The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN :1 K - 0_ CARDIOLOGY M1IkC~L CLINIC . v ,.. ~ ~ . + CENTRAL ------------------- ------------------- SiteID: 015-021-002271 + Manager Location: 2110 TRUXTUN AVE City BAKERSFIELD AUG 2'7 - BusPhone: Map : 102 Grid: 25D (661) 323-8384 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code:8011 EPA Numb: --DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency Contact / Title TROY KIRK / ::::J~~'Î'\\~('" ~(õ.VD / Business Phone: (661) 323-8384x Business Phone: (Co~U~ -~~<6l\.x\SL\ 24 -Hour Phone : (~&.¡) ff'1-t~-£j'2-x 24 -Hour Phone : () x Pager Phone : () x Pager Phone () x +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire React ImmHlth DelHlth I +------------------------------------------------------------------------------+ Contact : TROY KIRK Phone: (661) 323-8384x MailAddr: 2110 TRUXTUN AVE State: CA City : BAKERSFIELD Zip : 93301 +------------------------------------------------------------------------------+ Owner ~-\'s~ ~\r..A...~\( \. ,M. ~ ~ Phone: ~\\., ~~ 2ð~ x Address : 2110 TRUXTUN AVE State: CA City : BAKERSFIELD Zip : 93301 +------------------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: Gal Certif'd: RSs: No ParcelNo: +------------------------------------------------------------------------------+ Emergency Directives: , \ \ '1 ~ +=======================================================~~================+ -1- 07/30/2003 . .'~~}£ ,. ;- . , .' For matters of the heart.. CCAë' central Cardiolog~ Medical Clinic Linda J. Smith Director of operations 2110 Truxtun Avenue ",Bakersfield, CA 93301-3703 661/323-8384 661J283-8528 (fax) 1_800-HEART 24 website: www.heart24.cotn ...\. --. \.. + ~ENTRAL CARDIOLOGY M~CAL CLINIC =============~=== SiteID: 015-021-002271 + += Hazmat Inventory ========================================= By Facility Unit + +== MCP+DailyMax Order ============================== Fixed Containers at Site + +--------------------------------+-------+-----------+-----+----------+----+---+ I Hazmat Common Name... SpecHazlEPA Hazards Frm DailyMax UnitMCP +--------------------------------+-------+-----------+-----+----------+----+---+ OXYGEN F IH DH G 200.00 FT3 Low jl:!!.':"TB FHŒR . R !:i +==============================================================================+ -2- 07/30/2003 : . . + CENTRAL CARDIOLOGY MEDICAL CLINIC =================== SiteID: 015-021-002271 + += Inventory Item 0001 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICA;(2N E ==============================+================+ WASTE FI%9R/~ I I Days On Site I SPENT PH T G C FixE ' 365 Locatio wit in th~s acility Unit Map: Grid: +----------------+ INSIDE DARKROOM " ., I CAS# I +===========dÓLJ2===~~f{~Jf1?=====¿~===~~~==============+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Liquid I Waste I Ambient I Ambient I PLASTIC CONTAINER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 5.00 GAL 5.00 GAL 5.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt . I IRS I CAS# I Silver No 7440224 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ I TSecretI RSBioHaz Radioactive/Amo~nt I EPA Hazards I NFPA I USDOT# I M~P I No No No No/ Curles R / / / Mln +=======+===+======+====================+=============+=========+========+=====+ +==================+=========+====== WASTE DATA ===========+===================+ I TreatedN~n Site I CA Code I US Code I GAL Generated/Mo. I GAL Generated/Yr. I +----------~-------+---------++--------+-------------------+-------------------+ I Treatment UnitID: I Unit Type: I +-----------------------------+------------------------------------------------+ Agency-Defined Text Label ,Nfl ,-Q,vµl! IN ~..f~ +==============================================================================+ -4- 07/30/2003 + ~ENTRAL CARDIOLOGY M~CAL CLINIC =============~=== SiteID: 015-021-002271 +================================================================= Fast Format ~ ::=N~~;~~~E~~~~~~~~~{~~d:~::=::::::::::::::::::::::::::::::::::::=~~:::::=~:::=: I q/f ' I +==============================================================================+ +=== Employee Notif./Evacuation L====£=¥..