HomeMy WebLinkAboutBUSINESS PLAN 9/28/1992~ ~YLANNI;ll YAKL+'N'1'HUUll - - -- ~\
X000 STOCKDALE HWY, SUITE #D
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PLANNED PARENTHOOr:Á'
OF CENTRAL CALlFORNIJI'''
4000 Stockdale Hwy, Suite C
Bakersfield, CA 93309
(805) 324-4900
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D~ Farm and Agriculture ~ st'andard Business
CITY OF BAKERSFIELD
HAZARDOUS MATERIALS INVENTORY
!~P 2 9 1992
,<\,
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NON - TRADE SECRET
BUSINESS NAHE.P1l~0N~~
LOCATION. ~ - - 1 II f-
CITY, ZIP: ~ #
PHONE #: . _ 0
OWNER NAME:
ADDRESS:
CITY"ZIP:
PHONE,,#: '
¡
NAME OF THIS"iFACILITY:
STANDARD IND. CLASS CO
DUN AND BR,ðl)STREET
, ~-'¿/- .1 L L
/
6
Measure
Units
14
Names of Mixture/Components
See Instructions
p.,}
Plical and Health Hazard
ck all that apply)
. Fire Hazard c:J Sudden 'Release
of Pressure
·o~'~c¡ J
;:
Component i 1 Name & C.A.S. Number
OXIDE"
o Reactivity ~Immediate~elaYed
Health Health
Component # 2 Name & C.A.S. NUmber
Component # 3 Name & C.A.S. Number
Physical and Health Hazard
(Check all that apply)
o Fire Hazard 0 Sudden ReleaseD
of Pressure
C.A.S. Number
Component' 1 Name '& C.A.S. Number
Reactivity 0 Immediate 0 Delayed
Health Health
, ;., component # 2 Name & C.A.S. Number
Component I 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number
(Check all that apply)
o Fire Hazard 0 Sudden Release 0 Reactivity 0 Immediate 0 Delayed
of Pressure Health Health
Component I 1 Name'& C.A.S. Number
"-,,',
Component I 2 NÌIme & C.A.S. Number'
component I 3 Name & C.A.S. Number
Physical and Health Hazard
(Check all that apply)
C.A.S. Number
Component I 1 Name & C.A.S. Number
:~
D Fire Hazard [J Sudden Relesse 0 Reactivity C1 I~ediate 0 Delayed
of Pressure Health Health
Component I 2 Name & C.A.S. Number
Component # 3 Name & C.A.S. Number
EMERGENCY CONTACTS
#1
#2
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Name
Title
24 Hr. Phone
Name
Title
24 Hr Phone
Certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS)
I certify under peanlty of law that I haver personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those
individuals responsible for obtaining the information. I believe that the submitted information is true, accurate, and complete.
Rf.~.~¿~~··· ¡¡;.l5_~
NJlMEAND OFFICIAL TITLE OF CMNER/OP R OR OWNER/OPERATOR'S AUTHORIZED REPRESENTATIVE SIGNATURE
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08/18/92
PLANNED PARENTHOOD OF CENTRAL CA 215-000-000052
Overall Site with 1 Fac. Unit
Page
1
General Information
Location: 4000 STOCKDALE HWY C
Community: BAKERSFIELD STATION 03
Map: 123 Hazard: Minimal
Grid: 02A FlU: 1 AOV: 0.0
Contact Name
DARBARA J. MARTS
Pl'..MELl\ DOSS ¿' ....~tßP'- :'
Title
Business Phone
(805) 324-4900 x
(805) 324-4900 x
24-Hour Phone
(-BÐS) BJ2 322-9'
~805) 834 2910
Administrative Data
Mail Addrs: 255 N FULTON SUITE 106
City: FRESNO
Comm Code: 215-003 BAKERSFIELD STATION 03
D&B Number:
State: CA Zip:
SIC C
/
Owner: PLANNED PARENTHOOD OF CENTRAL CA
Address: 255 N FULTON SU 106
City: FRE$NO
Summary
RECEIVED
SEP ? 9 1992
HAZ. MÞT. "'V.
0(\
~t B:è: ..5ftA1)~ D;:; ~-:~!['ebv ç,ertif\t' that ! have
(Type or print name) ;
reviewed the attached iJi;¿;."...; materials rnanage-
PLA~}Ja:>
ment plan forP~7J.I!fODÞ Ðí1d that it alona with
(Name 01. Buslnesa) ~.
any corrections constitute a complete and correct man-
agement plan for my facility.
