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HomeMy WebLinkAboutBUSINESS PLAN 10/2/2003 UNIFIED PROGRAM .PECTION CHECKLIST SECTION 1 Business Plan and Invent()ry Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME K~l5£<Z- (V\<qJ\LpL__c..-GJ'0.!~~~____.._______,___,________,_, J o-Z_-=-ô3_ ö fQ__ ADDRESS PHONE No, ~ð t 5 To<:X.D A-L£.11_~ ~ ____,__________'.., 1-02.Z { _7..5.__,,__, Business ID Number ~e.. 15-021- OQ::)1 17 . No. of Employees Sectipn 1: Business Plan and InventòryProgÍ"am D Joint Agency D Multi-Agency D Complaint D Re-inspection ( C=Compliance ) V=Violation OPERATION COMMENTS c V ¡;ý'D iY"D ApPROPRIATE PERMIT ON HAND ------_._-----~-~ -------------~-_. ------~----<-------.-~- --...---.,.-----------------------.---.-.--.-.--- BUSINESS PLAN CONTACT INFORMATION ACCURATE ._______ _____.__.__._____u_____ ___ __ __.___________ ______._____.__._.________~__._~___________n_._._. _._____ __u_._._. ._. .___.__ 1I]./ D VISIBLE ADDRESS ----.-.----------.-----.------ ."-- _.._--------~-_._~._--_.__._-_._--_.__._.__._--"-._._---_.._-"_.-._~-_.~_..__._-_._-~- ---- c:;r"D ~/~ CORRECT OCCUPANCY -------------.------- ------..-.----.-..----.---.-- ---------~_._._-----~._------------_._--------_._._-- -- ---~-_._---_. VERIFICATION OF INVENTORY MATERIALS -~-----------_.__._~_. .---_.~--_..-._._---_._._. ------.--.----.---.------------.---.--- ---",., ttY"D 7D ~/D VERIFICATION OF QUANTITIES -----------~--~~.._--_.-_._-------- ---_._---~----------------------_.--_.---.---------------.--..-..----.---- VERIFICATION OF LOCATION ----_._._---~-~---_.._,....__. ---_._~_._---._-----+------_. PROPER SEGREGATION OF MATERIAL --~ ..--."---,------,-..-..,---. D'" D VERIFICATION OF MSDS AVAILABILITYE .----------~-_._--------- -_.._._---_._---------_.__..._--_._-_._~_..._-_..------ ?a --------'---~---_.._--_-. .-.-----.--- ---.--.----.------.- -~-_.._---_._--------------_..------_.-._._-----~- VERIFICATION OF HAT MAT TRAINING --------------------.----...--.--- ._-----~.__._--------_.~---_.__._----~-_._-_._--_.._.-..-----.-_-------- o VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ------_._--------_.~.._._-- ----~------_.__._--_._-_.._-_._--_.__.~--_...~-_._-_.~--"---------.-- rw" D EMERGENCY PROCEDURES ADEQUATE ------·----'..--......-'-1....----..--..'....-..-.."-·'-..'-..'------_,..,___,'.._..·.._'_·_..n'___..'_,·..·..·_'..__ c;Y" D CONTAINERS PROPERLY LABELED ------r--' .------.- ~..---..._-,.. ....,..---- n__'___,_..__"_,__,.._....,_..__"...__·,__·'_....mu.__.__.._.--..,------, 31' D HOUSEKEEPING _* --~~--- _.__.----~---_.- -------~--~"-_._._--~-_.~---------_._-_._-------- e/ D FIRE PROTECTION -'-T-" . .-.----,---,---, ---------.-,--:..-..-..--.-------.-.---..-,---,.,..,.,----. ~ D SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: DYES D No ~~~ Jd¿1ð ~_ ~ ~ ~ ?1/a.....Q;-L...ç;.'~cr $3 -S- ð 3 ~ EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Þ..ff~S-_....,___.._.__Y3_______ ~~_,_ Inspector Badge No. Business Sile Responsible Party White . Environmental Services Yellow . Station Copy Pink, Business Copy 7~ ·. Per ,;.., '1'\:'-:';' ',... .:t:a:":~""· :><:··::~·:;<;'·"'.(D·~·'~:;:":"\;~/';¡:)á)"~~~: è':' , . ':'" : t" ..:./' ',;: .'. ,'.., '," ,·O"'·"··~:·,'~·:::7:: ;~ "11':'" er' '..' 'e" :.,' , c ~ '.; ~ . ~ . '''_': :-;., ~ ,', <. . _ ~ . : . . ... . .. ~...": ~.. . , 'I , ..' Hazardous Materials/Haza.rdous Waste Unified Permit . , " , , CONDITIONS OF ·PERMIT ON REVERSE SIDE ". ' : ',". Permit 10 #:: 015-000-000117 KAISER MEDICAL CLINIC LOCATION: 3501 STOCKDALE HWY -=-..d, Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: -.{.' -: . .~ " " .' ;, ....< ,: I Issue Date 'June 30, 2003 ---.--"---.- ---, -- - --- Per it toOperil.te . Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ,. :¡¡thiJ~rdous Materials Plan , ·"""",,:tground Storage of Hazardous Materials "'!"Q~gement Program "'¡¡" Waste PERMIT ID# 01S-D21.Q00117 KAISER, MEDICAL CLINIC LOCATION 3501 . 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 *~ ph Huey, ffice of ental Servi es June 30, 2000 Approved by: Expiration Date: @--': , , , 0-- -C_ ~ (7--- ---- -~ (.=~~-~. -- - -; w ® 8>- -- ~ (0)-- -- ~ 'C' , , , , u-- -'-" (o\-~ -- ...: '-C/ , 0-- -- -i e û---~ 8--- C£)-~ ~ -~ - ? ? r I I I (2) r I I r ~ I O'(.~~"'-l ,1".""....1""""," r 0 r r ? ~ I I I I I I I i._ ,__,___,l,_., ..,L_____ I I c (" '~ \J 'J , I '.J ..------------------------------ .-. ~ ~ ~ Kaiser Foundation Health Plan, Inc. ~otot¥"pical Medical Office Building FLOOR PLAN 1/6°"1"-0. 'f-~c..\l..n i ~\ ~ 4. ~"^ - "5\0 ~\Lb l'-l..'i:- 't\- ~~ ,....~ ~'.. "f-\~~ OS r~\~\I-\'~ t::i- \ ~ v....(L "" M~t>tc...\'>-L \N~~\!L L,- ~--'\]I r <=;¡~;- J : =< .0 _J , ------ , \ , L- : r~-~ ',==~~~~J [111 -:x:. ~ ~ a ¿ ~ IJ ~ I 1 I ß 01 v <tl 0 ccl -JI <tl UJ - 0:1 I I 1 u! I I SIGN ,) .... ! ""' t û a ~ ..~ ~\\\L ~I~ ~~~N\ ~'œ:..~\~~\ \~L- ~. -. -~ '~ ~ t~""~__,____ ~ "'ŒR.. ï j I I I I r---~ 5 TAT E H I G H WAY 5 8 f 1.\",..11\ 1=-~'"t\t\JB:.. ßO\l-!> ''( ~ S~\i\\\L.\....~ fw~ 0·. ~" ~ Kaiser Foundation Health Plan, Inc. Prototypical Medical Office Building SITE PLAN 1/8--1'-0· - g -7- q ò ", '-' ~6 3Czg-SVd-'~ ..; -' I ,\'Al;c,td1(' ¡t)ed,-cJ 0 '0 I i / 3&JI ~dA0G- '0 pe.e A. I '770 Pr3 éht~~ \d.~ II [tJlf(tì.C-r: "Slar"\ 4'iv~ @~ I 1D ¡;'"ú 'Ø.-~ .b:t 7- /-10 c? I Qat. .tflrrrpf ß/l1.? ()ÅLRS5 I ,_,fJr)¿1( IOWPt3 3.;28-0~&¡J.- I- I ~ ~___.J.' 1 :- ~~SER MEDICAL CLIN. . -----\ / _/.-1 // ./' // / SiteID: 015-02i~000117 Manager : BILL ORR Location: 3501 STOCKDALE HWY City BAKERSFIELD \~~~ ~ S~~ BusPhone: Map : 123 Grid: 02B (661) 327-0281 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code:8011 DunnBrad: Emergency Contact BILL ORR Business Phone: 24-Hour Phone : Pager Phone : / Title / ADMIN (661) 398-5027x (661) 328-9831x ( ) - x Emergency Contact / Title / Business Phone: ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Fire Press React ImmHlth Hazmat Hazards: Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 327-0281x State: CA Zip : 93389 Phone: (661) 398-5000x State: CA Zip : 91188 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : BILL ORR MailAddr: PO BOX 12099 City : BAKERSFIELD Owner Address City KAISER PERMANENTE : 393 E WALNUT : PASADENA Emergency Directives: I, -.ß I L L Orr Do hereby certify that I have rrype or print name) reviewed the attached hazardous materials manage- ment plan1oli' ~'!r Plr'''''Ji~t and that it along with (Name õiãüsineu) any corrections constitute a complete and correct m,an- agement plan for my facility. niL 810n811.1re ~3 -1- 08/22/2003 .