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HomeMy WebLinkAboutBUSINESS PLAN 2/7/2001 ... .. ---,~~ ~~. ('II ttW -il I : \ I I -11 j , . I , I' "A..... LOT.,. PA..... LOr ..- i, I 11 ~! J ~ ¡¡; : I' IU .:; .., It! ,.&..~ LOT ~ I" ,~ II II i :; 1 -- I I ¡... ! ~..,¡ '..., , ' c I .., I I.... I ,...... ,"01' ow- .~ o I:' 11 .,! .,: . ¡ .... I i . I I I ~...- !II 01 I LOTT' PI . , ¡ij ¡ . Ç"H ,9'?) 1:1 :_:----! " TAUXTUN ')--- ---' ~ \.. -- , ~ MERCY HOSPITAL _ SITE .,(:< /~ /,l(ÙJX7'v'u .4(,/&. S ,te /. o· '# roZE> .~~~~~~. ~~~ ~,~~. ." (V I +Iv./. ?I~-'- bf M (V/BW Ç"Yt) rv < -'ó 'VJ ~ ðI /::1 ? "J. J..l:I (VI n U .....Il1O ,i ~ n '. fft'.. '1' . ",,~ Ai , '''- / r-:=- ~o :¡ :r 'i'. ~; ..~¡ I ,.,1 'fl1Jl~ .C::Þ f '" , ' I ~, -\ ~I \ :_..n . . . 1 __J ~,-, ,__ AVENUE \...._- '" , --. -Ef. PL}N B ¡JILl>! rJ6- /3{ JLI R.'IUfl:~· /:e.~ ¥ BUILD/~G- 0) SPR..lrV1<.L~¡¿S F / R. 5 T F Lo 0 I<.. ¿ Pit Æ. r <:) t= ¿;J. /'Jß '* B VI L»rt0(;-, C)b.-! NO SfJR.Jf\J~Le.~ *- !h ~I - NO SPR.fN¡¿ LeI!.. 5 * BUT L þ)vV 6=- S 10) / I)_ 7 I /:2 N ò 5 f I<. J IV ¡< L e í!!...s * Re ff\ A IrU' f\J6- B V{ LPJN65 f-/ II-l/ e 5 P ¡¿IN K L e~S !t. 6' tJ oQl " . -.. 'I t. \......; .". Ne",ro· Intensive Cpre l!nit I Pastoral C~re ~ =---i i Social Se~vÍ<e- -4 i '!l!""7ì ' -, lï':~ t:4X ; '~~I ,- 4t~ MAJ~ 401-A15 Chaplain Surgical/ Waiting - 2>UILDING SS \-. WILDING 27 -EGBRT ,t\' ~~fkG0R---·· . -___.___~_, e.". "-' , T~EA TMENT AND DIAGNOSTIC' BUILDING .... I '.. .. 1/ .·r; ' '. . ", --.0: ___'" .'·,_e·· ___._ .,' ': ..... ....-.. wt-t· l"1¡ 'fll¡ :', """"" '~i ~ -c, j¿ '., ,- ,'í'!! ;' f¡ f: -:' p ,,~L ~I: ' . "I':;' , " : [,.~ i F? il. [ : ',' I;' .f: ~~ '~: í.~' .": rr f.Ù·· : I ~;? j I . ¡ ..' ; i :1 . ; ; , i ~. ¡ j 1: .If i n:, I' ¡ . ¡, ~. { L¡ i V:i¡ H' f'/\" ~ l~;~·l ~ ,..~. ,j. p, 4.;,'.'( 1 ~:-. .~(. ~' ~\':",1 1:': I' ......, . 1 II' . J-. e e Catholic Healthcare West +CHW CHW Central California 2215 Truxtun Avenue Bakersfield, CA 93301 661 632-5000 Ralph Huey, Director Bakersfield Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 A TTN: Esther Duran, Accounting Clerk II Enclosed please find copies of the site and facility diagrams for Mercy Hospital and Mercy Southwest Hospital. The diagrams have been labeled to show the location of utility shutoff points for gas, electric, and water. They also have indications listed for automatic sprinkler systems. The location of hazardous materials is now listed, as well as being specified in the business plan. Fire department personnel have been given a tour of these locations during previous site visits and again during annual inspections at each facility. Please let me know if there are any questions or further information needed. I can be reached at (661) 632-5572. Sincerely, Kitty Ringer, Safety and Security Coordinator for CHW Southern California Division, Kern Natural Market '~~ Bakersfield Memorial Hospital Memorial Center Mercy Hospital Mercy Southwest Hospital Mercy Wests ide Hospital .... ,'. .,. e e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ROLLING POWER OUTAGE Mercy Hospital Name of Business 2215 Truxtun Ave Address ~~c~ P'f./J 0 ;_ 1¡'~ð ~4I~~I)" . <00/ .,1 <' ~~WC~8 SURVEY _ ____ _ __ -1,---- DOGs_yoU¡; facility_have~k up_lt~wer ~ypJY?__-----=-~- _ ~,__ ~_ _ _ Yes'&l No a . - - - I 2. If yes, does back up generator supply power to all critical systems, valves, vents, alarms, monitor, phones? Yes ø No a Other,explain 3. Could electrical power loss cause a fire, explosion, or unplanned release of a chemical? Yes a NoR 4. Would electric power, or telecommunication loss prevent the business from contacting emergency responders? Yes a No'~ 5. Has your business prepared a contingency plan in the event of a rolling power outage? Yese NoO 6. What percentage of your business is electrical dependant? a less than 5% 0 5% to 10% a 26% to 50% ø51%t075% o over 75% 0100% ;;"-!-õ( Date Please complete and return this survey no later than February 12, 2001, to the following address or fax number. Bakersfield City Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 Bakersfield, Ca 93301 Fax: 661-326-0576 / "1Þ /,,"'- " - ./' ~ ' e e MERCY HOSPITAL SiteID: 015-021-000628 Manager : Location: 2215 TRUXTUN AVE City BAKERSFIELD BusPhone: Map : 102 Grid: 25D (661) 327-3371 CommHaz : Moderate FacUnits: 34 AOV: CommCode: BAKERSFIELD STATION 01 EPA Numb: CAD981400237 SIC Code:8062 DunnBrad:95-166-0858 Emergency Contact KITTY RINGER Business Phone: 24-Hour Phone Pager Phone / Title / SAFETY COORD (661) 632-5572x (661) 632-5000x (661) 632-3287x Emergency Contact / Titl;l I:'A'P JACOBS / MNJAOE!R )FA.~U..\\ Business Phone: (661) GG) 6'OQx~~ 24-Hour Phone : (661) 632-5000x Pager Phone : (661) lx ~« ~ Hazmat Hazards: RSs Fire Press React ImmHlth DelHlth Period Preparer: Certif'd: to Phone: (661) 327-3371x RECEjV!EPte: CA Zlp : 93301 ,.. s LJ one: (415) 397-1823x ENVIRf\I\I ~FR]q~S ~ CA 94111 TotalASTs: = Gal TotalUSTs: = Gal RSs: Yes Contact : MailAddr: 2215 TRUXTUN AVE City BAKERSFIELD Owner Address City CATHOLIC HEALTHCARE WEST 1700 MONTGOMERY ST 300 SAN FRANCISCO Emergency Directives: THIS SITE CONTAINS UNDERGROUND STORAGE TANKS AND IS A WASTE TREATMENT SITE! JOINT INSPECTIONS WITH STEVE UNDERWOOD, HOWARD WINES AND THE ENGINE COMPANY ARE REQUIRED. PLEASE CALL THIS OFFICE AT LEAST 5 DAYS PRIOR TO SCHEDULING THIS INSPECTION. f= Hazmat Inventory One Unified List ì p== As Designated Order All Materials at Site 1 Hazmat Common Name. . . SpecHaz EPA Hazards DailyMax MCP OXYGEN F P IH G 3600.00 FT3 Low DICHLOROD F P IH G 635.00 FT3 Min XENON, X F P IH G 250.00 FT3 Min OXYGEN o her~by certi~ttj.t ~ ~s G 46.00 FT3 Low OXYGEN G 46.00 FT3 Low SUN GLOH azardous matsri~s pnan~- L 48.00 GAL UnR OXYGEN G 46.00 FT3 Low OXYGEN ' ~$ IH G 23.00 FT3 Low OXYGEN and that ng '.Mth G 92.00 FT3 Low OXYGEN F P IH G 23.00 FT3 Low ALCOHOL, Iste and correct man-DH L 10.00 GAL Mod 12/12/2000 ~ t- e e ..' F MERCY HOSPITAL p= Hazmat Inventory p== As Designated Order SiteID: 015-021-000628 ì One Unified List ì All Materials at Site ì Hazmat Common Name... speCHaz EPA Hazards I Frm I DailyMax Unit MCP' COMPRESSED GAS CYLINDERS F P IH G 209.00 FT3 Ext NITROUS OXIDE F P IH G 700.00 LBS Hi ALCOHOL, ISOPROPYL DH L 1. 00 GAL Mod NITROGEN P R IH G 6312.00 FT3 Min DIESEL TANKS F IH DH L 8000.00 GAL Low TRICHLOROMONOFLUOROMETHANE F P IH G 274.00 FT3 Min C02/02/N2 F P IH G 209.00 FT3 Low OXYGEN COMPRESSED F P IH G FT3 Low HELIUM F P IH DH G 22407.00 FT3 Min KATHON LM F IH L 30.00 GAL Mod FREON 22 F P IH G 670.00 FT3 Low FORMALIN SOLUTION F IH DH L 20.00 GAL Hi CO2 F P IH G 437.00 FT3 Min WASTE FIXER R L 10.00 GAL Min WASTE OIL F DH L 55.00 GAL Low CHLORODIFLOUROMETHANE F P IH G 1116.00 FT3 Low ALCOHOL DH L 32.00 GAL Mod C02/H2/N2 F P IH G 209.00 FT3 Ext PHOTOGRAPHIC DEVELOPERS R IH L 180.00 GAL Mod PAINT THINNER F L 5.00 GAL Hi NITROGEN 304 F P IH G 6080.00 FT3 Min ALCOHOL DH L 48.00 GAL Mod C02/N2 F P IH G 209.00 FT3 Min PHOTOGRAPHIC FIXERS R IH L 239.00 GAL Mod OXYGEN 281 F P IH G 5620.00 FT3 Low ACETYLENE 130 F P IH G 1300.00 FT3 Hi HELIUM NON-FLAMMABLE P IH G 1250.00 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500.00 LBS Min HYDROGEN/CARBON DIOXIDE/NITROGE F P IH G 100.00 FT3 Ext ALCOHOL IH L 10.00 GAL Mod OXYGEN COMPRESSED 250 CF F P IH G 2500.00 FT3 Low CARBON DIOXIDE USP, OXYGEN USP F P IH G 160.00 GAL Low COMPRESSED GAS NON-FLAMMABLE 25 P IH G 1500.00 FT3 UnR COMPRESSED AIR 250CF F P IH G 2000.00 FT3 Min NITROUS OXIDE F P IH G 200.00 FT3 Hi It/( 6-ðA) H-CYL ÙJ PI 57£ }v\. ~C!.. u q Xy L E.N~ -2- 12/12/2000 '9 L e e 'S F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 015-021-000628 ì Facility Unit: EXTERIOR CAMPUS ì Days On Site 365 Location within this Facility Unit A STREET Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Below Ambient Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Container ~FT3 AMOUNTS AT THIS LOCATION Daily Maximum 3600.00 FT3 Daily Average 1800.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME DICHLORODIFLOROMETHANE Facility Unit: MAIN BLDG 1ST FLOOR ì Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 75-71-8 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container Daily Maximum Daily Average ~~ 0.~ . FT3 635.00 FT3 317.00 FT3 \.'\ HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Dichlorodifluoromethane No 75718 AMOUNTS AT THIS LOCATION TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -3- 12/12/2000 .... '",--. í e e ~. F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME XENON, XE 133 GAS SiteID: 015-021-000628 ì Facility Unit: MAIN BLDG 2ND FLOOR ì Days On Site 365 Location within this Facility Unit HOT LAB NUCLEAR MEDICINE Map: Grid: CAS # 7440633 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE GLASS CONTAINER Largest Container ~ FT3 AMOUNTS AT THIS LOCATION Daily Maximum 250.00 FT3 Daily Average 125.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Xenon RS No CAS # 7440633 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: MAIN BLDG 3RD FLOOR ì Days On Site 365 Location within this Facility Unit MED STORAGE ROOM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container E.. FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 7782447 100.00 Oxygen, Compressed TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -4- 12/12/2000 {~ ¡: e e ""' SiteID: 015-021-000628 ì Facility Unit: MAIN BLDG 5TH FLOOR ì f MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit SUPPLY CLOSET Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container ~ FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 7782447 100.00 Oxygen, Compressed TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low .. HAZARD ASSESSMENTS p= Inventory Item 0001 F= COMMON NAME / CHEMICAL NAME SUN GLOH Facility Unit: WEST TOWER 1ST FLOOR ì Days On Site 365 Location within this Facility Unit DIETARY CLEANING SUPPLY Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container S .<:::x::J GAL AMOUNTS AT THIS LOCATION Daily Maximum 48.00 GAL Daily Average 24.00 GAL %Wt. I HAZARDOUS COMPONENTS I~I CAS # TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARD ASSESSMENTS -5- 12/12/2000 A, " e e ~~ SiteID: 015-021-000628 1 Facility Unit: WEST TOWER 2ND FLOOR 1 F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME OXYGEN Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Oxygen, Compressed RS No CAS # 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0001 F== COMMON NAME / CHEMI CAL NAME OXYGEN Facility Unit: WEST TOWER 3RD FLOOR 1 Days On Site 365 Location within this Facility Unit SUPPLY RM BY NURSING STA Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container £ T3 AMOUNTS AT THIS LOCATION Daily Maximum 23.00 FT3 Daily Average 12.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Oxygen, Compressed RS No CAS # 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -6- 12/12/2000 ;: e - :~ 0001 CHEMICAL NAME SiteID: 015-021-000628 ì Facility Unit: WEST TOWER 4TH FLOOR ì F MERCY HOSPITAL f= Inventory Item = COMMON NAME / OXYGEN Days On Site 365 Location within this Facility Unit EQUIPMENT RM W HALLWAY Map: Grid: CAS # 7782-44-7 Container . FT3 AMOUNTS AT THIS LOCATION Daily Maximum 92.00 FT3 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient Daily Average 41.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Oxygen, Compressed RS No CAS # 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS f= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME OXYGEN Facility Unit: WEST TOWER 5TH FLOOR ì Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM Map: Grid: CAS# 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container ~ AMOUNTS AT THIS LOCATION Daily Maximum 23.00 FT3 Daily Average 12.00 FT3 COMPONENTS %Wt. 100.00 Oxygen, Compressed RS No CAS # 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -7- 12/12/2000 .- e e , SiteID: 015-021-000628 ì Facility Unit: PATHOLOGY LAB/RADIOLOGY ì F MERCY HOSPITAL p= Inventory Item 0001 ¡:::::= COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Days On Site 365 Location within this Facility Unit S WALL STORAGE CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container \.~ GAL HAZARDOUS COMPONENTS AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %Wt. RS CAS # 99.00 Isopropyl Alcohol No 67630 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME COMPRESSED GAS CYLINDERS Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ì Days On Site 365 Location within this Facility Unit LAB CENTER RM MICRO RM Map: Grid: CAS # - TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 209.00 FT3 Daily Average 104.00 FT3 HAZARDOUS COMPONENTS %Wt. 72.00 HYdrogen 10.30 Carbon Dioxide 17.70 Nitrogen RS Yes No No CAS # 1333740 124389 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext HAZARD ASSESSMENTS -8- 12/12/2000 -' e e 0001 CHEMICAL NAME SiteID: 015-021-000628 ì .Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ì f MERCY HOSPITAL p= Inventory Item = COMMON NAME / NITROUS OXIDE Days On Site 365 Location within this Facility Unit STORAGE RM Map: Grid: CAS # 10024-97-2 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Container . LBS AMOUNTS AT THIS LOCATION Daily Maximum 700.00 LBS Daily Average 350.00 LBS HAZARDOUS COMPONENTS %Wt. 100.00 Nitrous Oxide RS No CAS # 10024972 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Facility Unit: CARDIAC REHAB CENTER ì Days On Site 365 Location within this Facility Unit NWALL COUNTE~ & CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container ,~ GAL AMOUNTS AT THIS LOCATION Daily Maximum 1. 00 GAL Daily Average 0.50 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS -9- 12/12/2000 .... e e .' SiteID: 015-021-000628 1 Facility Unit: MRI 1 F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME NITROGEN Days On Site 365 Location within this Facility Unit (~~~a~ ~ ~rid: MRI UNIT TRUXTUN & A ST ,,~~~~"'~~ CAS # 7782-37-9 CONTAINER TYPE roR~~S. CYLI-NDB:R: [GSaTsATEI TYPE ~ PRESSUR~ ::-T TEM~ERATURE I = __pure ~ove Amble~ Amblent ~ AMOUNTS AT THIS LOCATION Daily Maximum ..eE::æ. 00 ,_ COMPONENTS Daily Average .00 FT3 ~ No CAS # I 7727379 I %Wt. I ' 100.00 Nitrogen TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ ' Curies P R IH / / / Min HAZARD ASSESSMENTS f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME DIESEL TANKS Facility Unit: EXTERIOR CAMPUS 1 Days On Site 365 Location within this Facility Unit SOUTH OF BOILER ROOM Map: Grid: CAS # 68476-34-6 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 8000.00 GAL Daily Average 4000.00 GAL HAZARDOUS COMPONENTS %Wt. RS No CAS # 68476302 100.00 Diesel Fuel No.2 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -10- 12/12/2000 ~ e e F MERCY HOSPITAL f= Inventory Item 0002 F= COMMON NAME / CHEMI CAL NAME TRICHLOROMONOFLUOROMETHANE SiteID: 015-021-000628 ì Facility Unit: MAIN BLDG 1ST FLOOR ì Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 75-69-4 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container ?:J:J ~ FT3 AMOUNTS AT THIS LOCATION Daily Maximum 274.00 FT3 Daily Average 137.00 FT3 %Wt. RS CAS # 100.00 Trichlorotrifluoroethane No 76131 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME C02/02/N2 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ì Days On Site 365 Location within this Facility Unit LAB MICRO Map: Grid: CAS # STATE - TYPE Gas Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 209.00 FT3 Daily Average 104.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No No No CAS # 5.00 Carbon Dioxide 20.00 Oxygen, Compressed 75.00 Nitrogen 124389 7782447 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -11- 12/12/2000 " e e SiteID: 015-021-000628 ì Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ì F MERCY HOSPITAL f= Inventory Item 0002 = COMMON NAME / CHEMI CAL OXYGEN COMPRESSED NAME Days On Site 365 Location within this Facility Unit THRU OUT SURGERY AREA Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER £ AMOUNTS AT THIS LOCATION Daily Maximum Daily Average FT3 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 7782447 100.00 Oxygen, Compressed TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS f= Inventory Item 0002 F== COMMON NAME / CHEMI CAL NAME HELIUM Facility Unit: MRI ì Days On Site 365 Location within this Facility Unit I~ .~ _~ap: Grid: MRI UNIT TRUXTUN & A ST }\;:..~~~\...~ ~~ CAS # 7440-59-7 [ STATE - TYPE PRESSURE - TEMPERATURE ,Gas ~pure ~elow Ambie~ Below Ambien~ AMOUNTS AT THIS LOCATION Daily Maximum CONTAINER TYPE PO~~CYLnmER OUS COMPONENTS %Wt. 100.00 Helium RS No CAS # 7440597 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH DH / / / Min HAZARD ASSESSMENTS -12- 12/12/2000 " e e .. SiteID: 015-021-000628 1 Facility Unit: EXTERIOR CAMPUS 1 F MERCY HOSPITAL f= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME KATHON LM MICROBIOCIDE Location within this Facility Unit ~~~~~~~~~~~ Days On Site 365 Map: Grid: CAS # [ ~TA~E I ~YPE ~ P~ESSURE ~ TEM~ERATURE I =Llquld __Mlxtur~mblent ---1 Amblent ~ AMOUNTS AT THIS LOCATION Daily Maximum 30.00 GAL ~\.im.