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HomeMy WebLinkAboutBUSINESS PLAN~/' ~~ ~ STOCI~ALE FAMILY DENTISTRY 3615 STOCI~ALE HWY, STE 2 _, ~~ ~'"-.~`9 o~ r ~. _ .; ,~ -:_ ''~ STOCKDALE FAMILY DENTISTRY Manager ERIC S SMALL Location: 3615 STOCKDALE HWY 2 City BAKERSFIELD SiteID: 015-021-000479 ~BusPhone: (661) 832-0895 Map 102 CommHaz Minimal Grid: 35D FaCUnits: 1 AOV: CommCode: BFD STA 03 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title ERIC S SMALL DDS / OWNER / Business Phone: (661) 832-0895x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact ERIC S SMALL Phone: (661) 832-0895x MailAddr: 3615 STOCKDALE HWY 2 State: CA City BAKERSFIELD Zip 93309 Owner ERIC S SMALL DDS Phone: (661) 832-0895x Address 3615 STOCKDALE HWY 2 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~A~~~® ~ YY JV ~ ~ ~ y ~Q~/ Da.:red on my i„quiry of those indi~~idu?is res~u,~s~ti.`r fc;r oh?aini;lg the in#ormation, I c::rtify under den !t,~ of i„~,- that 1 have perconaliy examined and am #zm~liar Niith thG in#crmation suurn!tter" ant believe the in#ormation is true, accurate, and com p~ ete. /j - Signature Date -1- 07/16/2007 F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L S.OO GAL Min -2- 07/16/2007 ~- -3- 07/16/2007 F STOCKDALE FAMILY DENTISTRY ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM STATE T TYPE PRESSURE Liquid I Waste ~ Ambient SiteID: 015-021-000479 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL --- r~~r~ttLUU~ ~ui~irulv~lv-15 oWt. RS CAS# Silver No 7440224 riHGHKL A5~~551~1~1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/16/2007 F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/22/2007 ~ 911 Employee Notif./Evacuation 03/22/2007 VERBAL Public Notif./Evacuation 03/22/2007 VERBAL Emergency Medical Plan 03/22/2007 911 -5- 07/16/2007 -_ ~ y F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention Release Containment 03/22/2007 SECONDARY CONTAINMENT Clean Up HAZARDOUS SPILL KIT (3-SPILL USE) PROTOCOL IN PLACE. 04/23/2007 Other Resource Activation -6- 07/16/2007 ._ ._ 5 F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~YC~:iai nuc,aiu5 Utility Shut-Offs 04/23/2007 GAS: SW CRNR OF BLDG ELECTRICAL: SW CRNR OF BLDG - CIRCUIT BREAKER IN DOCTORS OFFICE ON WALL WATER: W SIDE OF BLDG SHUT-OFF IN COMPRESSOR RM BACK OF OFFICE W SIDE OF RM Fire Protec./Avail. Water 04/23/2007 FIRE EXTINGUISHER IN LAB MID OF OFFICE FIRE HYDRANT: E PARKING LOT IN PLANTER Building Occupancy Level 03/22/2007 7 EMPLOYEES -7- 07/16/2007 ~-: <~ ~- s: - ,, F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/23/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: MANUAL IN CLEANING STATION FOR STERILIZATION PROTOCOL IN PLACE. rc~y c G Held for Future Use _, r_ aic.i.u ivi ru~,u.a.c vac -8- 07/16/2007 ~~" `~- ~?~ ° Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST I ~ ~ e_.. E- R _s F- ,_ 0 900 Truxtun Ave. , Suite 210 ~-=- ~--~-~ -- -~-~~~~ ---- ----=~~~-~ = ~- =_ ~ F~Re Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program l ARTM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME .~'rO G k j~A L E ~~ r-, y ~ ~ E ~, ~ ~~ -- INSPECTION D TE ~ 2 z o' INSPECTION TIME ADDRESS ~ ~ ~ S~OG~ c~ l ~ ~w 2 pper~{I p~~ °~D.S'~~' C NO OF EMPLOYEES /~7 FACILITY CONTACT BUSINESS ID NUMBER 15-021-d~$-OZ1~-0 ~ ~ 5ectlon 1: Business Plan and inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES t - {fin ~~ t~1 ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ ~ FIRE PROTECTION /b ^ SITE DIAGRAM ADEQUATE & ON HAND 1 ~©~~ Kur-uui~ ANY HAZA~~R!!D~~OUS WASTE ON SITE? ~'ES ^ NO EXPLAIN: W ~-s'~C~ ~ ~ '~CQ T QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT {661) 326-3979 C""- Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # si es i e /Responsible Pa lea Pri White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ~-~ e4Gjs - -T~= Pw d ~ ~~ y ~ ~ ~~ Z~ c~~ FACILITY NAME S'r°~~`~~ ~ Section 4: Ilazardous Waste G CITE' OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 -~a +r.0 ~ ~ ~or.