¡ . '* ~, F KAISER I F Training Employee SS WE HAVE ~ " .: r MEDICAL CLIN. . SiteID: 015-021-000117 ì Fast Format ì Overall Site ì 11/16/2000 . ' Training EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM EFFECTED. IF PROBLEM DEVELOPS CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. Page 2 l I I Held for Future Use Held for Future Use -8- 08/22/2003 APR 09 2003 15:34 BKSFLD FIRE PREVENTION e (61) 852-2172 p.2 X -451 CITY OF BAKERSFIELD 7 úJ1..-- OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 APPLICATION TO~TAW AND/OR REMOVE ABOVE GROUND STORAGE TANK(S) In conformity with provisions of pertinent ordinances. codes, and/or regulations, permission is hereby granted to: ,..J?7\1?l.!7t- PL£fLnhJL4>TTã ' Name of Company ~6õl ~,Ã1..é. ~HtJA-7 I fb~Fltáo Address to display~nsta1l, use, operát~ sell or handle materials or process ~voJving or creating conditions deemed hazardous to life or property as follows: Féf- ~IO ~. o~ ~IØJ- fi;¡n...v()~/5'. 1;.1 ~~~'f ~aH~~ subject to the provisions and/or limitations as provided. Violation of pertiÍ1eot ordinances, codes and/or regulations shalJ void this pennit. ~ ,,/._1- > Permit Denied ~ Date J:tßJt!i) ~#- c47wus ~~ - Approved by: '---" ~ Applicant Name (print) . / AppIi~~ - tJ;i.l ~M~.;..I p¡tD J tZ c:r MbJ./..4lH- THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ¡ '~-'-----'---ê-----'-'---'-------'-----'-----'---'-' I ¡ ! 112.11' ....9"04'00'". :, ------~-' 1~M"oo"'( ¡ ¡ ¡ ¡ ¡ ¡ ¡ i i ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ 0' J «i O! I a:::i ¡ i ...J , I «¡ wi I a:::¡ ¡ ¡ i ¡ ¡ ¡ ¡ i ¡ ¡ ¡ ¡ ¡ ¡ ! I ¡ ¡ i ¡ ¡ ¡ ¡ i ¡ ¡ ,-----,-------------------,-------'----------_._----------------------~---~------------------------------------------ S Toe K D ALE HIGHWAY __==______r~:----------------------------------------------------------------- I I I I I I I I ........-..-..-..-..-..----..-..-.--..-..-..-..-..-..-.--.._.._.~.~~~~~_.._.._.._.._.._-._.._._-- ¡ I II HIGHWAY 58 ...\phase2\1097sp01.dgn Apr. 09, 2003 16:16:11 e Dual Wall Sub-Base Tanks Standard Models for use with OF & DQ Series 200 kW - 500 kW Generator Sets Description These Cummins Power Generation dual wail diesel fuel tank are steel rectangular tanks with a sealed, separately vented, integral fuel containment basin. They are UL Listed as Secondary Containment Generat()r Base Tanks and meet the requirements of UL 142. Inner and outer tanks are pressurized at 3 psi and leak checked to ensure integrity of weld seams per UL 142 standards prior to shipment. Tanks are constructed of heavy gauge steel and include a reinforced steel box channel for generator support. Full height gussets are provided at generator set mounting holes. Tanks are load rated at 5,000 pounds per generator set mounting point. The tank design has been tested extensively under conditions far in excess of normal use to ensure that it can safely support the full weight of the generator set. In addition, tanks are pressure washed with an iron phosphate solution and then finished with an acrylic primer . and enamel paint. Tank interior is coated with a solvent- based rust preventative. .._-- e Power Generation Features' · ' UL 142 Listed - Secondary containment generator sub base tank meets UL requirements · Designed to meet requirements of NFPA - NFPA 30, NFPA 37 and NFPA 110 (see last page for details) · Emergency pressure relief vent cap - Meets or exceeds UL requirements - insures adequate venting and pressure relief for inner and outer tank under extreme temperature and emergency conditions · Atmospheric vent cap - Accommodates normal venting (oversized 2" vent is raised above the fuel fill) · Raised fuel fill- Includes lockable flip top to prevent tampering and/or fuel contamination · Fuel level gauge - Provides direct reading, top mounted · Low Fuel level switch - Annunciates a 50% low fuel level condition at generator set control panel · Leak detection switch - Side mounted, annunciates a contained primary tank fuel leak at generator set control panel · Enclosure Compatible - Compatible with gensets fitted with standard Cummins PGA skid-mounted weather protective and sound attenuated enclosures · Pre-drllled mounting pads - Accepts Cummins Power Generation Accessories (402-xxxx series) spring vibration isolators between tank and genset (as required by T-030) · Tank top mounting bracket - Provides mounting for (optional) pump and control for day tank operation · Removable end panel/channel - Provides access to a full width, 22- to 24-inch electrical stub-up area Options · Local code approval - See Specification Sheets S- 1391 (Chicago), 8-1392 (LA.) & S-1393 (Florida) for details an tanks with local code approval · Fuel transfer control and pump kit - Enables field upgrade of standard tank to a day tank I. e e Height 15.25(387) 26.75(679) 15.25(387) 26.75(679) 15.25(387) 26.75(679) 21.~~(~0) .'. 28:75(730) 21.25(540) 34.25(870) 21,~5(540) 28.75(730) 21.25(540) 3{25(870) ,. .. 21,2~(s.1g) . :38.25(97~)' 18.75(476) 34.75(883) 18.75(476) 34.75(883) 18.75(476) 34.75(883) 2(,1:25(514) ··'36.25(921 ) 20.25(514) 36.25(921) 20.25(514) 36.25(921 ) 20.25(514) 36.25(921) Tank Weight + lb. (Kg) 1300(590) 1700(771 ) 1300(590) 1700(771 ) 1300(590) 1700(771 ) 1575(714) .. ·..1850(a39) '1575(714) .; 2025(919) . 1~75(714) 1850(839) 157~(714) .. .," ~0~5(919) . . 157$(71~)' . .. .2175(~87) ...'. 1850(839) 2525(1145) 1850(839) 2525(1145) 1850(839) 2525(1145) ~g55(932r , 2770(1256) ·2055(932) . 2770(12~6) 2055(932) . . ' . . . '2770(1256) 2055(932) 2770(1256) ; * Fuel capacity listed is usable amount. Initial fill will be approximately 5 gallons more than listed. + Tank weight listed is dry with standard features. A Fuel capacity listed is usable amount. Initial fill will be approximately 20 gallons more than listed NOTE: All tanks in anyone of the shaded or unshaded bands in the table will fit all gen5ets in the same band (same skid base dimensions). These alternate combinations can be used to obtain a specific gallon capacity or dimensional size as may be . required Standard Dual Wall Sub-Base Tanks for use with 230 kW - 500 kW DF & DQ Series Generator Sets Tank Capacity* Tank Dimensions Inches mm Width Model Length 230 DFAB 250 DFAC 250 DOAB (.",' . 