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Home My WebLink AboutBUSINESS PLAN -...--.-.--.--. " .-----..-.---- .---." ---"---" ---" -- --- Per... It - to ··Operftte Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ,'¡¡N zardous Materials Plan ~~9round Storage of Hazardous Materials agement Program Waste 5768 STINE PERMIT ID# 015-021.000362 CARET RAN MEDICAL SUPPL lOCATION -- , Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rdFloor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 *~ ph Huey, . ffice of ental Servi es June 30, 2000 Approv~ by: Expiration Date: 'ITE/FACILITY DI.;R~~ FORM 5 I NORTH SCALE: BUS rXESS .-.IA.'E: flOOR: or I ~ inch = 70 ft. Caretran Medical Supply Center 1 1 , DATE: 12/19/88 FACILITY ~A.'!E: Caretran Medical Supply Ceni:¥T ... OJ: - . 1 1 - {CHECK ONE} SIT~ OIACiRA'f I/o FACILITY OIAGF~'! - )I w+¡: ? Empty Field , i , , I I I I rg o c:r:: CD s=: oM -to> tf) , · I · · , ..... - ., - .. . ., - - - . . . . - -... Harris Road - - · .-- . fs~ I 7.a = Fire Hydrants 6.a = Gas Utility Contrale 6.h = Also þas lock (key) box --Fe> < eo \ e.c.. -\:..,. L c.a. \ 12 = Fence 13 = Baxrier ~a"1 Pumps L2J . . TC's ----------~_.------.__.-._.- Executive & ~ Hou~e , I : 1. : ~ 2 :L~.:~:·:::~~J.:;!) l ~.~+Kl · I I , I I f I I \ I I' ¡ · ......!...L~ ~_J.J~I.I ~ () or1, .¡.) () cù H A o H ·n 6 ù5 [Ho~e .b \ l41D j 16'.' I i~' I JI~ ''- , ~~; .. C5 ro -to> or1 c:r:: ~ .¡..J ~ r:<1 ~~ IE~ - .,. I ....... -OFFICIAL USE ONLY- (Insppctcr's Comments): I -~ - 5A- ".¡ ~ITE/FACILITY D~GRAM FORM 5 " NORTH SCALE: BUSI~ESS NA."fE: FLOOR: OF 1 inch = 10 ft. Caretran Medical SU'P'PlY Center 1 1 DATE :12.119 )38 FACILITY ~A.'fE: UNIT ~:1 OF 1 Caretran Medical Supply Center (CHECK ONE) SITE OIAGRA)[ FACILITY OrAGRA'f ~ Thera- CD Security Crib l Cy~.rl I Bé-~h- ist r«Jm Conference For Medical Supplies S torag'E' Office I Room .~ y @ R:!:l ~ II! !-t 0 ~. Bill ing @ ~ Room (J) W!C Offi,~e rU () ~ Storage S'roRE SHOW ROOM . fÈ4 0 :x:: F.xe('11H ve Office Receptionist Display Area Room 1'o{o.........,"~. 7tJ ~ "( t"i!''''''''''''''''@'' '" "':'''''''' Y J\, 2 = Partitions 6 = Attic Access 9 = Air Conditioning 10 = Windows 14 = Sewer Drain Inlets (Inspector's Comments): -OFFICIAL USE ONLY- I - SA - ,{~. , .1 -t!'l ~~~: NORTH ~ .v+E 5 &"pt/ ¡7eJd ~TE/FACILITY DIJlR~~ FORM 5 SCALE: /1 , BUS I NESS NA.'1E: ~ 70 C.2ve Y DATE:" !.;l~/.grrFACILrTY NA."fE: ~A . <'\ r-\2!\y\ ""::>Þ'1D (CHECR ONE) SITE DIAG~~ v FACILITY DIAGR~~ I ì , ' I . I FLOOR: OF \ UNIT::: OF '7. a ::. í=";'I' e. ~ td.,<"ð-r\-t s . ~.'â .::. G~ LH:.\\.\t.¡ Cof\tYD\~ ~. b:: E\e.c..tY";¿'tt Ccl'\tyÞl~ '.Þ =- .;:3.1."0 h~ .LoG\-:. (~) box.- I 2 ~ ç.-e-~e..... J~ :- ß ël-VY \ e...-..".. :---- --~-.--_.. .--- Ha'(Y'i£'~"'~4-----------~----~"----------"- .a .' c.1..· '/);¡ ®- J 'Ç :'v"'\~ 1"c.:~ c;.~e.c.~ \..IVe.. "~ ,~ ~';.òe.P l-o""~ ~ 4ð~J/. I -----/ '-1 0 Il'f- -¡ TTI~ïT1~ITI~TT\~Tï~~ ~ e (Inspecto~ls Comments): -OFFICIAL USE ONLY- r: :s (b ;d o ru ~ I I I I , (®ì ~ =: . '~ l!Ø : 1};" :l:~~:~~h~~:~_*}·:I~~ , I II I I I I I I II \ I I . ' 1 \ .1.: I I .llii I tò'Þ) I 61 .1 I I \\ I" 1 p. d~Q~ w'1~1~ - 5A - ~.~~' '~~C!I e e SITE/FACILITY DIAGRAM FORM .5 NORTH SCALE: / lie. I~ BUS I NESS NA.\{E: ~ If e.1:. ya ' DATE: G /~ /«3'7 FACILITY NAME: )J¡a.)'t'\ FLOOR: 1 OF I 'NIT ~: \ ~F (CHECK ONE) SITE D!AGRA\{ . FACILITY DIAGR~\{ I " I ~ .,-/ .. -@~ / ,,"/" Pay-t~t ,"oV\~ h. (H:..~\c... Ac..~·S ~ A''.r 6,J~tl~~/~) Ù: l-t,~ . /0, tt.J I ~dOl.V S @~ «5evX.Y' Jva \""" , \~'\f!.~ . " . o~.ç\te s~o~ ~M. 'V ..;Jo{ ~"'o~ ® ® .stD'¡~!3 e G LO¡Y3eN &'+oR.Q3 e ~ ~(,r; o (Inspector's Comments); -OFFICIAL USE ONLY- - 5A - :: ,) /:.~' ¿"'f .,..,..~ NORTH e e SiTE/FACiLiTY DiAGRAM FORM 5 SCALE: I"e. I~' BUS INESS NA.'IE: Ca re.o\:. 'fa ' DATE:6 lZq/ß'7FACILITY NAi'fE: \. ~ _ .-,a. \ ~ FLOO~: 1 OF NIT~: OF \ ' (CHECK ONE) SITE DIAGR~'f -@)-/ ¡/ o~h(.t ~~<þ () ~ liJo~ ~"o~ . ~@) s~o~ ~fo'\. (j) ® stø-fð~ e . FACILITY DrAGRA'f / ~-, Pay-\:.~t \"on~ b. A-t:.·\:)c- A c.eJ!!!.C;:, t¡, A,: 6.J.·b~~I~j !.ot~ It,~ · 10, w:',Jow~ @J -5'C!!~Y' Jva \ "v1 , r~\~~ G LOfy~eN &'fuIèQ3 e (Inspector's Comments): -OFFICIAL USE ONLY- - SA - ~ ':-" &111" . ' - ,'f!;:"" "" wl.,j .,' ~ .-:~ <~ ::." NORTH ~ W+E S ~r+'/ f7eJd e S:I:TE/FAC:I:LITY FORM 5 e D:I:AGRAM 'S1~B ~+þ~~ Cd ;& 2. = I J1.,.~ 7 SCALE: " , BUSINESS NA.'fE: J ~ 70 Cãye y eJ¡.. DATE: '/~~/'ß,.,FACIr.rTY NAi'lE: ~J . ~, rr\2!\y\ ~,..,o (CHECK ONE) SITE DtAG~~ v FACILITY DIAG~'I ~. .t :s (\ ~ o IU ~ t I J I . , .. - - - - .. - .. - - - . . .. - . -.. \-\ a ~~ i'6 -.::::Þ...¿ - - - - ... - - - - - ~ - - - - - - ... - - - - - - - -' - . - ....,-J'! _ ". , . , I . J FLO R: OF \ UNIT~: OF , '7. a ::. ~ive. ~ tt:k.iir\ts. " b.'f! ~ 6~ Ût~\\1:.1' CoÞ'ItYD\<; ~. b = E1~~t"'~¿11 CoV\tV'Þl~ '.