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Home My WebLink AboutBUSINESS PLAN Per . it Operate to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This pennit Is Issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Slte Treatment PERMIT ID # 015-021-002183 MED MART #01 LOCATION: 3101 SILLECT AVE, t:,! . . . Issued by: CA 93308 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: Issue Date June 3-D, 2003 ',. ~ ~~ .. :.... :.;...,~:. - b- '.. r . ;: ! . ! ~. . -' .'.~ .' ,. . f· ~. ~ : Æl~ ~: ';. IJ1" .: . !" L '1f!#~ . ~-- ·1~ .¡ . ! t -\1:' - , . - - . . £1 39\;;1d ;~~~::t øz¡¡. , . ~ :: t. .... . j .,,.,./.,., ,', r~L Y. c/o ,. ,," /., .., ...... I . I / J "I( ,. ¡::: 4.T,-1 1." · -. \ *~ ~~o ~o . - -;~." .. .... 0 'r - , - . f :\ ......t f.r· c ~r ... ff' f~ --~~- , : ,. .. . ~. ,~~f;':·~,. '~,<\i~ " :. .1;. .:'" _ .:-~,.;);{. . '..... o ., :O.¡o·. , .0' , . ,,,.,...y..:. .' ÉLec-trlC- -sG~foÇÇ. t1l D·, òÇ'f\c.", s¡,,~C:b(n~\ wa;t:if ":> 'o'Jf o~.{ , VVe.-'?f' ?t"~'¿c+\ L:,¡'\e.. 'v.J~~ ,'S1Ó v oR .-::,+~ ':'" \4 ¿a;"V'\-\- töcÿ>-t,<.)\o--.. ~ . . .' E~-t:' oç o.ÇQ l<...JZ- Ï\CXDSS. . ?~ . v..>es-\- ",:>\Ó.(.I ~L òç: 'ou'\ \è\ \.~. "fj' ~.- .:'- - . . .~ \J 1~ . ¡}iJ- . .:._ ' ~o -s' III; -, == '-, ':. , ~. ,< ~ ~c= :z.~ ...,... " ~~ ~. .....1: ~., =:; - ~¢ ...... 'e"T': ... .'''::--,. ; ....;...' .," . ~. ;..... - - .. a;t I .. ~. H!\;;IW 03W .. ,;. , . 8L1'31'381'3'3 a. :Þ1 10øGløz;ïÞÖ-··.. '. .-" r' -~. .~ MED ·M~R' ,. PACIFIC PULMONARY SERVICES 88 ROWLAND WAY, SUITE 300 TEL. (415) 893-1518 NOVATO, CA 94945 FAX. (415) 893-0513 March 24, 2004 City of Bakersfield PO Box 2057 Bakersfield, CA 93303-2057 Re: Annual HAZMAT Invoice 30(dY t.¡Ij,~ Dear Sir/Maam, Please find enclosed an invoice forAnnual HAZMAT billing, and a check for $263.00. Please send a copy of the latest HAZMA T HMBP fonns, so that we can be timely with any adjustments to our HMBP that may be needed in the future. Thanks for your help. ~ ;/. Sincerely, KayVee Larsen Operations Pacific Pulmonary Services Tel. (415) 893-1518 x 239 Fax. (415) 893-0513 Email: kayvee1@ppsc.com "'_-' -.;ï. -- '~',- , (:;¡,úù oBpf {1f13 /V7t1T -.........--- "':" : i, ,-" ¡~ , -.::~-- --I 1 MED MART #01 .. - J ~ / ;,-" I ~\..... .... Manager : Location: 3101 SILLECT AVE 106 City BAKERSFIELD 'l..~~ -':j ~~\,'I,. . SiteID: 015-021-002183 ¿: (661) 861-6160 102 CommHaz: Minimal 23D FacUnits: 1 AOV: CommCode: COUNTY STATION 66 EPA Numb: Emergency Contact ~RREN CESSMA'f Business Phone: 24-Hour Phone Pager Phone / Title / MANAGER (661) 861-6160x (7<.0) ììc.{ -(ßJ.