HomeMy WebLinkAboutHAZ-WASTE REP 6/22/2009
'(-
\
.'i
FORM 1772 .1DßJJ~i~Y1:{EVIEW PROBLlf CHECKLIST
PROBLEM IDENTIFICA TIOr~i
Fadlity Name:...JttorI ~~~ia" ID # ~ 000 M6 ~16
. e::tUA.
~ INITIAL NOTIFICATION CUPA: Ate Þ=pI-
e O'fHER (amended, closure, withdrawal, exempted)
e
I.
e
e
a
e
D.
o
o
e
o
DI.
,ð
IV.
8'
o
o
Notification Cateeories:
Tiers marked do not match type of fonns filed.
## of fonns attached do not match total # of units.
Tier 'A' checked With other tiers.
Generator Identification:
EP A # incorrect/missine
Name/Address incomplete
Contact Person/Phone # missine
Type of Company: Standard Industrial Classification Code - missing
Attachments (missing):
o Certification(s)
a Plot Plan missing
No signature/tit~~
Questionable title
No original signature
Unit Specific Fonns:
a Unit Name/Unit ID # - missing
a Number of Devices - # (x is unacceptable)
I.
e
0
a
0 ß.
e III.
a IV.
Waste streams & Treatment Processes
Total Volume Treated - no quantity
Waste streams - none marked
Certified Technology - certification ## missing
Narrative Descriptions: Blank
123
Residual Management - #3 -letter not checked when Yes (others can be blank)
Basis For Not Needing A Federal Pennit - missing
Additional Comments/Problems:
Reviewedby~
Date: f/2 '1/q~
-v '.
7\~'e O,~O...... ~.I"IIIÍII L~b_~.I.D ~
~ ~q I <¡)Q.\
_ Depanmca& 01 Tøic SuW"_ C.1W'o1
.. Pa¡e 1 of _
~ ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION
FACILITY SPECIFIC NOTIFICATION ;a
For Use by Hazardous Waste Gellerators Perla "'r¡fo;,¡,...JlWRTMENT OF TOXIC
Under CoaditioaaJ Exempåoø lad Conditioaal AU'~~,~~ANCES CONTROL
and by Permit By Rule Facilities ;J~:
~~" JUN!' I.
Please refer 10 the aIladred In.r17Uaions 1Nf0n complsing this form. You mtlY 1IDn hit n than one pÐ1tÚ11i
norifiCalionform, DTSC 1772. You musl attadJ a sqKlrøle II1Úl specific norifiazrio ~ M
differmr unit specific Mrificarionfomrs for five of the ctIlegorles and an o.4dilioNZl. ' Ie units
(ITU's). you only htrve 10 submit forms for the tiu(s)/CIlIegory(ies) thaJ cover your unlt(s). Discard or recycle the other lI1UUed
forms. Number each page of your completed notifiazrionpadr.age tl(rd ÎNÜCtlle the tottllllll1llber of pages ar the top of «1m JHlgø Dl
1M 'Page _ of _ '. 1'ul your EPA ID Number on ~ page. PletJse p7T1VÚ:Ú all of 1M informalion requested; 'llllfieltJs must be
complaed t!XCqJl those ,that SIDle 'if diJf~' or 'if ilVØÜDble'. Please ry¡n the injomuzrion provùúd on this form and œry
aIlacJrmenls.
1ñe norijiauion fus an assessed on the basis of the mghest tier 1M Mtijier wlU t1ptl'Øle under and wlU be coUtt:ltJd by the Stare
Board of Et¡uizlimtion. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOT1F1CATlON FORM.
I. NOTIFICA.110N CATEGORIES
In.diCllle the 1UI1ffbeT tJf II1ÚU you operate in «Idr tier. 'lids wiU also 1M 1M II1l1JIbø tJf II1Ii.t sp«ijic norifiazrion forms you
must anadz. ConditioMll} Exempt SnuIll {};ruIIItüy TreøtmÐU t1JH1fIIØn """ IIDI opmlte IUÙtI ruuler till} other tier.
Number of units .ad attached unit spedfic øodficatioas for' each tier reponed.
A. CoDditiouaDy Exempt-Small QuaDIity T~'~'. (CBSQT) . D. ~ -.Peu.nit by~~~~B,~J, _'__'_-=~- -=-__,
B. ....L. Conditicmally Excmpt-~pecified Wastestrcam (CESW)E. ___,-CEd:ommercial,1,.auDdry (~-CL.)
C. . CoudiIiODa11y Authorized (CA) .. ... ,,' ,. F. .;.;.;;;;;...;;;-Coødiûcmally E.xempt-Limited.<q::L) .
-_..-
..... --- .....
U. GENERATOR IDENTIFICA110N
EPA ID NUMBER CA.1. JL Q.. º- L.!t...2.. LL8~ BOE NUMBER (sf available) H_H<t- _ _ _ _ _ __
FACnJTY NAME KERN RADIOLOGY MEDICAL GROUP. TNC. -KA T SER STOCKDA LF.
,(DBA-DoiD¡ Busiøess As)
PHYSICAL LOCATION 3501 STOCKDALE HWY.
CITY
BAKERSFIELD
CA
ZIP93309
COUNTY
CONTACT PERSON
KERN
D'LN
(first Name)
BROWN
(Last Name)
PHONE NUMBER<.aa.5..) 1?? - 1981
MAILING ADDRESS, IF DIFFERENT:
COMPANY NAME
KERN RADIOLOGY MEDICAL c;ROTTPr TNr.
STREET
2301 BAHAMAS DRIVE
CITY
BAKERSFIELD
STATE -f!. ZIP93309
COUNTRY
CONTACT PERSON
(oaly compJccc Ü QQ' USA)
D'LN
(FltSt Name)
BROWN
(1..u1 NUDe)
PHONE NUMBER(805 ) 322 _1981
DTSC 1172 (1/96)
Pale :
m.
EPA [D NUMBER CALOOO.28
RADIOACTIVE MATERIALS OR WASTE
!.
Page' 2 of I
-«
~
e
J. .
õ fiö Does Ìhe f;.;~!tý;.... ~:+ radioacûvc ......ws or .-.a;vc was..? (
. ~.t I î
IV. TYPE OF CO~: STAND.$» ~USTRIAL CLASSIFICATION (SIC) CODE:
'I
, .. ..-,_., '"..~ I
Use GlMr OM or IWØ SIC codu (a lour di,iii1Ullflber) IluJl bur describe your company's products, servicu, or industrial activity.
,
.... . --;....----.......-.:::..
Extrmple: .
v.
YES
o
o
o
o
o
ZJM Phorøfinishintt l/Ib
7218 IndllStrÜÚ launderus
~nd:7384 PHOTOFINISHING LAB
,
First: 8011 MEDICAL OFFICE
CLINIC
PRIOR PERMIT Sl'ATVS: CMck,u or IIØ to each l Ilutiøn:
NO
œ
[XJ
1.
2.
Did you file a PBR Notice of lmem 10 Operare (DTSC Form 8462) in 1992 for this locaûon?
Do you now have or have you ever held a stare or federal hazardous wasœ facility full permit or interim
status for my of these tr-t'Inf!ftf 1IIIÙS?
[]
Do you now have or .have you ever held a swe or federal full permit or imcrim status for any other
hazardous wasu:.acdvides 11 this locaûop?
Haveyou"êVerJiê1ël ã virïauëè- isSued' by tië ~n~t of To,dc ~'~ Conttöl fOiihi twt~~-;~ii-"
are now notifying for at this locaJion? ." - . ..,
~~,_ __"~~ ,~l~~~ ~_~by th~ state or my local ageøcyas ahazardouswasteg~,:(" .
3..
[J' 4.
JiJ
VI. PRIOR ENFORCEMENT HISTORY: 1jot ret¡Øirtdfrom co1UliJiolUllly aempt genuatøn or commerciallaundriu.
YES NO
o 0 Wid1in the last three years, has this facility been the subject of any convictions. judgments. sculem=u.· ~ final
orders resulting from an action by any local, swe, or federal enVÍ1'OlUDeDtl1. haz.ardous waste, or public health
cnforœmcnt agency?
(For the purposes of this form. a notice of violation does DOt constitute an order and need not be reported unless
it was not corrected and became a final order.)
o If you answered Yes, check this box and anach a 1i.stiD.g of convictions. judgments. settlements, or orders and a copy
. of the cover sheet from each (lnl·umMlt. (See thè Instructions for more information)
vu. A Tr ACBMENTS: Atla&hmmts are aøt nl uirtd from cø1ll1lWt:Ü2l ùuuulria.
[2J
o
1.
2.
A plot plan/map detailing the locaûOD(s) of the covered UDÏt(s) in rela1ion to the facUity boundaries.
A unit specific notification form for each unit to be covered at this location.
l
DTSC 1172 (1/96)
Page 2
:
'.
\
EPA ID NUMBER CALOOOl.Z8
e
Page 3 o(
vm. CERTIF1CA -nONS: This form must In SÎgMd I1y Q1I aMlhDri:ed œ1'pOrøJe officer or œry other penon in the company who
h4r opera/ionaJ conrrol and performs d«ision-mDlång junaions tluJt gOWT1L operøJion of the jDciliry (per Tille 22. CDlifomitJ
Code of Reguú:uions (CCR) Seaion 66270.11). All three copits mu.st /unit origiluzl ngtUllrlres.
Waste Minimization I çenify that I have a pro¡ram in place co reduce the voluu=. quaøWy. &ad toxicity of waste geDCrlled 10 Ibe
degree r have determined to be economically prxùcable IUd dw I have selected the practicable method of treaUDcDt, storage. or
disposal currently available to me which minimi7.e$ the present aud future tbrea1 to human health and the c:DViroDIDCIU.
Tiered Pennittinl! Certification I ccrúfy that the unit or units described in these dOCUJ:DcDts meet the eligibility and oper.uiug
requiremc:Dts of swe SWUICS and regu!alions for the iwti(:Sled permiUiDg tier, includiDg generatOr aDd secondary COftf:llÎftftteDt
requirements. I understand thaI if any of the unitS operaœ UDder Permit by Rule or Conditional Authorization. I will also provide
the required fmanc:ial assurmce for c:1osure of the aaaoeur UDit b)t0c:t0ber 1. 1996.
1 certify under pcoalty of law thaI this document md all ~~--bft'lf!ft1S were prepared UDder my dir1:cúon or supervisioD in ICt'OI'daDœ
with a system designed to assure tlw qualified personnel property p1her and evaluate the iDformuiOD submiaed. Based on my
inquiry of the person or persons who manage the- system. or chose directly respoDSiblc for pIhcring the iDformapoD, the iDfomwiOD
is. to the best of my knowledge JDd be1id. trUe. aa:ura1C. aDd complete. .
I am aware that Ihere are substmûal peulties for submiaiDg false iDformIIion. iDcluding d1e possibility of fiDes aDd imprisoDmaø
for knowing violations.
DAVTD P. SCHAU:. M D.
:wIi
AM! rrd}
Si~ . - .
PRF.~TDF.N1'
rUle
D~ Signed, .'
.._. ..-.. _._--'~~"--
. . . -.. ... ". - -.
. .
IX. REQUESTING A SHORTENED REVIEW PERIOD:··Gøremton opmzring undO' Cf tmd/ør CE ørt 16gQ1ly à1IthDriÜi1~'-
to opuOJe 60 days aftu submilting a œmpltle nodjiœrion. DTSC 1IIIZJ shonen th~ li~ poitxl ~en nodjiœrion tmd_ ,.
authorization when the owner or opeTØ1or establishes good aJlUt. If you Med to be authorized sooner thtIn the .srøndard'- --.
6O-d4y period. pÙtZSt check the box below ønd SlOJt the TetUD1L' YDllr IDlÙJDTÎZ/IliDn wiU be IDIIDIIItIlÌCtJ11y eJltClÌve on tM-
dOJe your completed nDtifiauionjonn is r«aWl! by DTSC. (USt addilioMl sluers. if MCessary.)
YES
o Reasou:
- --..
OPERATING REQUIREMENTS:
PltaSt nolt tlu:lt gÐleTØlon tTealing Iuz:z.tmImu WlUte onsite are nt¡IÙred to œmply with a røunbu of opmuing requiremt!lllS which
difftr dqJmding on tlu liO'(s). 77wt DpÐ'tl1ing rU UÌmnÐW art ltl fonh in the stDtUla and regulOJions. some of which are
rqerenctd in the Tier--SJHdfic Faa Shuts availDb16 from DTSC's regional and het1dquJmus offices.
SUBMISSION PROCEDURES:
All three forms mzut hlne oririMl sigJUltUfU, øot phøtøœpw. You must submit two copies of this completed DOÙflCalion by
certified mail, ~tum receipt requested. 10:
Department of Toxic SubstaDCes Control
Program Data Management Section, HQ-I0
AnD: TP NoûticaúODS . Form 1772
400 P Street, 4th Floor. Room 4453 (walk in only)
P.O. Box 806
Sacramento, CA 95812-0806
You must also submit one copv of the noúfica1ion and anachmenU to the local regulatory agency in your jurisdiction as listed ÍD
oendu 2 of the instruction materials. You must also retain a copy as part of your opcra1ing record.
PI:.EASE, DO NOT SEND YOUR FEE PAYMENT wrm THIS FORM.
DTSC 1772 (1/96)
Page 3
I
.' \
EPA [D NUMBER e e
CONDmONALLY EXEMPT..SMALL QUANTITY TREATMENT
UNIT SPECIFIC NOTIFICA nON
(pW'S\W1t to Health aud Safety Code Section 2S201.S(a»
The Tier-Spedfic Fact Sheets contain a annrn~ry of the opttatiug requiremeDts for this category. PlJ
review those requirements carefully before completiDg or submitting this DotificatiOD package.
Page or f.
-
-
~
UNIT NAME
UNIT m NUMBER
NtJMBER OF TREATMENT DEVICES:
_ Tmk(s)
_ Comainer(s)/Coutainer Treatment Area(s)
Please Note: Generators operating units under Conditionally Exempt Small Quantity Treatment
may not operate any other ~ under other permitting tiers or hold any other state or federal
hazardous waste permit or authorization for this facDity.
EtJd¡ unit must b~ dearly identified and labtled on 1M plot pùzn tllllldIed to Form 1772. Assign your own IUÙqu~ n.wnb~r to each.
U1Ùl. TM 1UI1I'Iber am b~ sequential (1. 2. 3) or yolllNZy IU~ œry system yoll choose. .
7ñis ctlI~gory is only avaiùzbk to gÐlD'Qlors thar rretllleø t1uzn 55 rll11Du or 500 powub o/1uz:An:loru wlISU in tIIIy CilÙ1IdJ:lr nUJIIlh
in ð,,[.k WÙlS at this f4Cility and tJuzt lUt not otherwiÏt required to obUlin " htzziudous W4S'te ftzdlitia permit. This \lØlzune limit
"Pplies to the TOTAL htzzardou.r waste tmlled onsile in any caleru:lar mD1Ilh. œuJ ,is !i!lI II limit for eIlCñ W4S'ttsmœn or unir
sqHUa/ely. 1ñe wasttsrreœns rretZJed nu.ut be limited to those listed in Tille 22. CCR. S~aion 67450.11. which tzn tzlso listed below.
~ ..~.. .~.- --
......----
Emu th~ UfÌmartd monJhly tottzl volzune of htzztzrdous waste rrell/ed by this unit. 11ús should be the maximJIm or highest omoll!.'!...,
lretZJed in tl1t)I month. Indicate in the 1&llT1'tl1iw: (Seaitm 11) if your opetr1lÍ01lS Iuzve stllSoNZ1 wuitzIúnis. ..." ,- - - ,.... - - .
- . - -. --~--..
". ._._.~-_. .---..-- ---..-- .-._-"~
--_.--- -----.- ... _.--
-- -- . -~- --
......~-,----- ---..- .-....' ."
'c
I. ·W ASTESTREAMS AND TREATMENT PROCESSES:
Estimated Monthly Total Volume Treated:
pounds and/or'
gallons
YES NO
o 0
o 0
o 0
Is the waste treated in this Unit radioacúve?
Is the waste tteaICd in this wùt a bio-hazardous/infectiouslmcdical waste?
Is remotely gencræcd hazardous waste (HSC 25110.10) treated in this wùt?
The following lIre th~ ~ligiblt WGSltSlTeœns œuJ lTttmnDU processes. PltQS~ chedc CJll oppliazble boxes:
1. Aqueous wastes containing hexavalent chromium may be treated by the Collowing process:
o
&.
Reduction of hexavalent chromium to ttivalem chromium with sodium bisulfite, sodium merabisulfíte. sodium
thiosulfate. ferrous sulfate. ferrous sulfide or sulfur dioxide provided both pH and addiûon of the reducing agent
are automatically controlled.
to
...
DTSC 1772A (1/96)
Page 4
:;-
'.
. EPA ID NUMBER
e e
CONDmONALLY EXEMPT-SMALL QUANTITY TREATMENT
UNIT SPECIFIC N011FICA nON
(pursuant to Health aDd Safay Code Section 2S201.S(a»
Page _ of
i.
"
The Tier~pedfic Fact sheds contain a cnmrn2ry of the operatidg requiremeats for this category. Ple£
review those requiremeats carefuDy before completiDg or subrn~g this DotificatiOD package.
UNIT NAME METALLIC REPLACEMENT TRICKLE DOWN
UNIT U> NUMBER
NUMBER OF TREATMENT DEVICES:
-2- Tak(s)
..2..... Comaincr(s)/CoD1aiDer Treatment Årea(S)
Please Note: Gmerators operating units UDder Conditionally Exempt Small Quantity Treatment
may not operate any other II:DÏtS under other permitting tiers or hold any other state or federal
hazardous waste permit or authorization for this facility.
Each IUÚt must b~ d«uly identified and labd«! on 1M plot pllJn attIldu!tl to Form 1772. Assign your own unique munb~r to each
unit. 1M 1UUnber CQ1J be sequenziDJ (1, 2, 3) or YOllmllJ lØe œry zystÐ1l yoll chDose. .
77ús CJJ egory is only available to gÐJÐ'Dlors rJuz rret11 ~ tJum 556øJløJU or 500 powub of luIZIurloøs wøsu in tiny ealerular "",nth
in ~ II1ÙlS Ql this ftzeility t1.1Jd th41 an not otherwiSe TtJ{IlÍTed 10 obUlin Q luztJudous W4S'te ftzeilities pennil. This W1bune limir
tlJ1pliu to 1M TOTAL luzztzrdous waste tTtQled onsite in œry cølmdi:u mo1Jlh, lDJd.is B!JI tJ limit for each W4S'testrtœn or II1IÙ
septZTtJlely. 1ñe waslUlTeœns lTeared 1IUlSt be limired 10 tJwse listed in Tule 22, CCR, Semon 67450.11. which an also listed below.
_. _~'ø' ~ __ _ ~ ~.- '" '.'. -.'
.....-----
EllIe the estimared mo1Jlhly toull vo~ of hazardous waste lTl!iZled by lhis WÚl. This shollld be 1M ma:x:inuun or highut tJ11IOU1Jl
tTeared in œry mo1llh. lndicare in 1M n.amzriw (Seaùm II) iJyDIlr opertIli01lS Iuzvt seasonal vtl1'ÏDlÌD1iS.---' ,- - - ,....- ---,-
C
-"" --. . -. .
_.- --- ---,-.-
---" .---"..- ---.--- .-.-- --.
__,_,.__ .____.__ . - - __'n
-. -- . _.- ...
. .' .---' --- -. -- - ... . -.'.' -. - -."' . -..-
I. ·W AS'I'ESTREAMS AND TREATMENT PROCESSES:
Estimated MoothJy Total Volume Treated:
pounds and/or 60 . gallons
YES NO
o /L)
o []
o (!]
Is the waste treated in this unit radioactive?