Þ =- a.I*C ha<. .L.DG" (ke.y) b 0)(. \ 2. ~ ç-e.,~e..., . J~ -=- ß~v",,'e...:(" (Inspector's Comments): -OFFICIAL USE ONLY- ~ l!Ø .r®! "~ \~ 1¡~,J -I .Cð ~ 1"c.:~ E:',c.e.c.~ '\:''''e. : ~r:¡ ~¡~:?}~Þ~ì~}Yf~~ . ' I 1.~4tLi-fÀ~,JJd/.tJ' ~q..LU~ I~... ~ .~ .~ '.b ~ I - SA - /" ~<a-.t:, NORTH ~ W+E S ÓV1P1:! f1eJd e SITE/FACILITY FORM 5 SCALE: II , BUSINESS NA..'lE: I -:::.70 Cave y ~.. DATE: " !..1~/~ '1 F AC I L ITV N'Ai\1E: ... J - ~ \ r-\2!\Y\ .....::> no (CHECK ONE) SITE DIAG~~ ¿/ DI&RAM 57' 8 ?t,n~ itd, ~"1.. --.lit 5P 7 FLOOR: OF \ UNIT:: OF FACILITY DIAGRk\1 !ð ~g .b8 '7.,; ~ ~;ve.. ~7J.'1"Ør\t!." 6.11. .::. ~ Ut.~\-f:./ ~tYO~~ ,. b = E\e.c..t.,.;¿~ Co~tY'Þ l~ ~.Þ =- a.l*Q h~ .LcG\c. (I~; : ÞO~. ! \ 2. 'So Ç""e."",e.;, . )~ -=- ß....v..,.,~ .... \-¿; r;;] ë: $ ~ ïd o IU ~ I . I. , , : - - - - - - . - - - - - . . - . -.. \-\ d.'-(~' s ~.,,4 - - - - - - .... - ... - '!" - .. -- ~.- - - - - ... - -... -'- , I , ' , . 1 . [®ì. '~ 'f§J ~ .a 'Ça\:."~" 1"c.:~ E:";II.e.c.",t\'ve. · ~'.ÞeP L.O\II"'j Q.. , --/. '-l, · -¡- TlI¿m TTì~ I ct.1i~~ · : [;.:~: ;~~;~~:!~~~1~b-:l ¡.~ · I I I " I I II I' \ I I I · ' I I d~~4'd.Ì....L14~J I~~~~\ LU.a ,-"- -.:.. .,}, C:at(~t;a.)'l f'· ~,C': .-.L ,:. ' " , (Inspector'S Comments): -OFFICIAL USE ONLV- . - SA - ~_. .. tit e SITE/FACILITY DIAGRAM FORM !5 SCALE: I"e. )~' BUS INESS ~A.,>{E: 6re.t 'fa . DATE:6 /~/S'7FACILITY NAME: ~3)y'\ FLOOR: 1 Of NIT~: OF \ . NORTH (CHECK O~E) SITE DIAGRA.'{ . FACILITY DrAGRA~ II ..., e 1; vtJevs. <"-èÞY"¿!~)'!:- z:¡-Ç -Ç..,¡¡ J'e.Y'\ ¿þ;", e..-.t. rTV\ \oY1ov.s... b\~ /AJO ..s~ oW J2t-'\. €J ®@ :L ?-toc.. k. "1200"", /-./~~. 7{)· t':;\" ®, , ~ '~ o~·h(.e.. r oç.ç.¡"c..e.. ()C>f.fì~ CoJ't fe'f"'QI1 ce 1Z.Þow1 1<€-f¡¡;V ~~ ® ® ç-toY"&je ,:~,,/W) <;¡ I ,~Ae..v~ e.mp1:1 E L¡l,,,,J.ev-s #.) (01 ~J 1 t.J- , . , Pea 'C" t '-\:'J C "\ ~ A -c\: i'c::.. Ii c:.c..~~ ~ A ìv Co.,d -1:.1 D.-t \ v\~ ~ vt ~ t Se..v~v C\.¡ è!.' \1 r", \ e.-t: ~ (Inspector's Comments): -OFFICIAL USE ONLY- . - ~^ - - .., . ... BAK.SFIELD "CITY FIRE *ARTMENT :;Q1'IÚf , 1715 CHESTER AVE. " . / - 'In ' BAKERSFIELD, CA. 93301 / JAN 18 7995 . U " (805) 326-3979 .;; ¡ Þ3\1 HAZARDOUS MATERIALS INVENTOR~~ , FACILITY DESCRIPTION , ¡ CHECK IF BUSINESS IS A FARM [] _J_BUS¡NE~S NAM~ çJ~'~_~_R 1\0 Tí\J~~_ \ FACILITY NAME C-'F\ K:S-TK:'1\'~ '"T::~c.. SITE ADDRESSSr1Jt, X ~TL µ E:' ~ oAD CITY ~f~J(CæSr::/E'LO STATE cA, --- i I- I I ZIP 933./,3 I II I' :1 Ii I! ' ¡: ¡: NATURE OF BUSINESS SIC CODE DUN & BRADSTREET NUMBER /3 - s-o 3 ð L{ lo OWNER/OPERATOR ¿ A rJ A jl I E¡Ç" }J¡ / LU:::;f2 . I MAILING ADDRESS 3 íS 0 <¡; »E E TT E sr:- I CITY"7341{£R<;0E¿1} STATE CA· PHONE ~ J l..} -,fa 13 ¥ ZIP 933/3 - -..-------. -.-- -- - --- .:---..-_~-- -- -.- - -r_-- EMERGENCY CONTACTS" NAME L EE . jv~ ,t L-L 6f? BUSINESS PHONE ~ 3) - g'to g 9 TITLE 0 w t-J t;-re 24-HOUR PHONE ~ 3LI- b 7 3 ~ . NAME TD h1 [4~NI-'¿-Y' BUSINESS PHONE \(, 3 1- ð b ~ 9 TITLE 0 P E:¡:<ç A r I () rV .r M A "J A f3 ER. 24-HOUR PHONE t; &;3 - 0 ~ 2 ~ S40t1HrfO«:n 1 gg;z REGION V L.EPC STNlC~ F( I 3usiness Name C,q :g'E:-n2A ¡./ BAKERSFIELD CITY FIRE DEPAR~ENT. , HAZARIr>US MATERIALS INVENT~ : ¿'" " Z T'/L-" Address 5?h¥' ~// ~(:;.- Page_of_ /]/f-U) &~aô'HG?~ / cA Ý3.JIJ I . CHEMICAL DESCRIPTION /J 1) INVENTORY STATUS: New [ I Additio,~.-'Revision [ ] Deletion ( I 2) Common Name: 0 "'2.. Check if chemical is a NON TRADE SECRET ~ TRADE SECRET" [ ] 3) DOT # (optional) Chemical Name: 0 'l-YG F3"'¡ 4) PHYSICAL & HEALTH HAZARD CATEGORIES AHM ( ] CAS # Fire PHYSICAL Reactive (] Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) (] , 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [] Uquid [] Gas y(' Pure ~ixture [] Waste (] CHEOCAU. THATAPPtV Radioactive ( ] 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site l~D UNITSYF MEASURE , ~ ()ð() þjJ Ibs JVf gal' [] ft3 [ ] ~¡J.) ð ( " curies ( ] ,o0c) 1-; 0 . }O) ¡¿¥J Circle Which Months: 8) STORAGE CODES a) Container: CIJ.I 1v{)4/l b) Pressure: 2 :2 0 0 ,¡{.. 6 S c) Temperature: M, A, M, J, J, A, S, O. N, D 9) MIXTURE: Ust the three most hazardous chemical components or any AHM components COMPONENT CAS # %wr AHM [ ] [ ] ( ] 1) 2) 3) 10) Location CHEMICAL DESCRIPTION "/ 1) INVENTORY STATUS: Ne, "'Addition [ ] Revision [ ] Deletion [ ] 2) Common Name: L llP JJ l 0 (f) "Z..... Check if chemical is a NON TRADE SECRET ~ TRADE SECRET ( ] Chemical Name: o x.-y CL~ o -I¥ Gc?,../' 3) DOT # (optional) AHM [ ] CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES Fire PHYSICAL Reactive (] Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid (I Uquid -M Gas [ ] Pure ~ Mixture (] Waste (] CHfCX AU. THAT ;,ppty Radioactive [ ] 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site UNITS OF MEASURE {,2 0 ~'5'ÐTJ Ibs~ gal (] ft3 [ ] ~ curies ( ] o¿..