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~ Al""[1't-GT ./:J.MIlJ £
5~PJt@) !-f1ttV$ON
TMV\N\~ Rv.TLE!)(?E:
TITLE
(!X7\1TeR. ff)/}N
AS~. ~nQ,
L2 <f ...t{Ou~ ,pHoNe
(805) B9b- (013
C%os) ~72 - 78tft
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08/18/92
PLANNED PARENTHOOD OF CENTRAL CA 215-000-000052
02 - Fixed Containers on Site
Page
2
Hazmat Inventory Detail in Reference Number Order
02-001 OXYGEN
~ Fire, Pressure, Immed Hlth
Gas
Low
CAS #: 7782-44-7
Trade Secret: No
Form: Gas
Type: Pure
Days: 365 Use:
C'f MElJIUrL
IN IfItUt 11 oM
Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 --
6,792 I 6,792.00 I 6,792.00
Storage r Press T Temp ~
PORT. PRESS. CYLINDER Above AmbientlWORK STATION
Location
- Conc l
100.0% Oxygen, Compressed
Components
~ MCP -¡List
Low I
- Notes
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08/18/92
PLANNED PARENTHOOD OF CENTRAL CA 215-000-000052
00 - Overall Site
Page
3
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
THE FACILITY MAINTAINS AN EVACUATION PLAN AND DIAGRAM WHICH IS POSTED
THROUGHOUT THE FACILITY (REQUIRED BY STATE HEALTH LICENSING). STAFF IS
ROUTTNELY DRILLED ON EVACUATION PROCEDURES.
<3> Public Notif./Evacuation
EMPLOYEES ARE TRAINED IN EMERGENCY EVACUATION PROCED RES TO
FOLLOW TO ASSIST PATIENTS/VISITORS FROM THE BUILDIN , FOLLOWING
POSTED EVACUATION PLANS.
<4> Emergency Medical Plan
STAFF IS TO CALL THE 911 EMERGENCY NUMBER TO SUMMON THE FIRE DEPT/PARAMEDIC
TEAM FOR ASSISTANCE. EMERGENCY MEDICAL ASSISTANCE IS ALSO AVAILABLE AT:
KERN MEDICAL CENTER - 1830 FLOWER ST - 326-2000.
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~ 08/18/92
PLANNED PARENTHOOD OF CENTRAL CA 215-000-000052
00 - Overall Site
Page
4
<E> Mitigation/.Prevent/Abatemt
<1> Release Prevention
THE OXYGEN IS STORED IN A STANDARD CYLINDER AND IS ROUTINELY CHECKED BY
PERSONNEL FOR LEAKS AND LOSS OF PRESSURE. SUPPLY CO. REPLACES CYLINDER UPON
REQUEST.
<2> Release Containment
<3> Clean Up
<4> Other Resource Activation
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I 08/18/92
PLANNED PARENTHOOD OF C~NTRAL CA 215-000-000052
00 - Overall Site
Page
5
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - NONE
B) ELECTRICAL - UTILITY LOCATED AT WEST END OF BUILDING
C) WATER - OUTSIDE FRONT DOOR OF BUSINESS
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON SITE
FIRE HYDRANT - AT EAST END OF BUILDING TWO, CORNER OF STOCKDALE HWY &
MCDONALD WAY AT NORTHWEST CORNER.
<4> Building Occupancy Level
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08/18/92
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PLANNED PARENTHOOD OF CENTRAL CA 215~000-000052
00 - Overall Site
Page
6
<G> Training
<1~ Page 1 ~
WE HAVE Z EMPLOYYEES AT THIS FACILITY
WE HAVE MATEIAL SAFETY DATA SHEETS ON FILE'
BRIEF SUMMARY OF TRAINING:
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
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CITY of BAKERSFIELD
SO-
"¡IE CARE"
, ~ A1Gð/1ß?9- ..J. M ¡:;-¡e;r..s
ItYDe or print name)
RECEIVED
JAN 2" 1989
Ans'd..
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Doh ere b ~- c e r t ì f y t hat I h a -,' ere \. ì e h' e d the
attached Hazardous Materials business plan
for
¡'L/l?VNE5¡£} ¡7~I/tJZJ.O CJ? ~/;tIØL ~/Ft;:i¡t!!/l//4
(name of business)
and that it along with the attached additions
or corrections constitute a complete and correct
Business Plan for my facility.