Is the waste treated in this unit a bio-hazardouslinfectiouslmcdical waste?
Is remotely gencrau:d hazardous waste (HSC 25110.10) treated in this unit?
The following aTe lh~ eligibl~ wasteslTetJI1IS tJ/Id lTtJ1lmÐU procuses. Pleas~ chedc all appüœble boxes:
1. Aqueous wastes cootaùùng hexavalent chromium may be treated by the fo1JowiDg process:
o
a.
Reduction of hexavalent chromium to trivaleDt cbromium with sodium bisulfite. sodium metabisulfite, sodium
thiosulfa1c, ferrous sulfate, ferrous sulfide or sulfur dioxide provided both pH and addition of the reducing agent
are automaúca1ly coouoUed.
to
...
DTSC 1772A (1/96)
Page 4
I
"
t
..
o 10.
o 11.
o
'.
o
o
o 9."
EPA ID NUMBER CAL00014.8
e
Page of
- -
CONDmONALL Y EXEMPT . SPE\';LI'UW WASI'ESTREAMS
UNIT SPECIFIC NOTIFICATION '
(pUJ"SUaDt to Health aDd Safety Code Section 25201.S(c»
8.
Gravity separation of the folJowiDg, iDdudiDg the use of n.........~pts ud danulsifiers it:
a. The settling of solids from the waste where the resulting aqueouslliquid stream is not hazardous.
b. The sepaœion or oil/walei' mixtures aDd separuioD sludges. if rhc averaac oü recovered per IIIODda is less
than 2S barrels (42 gallons per barte1). (NOTE: AB 4lJJ (Ch 62S. 199$) øllows cenœn lISød oIlIwtztø
sqHlrtllÌon UNler new 1heCEL allegory. See Form J772L lJ1IIi CEL Fact Sheel.) ,
Neutraliziag acidic or a1ka1iDe (basic) material In' . state c:ertUied laboratory, a laboratory Opcl'ated by aD
educaûooa) institution, or a laboratory wbich treats less than one gallon of oosite generated bazardous waste
in any siD¡le batch. (To be eligible for coaditioaal exemptioD, this waste caDDOt coDtain more tbaa 10 pen:eat
acid or base by weight.)
Hazardous waste treatmeat is canied out iD quaUty coDtrOI or quaJity assurance laboratory at a facility that
is Dot an ofIsite bazardous waste fac:Wty.
A wastestreaID aDd à'raUDeat tedmoIoIY c:ambiaatJoa œrtIfied by the Depanmeat punuaIIt to SectiOD
25200.1.5 of the Health and Safety Code as appropriate for authOrizatiOD UDder CESW.
Please eater certificatiOD Dumber:
(See AppaKtix S)
U. The treatment of formaldebyde or glutaraldebyde by a health care facility usiDg a technology
__ ,__,~ co~biDati,)n ~ed by ~'Depanmeat, pursuaDt, to -+n 1A:'7OG.l.s..ot tIÍe IWItb--and·-,
. . Safety Code.
Please enter certification number:
-.-- -----..
-. _.- --- ..
. ' ,NARRATIVE DESCRIPTIONS: ,Prrwùú a brief dGaiptiDn-tJ.f*spedfic wøstitr«iltid and thi rmitniiñt procas us«L ---'- ,--
m.
YES
lXJ
o
ŒJ
n
I.....J
1. SPECIFIC WASTE TYPES TREATED: SI:LVER RECOVERY CARTRTDGE USTNG TONTr.-F.Xr.HANGE
PHOTO PROCESSING
2. TREATMENT PROCESS(ES) USED: IONIC EXCHANGE
. ,
RESIDUAL MANAGEMENT: CMck fa Dr No tD e«h questiøn as iJ tlppUes tD all resil:bl.als from !!Jil. tTmI1IIÐIllDIÍI.
N0
o
[X]
o
ŒJ
o
1. Do you discharge non-hazardous aqueous waste to a publicly owned treaUDCIU works (POTW)/sewer?
2. Do you discharge non-baDrdous aqueous waste under an NPDES permit?
3. Do you have your residual hazardous waste hauled offsite by a registered hazardous wastc hauler?
Ir you do, wbcrc is the waste sent? CMck alllJr.ar apply.
liJ
o
o
o
a.
Offsite recycling
b.
Thermal treatment
c.
Disposal to land
d.
further trP.2rmen~
4. Do you dispose of non-hazardous solid waste residues at an offsite location?
S. Other method of disposal. Specify:
DTSC 1772B (1/96)
Pagc 11
EPA lD NUMBER
CAL_146328
e
'i
Paae _ of ,~
CONDmONALL Y EXEMPT . SPE\,;J.tuw W ASI'ES'l'REAMS
UNIT SPECIFIC NOnPlCA nON
(PI1mW1C to Health and Safety Code Section 25201..s(c»
IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT:
(
In order 10 dt!11JOnsrrare eligibility for OM of lhe onsile lTemmenJ lien, fadlilies are required 10 provide the basis for delermining lMr
a Iuzvlrdðus wasle pemUl is nol nquired under 1M JedøøJ Raoura Consel"\lØlÌon and Recovery Aa (RCRA) and lhe federal
ngulolions adopted under RCRA (TUle 40, Code of FedøøJ ReguÜJtio7U (CFR».
Choose lhø reøson(s) lhar ducribe 1M optTtllion of your onsile tT~ IUÚU:
o
o
0 3.
D 4.
0 5.
0 6.
[¡] 7.
o 8.
o 9.
1.
·The hazardous waste beiDg treaIed is DOt a haœdous waste UDder federal1aw although it is regulaIed as a hazardous
waste UDdcr California S13te law.
2.
The waste is treated in wasrewater U-~r UDÍts (tIDb). as defiDed in 40 CPR Part 260.10,_ discharged to a
publicly oWDed ~~t worts (POTW)JseweriDg"c:acy or UDder ID NPDES permit. 40 CFR 264. I (g)(6) IIId
40 CPR 270.2.
Thc waste is treated in e1emenury œutraUza1iOD units, as defined in 40 CFR. Part 260.10, and discharged to a
POTW/scwering agency or UDder an NPDES permit. 40 CFR 264.1(g)(6) aDd 40 CPR 270.2.
The wa.ue is treÌscd m a toÌa11y ~osed trP.s1ftVI!nt iacility as defilied in 40 CFR. Pin 260.10; 40 é:FR 264:1(g)(5).
. ,.. .- . -" -.
_. .'._0". ._. _ .. __.. _n_ _ ..____..._...
._. _ ~ n
The company gcnëmes DO more than 100 kg (approximaœly 27 gallons) of hazardous waste in a calendar month,.
aDd is cJiBibleas afederal'CODditioDl11ycxempt small quantity genemor. ,40 CPR 2QUO .im4o'm '261.5. (.,
The waste is treated in an ---,,,,"1at.iOD tank or c:omaÏDcr wichiD 90 days for over 1000 kg/month generaI01'S'aad
180 or 270 days for generators of 100 to 1000 kglmonth. 40 CFR. 262.34,40 CPR. 270. 1 (c)(2)(i), and the Preamble
to the Mirch 24, 1986 Federal Register.
Recyclable materials are JW"1.im<"lf to recover economical1y significant artIOunrs of silver or other precious metals.
40 CPR 261.6(a)(2}(iv), 40 CPR 264. 1 (g)(2), and 40 CPR 266.70.
Empty conWDer rinsing and/or ~t. 40 CPR 261.7.
Other: Specify:
v. TRANSPORTABLE TREATMENT UNIT: Chedc Yes or No. PWue refer ro the 1n.sl11lcti07U for mon informarion.
YES NO
o Q
DTSC 17728 (1/96)
Is this unit a Transportable Treatment UDit?
U you answered yes, you must also complete aDd attach Form 17nE to this page.
(
Pagc 12
.,
)
e
e
I
-i----------¡
I
I .... .....v
' ;
--4----- : L.sr"E
I I a.-
,
I
,
I
,
I
I
I
,
°1
<[,
01
o:¡
,
..JI
I
<[I
W'
0:1
I
I
I
I
I
,
I
.
I
I
I
,
I
,
I
,
I
,
,
I
I
I
I
I
,
I
,
I
L-__
I
o
i
,
"
i
~
I
I
.,.
.
If
!
o
~
-1
----i
I
---J
;
-------J
-----1
-------J
--I
==1
__ t
-;
--1
----.J
----1
---j
----1
--1
----¡
_--.J
--1
---J
I
-.....¡
,
I
~
-----'
í
--.....;
(__1
.
U Uill~
I
n \! i j I ¡i
¡ ¡ : i ¡ ~ ! ! tzlJ
LLLLI ¡ ! I I "f
¡ ¡ i! ¡ ¡TLU
FUTL:RE PAft¡< l ~~o
! !! t i ¡ ì : ¡ ; I f¡
! j! -I I f ¡ ! 'I ¡ I ¡ ¡
J 'I J j I 1--1 i j J ! i ¡
._-~ -~~--j ì
r -;-T'''''''-'rT'--;-r-~ I
¡ I I / Iii , II I i
I ! ¡! ! I I J;
, ~ I ¡ I } ! t f U
n
S Toe K 0 ALE H I G H WAY
112.11" _____
'ÜWWE---------------------------------
: a...
I
I
I
I
i
,
i
I
I
I
I
I
I
I '/-
~~-~.
',] ... ....
t
......
5 8
G H WAY
H
S TAT E
P LAN
E
S I
,'·38',1'
, OARl<RO(J !IOCfI
! ¡rï5~ I LM
--;\j _~A'2 PROCESSING
1~
'H--01 .05 F .
, I UI PROCESSOO
-:- -Ii [ill
I I r;;.-,
0' ' ~ CHEll, ORLNS
, FlOM 51'1<
I
I
I
I
I
I
.rj
" , .' I" .
I
Ii
I
I
I
I
"-
,
., ,
'i
)~~PREf!
,!~
L-
. _J. F50~i.SUa ,yJA1
i ! --- -- _+7"'-- ,-
i j
~ ! ~. -
! ---...
, . , \ . .
Ji~~~}1~_O~R'D9R' ..' "
~. . '..'...._..-',r~.., .. ..
. .'
.~.. ',1'/0.2,'·
. .' ." f . 1&-70
,1.,.j .'. ,22 .
./
'\
\
" J
=r==¡
I \ ¡
~\ i
., " ,b~?1 0_ ~~SSJ
.'-+...' " t
,r;WR":.::tib' l,.AJ' ~ J
n~.5\3T8~~<?6,~RÁw~Lì'
<tt!;j, .,..~:--,..: ":'~~t"'oj
, .',,,. . ,.... ..,1
". ¡__ ~....' ···,,1
i !' (',.:1
,'.. l>'i
r~--'l .' 1~,1
.' . if~,
\ -, .-' . ~ ..,.
. .' I ~..,'
'~I~
)'ÎI
/
./
~'-~':"
I;. I
-.. -....~ .,
.)
I
. -..-.,....-..
.-...,.... . .--.'-
'e·
. t
.':
,1
.,
I:."
...., ~-; ~77~ n L
. .
:Sllli CORR
.;¡
~,
J. '.,~.'" '.
'fi
'., i }'
.'
,J-_!" ,~
,
17'-10,3/4"
18'-4.3/4"
,,"
'1
i
!
r-
CHEW'~RECOVERY ~
6'-1" CL~R
.- .'~
--- I
--:T:T
'\
. Stale 0' CalIf."" . Ca1Uonlia E.ht. _ral ~D ~
!
t:..-G 3)Li 1<6';"'\
e
Depanmc.a& 0' Tea:ic S-'--_ c...rol
Pqe 1 of
ONSITE HAZARDOUS WASTE TREATl\1ENT NOTIFICATION FORM
FACILITY SPECIFIC NOTIFICATION 0 lDiûal
For Use by Hazardous Waste Gc:aeraton PcrformiDg TreaunCDt 0 AmCDdcd
Under Conditional ExcmptiOD and CoDditiouaJ Authoriza1ion.
and by Permit By Rule Facilities
Please refer 10 rhe QlIachetJ /nslnlaions before complmng rJW form. You may MillY for mtJre IMn olle pmnilrillg tiu by IUing this
norificariollform, DTSC 1m. YOU11UlS1 atIIlCh a sqHlrœe llllil spedfic notificaliollformfor each llllil ar this Iocalioll. 77aue are
difJerDll unil spedfic norificarionfonns for five of rhe CtlIegoria and an additional MliJicalionform for mmsponable I7'etJImØII "'"IS
(ITU's). you only h.ave 10 submil forms Jor 1M riu(s)/azlegory(ia) thaJ œVO' your unit(s). Discard or recycle rhe orhu lllllUal
forms. Number each page oj your œmplÐed Mlljicarion p«Jcage o¡uJ indiCtlle the totDl IUIIftbu of paga ar rhe top oj «Ida ptlle tlt
the 'Page _ of _'. Pur your EPA ID Number on each pale. Ple.ase p1"'OVÏJk all of 1M illformtllion req<sted,"allfidds nuut be
completed ex&qJl those thaJ slale 'if diJIerÐll' or 'if awdlable'. Please type 1M injonnarion proVÛÙJ:l on this form tl1Id œry
QlIachnients .
The norificariOIl Jets art assessed on 1M basis of 1M highest liu the Mllfiu wiU DpmDe Wldu and wiU be œll«ted by the Suue
Board of EqwzJizmion. DO NOT SEND YOUR FEE PA.YMENI' W1T11 THIS NOTlFlCATlON FORM.
I. NOTIF1CA110N CATEGORIES
/ndicart the 1Øl1frbu of Il1Ùts you opmzIe in etlch riu. 77ús willlllso be the 1III1IIbu of unit specific Mrificazioll jtmns you
11UIS1 altI:lCh. eondmoMll} Exempt S1Mll QIumtity T1IØtIftGIt t1pÐ'IItOrr .., lIDt opD'tlle IUIits ruulu till} oth.u _.
Number or UD1ts .and attached unit spedfic DOtificatioas for eaeb tier reported.
.' .
A. CoDditiona11y Exempt-Small QuaDrity Tr-..,,~ (CESQT).
B. ....L. Conditionally Exempt~pecified Wastcstream (CESW)
C. . CcmdiIicma1Jy Authorized (CA)
. D. ~ -,~t by.~~~ ,~B.~J_,_-:-:
E. ~,_,œ~I..auDdry (~~) , ,
F. ,-:.. .~Coad.iIiODaI1y E.xempt·Umited.c~) .
... W__ _.._
II. GENERATOR IDENTIFICA110N
EPA ID NUMBER CA..1..Q. Q.. º-L.i. .£..1..L8_
BOE NUMBER Clf available) H_H<L- _ _ _ _ _ __
FACu.JTY NAME
(DBA-Doill¡ BusiDess As)
PHYSICAL LOCATION
KERN RADIOLOGY MEDICAL GROUP. INC. -KA ISER STOC-KnAT,E
3501 STOCKDALE HWY.
CITY
BAKERSFIELD
CA
ZIP93309
COUNTY
KERN
CONTACT PERSON
D'LN
(First Name)
BROWN
(Last Name)
PHONE NUMBER<&lí.J i?? - 1981
MAILING ADDRESS, IF DIFFERENT:
COMPANY NAME
KERN RADIOLOGY MEDIC-AT, C::ROTTP r TNr.
STREET
2301 BAHAMAS DRIVE
CITY
BAKERSFIELD
STATE CA ZIP93309
COUNTRY
CONTACT PERSON
(oaly complete if 1101 USA)
D'LN
(Ftm Name)
BROWN
(lAsI Name)
PHONE NUMBER(~) 322 .1981
DTSC 1772 (1/96)
PalC :
EPA ID NUMBER CAL0001.Z8
m. RADIOACTIVE MATERIALS OR WASTE
YES NO
o IÐ
,~
e
Page 2 of
,~
Docs the facility use, szore or treat radioacúve DWeria1s or ndioaaive waste?
(
IV. TYPE OF COMPANY: S1'ANDA.RD INDUSIlUAL CLASSD1CA110N (SIC) CODE:
Use dIher OM Dr two SIC œdes (a four digù ruunber) zJuzr best describe your compony's produas. services. or industrial llctiVÙ)'.
E:uunpÜ!: .
ZJ.M. . Phøtøfinishinf!' ltJb
Z1.H : IndustritJIlaunderus
~Dd:7384 PHOTOFINISHING LAB
.
First: 8011 MEDICAL OFFICE
CLINIC
V. PRIOR PERMIT STATUS: CMdc:¡es or IJØ to øch guUlÚ1n:
YES
o
o
o
o
o
NO
ŒJ
GJ
[]
Kl'-
fLJ
1. Did you file a PBR Noûce of InteDt to Operate (DTSC Form 8462) in 1992 for this locaWm?
2. Do you DOW have at haw you ever held a swe OJ' federal hazardous wasœ facility full permit or imerim
statUS for lIlY of tbese ~ 1IDÍU?
3.. Do you now have or. have you ever held a swc OJ' fcdcral full permit or interim statUS for any other
hazardous WasIC. activities at this locatiOJl?
--~-_.-._..-..... --...--.- . - ...~ _....__._~--=--:.~"-
4. ' - Haveyou-ëver-IidCi a vârïanœ- isSued--by dÏè DêPariment of Toxic Substanc:ës ContrOl fOrihc'tre2~t ÿöü
are now notifying for at this loc:aIion? '
~~__ _,_~ ,~I~~_~ ~_~,by ~ swc or my local ageDCy&5 a hazardous waste g~~(.
VI. PRIOR ENFORCEMENT msrORY: ~ot nt¡&ÚI'tdþom condiJiø1Ull1y e%Ðnpt genuators or commerr:iallaundria.
YES NO
o 0 Within the last three years. bas this facility been the subject of any ccmvictions, judgments, sculementS,' or: final
orders resulting from ID aaion by any local, SWC, or fc:dcra1 environmental, hazardous waste, or public health
enforcement agency?
(For the purposes of this form. a noûcc of violation does DOt constitute In order aDd need i10t be reported unless
it was Dot comc:ted and became a final order.)
o If you answered Yes, c:heck this box aDd aaach a IisåDg of c:onvic:tions, judgments. settlements, or orders and a copy
. of the cover sheet from each d()l"!u'I)Mtt. (See the InsuuctiODS for more information)
VD. A IT ACBMENTS: ~1rmÐús tin IJØt n'lu.in.d from comnun:W ùuuulries.
[]
o
l.
2.
.
A plot plan/map detailing the locatîOl1(s) of the covered UDit(s) in rela1ioD 10 the facility boundaries.
A unit specific noúfication form for each unit to be covered at this location.
l
DTSC 1712 (1/96)
Page 2
~
EPA ID NUMBER CALOOol328
e
. -
Page 3 of
VID. CERTIFICATIONS: This form must be si,ned I1y till tlIIlIrDrized CtJrpol'Øle officer or arry other penon in the company who
h4s operarionaJ COn/rol and pl!1fomu d«isìon-m4Iàng funaì01U tluzt ,o~ opøørion of the fadlity (per Title 22. C4lifomitz
Code of Reguúuio1U reCR) Semon 66270.11}. AU Ihrwe copies nwst June origin4l sigraaturws.
Waste Minimization I c:cnify dw I have a program in place 10 Rduce the volume, qUIDåIy, and toxicity of wuce ¡ezaerated 10 die
degree I bave determined to be economically pr3CÙcable and dw I have selcacd the practicable method of ueauDau, storaae, or
disposal cum:ntly available to me which minimi7n the present aDd future thrca1 to human health and the e:Dviroamcm.
,Tiered Pennittinl! Certification I ccrúfy that the unit or units described in these documents meet the eligibility and opcradDg
requirements of State swwcs and reguWioDS for the ind¡~red permittiDg tier, including ICDCœor IDd sccoDdary COfthlÍft_¡
rcquìrements. I undersw1d thaI if any of the unitS operate UDder Permit by Rule or CODditioDal Authorization, I wW also pmvùle
the required fmancial assunncc for closure of the 1J'I"'SfftV'!ftt unit ""October I, 1996.