~x ( ) - x Emergency Contact ANNA BEAR Business Phone: 24-Hour Phone Pager Phone / Title / MANAGER (661) 861-6160x () x () x Hazmat Hazards: Fire ImmHlth DelHlth Period Preparer: Certif'd: ParcelNo: to Phone: (661) 861-6160x State: CA Zip 93308 Phone: (415) 893-1518x State: CA Zip 94947 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : MailAddr: 3101 SILLECT AVE 106 City BAKERSFIELD Owner Address City BRADEN PARTNERS L P 1701 NOVATO BLVD 209 NOVATO Emergency Directives: One Unified List ì All Materials at Site ì SpecHaz EPA Hazards DailyMax MCP F IH DH G 5000.00 FT3 Low f= Hazmat Inventory f== Alphabetical Order Hazmat Common Name... OXYGEN r, rf<A¡u k YUTI\I\A-f.) Do h (Type or print name) , ereby certify that I have reviewed the attached hazardous materials manage- ment plan for (V'E1) - MA(¿:r . (Name of Business) and that It along with any corrections COnstitute a complete and C orrect man- agement pran for my facifity. - .,...."" : . Sigrilllure ""- _ ì-2.i-oj _ 1 _0.... 07/18/2003 . / UNIFIED PROGRAM ~PECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield. CA 93301 Tel: (661)326-3979 FACILITY NAM¡; I INSPECTION DATE INSPECTION TIME "¡,,.t\}~~&..t:Ì:- _.-- n - . - - -- --- - - -- -=I¡- ~~-!: 0 .~ ../.......- ___3.\ 0 5 \ Uc.~~-_-_ __ _ ,_ _ ___ ______ __ ___ ,___ _____,__'_ __,_Col."fl., ,- ,.____0,,___,__ FACllITYCONTACT Business 10 Number 15-021- - . Section 1: Business Plan and Inventory Program o Routine "Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection C V ( C=Compliance ) V=Violation OPERATION COMMENTS VO ApPROPRIATE PERMIT ON HAND '-;70 --;U~~~;;:::-~~~~:~~NF~~~:~I~~":~~:~~-"'--'-- - ..,.-",.-,--".-",------"-'--- ,. _.',--, -,- "~.. VISIBLE ADDRES~'---,·-u----,...-,,-"-n...-'..-'--' f---;7 0 CORRECT OC~~PA~~~--"'--"--'-....,·--- -'0-" ..-- - ._n..' ,,-,..,--' ,.. -." ,.- - ....- - ..--"..--'-- ,- ,.. 1--_._,...,__,_._,________,__,_,_____,_____,.._____..,'_.....__ .._._ -."-,,,-...-,--,,-. "'....,...-. ,......,..__._·u -.-.,.,-.--.." '-". ..-...-- ... r¡/ 0 VERIFICATION OF INVENTORY MATERIALS '7r:1---VERI~~~~~ON OF a~:~;~;~~'-------"'·--,..,--.., 7Du·-~ERIF~A;ON-;-:~~I~~-----·--·--------'u -~---';;~~~~~GREG~~IO~-~~-:~;I~:------..----,·..-·· . 1--------,-..,..,,'--.--' .....,.,..,---,--,-,---- ""'- ." .........--- -~..,--.._._.----.. __..._.u_ . _ _,._..___.__..____....__._...._______.n.. ... --_...._..~_. ".... ...-_... -. .__ __< ____,_ _. __._~__ _.n ... ....__ __.___._. .. ___ ._____.___._. ._n. __ _____.._._.. _.. n. -----.----------- --.. ._.-~_.- .._ .~___.________·__..._n___··_·___···__ __._ ...--..--'-- .-_.- .-.- -_._.._----~----_._---------_.~._--- ---.-----.------.--.-.--....--.--.- -- ._.__..~----_.-._.._.. .---...-..-... --- -..------.----.---- _._~--------_. -..-.-.-.. ----- if" 0 VERIFICATION OF MSDS AVAILABILlTYE .? 0 -'-V~~;I~~TION OF-H';-M~T ~~~~~~-o-"'.,-'u-m.'.'--u,- -,--,--,-----,,--, - . ,om_'__'.,'_ .._.__n '.....7--.-...----'-.--.'----"..'-.-.---- ---, _U"" . '. -.-,,- _.___,___.u, .,. ---,.----....---,.,- - ..-----,-..--. ...