400 DFEB 450 DFEC 500 DFED © 2001 Cummins Power Generation Specifications subject to change without notice S-1390a e e Refer to Cummins PGA Warranty Manual for warranty details. Optional and extended factory warranties and local distributor maintenance agreements are available. Contact your distributor/dealer for more information. Certifications I Standards I Codes ® m N..... .. Chicago Local Approval L.A. Local Approval Florida Local Approval .JI Ul142 - Cummins Power Generation dual wall sub-base tanks are Ulllsted (File MH17470) and constructed in accordance with Underwriters Laboratories Standard UL 142 "Steel Aboveground Tanks for Flammable and Combustible Liquids", as a "Secondary Containment Generator Base Tank" . NFPA - Cummins Power Generation tanks are built in accordance with all applicable NFPA Codes: NFPA 30 - Flammable and Combustible Liquids Code NFPA 37 - Standard for Installation and use of Stationary Combustible Engine and Gas Turbines NFP A 110 - Standard for Emergency and Standby Power System Optional Local Approval -- Meets the local code required for approval by the Chicago Department of In5pect/onal Services - Plan No. 0451. See Specification Sheet S-1391 for details. Optional local Approval -- Meets the local code required for approval by the City of Los Angeles Bureau of Fire Prevention. See Specification Sheet S-1392 for details Optional Local Approval - Meets the local code required for approval by the Florida Department of Environmental Protection. See Specification Sheet S-1393 for details NOTE: All 159-1486-xx tank Spec Sheets are available on the Accessories Web Site as S-1390 through 5-1393. See your local distributor for more information c. Power Generation Cummins Power Generation 1400 73rd Avenue N.E. Minneapolis, MN 55432 763.574.5000 Fax: 763.574.5298 www.cummlnspowergeneratlon.com Cummins is a registered trademarK of Cummins Inc. . WARNINGI Backfeed to a utility system can cause electrocution and/or property damage. Do not connect generator sets to any building electrical system except through an approved device. or after building main switch Is open. WARNING I The tank and generator set are heavy. Dropping either can cause severe personal Injury or death. Use a hoist of sufficient capacity, do not stand under a raised tank or set and keep hands and feet clear of the perimeter of the tank or set while maneuvering It J © 2001 Cummins Power Generation Specifications subject to change without notice S-1390a "" t":' 1'- ~ f > Manager : Location: City I- I / / KAISER MEDICAL CLINIe / I '""./ 6,L..L Or( ) 3501 STOCKDALE HWY (P,O.8D~ 1,21/11 BAKERSFIELD i C, A &t "$ J g-tt CommCode: BAKERSFIELD STATION 07 EPA Numb: - SiteID: 015-021-000117 BusPhone: Map : 123 Grid: 02B (805) 327-0281 CommHaz : Minimal FacUnits: 1 AOV: SIC Code:8011 DunnBrad: Emergency BILL ORR Business Phone: 24-Hour Phone : Pager Phone Contact / Title '611 ADMIN (~) 398-5027x (~) :42ß (,OJlx (6.61) )~8.: 4SJIx Emergency Contact / HNMY ~ItMßffi\W / Busines~ Phone: (~) 24-Hour Phone : ( ) Pager Phone : ( ) Title 83: 8égQx x x Hazmat Hazards: Fire Press React ImmHlth Contact : B,LL Ot"r' MailAddr: 393 g WALU:eT ~o. ØO.,c.. 1;2 Dqq City P1\SlÆBNA ¡:.lc.LïS-h.¿.lvI Ck t¡}T1'f Owner Address City KAISER PERMANENTE 393 E WALNUT PASADENA Phone: ( State: CA Zip 91188 Phone: (80S) 398-5000x State: CA Zip 91188 x Period Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal -:2<;-00 ( , ~ ::;:20-0Ò f= Hazmat Invento y p== As Designated Order One Unified £lst 1 All Materials at Site 1 Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP OXYGEN WASTE FIXER F P IH R G L 770.00 GAL Low 5.00 GAL Min I, t^¡'LLI ('~ Or,. 0 (Type or print name) 0 hereby certify that I have IJ':'¡Se,.... . d h '"!:::¡ft~~~ revlewe t e attached hazardous materials manage- II/O¡? , . ~l) K¿¡lstr Ptrwtlt-.Je,Æt ,~. V ¡ 5 ment plan for 5;-ocJ<,l.l¡. VIed",,' ~f and that it along with ~::;;t;!<t.f'." "20{J{) (Name of Business) ..) :I;.,~! "~).l;:'It~ ~ any corrections constitute a complete and correct man-"" iIICi:s agement plan for my facility. 11/06/2000 .' ir> ~ ~,...... - ':. .!; Î e e F KAISER MEDICAL CLINIC p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 015-021-000117 1 Facility Unit: Fixed Containers on Site 9 Days On Site 365 Location within this Facility Unit CLEAN UTILITY ROOM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 770.00 GAL Daily Average 770.00 GAL -%-Wt. , - RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME WASTE FIXER WASTE PHOTO FIXER SOLUTION Location within this Facility Unit INSIDE RADIOLOGY DARK ROOM Facility Unit: Fixed Containers on Site 1 Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 5.00 GAL Daily Average 3.00 GAL HAZARDOUS COMPONENTS ~ CAS#7440224 %wt. I Silver TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS -2- 11/06/2000 )t) :' e e SiteID: 015-021-000117 ì Fast Format ì Overall Site ì OS/20/1998 F KAISER MEDICAL CLINIC I f= Notif./Evacuation/Medical Agency Notification CALL FIRE DEPT AND NOTIFY ADMIN OFFICE. Employee Notif./Evacuation OS/20/1998 USE PAGING SYSTEM AND LOCK DOOR TO ROOM. Public Notif./Evacuation 10/04/1990 ] 10/04/1990 I N/A Emergency Medical Plan DOCTOR AT FACILITY IF REQUIRED. -3- 11/06/2000 .'-'- }~ ~ e e F KAISER MEDICAL CLINIC I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-000117 ì Fast Format ì Overall Site ì 10/04/1990 KEEP OXYGEN TANKS CHAINED TO WALL. LOCKED ROOM. BAG ALL INFECTIOUS WASTE AND STORE IN ~ARelease Containment I DISI:~:::~ AND M~P_OR SPONGE. I 10/04/1990 10/04/1990 1 J I Other Resource Activation -4- 11/06/2000 . -~'~ .. ..-:- ~ ,-r. -~ e e F KAISER MEDICAL CLINIC I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 015-021-000117 ì Fast Fermat ì Overall Site 9 I OS/20/1998 A) GAS - IN REAR BY LOADING FOR PHARMACY B) ELECTRICAL - IN ELECTRICAL RM AT REAR C) WATER - IN FRONT AT ST WITH LARGE ABOVEGROUND D) SPECIAL - NONE E) LOCK BOX - NO VALVE Fire Pretec./Avail. Water OS/20/1998 ..._ ~_o__~~ ~.~ -~ __ ----'""~ .__ - ~ . - -'- - - _ _ -,.-. --". PRIVATE FIRE PROTECTION - ON SITE HYDRANTS, FULLY SPRINKLERED BLDG AND FIRE EXTINGUISHERS THROUGHOUT. NEAREST FIRE HYDRANT - ON AND OFF SITE. Building Occupancy Level ~ - <'-~ ~- - -5- 11/06/2000 ,....- ;., .f~.. '. .... ......, .. ,"", '.,z e e F KAISER MEDICAL CLINIC I F Training Employee Training 35 WE HAVE ~ EMPLOYEES AT THIS FACILITY. SiteID: 015-021-000117 ì Fast Format ì Overall Site ì OS/20/1998 WE DO HAVE MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM EFFECTED. IF PROBLEM DEVELOPS CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. -[ I I Page 2 -~--~- ~. -- ------.--.-----=-- - --- - - -- ---..-.-- . .-:;-- - - - --~ - --- - - - ~ I I I Held for Future Use Held for Future Use ,- -_~-_ __.-r_..