~NE~\\\ijJ Largest Container 30.00 GAL Daily Average 30.00 GAL %Wt. I HAZARDOUS COMPONENTS ~ CAS # TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mod HAZARD ASSESSMENTS f= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME FREON 22 Facility Unit: MAIN BLDG 1ST FLOOR ì Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 75-45-6 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 670.00 FT3 Daily Average 335.00 FT3 %Wt. RS CAS # 100.00 Chlorodifluoromethane No 75456 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -13- 12/12/2000 . I .. e e . SiteID: 015-021-000628 ì Facility Unit: PATHOLOGY LAB/RADIOLOGY ì F MERCY HOSPITAL p= Inventory Item 0003 = COMMON NAME / CHEMICAL FORMALIN SOLUTION NAME Days On Site 365 Location within this Facility Unit PATH LAB Map: Grid: CAS # 50-00-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container .5 ~ GAL HAZARDOUS COMPONENTS AMOUNTS AT THIS LOCATION Daily Maximum 20.00 GAL Daily Average 16.00 GAL %'Wt. RS CAS # 10.00 Formaldehyde ( EPA) Yes 50000 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0003 = COMMON NAME / CHEMI CAL NAME C02 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ì Days On Site 365 Location within this Facility Unit LAB Map: Grid: CAS # 124-38-9 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Container · FT3 AMOUNTS AT THIS LOCATION Daily Maximum 437.00 FT3 Daily Average 218.00 FT3 HAZARDOUS COMPONENTS %'Wt. 100.00 Carbon Dioxide RS No CAS # 124389 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -14- 12/12/2000 · ' e e F MERCY HOSPITAL p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME WASTE FIXER WASTE PHOTOGRAPHIC FIXER Location within this Facility Unit MRI SiteID: 015-021-000628 ì Facility Unit: MRI ì Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 20.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %wt. I Silver HAZARDOUS COMPONENTS ~ CAS # I 7440224 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS p= Inventory Item 0004 = COMMON NAME / CHEMI CAL NAME WASTE OIL Facility Unit: EXTERIOR CAMPUS ì Days On Site 365 Location within this Facility Unit Map: E~t((\~{( '(\e.'K\ \0 \\~ ~~~~ Grid: CAS # 221 STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Largest Container 55.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 55.00 GAL Daily Average 50.00 GAL %Wt. RS CAS # 100.00 Waste Oil, Petroleum Based No 0 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low HAZARD ASSESSMENTS -15- 12/12/2000 ., 1 e e SiteID: 015-021-000628 1 Facility Unit: MAIN BLDG 1ST FLOOR 1 F MERCY HOSPITAL p= Inventory Item 0004 = COMMON NAME / CHEMI CAL NAME CHLORODIFLOUROMETHANE Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 75-45-6 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1116.00 FT3 Daily Average 558.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 100.00 Chlorodifluoromethane 75456 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME ALCOHOL Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 1 Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container \~GAL HAZARDOUS COMPONENTS AMOUNTS AT THIS LOCATION Daily Maximum 32.00 GAL Daily Average 16.00 GAL %Wt. RS CAS# 99.00 Isopropyl Alcohol No 67630 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS -16- 12/12/2000 .. e e F MERCY HOSPITAL f= Inventory Item = COMMON NAME / C02/H2/N2 0004 CHEMICAL NAME SiteID: 015-021-000628 ì Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ì Days On Site 365 Location within this Facility Unit LAB-MAIN Map: Grid: CAS # - TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 209.00 FT3 Daily Average 104.00 FT3 HAZARDOUS COMPONENTS %Wt. 5.00 Carbon Dioxide 10.00 Hydrogen 80.00 Nitrogen RS No Yes No CAS # 124389 1333740 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext HAZARD ASSESSMENTS f= Inventory Item 0004 F= COMMON NAME / CHEMI CAL NAME PHOTOGRAPHIC DEVELOPERS Facility Unit: MRI ì Days On Site 365 Location within this Facility Unit X-RAY DEVELOPER MACHINES Map: Grid: CAS # 123-31-9 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 30.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 180.00 GAL Daily Average 150.00 GAL %Wt. RS CAS # 12.00 Potassium Hydroxide No 1310583 3.00 Ethylene Glycol No 107211 7.00 Hydroquinone (EPA) No 123319 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EI>A Hazards NFPA USDOT# MCP No Yes No No/ Curies R IH / / / Mod HAZARD ASSESSMENTS -17- 12/12/2000 ~ e e SiteID: 015-021-000628 l Facility Unit: PAINT/CONSTRUCTION SHOP l F MERCY HOSPITAL p= Inventory Item 0005 F= COMMON NAME / CHEMI CAL NAME PAINT THINNER Days On Site 365 Location within this Facility Unit PAINT LOCKER Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM Largest Container \ .~ GAL AMOUNTS AT THIS LOCATION Daily Maximum 5.00 GAL Daily Average 5.00 GAL %Wt. RS CAS # 10.00 n-Butyl Acetate No 123864 20.00 Toluene No 108883 10.00 n-Propanol No 71238 5.00 Xylene, Mixed No 1330207 5.00 Methanol No 67561 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0005 = COMMON NAME / CHEMICAL NAME NITROGEN 304 Facility Unit: MAIN BLDG 1ST FLOOR l Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 7727-37-9 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 6080.00 FT3 Daily Average 3040.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Nitrogen RS No CAS # 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -18- 12/12/2000 , , ~ . ' . e SiteID: 015-021-000628 1 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì F MERCY HOSPITAL p= Inventory Item 0005 F= COMMON NAME / CHEMI CAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container t.~ GAL AMOUNTS AT THIS LOCATION Daily Maximum 48.00 GAL Daily Average 24.00 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0005 F= COMMON NAME / CHEMI CAL NAME C02/N2 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ì Days On Site 365 Location within this Facility Unit LAB-MAIN Map: Grid: CAS # - TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 209.00 FT3 Daily Average 104.00 FT3 HAZARDOUS COMPONENTS %Wt. 10.00 Carbon Dioxide 90.00 Nitrogen RS No No CAS # 124389 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -19- 12/12/2000 ," e e SiteID: 015-021-000628 ì Facility Unit: MRI ì F MERCY HOSPITAL p= Inventory Item 0005 = COMMON NAME / CHEMICAL PHOTOGRAPHIC FIXERS NAME Days On Site 365 Location within this Facility Unit Map: Grid: X-RAY DEVELOPER MACHINES, CANCER CENTER, ER X-RAY, CT LAB, NUCLEAR MED, SPECIAL DK RM, SURGERY DK RM, MAMOGRAPHY CAS # 64-19-7 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 30.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 239.00 GAL Daily Average 333.00 GAL %Wt. RS CAS # 46.00 Ammonium Thiosulfate No 7783188 2.00 l,2-Butylene Oxide No 106887 5.00 Acetic Acid Solution No 64196 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0006 = COMMON NAME / CHEMICAL NAME OXYGEN 281 Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 5620.00 FT3 Daily Average 2810.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 7782447 100.00 Oxygen, Compressed TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -20- 12/12/2000 '. e e . " SiteID: 015-021-000628 1 Facility Unit: MAIN BLDG 1ST FLOOR 1 F MERCY HOSPITAL p= Inventory Item 0007 = COMMON NAME / CHEMICAL NAME ACETYLENE 130 Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 74-86-2 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container · FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1300.00 FT3 Daily Average 650.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Acetylene RS Yes CAS # 74862 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0007 = COMMON NAME / CHEMI CAL NAME HELIUM NON-FLAMMABLE Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 1 Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # 7440-59-7 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 1250.00 FT3 Daily Average 625.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Helium RS No CAS # 7440597 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min HAZARD ASSESSMENTS -21- 12/12/2000 . e e . " SiteID: 015-021-000628 ì Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì F MERCY HOSPITAL p= Inventory Item 0008 = COMMON NAME / CHEMICAL NAME NITROGEN NON-FLAMMABLE Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # 7727-37-9 STATE - TYPE &e1id&AS Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 500.00 LBS Daily Average 250.00 LBS HAZARDOUS COMPONENTS %-Wt. 100.00 Nitrogen RS No CAS # 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0009 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 1 = COMMON NAME / CHEMICAL NAME HYDROGEN/CARBON DIOXIDE/NITROGEN Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # - TYPE Mixture PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Co E. . AMOUNTS AT THIS LOCATION Daily Maximum 100.00 FT3 Daily Average '50.00 FT3 HAZARDOUS COMPONENTS %-Wt. 4.70 Hydrogen 10.30 Carbon Dioxide 84.90 Nitrogen RS Yes No No CAS # 1333740 124389 7727379 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext HAZARD ASSESSMENTS -22- 12/12/2000 · .~. - e SiteID: 015-021-000628 9 Facility Unit: MAIN BLDG 1ST FLOOR ì F MERCY HOSPITAL p= Inventory Item 0010 = COMMON NAME / CHEMI CAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit RESPIRATORY THERAPY Map: Grid: CAS# 67-63-0 STATE - TYPE Liquid. Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container \.~ GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0010 = COMMON NAME / CHEMI CAL NAME OXYGEN COMPRESSED 250 CF Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 2500.00 FT3 Daily Average 1250.00 FT3 HAZARDOUS COMPONENTS %Wt. RS No CAS # 7782447 100.00 Oxygen, Compressed TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -23- 12/12/2000 · e e -, , . \. SiteID: ,015-021-000628 9 Facility Unit: MAIN BLDG 1ST FLOOR 9 F MERCY HOSPITAL p= Inventory Item 0011 F= COMMON NAME / CHEMI CAL NAME CARBON DIOXIDE USP, OXYGEN USP Days On Site 365 Location within this Facility Unit RESPIRATORY THERAPY Map: Grid: CAS # 124-35-9 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER AMOUNTS AT THIS LOCATION Daily Maximum 160.00 GAL Daily Average 80.00 GAL HAZARDOUS COMPONENTS 5.00 Carbon Dioxide 95.00 Oxygen, Compressed RS No No CAS # %Wt. 124389 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0011 = COMMON NAME / CHEMICAL NAME COMPRESSED GAS NON-FLAMMABLE 250CF Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 9 Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # o STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 1500.00 FT3 Daily Average 750.00 FT3 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / UnR HAZARD ASSESSMENTS CAS # HAZARDOUS COMPONENTS -24- 12/12/2000 ;;;1' e e , -, ~, 1 F MERCY HOSPITAL p= Inventory Item 0012 = COMMON NAME / CHEMICAL NAME COMPRESSED AIR 250CF SiteID: 015-021~000628 1 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # o - TYPE Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 2000.00 FT3 Daily Average 1000.00 FT3 HAZARDOUS COMPONENTS %Wt. 100.00 Air RS No CAS # o TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0013 = COMMON NAME / CHEMICAL NAME NITROUS OXIDE Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 1 Days 'On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY Map: Grid: CAS # 10024-97-2 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Daily Maximum 200.00 FT3 Daily Average 100.00 FT3 HAZARDOUS COMPONENTS 100.00 Nitrous Oxide RS No CAS # 10024972 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS -25- 12/12/2000 ~ ~ . \' " e e F MERCY HOSPITAL I f= Notif./Evacuation/Medical r=: Agency Notification LALL 911. Employee Notif./Evacuation SiteID: 015-021-000628 1 Fast Format 1 Overall Site 1 03/24/2000 1 10/20/1992 NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN EVENT OF INTERNAL DISASTER DECLARATION. Public Notif./Evacuation 10/20/1992 REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY) . Emergency Medical Plan 03/24/2000 ] MERCY HOSPITAL EMERGENCY DEPT. -26- 12/12/2000 ~ ~.~' e e SiteID: 015-021-000628 ì Fast Format 1 Overall Site 1 10/20/1992 F MERCY HOSPITAL I p= Mitigation/Prevent/Abatemt Release Prevention ON GOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY WHICH INCLUDES MONTHLY FIRE DRILLS - FIRE EXTINGUISHER INSPECTIONS MONTHLY INSPECTIONS OF FIRE SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC. AVAILABLE 24 HOURS TO ALL EMPLOYEES. HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, Release Containment 10/20/1992 SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS AVAILABLE IN ENGINEERING DEPT. Clean Up 03/24/2000 MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED WITH CALPI INC. MINOR CLEANUP BY INDIVIDUAL DEPARTMENTS. CLEANUP AND DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. Other Resource Activation 11/30/1998 AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL SERVICES. WASTE DISPOSAL BY CONTRACT BFI INC. -27- 12/12/2000 ~\i,~ y e e SiteID: 015-021-000628 1 Fast Format 1 Overall Site 1 03/24/2000 F MERCY HOSPITAL I p= Site Emergency Factors Special Hazards RADIOISATOPES ON HAND RADIATION HAZARD. Utility Shut-Offs 03/24/2000 A) GAS - S WALL EXTERIOR BOILER RM B) ELECTRICAL - S WALL INTERIOR BOILER RM C) WATER - S OF S EXTERIOR WALL ADJACENT TO BOILER RM D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 03/24/2000 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS THROUGHOUT ENTIRE FACILITY. W TOWER AND TREATMENT DIAGNOSTIC BLDG FULLY SPRINKLERED. MAIN BLDG PARTIAL SPRINKLERED. DRY STAND PIPES IN MAIN BLDG - W TOWER AND TREATMENT/DIAGNOSTIC BLDGS. IN HOUSE RESPONSE TEAM TO ALL AREAS. WET STANDPIPES IN SKILLED NURSING FACILITY. FIRE HYDRANT - CITY FIRE HYDRANTS SURROUND ENTIRE FACILITY. FIRE DEPT CONNECTIONS ON S WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG NEAR OLD MAIN ENTRANCE TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE LOCATED ON STREET PARKING LOT ENTRANCE. FIRE DEPT SPRINKLER CONNECTION FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS LOCATED ON 16TH ST MOUNTED ON CORNER OF BOILER RM BLDG NEXT TO SERVICE ENTRANCE BY TRASH COMPACTOR. Building Occupancy Level 11/30/1998 194 PATIENT BEDS - 144 ACUTE CARE AND 50 SKILLED NURSING. 1000 EMPLOYEES, ROTATING SHIFTS. -28- 12/12/2000 I, .~ ,_i ~ "'.L-\·- .~ ... e e f MERCY HOSPITAL I F Training Employee Training SiteID: 015-021-000628 ì Fast Format ì Overall Site ì 03/24/2000 WE HAVE 1000 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND DEPT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION DAY (8 HRS). Page 2 r I I Held for Future Use Held for Future Use -29- 12/12/2000 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395·1349 SUPPRESSION SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326·3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 e e January 23,2001 Kitty Ringer Mercy Hospital 2215 Truxtun Ave Bakersfield Ca 93301 DearM~ ~ Within California, approximately 130,000 businesses are involved in the manufacturing, use, storage and/or transport of hazardous materials. In the event of a rolling power outage, a hazardous materials facility or handler may experience an operational event that could potentially result in the accidental release of a hazardous substance. Such a release could cause or contribute to the loss of life, serious injury, environmental pollution or property damage. To assess the potential for a accidental release, the Bakersfield Fire Department Office of Environmental Services is requesting your assistance in completing the enclosed survey and returning the survey no later than February 12, 2001. Sincerely, <f¿¡r~ Ralph E. Huey, Director Office of Environmental Services REH/dm enclosure ~~.7~ de W~ ~OP ~tJPe .o/'"'kz, .A W~" ,~ \ .-;; "~ e e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ROLLING POWER OUTAGE SURVEY Mercy Hospital Name of Business 2215 Truxtun Ave Address 1. Does your facility have a back up power supply? YesO NoO 2. If yes, does back up generator supply power to all critical systems, valves, vents, alarms, monitor, phones? ,. Yes 0 No 0 Other,-explain 3. Could electrical power loss cause a fire, explosion, or unplanned release of a chemical? YesD NoD 4. Would electric power, or telecommunication loss prevent the business :from contacting emergency responders? YesD NoO 5. Has your business prepared a contingency plan in the event of a rolling power outage? YesO NoO 6. What percentage of your business is electrical dependant? ' o less than 5% 0 5% to 10% 0 26% to 50% 051%t075% o over 75% 0100% Authorized Representative Date Please complete and return this survey no later than February 12, 2001, to the following address or fax number. Bakersfield City Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 Bakersfield, Ca 93301 Fax: 661-326-0576 "~-....'?!o-_ ~ , e MERCY HOSPITAL SiteID: 215-000-000628 Manager : Location: 2215 TRUXTUN AVE City BAKERSFIELD BusPhone: Map : 102 Grid: 25D (805) 327 -33 71 CommHaz : Moderate FacUnits: 34 AOV: CommCode: BAKERSFIELD STATION 01 EPA Numb: CAD981400237 SIC Code:8062 DunnBrad:95-166-0858 Emergency Contact / Title Emergency Contact / Title KITTY~~~~\~~~~/ SAFETY COORD PAT JACOBS / MANAGER Business Phone: (805) 632-5572x Business Phone: (805) 663-6608x 24-Hour Phone : (805) 632-5000x 24-Hour Phone : (805) 632-5000x Pager Phone : (805) 632-3287x Pager Phone : (805) 334-6461x Hazmat Hazards: RSs Fire Press React ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 2215 TRUXTUN AVE State: CA City : BAKERSFIELD Zip : 93301 Owner CATHOLIC HEALTHCARE WEST Phone: (415) 397-1823x Address : 1700 MONTGOMERY ST 300 State: CA City : SAN FRANCISCO Zip : 94111 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: Yes Emergency Directives: THIS IS A UST AND WASTE TREATMENT SITE AND REQUIRES JOINT INSPECTIONS. PLEASE CALL ENV SVCS TO SCHEDULE THESE INSPECTIONS WITH HOWARD WINES AND STEVE UNDERWOOD. One Unified List ì All Materials at Site ì F Hazmat Inventory p== Alphabetical Order Hazmat Common Name. . . specHaz EPA Hazards Frm DailyMax unitlMCP ACETYLENE 130 F P IH G 1300 FT3 Hi ALCOHOL IH L 10 GAL Mod ALCOHOL DH L 32 GAL Mod ALCOHOL DH L 48 GAL Mod ALCOHOL, ISOPROPYL DH L 10 GAL Mod ALCOHOL, ISOPROPYL DH L 1 GAL Mod CARBON DIOXIDE USP, OXYGEN USP F P IH G 160 GAL Low CHLORODIFLOUROMETHANE F P IH G 1116 FT3 Low CO2 F P IH G 437 FT3 Min C02/H2/N2 F P IH G 209 FT3 Ext C02/N2 F P IH G 209 FT3 Min C02/02/N2 F P IH G 209 FT3 Low -1- 08/24/1999 , .. ...