ßS I 5" U15 ;;L¡? {JJO s G" r (Circle Which Months: 8) STORAGE CODES ~ _ . a) Container: R t; ~ t:: i< V 0 ( ¡2. b) Pressure: ~~ ¿. B :> c) Temperature: .:l F / - /g 3 c.. I A. M, J, J, A, S, 0, N. D 9) MIXTURE: Ust the three most hazardous chemical components or any AHM components COMPONENT CAS # %wr AHM [ ) [ ) ( ] 1) 2) 3) /-/:Z -f?~- Date ~."Þw3Q, 1S1Q2 AE~V LEPC"'~FCJ'I" fi e - ~~(0~~~~ ri6~OV 22 1993p 1 " ~\'.. 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-0 Overall Site with 1 Fac. Unit General Information By Location: 5768 STINE RD Map: 123 Hazard: Low Community: BAKERSFIELD STATION 13 Grid: 23C F/U: 1 AOV: 0.0 r-- Contact Name Title Business Phone - 24-Hour Phone MANU~L LEE MILLER CORP PRESIDENT (805) 8~1<~8689 x (805) 834- 67.38 'CÀÑÁ~YVÕNNE ¡'1ÎLLER CORP VICE-PRESIDENT (805 )8£ff"':" 8689'x ( 805) 834 - 6738 Administrative Data Mail Addrs: 5768 STINE RD D&B Number: 11-273-3936 City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: Owner: MANUEL LEE MILLER Phone: ( ) - Address: 3808 DE ETTE State: CA City: BAKERSFIELD Zip: 93313- Summary I, M;;Þ\",~\ ~ J-\;~ Do hereby certify that ! have (Type or print name) reviewed the attached hazardous materials manage- ment plan fot Ça~G:7 V'ð-~ar.d tha.t It along with ~ma~~¡Mf':>J any corrections constitu1e a compí9t9 and correct man- agement plan for my facilit'ý. ~!t<-1~ nalUrð ~. il ff'ß Date ·" ';' . e ,. 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 5120 Low FT3 02-001 OXYGEN ~ Fire, Pressure, Irnmed HIth Gas '" . e " 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 5120 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS ---- Daily Ma~ F~3 ----r-- D~~ly Ave;~g~ ~!~~ ~ Annual Amo~nt. 10,000 " 5,120' 2,867,200' Storage r Press T Temp -:t Location PORT. PRESS. CYLINDER Above" Ambient I SOUTHWEST CORNER FT3 - Cone l 100.0% Oxygen, Compressed Components r=- MCP -¡Guide I Low I 14 ~ . e ~ ~ ~ 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification NOTIFY THE FIRE DEPARTMENT BY DIALING 911 AND GIVING THE LOCATION OF THE FIRE OR SUSPECTED FIRE SUCH AS SMOKE OR BURNING ODORS. <2> Employee Notif./Evacuation TAKE NECESSARY STE,PS TO PROTECT ANY PERSON IN IMMEDIATE DANGER. CLOSE ALL WINDOWS AND DOORS. CALL 911 AND GIVE THE EXACT LOCATION OF FIRE AND SUSPECTED FIRE. OBEY THE INSTRUCTIONS OF THE RANKING FIREMAN. TURN OFF ALL GAS AND ELECTRICAL. REMAIN CALM - DO NOT PANIC. <3> Public Notif./Evacuation TAKE ALL NECESSARY STEPS TO ALERT ALL OTHER EMPLOYEES, CLIENTS, AND VISITORS THAT MAY BE IN THE BUILDING. INSTRUCT THEM TO LEAVE THE BUILDING TOWARD THE FRONT PARKING LOT AND TO OBEY THE INSTRUCTIONS OF THE FIREMEN WHEN THEY ARRIVE. <4> Emergency Medical Plan MEMORIAL URGENT CARE (APPROXIMATELY 4 MILES AWAY) 6501 MING AVENUE BAKERSFIELD, CA. (805) 397-4004 ':~ ., . e . .. .. , 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention NO SMOKING PERMITTED IN AREAS CONTAINING COMBUSTIBE SUPPLIES OR MATERIALS INCLUDING THE STORAGE AREA WHERE OXYGEN IS KEPT. ALL ELECTRICAL EQUIPMENT AND APPLIANCES USED IN THIS FACILITY WILL BE GROUNDED. SAFETY EDUCATION FOR ALL EMPLOYEES INCLUDING FIRE AND ELECTRICAL ARE PROVIDED AT NEW EMPLOYEE ORIENTATION. <2> Release Containment H CYLINDERS OF GASEOUS OXYGEN ARE FASTENED SECURELY WITH CHAIN CONNECTED TO A SOLID WALL. ,E CYCLINDERS (PORTABLE) ARE STORED IN LARGE MOVABLE CABINET. <3> Clean Up FOR GASEOUS EXYGEN, CLEAN UP WILL BE BY EVAPORATION. <4> Other Resource Activation FOR NEAR-BY FIRES WHICH COULD BE OF IMMINENT DANGER TO CARETRAN MEDICAL SUPPLY CENTER, WE CAN REMOVE ALL CYLINDERS FROM THE VICINITY WITHIN 10 MINUTES USING CARETRAN VEHICLES. " ·, . e '. "'R 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 00 - Overall Site Page 6 <F> Site Emergency Factors <1> Special Hazards THIS BUILDING (CARETRAN) IS MADE OF WOOD WITH TILE ROOFING. <2> Utility Shut-Offs A) GAS - SOUTHWEST CORNER OF BUILDING B) ELECTRICAL - EAST END ON SIDE OF BUILDING C) WATER - SOUTHWEST CORNER OF BUILDING D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - THERE ARE FIRE EXTINGUISHERS LOCATED AT VARIOUS VISIBLE LOCATIONS THROUGHOUT THIS BUILDING. FIRE HYDRANT - SOUTHWEST CORNER OF THIS BUILDING <4> Building Occupancy Level .. . ·e ;,;' . --. r~. 4- . 11/10/93 CARETRAN MEDICAL SUPPLY CENTER 215-000-000362 00 - Overall Site Page? <G> Training <1> Page 1 WE HAVE 5 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ':> - ~. , ~rp~, ~akersfield Fire De~ Hazardous Materials Inspection Date E;ompleted "- ~ ~o IO~cß 7-27-Y¡ Business Name: ~Ii-TìVH'L JIÝ1tf)icÆL _ÇUI'PLtt L€,¡f(,7í£1¿ JUl 2 8 1989 HAZ. MAT. DIV. ~ þr,¿(-e.... í Adequate Inadequate ~D Location: S7ro& STt ñ~ plan 10 # 215-000,J~ (Top right comer Business Plan) Station No. I ß Inspector 41tLL- Shift Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: f(cyk:..Jw(A (() ) Verification ofMSDS Availability JO L OK. Number of Employees ~ Verification of Haz Mat Training Comments: if B ~ o ø RECEIVED D D D ~ D Verification of Abatement Supplies & Procedures Comments: [if D Emergency Procedures Posted oZ Containers Properly Labeled Comments: o [1L( ~ D Verification of Facility Diagram ((), k . Special Hazards Associated with this Facility: o g Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office ,,,¡>~'T"""'-'.""""""