___ -~-~----- ---- - -- ---- -- -,- -- -6- 11/06/2000 ¿_ CITY OF BAKERse€LD OFFICE OF ENVIRONMENTÀL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 , \1 q DELETE o REVISE 200 DÓ( -I. FACILl1Y INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA· Doing Business As) K.J\· 5:>(57. ~(L ,--Pé> , N$\ r>Co SWCJéf)At~ 'DAA K R.oóN") CHEMICAL LOCATION fFÄëïÜTŸíÕ /I MDIOlOGI( i MAP II (optionaf) II. CHEMICAL INFORMATION CHEMICAL NAME W' A '5 'ï é:.. f'lbïtö f" I X6'Z- Sö-uY'(,rYJ COMMON NAME CAS II FIRE CODE HAZARD CLASSES (Complete il rec¡uested by local fire chiel) TYPE o p PURE o m MIXTURE .. s SaUD 01 UOUlD 0, FIRE o 2 REACTIVE .lirw WASTE 211 RADIOACTIVE PHYSICAL STATE 214 LARGEST CONTAINER o g GAS FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT o 3 PRESSURE RELEASE o 4 ACUTE HEALTH MAXIMUM ¿-- DAILY AMOUNT ....) "ga GAL 0 Cf CU FT . If EHS. amount must be in Ibs. 218 AVERAGE DAILY AMOUNT o Ib LBS 0 In TONS UNITS· STDRAGE CONTAINER (Check all thaI apply) 4re PLASTICINONMETALUC DRUM 01 CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG Ok BOX 01 CYUNDER o a ABOVEGROUND TANK Db UNDERGROUND TANK o c TANK INSIDE BUILDING o d STEEL DRUM STDRAGE PRESSURE ~ a AMBIENT . a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT 225 STORAGE TEMPERATURE o aa ABOVE AMBIENT HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per matenal per bUIlding or area) Page of 203 o Yes 0 No 202 204 3 205 TRADE SECRET 0 Yes 0 No 206 If Subject to EPCRA, refer to iinstructions 207 EHS' o Yes 0 No 208 209 . ~ EHS is"Yes·, an amounlS ~oW ~~ ~in;;;', Ibs. ",,':':'\,¡ 210 o Yes "0 CURIES 213 212 s 215 o 5 CHRONIC HEALTH 216 3 219 220 STATE WASTE CODE 221 DAYS ON SITE ~G~ 222 o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON o q RAIL CAR o r OTHER 223 224 - o ba BELOW AMBIENT o c CRYOGENIC - - , . '?}¡{HÂŽÂRDö~~'çt~MéQ~Ê~;:+ 226 S\L..v~ 2 230 3 234 4 238 242 ~_"'_H..__.... OES FORM 2731 (7198) 227 o Yes 0 No 228 231 o Yes 0 No 232 235 OYesONo 236 239 o Yes 0 No 240 229 233 237 241 243 245 o Yes 0 No 244 -------"-- .__.,-----------._-,..,-"---, DATE 246 P:\OES27J " TV4 _wpd '""" . ",..-.,..,' - KAISER MEDICAL CLINIC RECEIVED 1 9 1998 e SiteID: 215-000-000117 Manager : ~. Location: 3501 STOCKDALE HWYcBX: City BAKERSFIELD CommCode: BAKERSFIELD STATION 01 EPA Numb: BusPhone: Map : 123 Grid: 02B (80S) 327-0281 CommHaz : Minimal FacUnits: 1 AOV: SIC Code:8011 DunnBrad: Emergency Contact / Title Emergency Contact / Title BILL ORR / ADMIN KENNY BRADSHAW / Business Phone: (805) 398-S027x Business Phone: (80S) 83S-8600x 24-Hour Phone : (80S) 328-9831x . 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Emergency Directives: One Unified List 1 All Materials at Site 1 SpecHaz EPA Hazards DailyMax MCP F P IH G 770 GAL Low p= Hazmat Inventory p== MCP+DailyMax Order Hazmat Common Name... OXYGEN ~ W ¡/I/ .,,,"^ Dîr [)@ hereby certify that I have p (Typo@ '~ntMm&) r~"iewed ~he attooh~d h~~wdoos materials manage- meni pian for K'A/str pif l1JUlltJT.( aoo tha~ it ~loftQ with (~lMo'I~) any rorr@dêons constitl3te a oomplete and oorr&d man- agem~!'ì1~ plan for my ~d~åty. LJ JJ~ Signature 57e/9rx -1- 04/20/1998 ? ~ e e F KAISER MEDICAL CLINIC p= Inventory Item 0001 ¡:::=: COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000117 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit CLEAN UTILITY ROOM Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 770.00 GAL Daily Average 770.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -2- 04/20/1998 f r..o¡ e e SiteID: 215-000-000117 1 Fast Format 1 Overall Site 1 10/04/1990 F KAISER MEDICAL CLINIC I f= Notif./Evacuation/Medical Agency Notification CALL FIRE DEPT. NOTIFY ADMINISTRATION OFFICE ~ Employee Notif./Evacuation ~GING SYSTEM - LOCK DOOR TO ROOM I Public Notif./Evacuation · N/A I Emergency Medical Plan . DOCTOR AT FACILITY IF REQUIRED. 10/04/1990 10/04/1990 ] ] 10/04/1990 ] -3- 04/20/1998 ;' 'i, e e F KAISER MEDICAL CLINIC I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-000117 9 Fast Format 9 Overall Site 9 10/04/1990 KEEP OXYGEN TANKS CHAINED TO WALL. LOCKED ROOM. BAG ALL INFECTIOUS WASTE AND STORE IN 10/04/1990 10/04/1990 1 ] I ~ARelease Containment I Clean Up . DISINFECTANT AND MOP OR SPONGE. I Other Resource Activation -4- 04/20/1998 ~ '~ e e F KAISER MEDICAL CLINIC I f= Site Emergency Factors r== Special Hazards Utility Shut-Offs SiteID: 215-000-000117 1 Fast Format 1 Overall Site 1 I 10/04/1990 A) GAS - IN REAR BY LOADING FOR PHARMACY B) ELECTRICAL - IN ELECTRICAL ROOM AT REAR C) WATER - IN FRONT AT STREET WITH LARGE ABOVEGROUND VALVE D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 10/04/1990 PRIVATE FIRE PROTECTION - ON SITE HYDRANTS, FULLY SPRINKLERED AND FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ON AND OFF SITE. Building Occupancy Level -5- 04/20/1998 ;~'- .... .. f\:. e e f KAISER MEDICAL CLINIC I F Training Employee Training SiteID: 215-000-000117 ì Fast Format ì Overall Site ì 04/22/1994 WE HAVE 28 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM EFFECTED. IF PROBLEM DEVELOPS CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. Page 2 r I I Held for Future Use Held for Future Use -6- 04/20/1998 I···· .' . . .. - ~ .-," :;~,-~ , .' .' ,,'. . ..~- BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN. " INSTRUCTIONS: }~:J:~;';'rrfÖ-ÒVOid'fljrther"áèt¡ô~~:ietürn;1hfs'form within 30 days of receipt. :IOY;;,:ir'c:5·:,99S·,···· .' ·2:uu. TYPE/PRINT ANSWERS IN'ENGlISH. 3. Answer the questions below tor the business as 0 whole. 4. Be brief and concise os possible. ' SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: STOCKDALE MEDICAL OFFICES MAILING ADDRESS: 3501 STOCKDALE HIGHWAY CITY: BAKERSFIELD STATE: CA ZIP: 93309 PHONE: 805-398-5023 DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIV1TY: MEDICAL CARE OWNER: KAISER FOUNDATION HEALTH PLAN MAILING ADDRESS: 3501 MING AVENUE SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE. 1. ADMINISTRATOR ON CALL 805-632-3353 2. BILL ORR, DEPARTMENT ADMINISTRATOR 805-398-5023 ,......;.-!\.. . " Bakersfield Fire Dept. eazardous Materials Division . HAZARDOUS MATERIALS MANAGEMENT PLAN .-i._,_ .._:--:-. .. , SECTION 3: TRAINING: "... NUMBER OF EMPLOYEES: 60 MATERIAL SAFETY DATA SHEETS ON F¡U~: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL , .-' 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 00 NOT HANDLE HAZARDOUS MATERIALS. 'x , . . .. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TíMEEXCEED THE MINIMUM REPORTING QUANTrnES. OTHER (SPECIFY RE.;SON) SECTION 5: CERTIFICATION: I, JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBUGA nONS UNDER THE "CAUFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.9'5 SEC. 25500 ET Al.) AND THAT INACCURATE INFORMATION, CONSTITUTES PERJURY. ASST. MEDICAL GROUP'ADMINISTRATOR TITLE DATE .