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date
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CITY of BAKERSFIELD
~ HA-A~DOt.1S MATERXALS XNVENTORY
Sttnd,rd Bu, ,nn, '-+-' &.0 ~
NON-TR^DE SECRETS / /
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BUSINESS NAME:~.'L/JM ~ffJi#-t:l~ OWNER NAME#LAtYNØIJ I'~ ðF. NAME OF TtnS ~5=.IL!.T.!: S/fM¿
LOCATION: ~ _ _5://. ~e.-- ADDR!SS:..:2S;~¡v'¡~Tð~Sa¿Tz:?- /06 STANDARD IND. CLASS CODE
CITY, ZIP'__ 'E:. 7:Fa. CVj CITY. ZIP:~I'Vi1_ /J-lf-. _ ~t'¿7 DUN AND BRADSTREET NUMBER
PHONE .: - - PHON! II: ~-==- k-~"
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
(805) a28 .::,~(~
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RECEIVED
.;;;\0Sf l JUN 1 1981
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OFFICIAL USE ONLY
ID#
000052
BUSINESS NAME
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
INSTRUCTIONS:
1. To avoid further action, return this form by
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS· NAME: /¿II4VIV¿LJ· ¡J~/IItJ¿}LJ tJ'¡::::' tJBY7RAL ML/~JIf!AI//9-
B. LOCATION / STREET ADDRESS: ijooo .s/æj:::.,¿J/lL~ /hVV; S¡¿~ Œ-
CITY: þ~~~,LL) ZIP: ?JBBöJJ BUS.PHONE: (P~Sl 3.;;2 c/-l/9oc)
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAM~ AND TITLE DURING BUS. HRS. AFTER BUS. HRS.
A. 11M./ð1J-1Wl- .::it M~ Ph#POS-~ý'-ý"~OO Ph#?tJS - P3.J-- 3~.d;P
B. ¡:lthlr1Øt..A f)/)gS Ph#8t:<r-3.J{/- tj'9oo Ph#~00-~3V- ;;)9/0
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE: $~~ . .
B. ELECTRICAL: 1/7'/L/7 LJ:r #.I~ 6:;Vz;J tJr=-ð'L,o¿:..,
c. WATER'/?U7-<;/~"'- ¿7tJðþ rJE. 6//"
D. SPECIAL:
E. LOCK BOX: YES Ii NO F YES. LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO
FLOOR PLANS? YES / NO
MSDSS? YES / NO
KEYS? YES / NO
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SECTION 4;"PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
A full-time nurse practitioner in on duty and is trained
to handle most medical emergencies which may occur.
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,The staff is CPR certified each year and periodic drills
are conducted to handle minor medical emergencies.
The Agency publishes an emergency procedure guide for employees.
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
Staff is to call the 911 emergency number to summon the
Fire Department/Paramedic team for,assistance.
Emergency medical assistance is also available at:
Kern Medical Center
1830 Flower Street
Bakersfield (805) 326-2000
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL
A, METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS:.......,.....,.".,...,."..,...,.,.", ~ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES:.....,...,."'.".....,..,, ~(W)
C. PROPER USE OF SAFETY'EQUIPMENT:."",.."...,.". NO
D. EMERGENCY EVACUATION PROCEDURES: . , , . . . . . . , . . . . . . , NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:,..".. ~ NO
SECTION 7: HAZARDOUS MATERIAL
CIRCLE YES OR~
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A
SOLID, 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A COMPRËššÈD GAS:...:.. ~ -NO
(!7/V~ M;Kfrt3le/~ .wE ~E /.5 ë;)~'Á.. ¿);¡;t 7"7M/k..- ·@.{)~/JI/V//i7t;:-.3 €-tt ;=-r
I, ~~~ ~ fIYt~ , certify that the above information is accurate. 0z-
I understand that th~s information will be used to fulfill my firm's obligations under
the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter &.95
Sec. 25500 Et AI.) and that inaccurate information constitutes perjury.
REFRESHER
~NO
YES ~
~NO
. ES NO
E NO
SIGNATUREÄ~TLE ~ ~~ DATE ùß'7',h?
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BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
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BUSINESS NAME:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS
1. To avoid further action. this form must be retUl'ned by: 9-:;)8'-87
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possiBle.