~¡~";"~~"~"'-"'-~" j'J"'1IT;,<:,::,:;",rl\~~,",f~;\i(:_,,":<~~':' ,':..~'¡, '-";~.. ,),~~"--,::r,:'~w;J'JP"":;'¡ ·:~:,)t~'<;." ,";i .,'"';¡i-~?'¡;''''"'[' ,.. .. "',' " J/-/~- ~ rnIuv _ (/-€<-). - ~.~~ ,~ &<xJ ,~ ~ ~ ~ ~~æ:. ~d.ÎI: ~ ~ ~ EI l/-/ 7- ßf!¡, - (.Tat (i:::lV(~,.,,::\q .~.;;1 t"'-4,...).:,Jr, ~)~,,~ ~ \ ;1\1 \:ö\: U .... ,.f\.iL, .VIO .1 ¡'\M .S.AH 11-/7- ;;(.u.. ~ ~ ~ ~-P-~ v..p ~ ~ ~ cfu., uJî)ulct ~ U)&~ "-/7 - ~cJ. tÀu "f1~ .:',':....::¡'. ,~".-. I 11/17/8'3 ~ì' ' ,.. .RET RAN MED I CAL SUPPLY CENW..' , Site as a Whole ~ Page 001 General InforMation Location: 5768 Stine Rd Ident NUMber: 215-000-000362 Map: 123 Hazard: Low Grid:23C Area of Vul: AdMinistrative Data Mail Addrs: 5768 STINE RD City: BAKERSFIELD GeoSubdiv: BAKERSFIELD STATION 07 D&B NUMber: 11-273-3936 State: CA Zip: '33309- SIC Cc.de: Owner: MANUEL LEE MILLER Addrs: 3808 DE ETTE City: BAKERSFIELD Phone: (805) 831-8689 State: CA Zip: '33313- C':'Y'lt act MANUEL LEE MILLER 'YVòn.=BXaçKbUrn~' Title Corp. President Corp. Vice-President Bus i Y'less PhoY'le } 831-868'3 }'832:~2691'-. :" 24 Hc,ur PhclY'le ( ) 834-6738 ( ) SUMMary: In relationship to hazardous materials, Caretran Medical Supply Center stores compressed oxygen in "E" and "H" cylinders. RECE\VED NOV 1 7 1969 HAZ. MAT. OW. 11:17/~9 ~RETRAN MEDICAL SUPPLY CEN4jþR Overall Site HAZMAT INVENTORY - LIST Page 002 01-001 Oxygen > 3,000 FT3 Low 20 to:30 "E" cylinders - 10 to 20 "H" cylinders - D.O.T. No. 3AL-2015 Full Pressure - 2015 psi @ 70'F Content - 682 ltr @ 2015 psi @ 70 F D.O.T. No. 3AA2256 Full Pressure - 2200 psi @ 70·F Content -"7,245 ltr @2200 psi @ 70 F ; 11/17/~9 eRETRAN MEDICAL SUPPLY CENW Overall Site HAZMAT INVENTORY - DETAILS Page 003 01-001 Oxyge'rl > 3,000 LClw FT3 Form: Unknown Type: Pure Days in use: Use: - Dai l.X..tr1,a,'.~ Amt T Dai ly Average Amt -~ Armual Amcll.I1'",t --yUr'i t - 5, 120 ~,' 2,560 I 144, 000 I FT3 - CC,y,t a i y,er PORT. PRESS. CYLINDER 20 to 30 - conc.l Components 100.0~ Oxygen, Compressed ,+'t'essITernp r:::-:: LClcat iCIYI I') 0 0 I SOUTHEAST CORNER 2, 15psi 70 1-:- MCP îist- I LClw i" Ii <0> .. RETRAN MEDICAL SUPPLY CENTER N.:.tif. /E uatic'YOIIMedical f,:,r: 00 - ~e as a Whc,le Page 004 11/17/89 <1> Agency Notification Notify the fire department by dialing 911 and giving the location of the fire or suspected fire such as smoke or burning odors. <2> Employee Notif./Evacuation 3A SEC 2) TAKE NECESSARY STEPS TO PROTECT ANY PERSON IN IMMEDIATE DANGER CLOSE ALL WINDOWS AND DOORS CALL 911 AND GIVE THE EXACT LOCATION OF FIRE OR SUSPECTED FIRE OBEY THE INSTRUCTIONS OF THE RANKING FIREMAN TURN OFF ALL GAS AND ELECTRICAL REMAIN CALM - DO NOT PANIC <3> Public Notif./Evacuation Take all necessary steps to alert all other employees, clients, and visitors that may be in the building. Instruct them to leave the building toward the front parking lot and to obey the instructions of the firemen when they arrive. 11/17/89 7' r¡ ~ETRAN MEDICAL SUPPLY CEN. <D> Nc.tif./EvWl.laticlY".JMedical fm~: 00 -' e as a Whc,le Page 005 <4> Emergency Medical Plan 2A SEC 5} 'WIll TC LANC MED I COL CL I N I C OPPROX I MOTEL Y 1. MILE: mmy 5401. WliITE LN 032 2000 Memorial Urgent Care approximately 4 miles away 6501 Ming Ave. 397-4004 7' .RETRAN MEDICAL SUPPLY CEN);¡R <E} Mitigati_ Prevent/AbateMt for: 00 ~te as a Whole Page 006 11/17/8'3 <1} Release Prevention 3A SEC 1) NO SMOKING PERMITTED IN AREAS CONTAINING COMBUSTIBE SUPPLIES OR MATERIALS INCLUDING THE STORAGE AREA WHERE OXYGEN IS KEPT ALL ELECTRICAL EQUIPMENT AND APPLIANCES USED IN THIS FACILITY WILL BE GROUNDED SAFETY EDUCATION FOR ALL EMPLOYEES INCLUDING FIRE AND ELECTRICAL ARE PROVIDED AT NEW EM~~OYEE ORIENTATION <2} Release C·:n".ta i rlMerlt "H" cyl i nders of gaseous oxygen are fasten securely v~ith chain connected to a solid wall. "E" cylinders (portable) are stored in large movable cabi rret. <3> Clear. Up For gaseous oxygen, the clean up will be by evaporation. " .RETRAN MEDICAL SUPPLY CEN~ <E) Mitigatio Prevent/Abatemt for: 00 ~te as a Whole 11/17/89 Page 007 <4) Other Resource Activation For ~~àr-by fires which could be of immi~ht danger to Caretran Medical Supply Center, we can remove all cylinders from the vicinity within 10 minutes using Caretran vehicles. 