-. e e ~ F MERCY HOSPITAL SiteID: 215-000-000628 ì F Hazmat Inventory One Unified List =¡ f== Alphabetical Order All Materials at Site =¡ Hazmat Common Name. . . SpecHaz EPA Hazards DailyMax MCP COMPRESSED AIR 250CF F P IH G 2000 FT3 Min COMPRESSED GAS CYLINDERS F P IH G 209 FT3 Ext COMPRESSED GAS NON-FLAMMABLE 25 P IH G 1500 FT3 UnR DICHLORODIFLOROMETHANE F P IH G 635 FT3 Min DIESEL TANKS F IH DH L 8000 GAL Low FORMALIN SOLUTION F IH DH L 20 GAL Hi FREON 22 F P IH G 670 FT3 Low HELIUM F P IH DH G 22407 FT3 Min HELIUM NON-FLAMMABLE P IH G 1250 FT3 Min HYDROGEN/CARBON DIOXIDE/NITROGE F P IH G 100 FT3 Ext NITROGEN P R IH G 6312 FT3 Min NITROGEN 304 F P IH G 6080 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500 LBS Min NITROUS OXIDE F P IH G 200 FT3 Hi NITROUS OXIDE F P IH G 700 LBS Hi OXYGEN F P IH G 3600 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 23 FT3 Low OXYGEN F P IH G 92 FT3 Low OXYGEN F P IH G 23 FT3 Low OXYGEN 281 F P IH G 5620 FT3 Low OXYGEN COMPRESSED F P IH G FT3 Low OXYGEN COMPRESSED 250 CF F P IH G 2500 FT3 Low PAINT THINNER F L 5 GAL Hi ' PHOTOGRAPHIC DEVELOPERS E R IH L 180 GAL Mod PHOTOGRAPHIC FIXERS R IH L 239 GAL Mod SUN GLOH L 48 GAL UnR TRICHLOROMONOFLUOROMETHANE F P IH G 274 FT3 Min WASTE FIXER R L 10 GAL Min XENON, XE 133 GAS F P IH G 250 FT3 Min I, D© hereby CGrii~ tha~ ~ havs meni plan 1~rr I~~s taJi1~ OOITlSd maú10 ag@)ml~Wi)~ ¡r;»!Œln 1©fi" m1? ~©¡¡iiW. " , , .~-\}-~~ -2- 08/24/1999 i'.__ e e . . SiteID: 215-000-000628 ì Facility Unit: MAIN BLDG 1ST FLOOR ì F MERCY HOSPITAL p= Inventory Item 0007 = COMMON NAME / CHEMICAL NAME ACETYLENE 130 Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 74-86-2 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1300.00 FT3 Daily Average 650.00 FT3 HAZARDOUS COMPONENTS ~ CAS # 748621 I l~~~åoIAcetYlene HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi p= Inventory Item 0010 = COMMON NAME / CHEMICAL NAME ALCOHOL Facility Unit: MAIN BLDG 1ST FLOOR ì Days On Site 365 Location within this Facility Unit RESPIRATORY THERAPY Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL HAZARD US COMPONENTS %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 o HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Mod -3- 08/24/1999 .- e - 0004 CHEMICAL NAME SiteID: 215-000-000628 ì Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì F MERCY HOSPITAL p= Inventory Item = COMMON NAME / ALCOHOL Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 32.00 GAL Daily Average 16.00 GAL %Wt. RS CAS # 99.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0005 F== COMMON NAME / CHEMI CAL NAME ALCOHOL Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ì Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C Map: Grid: CAS # 67-63-0 STAT:ß - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 48.00 GAL Daily Average 24.00 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS -4- 08/24/1999 i-- e e SiteID: 215-000-000628 1 Facility Unit: PATHOLOGY LAB/RADIOLOGY 1 F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Days On Site 365 Location within this Facility Unit S WALL STORAGE CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Pure PRESSURE ---- TEMPERATURE Ambient Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %Wt. RS CAS # 99.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME ALCOHOL, ISOPROPYL Facility Unit: CARDIAC REHAB CENTER 1 Days On Site 365 Location within this Facility Unit NWALL COUNTER & CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 1. 00 GAL Daily Average 0.50 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS -5- 08/24/1999 · - ," e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0011 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o CARBON DIOXIDE USP, OXYGEN USP 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o RESPIRATORY THERAPY 0 CAS # 0 o 0 124-35-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 160.00 GAL 0 80.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 5. OOoCarbon Dioxide 0No 0 1243890 o 95.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj e e íë Inventory Item 0004 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o CHLORODIFLOUROMETHANE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-45-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1116.00 FT3 0 558.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Chlorodifluoromethane 0No 0 754560 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -6- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0003 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o C02 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o LAB 0 CAS # 0 o 0 124-38-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 437.00 FT3 0 218.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Carbon Dioxide 0No 0 1243890 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o Location within this Facility Unit o LAB-MAIN 0004 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: íë Inventory Item íëë COMMON NAME / o C02/H2/N2 o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë'¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 5.000Carbon Dioxide 0No 0 1243890 o 10.000Hydrogen 0No 0 13337400 o 80.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -7- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0005 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o C02/N2 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o LAB-MAIN Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëuëëëëëëëëëëuëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 10.000Carbon Dioxide 0No 0 1243890 o 90.000Nitrogen 0No 0 77273790 åëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëuëëëuëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëuëëëuëëëëëëuëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëuëëëëëëëëëuëëëëëëëëuëëëëëj o Location within this Facility Unit o LAB MICRO 0002 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: íë Inventory Item íëë COMMON NAME / o C02/02/N2 o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëuëëëëëëëëëëuëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 5.000Carbon Dioxide 0No 0 1243890 o 20.0000xygen, Compressed 0No 0 77824470 o 75.000Nitrogen 0No 0 77273790 åëëëëëëëuëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëuëëëuëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëuëëëuëëëëëëuëëëëëëëëëëëëëëëëëëëëuëëëëëëëëëëëëëuëëëëëëëëëuëëëëëëëëuëëëëëj -8- 08/24/1999 e 'e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0012 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o COMPRESSED AIR 250CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o STORAGE RM NSIDE HALLWAY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o 0 0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 2000.00 FT3 0 1000.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Air 0No 0 00 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o COMPRESSED GAS CYLINDERS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o LAB CENTER RM MICRO RM 0 CAS # Q o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëël o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 72.000Hydrogen 0No 0 13337400 o 10. 300Carbon Dioxide 0No 0 1243890 o 17.700Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -9- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0011 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o COMPRESSED GAS NON-FLAMMABLE 250CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o STORAGE RM NSIDE HALLWAY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o 0 0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1500.00 FT3 0 750.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o DICHLORODIFLOROMETHANE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-71-8 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 INSUL.TANK / CRYOGENIC 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 635.00 FT3 0 317.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSO CAS # 0 o 100.000Dichlorodifluoromethane 0No 0 757180 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -10- 08/24/1999 · e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0002 ëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: EXTERIOR CAMPUS i íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o DIESEL TANKS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o SOUTH OF BOILER ROOM 0 CAS # 0 o 0 68476-34-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 UNDER GROUND TANK 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 8000.00 GAL 0 4000.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Diesel Fuel No.2 °No 0 684763020 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH DH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0003 ëëëëëëëëëëëëëëëë Facility Unit: PATHOLOGY LAB/RADIOLOGY ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FORMALIN SOLUTION 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o PATH LAB 0 CAS # 0 o 0 50-00-0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë-¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 20.00 GAL 0 16.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 10.000Formaldehyde (EPA) °Yeso 500000 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH DH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -11- 08/24/1999 ~ - e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0003 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FREON 22 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-45-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 670.00 FT3 0 335.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Chlorodifluoromethane 0No 0 754560 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0002 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HELIUM 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o MRI UNIT TRUXTUN & A ST 0 CAS # 0 o 0 7440-59-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëëi o Gas 0 Pure 0 Below Ambient 0 Below Ambient 0 PORT. PRESS. CYLINDER 0 äëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 22407.00 FT3 0 22407.00 FT3 0 äëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Helium 0No 0 74405970 äëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH DH 0 / / / 0 0 Min 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -12- 08/24/1999 · .- e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0007 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HELIUM NON-FLAMMABLE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 7440-59-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1250.00 FT3 0 625.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Helium 0No 0 74405970 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0009 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HYDROGEN/CARBON DIOXIDE/NITROGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o STORAGE RM NSIDE HALLWAY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 100.00 FT3 0 50.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 4.700Hydrogen 0No 0 13337400 o 10.300Carbon Dioxide 0No 0 1243890 o 84.900Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -13- 08/24/1999 · . e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o MRI UNIT TRUXTUN & A ST 0 CAS # ° o 0 7782-37-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ ° Largest Container 0 Daily Maximum 0 Daily Average 0 ° FT3 0 6312.00 FT3 0 9468.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P R IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj fë Inventory Item 0005 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROGEN 304 0 Days On Site 0 o 0 365 0 ° Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 7727-37-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 6080.00 FT3 0 3040.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -14- 08/24/1999 · , e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0008 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROGEN NON-FLAMMABLE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 7727-37-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Solid 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o LBS 0 500.00 LBS 0 250.00 LBS 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o 0013 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 íë Inventory Item íëë COMMON NAME / o NITROUS OXIDE o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 10024-97-2 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 200.00 FT3 0 100.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Nitrous Oxide 0No 0 100249720 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -15- 08/24/1999 It e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROUS OXIDE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM 0 CAS # 0 o 0 10024-97-2 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o LBS 0 700.00 LBS 0 350.00 LBS 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Nitrous Oxide 0No 0 100249720 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: EXTERIOR CAMPUS ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o A STREET 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Below Ambient 0 Ambient 0 INSUL.TANK / CRYOGENIC 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 3600.00 FT3 0 1800.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CÂS# 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëèëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -16- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 3RD FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o MED STORAGE ROOM 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 46.00 FT3 0 23.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %-Wt. 0 0 RS 0 CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 5TH FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o SUPPLY CLOSET 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 46.00 FT3 0 23.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %-Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -17- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëë Facility Unit: WEST TOWER 2ND FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o NURSES STATION SUPPLY RM 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 46.00 FT3 0 23.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëë Facility Unit: WEST TOWER 3RD FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o SUPPLY RM BY NURSING STA 0 CAS # ô o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 23.00 FT3 0 12.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 äëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -18- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëë Facility Unit: WEST TOWER 4TH FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o EQUIPMENT RM W HALLWAY 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 INSUL.TANK / CRYOGENIC 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 92.00 FT3 0 41.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100. 00 o Oxygen , Compressed 0No 0 77824470 äëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëë Facility Unit: WEST TOWER 5TH FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o NURSES STATION SUPPLY RM 0 CAS # ó o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 23.00 FT3 0 12.00 FT3 0 äëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100. 00 o Oxygen , Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -19- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0006 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN 281 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 5620.00 FT3 0 2810.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0002 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN COMPRESSED 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o THRU OUT SURGERY AREA 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 FT3 0 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 0"......""""...."........""........"........""......"..".."............""".."......"............"""".."""""..""".."....".. "j ~~~~~~~~~~~~:~~~~~~:~~~~~~~~~~~eHAeeeZAReeDeeAeSeeSEeSeSeMeEeNeTeeSe~~~:~~~~~~~~~:~~~~~~~~:~~~~~ ~eeeeeee~eee~~eeeee~eeeeeeeeeee eee~eeeeeeeee~eeeeeeee~eeeee¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -20- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0010 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN COMPRESSED 250 CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NS IDE HALLWAY 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 2500.00 FT3 0 1250.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o Location within this Facility Unit o PAINT LOCKER 0005 ëëëëëëëëëëëëëëëë Facility Unit: PAINT/CONSTRUCTION SHOP ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: íë Inventory Item íëë COMMON NAME / o PAINT THINNER o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 METAL CONTAINR-NONDRUM 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 5.00 GAL 0 5.