~ -. ') '., ," - '.. . '. . ,. . , . - .' -",.' . . . .- " -"'" ø ~i.,._ '....-1" . . .' BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ¡ 1715 CHESTER AVENUE, 3RD FLOOR ,¡ . ¡ BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN. INSTRUCTIONS: IJ ::.~' ;':':;'~Tô'avo¡d further ,áction; retûrn'this form ~ithi~ 30 days of receiPt.,::~,:IOV~~O;"·5;;ii'995~j¿,j!;~,)~ . '2. -. TYPE/PRINT ANSWERS iN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: 4000 PHYSICIANS PLAZA MAILING ADDRESS: 4000 PHYSICIANS BOULEVARD· CITY: BAKERSFIELD STATE: ~ ZIP: 93301 PHONE: 805-631-3925 DUN & 6RADSTRE::T NUMBER: SIC CODE: PRIMARY ACTIVITY: MEDICAL CARE OWNER: SIERRA FAIRWAY ASSOCIATION MAILING ADDRESS: 1104 PRINCETON, BAKERSFIELD, CA '93305 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. LEROY ~MAT.F., M.D. ·805-871-9055 -. 2. LYNN VALOS, DEPT. ADMINISTRATOR 805-631-3911 , . Bakersfield Fire Dept. . 4tazardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN ,,-~'-~ ...;...;;..~. .. , SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 13 MATERIAL SAFETY DATA SHEETS ON FILE.: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL .., SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAfMY BUSINESS IS EXEMPT FROM THE REPORTING REQU!REMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING RE.tl.SONS: WE 00 NOT HANDLE HAZARDOUS MATERIALS. - x , WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANiiTIES AT NO TíMEEXCEED THE MINIMUM REPORTiNG QUANTrnES' OTHER (SPECtFY REASON) SECTION 5: CERTIFICATION: I. JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S 08LlGA TIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄT INACCURATE INFORMATION. CONSTITUTES PERJURY. SST. MEDICAL GROUP ADMINISTRATOR TITLE DATE ... '-"'''''"r~ _. ') '. :. . ,. .: , . ~ 1/' . . ...... BAKERSFIELD CI~ FIRE DEPART MEN f1,/f:?';:l;:--:. _ OFFICE OF ENVIRONMENTAL SERVICES i !::f~C;~~l~~ 1715 CHESTER AVENUE, 3RD FLOOR ¡J, /VOl! "~' ~/ BAKERSFIELD, CA 93301 8 :1 0 7995 (805) 326-3979 . 'Y~ HAZARDOUS MATERIALS MANAGEMENT PLAN',' ' INSTRUCTIONS: , '~:t'~;r,~'~:i;~¡~;~~i~:Övôid turthêr>,actiôn:' ieturÎ1this fòrm within 30 days of receipt. :. JfOV~~itr'5:';¡f995~' ' ,,' . :2;- '" ""TYPElPRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: 16TH STREET WAREHOUSE MAILING ADDRESS: 3101 - 16TH STREET CITY: BAKERSFIELD STATE: ~ ZIP: 93301 PHONE: 805-633-5900 DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIV1TY: MATERIALS MANAGEMENT AND MEDICAL RECORDS MAILING ADDRESS: PACIFIC WEST MANAGEMENT 16027 VENTURA BOULEVARD, SÜITE #601, ENCINO, CA 91436 OWNER: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1 . JEANNE MESHEKOW ,818-995-7965 2. ADMINISTRATOR-ON-CALL 805-632-3353 ~-......--~-- . : Bakersfield Fire Dept. e 4tazardous Materials Division - HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAIN1NG: NUMBER OF EMPLOYEES: 26 MATERIAL SAFETY DATA SHEETS ON FIL~: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL -- ....._-. .', SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THArMY 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. ~~ _-_---::: ,....0..:.-...., _~ ....-.:-----...:......-.........---:-~-- ----"'"""--~- -- -,,--, ------ --=-~~-- . - .--...... x WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTtTlES AT NO ïiMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: ." . . \ - ---..:.,--. -~ I, JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBUGATIONS UNDER THE "CALlFORNIA HEALTH AND SAFEïY CaDEll ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄ T INACCURATE INFORMATION, CONSTITUTES PERJURY. ASST. MEDICAL GROUP ADMINISTRATOR TITLE ~ ?-'J_ -----,~------ ---- DATE. ~ .-. ,. . < . . '. . . . .' ,- . BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979! HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: ·>::L·?~Jsr,TÕ:Oàvõ'ièrfLirthér'åètìon;·~eti.Jrn this form within 30·days.'ot receipt., ':2:"'C""C lYPEJPRINT ANSWERS iN ENGLISH.:' . 3. Answer the questions below for the business os 0 whole. 4. Be brief and concise as possible. . ,'IOVi:iÕ:5"1995 . 1- <.: SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: 2000 PHYSICIANS MEDICAL OFFICES MAILING ADDRESS: 2000 PHYSICIANS BLVD C!TY:BAKERSFIELD STATE:~ ZIP: 93301 PHONE: 805-631-3925 DUN & BRADSTRE::T NUMBER: SIC CODE: PRIMARY ACTIVITY: MEDICAL CARE OWNER: ,,' wa.---Wii.T_i:~_ð.SHER - - - -- - -~ - - - - ---- --._-- --- -- . -, -.,,- - -"-- ---- -~-- -- .. MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE - - - - - -- -- -- 1 . SUSAN HARRIS -. -805-861-0676 2. LYNN VALOS, DEPARTMENT ADMINISTRATOR 805-631-3925 - Bakersfield Fire Dept. &zardous Materials Divisiane HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 29 MATERIAL SAFETY DATA SHEETS ON F¡L~: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAr-MY BUSINESS IS EXEMPT FROM THE REPORT!NG REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE 00 NOT HANDLE HAZARDOUS MATERIALS. -." --+..,.-.."'--'" - -" -~ --.:-- -". --=......- - -~-- -. - -- - ~ "': -..-- '- ;- - . ~ .;.. - - - " - ---- ..---- - --. x WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANifTlES AT NO ïiMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I. JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBUGA TIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄT INACCURATE INFORMATION, CONSTITUTES PERJURY. .. ASST. MEDICAL GROUP ADMINISTRATOR TITLE DATE. 'J ,,,:,,,,,.;'1 . ,- : , ,,, .....~.-. ~"'.""'" . .. '--. . , , " . . ~ '-~ :_;;'!. . . .- BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 ,I ! HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: . '.~1:,::~j!;,;;1~;f8ãvò'¡d 'fürthetã~t¡óF;;'iëtüiñh this form ~ith¡n 30 '(jay; of receiPt:",~' :IOW(::'O/5:'i:i995,:,:,'~'i~ , '2. ,-' TYPElPRINT ANSWERS'IN ENGLISH. ' 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: 5055 CALIFORNIA AVENUE MAILING ADDRESS: 5055 CALIFORNIA AVENUE, SUITE #110 ) CITY: BAKERSFIELD STATE: ~ ZIP: 93309 PHONE: 805-334-2006 DUN & BRAOSTRE::T NUMBER: SIC CODE: PRIMARY ACTIVITY: ADMINISTRATIVE OFFICES OWNER:'DAYSON VÉNTuRE '#1; c/o M~D. ATKINSON MAILING ADDRESS: 5500 MING AVENUE. SUITE #228. SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. ADMINISTRATOR-ON-CALL 805-632-3353 ..-- SHELLEY 2. 805-397-5001 " Bakersfield Fire Dept. eazardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 54 MATERIAL SAFETY DATA SHEETS ON FILE,: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL 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 00 NOT HANDLE HAZARDOUS MATERIALS. - ---- --. X" -.....'