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BUSINESS PLAN 12/18/2000
Hazardous Materials/Hazardous Waste Unified.Permit' CONDITIONS OF-PERMIT ON'REVERSE .SIDE Permit ID#:: 015-000-000411 MERCY HOSPITAL 'OPERATII LOCATION: 551 SHANLEY ST TJhis hermit is issued for the followin_=: El Hazardous Materials Plan cI Underground Storage of Hazardous Materials [3 Risk Management Program [3 Hazardous Waste On-Site Treatment 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: Expiration Date: 'June 30. 2003 Issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ~,; ~,?'7 E=";~7);~i~"iy~,~, This permit is issued for the following: ' ~,,~,,ii,~"i~'~i~ ~" ~"/ !,Z~::Z~:::Z;~,.:::i;;:5~ :, iiii::, l~Hazardous Materials Plan ~ ~,¥~i: !.,~!~: i:~"~'~"~:~:~::~iiiiiil;ili!ilL ~ ii iiii;;::::iiiiiiiiiiii~iiU~Bemround Storage of Hazardous Materials PERMIT ID# 015-021000411 .d~i?~i' ~i;~* ;;iiiiiiiii!ii!iiiiiiIII:=' ,,!!!!:!: ii!ii!!!iiiiiii!!!i!! !!'!!!!i::: iiiii:~ii,~!!i~kli~apagement Program /i:~:", v~~?' ,~ii~: =:i:i~"~:'::: ;~:.:~ ::=:::::::i::=:,, :: ~..:~,.,..:,, ;';i' i ~;:~!!: ~!iha~fd~fis Waste LOCATION 551 SHANLEY · ~,,.. · ~ ~' . ........... ~ ; . '. ~, ~ i ~ '...~ Issued by: G 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: ~tlph Huey~7 Office of ~ff~ental ServiCes June 30, 2000 :~MP MAP SITE DIAGRAM ~. FACILITY DIAGRAM Business Name: . ,' ' / _ ' i Business AOdress: ~ First In Station: , l/, Area Map # /~?:~ ot Inspection Station: /// /~ NORTH MERCY HOSPITAL OPERATIONS WHSE j Manager : / Location: 551 SHANLEY ST City : BAKERSFIELD SiteID: 015-021-000411 BusPhone: Map : 123 Grid: 06C (805) 328-5260 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 EPA Numb: Eme rge~ '(~(~c~ Business Phone: 24-Hour Phone ~%[44~8z3) 632-5000x Pager Phone : SIC Code: 4226 DunnBrad: / ---'Ti'tie;%::------'- .... ~ Emergency Contact / Title ) 632 ~ Business Phone: ) 633-6000x 24-Hour Phone $~((S05) 632-5000x Pager Phone : (~) 34~ -~ x Hazmat Hazards: Fire React ImmHlth DelHlth Contact : Phone: ( ) - x Mailaddr~ PO BOX 119 ~C~V~ State: CA City : BAKERSFIELD Zip : 93302 0 OCl Owner CATHOLIC HEALTHCARE WEST Address : PO BOX 119 ~NVI~,~WC~S City : SAN FRANCISCO Phone: (415) 397-9000x State: CA Zip : 94111 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory --As Designated Order Hazmat Common Name... HYDROGEN PEROXIDE METHYL ALCOHOL GERMICIDALS CIDEX PLUS DETERGENTS CLOROX LIQUI~ BLEAC~ ACETONE CLEANER " WAST~ ALCOH~:¢~wowed t~l~ ment One Unified List Ail Materials at Site SpecHazlEPA Hazards Frm DH L . F IH DH L IH DH L IH DH L DH L F IH DH L F L ~_~_ ~0 F R'IH L _ hereby certify that Ir~a]ct~ L ')~"~ F IH DH L :h~8, hazardous materials mana~ L ,-, and ~hat it along wi~h ~am'e of ~O~iness~,~ -- , any corrections con~tute a complete and correct man- DailyMax Unit MCP 12 00 GAL Hi 110 00 GAL Hi 10 00 GAL Low 26 00 GAL Mod 40 00 GAL Mod 90 00 GAL Hi 40 00 GAL Hi 12 00 GAL Mod 30 00 GAL Hi 30 00 GAL Mod 10 00 GAL Mod , · 1 .12/12/2000 MERCY HOSPITAL OPERATIONS WHSE SiteID: 015-021-000411 ~ Inventory Item 0001~ Facility Unit: ,Fixed Containers on Site HYDROGEN PEROXIDE Days On Site 365 Location within this Facility Unit Map: Grid: WAREHOUSE CAS# 7722841 F STATE TYPE PRESSURE Liquid I Pure I Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Co~tainer~.~GAL I AMOUNTS AT THIS LOCATION Daily Maximum 12.00 GAL Daily Average 12.00 GAL %Wt. 100.00 HAZARDOUS COMPONENTS Hydrogen Peroxide HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards. No/ Curies DH NFPA/// USDOT# MCP Hi Inventory Item 0002 Facility Unit: Fixed Containers on Site METHYL ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: WAREHOUSE : CAS# FSTATE ~ TYPE Liquid IMixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container\.o<9 GAL AMOUNTS AT THIS LOCATION Daily Maximum 110.00 GAL Daily Average 120.00 GAL %Wt. RS CAS# 2.00 2-Propanol No 67630 91.00 Methyl Alcohol No 67561 TSecret ~S BioHaz No N No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# M°PI -2- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE ~~~~ SiteID: 015-021-00041 i~ Inventory Item 0003 ~~~ Facility Unit: Fixed Containers on Site i lEE COMMON NAME / CHEMICAL NAME EEEEEEEEEEE~EE~EEEEEEE~EEEi~EE~EEEE~E~EEEE GERMICIDALS °, Days On Site o ° 365 ° Location within this Facility Unit Map: Grid: WAREHOUSE o CAS# ° ° 25655-41-8. o i8 STATE ~8 TYPE ~ PRESSURE ~ TEMPERATURE ~88~. CONTAINER TYPE Liquid o Mixture o Ambient o Ambient o PLASTIC CONTAINER o i6~~~~i AMOUNTS AT THIS LOCATION Largest Container o Daily Maximum o Daily Average o [oaO GAL o 10.00 GAL o 10.00 GAL o i~i~~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS# o 10.00Oiodine ONo o 7553562° 1.00OGlycerine ONo o 56815° i~i~i6~i~~ HAZARD ASSESSMENTS °TSecret° RS°BioHaz° Radioactive/Amount o EPA Hazards ° NFPA o USDOT# ° MCP o No °No°No ° No/ Curies° IH DH ° /// o °Low° Inventory Item 0004 ~~~ Facility Unit: Fixed Containers on Site i~ COMMON NAME / CHEMICAL NAME CIDEX PLUS o Days On Site o 365 ~cation within this Facility Unit Map: Grid: WAREHOUSE o CAS~ o o 111-30-80 STATE EiE TYPE ~iE~ PRESSURE EEEi TEMPE~TURE ~Ei~EE~ CONTAINER TYPE Liquid o Mixture o Ambient o Ambient o PLASTIC CONTAINER o i~~~~5~i AMOUNTS AT THIS LOCATION Largest Container o Daily Maximum o Daily Average o ~.~ GAL o 26.00 GAL o 20.00 GAL i~i~55~~ HAZARDOUS COMPONENTS %Wt. o o. RS© CAS~ 3.00OGlutaraldehyde ONo o 110308© °TSecret° RS°BioHaz© Radioactive/Amount o EPA Hazards o NFPA o USDOT~ o MCP o No ONoONo o No/ Curies° IHDH° /// o -3- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE ~~~~ SitelD: 015-021-00041 i~ Inventory Item 0006 ~E~~ Facility Unit: Fixed Containers on Site i i~ COMMON NAME / CHEMICAL NAME DETERGENTS o Days On Site ° o 365 ° Location within this Facility Unit Map: , Grid: WAREHOUSE ° CAS// ° ~ ° 7681-52-9 o iE STATE'EiE TYPE EEEiEE PRESSURE EEEi TEMPERATURE EEiEEEE CONTAINER TYPE Liquid ° Mixture ° Ambient ° Ambient ° PLASTIC CONTAINER ° Largest Container o Daily Maximum o Daily Average o ~ .~OGAL o 40.00'.GAL ° 30.00 GAL o iEE~EEEEiEEEEEEEEEEEEEE HAZARDOUS COMPONENTS EEEEEEEEEEEEEEiEEEiEEEEEEEEEEEEEEEi %Wt. ° o RSo CAS// o 35.00OSodium Hydroxide °No o 1310732° 10.00OTetrasodium Pyrophosphate °No ° 7722885° ~i~i~i~i~~ HAZARD ASSESSMENTS °TSecret° RS°BioHaz° Radioactive/Amount ° EPA Hazards o NFPA ° USDOT# ° MCP ° No °No °No o No/ Curies° DH ° /// ° OModO Inventory Item 0007 ~~~ Facility Unit: Fixed Containers on Site i~ COMMON NAME / CHEMICAL NAME CLOROX LIQUID BLEACH o Days On Site o ° 365 o Location within this Facility Unit Map: Grid: WAREHOUSE o CAS// ° o 7681-52-8 o STATE ~i~ TYPE ~i~ PRESSURE ~i TEMPERATURE 55i55~5 CONTAINER TYPE Liquid ° Mixture o Ambient o Ambient o PLASTIC CONTAINER o i~~~~5~i AMOUNTS AT THIS LOCATION Largest Container ° Daily Maximum ° Daily Average o l,°° GAL ° 90.00 GAL o 90.00 GAL o i~i~~55~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS// ° 100.00OSodium Hypochlorite °No ° 7681529° i~¢i~~i~5~ HAZARD ASSESSMENTS °TSecret° RS°BioHaz° Radioactive/Amount ° EPA Hazards ° NFPA 0 USDOT# o MCP ° No ONoONo o No/ Curies°F IH DH° /// o OHi° -4- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE ~~~~ SiteID: 015-021-00041 i~ Inventory Item 0008 ~~~ Facility Unit: Fixed Containers on Site i i~ COMMON NAME / CHEMICAL NAME FORMALDEHYDE ° Days On Site o o 365 o Location within this Facility Unit Map: Grid: WAREHOUSE ° CAS// ° o 50-00-0 o ~ STATE ~ TYPE ~ PRESSURE ~5~ TEMPERATURE ~5~5555 CONTAINER TYPE Liquid o Mixture o Ambient o Ambient o PLASTIC CONTAINER o Largest Container ° Daily Maximum o Daily Average ° ~ ..