11/17/89 iìiRETRAN MEDICAL SUPPLY CENTER <F} Site E~"gency Factors for: 00 - ~ as a Whole Page 008 <1} Special Hazards This building (Caretran) is made of wood with tile roofing. <2} Utility Shut-Offs 2A SEC 3) A) GAS - SW CORNER OF BUILDING BUILDING C) WATER - SW CORNER OF BUILDING B) ELECTRICAL - EAST END ON SIDE OF D) SPECIAL - NONE E) LOCK BOX - NO <3} Fire Protec./Avail. Water 3A SEC 5) SW CORNER OF THIS BUILDING IS A FIRE HYDRANT There are fire èxtinguishers located at var.to:Ú's visible location throughout this building. Far~ and ~gticulture [] CITY of BAKERSFIELD ..... Standard Business HAZARDOUS~ MATERIALS INVENTORY - "I o NON-TRADE SECRETS Page of --'. OWNER NAME: Lee Miller NAME OF THIS FACILITY: Caretran Medical Supply ADDRESS· 1~U~ ~PT~fð A~~ STANDARD IND. CLASS CODF: CITY È Zíp:_-.È.2.k rf' rl - -~l-:': DUN AND BRADSTREET NUMBER-Tr~273-~9jb--"'--' ItRMR tfio:-rrv!müp!iltJNS-FVFrPROPER CODES - - - - 1 8 9 10 11 12 13 1l I Dys Cont Cont Cont Use Location Where 'by Nar.es of ~ixture{ç~r.oonents on Slte Type Press Temp Code Stored In Facl11ty Wt See Instruc Ions O~ 4 27 .s.~' CCrt12;r eø:r~0 ",9 Gaseous Oxygen Component 11 Name & C.A,S. Nu~ber ~l&:J BUSINESS NAME: Caretr&n, LOCATION:. ~/bö St!~~~ C 11 y È ZIP. ___-ÌE1.k.el:sf_l" ¡ .rA PHON tt: 8~1-868Q q~il ':; t 2 3 4 Trans Type ~ax Average Code Code A~t Amt U P 2,560 Fhysic~1 end Health Ha~ard (Check all that apply) ~ire Hazard 0 Reactivity 5 Annual ., PhYSic~l snd Health Ha~ard (Check all that apply) C.A.S. Humber 0 Component 12 Name & C,A,S, Number Immediate Health Component 13 Name & C,A.S. Number Component 11 Name & C.A,S, Number 0 Component 12 Name & C.A.S, Number Immediate Hea 1th Component 13 Name & C.A,S. Humber Component 11 Name & C,A,S. Number Component 12 Hame & C,A.S. Number 0 Immediate Hea 1th Component 13 Name & C.A.S. Number Component 11 Name & C,A.S, Number 0 Component 12 Name & C.A.S. Number Immediate Health - Component 13 Name & C,A.S, Number o Fire Hazard o Reactivity o Deleyed 0 Sudden Release Health of Pressure Physical end Health Ha~ard (Check all that apply} C,A,S. Number [] Fire Hazard o Reactivity o De layed 0 Sudden Re I ease Health of Pressure Physical snd Health Ha~ard (Check all that apply) [] F ire Hazard o Reactivity C,A,S. Humber o De 1ayed 0 Sudden Re lease Health of Pressure Title I nllfTñ~I· EMERGENCY CONTACTS tf1 «2 RãM Tfn e 2'4lIfl'nõõe-- Rame CertifjotiOQ (Reed and $ign af1er cÇJmpl~ting (ill sections) . I certIfy under penally. 0 la~ th~t I have persona Iy exam¡neQ OQd am famillar ~ith the informatlon ~ub~itteo In this ond all attaçhed dQcu~ents, anQ t at based on ~y lnQuiry Q those lnd1Vlduals responsible for obtaIning the lnformatlon. I belIeve that the submltted lnfor~atlon lS true, accurate, and co~plete. ~rr,ë~rãl5fîëiër-ritle Of owner/ooer!~~er7õPëfã~š-ãüthorlzea reõresentat1ve SlgñãliJTI UHn¡qr.~õ .oIf:'" / ., ~ ~,- ;,,4.~ ~. ····otv ;4u 4IÞ BAKERSFIELD CITY FIRE DEPAR~ 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY \;;ßG5~L RECEIVED JUl 1 1987 Ans'd.......... .. :rJJS ID# ~ ()dd- \ \ USINESS NAME HAZARDOUS MATERIALS BU$INESS 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 4. Be as brief and concise as possible. a whole. OOO?,ß2 SECTION 1: BUSINESS IDENTIFICATION DATA CdV',,-ty-a.n. Ajd,Cg~~"rr}Y c.exfev ~ t. /) B. LOCATION / STREET ADDRESS: S7fo<3 rl:1V\e'_ ¡?oað CITY: -:&-keYs~d4 ZIP: CA BUS.PHONE: (205)<¡)3J - ~~ ~cr A. BUSINESS NAME: 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: NAME AND TITLE A. H 8.VllAeJ J...er- ~ )..{: \\e.V Du:J1e...Ý DURING BUS. HRS. Ph# <?. ~ ì - '=6~~q Ph# ~ S L- - <6.(;> ~4 B. L \- ~'\LLa K O,t.t ~ I'l~ AFTER BUS. HRS. Ph# ~3>Y- -?ì '.5, ß Ph# ..5"'6.::r - s q. Dip SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. ~PROPANE: ~.. tù· B. ELECTRICAL: ~as C. WATER: S, u..J . D. SPEC IAL: ~() lit ~ --J:::;. E. LOCK BOX: E / NO IF YES, LOCATION: ~"'-> t- ~"~,~ f1 Vl ~"l¿ì~ ~~ k~" IF YES, DOES IT CONTAIN SITE PLANS?~/~ MSDSS? YES /~ ~ FLOOR PLANS?~~/~ KEYS? YES /~ - 2A - - . '\, " ~ , ,~ ,),"', i'~ .~" . . . - \:.;: ~ ~ 'j : " I I I, SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE Ou.y -teaW'\ WY\.S~~ t of' 2l :: ~e..~-b;'Yl.L's.t d~ l Yé'-v- Y -reV3.D Y1 b ,1t¿.ý' ( ~e-'Ý¿ ~ 7 !:. t. 2.. YIT~, L~ -ls:-.v-ø H uV:='<'::.. ï3-n¿y- V11ð-M a-~ ~- Y' SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE , S; a ~,:. 0 (} {j 0h7:t:e.. LVl- pL1 eJl. C ll~l L a fý?vof(, ;,le. Cl_i.<E-! 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 A, METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: . . .". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: . . . . . . . . . . . . . . . . . . . . . . . . . . C. PROPER USE OF SAFETY EQUIPMENT:................ .. D. EMERGENCY EVACUATIÐN PROCEDURES:................. E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: . ... ... INITIAL YES~ ~NO E~ )!§ŒQ-J ~ NO REFRESHER YES -z§) "~NO ~~ Œ§.V NO SECTION 7: HAZARDOUS MATERIAL " ,.-- ......' C !