!I-::-;'... WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TiMEEXCEED THE MINIMUM RE?ORnNG QUANTmES. OTHER (SPECIFY RE.~SON) SECTION 5: CERTIFICATION: I, JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFEïY CaDEll ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄT INACCURATE INFORMA TlON·CONSTlTUTES PERJURY. ASST. MEDICAL GROUP. ADMINISTRATOR TITLE DATE ., . ,",<';. .,,~ ~··"i " - - ~- ,. ".-.,.-. . ~. , . .' . " - .-.:...... . . ,..... .' ,'~ . BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES' 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 ·1 i HAZARDOUS MATERIALS MANAGEMENT PLAN ,';, INSTRUCTIONS: ~i;--·l:::-::. ·'-:;~')o"âvoÎë(tù·rther·,áctiôn.rètUrri thi'storm withi~ 30 days of receipt.' .. :IOV~¿¡;'O;'~5¥.1995;·,. . '2. . ,'-.., TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. - SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: CENTRAL MAILING ADDRESS: 3733 SAN DIMAS STREET CITY: BAKERSFIELD STATE: ~ ZIP: 93301 PHONE: 805-631-3008 DUN & BRADSTRE=T NUMBER: SIC CODE: PRIMARY ACTIVITY: APPOINTMENT MAKING OWNER: KAISER PERMANENTE MAILING ADDRESS: 3733 SAN DIMAS STREET, BAKERSFIELD, CA 93301 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHOI\lE 1.ADMINISTRATOR-ON-CALL . 805-632-3353 2. MARILYN LUKE, DEPARTMENT ADMINISTRATOR 805-631-3016 , . Bakersfield Fire Dept. eazardous Materials Division ,e HAZARDOUS MATERIALS MANAGEMENT,PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 42 MATERIAL SAFETY DATA SHEETS ON F¡L~: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL SECTION 4: EXEMPTION REQUEST: . . ¡ CERTIFY UNDER PENALTY OF PERJURY THArMY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REi~SONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. - . ,- -- X WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TiMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPEClFY REASON) SECTION 5: CERTIFICATION: I, JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. ¡ UNDERSTAND THAT THIS INFORMATION WILl8E USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CAUFORNIA HEALTH AND SAFETY CaDE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION, CONSTITUTES PERJURY. ASST. MEDICAL GROUP ADMINISTRATOR TITLE DATE ') ......,," <" ~. r:-' ' ,.... :1'" _),.C ._.," . . , ... '..'-"!..-. I"· . , "."- " . .- - -~~ ......; .~~ , .' BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ; 1715 CHESTER AVENUE, 3RD FLOOR ¡':' i, _,do' BAKERSFIELD, CA 93301 (80s) 326-3979 .' . .1 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: ;'l,t~r;,:;::)~:~Oia·furthe''t:aëtÌôr.¡~eretúrn:this iorm ~ithin 3Ò·dåy;'.~t re~eiPt.: .... l'ItOV";~;:O/5;::i995:' ·2:-- ',". . TYPE/PRINT ANSWERS IN ENGLISH. ' 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: KAISER PERMANENTE LOCATION: ;"M.ING AVENUE MEDICAL OFFICES MAILING ADDRESS: 8800 MING AVENUE CITY: BAKERSFIELD STATE: ~ ZIP: 93309 PHONE: 805-664-3712 DUN & BRADSTRE~T NUMBER: SIC CODE: PRIMARY ACTIVITY: MEDICAL CARE OWNER: RAISER FOUNDATIÖN HEÁLTH_ PLAN:-~'~~;<::: MAILING ADDRESS: 8800 MING AVENUE SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. ADMINISTRATOR ON CALL 805-632-3353 2. PEGBOARD, DEPARTMENT ADMINISTRATOR 805-664-3712 .., · . . Bakersfield Fire Dept. e,azardous Materials Division tit HAZARDOUS MATERIALS MANAGEMENT PLAN '~"'f-::-",... :-.. .. SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 43 MATERIAL SAFETY DATA SHEETS ON F¡L~: YES BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL , ,', SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAfMY BUSINESS IS EXEMPT FROM THE REPORTtNG REQUIREMENTS OF CHAPTER 6.95 OF THE "CALlFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING RE.'\SONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. - .....t x WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO iiMEEXCEEO THE MINIMUM REPORTING QUANTmES. OTHER (SPECIFY REASON) ,SECTION 5: CERTIFICATION: I, JOE WAGER CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WilL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFEïY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATlON,CONSTlTUTES PERJURY. ASST. MEDICAL GROUP'ADMINISTRATOR TITLE DATE. ~.-. _, .,< _0.4. .~~-~u··' " .---';' .......¡- ·' t'" . 04/12/94 -- . e 1 KAISER MEDICAL CLINIC 215-000-0001 Overall Site with 1 Fac. Unit General Information IBv Io~ Location: 3501 STOCKDALE HWY Community: BAKERSFIELD STATION 01 Map:123 Haz:1 Type: 3 Grid: 02B F/U: 1 AOV: 0.0 Contact Name Title MARSHA PRICE- ß¡ } Or-r ADMIN Business Phone (805) 398-5027 x () x 24-Hour Phone (805) 328-9831 ( ) Administrative Data Mail Addrs: 393 E WALNUT City: PASADENA Comm Code: 215-001 BAKERSFIELD STATION 01 D&B Number: State: CA lip: 91188- SIC Code: 8011 Owner: KAISER PERMANENTE Address: 393 E WALNUT City: PASADENA Phone: (805) 398-5000 State: CA Zip: 91188- Summary /, t,...J,LLIII.'" Or" D h (Type or print name) 0 ereby certify that' have reviewed the attached hazardous materials manage- ment plan for þl54"" R"~Aµt~U and that'~' . (Name -of Business) Ii a ong 'WIth any COrrections constitute a complete and correct man- agement plan for my facility. L::J J£~ ((L SlgnSI1II'Ø t/:';ß1 ,. 04/12/94 PIn-Ref Name/Hazards e e KAISER MEDICAL CLINIC 215-000-000117 Hazmat Inventory List inMCP Ordèr 02 -'Fixed Containers on Site Form 02-001 OXYGEN ~ Fire, Pressure, Immed HIth Gas Page 2 Max Qty MCP 770 Low GAL e e 04/12/94 KAISER MEDICAL CLINIC 215-000-000117 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 770 Low GAL CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL ----r-- Daily Average GAL ~ Annual Amount GAL 770 I 770.00 I 770.00 Storage r Press T Temp ~ Location PORT. PRESS. CYLINDER Ambient Ambient CLEAN UTILITY ROOM - Cone l 100.0% Oxygen, Compressed Components C MCP ---rGuide I Low I 14 e e 04/12/94 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification CALL FIRE DEPT. NOTIFY ADMINISTRATION OFFICE <2> Employee Notif./Evacuation PAGING\SYSTEM - LOCK DOOR TO ROOM <3> Public Notif./Evacuation N/A <4> Emergency Medical Plan DOCTOR AT FACILITY IF REQUIRED. ~, ,.~ e e 04/12/94 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention KEEP OXYGEN TANKS CHAINED TO WALL. BAG ALL INFECTIOUS WASTE AND STORE IN LOCKED ROOM. <2> Release Containment NIA <3> Clean Up DISINFECTANT AND MOP OR SPONGE. <4> Other Resource Activation , ~ e e 04/12/94 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 6 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - IN REAR BY LOADING FOR PHARMACY B) ELECTRICAL - IN ELECTRICAL ROOM AT REAR C) WATER - IN FRONT AT STREET WITH LARGE ABOVEGROUND VALVE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ON SITE HYDRANTS, FULLY SPRINKLERED AND FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ON AND OFF SITE. <4> Building Occupancy Level cr .