~.,m~GAL, o 40.00 GAL o 32.00 GAL o %Wt. o o RSo CAS# o 37.00OFormaldehyde (EPA) °Yes° 50000° OMethanol ONo o 67561 ° i~i~i~i5~5~5~ HAZARD ASSESSMENTS b.~5~55~5~b;~Si~5~i~i °TSecret° RS°BioHaz° Radioactive/Amount o EPA Hazards ° NFPA ° USDOT//o MCP ° No ONoONo o No/ Curies°F o /// o °Hi ° Inventory Item 0009 ~~/~/5~ Facility Unit: Fixed Containers on Site i~ COMMON NAME / CHEMICAL NAME ACETONE ° Days On Site ° ° 365 o Location within this Facility Unit Map: Grid: WAREHOUSE o CAS// ° o 67-64-1 o STATE ~i~ TYPE ~i~fi PRESSURE ~i TEMPERATURE 55i555~ CONTAINER TYPE Liquid o Pure o Ambient o Ambient o PLASTIC CONTAINER o i~/~~~i AMOUNTS AT THIS LOCATION Largest Container o Daily Maximum o Daily Average o I~GAL o 12.00 GAL o 8.00 GAL ° i~i~~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS# ° 100.00OAcetone ONo o 676'41 ° i/~888~/~i/~i~i~8~ HAZARD ASSESSMENTS °TSecret° RS°BioHaz° Radioactive/Amount ° EPA Hazards ° NFPA o USDOT# o MCP o No ONoONo o No/ Curies°F RIH o /// o °Mod ° -5- 12/12/2000 i MERCY HOSPITAL OPERATIONS WHSE ~~~e SitelD: 015-021-00041 i~ Inventory Item 0010 ~~~ Facility Unit: Fixed Containers on Site i i~ COMMON NAME / CHEMICAL NAME ° CLEANER o Days On Site ° o o 365 o o Location within this Facility Unit Map: Grid: ° WAREHOUSE o CAS// o o o o i8 STATE ~ TYPE ~6~ PRESSURE ~ TEMPERATURE ~ CONTAINER TYPE ° Liquid ° Mixture ° Ambient o Ambient o PLASTIC CONTAINER o ° Largest Container o Daily Maximum o Daily Average o o I? GAL o 30.00 GAL o 20.00 GAL o ~/~i~iSiSiSiSiSliSiSiSi~iSi~iSi~iSi~i~iSiSe HAZARDOUS COMPONENTS/~i~isisisiseisisis/sisisis~is/~is~isisiseeeeeeeeeeeei o %Wt. o o RSo CAS// o o 2.00°Hydrogen Chloride °Yes° 7647010° o 5.00O2_Butoxyethanol ONo o 111762° o 30.00ophosphoric Acid ONo o 7664382° aeeeeeeeueeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee ..eueeeueeeeeeeeeeeeeeef i~i~i~i~~ HAZARD ASSESSMENTS ~~i~~i~i °TSecret° RS°BioHaz° Radioactive/Amount ° EPA Hazards ° NFPA ° USDOT//° MCP ° o No ONoONo o No/ Curies° IH DH° /// o °Hi o i~ Inventory Item 0011 e~e~e~e~ee~ Facility Unit: Fixed Containers on Site ie~ COMMON NAME / CHEMICAL NAME TONER o Days On Site o 365 ° Location within this Facility Unit Map: Grid: WAREHOUSE o CAS// o o o STATE ~i~ TYPE ee~i~ PRESSURE ~e~ TEMPERATURE ~ CONTAINER TYPE Liquid o Mixture o Ambient ° Ambient ° PLASTIC CONTAINER o ii~i~i~i~i~i~i~i~i~ei~isi~ei~i~isi~i~i AMOUNTS AT THIS LOCATION Largest Container o Daily Maximum o Daily Average o \ oml t,h,. rt o 30.00 q,*Leb a&e 4.00 i~i~~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS// o 85.00oStyrene ONo o 100425° °TSecret° RS°BioHaz° Radioactive/Amount o EPA Hazards ° NFPA o USDOT//o MCP ° No ONoONo o No/ Curies°F IH DH ° /// o °Mod° -6- 12/12/'2000 MERCY HOSPITAL OPERATIONS WHSE ~~~b~ SiteID: 015-021-00041 i~ Inventory Item 0012 ~~~ Facility Unit: Fixed Containers on Site i i~ COMMON NAME / CHEMICAL NAME WASTE ALCOHOL o Days On Site o o 365 Location within this Facility Unit Map: Grid: CAS o o i8 STATE ~i~ TYPE ~8~i88 PRESSURE ~8i TEMPE~TURE 88i8~ CONTAINER TYPE Liquid o Waste o Ambient o Ambient o PLASTIC CONTAINER o i5~¢~5~~5~i AMOUNTS AT THIS LOCATION Largest~ o Daily Maximum o Daily Average o (5.00 GAL3° 10.00 GAL o 5.00 GAL o i~i~~ HAZARDOUS COMPONENTS %Wt. o o RSo CAS~ o °Isopropyl Alcohol ONo o 67630° i~i~iS~i~~ HAZARD ASSESSMENTS ~i~~iS~8~i~i · °TSecret° RS°BioHaz° Radioactive/Amount o EPA Hazards o NEPA ~ USDOT~ o MCP o No ONoONo o No/ Curies° DH ~ /// o OMod° -7- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE i5~~~ SiteID: 015-021-00041 i~ Notif./Evacuation/Medical ~~~~~~ Overall Site i i/~/~ Agency Notification ~~~~~~~ 02/09/1996 i O BAKERSFIELD FIRE DEPARTMENT - 911 o o MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT - 632-5000 o o FACILITIES MANAGER - 632-5000 ° ADMINISTRATIVE COORDINATOR - 632-5000 o ii~ Employee Notif./Evacuation i~/~~~fi~fi~fi 02/09/1996 i O o ° FIRE ALARM SYSTEM ° NOTIFY EVERYONE IN BUILDING ° EVACUATE TO NORTHWEST OF BUILDING o o i~/5 Public Notif./Evacuation ~/~6~/~6fi~6~¢~66~6~,~, 02/09/1996 i °QUANTITY NoT SUFFICIENT TO REQUIRE SURROUNDING PUBLIC TO EVACUATE BECAUSE OF ° °DISATER TO NEAREST BUILDINGS. IF REQUIRED PROBABLY A DECISSION TO BE MADE o oBY HAZ MAT TEAM. ° i~ Emergency Medical Plan/~~6.~¢~¢~6~6~66~6~ 02/09/1996 i EXPOSED EMPLOYEES WOULD BE TRANSPORTATED .t ) N_(ERCY SOUTHWEST'URGENT CARE, ° TRIAGED AND TRANSPORTED TO OTHER FACILITIES AS NECESSARY. DECONTAMINATION ° ° SHOWER AVAILABLE ADJACENT TO URGENT CARE AMBULANCE ENTRANCE. ° -8- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE ~fififi~fi~¢~fi~fi~¢~ SitelD: 015-021-000411 i i~ Mitigation/Prevent/Abatemt ~~~~~ Overall Site i~ Release Prevention ~~~~~~~ 03/16/1994 o HAZARDOUS MATERIAL STORED AT LOWER LEVELS ° o ALL MATERIALS STORED IN BOXES WITHIN ORIGINAL CONTAINERS o ii~i~ Release Containment fi~/~/~O~fifi~/~OO~~O/~O~O~O~ 03/16/1994 o SPILL KITS TO CONTAIN SMALL SPILLS o o i~ Clean Up ~6~fi~~~~6~6~666~6~6 03/16/1994 o DEPENDING ON MATERIAL AND SIZE OF SPILL o o OBTAIN/REVIEW MATERIAL SAFETY DATA SHEETS o o RECOVER IF DONE SAFELY ° OUTSIDE AGENCY SUCH AS CALPI INC. TO CLEAN IF NEEDED ° i~i~/~ Other Resource Activation o o -9- 12/12/2000 ' MERCY HOSPITAL OPERATIONS WHSE ~~~~ SiteID: 015-021-000411 i ia Site Emergency Factors ~~~~~~ Overall Site i o o i~ Utility Shut-Offs ~~~fi~fi~fi~~ 02/09/1996 i o A) GAS - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA o B) ELECTRICAL - ELECTRICAL ROOM IN HALLWAY FROM WAREHOUSE OFFICE ° C) WATER - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA ° D) SPECIAL- NONE ° E)' LOCK BOX - NO ° o i~ Fire Protec./Avail. Water ~fi~~~~~ 02/09/1996 i o PRIVATE FIRE PROTECTION - COMPLETELY SPRINKLERED BUILDING, FIRE ° EXTINGUISHERS THROUGHOUT BUILDING, SPRINKLER FDC ON NORTHSIDE OF BUILDINGS ° DRIVEWAY ~ ° o o o o APPROXIMATELY 60 EMPLOYEES WORK OUT OF THIS FACH~ITY AND COULD BE OCCUPYING ° BUILDING. THE MAJORITY OF THE TIME 30 REGULAF, EMPLOYEES OCCUPY BUILDING ° DURING NORMAL WORKING HOURS. OTHER EMPLOYEES ARE COMMUNITY WORKERS (HOME HEALTH NURSES) THAT USE THIS BUILDING AS A HOME BASE. ° ' -10- 12/12/2000 MERCY HOSPITAL OPERATIONS WHSE eee~e~eeeeeee~eeee~eee SitelD: 015-021-000411 i i~ Training eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Overall Site i i~e Employee Training e~e~e~e~ee~e~ee~e~ee~eee~e~66 02/09/1996 i o WE HAVE 60 EMPLOYEES AT THIS FACILITY. . o o WE DO HAVE MATE~AL SAFETY DATA SHEETS ON FILE. o o B~EF SUMMARY OF T~INING: HAZARDOUS COMMUNICATION AND SAFETY FOR ALL NEW EMPLOYEES (GENE~L O~ENTATION). ANNUAL EDUCATION CLASS (2 HOURS) FOR ALL .o EMPLOYEES.