I cenify under penalty of law thaI this document and all )1"_1"""",.., were prepared UDder my direction or supervisiOD in acronIaDce
with a system designed to assure that qua1iñcd pcrsoDDC1 properly prher aDd evaluare the iDfomwion submiaed. Based em my
inquiry of the person or persons who mmage the- system, or those ctirect1y responsible for gad1ering the iDformapon. the iDformadcm
is. to the best of rrr¡ knowledge and belief, trUe, accura1C, aDd compleœ. .
I am aware that there are substmd.al peDI1ties for IUbmiaing fa1se iDfomwion. iDcludin¡ rhe possibility of fines IDd iJDpriscmmem
for knowing violatioDS.
M.D.
PRF.!:nnENT
Tule
Signamre
D~ Signed,.
.._, -._00 ____.~~.._-
. . .. e' .. '" _ _0 _ 0
IX. REQUEST1NG A SHORTENED REVIEW PERIOD:.. Genmzlon opmzring wn- CA Il1IJllor CE lITe kgäJ1y iIl.ltJuirižëJ ~ '-
to opUale 60 days after submilring a CtJmpltte notijiazrion. DTSC may shanen the time pmod ~en notiJiœrion 1l1IJl_ ." .
aullu:JTŽzalion when the owner or operœor esrablishe.s good CDlUe. q you need to be tIUIhDrized SODIII!T dum 1M øœultmJ- __,_ ., i
6O-doy period. pkase check the box bdqw and SUlJe the rmsDn.' Your IIIlIhorizDJiøn wiU be lDIIønuzzjœIly <ffeaîw 011 the -
dare your completed notifictJtionform is received I1y DTSC. (USt additional SMI!lS. if MCasary.)
YES
o Reasoo:
~ _. #0
OPERATING REQUIREMENTS:
. ,
PltQJe note that gDltTtllon maring haz.ørdtnu waste D1UÙe are ntpåred to comply with a I'ØUfÚ)Ð' of operating requlnmmu which
differ depmding on the tiu(s). 71we øpmIlÍlIg reqWrtmÐItS an se: fonh in the SUZlUl~ and reglÚaliØl&S, SOIM of which tzn
rqerDICed in rhI! Tin--$pedfic Faa Sh«u awzilDble from DTSC's rqioNJl tmd het:1dqu4nøs t1jJices.
SUBMISSION PROCEDURES:
All three forms must lurPe oriPiMl silJUllU1'U, IJOt photDctlpies. You must submit two conies of this completed noûfication by
cenificd mail, ~tum receipt requested, to:
Department of Toxic SubstaDCCS Conuol
Program Dm Management Sccúon, HQ-I0
AnD: TP Notifications - Form 1m
400 P Street, 4th Floor, Room 4453 (walk in only)
P.O. Box 806
Sacramento, CA 9S812.{)806
You must also submit one CODY of the Doúfic:a1ion and anachmcn1s to the local regulatory agency in your jurisdiction as listed. in
oendix 2 of the instruction matcrials. You must also retain a copy as pan of your operating record.
PLEASE, DO NOT SEND YOUR FEE PAYMENT WITH THIS FORM.
DTSC J772 (1196)
Palc 3
j
EPA ID NUMBER e e
CONDmONALLY EXEMPT-SMALL QUANTITY TREA'I1\1ENT
UNIT SPECIFIC NOTIFICATION
(pursuant to Health md Safei)' Code Section 25201.5(a»
The Tier-Specific Fact sheds contain a RJlll1II2Y')' of the o~atù.g requiremeDts for this category. Pie£:
reYiew those requirements carefully before compJetiDg or submitting this DotifirmiOD package.
Page _ or
7""
UNIT NAME
UNIT m NUMBER
NUMBER OF TREATMENT DEVICES:
_ Tank(s)
_ Containcr(s)/ComaiDer Treatment Area(s)
Please Note: Generators operating units under Conditionally Exempt Small Quantity Treatment
may not operate any other ~ under other' permittiDg tiers or hold any other state or federal
hazardous waste permit or authorization for this facDity.
Each unir musr be ckaTly idmrifit.d and lobtled on 1M plot plan attlICMd to Form I'm. ÂSSign your own unique number ro «lCh
unit. '1'h.4 1Ul17ÚMT am be sÞ¡Ut:nlÏ4l (1. 2. 3) or)'Oll may JUt any systl!11l you ch.oose. .
1ñi.s CQJegory is only availabk to gt!MTDlOTS tht1r tTttlI ~en tJum 55,ø1Jø1U or 500 pounds 0/ hazardous tlllUU in tiny CtÜmIlIu "",nth
in ~ Wtils Q1 this facility and th41 an not oÚlerw;Ù m¡uirtd to obUlin l2 havudous W4Ste /ad1i1ù:s permit. 1ñis YOlume Umir
applies ro the TOTAL luzzardous wastt tntUed onsile in arry azlendar mDnzh, and ,is l!JZl. a limit Jor «JdJ wasttm'tllm Dr unit
separarely. 'J"h¿ wasrestTeams tTetJltd 11UIS1 be limirtd to those listtd in Title 22, CCR, Staion 67450.11. which DTt also listed below.
-.-...-.--'- ..~..~- -' .-..------
EnID" rhe U1ÌmtZled monthly toro1 volume of ht1z.ardous waste 1Ttllled by this 1UÙ1. 1ñis should be 1M mll%Žmllm or higlwt tIlftDUnl
tretlled in arry month. IndiCQJe in 1M namzriw: (Seaúm 11) if your t1]H!TtIlions Iuzvt sea.roMl wzriatùnis."'· ,_.. - _. .. .. - - --'-'
...- -. -----.-
-. .--.-;-' ..~_..'-" ---.-. - ."-- _.
___.._. u.._·~ ._, ~....
.. _. . h__"
. . ..-~. --- -. -- - ..'
._..~. ... -... . -..... ...
-c
I. ·W ASTESTREAM.S AND TREATMENT PROCESSES:
Estimated Monthly Total Volume Treated:
pounds andlor'
gallons
YES NO
o 0
o 0
o 0
Is the waste treated in this unit radioacùve?
Is the waste trca1Cd in this unit a bio-bazMdousfmfeaiouslmcdica1 waste?
Is remotely gencræed hazardous waste (HSC 25110.10) treated in this unit?
The foUowìng are rhe eligible wasttsrretzmS and tTeannou processu. Please chtdc all appliœbù boxes:
1. Aqueous wastes containing bexavalent chromium may be treated by the fonowing process:
o
a.
Reduction of hexavalent chromium to trivalent chromium with sodium bisulfite. sodium metabisulfite. sodium
thiosulfa1c. ferrous sulfate. ferrous sulfide or sulfur dioxide provided both pH and addition of the reducing agent
are automatically controlled.
(0
...
DTSC 1772A (1/96)
Page 4
"
..
EPA ID NUMBER e e Page _ of
CONDmONALLY EXE1vfPT-SMALL QUANTITY TREATl\ŒNT
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safei)' Code Secùon 25201.5(a»
The TIer-Specific Fact Sheds contain a cnmm~ry of the Ope1.atiug requinmeats for this Cltegory. Pte:l:
:a''eYiew those nquirements carefuDy before completiDg or snbmiHñ1g this Dotific:atioD parlr~
UNIT NAME METALLIC REPLACEMENT TRICKLE DOWN
UNIT JD NUMBER
NUMBER OF TREATMENT DEVICES:
-º- TIDk(s)
-Ì- CoDWDcr(s)/ComaiDer TreatmcDt Å.rea(S)
Please Note: Generators operating units under Conditionally Exempt Small Quantity Treatment
may Dot operate any other D:Dits under other permitting tiers or hold any other state or federal
hazardous waste permit or authorizatioD for this facility.
Each unir musr be dearly ùJenrified IZ11d ltzbtletl on 1M plor plan iZItIldIM to Form 1772. Assign ytJllT own unique 1UI1IIber to each
unit. 1M IUUI'Iber can be sequÐflÚll (1, 2, J) or YØIl may llIe œry system you duJose. .
1ñis C/Zlegory is only available ro gÐleT/Zlors duzI rreat ~ tJum 55,dllølU or 500 pøruu:ls of /uzzørdøru WØ$U in IDlY tIlÜIullv IIIDnth
in 4U uni1s ar thi.s facility and that tUt nor otherwiSe rtt¡Uired to obuzin a luztJudous W4S'te fadlilies pmnir. Thù 'VOÚlme limit
applies to the TOTAL hazardous wœte tnalttd oruite in arry calendar molllh, and.is f!!JI a limit for each wtmatrtam or unit
separœely. 1M wastesrreoms rreJJJttd must ~ limirttd to tkose üsted in Tille 22, CCR, Section 67450.11, which an also lùred below.
_. ....... ~.- . - ~... ,- ...... -'
_...~----
Enter the utimmed momhly toral volume of hazardous wane rreall!d by this unit. This.should be 1M 1IIIlXimum or highat amount
rreJJJed in arry molllh. lndicale in the nanœiw (Seaúm 11) if your t1pØtZlions Itm>e sttzs01lD111tl1ÍtlZÍ/nÍS."-· -.. - - _.... - - --..,
_.- -. -----..
-. .--.---. --~_...- -_.... -~._~ ..
___.._. ...._._ .__ _,"h
.. .~ . ---...
..._~.____. ._._... ._........... ._.._u ...
..c
I.
·W ASTESI'REAMS AND TREATMENT PROCESSES:
Estimated MonthJy TotaJ Volume'Iì'eated:
pounds and/or 60 . gallODS
YES NO
o ILJ
o lEJ
o [!]
Is the waste treated in this unit radioactive?
Is the waste treated in this unit a bio-haz.ardousliDfcaiouslmcdica1 waste?
Is remorcly gcncra1Cd hazardous waste (Hse 25110.10) trealed in this unit?
The following are the eligible wastesrruzms ønd rreormenr processes. PletlSe chedc all appliCtlbk boxes:
I. Aqueous wastes containing hexavalent chromium may be treated by the following process:
o
a.
Reduction of hexavalent chromium to trivaleJIt chromium with sodium bisulfite, sodium metabisulfitc. sodium
thiosulfa1c. ferrous sulfate. fcnous sulfide or sulfur dioxide provided both pH and addition of the reducing agent
are automaùcally controlled.
t·
...
OTse 1772A (1/96)
Page 4
.
o
o
o
o 9.'
o 10.
o 11.
EPA 1D NUMBER CAL0001.Z8
e
Page of
- -
CONDmONALL Y EXEMPT· SPE\,;uuW WASTESTREAMS
UNIT SPECIFIC NOTIFICA T10N .
(punumt to Health and Safety Code Sccúon 2S201.S(c»
8.
Gravity separation of the rollowiDg, iDduding the use or Oo-',I""ts ud demu1s1fiers if':
a. The sen1ing of solids from the waste where the resulting aqueouslliquid sueam is not hazardous.
b. The separation or-oil/water mixtures and separaûon sludge$. if the averase oil recovered per momb is leu
than 2S barrels (42 gallons per barrel). (NOTE: All 48J (CIa 625. 199$) øllows cmtJin used oillwtutir
separarion under new rñeCEL œJegory. Søe Form 1772L and CEL Fact Shøer.) .
Neutraliziag acidic or a1ka.liDe (basic) material.". . state c:ertLfied laboratory, a laboratory operated by 8D
educaûoaal iDstitution, or a laboratory which trats less than oae gallon or onsite generated hazardous waste
in uy .single batch. (To be diglble for coaditioaal exemption, this wasle c:2IIDOt comaiD more tbaIIIO pen:eat
acid or base by weight.)
Hazardous waste treatmeat is carried out ill quality COJûrOI or quality assurance laboratory at a fadlity tbat
is Dot aD offsite buardous waste facility.
A wastestreaID aDd treatmeat tecbDoIocY eombJøatJoa certfljed by die :ÐeparImeat parsuant to Sectioa
25200.1.5 ot the Health aDd Safety Code as appropriate for authorization UDder CESW.
Please eater ca1if1catioa Dumber':
(See AppeIIdix S)
12. The' treatment ot tormaldehyde or glutaraldebyde by a bealth care racility using a tccbnolocy
__ ,_.,þ co~biDati9n ~ed by~'~cat,parsuaDt,to ~ 1~no.t.5...ot the ~-"""8Dd---
. Safety Code.
Please enter certification Dumber:
-.--.
_.
, ' ,NARRA.11VE DESCRIP'I10NS: ,høvùú Q brief dGcripriott D/ tIte- spødfic wøsrétriiDted and rhi rnømiiït procas 1Øèd. -_.:- : ,-
m.
YES
IîI
o
ŒJ
n
L.....J
1. SPECIFIC WASTE TYPES TREATED: SILVER RECOVERY CARTRIDGE USING IONTC-EXCHANGE
PHOTO PROCESSING
2. TREATMENT PROCESS(ES) USED: IONIC EXCHANGE
. .
RESIDUAL MANAGEMENT: CMd.: Yø ør Nø tø eat:h t¡IlmÎØft as it øppUu tø all røidIuJLs from IlJiÆ møtInÐIt 1IIIlt.
NO
o
[¡]
o
ŒJ
o
1. Do you discharge DOJ1·bazardous aqueous waste to a publicly owned aunncnt works (POTW)/~
2. Do you disc::barge non-b.azardous aqueous waste under an NPDES permit?
3. Do you have your residual hazardous waste hauled offsite by a fCgistered hazardous waste hauler'?
If you do. where is the waste SCD1? Check alllhaJ apply.
[Ð
o
o
o
a.
Offsite recycling
b.
Thermal treatment
c.
Disposal to land
d.
funher' U'e2tV"""t
4. Do you dispose of non-haurdous solid waste residues at an offsite localÏon?
S. Other method of disposal. Specify:
DTSC 1772B (1196)
Page 11
EP ^ 1D NUMBER
CAL_46328
Page _ of
e
..
CONDmONALLY EXEMPT· SP£u.I'lJW WAS'I'ES'I'REAMS
UNIT SPECIFIC NOTIFICATION
(punu.mt to Health and Safety Code ScaioQ -2S201.5(c»
IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT:
(
In ord~r 10 demonsrrar~ ~ligibiliry for one of Ih~ onsÍl~ rrearmenr 1Ï00, fadliJies ar~ TequjTed 10 pTOvid~ th~ basis fOT der~mùninglJuzr
a hazardous WQSlt p~mùl is IIDI requiTed undO" the federal ResOU1U CD1U~rvarion and lùcovery ¡fa (RCRA) and Ihe fedeTal
ngUÚllions adopted under RCRA (1'lJle 40, Code of FederallùgulDtions (CFR)).
Choose Ihø Teason(s) lhat describ~ the opuation of your onsite,'~ IIIÚU:
o
o
D 3.
D 4.
0 S.
0 6.
ill
7.
o
o
8.
9.
1.
.
·The hazardous waste beiDa treaU:d is DOt a ba2:ardous waste UDder federal law although it is regulated as a hazardous
waste under California swc law.
2.
The waste is ueaœd in wasrewater ~fml!nf UDits (taDb), IS defiDed in 40 CPR Pm 26O.10,1Dd discharged to a
publicly owned tft".sftntl!nf works (POTW)JseweriDg lIeDCy or UDder an NPDES permit. 40 CPR 264. 1 (gX6) IDd
40 CFR 270.2.
The waste is trea1ed in e1-I....'Y DeUttalizatiOD UDÍ1S. IS defined in 40 CPR Pan 260.10, IDd discharged to a
POTW/sewering ag~ or under an NPDES permit. 40 CPR 264.1(g)(6) and 40 CPR 270.2.
. 1 . .' .. .
1'he was¡e is treÏ1ed in a toWly eaclosed ~1JIV!ftf facility IS defiDed in 40 CPR Pan 260.10; 40 CPR 264. 1 (g)(S).
. ... 0- . _ .
_ _ .. _.'.. ... .. _ _ __ _.'_ _.._ ___.h_·
The company genèrates DO more than 100 kg (approxiDWely 27 gallons) of hazardous waste in a calendar month .
and is eligible IS a federal'cond.itional1yexempt ImIIl quamity generator. -40 CPR 260~'10 ~40cFR '261.5. ("
The waste is treaIed in ID -..o'1;m11vion tank or c:omamcr wirhiD 90 days for over 1000 kg/mond1 generators'aDd
180 or 270 days for generators of 100 to 1000 kglmond1. 40 CPR 262.34, 40 CPR 270. I (c)(2)(i). and the PrcambJc
to the March 24. 1986 Federal Register.
Recyclable materials are fP1"1.i~ to recover ec:ouomical1y signific:aut amounts of silver or other precious metals.
40 CPR 26 1. 6(a)(2Xiv) , 40 CPR 264.1(g)(2).1Dd 40 CPR 266.70.
Empty container riDsing lDdIor ~t. 40 CFR 261.7.
Other: Spcci!y:
v . TRANSPORTABLE TREATMENT UNIT: Chedc Yes Dr No. Please Tqer 10 the Insl71lctions for mon infOmuJlÎon.
YES NO
o Q
DTSC 17728 (1/96)
Is this unit a Transportable Trcannent Unit?
U you answered yes, you must also complete and attach Form 1772£ to this page.
(
Page 12
;l"
1111
illII
.
,
,
I
· I
I I
i ¡ :
, I ___________J_
--T---í---------------------------------------
o ~ 0 ~ l ~ 3 8
I I
, "-- -
I I
I I
I I
I I
I I
I I
I I
I .
I I
, .
~--r---I
, I
I I
I I
I
, .
I I
I I
I I
I I
,I 1
I
I
I
.
I
,
I
.
I
,
I
·
I
I
I
,
I
·
I
,
I
I
I
i >-
I <J:
3<
:x:
c:;¡
....
:x:
W
.J
<J:
o
~
u
o
I- .~ II
en I'" iii
.r--
~
o
~
""42' ... ......
----~------~....----...~--.........-..,..............---------
¡ 0 -}ffilTnTnTnnlTmT1TnTìlTIlllT~
1
I
I
I
1
I~
I.
" š=-=- ...,._,_
I h"____
1
I
I
I
I
I
.
1
~-'§-=~ ~n~; ~-=~r~
- =='--~1-r' ,--- \'> - ......._-, 1----·
=~ -----~ ~:'~_j ,___~:~ ~~j¡-t~=:=
. 0 i
-- -'" -', ---" ,,---,-- ~ -- - 1--"··-
- ..:~-~~, :~~~~' ..'=~', :¡: ~=~,~,: t=:=~:
~:I ~~~
., ,...1 L,.,
c_
)
~
;:
-. ,.-...... -~-_.~-~..._._.
....- . _...- ..~_.-
CJ:)
to
>-
<J:
3<
:x:
c:;¡
:x:
w
I-
<J:
l-
I en
~
I
,
Z
<I
-.-J
0...
,
I:
I,
¡
----------J
W
I-
1--1 .
'!'
Pt
(f):"
-"',
e
e
¡¡--,--
-----
.'
-=-,"~ I
~',~':"
)
, .
17'-10.3/4'
18'-4,3/4'
,.i
;1
i
I
I
e
L-
./
, ~,r ['sõš1:SUS .yJA1
, 1 ,~--......-- -+~
It' -.-
I ! ' .
, I '
- t ---..: . -
. . I," .
': [(~~}l~_O~RI DÇ>R .... .'.
~, """'--'-'r~'-," ,'.,
';;r-' '.i, ,A2. '.