-.....,... CJ 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 7O--E~~RGENC~-- PR~CED~;~-'ADEa~~TE--'···'-"--··,--"---"'-·---'---'n'·___· ,on --.., ---..--,,- --'-"-'--".. ----....- ,. ---~O-'-'C~-NTAI~~~~-~~~~;~~~-~~~~~~ -_..'--,--.-------- u,..,+'______.u,' "-,--,,, ---,..'- -" _ -" ....00' .ct';'HOUS~~-E~~ING---'- ,-....----..--- u__"'__'" -·l---,..,-,--- -----.-----,.,.-.. . on___m -.--.--' --- ,-'-"- . 'Cž(r;--F;~~--pR~~~~;~~'-----'-,u.,-'--,..,-- -, ----,-.- --, ---,.'-, ,---..,-- --,--- .,....,..---"..-----" --. - ----, _."u__'''' -~-" SI~~D~~~~~M A~~~~~~~-&'O~-H¡~~·---"- ,,-,.----- -,-,-----' ---,,----- ,--.-.-- .".",.,, -'--''''----.' . .... ....'-",..,. I - --..--.----- ANY HAZARDOUS WASTE ON SITE?: o YES '~NO EXPLAIN: aUE2EOMOING THIS INSPECTION? PLEASE CAll US AT (661) 326-3979 .-,"~. ---idiiiNÒ.--- J.~M,A;;~~..",~ White, Environmental Services Yellow . Slation Copy Pink· Business Copy ~- ~ 04/20/2001 14:27 5518515178 MED MART PAGE 09 .... ,--{)/~ {);L/ - Ó¿Jd-I ¡ 3 - SiteID: 01S-021-0021é3. t~ '. ,. MSD MART #01 Manager : Location: 3101 SILLECT AVE City BAKERSFIELD BuaPhone: Map : 1.02 Grid: 23D (661) 861.-6160 CommHaz : Minimal PadJnits: 1 AOV: ...... CommCode: COUNTY STATION 66 BPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title JEFF CASIDA I / Business Phone: (661) 861.-6160x Business Phone: ( ) - x 24-Hour phone : ( ) - x 24-Hour phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ~, ImmHlth DelHlth Contact : Phone: (661) 861.-6160x MailAddr: 3101 SILLECT AVE State: ÇA City : BAKERSFIELD Zip' : 93308 Owner MED MART Phone: (661) 861-6160x Address : 3101 SILLECT AVE state: CA City : BAKERSFIELD Zip : 93308 Period : to TotalASTs: ::: Gal Preparer: TotalUSTs: ." Gal Certif'd: RSs: No Emergency Directives: One Unified List 1 All Materials at Site 1 F Ha:zmat Inventory '- p== As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP OXYGEN, F IH DH I, DJ! ~ tw .¡c/..:hr Do hereby certítY that ( nave ype Of prll'lt ,.,~me reviewed the attached hazardous materials ma¡~age- merit plan for drt' 1111 ~íj- and that it along with (N~inÐII8) any corrections constitute a complete and correct man- agement plan for my facili~ G 5000.00 FT3 Low -1- 01/04/2001 04/20/2001 14:27 5518515178 ~' , 4IIÞ MED MART PAGE 05 - CITY OF BAKERSFIELD' OFFICE' OF ENVIRONMENTAL SERVICES, 1715' Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUSMATE~SMÄNAGEMŒNTPLAN INSTRUCTIONS: I. To avoid further aCtion, return this fonn within 30 days of receipt. 2. TYPEIPRINT ANSWERS IN ENGLISH_ 3. Answer the questions below for the business as a wh~le. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Opera.tor Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION 1. below for initial submission. SECTION I: BUSINESS IDENTlFICA TION DATA BUSINESS NAME: -.111..( j - 111 t{ V- + ¡(oj LOCATION: 3/0{ >¡((~c-f err!