- DEPARTMENT ORIENTATION AND INSERVICE T~INING. ALL o DEPARTMENTS/EMPLOYEES REQUIRED TO PARTICIPATE IN FIRE DRILLS AND DISASTER DRILLS ON AN ANNUAL BASIS. o o o o o o o o DEC 14 '99 01:29PM MERCY HOSP.INT AUDIT 327 7048 Catholic Healthcare West CHW Central Callfornl= 2215 Truxtun Avenue Bakersfield, CA 93301 TELEFAX TRANSMITTAL SHEET RISK MANAGEMENT DEPARTMENT No. of Pages (including cover page) From: ~ ~-~c,, ,~' ,,-, Phone: (805) 632-5~.13 M Fax: (805) 327-7048 . . COMMENTS: CONFIDENTIALITY NOT,,E The Information contained in this telecopy cover sheet and accompanying documents is intended only for the use and benefit of the person named on this cover sheet. The information contained heroin Is confidential and legally privileged, and any use of this information by anyone other than the person named herein is strictly prohibited. If you have received this telecopy In error, please call (805) 632-5633 and we will arrange for return of the tele¢opled documents at no cost to you. H:\WORD~FORMS~AXform.doc TEXAS NATURAL RESOURCE · ~ONSE"RVATION COMMISSION P,,O. Bo= 13087 Austin, Texas 78711-3087 DEC 14 '99 01:£9PM MERCY HOSP. IMT AUDIT 32? ?048 P' '~dnt or iype. (Form designed for use on ellis (12·pitch,) Form ~{: ~roved. OMI~ No. uN"iF0'RM ~AZARDOUS': '1. Generator's US EPA ID No. Mani~'~s't .... 2. Pege.!~ I Information in the shaded WASTE MANIFEST 'CAD'983660[~ ' ' I~~ ....... of ~I 's not r~quired ~y FederalareaSlaw, 3. Generator's Name and Mai~in~ Address A~RC~ ff~ALTHCA~E ~AX~' ~[ A. StateMamlest Document Numb~'~ ..... esl ~HANL~Y COURT SK 942401' BA~R~F Z~ LD CA 93 ~ ~ l B, State Ge~;'~'r~tor's ID 4, Gen~[,gtor,sPhone{ 805 )66~-6~60 99906 ' ~. 5, Transpo~er'l Company Name ~', US EPA ID ~umber C..S~t~ Trans;odefs I~ 8~88 ...... SAF~TY-~N CORP, [,,. ~LD ~8,~0¢2¢2, , , D, Transpo~¢;r;'~'Phone ZO9 ;7. Tra~o~er 2 '~'~pany Na~e ",' 8. US EPA'TD ~umber E. ~a~e Tran~ponads ID I , 9. ge$iqnste~ili~¢'~ame a~Jt~dd~e'ssgO O8 [ 8 10. US EPA ID Number 1722 COOPBR CREEK ROAD . , D~ ~T 0~, TX ? 62 0 8 "~, FsclliYs ;','hone' 1 lA. 11. US DOT Description (Including Proper Shipping Name, Hazard Class, ID ~2, Cofta~ners ~ '3, ~' I T,)tat Unit Waste HM Number and Packing Group) Ne. Type O~mntity 8, , ~ ..... 7) ........... RQ WA~T~ ~ETROLEUM DISTILLATES, N.O,S ~ (ALZ~HATZC AND AROMATIC HYD~0CAEBONS) DM P OUrS=ii. d, ~5. Special Handling Instructions and Additio~'al' ~ormation ~ .... ; : '" ' ....... . MFS~ E/?~ 958~5887 7-0&5-O1-2355 EMERGENCY RESP 800-468-1760(2~ HR). IF UNDELIVERABLE RETURN TO GENERATOR CTL/SMP A)37OO161-5/810535 B)37OO258-2/81,0536 ' ' PP SKDOT~ ,.; --.-~ B: 58~5 C: D: 16, GENERATOR'S CERTIFICATION: I hereby declare that the co,tents of this consignment are fully and accurately ¢escrlbod aDo~ g by ~he proper ship[ling name and are classified, packed, marked, and ~beJ[ed/ptacarded. and are in all respects In proper condition for Ira~s~o~ by highway accorCing to applicable interest:oriel sod ~ational gove¢~ment regulations, including applicable ~ta~e ~egulatlons, Ill am a I~rge q~a~ity generator, J ce~lty t~a~ I have a fr0gfam in place to reduce the volume and toxicity of waste gencfa~ed ~o ~he degree I I~ave determiGed ~ be economically practicable and ~at I have selected the p~cticable meth~ of treatment, storage, or disposal currently available t<) me which minimize3 the present and future ~reat to human health and the environment: O~, ,f I am a Sma[I quantity generator, i have made ~ good faith effort [c mir'imize my waste g~neration and select the bes~te management meth~ thai is available to me end t~St I can afford. ~ . 17j~po~er 1 Ack~&wmedge~ent of Receipt'of Materials ~ / . . . ' - -- ] Date c/o ........ 18. Transpo~er ~,ck~e~t of Receipt of '" , ...... "~ Month D~y 'Y~ar 19. Discrepancy Indication Space ........... ' 20- FaCIlity' ~wner or Operator: Ce~i~ication of receipt of hazardous' m~terials Cove red by this '~'an~fest except ss not~ ~";n item 19. '" ~ " Date t e a Month Day Year , DEC 14 '99 01:30PM MERCY HOSP. IUT RUDIT 3E? ?04@ CONSERVATION COMMISSION ,- . ~.0. Box 13087 . Austin, Texas 78711-3087 P.3/4 i=rin! or type. (Form. designed tar use an el,.ite, (12-1~itc~..ty~,ewrlter.) -"=,F'- ....... Form ":~roved..O,,M,~ NO. ~u~o.oo3g., ..... UNIFORM HAZARDOUS 1. Generator's OS EPA ID No. ' Manifest ' 2. Page 1 [ Information in the shaded areas WASTE MANIFEST · 'CAD98'3560].29' · · ~'C~_u' .._:~,~; ,J ,, un~en . of .t ts not required by Federal 'law. , ,~,~, - . ; · , , ,.,, , ........ ;,, T ...... .,...~,~.,~ :, . .,,.~,,. ,,,,. lA. 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID ~2. Cam=lasts 3. 14. '.', .,'~-~':.:1~': HM Number ~nd Packing Group} No, Type Quan~ W~I ' ~:,;.W~. o,,': 5. Spatial Handling Instruct(oas ~nd Addltionnl Info.atica ~F S T R/T ~ g ~ O 2 2 9 2 9 7 - O 15 - 0 ~ - ~ 3 5 5, EMERGENCY RE~D 8OO-~68-1360(24 HR). IF UNDELIV~RABL~ RETURN TO GENERATOr. CTL/SMP A) 3700161-5/810535 S] ~700258-2/810536 ~KDOT% A~ 1963 ~_~.~,~.C: D: 16. GENERATOR'S CER~FICATION: I ~ereby d~la.;'~hat the ~nte, ts of this con;';gnmenl ~re fu~y .~d a~ura,e,y descriOed .bow, 5Y th; proper ,hi,pi,g oam. claas~ied, packed, me.ed, an~ labelie~piaca~sd, a~d are In ali respe~s in proper ~Ddition for ffanspo~ by highway according la aDpticable international and nati~sl govemmem regulations, including ap~i~ble slate If I am a large quamlty generator, I ce~i~ ~at I have a program In place to reduce the, volume an~ to=tct~ of waste generated ~'o Ihs degree I have determined to economlcally practicable and that I have selected the predicable ~ethod ol tree, meat, storage, or disposal currently available ir,, me which ~inimizes the present futura threal to human health and the envtmmment OR, tf I am a ~aJl quantity generator, I have made a g~d fai~ effo~ to mia mize my waste generation and select the beat waste management me~ t~t iS evaltabte to me and lhat I can afford, ~. Tr~o~no~er ~ Acknowledgement oi' He~ei~t of ~ate~als .' ..... '18. Transpo~e~ 2 Acknowledgement,el Receipt of Materials ~' - "', "- ...... ~ - Pr~nte~ed Name I Signature Mon~ Day 19, Dis~repanc¢' ~[~ai~on Space ................................. 20. Facillty Owner or OPerator: Ceffiflcatlon ~f receipt of ~zardous mete~a'ls ~vered by th~ manifest except as note,:t in item 19. '' '" ['SIgnature Mon~ ~y Year Prlnte~yped Name DEC 14 '99 01:31PM MERCY HOSP. IHT TEXAS NATURAL RESOURCE *7 - 015 - . C:~NSERVATION COMMISSION. · Aba/in, Texas 78711-3087 Please print or type. ad fo~ use on el~ (12-p~lch) ~pewdter.) RUDTT 327 7048 UNIFORM HAZARDOUS 1. Generator's US EPA ID No. WASTE MANIFEST 'C A D 9 ~-3 ~ 6 ('~ 1 [~'? ~'¥, 3, Generator's Name COURT 805 663-6560 4, Ge6erator's Phone ( ) 5. Transpolar 1 CompaDy Name gAFETY-~LEEN SY~T~PI~, I~'~C 7, Transpolar 2 Gompsny Name SAFETY-KLEEN (TG), INC. 1722 COOP:R CR:EK ROAD DENTON, TX 7620~ 6. US EPA ID Number ILD 954908,202 8. US EPA ID Number S.CD 10. US EPA ID Number 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID Number and Packing Group) a. RQ NASTE ALC'OHOL~., N.O.g. ~ALI~HATTC ALCOHOLS.~)(fRG#127) DE[; 1 3 1999 CHW Cent~ Calllorni~ REiK & SAFETY MANAGEMENT Form app,'oved. OMB NO. 2050-003g. Pega~ Information in the shaded areas of ~ is not required by Federal law. A. State Manif,..at .Document Number .:'i -"' .!i.' .!.~ .,..:..'...,=...,.. 0'g fD ', C. Slate Transpo~ter's 1D 8 8 8 & 8, b. RQ [4ASTE PETROLfUM DISTILLATES, N.O. (ALZPHATIC AND ARO~ATZC HYDROCARBOt~'£) 3 UNt268, PG III 15. Special Handling Instructions and Additional information EM~i~GENCY REaP 800-~68-1760(2~ 'r CT~,..,MD A) 3700161-$/810535 B) ?P ::'I.,'""~. ' ' ".!ii.':.:'. ;' ..'.!'