~--.s}~r~ INSPECTION DATE ~ /~~'/~' einerator Program EPA ID # ~XG n- {~~` ^ Routine ~ Combined ^ Toint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~G~r~ Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line P/ Secondary containment provided Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste ~/~ Proper management of lead acid batteries including labels N Proper management of used oil filters N`~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years j , ,~,., ~.,~ q, ~ ,1 Retains hazardous waste analysis for 3 years u- ~Q ~ ~~ w ~ d Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~,=~.ompuance v=vtota[ton Inspector: ~~G2 ~""' "~> ~~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy usmess Site Responsible Party ()/6- {J;¿ I - D{)O '177' . . CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKI...IST 1715 Chester Ave., 3rd I~'loor, Bakersfield, CA 93301 j/lntJ/ f f/¡n(}/l .5S()Ó / FACILITY NAME S~Mé F~'&"V 'D6ÑrtsrtY ADDRESS 3fDlS- S'~ S~~ FACILITY CONTACT_ INSPECTION TIME INSPECTION DATE s:- ) 3 /6/ PHONE NO. S(3Z - O&'1.s- BUSINESS ID NO. 15-210- f\.lEt..Ù NUMBER OF EMPLOYEES /)3-026 Section I: CS ~cJ-/Y Business Plan and Inventory Program 3A- o Routine &ombined o Joint Agency a Multi·Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate pennit on hand ~ f~tr >(~ Business plan contact infonnation accurate 10 is&- su~ r1'éD vJl.Af'I'LtCM7cYJ " Visible address !v " Correct occupancy V Verification of inventory materials ¡/ ~~ ?( XC-"""'L Verification ôf quantities ". ~ ( ø 6AV''rfL) Y" 6A<- 7'-'1A--)L Verification of location :/ INS «DG pAR.t<: ~ r Proper segregation of material V Verification of MSDS availability / Verification of Haz Mat training ./ VG-.J'~ (./¡W)Lé-s Verification of abatement supplies and procedures / Emergency procedures adequate V Containers properly labeled ./ Housekeeping ,/ Fire Protection !/ Site Diagram Adequate & On Hand 'Íl> 'í36 $:J~' 1j'Ef.:) t-JI Af'PuC/Jrf"l~ C=Compliance V=Violation White - Env. Svcs. Yellow· Station Copy Pink - Business Copy 4~~arty Inspector: 0J/~ Any hazardous waste 9D site?: }5.Yes 0 No Explain: ~~ f-I x:C<7....... Questions regarding this inspection? Please call us at (661) 326-3979 -----.-'i'- - - - ----.- - . Ôffíce Hours By Appointment STOCKDALE FAMILY DENTISTRY ERIC S. SMAU. D.D.S. 3615 Stockdale Hwy:, Ste, 2 / Bakersfield, CA 93309 " " I ", Tel: (661) 832,0895 ~ ¡; Fax: (661) 832-8462 'rJYf rt1t. - - ----------- -- . --- I:r ar In ~ ~ Y?enee' J{anos.ki ÿ(7X7! öloc.kda!e Januly 'lJenlislry 'lJr. Gric Ö. ömall'lJ'l)ö JJahersßelJ, Ga. g.1.10g (661) ð.:J2-oðP..5 ! . __.J CORREC,.,N NOTICE . 04870 BAKERSFIELD FIRE DEPARTMENT Location Cu'rS\o€ 3'15"" $~C.KOAU:- $'\ê '2- Name S"'jÜe.(~~.A-c.£ ~I~V OC--.J' -($'J"'.y' You are hereby required to make the following corrections at the above location: Cor. No. (j) f>¿Co.A-S e- fl.GPlA<zé ju "'c...rl~ '80)'. LC>JØ- ðl'oi ()J'ÍS ,0 E" FLð:.>(::) l.t4Hr .Aí AWNING- . ~ I " Completion Date for Corrections 51{o/O"L- Date Ç/3/o'L WI AJé:S FD 1950 Inspector 326-3951 · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE S' /3/oz... FACILITYNAME~~tÆ: ~H..yI "¡)~~Y Section 4: Hazardous Waste Generator Program EP A ID # o Routine -¢-. Combined 0 Joint Agency 0 Multi-Agency 0 Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made Av.- rn::::-.,.,..,,> ð/G. EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal /7 C=Compliance V=Violation ~~ j£Mnh/ Inspector:--L^ ) IN6 ,.J(/ UH £ / J VI (.-{ Office of Environmental Services (661) 326-3979 White - Env. Svcs, Busmess SIte Responsible Party Pink.. Business Copy