-RCLE YES OR~)' DOES YOUR BUSINESS HANDLE HAZARDOUS TERIAL IN QUANTITIES LESS THAN 500 POU~OF A SOLID, 55 GALLONS OF _ A LIQUID, OR CUBI~ FEET OF A COMPRESSED G~. : . . . . (~~v ® We- ~ð' e tIotOy~ lZTt ~wvnf'...¥-'S. , certify that the above information is accurate. ·s information will be used to fulfill my firm's obligations under Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 and that inac6urate information constitutes perjury. SIGNATURE ~j; TITLE Qo~er DATE Þ -2q~<¿?J - 2B - I t~ ~ " !~.." '. .¡ e e BAKERSFIELD CITY FIRE DEPARTMENT 2130 fa" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS N¡-\~E: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRI~T 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# FACILITY UNIT NAME: SECTION 1: ~ITIaATION, PREVENTION, ABATEMENT PROCEDURES \ j ~C:> SM~ k~~ f'e;.r~.-t::t.~ ~~ a..yea.$ é::.Vh ta--:vt t'l-1.~ 6:nvt b ",-6. -b \:" Yc::... ~ f'-rd e..:s. 6 Y lV1-, a--le.v I ~l S I'" C. } KJ?--' :) . "tie.. Þ'-6Y'2j~ 'Z$ved. ¿.Ù}le..y~ Ò"^/:J'f2..'Vt :~ kf"l- c::< I 11 q e.fe.c..*-:~ c.a..} ~'. yOW\.e.....1:. ,d)'l4 ~ 1 a-}/Ice:š useA' ~}-} 't:Jt~ I". -ÇðC.,l:-9 t-O~' Il be.ð YOIÆ JeJ . "---. 3~ ~~ -v:~~ d ~U'L-bD0. -fo-í a¡[ ~JtJlees , 1>1 c..lµcrl~ç ç -€-/..Cc....-D-iQJare PY'DY I~~ a.t ~u..:J .:e.tup/a -'<t SECTION 2: NOTIFICATION A~~ EVACUATION PROCEDL~ES AT THIS L~IT ON~ {::. c: ¿¡ 'f ~e:.'Yt -t....;z. i:..:- D ~ J I., T~ ""<"~"'''-''''''7 ;k-ts 19 rob:±. ='7 ¡=e-,,""'-D" .:.... t >vt wt~ 'a.-1:e. j'¿n~5e-Y-. ¿j êb<&e. ð-l[ ~):dD..o.s ;;;J¡.tð dODVS . 3 j Czll ~ '\ ~7IJ7 ,57.--e -the.. e.R?~ LèX:¿-6cM. ¿¡+ + ~'-e or ~ F~e.£ +\ ¡<e . '7-, 0.7 i1~ ;",sh",-4,'o,,-.5. zrf & van b~ ¡:-;yd..~ 3Vl .5 ,--rtAY Y\ ~-Ff &3J[ ~ ? de-c-tr; LdLl ----7e.WJ¿IYJ &Jwz -.=J)D n;t ßYl >L - 3A - e SECTION 3: HAZARDOUS MATERIALS FOR THIS ú~IT ONLY '.!:" e A, Does this Facility Unit contain Hazardous Materials?...., YES@ If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a" separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inveötory form marked: TRADE SECRETS ONLY (yellow form #4A-2)in addition to the non-trade secret form. List only the trade secrets on form 4Ä-2. SECTION 4: PRIVATE FIRE PROTECTION' '- SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS S , L-Ù _ COql't~V ¡r---f" -~1J 1(:$ b ~\ l?ru~) SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A, XAT ~ROPAXtf: . Î' .s. Lù. C-tJ-.rJ-1e.:ý DT ~-; S E. LOCK' BOX:~/ ~O IF YES, LOCATION: &4,.£ e..v~ of'-~\Ç. _h<l~\J'5' IF YES, SITE PLÁN~? YES'~ FLOOR PLANS? JES~, -' B. ELECTRICAL: ~~ erl¿{? bw ÌJ'5 C. WATER: ~. W. CDv1 ev ~~é' ¿::¡ Þ1 ~ iftz~ D. SPECIAL: 000e - 38 - b.,.TJ'j t7-F*1 ~S ~~,LL~.. 011.. ?~e MSDSs? KEYS? YES i~ Y~/D ¡A. " .! "€ ~:; '". .y-- r, "";~ 1. D. # " BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: CaY"e.t.Y"ðY\. Me.d\~:a.\ ..5c.(fP'Y OWNER NAME: Ma.Y1ùt"' Le.e.1-/\;\\ßv- FACILITY UNIT #: ADDRESS: S7b.g 5tiYl.i>~. ADDRESS: 3c;?ð~ ""De E:ttl'" FACILITY UNIT NAME: Page of -1 ,~ ~ CITY, ZIP : ""ß::;tke."("~.ç:.;... \J.) r A cq3~\~ CITY, ZIP: r"7 I - +. ~""lÅ cA cq3~P.. PHONE #: ('8'0.5) ~3\-~fog4 PHONE # : (<ó'os) cg3'-b- - G:,7.39. . IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6· 7 8 9 10 I 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 I) P .3~OoO I Lt <\-~ (jbO ¡::- t.3 OS*, -;...7 £.E:". Covt'\.e.,y \00 o x V G\ e.> Y\... ~jS9' N~LG . / J I I I r- r'- I ~AME: H.aY\l.le,,\ L~ H.~ )\e..y- TITLE: Ow>1e...v- SIGNATURE: ~A/-. nY~# ~~ ,.1/~ DA TE: 6-;;4 - ~ 7 I _,EMERGENCY CONTACT: La-:'1 à. N ; l).e...ý TITLE: (' ÃJ - DiÁJne.v C. P JI.è1(E~ BUS HOURS: "3 - ~ I "\. ","' ÉM,ERG E-~CY ~RINC.IPAL '" "" - -- CONTACT: LL~¿L BUSINESS ACTIVITY: ¡f>D ~ l:t e tv1.e...t£ l.è..a..1 TIT L E : -Kec.:-v:+-Ú>YIt5 t ~lA..fr J~ 1~ "-t y Lh ;t -t.e.>'Ï ( 1- 4A-l - AFTER BUS HRS: PHONE # BUS HOURS: AFTER BUS HRS: ~>~~~~rsH ~:z,.,-~~~Cf I 5'~~ - '3.1f-b 0 I I I. ,:.,..,/' ~....... ~'I o~ . ~y 4IÞAKERSFIELD CITY FIRE DEPAR~EN~ 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 (t , .-------.. !, -"! \ '....\........./ RECEIVED J U l 1 1987 Ans'd. ........... ~ OFFICIAL USE ONLY 10# _! l)dd- \ \ USINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: QO\}?,G2 1, To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business 4. Be as brief and concise as possible. as a whole. SECTION 1: BUSINESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: CITY: ~keYs..(;dJ ' Cóvety-B-Yl. /L!gj;¿~j ~Urr)Y Cexfev S7fo <6 ~-CI·Vte, ~oad ZIP: CA BUS. PHONE: (~5) ?53) - 8'~ rgcr A. BUSINESS NAME: 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: NAME AND TITLE A. HCli1¡.\eJ J.ee ~:\\é',v (),.j11E'_Ý DURING BUS. HRS. Ph# ~ -:; ~ - ~t::/64 Ph# ~.:; 1 - <?,~ <64 AFTER BUS. HRS. Ph# ~ ~y.. - ?, ì š 'ß Ph# ...5<6 c¡ - oS if C tF B. L\.,,\.d..a KO\.-i-1.~~l('"' SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. ~PROPANE: -::;.