... ..:' !:'. ::"?" : : 3700258-2/810535 SKDOT~ A: 1963 ~C; D: 1 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described show. by the proper shipping name and are classified, packed, marked, and {abellsct/placa~:led, and are In all respects In proper condition for transporl by highway according ;'.) applicable international and national government regulations, including applicable state rsgula~one. If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxlclly of waste generated t~3 the degree I have determined to be economically practicable a~'d that I have selected the [0race,able method of treatment, storage, ar disposal currently available to me which minimizes tl~e present and future threat to human health and the environment; OR, ~f I am a small quantity generator. I have made a good faith affo~ to mini'~[ze my waste gerte,'atlon &nd select the beat waste management method that i~ available to me and that I can affo~l. Printed/Typed Name Month Day Year I Acknowledgement of Ipt of Materials Dale 18. Transporter 2 ement of Receipt of Materials 9, Discrepancy trion Space Month Day Year Date Month Day Year 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19, Printed/Typed Name C'--'~,~ F+4 ~,gttl~ ~ .......... Date FACILITY NAME Section 4: Hazardous Waste Generator Program CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersticld, CA 93301 INSPECTION DATE EPA ID # ~,&.-t') ~ 8 3~,(DO(2-) [21 Routine [] Combined ~oint Agency ' [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous xvaste determination has been made EPA ID Number (Phone: 916-324-1781to obtain EPA ID #) Authorized tbr waste treatment and/or storage ..,-.--'~ Reported release, fire. or explosion xvithin 15 days of occurance /.-J /pt Established or maintains a contingency plan and trainina Hazardous waste accumulation time Ii'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 Secondary containment provi_._ ,j 1,/ Conducts dally 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 kA.)t Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted fi'om land disposal Office of Environmental Services (805)326-3979 \Vhite - Eiw. Svcs. Pink - Business Copy CITY OF BAKERSFIEL OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per mate~al per builgi~g or ama) [] NEW [] ADD [] DELETE [] REVISE 200 P;.ge __ of __ 205 T~E SECR~ CHEMI~ME ~Y~ ~N° ~ ~ ~7 ~M~N~E EHS* ~Y~ D ~ ~ 210 TYPE [] p PURE [] m MIXTURE ~,u~ WASTE 211 RADIOACTIVE []Yes [--INo 2121 CURIES 213 PHYSICAl. STATE [] s SOLID ~,LUQUID [] g GAS 214 LARGEST CONTAINER ~ 215 FED HAZARD CATEGORIES ~1 (Chec~ ail that apply) FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 ANNUAL WASTE 217 MAXIMUM 1 O 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT DALLY AMOUNT DAILY AMOUNT UNITS* [] ga ~ [] cf CU FT [] lb LBS [] tn TONS 221 DAYS ON SITE 222 * If EHS. amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK ,~k, PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [-I m GLASS BO'I'FLE [] q RAIL CAR 223 (Check all b~at apply) []b UNDERGROUND TANK []f CAN []j BAG I-'In PLASTIC BOTTLE Dr OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE ,~a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [-I c CRYOGENIC 225 226 227 []Yes •No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd MISCELLANEOUS RECEIVABLES ADJUSTMENT CUSTOMER NAME MAILING ADDRESS CITY SITE ADDRESS PARCEL NUMBER NEW ACCOUNT ADDRESa CHANGE CLOSEACCT j FINANCE CHARGE I. / I OTHER ADJ i '_~_ ! /- ZIP CODE~~ OF APPUCABLE) ADJUSTMENT i CHG DATE J CHARGE CODE I ADJUSTMENT AMOUNT f I . REMARKS: '~'-~ ~ ~,\y b ~,e _~.. APPROVED BY~ 01/26/96 Overall Site with 1 Fac. Unit General Information Location: 551 SHANLEY ST Map:123 Haz:3 Type: 3 City : BAKERSFIELD Grid: 06C F/U: 1 AOV: 0.0 Contact Name JACK RESENDEZ Business Phone: 24-Hour Phone : Pager Phone : Title / DIRECTOR OF SAF (805) 632-5640x (805) 632-5000x ( ) - x Contact Name PAT JACOBS Business Phone: 24-Hour Phone : Pager Phone : Administrative Data Mail Addrs: P O BOX 119 City: BAKERSFIELD Comm Code: 215-011 BAKERSFIELD STATION 11 Title / FACILITIES MANA (805) 633-6000x (805) 632-5000x ( ) - x D&B Number: State: CA Zip: 93302- SIC Code: 4226 Owner: CATHOLIC HEALTHCARE WEST Phone: (415) 397-9000 Address: P O BOX 119 State: CA City: SAN FRANCISCO Zip: 94111- Summary '~~~'/.~Do hereby certify that I have (Type, hr print name) reviewed the attached hazardous materials manage- ment plan for ,/~...~~~.at it,, along with - - (NameorBusineS;) -- ~_/,~,~ any corrections constitute a complete and correct man- agem 01/26/~6 Pln-Ref MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Name/Hazards Form Max Qty Page MCP 02-001 HYDROGEN PEROXIDE · Delay Hlth Liquid 12 High ___GAL 02-002 METHYL ALCOHOL · Fire, Immed Hlth, Delay Hlth Liquid 110 High 02-007 CLOROX LIQUID BLEACH · Fire, Inured Hlth, Delay Hlth Liquid 90 h GAL 02-008 FORMALDEHYDE · Fire Liquid 40 High GAL 02-010 CLEANER · Inuned Hlth, Delay Hlth Liquid 30 High GAL 02-004 CIDEX PLUS · Immed Hlth, Delay Hlth Liquid 26 Moderate GAL 02-006 DETERGENTS · Delay Hlth Liquid 40 Moderate GAL 02-009 ACETONE · Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL 02-011 TONER · Fire, Inured Hlth, Delay Hlth Liquid 30 Moderate GAL 02-003 GERMICIDALS · Immed Hlth, Delay Hlth Liquid 10 Low GAL 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-001 HYDROGEN PEROXIDE · Delay Hlth Liquid 12 High GAL CAS #: 7722841 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 12.00 Annual Amount GAL 140.00 Storage PLASTIC CONTAINER Press T Temp IAmbient IAmbient IWAREHOUSE Location -- Conc 100.0% IHydrogen Peroxide Components MCP ---/Guide IHigh ! 47 02-002 METHYL ALCOHOL · Fire, Immed Hlth, Delay Hlth Liquid 110 High GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 110 I 120.00 Annual Amount GAL 1,400.00 Storage PLASTIC CONTAINER Press T Temp IAmbient IAmbient IWAREHOUSE Location -- Conc 2.0% 12-Propanol 91.0% Methyl Alcohol Components MCP ---[Guide ModerateI 26 High ~ 28 02-007 CLOROX LIQUID BLEACH · Fire, Immed Hlth, Delay Hlth Liquid 90 High GAL CAS #: 7681-52-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL Daily Average GAL Annual Amount GAL -- 1,100.00 Storage PLASTIC CONTAINER Press T Temp I Ambi ent I Ambi entlWAREHOUSE Location -- Conc 100.0% ISodium Hypochlorite Components MCP ---/Guide High ~ 45 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-008 FORMALDEHYDE Liquid 40 High · Fire GAL CAS #: 50-00-0 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL40 I Daily Average32.00GAL Annual Amount GAL 400.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location - Conc 37.0% 0.0% IFormaldehyde (EPA) Methanol Components MCP fGuide High 02-010 CLEANER · Immed Hlth, Delay Hlth Liquid 30 High GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL30 I Daily Average20.00GAL Annual Amount GAL 300.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 2.0% 5.0% 30.0% IHydrogen Chloride 2-Butoxyethanol Phosphoric Acid Components MCP ---~uide High ! 