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 10.000n-Butyl Acetate 0No 0 1238640 o 20.000Toluene 0No 0 1088830 o 10.000n-Propanol 0No 0 712380 o 5.000Xylene, Mixed 0No 0 13302070 ° 5.000Methanol 0No 0 675610 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP ° ° No °No 0 No 0 No/ Curies 0 F 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -21- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0004 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o PHOTOGRAPHIC DEVELOPERS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o X-RAY DEVELOPER MACHINES 0 CAS # 0 o 0 123-31-90 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o 30.00 GAL 0 180.00 GAL 0 150.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 12.000Potassium Hydroxide 0No 0 13105830 o 3.000Ethylene Glycol 0No 0 1072110 o 7.000Hydroquinone (EPA) °Yeso 1233190 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0Yeso No 0 No/ Curies 0 R IH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ íë Inventory Item 0005 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o PHOTOGRAPHIC FIXERS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o X-RAY DEVELOPER MACHINES, CANCER CENTER, ER X-RAY, CT LAB, 0 CAS # 0 o NUCLEAR MED, SPECIAL DK RM, SURGERY DK RM, MAMOGRAPHY 0 64-19-70 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 OTHER - SPECIFY 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o 30.00 GAL 0 239.00 GAL 0 333.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 46.000Ammonium Thiosulfate 0No 0 77831880 o 2.0001,2-Butylene Oxide 0No 0 1068870 o 5.000Acetic Acid Solution 0No 0 641960 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 R IH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ -22- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëë Facility Unit: WEST TOWER 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o SUN GLOH 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o DIETARY CLEANING SUPPLY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 48.00 GAL 0 24.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0002 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o TRICHLOROMONOFLUOROMETHANE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-69-4 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëëj o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 274.00 FT3 0 137.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Trichlorotrifluoroethane 0No 0 761310 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -23- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0003 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o WASTE FIXER 0 Days On Site 0 o WASTE PHOTOGRAPHIC FIXER 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o MRI 0 CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Waste 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o 20.00 GAL 0 10.00 GAL 0 5.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 0Silver 0No 0 74402240 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 R 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 2ND FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o XENON, XE 133 GAS 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o HOT LAB NUCLEAR MEDICINE 0 CAS # 0 o 0 7440633 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 GLASS CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 250.00 FT3 0 125.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Xenon 0No 0 74406330 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ -24- 08/24/1999 e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Notif./Evacuation/Medical ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Agency Notification ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o CALL 911 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Employee Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM 0 o SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING 0 o ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN 0 o EVENT OF INTERNAL DISASTER DECLARATION. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Public Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY) . o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Emergency Medical Plan ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o MERCY HOSPITAL EMERGENCY DEPARTMENT o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -25- 08/24/1999 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Mitigation/Prevent/Abatemt ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Release Prevention ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 ¡ o 0 o ON GOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY WHICH INCLUDES MONTHLY FIRE 0 o DRILLS - FIRE EXTINGUISHER INSPECTIONS MONTHLY INSPECTIONS OF FIRE 0 o SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE 0 o BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED 0 o EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC. AVAILABLE 24 HOURS TO ALL 0 o EMPLOYEES. 0 o o o HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS o USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN o SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL o CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF o SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Release Containment ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 ¡ o 0 o SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE 0 o THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE 0 o AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS 0 o AVAILABLE IN ENGINEERING DEPT. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Clean Up ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 ¡ o 0 o MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED 0 o WITH CALPI INC. MINOR CLEANUP BY INDIVIDUAL DEPARTMENTS. CLEAN-UP AND 0 o DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Other Resource Activation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 11/30/1998 "¡ o 0 o AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR 0 o ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL 0 o SERVICES. WASTE DISPOSAL BY CONTRACT BFI INC. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -26- 08/24/1999 ~ .... e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Site Emergency Factors ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Special Hazards ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o RADIOISATOPES ON HAND RADIATION HAZARD o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Utility Shut-Offs ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o A) GAS - SOUTH WALL EXTERIOR BOILER ROOM o B) ELECTRICAL - SOUTH WALL INTERIOR BOILER ROOM o C) WATER - SOUTH OF SOUTH EXTERIOR WALL ADJACENT TO BOILER ROOM o D) SPECIAL - NONE o E) LOCK BOX - NO o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Fire Protec./Avail. Water ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS THROUGHOUT ENTIRE FACILITY. o WEST TOWER AND TREATMENT DIAGNOSTIC BUILDING FULLY SPRINKLERED. MAIN o BUILDING PARTIAL SPRINKLERED. DRY STAND PIPES IN MAIN BUILDING - WEST TOWER o AND TREATMENT/DIAGNOSTIC BUILDINGS. IN HOUSE RESPONSE TEAM TO ALL AREAS. o WET STANDPIPES IN SKILLED NURSING FACILITY. o o o o o o o o o FIRE HYDRANT - CITY FIRE HYDRANTS SURROUND ENTIRE FACILITY. FIRE DEPARTMENT o CONNECTIONS ON SOUTH WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG o NEAR OLD MAIN ENTRANCE TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE o LOCATED ON A STREET PARKING LOT ENTRANCE. FIRE DEPT SPRINKLER CONNECTION o FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS LOCATED ON 16TH ST MOUNTED ON o CORNER OF BOILER ROOM BLDG NEXT TO SERVICE ENTRANCE BY TRASH COMPACTOR. o o o o o o C) åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Building Occupancy Level ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 11/30/1998 i o ~ o 194 PATIENT BEDS - 144 ACUTE CARE AND 50 SKILLED NURSING. o 1000 EMPLOYEES, ROTATING SHIFTS. o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -27- 08/24/1999 '..' '" e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 11/30/1998 ¡ o 0 o WE HAVE 1000 EMPLOYEES AT THIS FACILITY. o o o o WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. o o o o BRIEF SUMMARY OF TRAINING: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL 0 o EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, 0 o HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND 0 o DEPARTMENT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION 0 o DAY (8 HRS) . 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Page 4 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj e - ..; ~ ---------- \ Catholic \ka1thcare West ~Cß\\T v \<.itt)' Ringer Sate\)' Coor<iinator Risk Ma1\agett\ent \\,\erc)' \\os\Jita\ 22\5 'trur.wn /\ \Je1\~e l' 0 Bor. \\9 Bakersüe\<i, C/\ 93302 (66\) 632-5512 'te\e\1n01\e (66\) 321-1M'ð facS\f1\Ùe (66\) 632-32'ð1 1'ager e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 .,~c ~ ~/V~ HAZARDOUS MATERIALS INVENTO~~ r4q I S 3b... '() ~a 'VUIJ F ACll..ITY DESCRIPTION ~ 8~,,~ ' t'ta CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME CATHOLIC HEALTHCARE WEST (CHW) CENTRAL CALIFORNIA FACILITY NAME MERCY HOSPITAL SITE ADDRESS 2215 TRUXTUN AVENUE CITY BAKERSFIELD, STATE CA " ZIP 93301 NATURE OF BUSINESS HEALTHCARE SIC CODE 8062 DUN & BRADS1REET NUMBER 95-166-0858 OWNER/OPERATOR CATHOLIC HEALTHCARE WEST PflO~ (415) 397~1823 MAILING ADDRESS 1700 MONTGOMERY STREET, SUITE 300 CITY SAN FRANCISCO, STATE CA ZIP 94111 EMERGENCY CONTACTS NAME KITTY RINGER TITLE REGIONAL SAFETY/SECURITY COORDINATOR BUSINESS PflO~ (661) 632-5572 24 flOUR PflONE (661) 632-5000 PAGER: 661-632~3287 TITLE FACILITIES MANAGER NAùVUE PAT JACOBS BUSINESS PflONE (661) 663-6608 24f10URPflONE (661) 632-5000 PAGER: 661-334-6461 1 AAanous MATERIALS INVEN.V Business Name Address CHEMICAL DESCRIPTION Page_of_ 2) Common Name: 1) INVENTORY STAruS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 3) DOT II (optional) AHM [ ] CAS II PHYSICAL HEALTII ] Sudden Release of Pressure [ ] Immediate Health (Acute)[ ) Delayed Health (Chronic)[ Chemical Name:, -'I,1:" .,...!..,~ .'~"" ,. ...~.J " 4) Physica(~Ntealth < ,;;-~0Î'· Hazard Ca~~.fÌ~ \ Fire [,j'-t~~ve [ 5) WASTE ~~~IFIRATß~\'" ." ~~ i··~....\ .. . .... .~~.\\, 6) PHYSICA1/.sTATE (3-digit code from DHS Form 8022) Solid [ ] Liquid [ Gas [ ] Pure [ 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container II Days on Site UNITS OF MEASURE Lbs[ ] Gal [ ]ft3[ ] Curies [ ] Circle Which Months: 9) MIXTURE: List the three most hazardous 1 ) chemical components or 2) any AHM components 3) COMPONENT lO)LOCATION USE CODE Mixture [ 1 Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature All Year, J, F, M. A. M. J, J, A. s, 0, N. D CASII %WT AHM [ ] [ ) [ ) I) INVENTORY STA ruS: New [ ] Addition [ ) Revision [ ) Deletion [ ] Check if chemical is a NON Trade Secret [ ) Trade Secret [ ) 2) Common Name: 3) DOT II (optional) , Chemical Name: AHM [ ] CAS II 4) Physical & Health PHYSICAL HEAL TII Hazard Categories Fire [ ) Reactive [ ) Sudden Release of Pressure [ ) Immediate Health (Acute) [ ) Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) 6) PHYSICAL STATE Gas [ ) Pure [ Solid [ Liquid [ 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container II Days on Site UNITS OF MEASURE Lbs [ ) Gal [ ) ft3 [ Curies [ ) Circle Which Months: 9)~: List the three most hazardous I) chemical components or 2) any AHM components 3) COMPONENT USE CODE Mixture [ ) Waste [ ) Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature All Year, J, F, M. A. M. J, J, A. S, 0, N, D CASII %WT AHM [ ) [ ) [ ) lO)LOCATION I certifY Meier penalty of law, that I have personally examined and am familiar with the information on this and all attached documents. I believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date ~ ~ous MATERIALS INVENT. J / Pa$e --'- of 2- Busmcss Name ¡(\f:..t..t!- Ý TY() 5{JITI1L Address ,:( J( /.s- 7Æ'uXTU ^.J 4JL.E, CHEMICAL DESCRIPTION I) INVENrOR Y STATUS: New (.X Addition [ J Revision [ J Deletion [ 1 Check if chemical isa NON Trade Secret [ ) Trade Secret [ 2) Common Name: ß I () C I b £.. 3) DOT II (optional) (A N I 7 (ÇO Chemical Name: fY)1 C. [(f) ß/ (1~ I ÞE. AHM [ ] CAS II / 1/ -.?O .- g 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire [ ) Reactive ( J Sudden Release of Pressure ( J Immediate Health (Acute) ( ] Delayed Health (Chronic) ( 7) AMOUNT AND TIME AT FACILITY Maximum Daily AmO\Dlt A verage Daily AmO\Dlt Annual Amount .10 Glrt_ Largest Size Container 1# Days on Site 5 ) WASTE CLASSŒ1CA 110N 6) PHYSICAL STATE 9)~: Li~ the three most hazardous chemical components or any ARM components 10)LOCATION (3-digit code ûom DHS Form 8022) USE CODE Solid { Liquid { Pure ( Mixture [ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) ContAiner. b) Pressure: c ) Temperature ~1, F, M. A. M.l, J, A. S, 0, N, D CASI# %Wf ~ AHM [ J { J ( ] Gas [ ) UNITS OF MEASURE Lbs ( 1 Gal [)(] ft3 [ ] curfeS ( ] Circle Which Months: I) INVENTORY STA'IUS: New r;4 Addition ( ] Revision f ] Deletion f ] Check if chemical is a NON Trade Secret ( J Trade Secret f J 2) Common Name: 0/ L 3) DOT 1# (optional) Chemical Name: W A-j'T e.. CJ ( L AHM [ ] CAS 1# 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire {/J Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) ( 6) PHYSICAL STATE Solid [ Liquid [X-] 7) AMOUNT AND TIME AT F ACn.ITY Maximum Daily Amount Average Daily Amount Annual Amount ~ 0 G ~L Largest Size Container 1# Days on Site 5) WASTE CLASSŒ1CATION 9) MIXTURE: List the three most hazardous chemical components or any AHM components IO)LOCA TION ð COMPONENT I) JS70 G LUTflR.AL r-. -eJ-J Ybe 2);rI'J~T IftJ6fPbJ£tJT5 ~ 3) (3-digit code from DHS Form 8022) USE CODE Gas[] Pure [ UNITS OF MEASURE Lbs [ ] Ga1(,xJ 1\3 [ ] Curies [ ] Mixture [ ] Waste [« } RBdioactive [ 8) STORAGE CODES a) Container. b) Pressure: c) Temperature ~I, F, M, A. M, I, I, A. S, 0, N, D COMPONENT CASI# 1) /Ÿ\-ðTo~ OIL, &e..q..,e, OIL I V'íl-CUOM.OIL, 2) , 3) %Wf AHM [ ] [ ] [ ] Circle Which Months: [certify under penalty of law, that 1 have penona11y examined and am familiar with the in1òrmation on this and all attached docuou:.nts. I believe the submitted intonnaûon is true, accurate and complete. ~~~~ *7 ¿?oz:> /(€"A.J STONI£t!J¡;IIE~ /an..5V?€/èV/SO,e.£AJ¡;' _ _ __ é.- PRINT Name ct Title of Authorized Com y Representative I Ignature Date . - ¿ . . o o o - ---=-. '" ~ ;1.';< - -\ ID:Ã. TREAT ·CHËMICALS· -. TEL NO:415593"9 ··"i26~PØ8------------ JUN-10-'97 14:45 ~ RECEiVED ~rf:~ '~ ~ lcna A[JUA TREAT CHEMICALS ING. QUAlm' ANI) Slnvlcr¡ ..au CAN UEPEND ON IGOI 111l1u.hI81 Wily · Suit. 120. U,llIIolII. CA 94002. (415) 693.2100 CHW C~ntra!Oalirorn¡ê, RISK & SAFEíY MANAGEMENT HNl'ERIAL SME'1'f DA'l'A BllEET CI!EJUREC ÐŒRGENCY' PllotIEI t-BUO·O\Z4·9]ùO (EVES & lIuLlDAYS) "t.,,"liAblt.ITV cnlilU 1\ I \ I \ NI'rA IJIõBIOtlM 'Ult 704 I 0 \ 1\ 1\ " , \ II£^LIII I " \hI;MTlVITY IÞLUUI 2 \I 1 \I\'E.....tJW' , 1\ I ul\Qnu UF "I'tIMD \ " I8I'EClrrlC 1I^I^nD \ I \ I \' \1 UK . UXIIJlltn \ I Atlll. ACID . \ 1 AI.I\. /IlM^t.1 \ I CUll. CUnnolllva " 'rI!CI" III 1!AIAnD , ' u~ ,,,"IOUIF 'CA,n , -ØLl om '-"UU¡¡1t1tt I . U·II'QII "·¡:X'''II'1i GENßluu, :INFOltHATlON ~;~~Lh;-----~------~----~~~-7-~;~Ñ;;-~~~~---~~~---~~~~~--~~~~~--~ ______~Çp21ÿ~~~~~~!ti~t~ú~~L~~_______~___lit~_________~__~_~ø_w___ Þate 188ued , Date Reviled . ______~_§Lªt_~~~______~__~________~M____~~~j__~M~~__~~_~~~~~~~__~ . 11AZARÐW!J INGIIEDIENI8 0811A ACOIN JIAU1BIL lWA - . 't~V IrritunL,S~I,sith.er N/E ' '0.' ppn .1lliIMP JEll T Glulan11uehyúc t;AUi2s. 1l1-~O-8 Glutaraldehyde OšiìAiïE~ SKIN Y OšiiÃCEIL'NQ bOILING rOlllT ( F) PllfsÎcAl¡¡Ã1A SPECIFIC GRAVITY v'iJiõiþËNii'iT(AlR-t) 1.0~2 >1 (1 I, .1 2l2.S0F vÃrUREšsu"ñ¡ (n,n II,,) 18.1 O[)OR iõThiiffi'ŸiÑ "'AIER ^rPËffiNCI! EVAPORl\T ION RAïr"'iii^'ER-') Shurp ahlehxde oùo~; PROOUCT pll Canplete Colorless liquid -----~-------~~-------~~------------------~-----~~~----~-~~~-~-~~ WI!!I! POINT flU! IJ/þ Exr~ULIWðBIU!A1A FLAMMABLE L'"IT'~ LEL N/A N/A un None EXTïNGOlsÏliHíîïHËDI^ WatersprAY..I CBL-bot,_úioxid.::.. dry chemiC$t1 . foam SPECI^" FlIIE r IGlltIIlG I'ROCEIJURU Firefi~hlerB should hnvc availDblc 5clf-cQlllnined ureathing ... t , .J u 1 LP}~oLill!.Y!L.£ 1 ot !l!.m~ UIIUSU¡\L r IRE AND EIlPlOSIOH "^l^RÞ8 Irritatiug vapors may be emitted durin~ a fiqL npP&\",alllsnnd ., . ,', Of _'. -.. c) -: , .. ~c-~' "" ~ IÌÚ Ä. TRÊAT" CHEMi CALS -. TEl.' NO': 41559319' -. . .. ~ . .-- .. - - **126'" P09" . . . ' JUN-10-'97 14:45 t.1U!WU..R!!lILI,![J.JjLU:_Ull..i~~. INIiESfløt. IØI\ÞIJ\JlIM.ðHJ.I TIIEIK SIGNB AltU 8YftP1QtS Of IXI'OIURI' '"',. EYElI Severe con iUl1ct tv it ~fJ Ql\ú £omeal in~ury sklNI_L..ocal !.n:ilaliol\ Lo severe inflamnauol\ II/GEnIONI lrdtatiUl\ to mouth anti lht'OtU."~J)DUSeÛt vOIIMa-awJ dIarrhea, 11I1I^l^,IOH, Respj,rªlQfV lracl i.~·dLQtion.Þl"CalhiI1G ~j,UicullYtheadaches UŒ~I;Jiøs;1 Mil fiRST AID rRUCEDURe~ ' , nE9'-,~!IUQ(h,qtili~jlwdL 'iUlLj'l~ler fO!:Ju.....JenaL. 15 uÜnutes obtain me4is:d"ALLention SKINI wash \o'1[h 500[> anu ,,,alcr t U~OE8JjÕ"' Di:-i.mt" SI!"ìTl amounts of \t/ar.el',':o.hLÃ1LUlledicnl al Lpnl,ipn W^lMlUlhJ~clllove Lo fresh air. ÇL'le oxyg~l1 if nece~~jfU:Y ilEAl. T II IIAZARlIS 1_5lÜn_~.en.5.i Uz;at.1cILalld-conLacLdanna.û.U s HEDICAl CoNDITIOns AGGRAvAtED DY UPOSURfl....¥aIU2tlU1ta~ggrtl"nl e l"eapiJ"alnry prnhlA111'1 11 Co JEðCflvnT DAtA IH^Ø'LIH'__~laul~_~ "^~R~W' ÐEt~I/'O$"'VN9' Cat'uon lIIonoxid~,C..ßJ:hnn tfinJ('id~ "^lAR[)oo9 POL YliERl^ 1 101l,_JýoOil.LI1QL.Q~[__.