. . \ . 1&-20
. .1 '. '.' ,¡ '.' 22
CONTROl
,~...,... ,.-.-
'\
I
" \
~
I \
~\ i
~; .... ,-'.b~?~~R'~S·SJ
~...::I:tb LÞJ' ~ J
,',:Í,ï,:s-r31BlOOO ~RAW,~14 , Ii'
I" __ ~__ ," ,'+'Z·'·
~L:'J .- - -r.--:-:-;:--"- . "'t: :'\j
"····II-.-'.:.·~·, ..' ,;. '" t.·'·:,·,'.',:,'IJ
',!,:,;: ",
I : '. ¡>i
" r~':~--i ~J
I;, , 1-:~!
'J--'. -. . . ·.1
I. .' ,t~,
~~7~jriL¡t /ºJ'
:.,
;//
/
, t
~ _ DARKROOI DOaI ..
'I ,,~ILM
--N ,_ ~PROCESSING
Ir-g)
~
- -ii
, I
0:'
e
, m.w PROCESSOR
[£D
ŒIJ 0i0/. DR\.IIS
rux»I Sli'I<
,I
.,
...
f-
OiEW,~E~~~
~~1~_~~
'--rr
151~ CORR ~,
I ,~
Jesse R. Huff, Director
400 P Street, 4th Floor, P.O. Box 806
Sacramento, California 95812-0806
~~'J:U> cny
(~)
a
'1
I
fItùfe, · ·
/ r Department of Toxic Substances Control
September 11, 1998
Peter M. Rooney
Secretary for
Environmental
Protection
Pete Wilson
Governor
Physicians Plaza Med Imaging Ctr
Joyce Ayers
4000 Physicians Blvd # 1 0 1
Bakersfield, CA 93301
EPA ill: CAL912693010
For facility located at:
3501 Stockdale Hwy
Bakersfield, CA 93309
DATE CLOSED: 09/22/97
"'::'1",,,:::,- ;: ::, ,~;~;
CCl {j ó
¡[){)Ç!
. ...;It}
Dear Onsite Treatment Facility:
The Department of Toxic Substances Control (DTSC) has received yourletter and/or
notice informing DTSC and/or the California Board of Equalization (BOE) of the closure of your
facility or treatment unites).
Pursuant to your request, DTSC considers your treatment unit to be closed and no longer
subject to the standards of your treatment authorization tier. DTSC will change your status in its
Tiered Permitting database to "closed" and forward a copy of this letter to BOE for billing
purposes.
DTSC is acknowledging your closure letter because the closure date is prior to January 1,
1998. Pursuant to Assembly Bill 1357, as of January 1, 1998, Certified Unified Program
Agencies (CUP As) are responsible for processing Conditionally Authorized and Conditionally
Exempt notifications and closures.
If you have re-Iocatèd and continue to treat hazardous waste at the new site you need to
(1) obtain an EPA ID number for the new site and, (2) submit an onsite treatment notification
form to your local CUP A and a copy to DTSC. Please see the cc on page 2 for your local CUP A
information. If there is no CUP A listed, your non-CUPA agency will be listed.
(Continued on next page)
California Environmental Protection Agency
@ Printed on Recycled Paper
I 'ì
\ #1
e
Physicians Plaza Med Imaging Ctr
Page 2.
e
EPA ill: CAL912693010
If you have any questions regarding this letter, please contact Ms. Marina Baiza, of my
staff, at (916) 322-0471.
cc: Mr. Ralph Huey
Bakersfield City Fire Dept
1715 Chester Ave
Bakersfield, CA 93301
(805) 326-3979
Stephen R. Rudd, Administrator
Environmental Fees Division
State Board of Equalization
PO Box 942879
Sacramento, CA 942-0001
Sincerely,
~ - ¿--
~..
Sangat S. Kals, Section Chief
Unified Program Section
State Regulatory Program Division
r,¡
\¡
I
- - e
+-TRIOIA---------------~---------------------------------------------------+ +
Tiered Permitting System Screen 1 of 2 I
Onsite Notifier Information I
EPA ID: CAL912693010 Initial Date: 122294 Init/Amend/Renew: A (I/A/R) I
Amended Date : 050895 Renewal Date: I
Conditionally Exempt, Small Quantity Treater Units I
1 Conditionally Exempt, Specified Wastestream Units I
Conditionally Authorized Units I
Permit by Rule Units
Commercial Laundry
Conditionally Exempt - Limited
Total Fee Attached: Check No:
I
I
I
II.
I
I
I
I
I
I
I
I I I. BOE :
I Company Name: PHYSICIANS PLAZA MED IMAGING CTR
I Address 1: 3501 STOCKDALE HWY
I 2:
I City: BAKERSFIELD
I County: KERN Region: 1
I Contact First: JOYCE Last: AYERS
I Phone: 805/395-0155 Ext:
I +---------Enter the data and pres~ ENTER to go to screen 2--------+
+-F2=Cncl---------F4=Ina--F5=Unit-F6=Hist---------F8=Next-F9=DVal--Entr=Acpt+
CA ZIP: 93309
, '.
~,
'1i
+
(' ,,,~; '1.Î, ,,/-li)., '6- 't'''),
~.lt,'~Ll q- 1.\;/ [ I~,~",-, .; .
\ ~
"
+-TR101A----------------~-------------------------~---------------------+ +
I Tiered Permitting System Screen 1 of 2 I I
I Onsite Notifier Information I I
I EPA ID: CAL000077802 Initial Date: 122294 Init/Amend/Renew: I (I/A/R) I I
I Amended Date : Renewal Date: I I
I I. Conditionally Exempt, Small Quantity Treater Units I I
I 1 Conditionally Exempt, Specified Wastestream Units I I
I Conditionally Authorized Units I I
I Permi t by Rule Uni ts I I
I Commercial Laundry I I
I Conditionally Exempt - Limited I I
I Total Fee Attached: Check No: I I
I I I
I II. BOE: I I
I Company Name: PHYSICIANS PLAZA MED IMAGING CTR I I
I Address 1: 3700 MALL VIEW RD I I
I 2: I I
I Ci ty: BAKERSFIELD CA ZIP: 93306 I I
I County: KERN Region: 1 I I
I Contact First: JOYCE Last: AYERS I I
I Phone: 805/395-0155 Ext: I I
I +---------Enter the data and press ENTER to go to screen 2--------+ I I
+-F2=Cncl---------F4=Ina--F5=Unit-F6=Hist---------F8=Next-F9=DVal--Entr=Acpt+ I
+
'i -_.. --
I î,
~
PLA~
ME AL
.. IMA IN~~- .. ~
". . . where the Patient is Most Important. .. 7- c,A \, 4' ,~f.p 7.3 0 I ð '
,. ~ ¿ C" 0"2'1 &0 . -.. j
\-.,~../ " . ~-~
/ .- '7 Q C' 1'1 ç lJ (), (7). ""~
' ,..) .,...) ../ V (j U /"6
( CAL.OCC 0'7;80:::" - !
. I
/
//
~-
.'-
/,
---
~~} Î 19q9
STATE BOARD OF EQUALIZATION
DEP~TMENT OF TOXIC SUBSTANCES CONTROL
PERMITTING SECTION
744 P Street
. P.O. Box 942732
Sacramento, CA 94234-7320
--
---
-"
To Whom it May Concern,
I am writing this letter to inform you that we no longer have the attached imaging sites in .
operation to perform any radiological exams and/or process any film images.
As of September 22, 1997 EPA # CAL912693010 and September 25, 1997 EPA #
CAL000077802 are no longer iÌ1 use. ~
Please feel ftee to contact me at PM!, our main office, at (805) 395-0155 with any
questions.
Thank you, , n
\/~ ¿J¡, tJo.1tL
Mod~'~tugard
Chief Technologist
I
,
I
i
enclosure
cc: Bill Pankey
M!C57
4000 Physicians Boulevard, Building E, Suite 101, Bakersfield, CA 93301 Tel. (805) 395-0155 Fax (805) 395-0102
--~_.-
~
'"'~~
~ ~ j,'C'1
.:./~.,;~
"~ru:r.'\~
ST. BOARD OF eQUALIZATION' a
ECIAL TAXES DIVISION ..
P.O. BOX 942754. SACP~ENTO, CALIFORNIA 94291-2754
(91 ,:i) 739-2582
RE
MO.
l
.
TR
PET COP\'
I
PHYSICIANS PLAZA MED IMAGING eTR
ATTN: MOllY STUGARD
~OOO PHYSICIANS BLVD STE 101
-¡
o
2
DATE:
ACCOUNT NUMBER
HWCA
HF EF 38-008100
7
GfA# C,'A-L9/2(PC1SDIO
DEMAND IS HEREBY MADE FOR THE DELINQUENT
AMOUNTS AS SHOWN BELOW.
HAZARDOUS SUBSTANCE TAX
CONDITIONAllY EXEMPT FACiliTY
FEE
AMOUNT
INTEREST PENALTY
TOTAL
AS DETERMINED 50.00
FOR THE PERIOD 01/01/97 - 12/31/97
PENALTY CHARGED
TOTAL 50.00
5.00
5.00
50 . 00
5.00
55.00
55.oC
************* PAY THIS AMOUNT
Ii}' '
~:~.,
ADDITIONAL INTEREST OF $0.50 ACCRUES ON THE AMOUNT OF FEE AT THE RATE OF
1.0000% PER HONTH AFTER 12/31/97.
A NOTICE OF TAX LIEN COULD BE fILED OR RECORDED UNDER CHAPTER 1~
(COHHENCING WITH SECTION 7150) OR CHAPTER 1~.5 (COHHENCING WITH
SECTioN 7220) OF DIVISION 7 OF TITLE 1 OF THE GOVERNMENT CODE )0 DAYS FROM
THE DATE OF THIS DEMAND BILLING If PAYMENT OF THIS DELINQUENT TAX LIABILITY
IS NOT HADE IN FULL.
.'
·!.t··.· .
..:~ .
i
I~'··"
. ...¡o. '. .
, ..~.. .
;. ".r
~:'
'0
J.
-. .
..J;;:t;lt¡
. ... -;-"~:~~~I
.....~
MAKE CHECK OR MONEY ORDER PAYABLE TO THE STATE BOARD OF EaUAUZATlOtlii~ :of .
Always write your account number on your check or money order. Make a copy of this document ~.y' _ ; s.
·.~è~~
~~ of caÌirornia . California Eoviroumen.. Ageocy
~r
'bI vJ , -
.~ ,j,
.~, - Department of Toxic: SubstaDces r.ootrol
~' Page 1 oF7
ONSITE HAZARDOUS WAST:f; TREATMENT NOTIF1CATION FORM
FACILITY SPECIFIC NOTIFICATION
For Use by Hazardous Waste Generators Performing Treatment
Under Condiûonal Exemption and Conditional Authorization,
and by Permit By Rule Facilities
[J
o
o
Iniûal
Renewal
Revision
Please refer to the alIached Instructions before completingthisfonn. You may IWtifyfor more than one pennitting tier by using this
IWtificalionfonn, DTSC 1m. You must attach a separate unit spedfic IWtificaJionfonnfor each unit at this location. There are
different unit spedfic IWtificationfonnsfor each of the four categories and an additionallWtificationfonnfor transportable treatment
units (lTU's). You only have to submit fonns for the tier(s) thai cover your unit(s). Discard or recycle the other unused fonns.
Number each page of your completed IWtification package and indicate the total number of pages at the top of each page at the
'Page _ of _'. Put your EPA ID Number on each page. Please provi4e all of the infonnation requuted,' a//fie/dr must be
completed except those thai state 'if differenl' or 'if available'. Please type the info17TUJ/ion provitkd on this fonn and any
attachmenls. '
The IWtificationfees are assessed on the basis of the number of tiers the IWtifier will operate under, and wiil be collected by the Slate
Board of Equalization. DO NOT SEND YOUR FEE wrm mrs N077FlCA770N FORM.
1. NOTIFICATION CATEGORŒS
Indiçate the number of units you operate in each tier. This will also be the number of unit specific IWtificationfonns you must attach.
CcnÆtionally Exempt SmallQuanriJy Tre.aJmoJJ operations may noI operate uniJ.s under arty other tier.
. ll. GENERATOR IDENTIFICATION
A.
D.
Permit by Rule
B.
1
Condiûonally Exempt-Specified
E.
Commercial Laundry
C.
Conditionally Authorized
F.
Variance (Section 25205.7)
EP A ID NUMBER CA -L ..s. .l.. 2.. 6-9......3-D -1 -D. _
~o
~"
MBER (if available) H_H~ _ _ _ _
---
F ACll.ITY NAME
(DBA-Doing Buaine.. As)
PHYSICAL LOCATION
PhY9;~;~n~ Pl~7.~ Mpdir~l Tmnging Center-Kaiser Stockdale
3501 Stockdale Hwy
CITY
Bakersfield
CA
ZIP 93309 -
COUNTY
Kern
CONTACf PERSON
Jovce
(Firat Name)
Ayers
(Last Name)
PHONE NUMBER~·395 - 0155
MAILING ADDRESS, IF DIFFERENT:
COMP~YNAME Physicians Plaza Medical Imaging Center
STREET
4000 Physicians Blvd #101
CITY
Bakersfield
STATE CA ZIP 93301 -
COUNTRY
CONT ACf PERSON
Kern
(olÙY complete if not USA)
.Toyre
(Firat Name)
Avers
(Lall Name)
PHONE NUMBER~ 395-0155
DTSC 1772 (7/94)
Page 1
EPA ID NUMBER~
.'.
,... .., ~
Page 2 ' of -!". .
~--- ~ --~
1__ '
m. RADIOACTIVE MATERIALS OR WASTE
YES NO
o IKJ
Does the facility use, store or treat radioactive materials or radioactive waste?
IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE:
Use either one or two SIC codes (a four digit number) thai best describe your company's products, services, or industrial activity.
ExampÚ!: ZlJH' Photofin~hing lab
7218 Industriallaundert:n
FÎISt: 8011 Off] CP-S & c] inics of
medical doctors
~nd: 7384 Photofinishinq lab
V. PRIOR PERMIT STATUS: Check yes or no to each question:
YES
o Did you tile a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location?
o Do you now have or have you ever held a sbte or federal hazardous waste facility full permit or interim
status for any of these treatment units?
o Do you now have or have you ever held a state or federal full pennit or interim status for any other, .
hazardous waste activities at this location? ' .,
o Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you
are now notifying for at this location?
o Has this location ever been inspected by the state or any local agency as a hazardous waste generator?
NO
~ 1.
~ 2.
~ 3.
~ 4.
~ 5.
-~~.
VI. PRIOR ENFORCEMENT IDSTORY: Not n:quired from genaaJon only 1Wlifying as condilionally exempt or as a
COm17lO"dal.laundry. '
YES NO
o 0
Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final
orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health
enforcement agency?
(For the purposes of this form, a notice of violation does not constitUte an order and need not be reported unless
it was not corrected and became a fInal order.)
o If you answered Yes, check this box and attach a listing of convictions, judgments, seltlements, or orders and a copy
of the cover sheet from each document. (See the Instructions for more information)
Vll, ATTACHMENTS: Attaduru:n1s are nol rc.quimifor Cornmodol úwndrj faåliJies.
8
o
1.
A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries.
A unit specific notification form for each unit to be covered at this location.
2.
DTSC 1772 (1/94)
Page 2 .
EPAID NUMBER~
..
Page 3 of 7
VIII. CERTIFICATIONS: Thisfonn must be signed ùy an aUlhorized corporate officer or any other person in the company who
has operatioTUJI control and performs decision-makingfunctions that govern operation of the facility (per Title 22, California
Code of Regulalions (CCR) Section 66270.11). AU Wet! copies nwst haw: original signarures.
Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the
degree I have determined to be economically practicable and that I bave selected the practicable method of treatment, storage, or
disposal currently available to me which minimizes the ptesent and future threat to human health and the environment.
1 ,
Tiered PennittiOl! Gertification I certify that the unit or units described in these documents meet the eligibility and operating
requirements of stat¿ statutes and regulations for the indicated permitting tier, including generator and secondary containment
requirements. I understand that if any of the units operate under PeJ'1DÍt by Rule or Conditional Authorization, I will also be required
to provide required financial assurances by January 1, 1995, and conduct a Phase I environmental assessment by January I, 1995.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry ,
of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to
the best of my knowledge and belief, true, accurate, and complete.
I am aware that there' are substantial penalties for submitting false infonnation, including the possibility of flnes and imprisonment
for knowing violations.
Jerry Sturz
Name (print or Type)
A~mini~tr~.i,~ ni~~ctor
Title
--.:\.- --f?
Signature
~
-==--
~
i~-I '}-o( 'í L(
Date Signed
OPERATING REQUIREMENTS:
Please note thai generators treating hazardous waste onsite are required to comply with a number of operating requirements which
differ depending on the t¡er(s). These operating requirements are set forth in the statutes and regula/ions, some of which are
referenced in the Tier-Specific Fact Sheets availabú: from the Department's regional and headquarters offices.
SUBMISSION PROCEDURES:
You must submiJ two copies of this completed 1WtiJication by certified mail, return receipt requested, to:
Department of Toxic Substances COlllrol
Onsite Hazardous Waste Treatment Unit
400 P Street, 4th Floor (walk in only)
P. O. Box 806
Sacramento, CA 95812-0806.
You must also submit one COUY of the 1WtificaJion and altachmellls to the local regulo.tory agency in your jurisdiction as listed in
Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record.
AU thraforms 17UISt haw: ori2inal signatures, not photocopies.
DTSC 1772 (7/94)
Page 3
EPA ID NUMBER CAT.gb n
-'
..
Page ~. of :L
CONDITIONALLY EXEl\1PT - SPECIFIED WASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c»
The 'Iíer-Specific Fact Sheets conf.!Ün a snmrrulry of the operating requirements for this category. Please
review those Ï-equirements carefully before completing or submitting this notification package.
UNIT ID NUMBER 1
UNIT NAME Silver Reclaimer
NUMBER OF TREATMENT DEVICES:
...L- Tank(s)
-L Conta.iner(s)/CoIita.iner Treatment Area(s)
Each unit must be clearly identified and labeled on the pIet plan allached to Fonn 1772. Assign your own unique number to each
unit. '!he number can be sequential (1, 2, 3) or using any system you choose.
Enter the estimated monthly total volume of hazardous waste trea/ed by this unit. This should be the maximum or highest anwunt
treated in any month. Indicate in tM narrative (Section 1/) if your opera/ions have seasonal variations.
L W ASTESTREAMS AND TREATMENT PROCESSES:
pounds and/or 60
gallons
Estimated MonlhIy Total Volwne Treated:
YES NO
o ŒI
o [B
D
o
o
o
o
o
Is the waste lreated in this unit radioactive?
Is the waste treated in thisunit a bio-haz.ard/infectious/mediC4Ù waste?
'!he folIewing are the eligible wastestreams and trea/men/ processes. Please check all applicable boxes:
1.
II
Treats resins mÏ:Xed in accordance with the manufacturer's instructions.
2.
Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical
processes, such as crushing, shredding, grinding, or puncturing.
3.
Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.124, by
pressing or by passive or heat-aided evaporation to remove water.
4.
Magnetic separation or screening to remove components from special waste, as classified by the department
pursuant to Title 22, CCR, Section 66261.124.
5.
Neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize
water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for conditional
exemption.)
. ,
6.
Neutralize acidic or alkaline (base) wastes from the food processing industry.
.~~
","!
~ Recovery or silver rrom photofinishing. The volwne limit ror condiûonal exempûon is Soo gallons per
~ generator (at the same location) in any calendar month. .
DTSC 1772B (7/94)
Page 10
EPA ID NUMBER CAL9126_
..
."
Pag: .2 of _.7'
8.
o
o
o
9.
o
10.
o
11.
~
CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c»
Gravity separation of the following, including the use of nocculants and demulsifiers if
&. The settling of solids from the waste where the resulting aqueouslliquid stream is not hazardous.
b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less
than 25 barrels (42 gallons per barrel).