15 ModerateI 26 ModerateI 60 02-004 CIDEX PLUS · Immed Hlth, Delay Hlth Liquid 26 Moderate GAL CAS #: 111-30-80 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL26 I Daily Average20.00GAL Annual Amount GAL 2,400.00 Storage PLASTIC CONTAINER Press T Temp I Ambient~Ambient I WAREHOUSE Location -- Conc 3.0% IGlutaraldehyde Components iMCP ---~uide ModerateI 58 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 5 02-006 DETERGENTS · Delay Hlth Liquid 40 Moderate GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL Daily Average GAL 40 [ 30.00 Annual Amount GAL 500.00 Storage PLASTIC CONTAINER Press'T Temp I Ambi ent[Ambi ent [WAREHOUSE Location -- Conc Components 35.0% ISodium Hydroxide 10.0% Tetrasodium Pyrophosphate MCP --TGuide ModerateI 60 Minimal [ 6 02-009 ACETONE · Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL CAS #: 67-64-1 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL Daily Average GAL 8.00 Annual Amount GAL 100.00 Storage PLASTIC CONTAINER Press T Temp Ambient[Ambient WAREHOUSE Location -- Conc 100.0% IAcetone Components MCP ---~uide ModerateI 26 02-011 TONER · Fire, Immed Hlth, Delay Hlth Liquid 30 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: OTHER Daily Max GAL Daily Average GAL Annual Amount GAL 100.00 Storage PLASTIC CONTAINER Press T Temp I Ambient I Ambient I WAREHOUSE Location -- Conc 85.0% [Styrene Components iMCP -~Guide ModerateI 27 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 6 02-003 GERMICIDALS · Immed Hlth, Delay Hlth Liquid 10 Low GAL CAS #: 25655-41-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL Annual Amount GAL 120.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- ConcI Components ] MCP ]Guide 10.0% iIodine Low 45 1.0% Glycerine Low 27 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 - Overall Site <D> Notif./Evacuation/Medical Page <1> Agency Notification BAKERSFIELD FIRE DEPARTMENT - 911 MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT FACILITIES MANAGER ~~ >-z~ ADMINISTRATIVE COORDINATOR ~;A- ~~ <2> Employee Notif./Evacuation FIRE ALARM SYSTEM NOTIFY EVERYONE IN BUILDING EVACUATE TO NORTHWEST OF BUILDING <3> Public Notif./Evacuation QUANTITY NOT SUFFICIENT TO REQUIRE SURROUNDING PUBLIC TO EVACUATE BECAUSE OF DISATER TO NEAREST BUILDINGS. IF REQUIRED PROBABLY A DECISSION TO BE MADE BY HAZ MAT TEAM. <4> Emergency Medical Plan EXPOSED EMPLOYEES WOULD BE ~..m~.~;SPORTATED TO 14ERCY HOSPITAL 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 8 <1> Release Prevention HAZARDOUS MATERIAL STORED AT LOWER LEVELS ALL MATERIALS STORED IN BOXES WITHIN ORIGINAL CONTAINERS <2> Release Containment SPILL KITS TO CONTAIN SMALL SPILLS <3> Clean Up DEPENDING ON MATERIAL AND SIZE OF SPILL OBTAIN/REVIEW MATERIAL SAFETY DATA SHEETS RECOVER IF DONE SAFELY OUTSIDE AGENCY SUCH AS CALPI INC. TO CLEAN IF NEEDED <4> Other Resource Activation 01/26/96 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA B) ELECTRICAL - ELECTRICAL ROOM IN HALLWAY FROM WAREHOUSE OFFICE C) WATER - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - COMPLETELY SPRINKLERED BUILDING, FIRE EXTINGUISHERS THROUGHOUT BUILDING, SPRINKLER FDC ON NORTHSIDE OF BUILDINGS DRIVEWAY ' FIRE HYDRANT - NORTH SIDE <4> Building O. ccupancy Level 0~/26/96 MERCY HOSPITAL OPERATIONS WHSE 00 - Overall Site <G> Training 215-000-000411 Page 10 <1> Employee Training WE HAVE '~EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? y~ BRIEF SUMMARY OF TRAINING: HAZARDOUS COMMUNICATION AND SAFETY FOR ALL NEW EMPLOYEES (GENERAL ORIENTATION) ANNUAL EDUCATION CLASS (~HOURS) FOR ALL EMPLOYEES DEPARTMENT ORIENTATION AND INSERVICE TRAINING <2> Page 2 k3> Held for Future Use <4> Held for Future Use 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 Overall Site with 1 Fac. Unit General Information Page Location: 551SHANLEY ST Community: BAKERSFIELD STATION 11 Contact Name JACK RESENDEZ PAT JACOBS Title DIRECTOR OF SAFETY (805) ~ FACILITIES MANAGER (805) ~ / Administrative Data Map: 123 Hazard: Moderate Grid:J~_/F/U: 1 AOV: 0.0 24-Hour Phone- (805) ~ Mail Addrs: P O BOX 119 D&B Number: City: BAKERSFIELD State: CA Zip: 93302- Comm Code: 215-011. BAKERSFIELD STATION' 11 SIC Code: 4226 Owner: ~$--u~RATIONS W~ Address: ~9 /~d~~~~~/~~~~ State: CA City: ~D S~ ~0/ ~//// Zip: ~ ~/// Summary RECEIVED o HA;:. ~AT. DiV. -- (Type Oil~nt name) reviewed the attached hazardous materials manage- ment plan for,/~~ ~--~/'~/~aC~~along with (~ of Business) any corrections constitute a complete and correct man- agement plan for my fac!l~~ 02/11/94 Pln-Ref MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 Hazmat Inventory List in MCP Order 02 - FiXed Containers on Site Name/Hazards Page 2 Form Max Qty MCP 02-001 HYDROGEN PEROXIDE · Delay Hlth Liquid 12 High GAL 02-002 METHYL ALCOHOL · Fire, Immed Hlth, Delay Hlth Liquid High 110 GAL 02-007' CLOROX LIQUID BLEACH · Fire, Immed Hlth, Delay Hlth Liquid 90 High GAL 02-008 FORMALDEHYDE · Fire Liquid 40 High GAL 02-010 CLEANER · Immed Hlth, Delay Hlth Liquid 30 High GAL 02-004 CIDEX PLUS · Immed Hi~, Delay Hlth Liquid 26 Moderate GAL · . ' ela~H±tn ~ 16 02-006 DETERGENTS · Delay Hlth Liquid 40 Moderate GAL 02-009 ACETONE · Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL 02-011 TONER · Fire, Imaled Hlth, Delay Hlth Liquid 30 Moderate GAL 02-003 GERMICIDALS · Immed Hlth, Delay Hlth Liquid 10 Low GAL 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-001 HYDROGEN PEROXIDE · Delay Hlth Liquid 12 High GAL CAS #: 7722841 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 12.00 Annual A~ount GAL 140.00 StOrage PLASTIC'CONTAINER Press T Temp I Ambient~Ambient I WAREHOUSE Location - Conc 100.0% IHydrogen Peroxide Components MCP ----~Guide IHigh ~ 47 02-002 METHYL ALCOHOL · Fire, Immed.Hlth, Delay Hlth Liquid 110 High GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL110 I Daily Average 120 00 GAL Annual Amount GAL.-- 1,400.00 Storage PLASTIC CONTAINER Press T Temp Ambient~AmbientlWAREHOUSE Location -- Conc 2.0% 12-Propanol 91.0% MethYl Alcohol Components MCP --TGuide ModerateI '26 High ! 28 02-007 CLOROX LIQUID BLEACH · Fire, Immed Hlth, Delay Hlth Liquid 90 High GAL CAS #: 7681-52-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL Daily Average GAL Annual Amount GAL 1,100.00 Storage PLASTIC CONTAINER Press T Temp [Ambient~AmbientlWAREHOUSE Location -- Conc 100.0% ISodium Hypochlorite Components McP ---~uide High ~ 45 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-008 FORMALDEHYDE · Fire Liquid 40 High GAL cAs #: 50-00-0 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL40 I Daily Average32.00GAL Annual Amount GAL 400.00 Storage PLASTIC CONTAINER Press T Temp I AmbientJAmbient I WAREHOUSE Location -- Conc 37.0% IFormaldehyde (EPA) 0.0% Methanol Components MCP ---~uide High 02-010 CLEANER · Immed Hlth, Delay Hlth Liquid 30 · High GAL CAS #: Trade Secret: No FOrm: Liquid Type: Mixture Days: 365 Use: CLEANING --. Daily Max GAL Daily Average GAL Annual Amount GAL 30 I 20.00 I 300.00 Storage PLASTIC CONTAINER Press T Temp I Ambient~Ambient WAREHOUSE Location -- Conc 2.0% 5.0% 3O.0% Hydrogen Chloride 2-Butoxyethanol Phosphoric Acid Components MCP ----~uide High ~ 15 ModerateI 26 ModerateI 60 02-004 CIDEX PLUS · Immed Hlth, Delay Hlth Liquid 26 Moderate GAL CAS #: 111-30-80 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL26 I Daily Average20.00GAL I Annual Amount2,400.00GAL Storage PLASTIC CONTAINER Press T Temp AmbientJAmbient I WAREHOUSE Location -- Conc 3.0% IGlutaraldehyde Components MCP'---~uide IModerateI 58 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 Page 5 / 02 - Fixed Containers on Site ~ / ' / Hazmat Inventory Detail in MCP Order / 02-005 ~YLENE %/ ' Liquid 16 Moderate · ire, ~mmed Hlth,. Delay. Hlth G~ ~~~_1'20-7 Trade Secret: No ~ Form: Liqu~ Type: Mixture Days: 36/~Use: MEDICAL AID OR PROCESS -- Daily Max ~ ~ Dailjy.