-4ç,~~=U~~LA!=~L~====!!'.Æ[,t[£==L!y==g.f£-f~=¿f=~~=======J +==== Public Notif./Evacuation ================================================+ l=======================~lS===================================================1 + + ===============================================+ +----- ----- I Emergency Medical Plan =================================================+ I v () rÌJ +==============================================================================+ -5- 07/30/2003 + éENTRAL CARDIOLOGY M~CAL CLINIC =============~=== SiteID: 015-021-002271 +================================================================= Fast Format += Mitigation/Prevent/Abatemt =================================== Overall Site + +== Release Prevention ========================================================+ I I + + +==============================================================================+ +=== Release Containment ======================================================+ I ~ I'1l A ¿ L C ,,/It fA """ ~ I!; I +============-=================================================================+ +==== Clean Up l~~~~~~~~~~~~!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~l Other Resource Activation ================================================================+ +===== I ==============================================+ I +==============================================================================+ -6- 07/30/2003 , i + éENTRAL CARDIOLOGY M~CAL CLINIC =============~=== SiteID: 015-021-002271 + +================================================================= Fast Format + += Site Emergency Factors ======================================= Overall Site + +== Special Hazards ===========================================================+ I I +==============================================================================+ +--- Utility Shut-Offs --------------------------------------------------------+ ,--- ri l6~tl(¡t.. m ,:JOl! -ïv;~-'t:_¡~ø-;;--ij·if;;¡¡)-;~,,~-^'~i;~-rõ--J-¡=&$------------I tr f.}~ 1/ ¡:} t. tll! t t} t II t;r,() ~l;~ T" J I iJl! fJl ßtt. ¡¿¿)¡¡..\9&' +==============================================================================+ +==== Fire Protec./Avail. Water ===============================================+ I oS CJu íll EAr r (! d/;A1/~A o{l ße(', ¿./) , Nt; I +=========================~====================================================+ Building Occupancy Level +----- ----- I ===============================================+ I +==============================================================================+ -7- 07/30/2003 ~ ~ø +4 ~~NT~L CARDIOLOGY M~CAL CLINIC =============~=== SiteID: 015-021-002271 +==7============================================================== Fast Format += Training ===================================================== Overall Site + +== Employee Training =========================================================+ l===~~~~~~~~~~========t?=~~t,{=~=~=~~=~~fj~~~~~~~"=~=t~~¿~~~~~~~~~~~~~~~~l Page 2 + + +--- --- I ===================================================================+ I +==============================================================================+ +==== Held for Future Use =====================================================+ I I +==============================================================================+ +===== Held for Future Use ====================================================+ I I +==============================================================================+ -8- 07/30/2003 . . CITY OF BAKERSFlEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENT At SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd ["Ioor, Bakersfield, CA 93301 ~ 1.