~___' , IIICOHrnJABllI'f (HI\fERIAU '1;1 IIVUIÞ) '.QY·ºmLIDS..LJ.iz.1nR..J)&J.ml:t,li..l.ron~J.lc.l.da..fitrgngtlU~~1t t~ CARCINOGENICity !.ISlE } 8Y NIP, lARC, 0911A REClUJREDc 'to ( X) re. C ), " Cl!..r~ino&..t'U1ß~~J~oducUye t~xi~~ ~!!f: ted__Ql1 C~4 Proposition 65: no(JO:~ye~~ ( ) ~[I~f1..tWfWUjlJ D IJ~ $YEI'S TO tiE TAkEN IN CASE 111\'£Rll\l It RI!I.E^8EÞ OR IPILUD~~caL~r.oLcc.t.i\l~C.tt)IIIÌ'~ 'b.t1Jc~l .J:'ljŸ.~.Q!:,n~rl.~.º t. P¡.9gg.!º.ª..£C5nin~J.Ç!!:: SOª!U!V_JiI!il...L\~ i lh....M!,J~ or Ol_~S~:r' J~_º_Ç.Ç_Jl1l0 ChCllllt:¿ll, \~aste contall'!,g£.....!gLcJl§PQª-Q.L......E!Wl!uPJ.l1 ßL·eLltill.:.....___...,. o \lASiË-ÞISPüSÃl.iE1110D -º.i'§Eºª~Ú!ul1wI.Î..Gl!L~~ ~~PÎ:AÇ~·~;r;'g . fac fITLy approved _ _[01' handl ÙJg_.p-illkÜ1ßa..._ ' ---- L~n~ ~ ' rR~(;^UflUIIII to BE JAKEN IN IlANDLlNO ^NP UORI/IOI SLOl"C in l\ cool prolccLed local e~p~ . _ç~m1J!b~ L_Ç lQ:il~d_J~lœu..JlS]_lJ.lLlISe....._~_-____ .-..- ----- --.----. . 1 It !tLCI4!!!.~ 'lIl!~".,jJl ;r (l¡U~º§L~~J...A!W..I!JfLU11U [~! c PilAt UtU....ALIlAlLY4IIl J JlIJIJIlGHLY AnlR 1IlUm1.1J U, kE~" wr ur ItEAtlLO' CIIILVn8. mt:'^l rROI~CTIUI..J1U:!WllJI!t II ESP I 111\ fORY PROI te' 10lh .JJ§!Lf\C.hl.gaaÚlr~al1iC-1lß 1101:... r.espira Lm:-Lf..JlCll.l,llll L 1 ß(Jtj8 le Vr:II1I\^, 1011- !.OCM EKIIIIU$' :__ j\J.!. ,';{1\ "ll,rcU t'ECII^IlIr.AL (GEI/ER^L) CoO Rg£OIlI\cnd.£U sé( m-~I I'ROIECIIV£ IiLOVE5:Jtl!~~Þ,~a:..J~L~plns u.c I . EYE PRUIECTlUllc_,~l facesluc Olll£/( PROIECIIVE EOUI >HEIH: E~~ \~l1511 stallQ!LJ..u.LL!lrench sh~'. ¡.uJllfU~I..JVft dp~IJlng B1!WtAIŒr IHfUUiAuœ STAtU' 'lUre s,,,rPINt¡ /lNIIir éOrToijive Hqu1.da. NOS L (cQntaJ ns dutaraldehvde) 0,0. T. ClASS=-Cc.rr.aWe . IU ...D.O. T. NUHBERr \!lH Z 60 RCM LISTE!)I no C ) yu ( X ), D002 o CERCL^ LlStEDI 110 ( X) Vel ( ), iÃR.vITiTi'TI-:SËCJ ïõiïjÕ2EHERÌÍËNëïfífÄññHIg NOn fiëà Hiiìiiiiiiišiiõì.o PLANNÏNÕÕÍlAHiffi iii no (X , VII ( " šÃRÃiïïãïi¡-ïí¡-:-¡¡Ciiõftï3õ¡-¡}iiiõENCY RELEASE NOTlfIC^TION no C X ) yea ( ), ~ ~. _ sÃlwTinEï II - šËéTION 3ïJioxiêi:iiiHiEALAHAAl IIElEASE IIEf'ORrtNO "0 (X ) yel ( ), TSCMÃITCiIEHUÃitu-tiiõNEN,elISJED ON TSCA INVE~'ORT UIIILE 111E IHr( It'tI\JlUf AND REr.U'Ætll)^"UfB 8ET ·rORfII ARE IIFLlIMD 10 hI; ACI1IRA1E AI OF 111E PATE IŒUOf', III IWtE NO ~ W IY VIlli RurEtT 111EREIU MID DISI;u\IK ^lL LI^BILlIT fRut RI;LlIINCE 111WCMo e CITY OF BAKERSaLD (\ / t:n 1\ ^ ^ ( OFFICE OF ENVIRONMENTAL SERVICES c:P7 ~\J v 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200 tI ADD o DELETE o REVISE HAZARDOUS MA TERJALS Hazardous Materials Inventory- Chemical Description Page I I Of I BUSINESS NAME 201 CHEMICAL LOCATION MAP # (opliona') 202 203 Facility ID Number CHEMICAL NAME WM1l$ ~""C- F X~ 204 TRADE SECRET 0 YON 205 COMMON NAME 206 o YON 207 219 UNITS· -GAL 0 CU FT o LBS 0 TONS 220 MAX DAILY AMT AVG DAILY AMT 215 CAS # 208 If EHS ¡s"Y", all Amounts must be in Ibs TYPE o PURE 0 MIXTURE "WASTE 210 RADIOACTIVE I 0 Y ii N 211 I Curies PHYSICAL STATE o SOLID "LIQUID 0 GAS 213 FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE o FIRE 0 REACTIVE 0 PRESSURE RELEASE 0 ACUTE HEALTH .CHRONIC HEALTH PD( ( 3b~ 216 218 (0 LARGEST CONTAINER 2-0 214 ·If EHS, amounts must be in Ibs, ANNUAL WAST~ ~MT 3d¡ ,... 221 > 217 3~Ò RECYCLABLE MATERIAL oy ON 222 PRODUCT Made from RECYCLABLE MATERIAL OY ON 223 STORAGE CONTAINER o ABOVE GROUND TANK o UNDERGROUND TANK o TANK INSIDE BUILDING o STEEL DRUM tI PLASTIC/NONMETALLIC DRUM o CAN o CARBOY o SILO o FIBER DRUM o BAG o BOX o CYLINDER o GLASS BTL o PLASTIC BTL o TOTE BIN o TANK WAGON o RAIL CAR o OTHER 224 STORAGE PRESSURE 1II1 AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 STORAGE "AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 226 TEMPERATURE %Wf HAZARDOUS COMPONENT EHS CAS# 1 228 OY ON 230 I 227 >/ C. VC-../L 229 2 232 OY 0 N 234 231 233 3 236 oy ON 238 235 237 4 240 OY 0 N 2421 239 241 5 244 OY ON 246 \ 243 245 OES I=ORM 2731 P:\30ES2731,3D,wpd AU9ust 6. 1998' ' e CITY OF BAKERS.eLD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200 ,~DD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I BUSINESS NAME (V\ (;. (2.<: y X RAV v6lewp~ f'tAÇC+,,J<:S 3 CHEMICAL LOCATION 201 MAP # (optiona') 202 GRID # (optional) 203 Facility ID Number CHEMICAL NAME P~OGllAP( L. 204 TRADE SECRET I 0 YON 205 1) 61C-u:)PC-4C.. i COMMON NAME 206 I EHS I 0 YON 207 CAS # 20B I /I EHS Is·Y", all Amounts must be in Ibs 'G CD TYPE o PURE ~ MIXTURE o WASTE RADIOACTIVE I o YON 211 I Curies 212 ~, 210 g PHYSICAL STATE o SOLID . LIQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH rCHRONIC HEALTH 215 (!) ::! CATEGORIES -0 - J& 0 STATE WASTE CODE 216 MAX DAILY AMT ::) - DA YS ON SITE 219 UNITS· I M!l"GAL 0 CU FT I A VG DAJL Y AMT )bS"" o LBS 0 TONS 220 221 {S"Ö LARGEST CONTAINER 3D 214 'If EHS. amounts must be in ANNUAL WASTE AMT 217 Ibs. - RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL WPLASTIC/NONMET ALLlC DRUM o BAG o TOTE BIN STORAGE PRESSURE . AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE lit AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# 1 PD \.AS~ u rv1 228 OY 0 N 230 227 5uLF"IT~ 229 IOtl7,ji-! 2 fb 'f'A '39 u '^" 232 oy 0 N 234 231 f:{ f.-PÆd XI () e: 233 13 (D ... ..r-~.. "'S 3 fEY D 12.0 (X ú 11\/ ONE 236 OY 0 N ('Z.3- ~/-~ 238 ! I 235 237 4 .s. C) ()f<.J "" 240 OY 0 N 242 ' 239 $V'l-F- ,-e 241 7 7 ~7 - ~3 - 7 5 244 OY ON ì4Z0 - ~q....s- 246 6- Lv r.AR Ac...P E '-''I J)(g' , 243 245 OES FORM 2731 P:\30ES2731,3D.wpd August 6, 1998 ! l ; ¡ ! , \ " ¡ II 1; e CITY OF BAKERS.eLD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200..,ADD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I BUSINESS NAME M C~C'r' CHEMICAL LOCATION x.. " (z~<,.J î)tZv(éwPt:R... fl"ACU"..¡E-5 201 MAP # (optiona') 202 GRID # (optional) 203 Facility 10 Number CHEMICAL NAME P !-t.r\oGflAp¡ (., F· xé:R- 204 TRADE SECRET oy ~ 205 COMMON NAME 2061 EHS I 0 YON 207 CAS # 208 I If EHS Is"Y', all Amounts must be in Ibs e ëD TYPE o PURE ~IXTURE o WASTE RADIOACTIVE I o Y ~ 211 I Curies 212 ~ 210 g - PHYSICAL STATE o SOLID ¡¡("LIQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH Oð"éHRONIC HEALTH ~ 215 ~. CATEGORIES "0 - 218 ({f6 0 STATE WASTE CODE 216 MAX DAILY AMT ::J . - DAYS ON SITE 3bS' 219 UNITS· I ~AL 0 CU FT I AVG DAILY AMT o LBS 0 TONS 220 221 15"'0 LARGEST CONTAINER .ifl .>0 214 'If EHS, amounts must be in ANNUAL WASTE AMT 217 Ibs. RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL . PLASTIC/NONMET ALLlC DRUM o BAG o TOTE BIN STORAGE PRESSURE If' AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE ,. AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# 1 228 OY 0 N 230 227 SOD tV"" A <:érA-ré. 229 12ì-C'i -3 2 A(.....()t)A INUW'\ 232 OY 0 N (OOQ3-6t- 5 234 231 5VLrÞ-Tt 233 , I 3 ~ (Sc..J(..r.ð- æ 236 OY ON 238 I 235 SO\)\'ÚM 237 76:3(- 90-~- i 4 240 OY 0 N 77'"8"] - I t- ~ 242 ' 239 ~MórJ' V"" 1'1-{ (CJ $ Vl FA ï~ 241 5 244 OY ON 246 243 245 OES FORM 2731 P:\30ES2731,3D,wpd August 6. 1998 ¡ \ I I , , e CITY OF BAKERSe:LD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 ~ 200 ¡ø ADD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I : BUSINESS NAME IIVt ~C Crt' C Mc..<SR- 3 CHEMICAL LOCATION cc-v-~ 201 CHEMICAL NAME . W AS~ TrßtU:>.PHI C. FIX'6'c... t>t I.e.' f'tj ~ ~C:::» ..~;.,- '6r t... t b co: -r C GRID # (optiona') 203 Facility ID Number MAP # (optiona') 204 TRADE SECRET 0 YON 205 COMMON NAME 206 o YON 207 CAS # 208 If EHS Is"Y", all Amounts must be in Ibs 215 PHYSICAL STATE o PURE 0 MIXTURE $WASTE 210 o SOLID !fLlQUID 0 GAS RADIOACTIVE I 0 Y ~ N 211 I Curies TYPE 213 FED HAZARD CATEGORIES o FIRE 0 REACTIVE 0 PRESSURE RELEASE 0 ACUTE HEALTH (!1 CHRONIC HEALTH STATE WASTE CODE DAYS ON SITE UNITS· QGAL OCU FT o LBS 0 TONS 220 MAX DAILY AMT (~ 218 AVG DAILY AMT 221 10 ANNUAL WAS E AMT 217 '2D ""- c ~40 OY ON 223 LARGEST CONTAINER I( 216 Jb~ 219 3ö OY ON 214 ·If EHS, amounts must be in Ibs, RECYCLABLE MATERIAL 222 PRODUCT Made from RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o UNDERGROUND TANK o TANK INSIDE BUILDING o STEEL DRUM ~PLASTIC/NONMETALLlC DRUM o CAN o CARBOY o SILO o FIBER DRUM o BAG o BOX o CYLINDER o GLASS BTL o PLASTIC BTL o TOTE BIN o TANK WAGON o RAIL CAR o OTHER 224 STORAGE PRESSURE pAMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 STORAGE i7AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 226 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# I 1 228 OY 0 N 230 ! S ( l... V"C'""'- I 227 229 ! 2 232 OY 0 N 234 i 231 233 I 3 236 OY 0 N 2381 235 237 4 240 OY ON 242 [ 239 241 I 5 244 OY ON 246 \ 243 245 OES FORM 2731 P:\30ES2731,3D,wpd August 6, 1998 e e -", ~~cl\é zw ~ ( ) ß(L\ TE: '2-ÒÙ Oll'~ { oe -r(2U'- >0v{2- 1 ( '6Òt L t3L ~ J \ ( CLa<L~.r>r::. WE\~W - {),L, ~~ C-A.t- 200 ¥ ADD o DELETE e CITY OF BAKERSeLD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I : o REVISE BUSINESS NAME M-G'tcÇ.l 3 CHEMICAL LOCATION E:R.. ~-R.ilY 201 MAP # (optiona') 202 I GRID # (optional) I 203 I Facility ID Number I 1 CHEMICAL NAME WAs.~ .p.q¿;~/.{' <... 204 TRADE SECRET OYON205 f='; )(~ COMMON NAME 206 I EHS I 0 YON 207 CAS # 208 I If EHS Is"Y", all Amounts must be in Ibs Q a> TYPE o PURE o MIXTURE gJfWASTE RADIOACTIVE I o Y III N 211 I Curies 212 ~. 210 g - PHYSICAL STATE o SOLID ~ LIQUID o GAS 213 fï? FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH " CHRONIC HEALTH I~ 215 ~. CATEGORIES "0 - 0 STATE WASTE CODE 216 MAX DAILY AMT 218 (0 :J ~ DAYS ON SITE 3bS' 219 UNITS· 18 GAL 0 CU FT I AVG DAILY AMT o LBS 0 TONS 220 221 S- LARGEST CONTAINER 3~ 214 ·If EHS, amounts must be in ANNUAL WASTE AMT 217 66> Ibs. RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL . PLASTIC/NONMET ALLlC DRUM o BAG o TOTE BIN STORAGE PRESSURE II AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE . AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# 1 228 OY 0 N 230 227 5 (LvC-<L 229 2 232 OY 0 N 234 231 233 3 236 OY ON 238 235 237 4 240 OY ON 242 239 241 5 244 OY ON 246 243 245 OES FORM 2731 P:130ES2731,3D,wpd August 6, 1998 200 ~ ADD o DELETE e CITY OF BAKERSeLD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I ~ o REVISE BUSINESS NAME I""- C<ltc. cr 3 CHEMICAL LOCATION c, LAß 201 MAP # (optiona') 202 I GRID # (optiona') I 203 I Facility ID Number I 1 CHEMICAL NAME 204 TRADE SECRET OYON205 : - W'f>...~ 'T £. ~Gk.).f?41c.. ~ X&Jt. COMMON NAME 206 I EHS I 0 YON 207 CAS # 208 I If EHS Is"Y", all Amounts must be in Ibs Q ã5 TYPE o PURE o MIXTURE &WASTE RADIOACTIVE [ o Y ¡a,N 211 I Curies 212 ~ 210 g - PHYSICAL STATE o SOLID .LlQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH ~HRONIC HEALTH ~ 215 ::!. CATEGORIES "0 - f) DII s:- O STATE WASTE CODE 216 MAX DAILY AMT :J 218 - DAYS ON SITE 219 UNITS· ,. GAL 0 CU FT I AVG DAILY AMT o LBS 0 TONS 220 221 ~ LARGEST CONTAINER ç- 214 'If EHS, amounts must be in ANNUAL WASTE AMT 217 60 Ibs, RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAil CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL . PLASTIC/NONMETALLIC DRUM o BAG o TOTE BIN STORAGE PRESSURE æ AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE 4it AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# ! 1 228 OY 0 N 230 I 227 51'~..v~ 229 I I , 2 232 OY 0 N 234 I 231 233 I 3 236 OY ON 238 235 237 4 240 OY ON 242 239 241 5 244 OY ON 246 243 245 ,) OES FORM 2731 P:130ES2731.3D,wpd August 6. 1998 200 . ADD o DELETE e CITY OF BAKERS.D OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I o REVISE BUSINESS NAME Jt1. {';. (l.. c.. c¡ 3 CHEMICAL LOCATION rJuC,l..tSNl.. Mtf:O I c("I/e R.OOM 201 MAP # (optiona') 202 I GRID # (optiona') I 203 I' Facility 10 Number I 1 CHEMICAL NAME 204 TRADE SECRET OYON205 v...JV>. ;) T€ p¡..{.o 'f(J6I'V:J..P I~I C rf x.. Gf?... COMMON NAME 206 I EHS I 0 YON 207 CAS # 208 I If EHS Is'V", all Amounts must be in Ibs Q CD TYPE o PURE o MIXTURE "WASTE RADIOACTIVE I o Y.N 211 I Curies 212 ::!. 210 ~ PHYSICAL STATE o SOLID !ilLIQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH -CHRONIC HEALTH èï 215 :::!. CATEGORIES '"0 - 1)Or{ 0 STATE WASTE CODE 216 MAX DAILY AMT S- ::J 218 .- DAYS ON SITE 219 UNITS' -GAL 0 CU FT I AVG DAILY AMT 3b~ o LBS 0 TONS 220 221 J LARGEST CONTAINER >- 214 "If EHS. amounts must be in ANNUAL Wï;E AMT 217 Ibs. {() M6 {<.O RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL _PLASTIC/NONMETALLIC DRUM o BAG o TOTE BIN STORAGE PRESSURE ':MMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE .AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %VVT HAZARDOUS COMPONENT EHS CAS# I 1 228 OY ON 230 i 227 51 '-vf:(L 229 I 2 232 OY ON 234 I I 231 233 I 3 236 OY 0 N 2381 235 237 4 240 OY 0 N 242 I 239 241 I 5 244 OY ON 246 I 243 245 ! OES FORM 2731 P:130ES2731,3D.wpd AU9ust 6, 1998 _ CITY OF BAKERSFer.D OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200 ¡t. ADD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I ' n., 6.R. <: ýJ , BUSINESS NAME 3 CHEMICAL LOCATION 5: f' á , L>-c.. p~ ~ON'\ 201 MAP # (optiona') 202 I GRID # (optional) I 203 I Facility ID Number I 1 CHEMICAL NAME 204 TRADE SECRET OYON205 WA)fÇ P4-lO()O~,c... f; 1<. C-iC- COMMON NAME 206 I EHS I 0 YON 207 CAS # 208 I If EHS Is"Y". all Amounts must be in Ibs Q ëD TYPE o PURE o MIXTURE l3tWASTE RADIOACTIVE I o Y ilfN 211 I Curies 212 ~. 210 ~ PHYSICAL STATE o SOLID ~ LIQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH dÞCHRONIC HEALTH 0 215 ~. CATEGORIES "0 - 0 STATE WASTE CODE 1>0 (( 216 MAX DAILY AMT (Ö ::I 218 - DAYS ON SITE 219 UNITS· I a GAL 0 CU FT I AVG DAILY AMT '3' S- o LBS 0 TONS 220 221 ~ LARGEST CONTAINER 20 214 ·If EHS. amounts must be In ANNUAL I/,.STE AMT 217 Ibs. 1-0 /VIO '2 ? S() RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL ~ PLASTIC/NONMETALLIC DRUM o BAG o TOTE BIN STORAGE PRESSURE " AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE ¡¡; AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %WT HAZARDOUS COMPONENT EHS CAS# 1 228 OY 0 N 230 227 '5 I <- V c.-I?.. 229 2 232 OY ON 234 231 233 I , 3 236 OY ON 238 I 235 237 I I 4 240 OY 0 N 242 I 239 241 5 244 OY ON 246 \ 243 245 \ OES FORM 2731 P:\30ES2731.3D,wpd August 6, 1998 __ CITY OF BAKERSF.D OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200 ~ ADD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I . BUSINESS NAME M C...e.C ~ 3 CHEMICAL LOCATION 411-\ ~ 5~6ga.Y ù1( ~ 201 MAP # (optiona') 202 I GRID # (optional) I 203 I Facility ID Number I 1 CHEMICAL NAME vJ I),. S rG= p~.(d "-OGe.A!PH f (. 204 TRADE SECRET 0 YON 205 PIX~ I COMMON NAME 206 I EHS I 0 YON 207 CAS # 208 I If EHS Is"Y", all Amounts must be in Ibs ÇJ cD TYPE o PURE o MIXTURE ....wASTE RADIOACTIVE I o Y aÞN 211 I Curies 212 ~. 210 ~ - PHYSICAL STATE o SOLID ~LIQUID o GAS 213 ~ FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH IlbCHRONIC HEALTH ~ 215 ::::! CATEGORIES "0 I';; $" 0 STATE WASTE CODE DOl( 216 MAX DAILY AMT ::J 218 ¡..,." DAYS ON SITE 219 UNITS' I. GAL 0 CU FT I AVG DAILY AMT ""3>CoS"' o LBS 0 TONS 220 221 3> LARGEST CONTAINER ~ 214 'If EHS. amounts must be in ANNUAL WA~ì; AMT 217 126 Ibs. IQ ,..... RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL Jþ PLASTIC/NONMET ALLlC DRUM o BAG o TOTE BIN STORAGE PRESSURE ~ AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE '-AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 226 TEMPERATURE %Wf HAZARDOUS COMPONENT EHS CAS# 1 228 OY 0 N 230 I 5fLVC~ I 227 229 ! 2 232 OY 0 N 234\ 231 233 3 236 OY 0 N 238 I 235 237 I I 4 240 OY 0 N 242 I 239 241 5 244 OY ON 246 \ 243 245 OES FORM 2731 P:\30ES2731.3D,wpd August 6, 1998 ì r I . CITY OF BAKERSF~D ()FFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 200 'ADD o DELETE o REVISE HAZARDOUS MATERIALS Hazardous Materials Inventory- Chemical Description Page I I Of I BUSINESS NAME IlA Qzc.C(-' 3 CHEMICAL LOCATION 4~ q;¿ /Vf" -- -~V 201 ",.~ MAP # (optional) 202 I GRID # (optional) I 203 I Facility 10 Number I 1 CHEMICAL NAME {¡..1'Pr.'7{~ 204 TRADE SECRET I 0 YON 205 .p~ro6-flM~ Ç1xeL ì f I COMMON NAME 206! EHS 0 YON 207 CAS # 208 I If EHS Is"Y", all Amounts must be in Ibs C ëD TYPE o PURE o MIXTURE . WASTE RADIOACTIVE I o Y fiJ N 211 I Curies 212 ~. 210 g - PHYSICAL STATE o SOLID -'LIQUID o GAS 213 ð? FED HAZARD o FIRE o REACTIVE o PRESSURE RELEASE o ACUTE HEALTH ¡r CHRONIC HEALTH (!) 215 ::!. CATEGORIES "0 - 4 0 STATE WASTE CODE DOl r 216 MAX DAILY AMT ::J 218 l- DAYS ON SITE 219 UNITS' I "GAL OCU FT I AVG DAILY AMT ~,ç- o LBS 0 TONS 220 221 '2....- LARGEST CONTAINER S- 214 'If EHS, amounts must be in ANNUAL WAST~MT 217 Ibs, (0 MO /'ld RECYCLABLE MATERIAL OY ON 222 PRODUCT Made from IOY ON 223 RECYCLABLE MATERIAL STORAGE CONTAINER o ABOVE GROUND TANK o CAN o BOX o TANK WAGON 224 o UNDERGROUND TANK o CARBOY o CYLINDER o RAIL CAR o TANK INSIDE BUILDING o SILO o GLASS BTL o OTHER o STEEL DRUM o FIBER DRUM o PLASTIC BTL .. PLASTIC/NONMET ALLlC DRUM o BAG o TOTE BIN STORAGE PRESSURE f! AMBIENT o ABOVE AMBIENT o BELOW AMBIENT 225 I STORAGE It' AMBIENT o ABOVE AMBIENT o BELOW AMBIENT o CRYOGENIC 2261 TEMPERATURE %Wf HAZARDOUS COMPONENT EHS CAS# , 1 S (<.. (/ t:(¿. 228 OY 0 N 230 I 227 229 I I 2 232 OY ON 234 : 231 233 I 3 236 OY 0 N 238 235 237 4 240 OY ON 242 239 241 5 244 Oy ON 246 I I 243 245 \ OES FORM 2731 P:130ES2731,3D,wpd ¡ I i AU9ust 6, 1998 e FACILITY NAME MER-c( CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 GPA (O~: CAt> 9cg 1400..2.37 -tkD SP,To..L INSPECTION DATE <g (1-b lfð Section 5: Hazardous Waste Tier Permit Treatment Program o Routine 0 Combined ,œ Joint Agency 0 Multi-Agency 0 Complaint 0 Re-inspection Onsite Treatment Unit Tier: (':,:\ Unit number & name: fVl.,AI¡J /sr, OK (¿t'I1,/Cí o PBR 0 CA lØ CESW~ V1J IT':» 0 CESQT 0 CEL 0 CECL OPERATION C V COMMENTS All hazardous wastes treated are generated onsite / Onsite treatment notification fonns available and complete .