-~verage GAL ~ Annual Amount GAL -- 16 ~ / 13.00 I 200.00 ation ~ PLASTIC CONTAINE>w/,Ambiont~REHOUSE MCP'---TGuide ModerateI 27 17.0%~ylbenzene IModerateI 26 02-006 DETERGENTS · Delay Hlth Liquid 40 Moderate GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL40 I Daily Average30.00GAL Annual Amount GAL 500.00 Storage PLASTIC CONTAINER Press T Temp AmD i ent~Amb ient l WAREHOUSE Location - Conc Components 35.0% Isodium Hydroxide 10.0% ITetrasodium Pyrophosphate MCP ----~Guide ModerateI 60 Minimal I 31 02-009 ACETONE · Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL CAS #: 67,64-1 Trade Secret: No Form: Liquid Type: Pure Days: 365. Use: CLEANING Daily Max GAL Daily Average GAL 8.00 Annual Amount GAL -- 100.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location - Conc 100.0% IAcetone Components MCP ---TGuide IModerateI 26 02/11/94 Page 6 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-011 TONER · Fire, Immed Hlth, Delay Hlth Liquid 30 GAL Moderate CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 ' Use: OTHER Daily Max GAL Daily Average GAL Annual Amount GAL -- 100.00 StOrage PLASTIC CONTAINER Press T Temp Ambient~AmbientlWAREHOUSE Location -- Conc 85.0% IStyrene Components MCP ---TGuide ModerateI 27 02-003 GERMICIDALS · Immed Hlth, Delay Hlth Liquid 10 Low GAL CAS #: 25655-41-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL Annual Amount GAL 120' 00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 10.0% IIodine 1.0% Glycerine Components MCP ~uide Low 45 Low 27 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 -~Overall Site <D> Notif./Evacuation/Medical Page 7 <1> Agency Notification BAKERSFIELD FIRE DEPARTMENT - 911 MERCY HOSPITAL SECURITY/SAFETY DEPARTMEN~ FACILITIES MANAGER ADMINISTRATIVE COORDINATOR <2> Employee Notif./Evacuation FIRE ALARM SYSTEM NOTIFY EVERYONE IN BUILDING EVACUATE TO NORTHWEST OF BUILDING <3> Public Notif./Evacuation QUANTITY NOT SUFFICIENT TO REQUIRE SURROUNDING PUBLIC TO EVACUATE BECAUSE OF DISATER TO NEAREST BUILDINGS. IF REQUIRED'PROBABLY A DECISSION TO BE MADE BY HAZ MAT TEAM. <4> Emergency Medical Plan EXPOSED EMPLOYEES WOULD BE TRANSPORTATED TO MERCY HOSPITAL 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 - Overall Site <E> Mitigation/PreVent/Abatemt Page <1> Release Prevention HAZARDOUS MATERIAL STORED AT LOWER LEVELS ALL MATERIALS STORED IN BOXES WITHIN ORIGINAL CONTAINERS <2> Release cOntainment SPILL KITS TO CONTAIN SMALL SPILLS <3> Clean Up DEPENDING ON MATERIAL AND SIZE OF SPILL OBTAIN/REVIEW MATERIAL SAFETY DATA SHEETS RECOVER IF DONE SAFELY · OUTSIDE AGENCY SUCH AS TO CLEAN IF NEEDED <4> Other Resource Activation 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 00 - Overall Site <F> Site Emergency Factors Page <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA B) ELECTRICAL - ELECTRICAL ROOM IN HALLWAY FROM WAREHOUSE OFFICE C) WATER - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - COMPLETELY SPRINKLERED BUILDING, FIRE EXTINGUISHERS THROUGHOUT BUILDING, SPRINKLER FDC ON NORTHSIDE OF BUILDINGS DRIVEWAY FIRE HYDRANT - NORTH SIDE <4> Building Occupancy Level 02/11/94 MERCY HOSPITAL OPERATIONS WHSE 215-000-000411 Page 00 - Overall Site <G> Training 10 <1> Page 1 WE HAVE 32 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: HAZARDOUS COMMUNICATION AND SAFETY FOR ALL NEW EMPLOYEES (GENERAL ORIENTATION) ANNUAL EDUCATION CLASS (2 HOURS) FOR ALL EMPLOYEES DEPARTMENT ORIENTATION AND INSERVICE TRAINING <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street ~~/ ~~~ld, CA. 93301 _ HAZARDOus MATE,~IALS MANAGEMENT PLAN INSTRUCTIONS: To avoid further action, return this,form within 30 clays of receiDt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be Drier and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~ LOCATION: MAILING ADDRESS: ~ DUN · BRADSTREET NUMBER: ~/~~,~' SIC CODE: PRIMARY ACTIVIn' ~ ' MAILING ADDRESS: SECTION 2: EMERGENCY,, NOTIFICATION: ' CONTACT TITLE BUS. PHONE 24 HE. PHONE 1. Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAG~:MENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: .~.~.~ MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAiNiNG PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY'CODE" FOR THE FOLLOWING REASONS: WE 'DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, ~~~L~~~--~ CERTIFY THATTHE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" US MATERIALS (DIV. 20 CHAPTER 6.95 SEC. ON HAZAR.~.Q.( N '"-'ION CONSTITUTES PERJURY. 25500 .ET AL.) AND THAT , 2. Bakersfield Fire Dept~ Hazardous Materials Divil '"HAZARDOUS MATERIALS MANAGEMENT pLAN Facility Unit Name: SECTION 6: NOTIFICATION'AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: .. /' B, EMPLOYEE NOTIFICATION AND EVACU. ATION: EMERGENCY MEDICAL PLAN: . Bakersfield Fire Dept. Hazardous Materials Divisi, HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEME?iT PLAN: RELEASE CONTAINMENT AND/OR MINIMIZATION: CLEAN-UP PROCEDURES: /'u :.../~ ~",1~ ~ ~"~::~'."~'//'" UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK. BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: WATER AVAILABILITY (,.FIRE HYORA. NT): .. , CI'I'Y of BAKERSFIELL) HAZARDOUS HATERTALS TNVENTORY Farm and Agriculture [] Standard Business [] NON--TRADE SECRETS Pa~je / of iY ~IP. ---- TY J ' ~DUtt A/ID BRAD~TREEI NUHBER-~" ~---~ ..... - ....~ .......... 14 r~las !¥r~e vax lv~ra.~e .~nnusl Heasure I {;oat ~oot ~ont ~e toc~tjon. Whe[e. ooe Loam AmL xm~ Es~ Units on e /)pm Press )emp Storea In taCl/iCy see instructions C.A.a. Humber ~~- ~/ Component II Hame I C.A,S. Humber hysiCm~l and Hemlth Hm~mrd Co~ponen~ I~ N~me i C.A.S, Humber Health of Pressure Component 13 Hame I C.A.S. Number hvsica) and pealth Hazard C,A.S. Number ~~ ~ ComponenC II Name I C.A.a. Number Hem/t~ of Pressure ~ .... / Component 13 Name I C.A.S. Humber ~sic~l ~,d mlLh Hmrd C.X.S. Number ~~~Z-~ Com~onenL ~l Name ~ C.A.S. Number Componen[ Ii Nsme I C.X.S. NuLber -,, Hea/C~ of Pressure Health Componen[ 13 HAm8 I C.A.S. Number ~ Hea/Ch of Pressure Component I1 Nnm~ I C.A.S. Humber .... ~-~ -- 'ti[i~,atioq .(Rep~ a..n.d.~ign af~pr' comp7~Cipg.all secCiPns.) er[t~y unoer penal[~ oija~ [n~[ i nav~¢e[sona/~,eXa~ln~qo~ ~a~illa(,lit~ the ached.docvmen&), an0 t~ac oaseo on. my ~nqu)ry 9f. tnose InOlvIOUal$ fespons'lD/e Iof obLmlflin9 the Inror~a~loa. ! bemmeve CITY of BAKERSFIELD HAZARDOUS HATERZALS TNVENTORY Farm and ADticulture ri Standard Business rJ NON--TRADE SECRETS JSINESS NAHE: OWNER NAME: NAME OF THIS FACILITY: ._.. :)CATION; ADDRESS; STANDARD IND CLASS CODE: flY. ZIP.~ CIIY. ZIP;.- DUN MID BRAD~;TREEI NUMBER ................................ IOUE #: -- PtIONE Il; - - ._ - ---- REFER TO-XNSTRUUT'ZDNS-FOR-PROPER CODES .... co~e A~t A~[ Est Units on e ~pe Press mem~ Stereo In )aci/ILy See Instructions ~hvsical and Health Hazard C.A.S. Number /~3~- ~O- ~ ComPonent II Hame I C.A.S. Humber /~a- ~/-~ IChe~ll that appl~} ' / ~F~reHazard ~ Reactivit~ ~ Delayed ~ Sudden Release ~iaLeC°mp°nenLl2 NameiC.A.S. Humber Health of Pressure Healt,~ ..... Component 13 Name I C.A.S. Number Fire Hazard n Re,ctiYit, n Delayed n Sudd, n Release--~di'~' C°mp°nenLea'~, 12 Name, C.A.S. Number--~ ~.~;~ .~~~-- Hea/~ ' of Pressure Component 13 N~me I C.A.S. Humber I~1 ~¢ I ~ I/Mo ~/I 3;~1/~ I / [ ¢ I~1 ~~~f~. .