~ tù . B. ELECTRICAL: t9/-, .ï' C. WATER: s_¿ù~ D. SPECIAL: E. LOCK BOX: IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS?/~/~'; FLOOR PLANS?~S I~~ MSDSS? YES /'80:) KEYS? YES I ~ - 2.4 - "' , e e SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE C i.-lY' '-cC¿L'W\ CC}\ -:",,~,::., t öf- a :: "re~f't ;;rll'~;'-t.. c/ ~I \ : ~_\! f CY.:;¿) )1 b I Il.é:-Ý 'i::.~¡(?-'--a \- ~. s, L _ ~.,,> 2. Y<5 l_¿J:S'::Ji:--:cÇ j~ J-{V =c '3- ì1¿\ 1---11 ¿t j 1 a 5 e:. ý SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE (: "¡ ", '. .... c (~.t ! ':- /..~ "- <\oJ U 1 f !; . !. J' ¿~)z~t-e LYLe M~, C}¡~,L a jf"I"OK ' W:;,le. a-i-<.21 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 A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS: '. ................................, .... .. B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: . . . . . . . . . . . . . . . . . . . . . . . . . . C. PROPER USE OF SAFETY EQUIPMENT:.................. D. EMERGENCY EVACUATION PROCEDURES:................. E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:. '" .. . INITIAL YES ~ ~NO ""'YE N~ xgd9J ~' NO REFRESHER YES CV iB~ Y~ @2) @JNO SECTION 7: HAZARDOUS MATERIAL F CIRCLE YES OR,NO , ....,----- DOES YOUR BUSINESS HANDLE HAZARDOU~_~~TERIAL IN QUANTITIES LESS THAN 500 POL~OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED ~. :.... YES ~~ CA ' ,". ,_,' We-, 'ho ''1&\ k ¡'to Yê -thé7vt 7ZZ'7C,'{. Tt 0--\ écv1rl),...¥ s.. I, ~ . (, . / \ / .-' e.r ,certify that the above information is accurate. I und rstan~t at information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et AI.) and that inaccurate information constitutes perjury. C~:--I'lé~ rr DATE þ- cC¿ ._<gj - 2B - ... ,-~,. e e BAKERSFIELD CITY FIRE DEPAR~EXT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY" ID# ------ BUSINESS NN'Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 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# FACILITY UNIT NAME: SECTION 1: ~ITIGATION, PREVENTION, ABATEME~~ PROCEDURES \} ~C:> .sM~ ~~~ fe)n~ .tt..ecþ ~~ 2.:n:::.2..-s C-Vn ta.-':v¡ l'l-1, C-z:n"'t 1:;, "I. ~ -t:¿b Y c:... ;:'--l-t f'-r' 1 e.. 5,. ¢ 'í" )V\. a.. ~_ v l ~ l S I'=' c-l <Æ.~t "ti e. Þ1::o Y 2j"'- ""Ved .0 ),ECY= Ó >-,/5 '<LV>. v;. k~- ~/" Aq e.f~-l'a""7c.a..) ~"rW\.e.i-1.t.. d,'\¿;f âffla..J1c.e.:;; LÁ~d' ;11 -e1't ~ ~ -ÇðC: l :-9 t-..:J ;'ll be ,,5 yo IÆ Y1JeJ' " 31 721-rfY d¿CZl.-bD·...1 ~-(" a2[ e?vcrJv/ee.s I ~rtc..L'-cr'~j -f;~c:. . ..e.. e..:,c.---t:ylc2../ a¡'e Fyov,Je::¿; a.t J?e.:u..:J .e.Juf>/ay-«' ð"i'~e.H-t..d.t..:-(Hl SECTION 2: NOTIFICATION A~1) EVACUATION PROCEDURES AT Trns _ u"XITOm. Y 1./ -Y:~k~ V1~~eJ~.(--?-7 ¡:k¡ßs ~"F'oiec± c.¡ L "-1 ~~,(e...¿::1 ,?"t.e. ¿a:5ey-. ¿j êL'D.c~e. ð-l[ ¡"'cJ:LdDL0S ¿:;Hcf dooY's ' 3; C2.Ll q \\ ð71cf ~;,,'é' -t1H;:~_ e-72¿t.. lèC¿7-6-cM. p+ --Ç:;~-e c) \'" ¿-:::<-t.~;> f' e~-ð +\;:. 'é" , '7-, ~7 iic~ ,r"styoAci.-O"S... dti,¿ ý¿ut b:\j FY~OV¡ L ""- y-\ 'ÝC- Wt a VI ' If' ~ ~ I .5 ,=-JtA-YI--\ z;1/ a-J{ ,~'"> Ç' é-:.lé:'J'-lT;&ll '~------2~ IV/?¡J1 Gl.-J ¡-v¿ -'~D V1 yt o " ) '3)1) L - 3<\ - ,.... .-: e e SECTION 3: HAZARDOUS MATERIALS FOR THIS u~IT ONLY A. Does this Facility Unit contain·'Hazardous~laterit\ls?...., YES8 If YES. see B. If NO, continue with SECTION 4, B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No. complete a" separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inverttory for~ marked: TBADE 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' SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~~ERS :5; / LÙ, COV-Me-V P-t' ---¿/(lr-Sb~ì [¿rJ;¡) SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. XAT ~ROPANt': Î' --1---[ . " S. LO. C-b"/^Yle..ý' DT -Ut"; S B. ELECTRICAL: ~ t Ð/lð bw D!'5 " U"' -~ ~ ~ bµ,LL'5 ¿7-f~:S ¿u'1 C. WATER: ~'&l~ J,C:< ¡JI ~J" ...:::; . LÙ . CDv1 ~ y D. SPECIAL: \ }0ovt e E. LOC:< BOX:@/ NO IF YES, LOCATIOX: .:u"<~t o-f'-ù, ;<:~hc,: \J,:s, IF YES, SITE PLANS? YES' ij?/ FLOOR PLAXS? YES,~ e.Y(j) D ¡1.. ?"J' ~ ~fSDSs? !ŒYS ') YES "~ YES >~) - 38 - 1. D. j't BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY ßUSINESS NAME: Caye..-t:.y¿¡.y\ fV\e.d\~â\ S£(pf'ly OWNER NAME: ty'\ël-Ylu.e Le..e. }/\;\\e,y- FACILITY UNIT #: ADDRESS: 57ú,g -5ti~~~¿ ADDRESS: 3<;?Q8 ""De.t::±.tt" FACILITY UNIT NAME: Page of - CITY, ZIP: b;q.ke..y~.ç:.;e \d r A C¡3'3.\~ CITY,ZIP: R""l_.~_l::.~p\Å CA q3~\~ .I (C¡SCS) PHONE #: (<8'OS) CZ3\-Rtog4 PHONE #: '33~ - (0'7.3)< 10FFICIAL USE CFIRS CODE -- --- ONLY 1 2 3 4 5 6· 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD 0.0.1' CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE ,'" . ..~: '-:.' . . "" '. ", . 1"::" ~·.1 . " , ~3s9' "'!;::'¡:: :" , ,-.,<1 I .3/000 ~t.3 ' ø£t: 7-7 .. C~v·..{e.Y" '100:.' OX.VC\e>VL N ç:"LG ILt,,\-,6D6 / J I I . I i -- ! I I . r r' NAME: H¿'1.I~l(~_\ LêC_ )vI'. )\ e,ý TITLE: r)t.vIJe_y SIGNATURE: '--;l-1'~¡',..