\)\ß O'\ì\ ~ FACILlTYNAMEC~'.Wl ~J,;I'\I ADDRESS2.JI/) ~"~.., ~r- FACILITY CONTACT R. /' /' 1<. INSPECTION TIME INSPECTION DATE 10 - 22. - 0'3 PHONE NO. 12).. <¡ 3 ~~ BUSINESS ID NO. 15-2) 0- 00 2 ~ 71 NUMBER OF EMPLOYEES :Jt Section I: Business Plan and Inventory Program 'ŒI Routine o Combined o Joint Agency CJ Multi-Agency o Complaint ORe-inspection OPERA nON C v COMMENTS Appropriate permit on hand 1.1 Business plan contact information accurate II I ,¡ Visible address Correct occupancy V Verification of inventory materials V Verification of quantities v Veri fication of location V" Proper segregation of material v ~ .,.. .. /' ~~ Verification of MSDS availability Iv' Verification of Haz Mat training ~v ~ .....--- Verification of abatement supplies and procedures v ~ IÝ/() 0 0 I Emergency procedures adequate V 10--<, 7-ó 3 IIr()OI7 Containers properly labeled \/ 6.:sðOj Housekeeping ./ /lmD18 Fire Protection V ¡, Site Diagram Adequate & On Hand tI C=Compliance V=Violation Any hazardous waste on site?: Explain: ~es QNo White - Env. Svcs. Yellow - Station Copy Pink - Business Copy / C-., Questions regarding this inspection? Please call us at (661) 326-3979 e It. . Ð \ I~ \ 9; ~1"1 500 ( CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME CG--J~~ CA(U)fó'-CJC,ÇJ ADDRESS -Z llO -r/2.v)(;u,J AJ FACILITY CONTACT -ql.ÞV t<le.t<.. INSPECTION TIME INSPECTION DATE 1 ,) '$6/61 PHONE NO. 3'2..3 - g3 'B'4 BUSINESS ID NO. 15-210- Nt:-cJ NUMBER OF EMPLOYEES LØ /() 22JD / fOIl Section I: Business Plan and Inventory Program o Routine ~ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand fJ't:w ¡AJSp Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials Oß 1""A-r~ w.J ( AJSf> Verification of quantities 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 Site Diagram Adequate & On Hand White· Env, Svcs. Yellow· Station Copy Pink - Business Copy Inspector: W/AJé~ \. C=Compliance V=Violation Any hazardous waste on site?: ~s 0 No Explain: ~~ ñ~-L. Questions regarding this inspection? Please call us at (661) 326-3979 ~. /I.'V ¡ cO \ ¡ (l 1\(1 ( c¿) , CfJ/V VI CITY OF BAKERSFIEI.lD FIRE DE; ARTMENT 1,yV\ r1 OFFICE OF ENVIRONMENTAL SERVICES ~r UNIFIED PROGRAM INSPECTION CHECKLIST 5t.J 0 / 1715 Chester Ave., 3rd floor, Bakersfield, CA 93301 '- Ie.., . 1 , INSPECTION DATE ) I) 'S 6/6 f PHONE NO. '3'2. 3- g3 "B'4 . BUSINESS ID NO. 15-21 0- N'C~ NUMBER OF ~LOYEES L.tÐ 102,(?D T Business Plan and Inventory Program ., .}:O// . FACILITY NAME CJ::,,-J-rfl.C>c, CAlli) fd\GJdJ ADDRÉSS' "'Z t 16 -ra..u)( "ru,j AJ F AOÙ.JTY CONTACT -1/lPV ,<, u.. INSPECTION TIME Section 1: o Routine ¡p-combined o Joint Agency o Multi-Agency o Complaint ORe-inspection /. OPERA nON C v COMMENTS Appropriate peon it on hand /'J'a....} , NSt> Business plan contact infoonation accurate Visible address Correct occupancy Veritication of inventory materials Oß~~ ,..,.J fAJSP Veritication of quantities Veritication of location Proper segregation of material , Verification of MSDS availability Veritication of Haz Mat training Veri fication of abatement supplies and procedures " Emergency procedures adequate Containers properly labeled Housekeeping " I " Fire Protection Site Diagram Adequate & On Hand C=Compliance V":'Violation .l" Any hazardous waste on site?: Ø'Ýes O"No·"'" Exp!ain: l...VA-s r" F, )C.C-t..... Questions regarding this inspection? Please call us at (661) 326-3979 While· Env, Svcs. Yellow - Station Copy Pink· Business Copy Inspector: WtAJé-) \ · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE U/?