- ' ~e Hazard ~ ~eacLivity ~ Oelayed ~ Sudden Release ~ immedi~teC°mp°nenL 12 Hame I C.A.S, Nu.ber -,. HeaKh of Pressure Health Componen~ 13 Na~e I C.A.5. Nu~ber · . .. / 'h,sical And Health Hazard C.X.S. Nu,ber ~ ~--~- ~ ComponenL II Na,e I C,X,S. Hu,ber ./_?~/~///~~~/~~--~/ ICheck all that apply) ~' ...., · o ,,,c,,,,,, o ,..,,,,,,,, of Pressure Health .. Component I~ Ham~ I C.A.S. Humber rtiLi ~tio Re and i n af r corn ; ting ~11. secCi~ns) certlly unler @enal~¥ O~a~l~ that ,~,v~ ,e~sona~.eXamlnq~,q~ ~, famillBc,It~ the In[ormaL}pn ,u~miLtpd in this.end tached.doc~eent~', an~ t~ac oasea on.my Inquiry 9i.[nose InalvlOUalS responslo/e for obtalnin9 [ne inror~a:lon. I believe that the beit[~ lnlorAaLIon Is true, accurate, aflo complete. · .~...."73.~-~rT~T1-TTTT~t o,nerloperHor UR o~nerlb-p-~rlt'~TT'~horlzed represen~tlve Sl~fiatbre Pa~-Ti~]'~ CT'I'Y Of BAKERSFIELD HAZARDOUS HATERTALS TNVENTORY Farm andADticulture r_] Standard Business D NON--TRADE SECRETS Pa~e ~USIhlESS NAME: OWNER NAME: NAME OF THIS FACILITY: .0CATION; ADDRESS: STANDARD IND. CLASS CODE~ ............................... :flY. ZIP.~ C:ITY. ZIPS- DUll AItD BRADSTREEI HUHBER ............................ 'IIOUE #: __ P~tlCNEIO fl' - __ - - F E R 'f O--ZNS rtTUC rZ O/VS-'FOR-'PROPER COOE S 14 Ir~ns .lyl~e Hex Average Annual Neasure m ~ont tont ~ont U?.le tocqtion. Whe(e. Code cooe Amt Amt Est Unmts on e ~pe press ~e~o Storeo ~n tac~l~t~ ~e Instructions Phvsic,I and Health Halard C.A.S. ,uaber ~~ ~/ Co,ponent II flame I C.A.S. ffueber (Check ~1 that apply) · Component Hame I C,A,S. Humber Health of P~essure- ,ealt~ ~ '- Component 13 Hame I C,A,S. Humber PhysiCal and Health,Hazard C.A.S. Number Component ~1 Name & C.A.a. Number~-~/~ ICheck all that applyJ - ' _ j , __ . ,. _ . _ , _ / . . Co~ponent 12 Name I C.A.S, Number ///- ~ Fire Hazard ~ Reactiyit~ U D~layed ~ ~udd~n He,ease ~leqeeiAte Health Of Pressure Health Component I~ Name I C.A,S, Humber~¢-~ Physical and Health Hazard C.A.S. Number ~/~~- Component II Name I C.A.S. Number ., (Check all that 4pplyl ' ~ ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release Component 12 Name I C.A.S. Number Hea Ith of Pressure Component 13 Name I C,A.S. Number Physical and Health Halard C.A.S. Number ........... :-. ......... (Check 411 that applyl "- -:~ ~ Hea/th of Pre~sure .... Coaponent 13 Name I C.A,S. Humber EMERGEUCY CONTACTS ~1 ,rtiijcation (Rel~l and sign armlet' compl~t;i(]g.¢~ll sect~i,ons.) 'certify under penaRl gj~a~ thqt l havepe[sona/ILexamln~O~qal, ~amilla(.~it~ the jnlormatjpn lu~mitted in this.lnd all ,tached,docwment~, eno [pit oaseo ofl.~ Iflqulr~ ~f.t~ose I,~lVlOUalS responsible ~ot obtaining the InlotAatlO~. ] bel)eve that the pbml~teo In[ormatlon IS [rue, accurate, ano complete. - ; ~ri~i~l~Of o~n~ttopetitOr u~ owner/~~tlzed re~resen~,tlve ~t~ CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY ' ¢armandAgticulture r_J Standard Business E] NON--TRADE SECRETS ~c]e _~il:._,__ of JSiNESS NAHE'~,~.~_EO ~,g~~ ~gz2~OWNER NAME' NAME OF THIS FACILITY: ~CATION; .~~~ ~ DDRESS ' -- ~O--INSTRUCTIDNS-'~R-'PROPER CODES - - 14 Irons ,ooe!V"e 'Ant'Hex AverHeAmt AnnualEst Neasureunlts on! ti~e ~ont, ~ont ~ont mype Press lamp Stored In ~acl/Ity See Instructions __ ~hvsic,l and Health Hazard C.A.S. Humber ComPonent ~'¢~7e Hazard ~ Reac~iyitr ~ Delayed ~ Sudden Release ~ leAediate / Hea/[h ct Pressure Heal[h Componen[ '3 Hame ~ C.A,S. Number .:~~~ ~/~ ~hvsical and Health. Hazard C,A.S, Humber Component II Hame I C,A,S, Number ICheck all that apply~ Coeponeflt 12 Name I C.A,S, Number Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate Health of Pressure Health Component 13 Name I C,A,S, Humber II II II IIt,,ll _ ICheck al} that apply) Component I~ Name I C.A.S. Number ~.~H4zard ~ Reactivity ~ Delayed ~ Sudden Release ~immediate '~ Healt~ of Pressure Health Component 13 Name I C,k.S. Number 'hysical and Health HA~a~ C,A.S, Humber CoAponent II Hame I C.A.S, Humber. ICheck all that applyl Component I~ Hame t C.A.S. Number Fire Hazard · ~ Reactivity ~ Delayed ~ Sudden Release ~ Im~i~ He4/Ch of Pressure Component I~ NAm~ I C.A.S. Humber EHERGEtiCY CONTACTS #1 R~me 112 rti~i~atioq .(Re/~d ~.n.d.~ign aC{pr compl~ti(]g.~ll secCi,on~) cerLuy unoer @enal[y o~!aW [~{t l nsvepe[sona/~Lexamln{O{qoQm ~amille(.~it~ the 1nlormat!pn ~u~miLtp~ in this,~nd all . cached docvment~, uno t~at baSeD on.my Inquiry 9Lcnose InOlvlouHs responsible lop obtaining cna Information, I believe that the b~ltt~d InlofmatloA IS true, accurate, eno complete, - ~aT..,~ri~1"-I~.t1~1~f o~netioo~fa~t U~ ~nerlb'D~ra-~FOT~-~u-':norlzed represen~tlve BUSINESS NAME Bakersfield Fire ept. Hazardous Materials Division HAZARDOUS MATERIALS COMPLIANCE STATEMENT (To be completed by Building Permit Applicant and/or Site Plan Review Applicant) Mercy Hospital/San Dimas Medical Group LOCATION 400 Old River Road; Bakersfield, CA 93311 PLEASE READ ALL OF THE INFORMATON CAREFULLY, FAILURE TO COMPLY WITH THE HAZARDOUS MATERIALS REGULAtiONS MAY RESULT IN CIVIL LIABILItiES OF UP TO $2000.00 FOR EACH DAY IN WHICH THE VIOLATION OCCURS. Will the Applicant or future building occupant be requi~ed to complete a Hazardous Materials Business Plan? NO · (NOTE) I1 you handle, store, use or d~pose of, reportable quantities of any hazardous substance, you are required by California Law to complete a Hazardous Materials Business Plan. Forms can be obtained from the Bakersfield Fire Department, Hazardous Materials Division, 2130 G Street. Typical every day hazardous materials you may find in your facilities may include, but not limited to: compressed gases; fuels - ail types; solvents; oils (new and waste); thinners; caustic or corrosive materials; poisonous or toxic materials; and radioactive materials. Will the applicant or future building occupant be requi~ed to complete a Risk Manage- merit and Prevention Program? YES (NOTE) If you handle, store, use or dispose of reportable quantifies of any extremely hazardous substance you must develop a Risk Management and Prevention Program. THIS PLAN MUST BE APPROVED BY THE LOCAL ADMINISTERING AGENCY BEFORE YOU COMMENCE OPERATIONS AT THIS FACILITY. The list ofregulated chemicals is contained In Appendix A of part 355 of Subchapter J of Chapter I of Title 40 of the Code of Federal {~egutations. This list of chemicals isavaiiable at the Bakersfield Fire Department, Hazardous Materials Division, 2130 G Street. Will lhe applicant or furture building occupant be required to obtain a permit from the Kern County Air Polution Control District? Location wilhin 1.000 feet of outer boundw of the following: School -(any school, public or private used for the purposes of education of children Kindergarten or any of grade I to 12, inclusive) Hospital - Long Term Care Facility. Check here if none of the above apply to this project. YES YES NO ) NO ~,~ (Owner. Priniple or Officer of Business) Date: FD 165~ 0~6/17/93 Overall Site wi th 1 Fac. Unit .