FACILITY UNIT# G- FACILITY UNIT NA.J>Œ:/L.4í1rA/~ /l/J£GA/T~OP
~~/þ
SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES
7#E cJX Yt£.Øtf/ / S .$77;J ~ / Ill" 19 ::5//J'h.o~..¿;J a yu I /¿?~
/JI'vo /S ¡ûJtCT/A/é:~j/ ~6a.eG;t:J ¿y ;P~Sò/JrA/EL...
.FðI2.. ~~~~t)s;s Or /,¿{J.G~C/~ 5tL/~Lf/ &.¿¿
/!A5¡PL FH!AS-5 ß..YL/A/ð~ tt/'cJ/I/ ~ÇJt/G-~
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY
-¡-h'G Pitia/L.. /Ty' /I/IA-/~/J6' IM/ ¿U/~7-/M/
flL/f¥ ¡é}N¡t:J ¡:J//Jt£¡I?~1V\ tl/Mæ.# /.:5 /t)S"/6;t::;) T~ð/7-
oaT '¡-ME ~/,-/ry (~tPl//~ ðV S//9T.£'" '
~'7-/I L/(it43/VS/A/ð-) S771,.c¿=- /.:5 µ¿¡//A/£~
.¡J ~ L.I.. .130 ð'\/ P,l!Jæ/l ý/-,// ðl)/ ¡::;~~EE,oR' Ø6-S; .
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SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
,A. Does this Facility Unit contain Hazardous Materials?..., .~NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES~
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
¡:;/Æh!E. G .Jf;r-/lt/a.a/S#~ tJ--1/ S' / ~
'TYI'£ M..4;e¡A/¿Ç' 7(//£ ¡¿SQ~
/!.-ðt£::r/,vG e#~ M~o¿:? 6;/ aøV7-~¿:p
¡&:/,¡é?6 .e. 10/ /'Z')\
~..... L,;.U.
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
#r ~T .G/I/.o ¿¡.z;:: 6~LJ~ ~?VtJ ¡(].Ø¡elf/G;?e tJ~ .5771<t;¿::L?~£
/J?f,/V oi M æ /.?ð/l//f;i.L;? ¡~ Þ-$T ~£.N ~
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT ONLY.
A. NAT. GAS/PROPANÉ: ~O~~
B. ELECTRICAL:
UJ é=-$T £3/Y¿? tJ r ¿LOti:- .;¿
C. WATER: ___ /)ð,A -. /1,., fA.k? . é'J1I/ Á E",c-r-
/,y' þ=-.ß.¿J/L/T' ¿),- r r~ 1fI-/C/ U.....<--"
D. SPECIAL:
~
E. LOCK BOX: YES I~IF YES, LOCATION:
IF YES, SITE PLANS? YES I NO
FLOOR PLANS? YES I NO
MSOSs? YES / NO
KEYS? YES I NO
- 38 -
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BAKERSFIELD CITY FIRE DEPARTMENT
FORM 4A-1
NON-TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
PLANNED PARENTHOOD
OF CENTRAL CALIFORNIA
Page -L oi~
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1. D. #
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BUSINERS NAME:
ADDRESS·
OWNER NAME PLANNED PARENTHOOD FACILITY UNIT #: e
ADDRESS· OF f:FNTRAJ f:AIIFORNJfACILITY UNIT NAME' ðJ..pt..::2..
, 40UU S'tockdale Hwy, Suite C
CITY, ZIP: CITY,ZIP: o t:; t:; 1\1 r- ,1.1. Q" :f....... -t "c
PHONE #: BaKersfield, CA 93309 PHONE #: --- - IOFFICIAL USE CFIRS CODE
(8U~) ~ 1~4-4~UU Fresno, CA ~3701 ONLY
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TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE
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NAME: r LJAI'J ¿ ~ .:::r M'"" TITLE: ~~~ M~IGNATURE: J'-.. /I... ...../j .......,J, l./ /8 A DATE: R/...J.-ðLÞ "/
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EMERGENCY CONTACT:~ - TITLE: ...<J~ PHONE '# BUS HOURS :-=?.:JC/-l/-9'OëY' -
AFTER BUS HRS: R3;;J. - ~;P
EMERGENCY CONTACT: ¡:J Iì-1'Vt. tJðS5 TITLE: () ¡::. €.. M~ PHONE # BUS HOURS: 3,;)0 (/900
. PRINCIPAL BUSINESS ACTIVITY:~~~ ~ AFTER BUS 'HRS: 9-=3 $/- :;J.9/0
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