¡ On site treatment unit tier and/or count is correct on fonn vi Unit number is correct on notification tonn ,/ Number of tanks or containers is correct on fonn V Treatment monthly volume is correct on fonn ,/ Waste identification & treatment is correct on fonn v' Complies with residual management requirements ¡/ 50uac.€: (Z60 lJ(,.'" (ON /- Ll ST' Properly closed a treatment unit ,/ ,. "- Complies with tank and containment certification v" '" ~éß ÑI>Ý _l" LA~'-) 0 ") z.: ~ . OoOffN/I1€N'í éR Developed and maintains a written inspection log ,/' Meets pretreatment standards for waste discharge 1/ Developed and maintains a Closure Plan on site (PBR) Developed and maintains a Waste Analysis Plan and Waste Analysis Records (PBR) Maintains Training Records on site (PBR) Obtained local penn its for treatment operations (PBR) Identifies and labels Treatment Units (PBR) C=Compliance V=Violation Inspector:~VI.o,(Z.O W (Ñ~ S Office of Environmental Services (805) 326-3979 5&V'(~ ßY CA, (\I ~D. tMÞ<.(T,,.,)f>I,J& White· Env. Svcs. CESW=Conditionally exempt specified wast tream CESQT=Conditionally exempt small quantity PBR=Permit by rule Pink - Business Copy esponsible Party CA=Conditionallyauthorized CECL=Conditionally exempt commercial laundry CEL=Conditionally exempt limited e e Catholic Healthcare West +CHW RECEIVED NOV 1 6 1998 CHW Central California 2215 Truxtun Avenue Bakersfield, CA 93301 805 632-5000 Telephone 805 327-2592 Facsimile :By: November 6, 1998 Steve Underwood Environmental Services 1715 Chester Avenue Bakersfield, CA 93301 RE: BUSINESS PLAN; MERCY HEALTHCARE, BAKERSFIELD Dear Steve, Here is the business plan for Mercy Healthcare, which is located at 2215 Truxtun Avenue, Bakersfield, CA 93301. I have signed the statement and have highlighted those areas that need correction. They are as foIIows: Page 2 - need to delete Sterilant Mixture (listed twice - delete both entries) Page 10 - need to delete Sterilant Mixture, Ethylene Oxide, and Freon 12 Next page after 10 (no number) - delete same items as on page 10 Page 17 - need to delete 30.00 percent Acetone Page 26 - change PFS to BFI Page 27 - Patient beds should be changed to 144 acute care and 50 skiIIed nursing; or total of 194 beds Last page - need to change the number of employees to 1,000 Please contact me at (805) 632-5572 if you have any questions regarding these changes or the business plan as submitted. Thanks for your help and cooperation in processing this report. Sincerely, ~ Kitty Brewer, Safety Coordina r H:\ WORD\SAFTYMGT\BusinessPlan.98.doc Bakersfield Memorial Hospital Memorial Center Mercy Hospital Mercy Southwest Hospital e e I, ~~1s~~ Do hereby œ11l1'y iha1I IMMI fe'.'· .0, '0 :; ?ry,-:!l'l'1sd hWZtalf«J100S m®~iSlfVSli~ m~f;~@®- mE';>' "~I :·'1 :~:.; .~~'\~ ___._and ~hG'~ ¡~ along WÒ~~ t~';¥t" ~. -'L.r.ìr.ess) @í1Y cNf>eMir.ns ~('Y13~!t... ãJ oom[Q)~®Q® @lfiiJ(QJ OO¡T®©~ Mtâ1fiÏ)ø ~~em®8"ùß B2>~®fiÏ) ~©rr my ~©i~~\&o :~ ~~.... .~-~. e e MERCY HOSPITAL SiteID: 215-000-000628 Manager : Location: 2215 TRUXTUN AVE City BAKERSFIELD BusPhone: Map : 102 Grid: 25D (805) 327 -33 71 CommHaz : Moderate FacUnits: 34 AOV: CommCode: BAKERSFIELD STATION 01 EPA Numb: CAD981400237 SIC Code:8062 DunnBrad:95-166-0858 Emergency Contact / Title Emergency Contact / Title KITTY BREWER / SAFETY COORD PAT JACOBS / MANAGER Business Phone: (805) 632-5572x Business Phone: (805) 663-6608x 24-Hour Phone : (805) 632-5000x 24-Hour Phone : (805) 632-5000x Pager Phone : (805) 632-3287x Pager Phone : (805) 334-6461x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 2215 TRUXTUN AVE State: CA City : BAKERSFIELD Zip : 93301 Owner CATHOLIC HEALTH CARE WEST Phone: (415) 397-1823x Address : 1700 MONTGOMERY ST 300 State: CA City : SAN FRANCISCO Zip : 94111 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: '\ THIS IS A UST AND WASTE TREATMENT SITE AND REQUIRES JOINT INSPECTIONS. PLEASE CALL ENV SVCS TO SCHEDULE THESE INSPECTIONS WITH HOWARD WINES AND STEVE UNDERWOOD. .' f= Hazmat Inventory One Unified List l p== As Designated Order All Materials at Site l Hazmat Common Name. . . SpecHaz EPA Hazards DailyMax MCP OXYGEN F P IH G 3600 FT3 Low DICHLORODIFLOROMETHANE F P IH G 635 FT3 Min XENON, XE 133 GAS F P IH G 250 FT3 Min OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 46 FT3 Low SUN GLOH L 48 GAL UnR OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 23 FT3 Low OXYGEN F P IH G 92 FT3 Low OXYGEN F P IH G 23 FT3 Low ALCOHOL, ISOPROPYL DH L 10 GAL Mod COMPRESSED GAS CYLINDERS F P IH G 209 FT3 Ext -1- 09/15/1998 ~~~ e e f MERCY HOSPITAL SiteID: 215-000-000628 ì f= Hazmat Inventory One Unified List ì p== As Designated Order All Materials at Site ì Hazmat Common Name.. . speCHaz EPA Hazards Frm I DailyMax Unit MCP NITROUS OXIDE F P IH G 700 LBS Hi ALCOHOL, ISOPROPYL DH L 1 GAL Mod NITROGEN P R IH G 6312 FT3 Min STERILANT MIXTURE F P IH G 1026 FT3 Ext STERILANT MIXTURE F P IH G 1539 FT3 Ext DIESEL TANKS F IH DH L 8000 GAL Low TRICHLOROMONOFLUOROMETHANE F P IH G 274 FT3 Min C02/02/N2 F P IH G 209 FT3 Low OXYGEN COMPRESSED F P IH G FT3 Low HELIUM F P IH DH G 22407 FT3 Min FREON 22 F P IH G 670 FT3 Low FORMALIN SOLUTION F IH DH L 20 GAL Hi CO2 F P IH G 437 FT3 Min CHLORODIFLOUROMETHANE F P IH G 1116 FT3 Low ALCOHOL DH L 32 GAL Mod C02/H2/N2 F P IH G 209 FT3 Ext PAINT THINNER F L 5 GAL Hi NITROGEN 304 F P IH G 6080 FT3 Min ALCOHOL DH L 48 GAL Mod C02/N2 F P IH G 209 FT3 Min OXYGEN 281 F P IH G 5620 FT3 Low ACETYLENE 130 F P IH G 1300 FT3 Hi HELIUM NON-FLAMMABLE P IH G 1250 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500 LBS Min HYDROGEN/CARBON DIOXIDE/NITROGE F P IH G 100 FT3 Ext ALCOHOL IH L 10 GAL Mod OXYGEN COMPRESSED 250 CF F P IH G 2500 FT3 Low CARBON DIOXIDE USP, OXYGEN USP F P IH G 160 GAL Low COMPRESSED GAS NON-FLAMMABLE 25 P IH G 1500 FT3 UnR COMPRESSED AIR 250CF F P IH G 2000 FT3 Min NITROUS OXIDE F P IH G 200 FT3 Hi -2- 09/15/1998 0- I~ e e F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME OXYGEN SiteID: 215-000-000628 ì Facility Unit: EXTERIOR CAMPUS ì Days On Site 365 Location within this Facility Unit A STREET Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Below Ambient Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 3600.00 FT3 Daily Average 1800.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME DICHLORODIFLOROMETHANE Facility Unit: MAIN BLDG 1ST FLOOR ì Days On Site 365 Location within this Facility Unit BOILER ROOM Map: Grid: CAS # 75-71-8 - TYPE Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 635.00 FT3 Daily Average 317.00 FT3 %Wt. RS CAS # 100.00 Dichlorodifluoromethane No 75718 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -3- 09/15/1998 ,,"- e e F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME XENON, XE 133 GAS SiteID: 215-000-000628 ì Facility Unit: MAIN BLDG 2ND FLOOR ì Days On Site 365 Location within this Facility Unit HOT LAB NUCLEAR MEDICINE Map: Grid: CAS # 7440633 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE GLASS CONTAINER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 250.00 FT3 Daily Average 125.00 FT3 I l~~~öolxenon HAZARDOUS COMPONENTS CAS # I 7440633 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME OXYGEN Facility Unit: MAIN BLDG 3RD FLOOR ì Days On Site 365 Location within this Facility Unit MED STORAGE ROOM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS HAZ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ARD ASSESSMENTS -4- 09/15/1998 , .. e e F MERCY HOSPITAL f= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME OXYGEN SiteID: 215-000-000628 ì Facility Unit: MAIN BLDG 5TH FLOOR ì Days On Site 365 Location within this Facility Unit SUPPLY CLOSET Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS f= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME SUN GLOH Facility Unit: WEST TOWER 1ST FLOOR ì Days On Site 365 Location within this Facility Unit DIETARY CLEANING SUPPLY Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 48.00 GAL Daily Average 24.00 GAL %Wt. I HAZARDOUS COMPONENTS G CAS # TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARD ASSESSMENTS -5- 09/15/1998 e e F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 ì Facility Unit: WEST TOWER 2ND FLOOR ì Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 46.00 FT3 Daily Average 23.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: WEST TOWER 3RD FLOOR ì Days On Site 365 Location within this Facility Unit SUPPLY RM BY NURSING STA Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 23.00 FT3 Daily Average 12.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS -6- 09/15/1998 · . e e SiteID: 215-000-000628 ì Facility Unit: WEST TOWER 4TH FLOOR ì F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME OXYGEN Days On Site 365 Location within this Facility Unit EQUIPMENT RM W HALLWAY Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 92.00 FT3 Daily Average 41.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME OXYGEN Facility Unit: WEST TOWER 5TH FLOOR ì Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 23.00 FT3 Daily Average 12.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -7- 09/15/1998 , ' e e SiteID: 215-000-000628 1 Facility Unit: PATHOLOGY LAB/RADIOLOGY ì F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME ALCOHOL, ISOPROPYL Days On Site 365 Location within this Facility Unit S WALL STORAGE CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %Wt. RS CAS # 99.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME COMPRESSED GAS CYLINDERS Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO 1 Days On Site 365 Location within this Facility Unit LAB CENTER RM MICRO RM Map: Grid: CAS # - TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 209.00 FT3 Daily Average 104.00 FT3 %Wt. RS CAS # 72.00 Hydrogen No 1333740 10.30 Carbon Dioxide No 124389 17.70 Nitrogen No 7727379 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext HAZARD ASSESSMENTS -8- 09/15/1998 e e F MERCY HOSPITAL p= Inventory Item 0001 ¡:::::= COMMON NAME / CHEMI CAL NAME NITROUS OXIDE SiteID: 215-000-000628 ì Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ì Days On Site 365 Location within this Facility Unit STORAGE RM Map: Grid: CAS # 10024-97-2 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container LBS AMOUNTS AT THIS LOCATION Daily Maximum 700.00 LBS Daily Average 350.00 LBS %Wt. RS CAS # 100.00 Nitrous Oxide No 10024972 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Facility Unit: CARDIAC REHAB CENTER ì Days On Site 365 Location within this Facility Unit NWALL COUNTER & CLOSET Map: Grid: CAS # 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum 1. 00 GAL Daily Average 0.50 GAL %Wt. RS CAS # 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod HAZARD ASSESSMENTS -9- 09/15/1998 e e SiteID: 215-000-000628 ì Facility Unit: MRI ì F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME NITROGEN Days On Site 365 Location within this Facility Unit MRI UNIT TRUXTUN & A ST Map: Grid: CAS # 7782-37-9 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 6312.00 FT3 Daily Average 9468.00 FT3 %Wt. RS CAS # 100.00 Nitrogen No 7727379 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P R IH / / / Min HAZARD ASSESSMENTS f= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME STERILANT MIXTURE Facility Unit: DECONTAMINATION ROOM ì Days On Site 365 Location within this Facility Unit DECONTAMINATION ROOM Map: Grid: CAS # - TYPE Mixture PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1026.00 FT3 Daily Average 684.00 FT3 %Wt. RS CAS # 12.00 Ethylene Oxide (EPA) Yes 75218 88.00 Freon 12 No 75718 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext HAZARD ASSESSMENTS -10- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0001 ëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: GAS STORAGE ROOM ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o STERILANT MIXTURE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o GAS CYLINDER STORAGE ROOM Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o äëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 äëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1539.00 FT3 0 1368.00 FT3 0 äëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 12.000Ethylene Oxide (EPA) °Yeso 752180 o 88.000Freon 12 0No 0 757180 äëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj e e íë Inventory Item íëë COMMON NAME / o DIESEL TANKS o 0002 ëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: EXTERIOR CAMPUS ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o SOUTH OF BOILER ROOM 0 CAS # 0 o 0 68476-34-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Pure 0 Ambient 0 Ambient 0 UNDER GROUND TANK 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 8000.00 GAL 0 4000.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSO CAS # 0 o 100.000Diesel Fuel No.2 0No 0 684763020 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH DH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -11- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0002 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o TRICHLOROMONOFLUOROMETHANE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-69-4 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 274.00 FT3 0 137.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Trichlorotrifluoroethane 0No 0 761310 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o Location within this Facility Unit o LAB MICRO 0002 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: íë Inventory Item íëë COMMON NAME / o C02/02/N2 o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 5.000Carbon Dioxide 0No 0 1243890 o 20.0000xygen, Compressed 0No 0 77824470 o 75.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -12- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0002 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN COMPRESSED 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o THRU OUT SURGERY AREA 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 FT3 0 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0002 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Facility Unit: MRI ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HELIUM 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o MRI UNIT TRUXTUN & A ST 0 CAS # 0 o 0 7440-59-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Below Ambient 0 Below Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 22407.00 FT3 0 22407.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Helium 0No 0 74405970 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH DH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -13- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0003 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FREON 22 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-45-6 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 670.00 FT3 0 335.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Chlorodifluoromethane 0No 0 754560 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0003 ëëëëëëëëëëëëëëëë Facility Unit: PATHOLOGY LAB/RADIOLOGY ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o FORMALIN SOLUTION 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o PATH LAB 0 CAS # 0 o 0 50-00-0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 20.00 GAL 0 16.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 10.000Formaldehyde (EPA) °Yeso 500000 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F IH DH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -14- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0003 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o C02 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o LAB 0 CAS # 0 o 0 124-38-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 437.00 FT3 0 218.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Carbon Dioxide 0No 0 1243890 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0004 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o CHLORODIFLOUROMETHANE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 75-45-6 0 äëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 äëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1116.00 FT3 0 558.00 FT3 0 äëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Chlorodifluoromethane 0No 0 754560 äëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 äëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -15- 09/15/1998 · ' e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0004 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o ALCOHOL 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o PURCHASING WAREHOUSE C Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 32.00 GAL 0 16.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 99.000Isopropyl Alcohol 0No 0 676300 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 DH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item íëë COMMON NAME / o C02/H2/N2 o 0004 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 ûááááááááááááááááÇ o CAS # 0 Map: Grid: o Location within this Facility Unit o LAB-MAIN o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient _ 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 5. 00 o Carbon Dioxide 0No 0 1243890 o 10.000Hydrogen 0No 0 13337400 o 80. OOONitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -16- 09/15/1998 · e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0005 ëëëëëëëëëëëëëëëë Facility Unit: PAINT/CONSTRUCTION SHOP ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o PAINT THINNER 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o PAINT LOCKER Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 METAL CONTAINR-NONDRUM 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 5.00 GAL 0 5.