ðtl FACILITY NAME G6..Jr'lA.L. ~-oI<.J't..C6.y Section 4: Hazardous Waste Generator Program EPAID# CAL ~2(943g o Routine ~ Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste detennination has been made 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 / (? U::../J..c;Ë flWPz::..~l..~ ~\Ç~ 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 Detennines if waste is restricted from land disposal C=Compliance V=VioJation Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs. W t,JE:S ¡j 1.Æ Bu~s Site Responsible Party Pink - Business Copy . CITY OF BAKERSFIF8 ~ICE OF ENVIRONMENTAL~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION DNEW 200 DADO D REVISE . ---".. '._~ '---'--..- ._-_.~._._-- I. FACILITY INFORMATION ACILlTY NAMÉÕrDãA=1)oiñg··Bu·sinãšš·ÃS)~-·~·· .-'-."' -,., '.'-. ..-.-., ... ~, ~_ot.~_,_____ CHEMICAL LOCA TJON-. - ¡ t.ft, If)e ì)~ ~ -rrL~[I~!i MAP#(Op~n~~ ._" '..----_.-.." H___'_______._n. . r-·-~·---·--- __~._.__u____._ 201~ CHEMICAL LOCATION : CONFIDENTIAL (EPCRA) ----- ------203~RiïY # (ôj;tionaÏ)-- ----._.._--~-----_._-_.- , " (one form per material per building or area) Page of DYes 0 No 202 204 " "II. CHI;MICAL I~FORMA TION " :,;:\"''¡,;' ,"', _. ;'~, F¡~;~:,: II . ! ',}.:..\~~~ ,~~>l-,> _<~-:r;!;; ; ,."~~,;,, , . < ..,J' ~, " , , , TRADE SECRET 0 Yes 0 No 206 If Subject to EPCRA. refer 10 instructions ,", -,----- ..,----,,-------,--,---,,- 205 I I i --. - -- ~..__. -----------------ži)f-r- I EHS' 0 Yes 0 No 208 -h--~~+:[f E~S ~~~.~ ~ ~~';¡;I:;'~~~~' ~ i 1 ",~~;f:::!:~: ¡~ '> ( ~,~:;.j¿~\;~::;~,:~;~~-':j/·-,r,)' FIRE CODE HAZARD CLASSES (Complete if requested by local firecitTëf) --- -- ---- --- - ----- n__ -- - -- --. - --------------- CHEMICAL NAME ç:( ?<:C..e.... ~ rt:- -~--~--- ,_._._-.~---_._---_._- COMMON NAME ---.---- ----- - --- - - - - ---- - -- -- --- --- - CAS # TYPE -----~-_._--_..__.._-...-.--~----_._----~~_._-- o P PURE o m MIXTURE D w WAST'E. L, , R;,OIOACTIVE Dyes oNo PHYSICAL STATE -- --¡..- --------._------_._-~--- I o s SOLID 0 ¡LIQUID 0 g GAS 214 ! LARGEST CONTAINER .s- ____________,___._u_________________,__,l__ _______ _________,___ _________,_,,______ -------_.-~~ FED HAZARD CATEGORIES (Cneck alllnat apply) ANNUAL WASTE AMOUNT 01 FIRE o 2 REACTIVE o 3 PRESSiJRE RELEASE 04 ACUTE HEALTH o 5 CHRONIC HEALTH 220 -.------- -- -_.~----------_.- - .-.-. -----...--- ._-~._~- .---.----.------.. , , ~ 217 ,\/IAXIMUM ~:¡18 i AVERAGE :;) ! DAILY AMOUNT ~ ¡ DAILY AMOUNT ___ ...l_____ _________.. _._.__ .._L___. ____.___.._____.._..__._..,.______._____._._. UNITS' ,~ GAL 0 c:t CU FT 0 Ib LBS 0 In TONS , . If EHS, amount musl be in Ibs, ç ---------- ---- 223 STORAGE CONTAINER (Check all that apply) ~PLASTrClNONMETALUC DRUM Of CAN D g CARBOY o h SILO o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON o i FIBER DRUM OJ BAG o k BOX o I CYLINDER o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM --.-.--.--..------. ----~_._.--- ..---- -' ..- ._~~--_._._--_._-~-- STORAGE PRESSURE ¢..a AMBIENT o ba BELOW AMBIENT o aa ABOVE AMBIENT 210 212 CURIES 213 215 216 219 STATE WASTE CODE 221 DAYS ON SITE 222 o q RAIL CAR o r OTHER 224 -.-------.....---.-..---------. --.--.--.-..- ...----.------ 225 o c CRYOGENIC STORAGE TEMPERATURE o aa ABOVE AMBIENT o ba BELOW AMBIENT HAZAj:mOustô~þ9~E:Nt .'..'. ~. v.. '," . .,' :;;; , 227 ¡DYes 0 No 228 I ------¡-._----'--------' 231 i 0 Yes 0 No 232 226 --_..._---_.-.~-_..._-------_._-~---. ... --.---. -. ----- --.. 2 230 -------_._-----_._._-------->~.._-.._----~- . ..-.---.-.-..---.------.--- , 235 . 0 Yes 0 No 236 3 234 4 238 -------_.__....._..~_._------_.--_._---._._--- .-.-.,. ....----. -- -.--.-------.- i 239 i 0 Yes 0 No 240 , .- ·---~--I-·-~-------- 243 ! 0 Yes 0 No 244 ! _.-----------------_._-~_.-~... ....