~. (. e e 04/12/94 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 7 <G> Training <1> Page 1 WE HAVE i EMPLOYEES AT THIS FACILITY. ~~ WE DO HAVE MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM EFFECTED. IF PROBLEM DEVELOPS CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ê___,,·,,:,- ,.....,. e tit "- ~ " - 07/29/92 KAISER MEDICAL CLINIC 215-000-000117 Overall Site with 1 Fac. Unit Page 1 General Information Location: 3501 STOCKDALE HWY Map: 123 Hazard: Minimal Community: BAKERSFIELD STATION 01 Grid: 02B FlU: 1 AOV: 0.0 , --- Contact Name Title Business Phone - 24-Hour Phone ANITA 'PERtF.N'B' µ C-;::>~ ADMIN (805) 398-5027 x (805) 328-9831 VICltI M.IJTU ~~ ADMIN (.a.g§ ) J98 5835 x.... (805) 328-9831 Administrative Data Mail Addrs: 393 E WALNUT D&B Number: City: PASADENA State: CA Zip: 91188- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 8011 OWner: KAISER,PERMANENTE Phone: (805) 398-5000 Address: 393 E WALNUT State: CA City: PASADENA Zip: 91188- Summary RECEIVED S£P 2 2 1992 HAl. M.&\T. OtV. - ' I S'1M ~~l~u.... . Do hereby certify that I have t (Ty,eorprintname) reviewed the attached hazardous materials manage- ment plan for v..~\~"U- ~~d that it along with (HallIe of BusineU) . any corrections constitute a complete and correct man- agement plan for my facility. ~))- 't\ìì£l~ Date L" ..' ~ e e 07/29/92 KAISER MEDICAL CLINIC 215-000~000117 02 - Fixed Containers on Site Page 2 Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 770 Low GAL CAS *: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max GAL ----r-- Daily Average GAL --r-- Annual Amount GAL 770 I 770.00 I 770.00 Storage r Press T Temp -:-1 Location PORT. PRESS. CYLINDER Ambient AmbientlCLEAN UTILITY ROOM - Conc -\ 100.0% Oxygen, Compressed Components C" MCP --rList Low I ~ ., ~ \ e e 07/29192 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site ,Page 3 <D> Notif./Evacuation/Medical <1> Agency Notification CALL FIRE DEPT. NOTIFY ADMINISTRATION OFFICE <2> Employee Notif./Evacuation PAGING SYSTEM - LOCK DOOR TO ROOM <3> Public Notif./Evacuation N/A <4> Emergency Medical Plan DOCTOR,AT FACILITY IF REQUIRED. .' '. .' .. e e I 07/29/92 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page. 4 <E> Mitigation/Prevent/Abatemt <1> Release Prevention KEEP OXYGEN TANKS CHAINED TO WALL. BAG ALL INFECTIOUS WASTE AND STORE IN LOCKED ROOM. <2> Release Containment N/A <3> Clean Up DISINFECTANT AND MOP OR SPONGE. <4> Other Resource Activation .". '. .' to e e ç - 07/2'9/92 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 5 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - IN REAR BY LOADING FOR PHARMACY B) ELECTRICAL - IN ELECTRICAL ROOM AT REAR C) WATER - IN FRONT AT STREET WITH LARGE ABOVEGROUND VALVE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ON SITE HYDRANTS, FULLY SPRINKLERED AND FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ON AND OFF SITE. <4> Building Occupancy Level .t) .. 'C· '"" e e , 07/2'9792 KAISER MEDICAL CLINIC 215-000-000117 00 - Overall Site Page 6 <G> 'X'raining <1> Page 1 WE HAVE 5 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM EFFECTED. IF PROBLEM DEVELOPS CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. <2> Page 2 as needed <3> Held for Future Use ' <4> Held for Future Use e e ii¡r¡ I<AlSER PERMANENTE Kaìser Foundation Health Plan, Inc. Southern California Region March 18, 1992 City of Bakersfield Treasury Division P. O. Box 2057 . Bakersfield, California 93303 Attention: Drew Sharples, Financial Investigator Dear Mr. Sharples: Unless we receive all billings to Kaiser Permanente of whatso- ever kind at the following address, we will have no way of knowing that a payment is due: KAISER PERMANENTE or KAISER FOUNDATION Property Acquisition Dept.j5th Floor 393 East Walnut Pasadena, California 91188 Attention: Steve Parkinson HEALTH PLAN \ ,J' ,. (, ' u...(l , : \. ,~v /-" ,,\ \ v /\ \ , , l\ Sinråre1Yí -1 ) , /7) \ 1( ~ / x\,· '~V'" \[: /\ / , , \ \. \, .\ x.\ I. Thank you for your cooperation. /(.1 r /;r/~'~ /~i.'· ~-~ //W?~·~-__. ~ Steve ParJft~n', CPM - PROPERTY MANAGEMENT SPECIALIST v"" " {} c.- c.-cnt/..J ~ Q,':B 01037 If l'VJ "7 () / 4 'J i " ) r I I W ""t I r - !./" "l.- I -¡ ; t.:.'"¡' ,'""",! (I i ,(;,_) I '. ..." ...,- NS·6)·P (!-8H . Walnut Center . Pasadena . California 91188 I ~¡f '" /"¡,' . '. ' I HAZARDOUS MATERIALS MANAGEMENT PLAN (02- Gr· { '~7C- " Bakersfield Fire De! Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 ()Y-- INSTRUCTIONS: 1. 2. 3. 4. To avoid further action. return this form within 30 days of receipt, TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be brief and concise as possible, SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: K-f\..\'ßf:.R.. 1\=.RMiW~\\:- LOCATION: ~~9i- ~''''',...v-''f'-\'''L ~~(¿~..... MAILING ADDRESS: "S~M i:- CITY: ~~~f'~\) STATE: ~ ZIP: DUN & BRADSTREET NUMBER: ';~ \?r 1 r........ PHONE: 3'{ß- 5CJC>c SIC CODE: PRIMARY ACTlVITY:tJ\1:...\,)\~'- ~f\\{...~- ~n"'~\~4 OWNER: \.(þ..\~~ f\=- £) tJ\ ~ 1:-tJ.-CE- ,,~~~~~~ ,C-~, 9\\~V MAILING ADDRESS: ~~~,.f1 ~-C~\ ~Co'~~~.2.o:;:~·<::<f~"¿;J:~TS· // SECTION 2: EMERGENCY NOTIFICATION: CONTACT 1, ~Ñ\\~ ~~~~ 2, ~ \ c.:"_\ R~ -N-\::.- BUS. PHONE TITLE ~~M "..1. (SoQ)3CfA- S01.t" ~ N\ \ t\.\ I '3't ~ - 5(:)3..~ 1 , 24 HR, PHONE ~'l.ß - 'te3 \ 3-z..ß - '{%~ \ FD1590 Bakersfield Fire Dept. tit Hazardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN I '\.., '{-'"" :, , I '~..i, · 1'1 SECTION 3: TRAINING: NUMBER OF EMPlOYESS: 5 MATERIAL SAFETY DATA SHEETS ON FilE: 02- BRIEF SUMMARY OF TRAINING PROGRAM: ~ ÞN\"\.-oS~ ~ ~\'\-\~ =t-l ~~~ "è"-t~~~ <é( ~'bc..\~- C>N~ C_~""'i"~\1\\. ~~~tc.U ~v't- ~'0~""..:>,"ì.\'\~ ~ '"'N\\\¡-..)\W\¡\\-\-- ~U~"1 \}~""'c- \..~ ~N\ ~~ \f- ~~0l-fc..M. ~~c¡\~-rS. - ~ ~ t.:I~'-\M- or o~ C(,t.4U cfL- ~~~~ <..Q)~ ~\'-1Løu\, ~\..f)\~ UJ~ì~. . ì,~ 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~ CERTIFYTHATTHEABOVEINFOR- MAT/ON IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMA TION,CONSTITUT.ESP-ERJURY. . ~ ~J' ~·P-~~Ù"""ì SIGNA TUR ' , TITLE ~ \ \31'(0 DATE 2. FD1590 \~~,r~ " .{ ."'~ ,J' e Bakersfield Fire Dept. Hazardous Materials Divisi<4!t ~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: \L~ '- o~~c(.\..tù '"l~\I-& q4....w,)\tQ) ~\.c U.)~ "'ß~ ~\....l..- LU~ .." t- \ è'"1o~ \ \\,;) l.