· ~q ;::¿'l> ~'e // l rd- MAILING ADDRESS: 3 to I ),'((-!cf J{r/'-< -tf(ðh t f1.r¡,/Þts.1-; (¡l.> ('If iJJ1J; CITY:' flt{ ~f¡~-t.(J. STATE: M ZIP: 1])ó{PHONE: {fI-ß6¡'-b;bV PRIMARY ACTMTY: f.",.fA. ,I ( o~ 1 t V1 Ar th Y't ~ j e./: y' e ~t OWNER: ß/de", ~vfn {(f [. f· PHONE:~I() ß?J-IflB MAILING ADDRESS: f?DI ¡JlJvwfo ß/vJ 1f-¡'D'1 ¡vP'I/Æ'¡', ('I 9c¡e¡r.¡r I I EMERGENCY NOTIFICATION CONTACT TITLE 1. Ð¿1((~ C15r;/YI& t(oll) ~J1f1j¡ fÝ¡;/ /f74¡tj. BUS. PHONE 24 HR. PHONE 6tl- gbt-6(~ð ~we. 2. 1 04/20/2001 14:27 5518515178 e MED MART PAGE 07 ;; e HAZARDOUSMATERfALSMANAGEMENTPLAN SECTION IT.I: DISCOVERY AND NOTIFICATIONS A. LEAK.DETECTION AND MONITORING PROCEDURES: - C. ï I ,'A. dof. n i'1/ (l Þ1, ~ Y ,'l d.. J a: ; I 1- - ¿~ {/Il'<r> h£lI~ 1-0 10: A f- /IL-y¿c..Hò^ èt{ch +;n-tL ¡'II~~ - C 7 r. It ¿-t" --V¡/'Æ {: 1,. ,,( (A 1 h r.¡...W) .Lv"",! r 'f ,", s þ'v ~ I fA.Ÿ"1,' fWt.&,... 1(1-4"/ of ¡,.!Y", 10 ~lQ," S .fìy s+te'¡. I- If/I, OJ"1jlJt !Þ'¡ J1¡/,IJILhi-l's -toccÞ/ ¡£¡I(c! ý'~(}ydt!. . B. EMPLOYEE AND AGENCY NOTIFICATION: >1iVVÞt( (J Ir~Æ I ð-! ~+ C. ENVIRONMENTAL RESPONSE MANAGEMENT: _ ;\.øt ~..({., S ! QL ) 0"2 j /s ç; f4ks r" . J(.¡' L n '- ÝlP-f ha.V/Ih Iv I D. ENfERGENCY MEDICAL PLAN: _ h~ ~ Vl.¿t''' SSl\vt 2 04/20/2001 14:27 5518515178 e MED MART PAGE 11 v e f: .. HAZARDOUS ,MATERIALS MANAGEMENT PLAN SECTION 11.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: _ ,( I ( t'1 ¡"A WS -rÝ~ ç'¡""J " + -f rl1b ).ud fe,O/LÝ....fu /-<. / I c f'n de-I' f AY"-. Î" t/>(.ýh'(1f I tJl to' -?ã /l-h I ý¡:¿.¿; /¿f -- " 1. . I' I I . I J... b lei ,L,l'-co!/-f tAY';j¿ (t1(/A':~S ¡,''1/CV¡ ÁY'I!. t'nlf/~e 71' . J ~i'~~I-rg. B. RELEASE CONTAINMENT AND/OR MITIGATION: - A /Æ c. CLEAN-UP AND RECOVERY PROCEDURES: -/.I(A UTILTIY SH1.IT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GASIPROPANP' , XI IA ELECTRlCAL: M; ù ~.ç.~,~~ WATER: ~ Î , 1& 5'0 ~ +c.." 0 ç.. ..f{.-c:. SPECIAL: LOCK BOX: YES/NO ~~ c....U<'.. S ~ Cor I't..¿$' vUC!...~+' :?...c ~~+'-( L ,',.J~ w(...s~ 5;.Jc.,.O.ç&ft; IF YES, LOCATION: PRIVATE FIRE PROTECTIONJW ATER A V AIL~ILITY A. PRIVATE FIRE PROTECTION: ;J l;r B. WATER AVAILABILITY (F\RE HYDRANT): f'.~ <õ t 0 f- ..,-J,,- 51 r.....tt.r (¡:"ra. ¡Jr-) I¥.~O ~ ~ c. ~ ~ o P ß.I.iI-." \ 1.\ 'Ñ ::, ( i) -H 't d r(LrJ ~ 3 o .p f , <:... ~ Ac tv$' ~ S tl J--e.... ~~ ¡< e \ (3-\C¿7 ~l~?---- CITY OF BAK~ 1El.,D FIRE DEPARTMENT 1.,Q:;.-,,-;2-f.JO," I OFFICE OF ENVIRONMENTAL SERVICES V ~ UNIFIED PROGRAM INSPECTION CHECKLIST ~<.e 1715 Chester Ave., 3rd Hoor, Bakersfield, CA 93301 +t FACILITY NAME fVl6Q fVlM..r 0 I ADDRESS ~tð t S;L('~ ....tt i66 FACILITY CONTACT JG-r-Ç CkS,~ INSPECTION TIME INSPECTION DATE 12( ?