__._~--._~~--_._._-- - --.- 5 242 ---_.._-_..._._--_._-_._----_..~..--.__.._~--....-_._-----... d.,:' _._._'-_.-.<--~ ",," . .. ,..i2'?l*'iI'i?ŠIGNA TUR~ f . J' ~ '.' ~ '>1,' ',- .. -' ';,< .~ /,~{!':;; "'1.,\. ' " , " . ,'" ---'-'-~-'ŠiGÑA,:ÜRE(-'-"---'-"--'-"--'-"~~---~~-- ' -----..----.-----. .-.-- _.------~-- .--- .- -.-._-.-_._.-. ....-.-... ---.-------.-...- .--..-------. --- 229 233 ----¡ 237 i 241 245 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4,wpd CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION D DELETE 200 (one fotm per material per building or area) Page of u:;-v~ ~?I~~_ h_~_~I}~~__h~'-(""c:... , CHEMICAL LOCATION 4l.(/leU>~<í ~ ÇtJIù~ eM..«> ' --201[ ~~~:g:~~EfJ~~~) :,Lr --rr'''-r-r!~MAP#(oPîional)---- ,,-,--------- 203-;-GRi5 #(Op¡~- " ;:fiZ , -1 Lll.! __.__".___________.'-_______,__ , ," '..,,:. ""',''-'',,,c''''->,:,: h""":,'¡ !1.~H~~~~~_~~~~~~ATiONh_____._ ..:;_,:.{j},25ir:~:;.. :,t:,~ "..".. ,',:''.'::' 205 ¡ TRADE SECRET 0 YeIS 0 No 206 ! i If Subject to EPCRA, re'er to instructions ! I .- -- --- ~UM.. .< --------- - -~-..~7-!-. I EHS' 0 YeIS 0 No 208 i , _h"___+_ ,,__,__~l~ 'U'E:~¥~~:£~~1~~;6ff~;~~'; FIRE CODE HAZARD CLASSES (Complete if requelSted by local firecíïTêi)--"h----------'---".-- -----.-------..- -----..------ DADD D REVISE ._---_.------,_.._~---_.- ..._._~.----_.._-_.. ._.- "-"--"-. --.-------,"----------.- I. FACILITY INFORMATION DYes ONo ! 202 I I 204 I i CHEMICAL NAME COMMON NAME CAS # TYPE PHYSICAL STATE FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT STORAGE CONTAINER (Check all that app'Y) STORAGE PRESSURE STORAGE TEMPERATURE .- o YG-C-J ._-~,-,--~-------- -.- ...- .------.- -.------.-.-----.--+--. -- - -.-. --. -- - -- - - ." 210 ---------~.._.__..+--------,---,---~----~-_. PURE o m MIXTURE CURIES 213 o w WAS,: DYes ONo R;,DIOACTIVE ,212 <, , ~---_·_---~t- ------...-.~-.----~.-------- .-.-- OS SOLID 01 LIQUID ~.GAS 214 ; LARGEST CONTAINER 2.4- __..____,_._._________.u_________..L._.._______ _________,___..'_,___________ 215 01 FIRE ~PRESsÛRE RELEASE 216 o 2 REACTIVE o 4 ACUTE HEALTH o 5 CHRONIC HEALTH "--.---.---------------."- ,,-- ~--_._. ...--"--.--"' _.~--~-_._+-_._-~-_._-+- 218 I AVERAGE 219 I ___L~~!::~~~~_~~___ ___________..___ I o ib LBS 0 tn TONS 221 I --------------___,_-=-1 STATE WASTE CODE 217 , MAXIMUM __ \ ! DAILY AMOUNT -z..ðU ___,___1..________....___ UNITS' 0 ga GAL ~ CU FT . If EHS, amount must be ,n ibs. 2201 DAYS ON SITE 222 o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM De PLASTIClNONMETALLlC DRUM Of CAN o g CARBOY o h SILO o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN Op TANK WAGON o q RAIL CAR o r OTHER o í FIBER DRUM OJ BAG o k BOX ~LlNDER 223 -."--.--....... --. --_.- -.-._----~-..,.----,----------- o a AMBIENT )9--aa ABOVE AMBIENT 224 o ba BELOW AMBIENT -.-.-.--..----.--------------.-- --- -..-. ---. ---- -. -~---- .- . ~-_. .,._----_..~--- ~ a AMBIENT o c CRYOGENIC 225 o aa ABOVE AMBIENT o ba BELOW AMBIENT 226 2 230 3 234 4 238 5 242 ;~7!:HAZÁ'RDòuscdMPÔNENT' ,':.?,C "'.','(. ,.¡.,:,'," . ";'~-:--":--~~'-"'-~--"':""""- I ____.._ _____ ---~~~L~- Y~__~~N~_~~8 229 -.-------. .._-_._..._._.~---,-~~_._-~-. ~-. 231 I 0 Yes 0 No 232 -----..-...,----------...-.. --"""-"-""'-..'"'' "'----,---'..-- '--'----r--------------,....- - . I 235 ; 0 Yes 0 No 236 i =~.--- ~-~=:=_~~_--_--~·~_:~~~i~-:~~~_J ;-' """ . .~ . ,," '.' :¡' '. "::;(III,SIGNATÚRE ", ~;;".."'" ",-,,/,.,>~~ \-:- ',-.;'.;. ·F·,;~<. '-<~j ;>',")r: .:!:: -,,' '>' >';;.¡-,';:;:>;~-.} ''',;-' 233 237 241 245 UPCF (7/99) . . " ~." -. , , '. .' '" . --SÎGNAfURe"'··-----'--'--'------------------·.. __.____.___._...__.._.________. ____._._. ___ _. _ .~...__~~__.._ ·_._..._________~·~'__·n_ _ ,~<".______,,____ __ . . S:\CUPAFORMS\OES2731.TV4.wpd ,~