-c::.c»-~ ~iV\ B. RElEASE CONTAINMENT AND/OR MINIMIZATION: ~(~ C. CLEAN-UP PROCEDURES: \)\ð\~ f"~~i'-t,r-l ~~~ ~o~ {~C>Ñ"'ct-- SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ¡~ ~.\f.fI~_ ~~ Lo~\\\,)c, "feta- ~~~~ 0'0 'Ú>þ¡~ ELECTRICAL: \I\'i,¡ '=--<-Ç::.e.... ~M. ~ ~~ WATER: h~ ~~ P.> ò'1\\--~' - ~"- ~cù('e. ~\k.ö~tI uf!ruJ*- SPECIAL: LOCK BOX: YESÐ IF YES, LOCATION: SECTION 9: PRIV ATE FIRE PROTECTION/WATER A V AILABILITY: A. PRIVATE FIRE PROTECTION: c~ 'E>ne- \\.'t~~~ "\,u\...l-~ ~t~\N.\ "\.-~ t-\?-~ l::,...""fo·'\Ñ.~Ò\~~~s. ~~\\~L" ~~ ~'f.Ç't~ I B. WATER AVAilABILITY (FIRE HYDRANT): ON. ~ Ciff .sn~ 4, FDI590 . Bakersfield Fire Dept. It Hazardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN I FacilitY Unit Name:\.(..-þ...\~ ~ SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: c-~ r-\~ 'b~\. ~ ~ U\.) I C> \f'c..>t..- ,~o 1.\ f( ~D B, EMPLOYEE NOTIFICATION AND EVACUATION: . ~k\tVCt S:¿.&'TIcAV\- ~Þ\l-- ~~ to ~W\. C, PUBLIC EVACUATION: ~O\, ~~,-,(p-~ D, EMERGENCY MEDICAL PLAN: ~~ ~c>c-.'"t~ ~ ~\.,\~ l~ ~\P--k.(.:) 3. ~ "", 'Î'r~, '(~ ' I "\f I r I. R)1~ , . HAZARDOUS MATERIALS INVENTORY Farm and Agtlculture [] Standard Business ~ r NON-TRADE SECRETS Paqe BUSINESS NAME: 4\~~ OWNER NAME: ~"'\~1:.J2- NAME OF THIS FACILITY: ¥-~~U- b9r¢ T I 2~ Þ: .~7- ~'C)c..\I-~_ .-- è9~QES~ i P:~~~ 5MN2~~O Bh~BsT~~~YS NS~B~~='---'--' . ...~-,------"---- PHON~ II: r~\'~' ~ .-- PHON~ II: ------, - " REFER TO-7NSTRUCTIONS-FDR-PROPER CODES - ~ - - 6 1 8 9 10 11 ,12 13 It Mea$ure I Dys Cont Cont Cont Usa locat Ion where 'by tlalles of IIi xture{CcII'conents U 3 on SIte Type Press Temp Code Stored In FacI I Ity Wt See Instru: Ions .\~,~~,,\ '.' .;-,:::. ."2'1 ~'"' 0 , Co~ponent II Name & C.A.S. Number O"6-~Ci~ O Component-12 Name & C.A.S. Number I mmed ia te Health Component 13 Name & C.A,S. Number C,A.S. Number o Fire Hazard o Reactivity o Delar' ed '[}( SUdd;n Release Hea th ~ 0 Pressure ~" '.; CITY of ~AKEHSrltLU of \ t> Phï~ical ood Health Haiard lçheck all that apply :P [] Fire Hazard [] Reactivity fit Delared [] SUdd;n Release Hea th 0 Pressure ~\V\ ~ ~ Component 11 Name & C.A.S. Number ""'~\~ Uj~ì.t... ~ Component 12 Name & C.A.S. Number I,N Immediate Hea Ith Component 13 'Name & C.A.S, Number Physical ond Health Hatard lçhe:k all that applYI C.A.S. Number o Fire Hazard o Reactivity o De Jared 0 SUdd;n Re I ease Hea th 0 Pressure Component.1 Name I C.A.S, Number O Component.2 Name I C,A,S. Number Immediate Health Component 13 Name I C,A.S, Number O ,Component 12 Name I C.A.S. Number Immed18te Health Component 13 Name I C.A.S. Number EMERGENCY CONTACTS #1~~..."t~ T~ I\'\.l~ , 2fi"~P~~-(-L tl2Rãñi~\u~ ~~-r"f-t. ' nt~M \,~ CerlifiotioQ fReed and $i9n afìf3r cÇJmp1etin9. ç¡11 sect,ions} . , I certIfy under penallx 0 la~ th~t J have persona Iy examlnao OQd an famllla( with the info(matlon $ubnltte~ In this ond all ~ attaçhed dQCUMnts. ano t at b sed n, my Inquiry 0 those Indlv',duats resp, onSlble lor obl..",g the "I""tlon. I believe th.t the ---L submItted Informa n IS tr e a ate, and co~plete. ~~~ ~'~~~ ______________~ It. op rator UR o\ n~)tfrÀWaut~~~lve STgñature Phy~ical ond Health Haiard , ICheck all that apply C,A.S. Number o Fire Hazard o Reactivity o De Jared 0 Sudd;n Re 1 ease Hea th 0 Pressure .' . ./" Component II Nane I C.A,S. Number irn''f'b~rJ-- : , " ~~ '\~i1 cro I oLnìi~e ~þ- ~ t ~- ""',IliIUITI171h.... ~\,\ ~"'~~~::':!'!l ;::: ,'/\'<.1.. j) ,..,"- .~ .§~, ~~; . .~~~ == ¡;; '~; h({J ¡ ~ ~ -'< 1~ :nS:::::2 s~~ ...,~-... ~" -, .~~ ~'-. -',' ~ _0" l ~",-'h- "'~""/. ""h -- - ~.''''", ~I/Il--'" e -pr" :-~....~r-:;e¡,..:; ¡:¡,~.,...~ L'e.........·( ...l.-ic::...i~L..... ...:)Á~ .....\......i.. .... ..u.. """ J ~t . ... Hazardous Materials Di.ion TO: BUILDING DEPT. BUSINESS NAME k-D.-~~ P_Q)üY"Y\AJ~ih ~ LOCATION 15<600 ~c¿ ~ STATUS OF HAZ MAT REGULATIONS I. \á Required to complete a Hazardous Materials r13usiness Plan .~,< ...Hazardous Materials Business Plan Complete II. 0 Risk Management & Prevention Program Required o Risk Management & Prevention Program Requirements are being met - OK to issue permit o Risk Management and Prevention Program has been approved, OK to issue Certificate of Occupancy, III. 0 No Hazardous Material Requirements. IV, 0 All Hazardoùs Materials Reporting Requirements Complete. Comments: -,; _1-d--C,-30 Date FD 1 655 Rev 1/90 D<::il\..C::l ':'ilelU FllCUClJl. Hazardous Materials Diwon HAZARDOUS MATERIALS COMPLIANCE STATEMENT (To be completed by Building Permit Applicant and/or Site Plan Review APPlicant). 2 9 '900 , AN I I ¡~ ~~, e REC:=¡VED BUSINESS NAME M}~ æf<~ 1Y\E::I2.J~ mœ~O V. ø~ ~ AVE,. LOCATION PLEASE READ ALL OF THE INFORMATON CAREFULLY, FAILURE TO COMPLY WITH THE HAZARDOUS MATERIALS REGULATIONS MAY RESULT IN CIVIL LIABILITIES OF UP TO $2000.00 FOR EACH DAY IN WHICH THE VIOLATION OCCURS, YES NO Will the Applicant or future building occupant be required to complete a Hazardous Materials Business Plan? D (NOTE) If you handle, store, use or dispose of, reportable quantities of any hazardous substance, you are required by California Law to complete a Hazardous Materials Business Plan. Forms can be obtained from the Bakersfield Fire Department, Hazardous Materials Division, 2130 G Street. Typical every day hazardous materials you may find in your facilities may include, but not limited to: compressed gases; fuels - all types; solvents; oils (new and waste); thinners; caustic or corrosive materials; poisonous or toxic materials; and radioactive materials. Will the applicant or future building occupant be required to complete a Risk Manage- ment and Prevention Program? YES D (NOTE) If you handle. store, use or dispose of reportable quantities of any extremely hazardous substance you must develop a Risk Management and Prevention Program. THIS PLAN MUST BE APPROVED BY THE LOCAL ADMINISTERING AGENCY BEFORE YOU COMMENCE OPERATIONS AT THIS FACILITY. The list of regulated chemicals is contained in Appendix A of part 355 of Subchapter J of Chapter I of Title 40 of the Code of Federal Regulations. This list of chemicals isavailable at the Bakersfield Fire Department. Hazardous Materials Division, 2J 30 G Street. Will the applicant or furture building occupant be required to obtain a permit from the Kern County Air Polution Control District? YES D Location within J .000 feet of outer boundry of the following: YES School -(any school. public or private used for the purposes of education of children Kindergarten or any of grade J to 12. inclusive) D D D Hospital . Long Term Care Facility - Check here if none of the above apply to this project. q 1 r$J Signed: Date: 1.4 ~ crt:> ~ NO W NO ~ NO ß ø m D FD 1654