~-~/~/~ General Information Page 1 Location: 551SHANLEY ST Community:_~jNTY 3TAT~um b~ ~~ ~ Map: 123 Hazard: Moderate Grid: 06C F/U: 1AOV: 0.0 Contact Name IJACK RESENDEZ PAT JACOBS !, Title DIRECTOR OF SAFETY FACILITIES MANAGER Business Phone . , 24-Hour Phone- (805) 328-5260 x [(805) 327-3371 (805) 327-3371 x ]( ) - Administrative Data Mail Addrs: P O BOX 119 City: BAKERSFIELD Comm Code: 215-065 COUNTY STATION 65 D&B Number: State: CA Zip: 93302- SIC Code: Owner: MERCY HOSPITAL OPERATIONS WHSE Phone: (805) - Address: P O BOX 119 State: CA City: BAKERSFIELD Zip: 93302- Summary 06/17/93 MERCY H~ITAL OPERATIONS WHSE 21 0-000411 Hazmat Inventory List in MCP Order Page 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 HYDROGEN PEROXIDE Delay Hlth Liquid 12 High GAL 02-002 METHYL ALCOHOL Fire, Immed Hlth, Delay Hlth Liquid 110 High GAL 02-007 CLOROX LIQUID BLEACH Fire, Immed Hlth, Delay Hlth Liquid 90 High GAL 02-008 FORMALDEHYDE Fire Liquid 40 High GAL 02-010 CLEANER Immed Hlth, Delay Hlth Liquid 30 High GAL 02-004 CIDEX PLUS Immed Hlth, Delay Hlth Liquid 26 Moderate GAL 02-005 XYLENE Fire, Immed Hlth, Delay Hlth Liquid 16 Moderate GAL 02-006 DETERGENTS Delay Hlth Liquid 40 Moderate GAL 02-009 ACETONE Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL 02-011 TONER Fire, Immed Hlth, Delay Hlth Liquid 30 Moderate GAL 02-003 GERMICIDALS Immed Hlth, Delay Hlth Liquid 10 Low GAL 06/17/93 MERCY HO~ITAL OPERATIONS WHSE 21 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 0411 Page 3 02-001 HYDROGEN PEROXIDE Delay Hlth Liquid 12 High GAL CAS #: 7722841 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 12.00 Annual Amount GAL 140.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 100.0% IHydrogen Peroxide Components I~H MCP -~Guide igh ! 47 02-002 METHYL ALCOHOL Fire, Immed Hlth, Delay Hlth Liquid 110 High GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL 110 Daily Average GAL 120.00 Annual Amount GAL 1,400.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbienttWAREHOUSE Location - Conc 2.0% [2-Propanol 91.0% Methyl Alcohol Components MCP -~TGuide ModerateI 26 High ! 28 02-007 CLOROX LIQUID BLEACH Fire, Immed Hlth, Delay Hlth Liquid 90 High GAL CAS #: 7681-52-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL 90 I Daily Average GAL 90.00 Annual Amount GAL 1,100.00 Storage PLASTIC CONTAINER Press T Temp [Ambient IAmb i ent I WAREHOUSE Location -- Conc 100.0% [Sodium Hypochlorite Components MCP ---[Guide IHigh / 45 06/17/93 MERCY £TAL OPERATIONS WHSE 21 0-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-008 FORMALDEHYDE Liquid 40 High Fire GAL CAS #: 50-00-0 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL 40 I Daily Average GAL 32.00 Annual Amount GAL 400.00 Storage PLASTIC CONTAINER Press T Temp Ambient~AmbientlWAREHOUSE Location -Conc 37.0% IFormaldehyde (EPA) 0.0% Methanol Components MCP ---~uide High 02-010 CLEANER Immed Hlth, Delay Hlth Liquid 30 High GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL 30 I Daily Average GAL 20.00 Annual Amount GAL 300.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 2.0% 5.0% 30.0% Hydrogen Chloride 2-Butoxyethanol Phosphoric Acid Components MCP ---TGuide IModeratel 26 IM°derate I 60 02-004 CIDEX PLUS Immed Hlth, Delay Hlth Liquid 26 Moderate GAL CAS #: 111-30-80 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 20.00 Annual Amount GAL 2,400.00 Storage PLASTIC CONTAINER Press T Temp IAmbientlAmbient IWAREHOUSE Location -- Conc 3.0% IGlutaraldehyde Components iMCP Guide ModerateI 58 06/17/93 MERCY HO~ITAL OPERATIONS WHSE 21 0-000411 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 02-005 XYLENE Fire, Immed Hlth, Delay Hlth Liquid 16 Moderate GAL CAS #: 1330-20-7 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL16 [ Daily Average 13.00 GAL Annual Amount GAL 200.00 Storage PLASTIC CONTAINER Press T Temp Ambient~AmbientlWAREHOUSE Location -- Conc 83.0% IXylene, Mixed 17.0% Ethylbenzene Components MCP Guide IModerateI 27 Moderate 26 02-006 DETERGENTS Delay Hlth Liquid 40 Moderate GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GAL40 I Daily .Average 30.00 GAL Annual Amount GAL 500.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc Components 35.0% ISodium Hydroxide 10.0% Tetrasodium Pyrophosphate MCP Guide IModerateI 60 Minimal 31 02-009 ACETONE Fire, Reactive, Immed Hlth Liquid 12 Moderate GAL CAS #: 67-64-1 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL Daily Average GAL 8.00 Annual Amount GAL 100.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 100.0% IAcetone Components MCP . i. Guide ModerateI 26 06/17/93 MERCY HO~W~ITAL OPERATIONS WHSE 21 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 0411 Page 6 02-011 TONER Fire, Immed Hlth, Delay Hlth Liquid 30 Moderate GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: OTHER Daily Max GAL 'Daily Average GAL 30 I 4.00 Annual Amount GAL 100.00 Storage PLASTIC CONTAINER Press T Temp . Ambient~AmbientlWAREHOUSE Location -- Conc Components MCP Guide . IModerate I 27 85 0% IStyrene 02-003 GERMICIDALS Immed Hlth, Delay Hlth Liquid 10 Low GAL CAS #: 25655-41-8 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL Daily Average GAL 10 I 10.00 Annual Amount GAL 120.00 Storage PLASTIC CONTAINER Press T Temp AmbientlAmbientlWAREHOUSE Location -- Conc 10.0% IIodine 1.0% Glycerine Components iMCP ---[Guide Lo~ 06/17/93 MERCY HOSPITAL OPERATIONS WHSE 2 00 - Overall Site <D> Notif./Evacuation/Medical 000411 Page <1> Agency Notification BAKERSFIELD FIRE DEPARTMENT - 911 MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT FACILITIES MANAGER ADMINISTRATIVE COORDINATOR <2> Employee Notif0/Evacuation FIRE ALARM SYSTEM NOTIFY EVERYONE IN BUILDING EVACUATE TO NORTHWEST OF BUILDING <3> Public Notif./Evacuation QUANTITY NOT SUFFICIENT TO REQUIRE SURROUNDING PUBLIC TO EVACUATE BECAUSE OF DISATER TO NEAREST BUILDINGS. IF REQUIRED PROBABLY A DECISSION TO BE MADE BY HAZ MAT TEAM. <4> Emergency Medical Plan EXPOSED EMPLOYEES WOULD BE TRANSPORTATED TO MERCY HOSPITAL 06/17/93 MERCY [TAL OPERATIONS WHSE 215~00-000411 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 8 <1> Release Prevention HAZARDOUS MATERIAL STORED AT LOWER LEVELS ALL MATERIALS STORED IN BOXES WITHIN ORIGINAL CONTAINERS <2> Release Containment SPILL KITS TO CONTAIN SMALL SPILLS <3> Clean Up DEPENDING ON MATERIAL AND SIZE OF SPILL OBTAIN/REVIEW MATERIAL SAFETY DATA SHEETS RECOVER IF DONE SAFELY OUTSIDE AGENCY SUCH AS CALIP TO CLEAN IF NEEDED <4> Other Resource Activation 06/17/93 00 - Overall Site <F> Site Emergency Factors Page 9 <1> Special Hazards <2> Utility Shut-Offs A) GAS - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA B) ELECTRICAL - ELECTRICAL ROOM IN HALLWAY FROM WAREHOUSE OFFICE C) WATER - WEST SIDE OF WAREHOUSE NORTH OF OFFICE AREA D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - COMPLETELY SPRINKLERED BUILDING, FIRE EXTINGUISHERS THROUGHOUT BUILDING, SPRINKLER FDC ON NORTHSIDE OF BUILDINGS DRIVEWAY FIRE HYDRANT - NORTH SIDE <4> Building Occupancy Level 06/17/93 MERCY H ITAL OPERATIONS WHSE 21 ~ 00 - Overall Site <G> Training -000411 Page 10 <l> Page 1 WE HAVE 32 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: HAZARDOUS COMMUNICATION AND SAFETY FOR ALL NEW EMPLOYEES IGENERAL ORIENTATION) ANNUAL EDUCATION CLASS (2 HOURS) FOR ALL EMPLOYEES DEPARTMENT ORIENTATION AND INSERVICE TRAINING <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 06/17/93 MERCY OPERATIONS WHSE 00 - Overall Site <H> RMPP DATA 215-~0-000411 Page 11 '<1> Release Containment <2> Offsite Consequences <3> In House Capabilities <4> Plant Shutdown Instruction