- cr / 'UW PHONE NO. &>(- G(~è> . BUSINESS ID NO. 15-21 0- WC~ NUMBER OF EMPLOYEES-.:J Section 1: Business Plan and Inventory Program ~outine D Combined D Joint Agency o Multi-Agency D Complaint D Re-inspection OPERA TION C V COMMENTS Appropriate pennit on hand N&J ?c....zw. ,<r Business plan contact infonnation accurate NG..J ßU$. PlAN 1J"1:::6J6D Visible address Correct occupancy Verification of inventory materials oxý6bJ t Verification of quantities S-ðCXJ 6c.J, Z~/ LNl.f:..c-1"-- V erification of location o.JTS tOE -:;vJ Cfl.t-J{2.. Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled ft.C~~ t..AßéL S~ ~-A Housekeeping P~'E ~ 6AS ðt'ù"-'?6e.S Fire Protection Site Diagram Adequate & On Hand w~ St1€'- '()I~~ (!?::JrÆ-/~l:':-C> Of\.) /AJ<1i.P ).. C==Compl iance V==Violation Any hazardous waste on site?: Explain: DYes ~ White - Env. Svcs, Yellow· Station Copy Pink - Business Copy ~ ~iness Site Responsible Party Inspector: W )~ Questions regarding this inspection? Please call us at (661) 326-3979 ,e , " t g\<b? ~\~?-- CITY OF BAKE IEI.,D FIRE DEPARTMENT _ ?- ~ ~ ^- I OFFICE OF ENVIRONMENTAL SERVICES ,( Od- ~ '-J UNIFIED PROGRAM INSPECTION CHECKI..IST tp~ 1715 Chester Ave., 3rd floor, Bakersfield, CA 93301 -.;t; FACILITY NAME f\16{) f1.1Aa. rot ADDRESS ~(ð t S/L<'t::c-T' ..tt 166 FACILITY CONTACT ..)c-r-Ç CAs/()A INSPECTION TIME INSPECTION DATE 17- /'z-~4".-v PHONE NO. <S'b (- G (~õ BUSINESS ID NO. 15-210- WC-w Nµ~.aEWOF EMPLOYEES~ ........." Section 1: " (-Þ'...... :s· Business Plan and Inventory\Progr~mì.·;·~; '!~. ~ ' "'........, J >~. ¡. ¡' D Combined D Joint Ägency 0 Multi-Agency D Complaint D Re-inspection Woutine OPERA TION C V COMMENTS '. Appropriate permit on hand N&J .f'c~t"'- Business plan contact information accurate N&...1 ßUS· PLAtv """f::$)r:;O Visible address Correct occupancy V erification of inventory materials OXÝGé"N f Verification of quantities S"""OCJO Co: c) I Zt51 L~~-r Verification of location 0.> TS 'Oé:. , SW CJl.f'J/2.. Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled flCA. ~ c..AßéL; S~ Aü:-A Housekeeping p l.(5I1.~cË ~~ <::.As ~~S Fire Protection Site Diagram Adequate & On Hand ---..". . .- ,.;~ SIrE 'OI~ ~-GQG? ~~A-/I1JC..-o ~ 1.v~P ). C=Compliance V=Violation , -.-.- Any hazardous waste on site?: Explain: DYes ~ \¡ ff~ " usmess Site Responsible Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env, Svcs. Yellow - Station Copy Pink - Busines.s Copy ,r~ Inspector: W·)~ . 10, ~"'t7 FIRE EXTINGUISImR e 0 e . ,,.. \. FIRST AID KIT - " MS.D.S. SHEETS L!l .. OXYGEN STORAGE AREA ,fZZJ . ,., ,', ", J I I I' , , I , II Y n- I " I t. I [". I , . I I , , I I ! . ~ '", . .0 -3 tr!q , . ill ,~ . .þòL- I]}e. ~ ' iD 4(1 .~ " i-œD-/å_~ . . ", ~ "'... "O~; . :.:~~, ~~ . . . ' 'J1'tø,i(ð .' ·1 ~ . '~ 'M L!~ \ .. ',> ., .' ~:.'~ ."." . ' . .. . " . ," ..:>..;.... , Jj'!~;.. . ~ 1 , f' I. , , .' I ,~~:. . . .."". . .. - .' ,. l 1. ' ~ í , 'f\ 1 . J - - --iF, ~- :"0 . .... ,. . . . . , ~ ~, . . . ,. t ILl - - - - m .;> ,< ~ ~c P' .-..- c:~ .~. ~ :: , ~'.... tIJ~ -;; o -I M