Neutralizing acidic or alkaline (base) material by a slate certified laboratory or a laboratory operated by an
educational institution. (To be eligible for conditional exemption, this waste cannot contain more than 10
'percent acid or base by weight.)
Hazardous waste treabnent is carried out in quality control or quality assurance laboratory at a facility that
is not an ofTsite hazardous waste faciHty.
A wastestream and treatment technology combination certified by the Department pursuant to Section
25200.15 of the Health and Safety Code.
n. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used.
1. SPECIFIC WASTE TYPES TREATED: Photo fixer containing siJvpr
2.
TREATMENT PROCESS(ES) USED:
Electronic and Metallic Repl~~pmpnt
rt.~
ID. RESIDUAL MANAGEMENT: Check Yes or No to each quesliofl as it applies to all residuals from this treatment unit.
YES NO
~ 0
o IQa
~ 0
o ŒI
o ŒI
1\
1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer?
2. Do you discharge non-hazardous aqueous waste under an NPDES permit?
3. Do you have your residual hazardous waste bauled offsite by a registered hazardous waste hauler?
If you do. where is the waste sent? Check all thai apply.
ŒI
o
o
o
&.
Offsite recycling
b.
Thermal treatment
C..'
Disposal to land
d.
Further treatment
4. Do you dispose of non-hazardous solid waste residues at an offsite location?
S. Other method of disposal. Specify:
DTSC I772B (7194)
Page 11
CAL91_.
..
I'
,
EPA IDNUMBER
:;-
Page6 of 7
- -
CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c»
IV. BASIS FOR NOT NEEDING A FEDERAL PE~m:
In order to demonstrate eligibilityfor 01U! oft~ onsite treatTlUnltiers.facilities are required to provid£ the basis for detennining that
a Jurzardous waste pennit is not required under the fetkral Resource Conservation and Recovery .Act (RCR.A) and t~ federal
regulations adopted under RCRA (Iitk 4(). Code of Federal Regulations (CFR)).
CJwose the reason(s) tJu:u describe the operation of your onsite treatment units:
o 1.
o 2.
O' 3.
o 4.
o 5.
o 6.
-P
D
o
The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a haz.a.rdous
waste under California state law.
The waste is treated in wastewater treatment U11.Ïts (tanks), as defined in 40 CFR Part 260.10, and discharged to a
publicly owned treatment works (POTW)/scwering agency or under an NPDES permit. 40 CFR 264. 1 (g)(6) and
40 CFR 270.2.
The waste is treated in elementary neutralization units. as defiDed in 40 CFR Part 260.10, and discharged to a
POTW /sewering agency or under an NPDES pernút. 40 CFR 264.1 (g)(6) and 40 CFR 270.2.
The waste is treated in a totaJJy enclosed treatment faciJity as defined in 40 CFR Part 260.10; 40 CFR 264. 1 (g)(5).
The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in aca.lendat month
and is eligible as a federal conditionally exempt smal1 quantity generator. 40 CFR 260.10 and 40 CFR 261.5.
The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and
180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34,40 CFR 270. 1 (c)(2)(i) , and the Preamble
to the March 24, 1986 Federal Register.
Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals.
40 CFR 261.6(a)(2)(iv), 40 CFR 264.1(g)(2). and 40 CFR 266.70.
8.
Empty container rinsing and/or treatment. 40 CFR 261.7.
9.
Other: Specify:
V. TRANSPORTABLE TREATI\1ENT UNIT: Check Yes or No. Please refer to the Instructions for more information.
YES NO
o Wi
Is this unit a Transportable Treatment Unit?
If you answered yes, you must also complete and attach Fonn 1772E to this page.
DTSC 1772B (7/94)
Page 12
EPA ID NUMBER
#CAL912693010
,
LOBBY
Stockdale Hwy
Physicians Pi
c/o Kaiser aza Medical Irna .
~3501 Stockd lPerrnanente St glng Center
kersf' a e Hwy ockdale
leid C .
. 805) 398-5Ó4 a 93309
(805) 395_0152 (facility)
5 (contact pe
rson)
~
..- .-
, "
.."., 0.·'
, '
;
. "
..
Page~of 7
PLOT PLAN
:
Real Rd.
o.
-.
PLAZA
MEDICAL
IMAGING
Center
~ f
;;
". . . where the Patient is Most Important. "
December 19, 1994
Valetti Lang
400 P street 4th floor
Sacramento, CA 95812-0806
Dear Ms. Lang;
Earlier this year I spoke with you regarding Hazardous Waste
Notification forms. Our previous Administrator, Mr. Greg
Harmon, had assumed responsibility of everything pertaining
to hazardous waste activity and had filled out all of the
necessary paperwork to comply with the State of California
Environmental Laws. After he left our facility I received
the letter of Acknowledgment of units operating Under
Conditional Exemption and noticed he only filled out the
paperwork for our site. We have three other faculties that
treat for hazardous. waste. At last we spoke you said you
would send out forms for me to complete with no late fees.
It has just come to my attention that the forms did in fact
arrive but they were not forwarded to me. I apologize for
any problems this delay may have caused. I have assumed
this responsibility again, should there be any further
questions or problems, though I do not anticipate any,
please feel free to call me. Thank you for your help and
understanding.
4000 Physicians Boulevard, Building E, Suite 101, Bakersfield, CA 93301 Tel. (805) 395-0155 Fax (805) 395-0102
..:n
. ~ -...;.....- ~. --,,----,----------:;----
---~_.. ...._-_..~....-,-.-.',,'--..-
"::':-:wJ ".~._._--~:.. .' -- -
= -
-. --
. -. - . .
. '-. ...~....-:-._->-~----...~...,.....,.~-~"~.~-
. ---_._: ,~:.... _~__~,,,.-,-.M'.,,~. ..........""".. .....,.,:~__.....u.""~,>-,;, ,....-~'<1.n,,~'...;;.':i¡L.I~...~,...~~-':"'~~f~'"':~:::¡~~;:i.~'.. ...~._
d' 'r
STATE OF CALiFORNIA-ENVIRONMENTA
....... '
Of:PARTMENT Of TOXIC SUBS
REGION "--1515 Tollhouse Road
Clo~.. CA 93612
.'
PROTECTION AGENCY
, CES CONTROL
. - ,.; . - . ~-
PETE WILSON, Governor
....j,'.-
.
CHECKLIST AND INSPECTION REPORT FOR
Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
FACll.lTYNAME:f/'~5jr:J4.·11 r ¡;kJ« ÂrrtP/;"I IJI"ttc¡tt;1 EPAIDNUMBER: (111. 'to. "9.3 0(0
PHYSICAL ADDRESS: 3'>0/ .5toc-k tfJt..!(- H","j I3c, k-rrs //r /d lI7· 93->'0 ~
COUNTY Afrh. PHONE: (9'65) .J'l.s-C>lS..f
FACll.lTY CONTAcr-NAME: h£¡U' /]'1"r..s SIC CODE(S): ~CJ/(
UNIT COUNT: . PBR CA CESW L- CESQT _ TOTAL-'--
UNIT COUNT(notified): PBR _ . CA _ CESW -I- CESQT _ TOTAL 1-
INSPECTION DATE: /I.t1ri ( '1, /99'> ,# of VIOLATIONS: -1- Minor _ Class 1
VIOLATION TYPE: . _ OÍ1site treatment -=::: Generator _ Waste min. _ Recycling
NOTICE to COMPLY ISSUED (y/n): 1(-s Local Agency # ~..
This checklist and iøspedion report identify violatioDS of st:Ite law regarding oDSite treaters of bazardoœ waste. operating
UDder an oDSite permittiag tier. This iaspedion verUleS the information provided on form DTSC 1772. It also covers generator
requirements, although a separate cheddist may be used for those requirements. A checkmark indicates violation of the law, which
are explained in more detail on the attadIed Dote sheets and Noûœ to Comply. The governing laws are the Health and Safety Code
(HSC) and TdIe n of the California Code of ReguIatioDS (U CCR).
Generator Standards:
Each inspection agency may use their own geneTtJlor inspection checJcJist or prOlOCol.r, which are summarized below. A..ftdi
evaluation of each item or document i.r noI cowb.u:ud during the Inspection. unJas seriofLr deficimciu are suspected.
NO
1. 01\ Contingency plan has been prepared (adequately minimize releases, has alannlcommunication
system, lists emergency equipment and phone numbers for emergency coordinators).
2. 6ß-. Written training documents and records prepared for employees handling hazardous waste.
3. or.. Meet container management standards (storage time limits, closed, labelled, compatibility,
inspected weekly, in good condition, with ignitableSlreactives 50 feet from property line).
4.,vt1 Meet tank management standards (either secondary containment or integrity assessments, plus
storage time limits, labelled, compatibility, inspected daily, in good condition, with
ignitables/reactives 50 feet from property line).
5. Ok All w~es ~ properly identified.
Treatment Items-Facility Wide: (Facility must submit a revised Fonn 1m to co"ect errors or omissions.)
6. Of: All units under PBR, CA, and CE are properly indicated on Form DTSC 1772. (Add any new
, units with unit sheets or correct tier on the unit sheet.)
7. (j '" All generator identification information on Form DTSC 1772 is correct.
8. or, The submitted plot plan/map adequately shows the location of all regulated units.
. 9. uK· There are records documenting compliance with sewer agency pretreatment standards and
industrial waste discharge requirements, where applicable.
10./11;1 Generator has prepared/maintained source reduction documents requirements (SB 14/SB 1726).
For many wastes, a checklist or plan is required ~ if annual hazardous waste volume is over
5,000 kilograms (approx 11,000 pounds or 1,350 gallons). HSC 25244.15, '25244.19-.21
For CA or PBR notifiers:
11.ftI/l.The generator has an annual waste minimization certification. (pBR submit with renewals.)
Onsite Checklist (A)
Paae 1 of (
I:> _
January 1, 1995
:.--
. "':---....
(I r .
STATE OF CALIFORNIA-ENVIRONMENTAL PROTECTION AGENCY
()EPARTMENT-OF TOXIC SUBeNCES CONTROL
REGION .1-1515 Tollhouse Road
Clovis. CA 93612
PETE WILSON. Governor
.
Q
CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR
Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
UNIT SHEET
Complete one unit sheet for each unit either listed in the notification or identified during the inspection.
Unit Number: /
Notified Tier: (£ 5 cu
Unit Name: S¡/tlN Rfc !o.IM'~r'
Correct Tier: {' e5 LJ
Notified Device Count:
Correct Device Count:
Tanks . /
Tanks 19
Containers I
Containers .2
For each Unit:
NO
---1:::
12. () (, All hazardous wastes treated are generated onsite.
13. The unit notification is accurate as to the number of tank(s) and/or container(s).
14. 0(,' The estimated notification monthly treatment volume is appropriate for the indicated tier.
15. The waste identification/evaluation is appropriate for the tier indicated.
16. The wastestream(s) given on the notification form are appropriate for the tier. "
17. The treatment process(es) given on the notification form are appropriateJor the tier.
18. The residuals management information on the form is correct and documented for the unit.
19. The indicated basis for not needing a federal permit on the notification form is correct.
20. There are written operating instructions and a record of the dates, volumes, residual
management, and types of wastes treated in the unit.
21. There is a written inspection schedule (containers-weekly and tanks-daily).
22 There is a written inspection log maintained of the inspections conducted.
23. ¡i/fllf the unit has been closed, the generator has notified DTSC and the local agency of the
closure.
For each CA or PBR unit: '
24.ß//1The generator has secondary containment for treatment in containers.
- ,
For each PBR unit:
25. There is a waste analysis plan
26.)tI¡! There are waste analysis records.
27. There is a closure plan for the unit.
Unit Comments/Observations: (If this is a unit thai was not included on the notifictltÌonform, the violation is operating without a
permil-HSC 25201 (a). Also note if the activity is currently ineligible for onsite aulhorization.)
On site Checklist (B)
Page 1- of -L
January 1, 1995
_.-.-,~ '..- ,---~-
~f-_'- .
>STATE'üF CALIFORNIA-ENVIRONMENTAL PROTECTlÔN AGENCY
~EP~RTM~NT OF TOXIC SUBS&CES CONTROL
REGION 1-1515 Tollhouse Road
Clovis. ÇA 93612
. PETE WILSON. -GoVernor
.
CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT. FOR
Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
SIGNATURE SHEET
e
Onsite Recycling: Only answer if this fadliry recycles more than 100 lålo~rams/month of hm..ardous waste onsite.
NO
28'JV/J The appropriate local agency has been notified. HSC 25143.10
29. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec.
Releases:
If there has been a release, provide the following information: number of releases, daters), rype(s) and qu(urriry of
maleriais/waste, and the causers). Use unit sheet or attach additional pages.
YES.
30.
ftló
31.
...
Within ~e last three years, were there any unauthorized or accidental rëieases .to the
environment of hazardous waste or hazardous waste constituents from onsite treatment units?
Within the last three years, were there any unauthorized or accidental releases
to the environment of hazardous waste or hazardoUs waste constituents from any location at
this facility?
For purposes of a Tiered Pennirring inspection, an unauthorized and/or accidental
release to the environment does not include spills contained within containment systems.
This report may identify conditions observed this date that are alleged to be violations of one or
more sections at the California Health and Safety Code (HSC) or the California Code of Regulations,
Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in
more detail on the attached note sheets. If any violations are noted, the facility is required to the submit
a signed Certification of Return to Compliance within 60 dåys, unless otherwise specified. (A
certification form is provided.) If any corrections are needed to the initial notification, the facility will
submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy
to the local enforcement agency.
Inspector(s):
Lead Inspector:
Signature: /)C<rr:'P y: .5 LJ
Print Name: .0 À vl;JJ j- .5 £ LI~lÆ 6. f r~
Title:)I "'1 - . .5 µ/., "; I...... U"s Jc If·;... -I r;' f
Agency: lJ ,..,,1. ¡¿ v r'; 5,-,6J Ie" ~ rr of Celt fre /
Phone Number: ;lor J ol1-ì 3YJ'6
Other Inspector:
Signature:
Print Name:
Title:
Agency:
Phone Number:
Facility Representative:
Your signature acknowledges receipt of this report and does not imply agreement with the imdings.
Signatur : . Prinr Name: ~C 1._ 'D. ~~.f5--
Title: Date: ~
Page L of --1. August 2, 1994
, Sï A T¿ OF CAUí=ORNIA-ENVIRONMENT AL PROTECTJON AGcNCf
DE~ART~ENT OF TOXIC SUBSaCES CONTROL
REGION 1-1515 Tollhouse Road
Clovis. CA 93612
P8"E W¡LSOì~.. Governor
.
. .
~
.
TIERED PERlVfITTING
CERTIFICATION OF RETURN TO COMPLIANCE
For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
J So ( 5 f ~\C F. cP.. It<' f/t<¡ C- l-,~. ì
. In the matter of the' Violation cited on: ~ / ) I i Y
As Ide~tified in.the Inspection Report dated 'f I-i /1 ..)-
Conducted by: Department of Toxic Substances Control
(agency~»
I certify under penalty of law that:
1. Respondent has corrected the violations specified in the notice of violation
cited above.
2. . I have personally examined any documentation attached to the certification to
establish that the violations have been corrected. '
3. Based on my examination of the attached documentation and inquiry of the
individuals who prepared or obtained it, r believe 'that the information is true,
accurate, and complete.
-4. I am authorized to file this certification on behalf of the Respondent.
. -
5. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Joyce D. Ayers
Name (Print or Type)
Chief Technologist
Title
Physicians Plaza·Medical Imaginq Center
Company Name
CAL912693010
EPA rD. Number
DTSC-RETCOMP.CRT (8/94)
. - ~'of Caliro~ . CalirorDia '£¡niromneabl ~A¡aICy
! "
.partmeat 01 Toxic S.,'--c1II CoaaroI
Page 1 of .3
ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM
. FACll.ITY SPECIFIC NOTIFICATION
For Use by Hazardous Waste Generators Performing Treatment
Under Conditional Exemption and Conditional Authorization,
and by Permit By Rule F2Cilitics
o Initial
o Renewal
181 Amendment
Please refu to the altached InstrUctions before completing this form.. You may notify for more than OM pemUning liD- by !ISing this
notificalionfonn, DTSC 1m. You must altach a sqxzrale unit ~d.fic notificalion fonn for each unit al this location. TMre an
differenl unit specific notificalionform.r for each of the four categories and an additional notification fonn for tran.rportabk trt!lltmCrl
uniu (TIV'.r). You only havë· to submù forms for the tÍD"(S) tha1 COW!T your unit(s). Discard or recyck the 0ÚU!r lllUlSed forms.
Numbu each page of your completed notificalion package and irrdicale the total number of pages al the top of each page at tM
'Page _ of _ '. PUl your EPA lD Number on each page. Please provitk all of the inforrrrÒtipn reqUl!Sted,· all fieldr must be
I completed except those that Stall! 'if differenl' or 'if available'. Please type the informalion provided on this fonn and any
attachments.
The notification/ees are assessed on the basis of the number of tiers the notifier will operate under, anJ will be colkcted by tM Stale
Board of Equalization. DO NOT SEND YOUR FEE wrrH 1111$ NOTIFTCA.110N FORM. .
L NOTIFICATION CATEGORIES
Indicall!,the number of uniu you opuale in each tier. This will aLro be the number of unit specific notificalion forms you must anach.
CondbioTUJ11y E:tempt Snuúl Quan.tity Trt:lZt11U:nl opualions may not opuau units under any otho tú:r.
Nwnber or w1Ïts and attached unit specific notifiC:ltions for e:1ch tier reported.
A.
Conditionally Exempt-Sma.ll Quantity Treatment
I'
D. Permit by Rule I,
i
) .
E. Commercial Laundry
i
I.
F. Variance (Section 25143) I
I
1
I
B.
1
Conditionally Exempt-Specified Wastestream
C. Conditionally Authorized
! II. GENERATOR IDENTIFICATION
EPA ID NUMBER CAL., 2..L2_6-9-3-º ~..Q._
BOE NUMBER (if available) H_H~ _ _ _ _ _ __
! FACIUTY NAME
(DBA-Coin¡ Buliocsa ~)
PHYSICAL LOCATION
Physicians Plaza Medical Imaging Center
3501 Stockdale Hwv
CITY
.'
Bakersfield
CA
ZIP 93309
COUNTY
Kern
¡ CONTACT PERSON
Joyce
(FitJ( Name)
Ayers
(La¡( Name)
PHONE NUMBER~ 395 . 0155
MAILING ADDRESS, IF DIFFERENT:
COMPANY NAME Physicians Plaza Medical Imaqinq Center
For DTSC UN Only
STREET
4000 Physicians Blvd. #101
Region
CITY
Bakersfield
STATE
ZIP 93301
-
-
COUNTRY
CONTACT PERSON
(only c:omplelC if ()( USA)
Joyce
(Firs( Name)
Ayers
(Last Name)
PHONE NUMBER(805 )~- 0155
DTSC 1772 (1/95)
Page 1
CAL91WOiO
P~ge -'-"of .3 .
- .-
'. E?A ID Ntì'MBER
.
CONDITIONALLY EXEMPT - SPECIFIED WASTE STREAMS
~ UNIT SPECIFIC NOTIFICATION
(pursuant to Health ånd Safety Code Section 2S201.5(c»
The Tier-Specific Fact Sheets contain a Sllmm~ry of the operating requirements for this category. Please
review those requirements carefully before completing or submitting this notification package.
UNIT NAME Silver Reclaimer
UNIT ID NUMBER
2
1
NUMBER OF TREATMENT DEVICES:
° Tank(s)
~ Tank(s)
Container(s)/Container Treatment Area(s)
NUMBER OF STORAGE DEVICES:
Each unit must be clearly identified and labeled on the plot plim ai/ached to Fonn 1m. Assign your own uniq~ number to each
unit. The nUl7{ber can be sequential (1. 2. 3) or using tmy system you choose.