~.NPj~r?;¿:~ .)1/,--" D ATE : ,(,.. .;J.c:'j , ~ '7 E,ftERGENCY CONTACT: L:::}..'l :8, '-I ; Lie _ ..." TITLE: (1....(-;) - ChO 11 e. ~V' l pnéNE~ BUS HOURS: 'is .~ \ .- <;«(~. <,< (-I~ < L l>lda. £>D}V\ 1:1C. --;7 f' -t AFTER BUS HRS: <;;(;>", L~ ~ t:;.: 7 :;; ''í\ OfERGENCY CONTACT: PHONE # BUS HOURS: "9;:2 I .,.-;" <60 T I TL E : . ;:¿é":.e.~ lbJ1l5 _ I "> ~'¡<,(c'" I PIIINCIPAL BUSINESS ACTIVITY: Me ...c\ l. è. ,,'2 \ ~/A. ft )\.) f) 'I£'" Ty I.b i.1. -t(>:í AFTER BUS HRS: 5'<XC¡ .. 3>'i-ú rr) ( I'~ , - 4A-l - e e CITY of BAKERSFIELD {).uyd.. I -;;¡ - ;)., ~ - g'iš, - oat . tJo·t Vv...- ~ ARE DEPARTMENT D. S. NEEDHAM ARE CHIEF 2101 H 5mEET BAKER5f18.D. 93301 326-3911 Dear Business Owner: Enc!osed please find a copy of your r~sponse to the Hazardous Material Business Plan reques~. We have found it necessary to reject your pìan for the foìlowing reason(s) as checked below. D Illegible Business Plan (please print or type information in English). Form ~SSing or D Incomplete Form 3A D Missing or D Incomplete Form 4A D Missing or D Incomplete Form SA Site Diagram D Mi ss i ng or D Incomp 1 ete Facilities Diagram D Missing or D Incomplete This is to be corrected and resubmitted within 30 days to: õakersfield City Fire Department Hazardous Materiaìs Division 2130 IIGII Street Bakersfield, CA 93301 If additional copies of any forms are needed they can be picked up from the Hazardous Materials Division at 2130 "G" Street in person. Coordinator .' , REH/eg 'C..' ", -- - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL ~SE ONLY ID# ------ B~S I~ESS ~A.\fE: BUSINESS PLAN SINGLE FACILITV UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRIXT 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*' FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES 1, No smoking permitted in areas containing combustible supplies or materials including the storage area where oxygen is kept. 2, All electrical equipment and appliances used in this facility will be grounded. ), Safety edu~ation for employees handling compressed gas cylinders. 4, Safety education for all employees, including fire and electrical are provided at the new employee orientation. SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY 1, Call 911 immediately and give the exact location of fire or suspected fire. 2, Take necessary steps to protect any person in immediate danger. ), If a fire is small and 'confined, use fire extinguishers to put out the fire. 4, Close all windows and doors. 5, Get everyone out. If smoke is present, crawl low in smoke. 6, Turn off all gas and electrical to the building. 7, Obey the instructions of the ranking FIREMAN. REMAIN CALM - IX.) NOT PANIC - 3A - - e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous ~aterials? , . .. ~'NO If YES. see B. If ~O. continue with SECTION 4. R. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous materials inventory furm markpd: ~ON-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 Multi-purpose (ABC) Dry Chemical type Fire Extinguishers located in areas so that there ~ill be no delay in case of fire. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS South~est corner of this bµilding ~ SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. XAT.~PROPANÉ: South~est corner of this building B. ELECTRICAL: East end on side of this building. r, WATER: South~est corner of this building. D, SPECIAL: None. E. LOCK BOX:~I NO rF YES, LOCATION: East end on side of this building. IF YES, SITE PLANS? YES I NO FLOOR PLANS? YES I NO MSDSs? KEYS? YES I NO YES I ~O - 38 -- - , BAKE RSF I ErJD CITY FIRE DEPARTMENT I .0. # FORM 4A-l Page of I - - NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORV BUSINESS NAME: Caretran Medical Supply Center OWNER NAME: Manuel Lee Miller FACILITY UNIT #: ADDRESS: 5768 Stine Road ADDRESS: 3808 DeEtte Ave. FACILITY UNIT NAME: CITY, ZIP: Bakersfield. CA 93'313 CITY,ZIP: Bakersfield. CA G1111 PHONE #: (805) 831-8689 PHONE #: ( 80 1) ) 834-6718 10FFICIAL USE CFIRS CODE ONLY " 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL r;ONT USE LOCATION IN THIS % BY HAZARD D.O.T 'CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE P ',. .s.~ corne~ ),000 144,000 Ft) 0.4\ 27 8.E. 100 Oxygen .~ F L C::a l-e . I I , -e . I r- r, / ...... . NAME: Manuel Lee Miller TITLE: Owner SIGNATURE: ..".. / -þ/? ,_/ ~·7rL- DATE: '7.....- V\ -~ I EMERGENCY CONTACT: Lana Miller TIT L E : \-'\ '3- Yl è'L.,5 c::.. 'C"' L PHO~#~USHOÙRS :'T s< ~.\- B'bgq '" AFTER' BUS HRS: ""ß ~4-- ~ 738 EMERGENCY CONTACT: Y'it::> 'f'l-. 'B \ a.G. "-þþ\. '<"V\. TIT L E: -The..\('a..f'~ 1::.. PHONE # BUS HOURS: "8'~1 ~ ~ go., PRINCIPAl" nUSINESS ACTIVITY: H eA tc..2- \ ~ iA ff) v .::::J::/ ~~-t.V' '\ Þ"- -\::-e..>r- AFTER BUS HRS: ~..3.;z. -.;2(pq , i ~" { - - - 4A 1