is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. Individual contractors will be held responsible for their post-removal paperwork. Tracking forms, hazardous waste manifests and analyses documentation are necessary for each site in order to clOSe a case file or move it into mitigation. When contractors do not follow through on necessary paperwork, an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new closures will increase. Accepted By: LF:caa DATE M1497-31.ptc Business Name: Location: Bakersfield Fire D~ept. Hazardous Materials Inspection Date Completed Plan ID Ct 215-000 Station No. ~ (Top right comer Business Plan) ~Shift t~ Inspector fication of Inventory, Materials j~. ~ ~ Verification of Quantities Verification of Location Proper Segregation of Material uate Inadequate Verification of MSDS Number of Employees Verification of Haz Ma Verification of r Procedures Posted C( Properly Labeled Comments: / Ver/ficafion 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 CITY FIRE 2130 G' STREET BAKERSFIELD, CA 93301 (805) 326-3979 0FF!C[AL USE 0NLV ID= 001370 HAZ.~J{D O US lvL-IT E R I :~%/.S BUS I NESS PL.~N AS A WHOLE FORM 2A INSTR. UCT!0NS: !. To avoid further action, return this form 2. TYPE/PRINT ANSWERS,IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as gossible. SECTION !: BUSLXTES$ IDE~.FFTF!CAT!0N UATA A. BUSL%IESS NAME: HalI Ambulance Service In9, B. LOCATION / STREET ADDRESS: 6201 Schirra Ct CI~J: Bakersfield i ZIP: 93309 $~te ~ BUS.?HONE: (805) RECEiVi~D HAZ. MAT. DIV. 327-4111 SECTION Z: EMERG~-NCY .YOTIF!CAT!0NS In case of an emer~eBcy involviny the release or threatened release of a hazardous material, call 911 and 1-800-8~2-T~0 or 1-915-427-4341. This will notify your local f£~e depa~tmen~ and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF ~ERGENCY: NAME ~YD TITLE DURING BUS. HRS. A. Louis Cox Ops Mqr B. Rick Scott Asst Ops ~gr Ph~ 322-8741 AFTER BUS. 5RS. Ph~ 836-1936 Ph~ 393-5823 SECTION 3: LOCATION OF UTILITY SR1]T-OFFS FOR BUSTNESS AS A WEOLE N/W !corner of building A. NAT. GAS/PROpA~IE: B. ELECTRICAL: N/E box in, front of complex C. WATER: Front lawn box.' D. SPECIAL: E. LOCK BOX: YES ,,'/~6) IF YES, LOCATION: IF YES. DOES tT CONTAIN SITE PLANS? FLOOR PLANS? YES / NO YES / NO MSDSS? YES / NO KEYS? YES / NO SECTION 2: Pg[VATE 2ES?~NSE TEAM ~a~ BUSINESS AS .% WHOEZ The on duty Field Supervisor and Operations Manager will respond to the site in the event of an incident. In the event of a spill, absokb-all shall be applied to the spill, and will be disposed of in the proper manner. In the ~vent of a major spill or incident, the building and surrounding area will b~..evac~:a~ed/, and the proper agency notified. ' ~'O,x,' ..:u ..... ASSISTANCE FOR YO~:,-~ 3USiNESS .AS A WHCLE SEC .... ~ ,~: LOCAL E:~ERGENC¥ ,~--~,r Industrial'Physician: WillardlChristiansen · . 2021 22~d St. Bakersfleld, Ca. 93301 Memorial HQspi~at:.,.~20 34th S~.. Bakersfield, Ca. 93301 SECTION, S.: ~%OYEE TRA~NT~G EM~QYERS ARE REQUIRED TO HAVE A TRAINING PROGRAN WI{ICH 'EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MATERIALS. A. NUMBER OF EMPLOYEES AT THIS FACILITY?' 2 at any time B. DO YOU HAVE MSDS (NATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS NATERIAL YOU HANDLE? Yes C. GIVE A BRIEF' SUNNARY OF YOUR HAZARDOUS >IATERIALS TRAINI:-~G PROGRAM. The outline procedures' for handling hazardous materials is outlined in the employee manual. Each employee is responsible for knowing the information contained in the manual, as each employee signs a letter of acknowledgement and understanding. SECTION 7: HAZARDOUS ~ATERIAL CIRCLE YES OR NO OR NONE DOES YOUR BUSINESS HANDLE HAZARDOUS ~¢TER!A5 iN QUANTITIES LESS THAN ~00 ?0L~DS OF A SOLID. ~$ GALLONS OF A LiQUiD. OR 200 CUBIC FEET OF A ~ .... ~-c ~r~ ~0 ,,~.~:r..:.~SED GAS: ......... I Rick Scott .. ~ ~ ,__~ , cert_~¥ that 'the above info:'mation is accur,~te. [ understand that t.'lis informal!on wi!! be used to futf"_ll '~y f'.'rm~s obl:~ar, ioP. s unde? the near California Health and Safer,¥ code on Hazardous :.!arer':als (Div. 20 Chaplet ~.