Enter the estinwted monthly total volume of haztzrdnus waste "ealed by this unit. This should be the 11U1Xþnum or higlresr OITUJunt
treated in atry month. Indicale in the lUZ1Talive (Section 1/) if YO,ur operalions have seasonal variations. -
L WASTESl'REAMS AND TREATMENT PROCESSES:
pounds andlor 60
°
gallons
Estimated Monthly Total Volume Treated:
Estimated MOQthly Total Volume Stored:
YES NO
o ~
o I!I
o Œ1
gallons
pounds andlor
Is the waste treated in this unit radioactive?
Is the waste treated in this unit a bio-hazardlinfectious/medical waste?
,
Is remotely generated hazardous waste (HSC 2S 110.10) treated in this unit?
The following are the eligible wastestreams and treatment processes. Please check all applicable boxes:
0 1.
0 2.
0 3.
D 4.
*NOTE*
D 6.
~ 7.
Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-part ,and
pre-impregnated materials).
Treat containers of 110 gallons or less capacity that contained hazardous' waste by rinsing or physical
processes, such as crushing, shredding, grinding, or puncturing.
Drying special wastes, as classified by the department pursuant to Tille 22,CCR, Section 66261.124, by
pressing or by passive or heat·aided evaporation to remove water.
Magnetic separation or screening to remove components from special waste, as classified by the department
pursuant to Tille 22, CCR, Section 66261.124.
s. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the
regeneration or ion exchange media used to demioeralize water. (This waste ClDDOt contain more
than 10 percent acid orbase by weight to be eligible for this exemption.)
Neutralize acidic or alkaline (base) wastes from the food processing industry.
Recovery of silver from photofinishing. The volwne limit for conditional e.'"<emption is 500 gallons per
generator (at the same location) in any calendar month.
*NOTE* Recovery of 10 gallons or less per month of silver from photofmishing is
completely exempt from permitting; this form need not be submitted.
DTSC 1772B (1/95)
Page 10
',.EPA.ID NUMBER CAL91269301,-
.
Page 3 of3
vrrI. CERTIFICATIONS: 7ñisform must be sig/Jed by an authorized corporale officer or any other person in the company who
has operational control and performs decision-makingjunction.s thai govern opermion ofthefacìliry (per Title 22, Califotnia
Code of Regulations (CCR) Section 66270.11). All thra copia must håve original siglllltllrQ. _
Waste Minimizntion I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to tho
degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or
, disposal currently available to me which minimizes the present and future thre3t to human health and the environment.
Tiered Pennittint! Certification I certify that the unit or units described in these documents meet the eligibility and operating
requirements of state statutes and regulations for the indicated permitting tier. including generator and secondary containment
requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authori~tion, I will also be required
to provide required financial assúrance for closure of the treatment unit by January 1. 1995.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to
the best of my knowledge and belief, tlUe, accurate, and complete. .
. I am aware that there are substantial penalties for submitting falsè infonnation, including the possibility of fines and imprisonment
for knowing violations.
Jerrv Sturz
Name (Print or Type)
~ -e ~--<-
Signature
~nm; n; !O:~r;:Ii"or
Title
Date ~Ln / q S-
OPERATING REQUIREMENTS:
Please note that generators treating hazardous waste o/uire are required to comply with a number of operating requirements which
differ depending on the tier(s). 7ñese operating requirements are set forth in the statutes and regulations, some of which are
rtiferenced in the Tier-Specific Fact Sheets available from the Department's regional and headquarters offices.
SUBMISSION PROCEDURES:
You must submit two cooit!S of this completed notification by certified mail, return receipt requested, to:
Department of Toxic Substances Control
Program Data Mallagement Section
-400 ~ Stf'eet, 4£1. Fluol, Ruultí 44::>.J (walk hr only)
P. 0.' Box 806
Sacramento. CA 95812"()806.
You must also submit o~ couy of the notification and attachments to the local regulatory agency in your jurisdiction as listed in
Appendix 2 of the instruction materials. You must also relail! a copy as pan of your operating record.
All three forms must have orir!Ìnal Signa/UTes, net photocopies.
DTSC 1772 (1/95)
'Page 3
;.
·ST ATE .OF CALlFORNIA-ENVIRONME
DEPARTMENT OF TOXIC SUB
REGION 1-1515 Tollhouse Road
Clovis, CA 93612
L PROTECTION AGENCY
ÄNCES CONTROL
PETE WILSON. Governor
Q
CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR
Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
NOTE SHEET
This sheet includes inspector observations and expands upon the violations identified on the checklist (by number). In
some cases, it indicates how the facility should correct the violations. It also includes the names of any others participating
in this inspection.
Onsite Checklist (D)
Page_of _
January 1, 1995
-- ..--,----.---.
. - .<-.--.. .
_._~-----
.- .-.--- ,.--- .
-..---.-..-------.. -
STATE OF (".AUFORNIA-cALlFORNIA ENVlRONME OTECTlON AGENCY
:iDEPARTMENT OF TOXIC S STANCES CONTROL
t 400 P STREET. 4TH FLOOR
I P.O. BOX B06
i~ SACRAMENTO, CA 95812-0806
PETE WILSON. Gcwemor
@
(916) 323-5871
01117/95
EPA ID: CAL912693010
PHYSICIANS PLAZA MED IMAGING CTR
JOYCE AYERS
4000 PHYSICIANS BL '101
BAKERSFIELD. CA 93301
For ftu:ility 1ooaIf'Jtl III:
3501 STOCKDALE HWY
BAKERSFIELD. CA 93309
Authorization Date: 01117/95
Dear Conditionally Authorized and/or Conditionally Exempt Facility:
ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDmONAL AUTHORIZATION AND/OR
CONDmONAL EXEMPTION
The Department of Toxic Substances Control (DTSC) bas received your facility specific notification (form
DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form
DTSC 1772B and/or 1772C). Your notifications are administratively complete. but have not been reviewed for technical
adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time,
you may be inspected and will be subject to penalty if violations of laws or regulations are found. .
The Department acknowledges receipt of your completed notification for the treatment unites) listed on the last
page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by
California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5.
Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully
closed the unit(s). You will be charged annual fees calculated on a calendar year basis for eacb year you operate and
have not notified DTSC that the units have been closed.
You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also
notify the DTSC whenever any of the information you provided in these notifications changes. To revise information,
mail a cover letter to the above address explaining the changes, attacb only the pages of your notification package that
have changed. and re-sign and date at the signature space on page 3 ofform 1772.
Your status to operate under Conditional Authorization andfor Conditional Exemption is contingent upon the
accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable
requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts
sball render your authorization to operate nuIl and void.
You are also required to properly close any treatment unit. Additional guidance on closure will be issued and
distributed to all authorized onsite facilities 1ater this year.
.n. .___ _
n
'-.,
. ' - Oft /IecrdId.......
-..._- --~'" .. -'---~-'-'
---..--....---.--
--..~.__._-.
.._. . . _.___.._ _.. _ _ n .._ _._._ __. _ ~__
I~__-----:...,,-,-,._~
---"-~---""
.. _ ' ____ m
--~_.~.~----~:-_-_..-~-'--~~"':"-'---:"-_~ ~~ ---...:....:... -..-- - .=~=.. -
-' .
.
.
~,---
t
~
Page 2
EPA ID: CAL912693010
-'
þ'
If you have any questions regarding this letter, or have questions on operating requirements for your facility,
please cœtact the nearest DTSC regional office, or this office at the letterhead address or phone number.
Sincerely.
iC~1 S. Ho~r,«r-
Onsite Hazardous Waste TreatmeI1t Unit
Permit Streamlining Branch
Hazardous Waste Management Program
Enclosure
cc: ASTRID JOHNSON
DTSC REGION I
STATE REGULATORY PROGRAM
1515 TOLLHOUSE
CLOVIS, CA 93611
STEVE MCCALLEY
KERN COUNTY
ENVIRON. HEALTH SERVICES DEPT
2700 M STREET, SUITE 300
BAKERSFIELD, CA 93301
- - "
~ _. __.n
I ._~
...-- '-'~-' .....----
..-
__ .'_ h_ _ _
- --~----- --- - "
_______0_"_ _ _
-. ._-~- , '..
.---..---.
---.--- -.---.-.---- -_.._-
...
~..¡
.
.
~
....
Page 3
ENCLOSURE 1
UJÚts ØIIIItori:utl to opÐYIIe at this locøtioII:
UNDER CONDITIONAL AUTHORIZATION:
UNDER CONDITIONAL EXEMPTION:
1
EPA ID: CAL912693010
,
f'\
, "'-
, - .... .""
~AT~ ~t~ALlF~RNIA-CALlFORNIA ENVIRONMa PROTECTION AGENCY
';
,
i<--
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
400 P STREET. 4TH FLOOR .
P.O. BOX 806
SACRAMENTb?~8~ð~871
October 10, 1995
EPA ID: CAL912693010
PHYSICIANS PLAZA MED IMAGING CTR
JOYCE AYERS
4000 PHYSICIANS Bt D101
BAKERSFIELD; CA 93301
Initial Authorization: 01/17/95
Amendment Date: 05/08/95
For facility located at:
3501 STOCKDALE HWY
BAKERSFIELD, CA 93309
Dear Onsite Treatment Facility:
The Department of Toxic Substances Control (DTSC) has received your
facility specific Amended notification (form DTSC 1772). Your
notification is administratively complete, but has not been reviewed
for technical adequacy. A technical review of your notification will
be conducted when an inspection is performed. At any time, you may be
inspected and will be subject to penalty if violations of laws or
regulations are found.
The Department acknowledges receipt of your completed Amended
notification for the treatment unites) listed on the last page of this
letter. These units are authorized by California law without additional
Department action. Your authorization to operate continues until you
notify DTSC that you have stopped treating waste and have fully closed
the unit(s). DTSC has revised its database records to reflect your
status and has notified the Board of Equalization (BOE). You will be
billed annual fees by BOE calculated on a calendar year basis for each
year you operate and/or have not notified DTSC that the units have been
closed.
If you have any questions regarding this letter, or have questions
on operating requirements for your facility, please contact the nearest
DTSC regional office, or this òffice at the letterhead address or
telephone number.
s,;Ph~
Tiered Permitting Compliance, Section
State Regulatory Program Diyision
cc: See next page.
.
\
PETE WILSON. Governor
~.
-. .
~'
."
~J
Printed on Røcyçled Paper
"
, :~
~:~E ~~lIF:RNIA-CAlIFORNIA ENVIRONM. PROTECTION AGENCY
.
PETE WILSON, Governor
~
'fiilIJ
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
400 P STREET, 4TH FLOOR
P,O. BOX 806
SACRAMENTO. CA 95812-0806
PHYSICIANS PLAZA MED 'IMAGING CTR
Page 2 '
EPA ID: CAL912693010
cc:
ASTRID JOHNSON
DTSC REGION 1
STATE REGULATORY PROGRAM
1515 TOLLHOUSE
CLOVIS, CA 93611
STEVE MCCALLEY
KERN COUNTY
ENVIRON. HEALTH SERVICES DEPT
2700 M STREET, SUITE 300
BAKERSFIELD, CA 93301
STATE BOARD OF EQUALIZATION
STEPHEN R. RUDD, ADMINISTRATOR
ENVIRONMENTAL FEES DIVISION
P.O. BOX 942879
SACRAMENTO, CA 94279-0001
Units authorized to operate at this location:
UNDER CONDITIONAL EXEMPTION: 1
.
~
\...
Primød on Røcyclød Paper
'",
{¡
',..-v
" .,:- Stau ot ("~;ronai. - ~01'1lÃa EAnroae Procectioa A¡eacy . DeplU1meat 01 Tœic ~,,,«IIIIC. CoaaroI
, Page 1 of .3
,\ , ,
\-,,\{'v\F \"I\\\\l> o NSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM
t'IL'" :':.\¡I' /' FACIL1TY SPECIFIC NOTIFICATION _ _'
1.\;'I\'ð'~'1 ~C(t,~ q,V\ '> For Use by ~~us Was~ Gc:ncr.¡tors .~erforming T~t~t 0 Initial
0\ _ _ :(,l'\ \ I \\) \ I . Uade< Coadibonal Ex_noo ..,.¡ Condibooal Awhonza_. 0 ~ .
ë G:~~'('t ~"\V and by Permit By Rule Facilities CI81 ~ ~!
~\V I
v Pl4ast! rqer to t~ altadwl InstrUctions bqort! completing this fonn. You may notify for mort! than 0114 permitting tic- by using this
notijicalionfonn, DTSC 1m. You must attach a separatt! unit ~cific notijicalionfonnfor each unil al this location. 'Ihere art!
differt!nt unit .rpt!cific notificalionformsfor each oftMfour ca:egoria and an additional notificationfonnfor transportabk treatnu:n:
unir.r (TIV's). You only 1ulVt!: to submit forms for tM tier(s) thaz cover your unir(s). Discard or recyck tM Olher 1UJUSeJ. forms.
Number each page of your completed notijicalion package and indicale tM total nurnbc- of pq.ga al tM top of each page at thl!
'Page _ of _ '. Put your EP A. ID Number on each page. Pl4ase provitk all of 1M infon7u:z¡ion requested: all fields must be
completed aCqJt thost! thai stale 'if different' or 'if availabl4'. Plt!ase type 1M information provided on this form and œry
attachmenr.r.
The notijicarionleù are assessed on t~ basir oft~ number ofliers the notijier will operale under, and will ~ colkaed by 1M Stale
Board of Equalization. DO NOT SEND YOUR FEE W171171flS NOTlFTCATlON FORM. .
1. NOTIFICATION CATEGORIES
Indicale, t~ number of units you operate in each tier. This will also be tM number of unit specijic notificalion forms you must attach.
Condilionally E:rempt Small Quanriry Trearnu:ru opuaJions may not operate uniu under any other tier.
Nwnber of wüts and attached unit specific noûficûons for e:lch ûer reported.
A.
Conditionally Exempt-Small Quantity Treatment
D.
Permit by Rule
B.
1
Conditionally Exempt-Specified Wastestre:1m
E.
Commercial Laundry
c.
ConditionaIly Authorized
F.
Variance (Section 25143)
ll. GENERATOR IDENTIFICATION
EPA ID NUMBER CALI 2-L2_6-9..l-º ~..Q._
BOE NUMBER (if available) H_H~ _ _ _ _ _ __
. FACIUTY NAME
(DBA-Coins Suúncu AI)
PHYSICAL LOCATION
Physicians Plaza Medical Imaging Center
3501 Stockdale Hwv
CITY
.'
Bakersfield
CA
ZIP 93309
COUNTY
Kern
CONTACf PERSON
Joyce
(Fin¡ Name)
Ayers
(Lut Name)
PHONE NUMBER~ 395 - 0155
MAn.ING ADDRESS, IF DIFFERENT:
COMPANY NAME Physicians Plaza Medical Irnaqinq Center
For DTSe UN Ou1y
STREET
4000 Physicians Blvd. #101
Region
CITY
Bakersfield STATE
ZIP 93301
COUNTRY
CONT ACf PERSON
(only complelC if no( USA)
Joyce
(Finl N'åmc)
Ayers
(Last Name)
PHONE NUMBER~ 395 - Ç)l55
DTSC 1772 (1/95)
Page 1
.,
"
.
E?A ~NUMBE.i.~
~..;,
Page Jof 3
- -
CAL9126WO
.
CONDITIONALLY EXEl\tIPT - SPECIFIED WASTE STREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health ånd Safety Code Section 25201.5(c»
The 1ier-Specific Fact Sheets contain a snmm..1ry of the operating requirements for ~ category. Please
review those requirements carefully before completing or submitting this notification package.
UNIT NAME Silver Reclaimer
NUMBER OF TREATMENT DEVICES:
UNIT ID NUMBER
2
1
o Tank(s)
o Tank(s)
Container(s)/Container Treatment Area(s)
NUMBER OF srORAGE DEVICES:
Each unit must be ckarlý Ukntified and Iabekd on the pwt plan aJtached to Fonn 1 m. Assign 'your own unique nwnber to each
unÌl. The nwnber can be sequential (1. 2. 3) or using arty system you choose.
Enter the estimmed monthly total volU/714 of hazardous waste rrealed by this unit. This should be the nutx¥nwn or higlu!st amount
treated in any month. [ndicale in tM lUUTalive (Section 11) if JO.ur operalions have seasolUZl variaJions. .
L W ASl'ESI'REAMS AND TREATMENT PROCESSES:
pounds and/or 60
o
Esti~ated Monthly Total Volume Treated:
Estimated Monthly Total Volume Stored:
YES NO
o IRI
o E9
o IRI
gallons
gallons
pounds and/or
Is the waste treated in this unit radioactive?
Is the waste treated in this unit a bio-hazardlinfectious/medic.al waste?
.
Is remotely generated hazardous waste (HSC 25110.10) treated in this unit?
The folwwing are the eligible wastestreams and treatment processes. Please check all applicable boxes:
0 l.
D 2.
0 3.
D 4.
*NOTE*
D 6.
~ 7.
Treats r'esins mixed or cured in accordance with the manufacturer's instructions (including one-part ,and
pre-impregnated materials).
Treat containers of 110 gallons or less capacity th:1t contained hazardous waste by rinsing or physical
processes, such as crushing, shredding, grinding, or puncturing.
Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.U4, by
pressing or by passive or heat-aided evaporation to remove water.
Magnetic separation or screening to remove components from special waste, as classified by the department
pursuant to Title 22, CCR, Section 66261.124.
S. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkalioe (base) wastes from the
regeneratioo of ioo exchange media used to dem.i.oeralize water. (This waste cannot cootain more
than 10 percent acid or base by weight to be eligible Cor this exemption.)
Neutralize acidic or alkaline (base) wastes from the food processing industry.
Recovery of silver from photofinishing. The volwne limit for conditional exemption is 500 gallons per
generator (at the same location) in any calendar month.
*NOTE* Recovery of 10 gallons or less per month of silver from photofmisbing is
completely exempt from permitting; this form need not be submitted.
DTSC 1772B (1/95)
Page 10
,",.__E?A}DNUMJÌER~ . Page3 o~3
VID. CERTIFICATIONS: Thi.rform must be .rigned by an aurhcrized corporale officer or any other person in the company who
has operational control and poforms deci.rion-malångfunction..r thai govun operation ofthefaciliry (per 'Iitle 22, California
Code of Regulations (CCR) Section 66270.11). All Wet! copia l1UISt hi:zve original signatures. _ .
Waste Minimiz:ltion I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the
degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or
disposal currently available to me which minimizes the present and future threat to human health and the environment.
Tiered Pennittin2 Certification I certify that the unit or wûts described in these documents meet the eligibility and operating
, requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary cont:l.inmMtt
requirements. 1 understand that if any of the units operate under Pennit by Rule or Conditional Authorization, I will also be required
to provide required financial assúrancc for closure of the treatment unit by January 1. 1995.
I certify under penalty of law that this document and all attachments were prepared under my direcûon or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to
the best of my knowledge and belief, true, accurate, and complete.
I am aware that there arc substantial penalties for submitting false information, including the possibility of fines and imprisonment
for knowing violations.
Jerry Sturz
Name (Print or Type)
__\.- -e S~
SIgnature
J.\nmini~t-r;:¡t-nr
Title
~l¡l/q~
Date Signed
OPERATING REQUIREMENTS:
Please note that generators treating ha::.ardous waste oluite are required to comply with a number of operating requirements which
differ depending on the tier(s). These operating requirements are .reI forth in the statutes and reguÚ:Uion..r, some of which are
referenced in the Tier-SpeciJic Fact Sheets available from the Department's regional and headquarters offices.
SUBI'tUSSION PROCEDURES:
I
You must submit two covies of this completed notification by certified mail, return receipt requested, to:
Department of Toxic Substances Control
Program Data Management Section
400 .~ Slt"eet ,-4th Float, Rvum 44:>~ (walk trr only)
P. 0.' Box 806
Sacramento, CA 95812..()806.