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSO CAS # ° o 30.000Acetone 0No 0 676410 o 20.000Toluene 0No 0 1088830 o 10.000n-Propanol 0No 0 712380 o 10.000n-Butyl Acetate 0No 0 1238640 o 5.000Xylene, Mixed 0No 0 13302070 o 5.000Methanol 0No 0 675610 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -17- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0005 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROGEN 304 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 7727-37-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 6080.00 FT3 0 3040.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0005 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o ALCOHOL 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o PURCHASING WAREHOUSE C 0 CAS # 0 o 0 67-63-0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 48.00 GAL 0 24.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 70.000Isopropyl Alcohol 0No 0 676300 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 DH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -18- 09/15/1998 , . e - í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0005 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o C02/N2 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o LAB-MAIN Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 209.00 FT3 0 104.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 10.000Carbon Dioxide 0No 0 1243890 o 90.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ íë Inventory Item íëë COMMON NAME / o OXYGEN 281 o 0006 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o Days On Site 0 o 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëë¡ íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 5620.00 FT3 0 2810.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëë¡ íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëë¡ -19- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0007 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o ACETYLENE 130 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o BOILER ROOM 0 CAS # 0 o 0 74-86-2 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Above Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1300.00 FT3 0 650.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Acetylene 0No 0 748620 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0007 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o HELIUM NON-FLAMMABLE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 7440-59-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1250.00 FT3 0 625.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Helium 0No 0 74405970 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -20- 09/15/1998 e e í MERCY HOSPITAL ëêëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0008 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROGEN NON-FLAMMABLE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 7727-37-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Solid 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o LBS 0 500.00 LBS 0 250.00 LBS 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj o 0009 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ DIOXIDE/NITROGEN 0 Days On Site 0 o 365 0 íë Inventory Item íëë COMMON NAME / o HYDROGEN/CARBON o Location within this Facility Unit o STORAGE RM NSIDE HALLWAY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Mixture 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 100.00 FT3 0 50.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 4. 70 o Hydrogen 0No 0 13337400 o 10.300Carbon Dioxide 0No 0 1243890 o 84.900Nitrogen 0No 0 77273790 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Ext 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -21- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 ¡ íë Inventory Item 0010 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o ALCOHOL 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o RESPIRATORY THERAPY 0 CAS # 0 o 0 67-63-0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëf íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Liquid 0 Mixture 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 10.00 GAL 0 5.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 70.000Isopropyl Alcohol 0No 0 676300 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëf íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 IH 0 / / / 0 0 Mod 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëf íë Inventory Item 0010 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o OXYGEN COMPRESSED 250 CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 7782-44-7 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëf íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 2500.00 FT3 0 1250.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëf íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëf -22- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 i íë Inventory Item 0011 ëëëëëëëëëëëëëëëëëëëë Facility Unit: MAIN BLDG 1ST FLOOR ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o CARBON DIOXIDE USP, OXYGEN USP 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o RESPIRATORY THERAPY 0 CAS # 0 o 0 124-35-9 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PLASTIC CONTAINER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o GAL 0 160.00 GAL 0 80.00 GAL 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 5.000Carbon Dioxide 0No 0 1243890 o 95.0000xygen, Compressed 0No 0 77824470 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Low 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0011 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o COMPRESSED GAS NON-FLAMMABLE 250CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit o STORAGE RM NSIDE HALLWAY Map: Grid: ûááááááááááááááááÇ o CAS # 0 o 000 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 1500.00 FT3 0 750.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 P IH 0 / / / 0 0 UnR 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -23- 09/15/1998 · . e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 j íë Inventory Item 0012 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o COMPRESSED AIR 250CF 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 0 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 2000.00 FT3 0 1000.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RSo CAS # 0 o 100.000Air 0No 0 00 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Min 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj íë Inventory Item 0013 ëëëëëëëëëëë Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ¡ íëë COMMON NAME / CHEMICAL NAME ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëîëëëëëëëëëëëëëëëë¡ o NITROUS OXIDE 0 Days On Site 0 o 0 365 0 o Location within this Facility Unit Map: Grid: ûááááááááááááááááÇ o STORAGE RM NSIDE HALLWAY 0 CAS # 0 o 0 10024-97-2 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëj íë STATE ëîë TYPE ëëëîëë PRESSURE ëëëî TEMPERATURE ëëîëëëë CONTAINER TYPE ëëëëë¡ o Gas 0 Pure 0 Ambient 0 Ambient 0 PORT. PRESS. CYLINDER 0 åëëëëëëëëëüëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëëëëëëëëëëëëëëëëëëëëî AMOUNTS AT THIS LOCATION ëëëëëëëëëëëëëëëëëëëëëëëëë¡ o Largest Container 0 Daily Maximum 0 Daily Average 0 o FT3 0 200.00 FT3 0 100.00 FT3 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëëëëîëëëëëëëëëëëëëë HAZARDOUS COMPONENTS ëëëëëëëëëëëëëëîëëëîëëëëëëëëëëëëëëë¡ o %Wt. 0 0 RS 0 CAS # 0 o 100.000Nitrous Oxide 0No 0 100249720 åëëëëëëëüëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëüëëëüëëëëëëëëëëëëëëëj íëëëëëëëîëëëîëëëëëëîëëëëëëëëëëë HAZARD ASSESSMENTS ëëëîëëëëëëëëëîëëëëëëëëîëëëëë¡ 0TSecretO RSoBioHazo Radioactive/Amount 0 EPA Hazards 0 NFPA 0 USDOT# 0 MCP 0 o No 0No 0 No 0 No/ Curies 0 F P IH 0 / / / 0 0 Hi 0 åëëëëëëëüëëëüëëëëëëüëëëëëëëëëëëëëëëëëëëëüëëëëëëëëëëëëëüëëëëëëëëëüëëëëëëëëüëëëëëj -24- 09/15/1998 > ~ e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Notif./Evacuation/Medical ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Agency Notification ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o CALL 911 o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Employee Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM 0 o SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING 0 o ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN 0 o EVENT OF INTERNAL DISASTER DECLARATION. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Public Notif./Evacuation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY) . o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Emergency Medical Plan ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o MERCY HOSPITAL EMERGENCY DEPARTMENT o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -25- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Mitigation/Prevent/Abatemt ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Release Prevention ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 j o 0 o ON GOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY WHICH INCLUDES MONTHLY FIRE 0 o DRILLS - FIRE EXTINGUISHER INSPECTIONS MONTHLY INSPECTIONS OF FIRE 0 o SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE 0 o BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED 0 o EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC. AVAILABLE 24 HOURS TO ALL 0 o EMPLOYEES. 0 o o o HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS o USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN o SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL o CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF o SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Release Containment ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 i o 0 o SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE 0 o THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE 0 o AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS 0 o AVAILABLE IN ENGINEERING DEPT. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Clean Up ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 j o 0 o MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED 0 o WITH CALPI INC. MINOR CLEANUP BY INDIVIDUAL DEPARTMENTS. CLEAN-UP AND 0 o DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Other Resource Activation ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/20/1992 j o 0 o AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR 0 o ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL 0 o SERVICES. WASTE DISPOSAL BY CONTRACT ~ INC. 0 o BFI 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf -26- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Site Emergency Factors ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Special Hazards ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o RADIOISATOPES ON HAND RADIATION HAZARD o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëë Utility Shut-Offs ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o A} GAS - SOUTH WALL EXTERIOR BOILER ROOM o B} ELECTRICAL - SOUTH WALL INTERIOR BOILER ROOM o C} WATER - SOUTH OF SOUTH EXTERIOR WALL ADJACENT TO BOILER ROOM o D} SPECIAL - NONE o E} LOCK BOX - NO o o o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëë Fire protec./Avail. Water ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS THROUGHOUT ENTIRE FACILITY. 0 o WEST TOWER AND TREATMENT DIAGNOSTIC BUILDING FULLY SPRINKLERED. MAIN 0 o BUILDING PARTIAL SPRINKLER ED. DRY STAND PIPES IN MAIN BUILDING - WEST TOWER 0 o AND TREATMENT/DIAGNOSTIC BUILDINGS. IN HOUSE RESPONSE TEAM TO ALL AREAS. 0 o WET STANDPIPES IN SKILLED NURSING FACILITY. 0 o 0 o FIRE HYDRANT - CITY FIRE HYDRANTS SURROUND ENTIRE FACILITY. FIRE DEPARTMENT 0 o CONNECTIONS ON SOUTH WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG 0 o NEAR OLD MAIN ENTRANCE TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE 0 o LOCATED ON A STREET PARKING LOT ENTRANCE. FIRE DEPT SPRINKLER CONNECTION 0 o FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS LOCATED ON 16TH ST MOUNTED ON 0 o CORNER OF BOILER ROOM BLDG NEXT TO SERVICE ENTRANCE BY TRASH COMPACTOR. 0 o 0 åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj íëëëëë Building Occupancy Level ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 i o 0 o 276 PATIENT BEDS o 1100 EMPLOYEES o ROTATING SHIFTS o o o o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëj -27- 09/15/1998 e e í MERCY HOSPITAL ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-000628 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 10/18/1995 ¡ o 0 o WE HAVE 1320 EMPLOYEES AT THIS FACILITY o o o o WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE o o o o BRIEF SUMMARY OF TRAINING: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL 0 o EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, 0 o HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND 0 o DEPARTMENT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION 0 o DAY (8 HRS) . 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëë Page 2 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ 0 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf íëëëëë Held for Future Use ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë¡ o 0 o o åëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëf MERCY HOSPITAL HECE!VE~ ~---~ \\ ,~~~~W~ \ , ¡ SiteID: 215-000-000628 " '. , 1 4 '~t.. ,'~- Manager : Location: 2215 TRUXTUN AV City BAKERSFIELD ';1" " ", .,:;: BusPhon ,_Jf~H~ _ .::.;.l 2 Grid: 25D (805) 327-3371 CommHaz : Moderate FacUnits: 34 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code:8062 EPA Numb: DunnBrad:95-166-0858 Emergency Contact / Title PAT JACOBS 1 MANAGER 632 5640xS5'rd-.. Business Phone: (805) 663-6608x 24-Hour Phone: (805) 632-5000x Pager Phone : (~o5J 33'-( - (Ô~CR lx Hazmat Hazards: Fire Press React ImmHlth DelHlth Agency-Defined Topic Title f= ~azmat Inventory One Unified List 1 ~ MCP+DailyMax Order All Materials at Site 1 Hazmat Common Name.. . SpecHaz EPA Hazards DailyMax MCP STERILANT MIXTURE F P IH G 1539 FT3 Ext STERILANT MIXTURE F P IH G 1026 FT3 Ext COMPRESSED GAS CYLINDERS F P IH G 209 FT3 Ext C02/H2/N2 F P IH G 209 FT3 Ext HYDROGEN/CARBON DIOXIDE/NITROGEN F P IH G 100 FT3 Ext ACETYLENE 130 F P IH G 1300 FT3 Hi NITROUS OXIDE F P IH G 700 LBS Hi NITROUS OXIDE F P IH G 200 FT3 Hi FORMALIN SOLUTION F IH DH L 20 GAL Hi PAINT THINNER F L 5 GAL Hi ALCOHOL DH L 48 GAL Mod ALCOHOL DH L 32 GAL Mod ALCOHOL IH L 10 GAL Mod ALCOHOL, ISOPROPYL DH L 10 GAL Mod ALCOHOL, ISOPROPYL DH L 1 GAL Mod DIESEL TANKS F IH DH L 8000 GAL Low OXYGEN 281 F P IH G 5620 FT3 Low OXYGEN F P IH G 3600 FT3 Low OXYGEN COMPRESSED 250 CF F P IH G 2500 FT3 Low CHLORODIFLOUROMETHANE F P IH G 1116 FT3 Low F;REON 2·~ F P IH G 670 FT3 Low C02/02/N2,' F P IH G 209 FT3 Low CARBON DIOXIDE USP, OXYGEN USP F P IH G 160 GAL Low OXYGEN· F P IH G 92 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 46 FT3 Low OXYGEN F P IH G 23 FT3 Low -1- 07/2311997' .-, , "- '" "'" ~. , """"'-.. 1 1 - "" ') - I f,S+kf I Hc\\:- (~+k 7ft¡t10 U ,?! t.l fed ).. vhfnt icf\{ .f- ecJl)(W~tJ fldf1 -før tf;1c.V'cý HlJ~l-ktr. (J(Co.SL He k ~(' lit t(( ( ctJ ~I e.. tit) td t!J t- C'?tu "a (s j " ", , ------ ---- ~ r -' f MERCY HOSPITAL SiteID: 215-000-000628 =¡ F Hazmat Inventory One Unified List =¡ p== MCP+DailyMax Order All Materials at Site =¡ Hazmat Common Name.. . SpecHaz EPA Hazards DailyMax MCP OXYGEN F P IH G 23 FT3 Low OXYGEN COMPRESSED F P IH G FT3 Low HELIUM F P IH DH G 22407 FT3 Min NITROGEN P R IH G 6312 FT3 Min NITROGEN 304 F P IH G 6080 FT3 Min COMPRESSED AIR 250CF F P IH G 2000 FT3 Min HELIUM NON-FLAMMABLE P IH G 1250 FT3 Min DICHLORODIFLOROMETHANE F P IH G 635 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500 LBS Min CO2 F P IH G 437 FT3 Min TRICHLOROMONOFLUOROMETHANE F P IH G 274 FT3 Min XENON, XE 133 GAS F P IH G 250 FT3 Min C02/N2 F P IH G 209 FT3 Min COMPRESSED GAS NON-FLAMMABLE 250 P IH G 1500 FT3 UnR SUN GLOH L 48 GAL UnR ~~~~.!)@ ~@~ œ¡ij\í? i~1Jill ~ M~® f®VU®t0J'~ ~h® ~~~ac~oo ~~i§lfd©UJ~ m~~®fIi~!$ m~1FR~@®~ li1!eiì~ ~¡~rì ~© 00 ftUì§ì~ ü~ ~¡©~ W~U"u lQ)~~ft® ~OO OOIT®~ m®&1~ ~~~m®f]ft ~!~f] ~(\)JU' Mlf ~©i~DiWo ~'-~~'\ -2- 07/23/1997 ~-- ,/~ I '" ?' j F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME STERILANT MIXTURE SiteID: 215-000-000628 1 Facility Unit: GAS STORAGE ROOM 1 Days On Site 365 Location within this Facility Unit GAS CYLINDER STORAGE ROOM CAS# STATE -------= TYPE Gas Mixture PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AM N Largest Container Daily Maximum Daily Average FT3 1539.00 FT3 1368.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 OU TS AT THIS LOCATION %Wt. EHS CAS# 12.00 E-t l+y 1 C I'l e üxide (EPA) ¥e6 t-\CI 75218 ('\('\ ~ , " T\T~ 75718 ~~.~~ J. ~ ~ ~.. ~~ HAZARDOUS COMPONENTS ."f -3- 07/23/1997 v1 ç. 1" j F MERCY HOSPITAL f= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME STERILANT MIXTURE SiteID: 215-000-000628 ì Facility Unit: DECONTAMINATION ROOM ì Days On Site 365 Location within this Facility Unit DECONTAMINATION ROOM CAS# STATE - TYPE Gas Mixture PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 1026.00 FT3 684.