~ Sec. 25,~00 Et Al.) and that inaccurate informauion cons~itu:es perjury. S I GNATURE Asst.' Ops. Mgr. TITLE 2R BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS N~E: OFFICIAL USE ONLY iD# BUSINESS 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 q}lestions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and C0NCISE as possible. FACILITY UNITe 918~ FACILITY UNIT NA~E: South-West SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES The on duty Field Supervisor 'and.Operations Manager will be notified in the event of an incident, and will respond to! the site. This facility contains a normal household supply of ~ousehold cleaning materiail. The material will be stored in the proper location. SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT Tills UNIT ONLY In the event of a spill or incident, and depending on th nature, damage and threat potential, an orderly evacuat!ion of the facility will be ordered, and if indicated, the proper agency notified. SA - SECTION 3: HAZARDOUS ,WATERIALS FOR THIS UNIT ONLY A. Does this FacilSty Unit contain Hazardous Materials? ...... YES NO If YES. see B. If NO. continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: N0~-TRADE SECRETS ONLY (white form =4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS 0~LY (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 This facility is equipped with A,B,C. fire extinguishers and automatic sprinklers. SECTION 5: LOCATION OF'WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS Automatic sprinkler stand pipe located in front of complex, hydrant located in bushes West of the stand pipe. SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPANE} N/w corner of building ELECTRICAL: Electrical box, N/E corner in front of complex. C. WATER: Front lawn box. D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS? YES / NO MSDSs? YES / NO KEYS? YES ,/ NO YES / NO - 3B - CITY of BAKERSFIELD Farm and Aqriculture t...J Standard B,siness ~ ['~Jl~Jk~ ~Jl'l~)O US ~,~,m~ ]~ i~r ,~T~.I".S '1" BUSINESS N~ME: Hall Ambulance Service Inc. OWNER NAME: Hnrve'~ Hn]] NAME OF T~ FACILITY:SOuth-West LOCATION: 620] .qnhirrn Pt. .qliitP ] ADDRESS: ]nnl 21~t qP STANDARD IND. CLASS CODE CITY, ZIP- ~aKers~le±~ 933U9 CITY, zIP:i~ers~[eld'93301 DUN AND BRADSTREET NUMBER PHONE ~27-4111~ PHONE ~: 327-411l __ - - ~ ~0 XMS~UCTXONS FOR FROF~ COD~ 1 2 3 4 5 6 ? 8 9 10 11 12 Trans Type Hex Average Annual Measure I ~s C~t C~t C~t Use L~attm Where % by Na~s of M~xture/C~ts Code Code AmC AmC Est Units ~ Site Ty~ Press INp C~e .. Stored tn Faciltty Ht See ]nstructi~s _M~___k~ ........ !__~_~ ...... 1.__~_~.~ .... ~_L~~l_~L~J_s~_-¢~-~_~.~n~=~_.. ~ .... ~~.~ ................................ : .... ~ysical' and Health Hazard ..... ~.l:S. Nu.~r 77~2-~4-~ _ - C~nent I1 Nlq & C.l.S. Number r--n C~mt t2 Na~ & C.A.S. Numbe~ u~ Fire Hazard u_a Reactivity u_a ~la~. -- ~dd~ Release u_a I~tatm Hca It~ of Pressure H~ Ich ................................................................... Cm~t ~ Nane ~ C.~.S. NunbaP 1, i ...................... ~L~L_~LI ........ ,_~I:~L~ ..... '~]:L5 ....... L_I ..... -~ ................................................ ~ ........................... Physical and Health Hazard C.A.S. NumNr Ca.mt II Na~ & C.A.S. (Check all t~t apply) ............................................................ -- r--n r--n r--n r--n Ca.mt I) Naa & C.A.S. Mumbr [ ] Fire Hazard u--~ Reactivity u--J ~lay~ u--J ~dd~ Release u--~ i~late ....... Health · of Pr~sure H~lth ..... C~t 13 Na~ & C.A.S. Mum~r ..... l--.::'[--:'m----:' .... :]:::' ........ ::1 ..... : ..... l I .[ I I :l.__l " ..... " .._.:_. Ph~ical and Health Hazard C.A.S. iu.~ h~.t II Naa i C.i.S. (C~k ail t~t r--n r--n ~t I~ Na~& C.A.S. Numar ~-~ Fire Hazard E-~ Reactivity ~-~ Oelay~ u_J ~dd~ Reiease u--J i~tate Health of Pressure Health ~ C~t l) N8~ & C.k.S. Numar Ph~ical and Health Hazard C.A.S. Hu.~ C~mt II Nam & C.A.S. (Ch~k a11 that apply) ......................... ~ ..................................... - ~-~ "-~ [-3 [-] c.~ t2 x~. & c.~.s. ~ ~ Fire Hazard u--a Reactivity ~--a Oelayed ~dd~ Release I~tate m Hea)th of Pressure Health Cm~t I) Na~ & C.A.S. Human 327-41~ 327-4111 ~a~8.~~.~~ ................ ~_.~_~¢~ ..... ~-~-~ ......... ME~GENCY CONTACTS ll~.m. ~'-~~ ....................... Ti.