You must also submit one corn of the notification alld allachmenrs to the local regulatory agency in your jurisdiction as listed in
Appendix 2 of the instruction materials. You must also retain a copy as part of your operaling record.
All three forms must Iurw: orifliNll signaJures, not photocopies.
..
DTSC 1772 (1/95)
'Page 3
-' ' Sï A 1~' 0:= CAU¡:ORNtA-ENVIRONMEiIIT AL PROTECTION AGENCY
. --Jt' .
- ~DEPÀRTMENT OF TOXIC SaTANCES CONTROL
REGION 1-1515 Tollhouse Road
Clovis. CA 93612
PETE WILSON, GQ~"
.
- Q.. '.;,.
. '
. "
TIERED PERMITTING
CERTIFICATION OF RETURN TO COMPLIANCE
For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
..lSof 5f:cfr.cfJ..(¡tÞ /!t~"~~' ~(
. In the matter of the' Violation cited on ,: .f /) / '1 ,Y
As Ide~ed in,the Inspection Report dated t¡ /7 J~ J-
Conducted by: Department of Toxic Substances Control
(agency~»
I certify under penalty of law that:
1. Respondent has corrected the violations specified in the notice of violation
cited above.
2. I have personally examined any documentation attached to the cenification to
establish that the violations have been corrected.
3. Based on my examination of the attached documentation and inquiry of the
individuals who prepared or obtained it, I believe 'that the information is true,
accurate, and complete.
-4. I am authorized to file this certification on behalf of the Respondent.
I - .
5. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Joyce D. Ayers
Name (Print or Type)
Chief Technologist
Title
-----
L( I Cl~
Date S i ned
I
Physicians Plaza·Medical Imaging Center CAL912693010
Company Name EPA rD. Number
DTSC-R.ETCOMP .CRT (8/94)
.
~ ~ '~
ri,;.-
.
.
~. #.
~.
ACTION REQUEST ORM
TIERED PERMITTING C LIANCE (TPC)
, PROGRAM DATA MANA ENT (PDM) SECTIONS
ECHNICAL REV EW , ACTION
DATB
INITIALS
-
- ~, \,..'
.., I"'¡~' <~..,
i ,';"
"
ì
I
ßJ,] v,.
';:.-,; .)) 1 '19' ",.
.v'....J.. ' ~",C'
";p. . ~, y~
DELETION (UNIT(S»
REQUESTING ADDITION OF (UNIT(S» .
\.
."
,"
REQUES~ING RESPONSE
REQUESTING REFUNJ/WI, TH ,ESPONS,. , _ ~ / / ~ _?
OTHER {IJj;(Lr {Í('/ß/J ~1ß úJú¡1r {aLe/? .
AMENDED
BILLING:
YES
NO
ACTION TO BE TAKEN BY PDM
DATE RECEIVED
INITIALS ~
OK FOR CLOSURE
DATE OF CLOSURE
OK FOR WITHDRAWAL
DATE OF WITHDRAWAL
OK FOR DENIAL
DATE OF DENIAL
.~..-"" "''"''"'' ...~ -.-'..,,'....
. ",." -:..j'i.":"
DELETE TIER(S)
DELETE UNIT(S)
/
/
/
/
. ."" ',' (' ::;.;.: .
.,.~,.. .
'~'''~'.
. ~t,
. >
""'.:"
-";Þ;/ .
~" ..-
/"
~..';J
-.-:"'?
'-:0...
~¡; -".
\
FILE/AWAITING CLOSURE DOCUMENTS (CERTS),,,
NO RESPONSE FROM FACILITY - SEND TO REGIÒN - .
~HER-'-pk~ ~~
)
~'
. ;)
~;
..,.......
l
/'
....''"'''''~...>".._--..;;..-''"'/
)
..
~~ .
ST~..-:-~ OF CALIFORNIA-CALIFORNIA ENVIRO AL PROTECTION AGENCY
e
PETE WILSON, Governor
,
,I
., ,¡
.I I ,-:".
/ ...
@-....
-,,;
~'
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
400 P STREET. 4TH FLOOR ,
P,O. BOX 806
SAé:RAMENT~?~~8~Õð>871
~.../
..
'''~ .
<6'
4IB$
October 10, 1995
,; ,:
./ /,
~ ., .'- ./..!'
'''-
EPA ID: CAL912693010
. -.j
PHYSICIANS PLAZA MED IMAGING CTR
JOYCE AYERS
4000 PHYSICIANS BL D101
BAKERSFIELD, CA 93301
Initial Authorization: 01/17/95
Amendment Date: 05/08/95
For facility located at:
3501 STOCKDALE HWY
BAKERSFIELD, CA 93309
Dear Onsite Treatment Facility:
The Department of Toxic Substances Control (DTSC) has received your
facility specific Amended notification (form DTSC 1772). Your
notification is administratively complete, but has not been reviewed
for technical adequacy. A technical review of your notification will
be conducted when an inspection is performed. At any time, you may be
inspected and will be subject to penalty if violations of laws or
regulations are found.
The Department acknowledges receipt of your completed Amended
notification for the treatment unit(s) listed on the last page of this
letter. These units are authorized by California law without additional
Department action. Your authorization to operate continues until you
notify DTSC that you have stopped treating waste and have fully closed
the unit(s). DTSC has revised its database records to reflect your
status and has notified the Board of Equalization (BOE). You will be
billed annual fees by BOE calculated on a calendar year basis for each
year you operate and/or have not notified DTSC that the units have been
closed.
If you have any questions regarding this letter, or have questions
on operating requirements for your facility, please contact the nearest
DTSC regional office, or this office at the letterhead address or
telephone number.
'~ 1/
s,Ph'~
Tiered Permitting Compliance, Section
State Regulatory Program Diyision
cc: See next page.
.
."
~J
Printed on Recvc'ed P.~r
'\
\
\... a
SJi'.1E OF ëALlFORNIA-CALlFORNIA ENVIRO"TAL PROTECTION AGENCY
e
PETE WILSON. Governor
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
400 P STREET. 4TH FLOOR
P.O. BOX 806
SACRAMENTO. CA 95812·0806
~-,'.
-..
. ~.
PHYSICIANS PLAZA MEDIMAGING CTR
Page 2 '
EPA ID: CAL912693010
cc:
ASTRID JOHNSON
DTSC REGION 1
STATE REGULATORY PROGRAM
1515 TOLLHOUSE
CLOVIS, CA 93611
STEVE MCCALLEY
KERN COUNTY
ENVIRON. HEALTH SERVICES DEPT
2700 M STREET, SUITE 300
BAKERSFIELD, CA 93301
STATE BOARD OF EQUALIZATION
STEPHEN R. ROOD, ADMINISTRATOR
ENVIRONMENTAL FEES DIVISION
P.O. BOX 942879
SACRAMENTO, CA 94279-0001
Units authorized to operate at this location:
UNDER CONDITIONAL EXEMPTION: 1
I ,
.
....
\..
Primed on Recycled PIper
~.. ~
, State or'c.'t1irorDÍa - CalÜorDÍa Eovirownwlal pAtion Ageocy
14 .,
e
Department or Toxic Subst:mcfS r.outrol
Page 1 or7
I.~
ONSITE HAZARDOUS WASTIt TREATl\1ENT NOTIFICATION FORM
FACILITY SPECIFIC NOTIFICATION
For Use by Hazardous Waste Generators Performing Treatment
Under ConditioDJÙ Exemption and Conditional Authorization,
and by Permit By Rule Facilities
r!]
o
o
Initial
Renewal
Revision
Pkase refer to tM attached Instructions before compkting this form. You may notify for more than one permitting tier by using this
rwtificaJionfonn, DTSC 1772. You must altach a separale unit spedfic notificalionfonnfor each unit al this local ion. There are
different unit spedfic rwtificalionformsfor each of the four calegories and an additional rwtificalionformfor transportabk trealment
units (lTU's). You only have to submit forms for tM tier(s) thai coYer your unit(s). Discard or recyck tM other unused forms.
Number each page of your compkted nctificalion package and indiCale tM total number of pages al tM top of each page al the
'Page _ of _'. Put your EPA lD Number on each page. Pkase provide all of the infomuJtion requested,' allfields must be
completed. except those that stale 'if different' or 'if available '. Pkase type the information provided on this form and any
altachments.
The nctificaJionfees are assessed on the basis oftM number of tiers tM nctifier will operate under, and will be colkcted by the Slale
Board of EqualiZaJion. DO NOT SEND YOUR FEE wrm 11l1S N07TF1CA710N FORM.
I. NOTIFICATION CATEGORIES
IndiçaJe tM number o/units you operale in each tier. This will also be the number of unit specific nctificalionforms you musl altach.
CcndiJiorudly E:u:mpt Small QuanJÏJy Tre.amrenJ ope:rariollJ may net opa-are uniLr undo- any othu tier.
Number of units and attached unit specitic noliticalions for each lice reported.
A.
Conditionally Exempt-Small Quantity Treatment
D.
Permit by Rule
B.
1
CondilioDJÙly Exempt-Specified Wastestream
E.
Commercial Laundry
C.
Conditionally Authorized
F.
Variance (Section 25205.7)
n. GENERA TOR IDENTIFICATION
EPA ID NUMBER CA-L.3. ..1. .2..JL<i...:LO.-.l ~_
BOE NUMBER (if available) H_H~ _ _ __ _
---
F ACn..ITY NAME
(DBA-Doing Billine.. Aa)
PHYSICAL LOCATION
p~Y9i~irln~ Plrl7.rl Mpdirrtl Imaging Center-Kaiser Stockdale
3501 Stockdale Hwy
CITY
Bakersfield
CA
ZIP 93309 ..
COUNTY
Kern
CONT ACf PERSON
Joyce
(FU'It Name)
Ayers
(Lul Name)
PHONE NUMBER~ .395 .. 0155
MAILING ADDRESS, IF DIFFERENT:
COMPAJfYNAJdE Physicians Plaza Medical Imaging Center
STREET
4000 Physicians Blvd #101
CITY
Bakersfield
STATE CA ZIP 93301 ..
COUNTRY
CONT ACf PERSON
Kern
(only complclc if not USA)
.Toyce
(Fitll Name)
Ayers
(Laal Name)
PHONE NUMBER~ 395-0155
DTSC 1772 (7/94)
Page 1
EPAID NUMBER~
e
, Page ,2 q$.:!.' ..
ID. RADIOACTIVE MATERIALS OR W ASfE
YES NO
o IK1
Does the facility use, store or treat radioactive materials or radioactive waste?
IV., TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIF1CATION (SIC) CODE:
Use either one or two SIC'codes (a/our digit number) that best describe your company's products, services, or industrialadivitý.
Example: 7384 Photofinishinc lab
7118 Indu.rtria1lountkrers
First: 801] Offices & clinics of
medical doctors
~nd: 7384 Photofinishinq lab
V. PRIOR PERM:IT STATUS: C/u:ck yes or no 10 each question:
YES
o Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location?
o Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim
status for any of these treatment units?
o Do you now have or have you ever held a slate or federal full permit or interim status for any other. .
hazardous waste activities at this location? I ",' : ,"
o Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you
are now notifying for at this location?
o Has this location ever been inspected by the sute or any loca1 agency as a hazardous waste generator'?
NO
~ 1.
R3 2.
EQI 3.
f§I 4.
~ S.
VI. PRIOR ENFORCEMENT IllSTORY: Not rr:.quired from genaaJon only notifying as condiJionally exempt or as a
commucia1 la.undry.
YES NO
o 0
Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final
orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health
enforcement agency?
(For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless
it was not corrected and became a final order.)
o If you answered Yes, check this box and attACh a listing of convictions, judgments, settlements, or orders and a copy
of the cover sheet from each document. (See the Instructions for more information)
vn. ATTACHMENTS: AJtadunmLr are rwI required/or Commacùú lAundrY/aåUJia.
B
o
l.
2.
A plot plan/map detailing the location(s) of the covered un.it(s) in relation to the facility boundaries.
A unit specific notification form for each unit to be covered at' this location.
,.,
DTSC 1772 (7/94)
Page 2 '
~ .~
~
'-
';J EPA lD NUMBER CAL91.0l0
,-.r..:í-,/ ';'"
-
Page 3 of 2.
VIn. CERTIFICATIONS: Thisfonn must be signed Þy an aUlhorized corporate officer or any other person in the company who
hAr operational control and performs deci.rion-maJdllgfuncrions thaI govern operation ofthefaciliry (per TI//¿ 22, California
Code of Regulalions (CCR) Section 66270.11). All Wa copies must iunIf! original signarures.
Waste Minimization I certify that I have a program in place to reduce the volume. qUlUltity, and toxicity of waste generated to the
degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or
disposal currently available to me which minimius the present and future threat to human health and the environment.
Tiered Pennittinl: Certification I certify that the un.it or un.its described in these documents meet the eligibility and operating
requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment
requirements. I understand that if any of the units operáte under Permit by Rule or Conditioo.al Authorization, I will also be required
to provide required financial assurances by January 1, 1995, and conduct a Phase I environmental assessment by January 1, 1995.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those directly responsible for gathering the information, the information is. to
the best of my knowledge and belief. true, accurate, and complete.
I am aware that there are substantial penalties for submiuing false information. including the possibility of fines and imprisonment
for knowing violations.
Jerry Sturz
Name (print or Type)
~__....(2 ~~
Signature
J.\nm; ni ~tr;:¡t hTE' Dj rector
Title
I~/h( '\ ý'
Date Signed
OPERATING REQUIREMENTS:
Please note tMJ generators treatillg hazardous waste onsile are required to comply with a number of operating requirements which
differ depending on the tier(s). These operating requirements are set forth in the statutes and regulatiollS, some of which are
referenced in the TIer-Specific Fact Sheets available from the Department's regional and headquarters offices.
SUBMISSION PROCEDURES:
You must submil two cooies of this completed notification by certified mail, return receipt requested, to:
Department of Toxic Substances Control
Onsite Hazardous Waste Treatme1Jl Unit
4()() P Street, 4th Floor (walk in only)
P. O. Box 8D6
Sacramento, CA 95812-()8()6.
You must also submil o~ coW of the notification and al/achmetlls to the local regulatory agency in your juri.rdicrion as li.rted in
Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record.
.All thraforms mu.rt hm>e original signa.tures, not photocopies.
DTSC 1772 (7/94)
Page 3
·'
,(i
CAL<:}l _01 n
.
Page .i of J_
EPA ID NUMBER
CONDITIONALLY EXEMYr - SPECIFIED WASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c))
The 1íer-Specific Fact Sheets contain a s:nmIru\ry of the operating requirements for this category. Please
review those Ï-equirements carefully before completing or submitting this notification package.
UNIT ID NUMBER 1
UNIT NAME Silver Reclaimer
NUMBER OF TREATMENT DEVICES:
-L-. Tank(s)
--L CootaÎ.ner(s)/ContaÎ.ner Treatment Area{s)
Each unit must be clearly identified and labeled on the plot plan attached to Fonn 1772.. Assign your own unique number to each
unit. 11u! number can be sequential (1, 2, 3) or using any system you choose.
Enter the estimaled monthly total volume of hazardous waste treaJed by this unit. This should be the maximum or highest anwunt
trealed in any month. 1ndiCale in tk narralive (Section /1) if your operaJions have seasonal variaJions.
L W ASI'ESTREAMS AND TREATMENT PROCESSES:
YES
o
o
D
D
o
o
o
D
K1
Estimated Mont1ùy Total Volume Treated:
pounds and/or 60
gallons
NO
ŒI
4.
Is the waste treated in this unit radioactive?
~
Is the waste treated in this. unit a bio-hazard/infectious/medical waste?
11u! following are the eligible wastestreams and trealment processes. Please check all applicable boxe.s:
1.
I,
Treats resins m~ed in accordance with Lhe manufacturer's instrucLions.
2.
Treat containers of 110 gallons or less capacity Lhat contained hazardous waste by rinsing or physical
processes, such as crushing, shredding, grinding, or puncturing.
3.
Drying special wastes, as classified by Lhe department pursuant to TitJe 22, CCR, SecLion 66261.124, by
'pressing or by passive or heat-aided evaporation to remove water.
MagneLic separaLion or screening to remove components from special waste, as classified by the department
pursuant to TitJe 22, CCR, SecLion 66261.124.
5.
Neutralize acidic or alkaline (base) wastes from the regeneraLion of ion exchange media used to demineralize
water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for condiLional
exemption.)
6.
Neutralize acidic or alkaline (base) wastes from the food processing industry.
····..1
7.
Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per
generator (at the same locaLion) in any calendar month.
DTSC 1772B (7/94)
Page 10
EPA ID NUMBER CAL912693014t
8.
o
o
o
9.
o
10.
10
11.
e
Page, 5 of~ :J
,) - _0
'. ·1
CONDITIONALLY EXEMPT - SPECIFIED W ASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c»
Gravity separation of the following, including the use of flocculants and demulsifiers if
a. The settling of solids from the waste where the resulting aqueouslliquid stream is not hazMdous.
b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less
than 25 barrels (42 gallons per barrel).
Neutralizing acidic or alkaline (base) matcrial by a slate certificd laboratory or a laboratory operated by an
educational institution. (To be eligiblc for conditional exemption, this wastc cannot contain more than 10
percent acid or base by weight.)
Hazardous waste treabnent is carried out in quality control or quality assurance laboratory at a facility that
is not an offsite hazardous waste facility.
A wasteslream and lreabnent technology combination certified by the Department pursuant to Section
25200.15 of the Health and Safcty Code.
ll. NARRATIVE DESCRIPTIONS: Provide a brief description of the specific waste treated and the treatment process used.
1. SPECIFIC WASTE TYPES TREATED: Photo fixer containing si lvpr
2. TREATMENT PROCESS(ES) USED: Electronic and Metallic Repl ;:¡r.pmpnt.
ID. RESIDUAL MANAGEl\1ENT: Check Yes or No to each questiofl as it applies to all residuals from this treatment unit.
1\
YES NO
w;J 0
o IQa
~ 0
o ŒJ
o Œ1
1. Do you discharge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer?
2. Do you discharge non-hazArdous aqueous waste under an NPDES permit?
3. Do you have your residual hazardous waste hauled offsite by a registered hazardous waste hauler?
If you do, where is· the waste sent? Check all thai apply.
Œ.I
o
o
o
a.
Offsite recycling
b.
Thermal treatment
c.
Disposal to land
d.
Further treatment
4. Do you dispose of non-hazardous solid waste residues at an offsite location?
5. Other method of disposal. Specify:
DTSC 1772B (7194)
Page 11
;¡.
,~ '~EPA ID NUMBER CAL912.10
.
Page.~ of .2
CONDITIONALL Y EXEMPT - SPECIFIED W ASTESTREAMS
UNIT SPECIFIC NOTIFICATION
(pursuant to Health and Safety Code Section 25201.5(c»
IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT:
In order to demonstraJe eligibilityfor one of the onsite treaJT7U!nt tiersJacilities are required to provide the basis for detennining thai
a hazardous waste pennil is /WI required under Ihe federal Resource ConservaJÍon and Recovery Act (RCRA) and the federal
regulations adopted under RCM (!itle 40, Code of Federal Regulations (CFR)).
C/wose the reason(s) thaJ describe the opermion of your onsite treaJment units:
o 1.
o 2.
O' 3.
o 4.
o 5.
o 6.
IX] 7.
o 8.
o
The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous
waste under California stAte law.
The waste is treated in wastewater treatment units (tanks), as defwed in 40 CFR Part 260.10, and discharged to a
publicly owned treatment works (POTW)/scwering agency or under an NPDES permit. 40 CFR 264.1(8)(6) and
40 CFR 270.2.
The waste is treated in elementAry neutralization units, as defined in 40 CFR Part 260.10, and discharged to a
P01W/sewering agency or under an NPDES pernút. 40 CFR 264.1(g)(6) and 40 CFR 270.2.
The waste is treated in a totally enclosed treatment facility as defwed in 40 CFR Part 260.10; 40 CFR 264. 1 (g)(5).
The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month
and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5.
The waste is treated in an accumulation tank or contAiner within 90 days for over 1000 kg/month generators and
180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34,40 CFR 270. 1 (c)(2)(i) , and the Preamble
to the March 24, 1986 Federal Register.
Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals.
40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70.
Empty contAiner rinsing and/or treatment. 40 CFR 261.7.
9.
Other: Specify:
V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructionsfor more informaÛon.
YES NO
o IiãI
Is this unit a Transportable Tr78tmcnt Unil?
H you answered yes, you must also complete and attach Fonn 1772E to this page.
DTSC 1772B (7/94)
Page 12
EPA ID NœBER
#CAL912693010
-.
Stockdale Hwy
Phys· .
lClans Pi
c/o Kaiser aza Medical Ima .
3501 Stockda1Permanente Stoc~~ng Center
Bakersfield e Hwy. ale
605) 398_5Ó4ca 93309
~805) 395-015~ (facility)
(contact
person)
~
. . -'
. .."."
. . ..~ .
, .
~
" .
. "
LOBBY
Page~of 7
PLOT PLAN
:
Real Rd.
, 57 A T~ OF CAU¡:ORNIA-ENVIRONMENT A
~:;
TECTlON AGENCY
PETE WILSON. Gomcr
-.,
, DEPARTMENT OF TOXIC SUBSTANCES CONTROL
REGION 1-15I.S Tollhouse RDad
Clovis. CA 93612
\ :~' ((,'
¡",VI ;! e<·
\\!\ \ - "
¡\ ~ \\..----~',~~..- ~_J
TIERED PERMITTING l_--~~----= .~~..
CERTIFICATION OF RETURN TO COMPLIANCE
. .
For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers
j>Sof 5 f<:.c~cP<-.lr:- /l1<iC'l--'~, I
. In the matter of the' Violation cited on: r' / ì / '1 y
As Ide~tified in. the Inspection Report dated ~ h )1 -.)-
Conducted by: Department of Toxic Substances Control
(agency~»
I certify under penalty of law that:
1. Respondent has corrected the violations specified in the notice of violation
cited above.
2. ; I have personally examined any documentation attached to the certification to
establish that the violations have been corrected.
3. Based on my examination of the attached documentation and inquiry of the
individuals who prepared or obtained it, I believe 'that the information is true,
accurate, and complete.
-4. I am authorized to file this ~ertification on behalf of the Respondent.
\
5. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Joyce D. Ayers
Name (Print or Type)
Chief Technologist
Title
Physicians Plaza·Medical Imaqing Center
Company Name
CAL912693010
EPA ID. Number
DTSC-RETCOMP.CRT (8/94)
~. tþ
'. Sbte 01 ~ - CüJ'ol"Dia Eu1i.roameutal Protectioa A¡tIIC1
tþ ,
DepartmeDt 01 TaD: Suhlta.acs,çoattol
Page 1 of;;
ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM
. FACll..ITY SPECIFIC NOTIFICATION
For Use by Hazardous Waste Gt':nerators Performing Treatment
Uader Conditioa.al Exemption and Conditional Authorization,
and by Permit By Rule Facilities
o Initial
o Renewal
181 Amendment
Please refer to tM altached InstTUdwns before completing thisform. You may notify for more than o~ permitting tig by using this
notiflcalion form, DTSC 1772. You must alCach a sqxzrale unit SJH!dfic lJOtificalion form for each unit az this loCalion. T1u:re are
different unit spedfic lJOtificalion forms for each of tM four categories and an aáditio/UÚ /JOtiflcalion form for lTansponabk 1Teatnu:1JI
uniu (ITU's). You only haW: to submiJ fomu for the tirr(.s) lhat cover your unil(s). Discard or recyck the other wwsedfomu.
Number each page of your completed lJOtificalion package and indicale tM total numlJq of pages az tM top of each page at tM
'Page _ of _ '. Pus your EP A ID Number on each page. Please provUk all of tM inform.àJipn reque.st~· all fields mu:r be
completed except those that stale 'if different' or 'if available'. Please type the ;nformalwn provitkd on this form and any
attachmenu.
The notificalÎOnfees ar/! assessed on the basis of the number of tiers the norifier will operale under, and will be colkcted óy the SIal/!
Board of Equali1JJlion. DO NOT SEND YOUR FEE wrrH THIS NOT1FTCATTON FORM.
L NOTffiCATION CATEGORIES
Ind;Cal/!,the number of units you opuale in each riu. This will also be the number of unit specific norificalionformr you must altach.
Condbionally E:umpt SmDJl Quantily Trœmu:nt opualÎOns may not operau: u.niu under arry olher tier.
Number of units and attached unit specific: notifications for e.üch tier reported.
A.
Conditionally Exempt-Small Quantity Tre:1tment
D. Permit by Rule i
I'
E. Commercial Laundry
F. Variance (Section 25143)
B.
1
Conditionally Exempt-Specified Wastestre:1m
C. Conditionally Authorized
ll. GENERATOR IDENTIFICATION
EPA ID NUMBER CAb.. ~L2_6-.9-ª-º ~.Q._
BOE NUMBER (if available) H_H~ _ _ _ _ _ __
FACILlTYNAME
(DBA-Coins Buliocsa Aa)
PHYSICAL LOCATION
Ph)rsicians Plaza Medical Imaging Center
3501· Stockdale Hwv
CITY
Bakersfield
CA
ZIP 93309
.
-
COUNTY
Kern
CONTAct PERSON
Joyce
(Fin/. Name)
Ayers
CUlt Name}
PHONE NUMBER~~- 0155
MAn..ING ADDRESS, IF DIFFERENT:
COMPANY NAME Physicians Plaza Medical Imaqinq Center
For DTSC UN OoIy
STREET
4000 Physicians Blvd. #101
Region
CITY
Bakersfield
STATE
ZIP 93301
-
-
COUNTRY
CONTAct PERSON
(only complete if no< USA)
J o}rce
(Fi~ Name)
Ayers
{l.ast Name)
PHONE NUMBER(805 . )~- 0155
DTSC 1772 (1/95)
Page 1
.' . EPA ID NUMBER CAL9126e'O
- ~
e
Page ?---of 3
- -
CONDITIONALLY EXEMPr - SPECIFIED WASTESTREAMS
~ UNIT SPECIFIC NOTIFICATION
(pursuant to Health ånd Safety Code Section 25201.S(c»
The 1ier-Specific Fact Sheets contain a snmm:1ry of the operating requirements Cor this category. Please
review those requirements carefully before completing or submitting this notification package.
UNIT NAME Silver Reclairner
UNIT m NUMBER
1
NUMBER OF TREATMENT DEVICES:
'.
-2- Tank(s)
--2- Tank(s)
Container(s)/Container Treatment Area(s)
2
NUMBER OF STORAGE DEVICES:
Each unit must be clearly identified and labeled on the plot plan aJtached to Fonn 1772. Assign 'your own uniq~ number to each
unit. The number can be seq~nlÎal (1. 2. 3) or using arry system you choose.
Enter the estimated monthly total volume of hazardous waste treaJed úy this unit. This should be the T1UttÍfnum or higlrest atnoUlll
treated in any month. Indicate in tM narraJive (Section II) if 'JO.ur operaJions have seasonal varianons. .
L W A.Sl'ESIREAMS AND TREATMENT PROCESSES:
Estimated Monthly Total Volwne Treated:
Estimated Monthly Total Volwne Stored:
pounds and/or 60
o
gallons
,YES NO
o [[I
o ~
o ~
gallons
pounds and/or
Is the waste treated in this unit radioactive?
Is the waste treated in this unit a bio-hazardJinfectious/medical waSte?
Is remotely generated hazardous waste (HSC 25110.10) treated in this unit?
The following are the eligible wastestreams and treatment procé$ses. Please check all applicable boxes:
0 1.
0 2.
0 3.
D 4.
*NOTE*
0 6.
[Z] 7.
Treats r'esins mixed or cured in accordance with the manufacturer's instructions (including one-part ,and
pre-impregnated materials).
Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical
processes, such as crushing, shredding, grinding, or puncturing.
Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 662()1.124, by
pressing or by passive or heat-aided evaporation to remove water.
Magnetic separation or screening to remove components from special waste, as classified by the department
pursuant to Title 22, CCR, Section 66261.124.
s. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the
regeneration of ion exchange media used to demineralize water. (This waste cannot contain more
than 10 perœut acid or base by weight to be eligible for this exemption.)
Neutralize acidic or alkaline (base) wastes from the food processing industry.
Recovery of silver from photofinishing. The volwne limit for conditional e."emption is 500 gallons per
generator (at the same location) in any calendar month.
*NOTE* Recovery of 10 gallons or Jess per month of silver from photofmishing is
completely exempt from permitting; this form need not be submitted.
DTSC 1772B (1/95)
Page 10
. ,.EPA ID NUMBER CAL912693a
.~
e
Page 3 0~3
VDI. CERTIF1CATIONS: 1ñisform must be signed by an authcriz.ed corporate officer or any other person in the company whc
has operational control and performs decision-maJdngfunctions thai govern operation ofthefacility (per Title 22, California
Code of Regulations (CCR) Section 66270.11). Æl three copia must Iiaw! original sig1Ultlues. _
Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the
degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or
disposal currently available to me which minimizes the present and future threat to human health and the environment.
Tiered Pennittin1! Certifiotion I certify that the unit or units described in these documents meet the eligibility and operating
requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment
requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required
to provide required fInancial assúrance for closure of the tre:1tment unit by January 1. 1995.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualifIed personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to
the best of my knowledge and belief, true, accurate, and complete.
. , I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment
for knowing violations.
Jerry Sturz
Name (Print or Type)
~-" --é: ~~
Signature
M1m; n; c:::d"r;::ltn~
Title
4fll/q-s-
Date Signed
OPERATING REQUIREMENTS:
Please note that generators treating hazardous waste oltSite are required to comply with a number of operating requirements which
differ depending on the tier(s). These operating requirements are set forth in rhe statutes and reguúuions, some of which are
referenced in the Tier-Specific Fact Sheets available from the Department's regional and headquarters offices.
SUBMISSION PROCEDURES:
'you must submit two cooies of this completed notifica.rion by certified mail, return receipt requested, to:
Department of Toxic Substances Control
Program Data Mallagement Seerion
~ I: Street, 4th Flvo, , RvCJ1tf443.:J (walk trr only)
P. O. . Box 806
Sacramento, CA 95812-0806.
You must also submit ont! couv of the notification and attachments to the local regulatory agency in your juri.rdiction as listed in
Appendix 2 of the instruction materials. You must also retain a copy as pan of your operating record.
Allthreeforms must have orir!Ínal siglUllures, not photocopies.
DTSC 1772 (1/95)
'Page 3
'f'
t Is;c;ans
e
..
PLAZA
lVIEDICAL
IlVIAGING
Center .
". . . where the Patient is Most Important. "
II ~ r~ rs n~. 7 /_., -'-',
, U í h~~'~7 -~:J_,~l.\.~-1:~.,ff111
I Am'i"3/995 1II1 ¡ II
" ¡,IUI
I ---1ß:J
Kern County Environmental Health Services
2700 "M" Street suite 300
Bakersfield, CA 93301
,
To Whom it May Concern;
. - -' - -.
This letter serves as notification that all hazardous waste
generated at 8800 Ming Ave., Bakersfield, Ca 93311 (EPA#
CAL000081737) is being hauled off site by our processor
service company, S.M.I. We had considered treating at this
site when the paperwork was submitted to D.T.S.C., however
this did not prove financially feasible. A written
acknowledgment of this letter would be greatly appreciated.
Thank you for your prompt attention to this matter.
Joy . Ayers
Chi echnologis
Phy cians Plaza M dical Imaging Center
400 Physicians Blvd. #101
Bakersfield, Ca 93301
CC: Department of Toxic Substances Control
Dav,id Shu.:m:;\te , Hazardous Substances Scientist
4000 Physicians Boulevard, Building E, Suite 101, Bakersfield, CA 93301 Tel. (805) 395-0155 Fax (805) 395-0102
'i~, .'
SI-E BOARD OF EQUALIZATION e
SPECIAL TAXES DIVISION
P.O. BOX 942754, SACRAMENTO. CALIFORNIA 94291-2754
(916) 739-2582
BOARD USE ONLY
RE PM
EFFECTIVE DATE OF PAYMENT
MO, ¡DAY I YEAR
TR PET COPY
PHYSICIANS PLAZA MED IMAGING CTR
4000 PHYSICIANS BLVD
BAKERSFIELD CA 93311
DATE:
MARCH 24 1995
ACCOUNT NUMBER
HWCA
HF HQ 38-008099 9
.
YOU ARE HEREBY NOTIFIED OF AN AMOUNT DUE
AS SHOWN BELOW.
HAZARDOUS SUBSTANCE TAX
CONDITIONALLY EXEMPT FACILITY
FEE
AMOUNT
I INTEREST -I PENAL TV I
TOTAL
AS DETERMINED
FOR THE PERIOD 01/01/94 - 12/31/94
TOTAL
100.00
100.00
100.00
100.00
************* PAY THIS AMOUNT
100.00
ADDITIONAL INTEREST OF $ 0.92 ACCRUES ON THE AMOUNT OF FEE AT THE RATE OF
0.9167% PER MONTH AFTER 05/01/95.
ADDITIONAL PENALTY OF $ 10.00 IS DUE IF NOT PAID BY 04/23/95.
EPA: CAlOOoOB1737.
THE ANNUAL FEE HAS BEEN ASSESSED PURSUANT TO SECTION 25205.14 OF THE HEALTH
AND SAFETY CODE AND IS BASED ON YOUR BEING IDENTIFIED BY THE DEPARTMENT OF
TOXIC SUBSTANCES CONTROL AS PERFORMING TREATMENT WHICH IS CONDITIONALLY
EXEMPT FROM OTHER FACiliTY PERMITTING REQUIREMENTS.
INFORMATION CONCERNING DETERMINATIONS
A PERSON AGAINST WHOM A DETERMINATION IS MADE OR ANY PERSON DIRECTLY
INTERESTED MAY PETITION FOR REDETERMINATION WITH THE BOARD OF EQUALIZATION
WITHIN 30 DAYS FROM THE DATE SHOWN AT THE TOP OF THIS NOTICE.
A PETITION MUST BE IN WRITING AND STATE THE SPECIFIC GROUNDS UPON WHICH
IT IS FOUNDED. ANYONE FILING A PETITION SHOULD BE PREPARED TO SUBMIT
DOCUMENTARY EVIDENCE TO SUPPORT THE SPECIFIC GROUNDS UPON REQUEST. ,
IF A HEARING IS DESIRED, IT SHOULD BE REQUESTED IN THE PETITION. THE
REQUEST SHOULD SPECIFY WHETHER AN APPEALS CONFERENCE WITH A STAFF COUNSEL
OR SUPERVISING TAX AUDITOR AT THE NEAREST DISTRICT OFFICE OR A HEARING
BEFORE THE BOARD IN SACRAMENTO IS DESIRED~ A 10 DAY NOTICE OF THE TIME AND
PLACE OF HEARING WILL BE GIVEN.
THE FILING OF A PETITION Will NOT PREVENT THE ACCRUAL OF INTEREST. THE
***** CONTINUED ON BACK *****
j...
MAKE CHECK OR MONEY ORDER PAYABLE TO THE STATE BOARD OF EQUALIZATION '
Always write your account number on your check or money order. Make a copy of this document for your records.
·_-=:::---~-------:-:::--;-----~,::-:-:,-----~~,:::.=-_--:-:----=:-.:.,::-----'--=--.-' -- ',- ,----
_ _....__".';".__ ___ ....___.~~_:---..;____ ...:_.___7~_:"::":":;._ __ __.._....:..;.:-__ _ _..:..... _ -.-
.__..___.<__n.
. - -"'--. -
-----.-.
STATE OF CAUFORNIA--cALlFORNIA ENVIRONMENTAL PROTECTION AGENCY
"
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
: 400 P STREET. 4TH FLOOR
fJ.. P.O. BOX 806
I --.- SACRAMENTO, CA 95812-0806
PETE WILSON. Governor
(916) 323-5871
01117/95
EPA ID: CAL912693010
PHYSICIANS PLAZA MED IMAGING CTR
JOYCE AYERS
4000 PHYSICIANS BL '101
BAKERSFIELD. CA 93301
For fadlily 1ocaI«l øt:
3501 STOCKDALE HWY
BAKERSFIELD. CA 93309
Authorization Date: 01117/95
Dear Conditionally Authorized and/or Conditionally Exempt Facility:
ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDmONAL AUTHORIZATION AND/OR
CONDmONAL EXEMPTION
The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form
DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form
DTSC 1772B and/or 1172C). Your notifications are administratively complete. but have not been reviewed for technical
adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time.
you may be inspected and will be subject to penalty if violations of laws or regulations are found. .
The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last
page of this letter. These units operating under Conditional Authoriution or Conditional Exemption are authorized by
California law without additional Department action. pursuant to Health and Safety Code sections 25200.3 and 25201.5.
Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully
closed the unit(s). You will be charged annual fees calculated on a calendar year basis for each year you operate and
have not notified DTSC that the units have been closed.
You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also
notify the DTSC whenever any of the information you provided in these notifications changes. To revise information.
mail a cover letter to the above address _ explaining the changes. attach only the pages of your notification package that
have changed, and re-sign and date at the signature space on page 3 of form 1772.
Your status to operate under Conditional AuthoriDtion and/or Conditional Exemption is contingent upon the
accuracy of information submitted by you in the notifications mentioned above. and your compliance with all applicable
requirements in the Health and Safety Code. Any mistepresentation or any failure to fully disclose all relevant facts
shall render your authorization to operate null and void.
You are also required to properly close any treatment unit. Additional guidance on closure will be issued and
distributed to all authorized onsite facilities later this year.
,
c
..~_ u·'_'__ .._.
{)
-_on~"-
----- ._---_.
'-, ---.-.--. -~.
.--,------- .--.-.--.-.-....-.. .."
----.-.- _.--
.--..
-~, ._-~----'
_._~.._"-.~
-- . -
,,___~__~~,"e-==-n~__'~h"~_____'_'-'-=~'7'_ .' _~==--::~~-."-:~ __ :,:'::'__
. u''''-' ~
t;
,
Page 2
EPA ID: CAL912693010
,..-
If you have any questions regarding this letter. or have questions on operating requirements for your facility.
please contact the nearest DTSC regional office, or this office at the letterhead address or phone number.
Sincerely.
iC~ls.Ho~r,~
Onsite Hazardous Waste Treatment Unit
Permit Streamlining Branch
Hazardous Waste Management Program
Enclosure
cc: ASTRID JOHNSON
DTSC REGION 1
STATE REGULATORY PROGRAM
1515 TOLLHOUSE
CLOVIS, CA 93611
STEVE MCCALLEY
KERN COUNTY
ENVIRON. HEALTH SERVICES DEPT
2700 M STREET. SUITE 300
BAKERSFIELD. CA 93301
--" ..
. ....n",-", _.'P_
.- .-., . ..... . - ~ .
--_.__.---_.--~--~_..- - ..---.----
-'.:' -::.~-- - --~-
..-.-----.- --.-.---- --+....
~~
i'
"
e
e
Page 3
ENCLOSURE 1
UIIiIs IIJIIhorizÞl to 0J1Ð't* at this locøtioø:
UNDER CONDITIONAL AUTHORIZATION:
UNDER CONDITIONAL EXEMPI'ION:
1
BPA ID: CAL912693010