--'''N-~''-~ ~ .......... ll-RF'~) ....... Certification (Read and siEn after compJetinE all sectJons) ! Certify under ~enalty of law that I have, personally examined and am familiar with the information submltt~n this ~n4 all attached documents, and that based ~ my inquiry of t~se individuals resp~sible for, obtaining the infor~ti~, [ believe t~t t~ submitted informati~ is true, accurate, and c~ple~e. ~ ~ ~ /~ ~Rick Scott As's~stant Operations Manager ~~ F~<:¢~_ ~-~-~-5V~5~F7~5~F-~-~F7~5~F~Fq-~F~-F~F~R~ ~R~[GF~ ................................................. D~ ..................... I TE/FACI LI TY FORM NORTH SCALE: ~ BUSINESS NAME: ~kLU A~~ ~_~ FLOOR: OF , '"DATE: / / FACILITY NAME: UNIT #: OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM Inspector's Comments): / -OFFICIAL USE ONLY- HMCU-13 . HALL AMBULANCE SERVICE, ~NC. ~L4~ Mn,u~ ~ AMBULANCE DIVISION POLICY ~ ~ ~ ~ FIELD OPERATIONS HANDBOOK NO. SUBJECT: HAZARDOUS MATER I ALS 901.0 Hazardous materials are &ny substance capable of posing an extraordinary r~sk to health, safety and property when transported in commerce and which has been so designated by the Federal Department of Transportation (DOT). These are materials that are highly explosive or flammable, poisonous and toxic chemicmls, radioactive products, cogrosive materials, and'biological agents. The American Automobile Association estimates that two billlon tons of haz~rdous materials aFe transported by highway vehicles annually. The largest portion of hazardous materials is carried in tank trucks or railroad tank cars. The 9rearer Bakersfield area is~in close proximity to four major highways, as well as rail networks and airline overflights. As a precaution, each ambulance is equipped with a D.O.T. Hazardous Material Guidebobk and chemical resistant garments. Be aware that these suits contain n° respiratory protection. .As such, they are designed to protect the crew from skin contact only. The following r, ules must be followed if you are exposed to a haza.rdous mater, ials incident: (1) Do not co~mpound the existing problem by creating a disaster 'out of an emergency. (2) You may .hiave to delay attending to the injured to DATE"ISSUED: DATE EFFECTIVE: DA'~E REVISED: APPROQED BY: SERVICE '~I"-~:L~I L AMBULANCE SERV C , INC. I~ ~;~lMn,~At ~ AMBULANCE DIVISION POLICY ,~~ FIELD OP ERATIONS HANDBOOK NO. SUBJECT: HAZARDOUS MATERIALS (ConL'd) 901.1 avoid being contaminated yourself. (3~ Keep the Communications Section advised at aL1 stages of your actions. Communications must advise othe~ responding units ~nd ~gencies. (4) Isolate the area of everyone Jot directly involved with the incident, unt~l relieved by the Fire Department or the agency with invest~gatin9 muthor i ~y. (5) DO NOT BECOME PART OF THE PROBLEM YOURSELF BY .. ATTEMPTING IRRESPONSIBLE RESCUE OR HEROICS. I I bATE ISSUED: DATE E~FECTIVE: DATE' R~QISED: APPROVED 'BY: L A ULANCE SERVICE, HAL _ EMPLOYEE TRAINING PROGRAM MEASURED LEARNING OBJECTIVES Driver Orientation page 4 i. Stand-by Paperwork j. Dry Run Paperwork k. AMA Papelrwork 1. LACO Resiponses m. C.O.D.~ P!ayments n. C.O.D. Bonus edge of policy, regarding hot and cold weather operation edge of vehicl,e operation at night, in fog, rain and .edge of the pr,oper method of chaining a vehicle (winter .tion only). ~ct procedure alt following facilities: a. Meadows :Field b. San Dima!s Birthing Center c. California Dialysis Service hedge of the policy regarding backing a vehicle: a. Correct !procedure for backing into Station 911 garage 1. From 21st Street 2. Back' lot Df triage tags .edge .of "PR" i,n the field ~r use of a fir. e extinguisher ~r use of highway flares, storage and replacement. Ige of ground unit~helicopter interaction. Ige of the procedu!re to be followed in the event of a ~us Material..Incid~nt, on site and on scene. Ige of the pr0ceduire to be followed in the event of a mechanical ~ful completion of a training test route while secured to the in the rear of the ambulance. 19. Knowledc 20. Knowl snow. 21. Knowled( ope 22. Corr, 23. Know~ 24. Use 25. Know] 26. P rot 27. Pro~ 28. Knowled~ 29. Knowled~ Hazard~ 30. Knowled~ failure. 31. Succes~ gurney Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed Location: Plan ID # 215-000 -ootsvo (Top right comer Business Plan) Station No. ~ Shift ~ Inspector Adequate Inadequate Verification of Inventory iMaterials RECEIVED Verification of Quantities AUg 2 I 19§9 Verification of Location HAZ. MAT. DIV. Proper Segregation of Material Comments: 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 Comments: 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