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %wt. ~ ~-r~ ~~~~~ï~01{ià¿ HAZARDOUS COMPONENTS ~ Yes No CAS# 752181 75718 (CFA) -4- 07/23/1997 r j F MERCY HOSPITAL f= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME COMPRESSED GAS CYLINDERS SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO 1 Days On Site 365 Location within this Facility Unit LAB CENTER RM MICRO RM CAS# STATE - TYPE Gas Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUN AT THIS LOCA Largest Container Daily Maximum Daily Average FT3 209.00 FT3 104.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 TS TION %Wt. EHS CAS# 72.00 Hydrogen No 1333740 10.30 Carbon Dioxide No 124389 17.70 Nitrogen No 7727379 HAZARDOUS COMPONENTS -5- 07/23/1997 L j F MERCY HOSPITAL p= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME C02/H2/N2 SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ Days On Site 365 Location within this Facility Unit LAB-MAIN CAS# STATE - TYPE Gas Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 209.00 FT3 104.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HA ARDOUS COMPO NTS %Wt. EHS CAS# 5.00 Carbon Dioxide No 124389 10.00 Hydrogen No 1333740 80.00 Nitrogen No 7727379 z NE -6- 07/23/1997 r F MERCY HOSPITAL p= Inventory Item 0009 F== COMMON NAME / CHEMICAL NAME HYDROGEN/CARBON DIOXIDE/NITROGEN SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# STATE - TYPE Gas Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 100.00 FT3 50.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZAR S CO EN %Wt. EHS CAS# 4.70 Hydrogen No 1333740 10.30 Carbon Dioxide No 124389 84.90 Nitrogen No 7727379 DOU MPON TS -7- 07/23/1997 /1 Î F MERCY HOSPITAL p= Inventory Item 0007 = COMMON NAME / CHEMICAL NAME ACETYLENE 130 SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 74-86-2 STATE - TYPE Gas Pure ' PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 1300.00 FT3 650.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %wt. EHS CAS# 100.00 Acetylene No 74862 HAZARDOUS COMPONENTS -8- 07/23/1997 ì F MERCY HOSPITAL f= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME NITROUS OXIDE SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM CAS# 10024-97-2 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average LBS 700.00 LBS 350.00 LBS Maximum Stored Maximum Open Use Maximum Closed Use LBS LBS LBS AMOUNTS AT THIS LOCATION HAZARDOUS COMPON NTS %Wt. EHS CAS# 100.00 Nitrous Oxide No 10024972 E -9- 07/23/1997 'ì F MERCY HOSPITAL f= Inventory Item 0013 == COMMON NAME / CHEMICAL NAME NITROUS OXIDE SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# 10024-97-2 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 200.00 FT3 100.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Nitrous Oxide No 10024972 HAZARDOUS COMPONENTS -10- 07/23/1997 'ï, F MERCY HOSPITAL f= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME FORMALIN SOLUTION SiteID: 215-000-000628 ì Facility Unit: PATHOLOGY LAB/RADIOLOGY ì Days On Site 365 Location within this Facility Unit PATH LAB CAS# 50-00-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER AMOUNTS Largest Container Daily Maximum Daily Average GAL 20.00 GAL 16.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AT THIS LOCATION HAZARDOUS CO %Wt. EHS CAS# 10.00 Formaldehyde (EPA) Yes 50000 MPONENTS -11- 07/23/1997 I it F MERCY HOSPITAL f= Inventory Item 0005 == COMMON NAME / CHEMICAL NAME PAINT THINNER SiteID: 215-000-000628 ~ Facility Unit: PAINT/CONSTRUCTION SHOP ~ Days On Site 365 Location within this Facility Unit PAINT LOCKER CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 5.00 GAL 5.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL %Wt. EHS CAS# 30.00 Acetone No 67641 20.00 Toluene No 108883 10.00 n-Propanol No 71238 10.00 n-Butyl Acetate No 123864 5.00 Xylene, Mixed No 1330207 5.00 Methanol No 67561 HAZARDOUS COMPONENTS -12- 07/23/1997 · F MERCY HOSPITAL p= Inventory Item 0005 = COMMON NAME / CHEMICAL NAME ALCOHOL SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 1 Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C CAS# 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 48.00 GAL 24.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 70.00 Isopropyl Alcohol No 67630 -13- 07/23/1997 J F MERCY HOSPITAL p= Inventory Item 0004 F= COMMON NAME / CHEMICAL NAME ALCOHOL SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit PURCHASING WAREHOUSE C CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container Daily Maximum Daily Average GAL 32.00 GAL 16.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 99.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS -14- 07/23/1997 '> F MERCY HOSPITAL f= Inventory Item 0010 = COMMON NAME / CHEMICAL NAME ALCOHOL SiteID: 215-000-000628 ì Facility Unit: MAIN BLDG 1ST FLOOR l Days On Site 365 Location within this Facility Unit RESPIRATORY THERAPY CAS# 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container Daily Maximum Daily Average GAL 10.00 GAL 5.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 70.00 Isopropyl Alcohol No 67630 HAZARDOUS COMPONENTS -15- 07/23/1997 ) F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL SiteID: 215-000-000628 l Facility Unit: PATHOLOGY LAB/RADIOLOGY l Days On Site 365 Location within this Facility Unit S WALL STORAGE CLOSET CAS# 67-63-0 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container Daily Maximum Daily Average GAL 10.00 GAL 5.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AMOUNTS AT THIS LOCATION HAZARD %Wt. EHS CAS# 99.00 Isopropyl Alcohol No 67630 OUS COMPONENTS -16- 07/23/1997 .. F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL SiteID: 215-000-000628 ~ Facility Unit: CARDIAC REHAB CENTER ~ Days On Site 365 Location within this Facility Unit NWALL COUNTER & CLOSET CAS# 67-63-0 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER AMOUNTS AT H S Largest Container Daily Maximum Daily Average GAL 1. 00 GAL 0.50 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL T I LOCATION HAZARDOUS 0 %Wt. EHS CAS# 70.00 Isopropyl Alcohol No 67630 C MPONENTS -17- 07/23/1997 /1 F MERCY HOSPITAL p= Inventory Item 0002 == COMMON NAME / CHEMICAL NAME DIESEL TANKS SiteID: 215-000-000628 ~ Facility Unit: EXTERIOR CAMPUS ~ Days On Site 365 Location within this Facility Unit SOUTH OF BOILER ROOM CAS# 68476-34-6 STATE - TYPE Liquid Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 8000.00 GAL 4000.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL %wt. EHS CAS# 100.00 Diesel Fuel No. 2 No 68476302 HAZARDOUS COMPONENTS -18- 07/23/1997 ~ F MERCY HOSPITAL p= Inventory Item 0006 == COMMON NAME / CHEMICAL NAME OXYGEN 281 SiteID: 215-000-000628 1 Facility Unit: MAIN BLDG 1ST FLOOR 1 Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 5620.00 FT3 2810.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -19- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 ~ Facility Unit: EXTERIOR CAMPUS ~ Days On Site 365 Location within this Facility Unit A STREET CASt 7782-44-7 r STATE T TYPE Gas Pure PRESSURE ---- TEMPERATURE Below Ambient Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container Daily Maximum Daily Average FT3 3600.00 FT3 1800.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CASt 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -20- 07/23/1997 F MERCY HOSPITAL f= Inventory Item 0010 == COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED 250 CF SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT HIS LOCATI Largest Container Daily Maximum Daily Average FT3 2500.00 FT3 1250.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 T ON %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -21- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE /1 I I SiteID: 215-000-000628 , Facility Unit: MAIN BLDG 1ST FLOOR, Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 75-45-6 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1116.00 FT3 558.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 %wt. EHS CAS# 100.00 Chlorodifluoromethane No 75456 HAZARDOUS COMPONENTS -22- 07/23/1997 SiteID: 215-000-000628 ì Facility Unit: MAIN BLDG 1ST FLOOR ì ~ I F MERCY HOSPITAL f= Inventory Item 0003 F== COMMON NAME / CHEMICAL NAME FREON 22 Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 75-45-6 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 670.00 FT3 335.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Chlorodifluoromethane No 75456 HAZARDOUS COMPONENTS -23- 07/23/1997 " f MERCY HOSPITAL f= Inventory Item 0002 F== COMMON NAME / CHEMICAL NAME C02/02/N2 SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ Days On Site 365 Location within this Facility Unit LAB MICRO CAS# - TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 209.00 FT3 104.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION H A DOUS ENT %Wt. EHS CAS# 5.00 Carbon Dioxide No 124389 20.00 Oxygen, Compressed No 7782447 75.00 Nitrogen No 7727379 AZ R COMPON S -24- 07/23/1997 .. F MERCY HOSPITAL f= Inventory Item 0011 = COMMON NAME / CHEMICAL NAME CARBON DIOXIDE USP, OXYGEN USP SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Location within this Facility Unit RESPIRATORY THERAPY CAS# 124-35-9 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container Daily Maximum Daily Average GAL 160.00 GAL 80.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AMOUNTS AT THIS LOCATION C %Wt. EHS CAS# 5.00 Carbon Dioxide No 124389 95.00 Oxygen, Compressed No 7782447 HAZARDOUS OMPONENTS -25- 07/23/1997 » F MERCY HOSPITAL f= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 9 Facility Unit: WEST TOWER 4TH FLOOR ~ Days On Site 365 Location within this Facility Unit EQUIPMENT RM W HALLWAY CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC AMOUNT HIS LO Largest Container Daily Maximum Daily Average FT3 92.00 FT3 41.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 S AT T CATION HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 -26- 07/23/1997 1" F MERCY HOSPITAL p= Inventory Item 0001 F= COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 9 Facility Unit: MAIN BLDG 3RD FLOOR 9 Days On Site 365 Location within this Facility Unit MED STORAGE ROOM CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 46.00 FT3 23.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 -27- 07/23/1997 ~ F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 5TH FLOOR ~ Days On Site 365 Location within this Facility Unit SUPPLY CLOSET CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 46.00 FT3 23.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Oxygen, Compressed No' 7782447 -28- 07/23/1997 / F MERCY HOSPITAL f= Inventory Item 0001 = COMMON NAME I CHEMICAL NAME OXYGEN SiteID: 215-000-000628 1 Facility Unit: WEST TOWER 2ND FLOOR 1 Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM CAS# 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 46.00 FT3 23.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -29- 07/23/1997 I F MERCY HOSPITAL p= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 ~ Facility Unit: WEST TOWER 3RD FLOOR 1 Days On Site 365 Location within this Facility Unit SUPPLY RM BY NURSING STA CAS# 7782-44-7 ~ATE ~ TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 23.00 FT3 12.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -30- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 215-000-000628 ~ Facility Unit: WEST TOWER 5TH FLOOR ~ Days On Site 365 Location within this Facility Unit NURSES STATION SUPPLY RM CAS# 7782-44-7 STATE -- TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 23.00 FT3 12.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -31- 07/23/1997 F MERCY HOSPITAL F Inventory Item 0002 = COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ Days On Site 365 Location within this Facility Unit THRU OUT SURGERY AREA CAS# 7782-44-7 STATE -- TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS L Largest Container Daily Maximum Daily Average FT3 FT3 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 OCATION %Wt. EHS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS -32- 07/23/1997 ~ F MERCY HOSPITAL f= Inventory Item 0002 == COMMON NAME / CHEMICAL NAME HELIUM SiteID: 215-000-000628 ~ Facility Unit: MRI ~ Days On Site 365 Location within this Facility Unit MRI UNIT TRUXTUN & A ST CAS# 7440-59-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Below Ambient Below Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATIO Largest Container Daily Maximum Daily Average FT3 22407.00 FT3 22407.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 N HAZARDOUS COMPONENTS ~ No CAS# I 7440597 I %Wt. I 100.00 Helium -33- 07/23/1997 F MERCY HOSPITAL f= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME NITROGEN SiteID: 215-000-000628 1 Facility Unit: MRI 1 Days On Site 365 Location within this Facility Unit MRI UNIT TRUXTUN & A ST CAS# 7782-37-9 --= TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 6312.00 FT3 9468.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Nitrogen No 7727379 -34- 07/23/1997 , / I F MERCY HOSPITAL f= Inventory Item 0005 = COMMON NAME I CHEMICAL NAME NITROGEN 304 SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR l Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 7727-37-9 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 6080.00 FT3 3040.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Nitrogen No 7727379 HAZARDOUS COMPONENTS -35- 07/23/1997 , F MERCY HOSPITAL f= Inventory Item 0012 = COMMON NAME / CHEMICAL NAME COMPRESSED AIR 250CF SiteID: 215-000-000628 9 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO 9 Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# o STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 2000.00 FT3 1000.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZARDOUS COMPONENTS ~ CAS# 01 Il¿~: ÖO I Air -36- 07/23/1997 " F MERCY HOSPITAL p= Inventory Item 0007 == COMMON NAME / CHEMICAL NAME HELIUM NON-FLAMMABLE SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# 7440-59-7 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 1250.00 FT3 625.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION HAZARDOUS COMPONENTS ~ CAS# I 7440597. Il~~~ÔO bum -37- 07/23/1997 .' / F MERCY HOSPITAL f= Inventory Item 0001 == COMMON NAME / CHEMICAL NAME DICHLORODIFLOROMETHANE SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 75-71-8 STATE ----:: TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container Daily Maximum Daily Average FT3 635.00 FT3 317.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %wt. EHS CAS# 100.00 Dichlorodifluoromethane No 75718 HAZARDOUS COMPONENTS -38- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0008 == COMMON NAME / CHEMICAL NAME NITROGEN NON-FLAMMABLE SiteID: 215-000-000628 l Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO l Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# 7727-37-9 r= ST~TE ~ TYPE SOlld Pure CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average LBS 500.00 LBS 250.00 LBS Maximum Stored Maximum Open Use Maximum Closed Use LBS LBS LBS ~ P~ESSURE ~ TEM~ERATURE ~ Amblent Amblent AMOUNTS AT THIS LOCATION HAZ %Wt. EHS CAS# 100.00 Nitrogen No 7727379 ARDOUS COMPONENTS -39- 07/23/1997 F MERCY HOSP ITAL p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME C02 SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ Days On Site 365 Location within this Facil¡ty Unit LAB CAS# 124-38-9 STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER H Largest Container Daily Maximum Daily Average FT3 437.00 FT3 218.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT T IS LOCATION %Wt. EHS CAS# 100.00 Carbon Dioxide No 124389 HAZARDOUS COMPONENTS -40- 07/23/1997 / F MERCY HOSPITAL p= Inventory Item 0002 === COMMON NAME / CHEMICAL NAME TRICHLOROMONOFLUOROMETHANE SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Location within this Facility Unit BOILER ROOM CAS# 75-69-4 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 274.00 FT3 137.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. EHS CAS# 100.00 Trichlorotrifluoroethane No 76131 HAZARDOUS COMPONENTS -41- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME XENON, XE 133 GAS SiteID: 215-000-000628 ~ Facility Unit: MAIN BLDG 2ND FLOOR ~ Days On Site 365 Location within this Facility Unit HOT LAB NUCLEAR MEDICINE CAS# 7440633 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE GLASS CONTAINER AMOUNTS AT THIS L C Largest Container Daily Maximum Daily Average FT3 250.00 FT3 125.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 o ATION HAZARDOUS COMPONENTS ~ CAS# I 7440633. I l~~:öolxenon -42- 07/23/1997 F MERCY HOSPITAL p= Inventory Item 0005 = COMMON NAME / CHEMICAL NAME C02/N2 SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ Location within this Facility Unit LAB-MAIN Days On Site 365 CAS# STATE - TYPE Gas Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 209.00 FT3 104.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 %Wt. EHS CAS# 10.00 Carbon Dioxide No 124389 90.00 Nitrogen No 7727379 HAZARDOUS COMPONENTS -43- 07/23/1997 , . F MERCY HOSPITAL p= Inventory Item 0011 F= COMMON NAME / CHEMICAL NAME COMPRESSED GAS NON-FLAMMABLE 250CF SiteID: 215-000-000628 ~ Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ Days On Site 365 Location within this Facility Unit STORAGE RM NSIDE HALLWAY CAS# o STATE - TYPE Gas Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container Daily Maximum Daily Average FT3 1500.00 FT3 750.00 FT3 Maximum Stored Maximum Open Use Maximum Closed Use FT3 FT3 FT3 AMOUNTS AT THIS LOCATION %Wt. I HAZARDOUS COMPONENTS EI CAS# -44- 07/23/1997 · . F MERCY HOSPITAL f= Inventory Item 0001 F= COMMON NAME / CHEMICAL NAME SUN GLOH SiteID: 215-000-000628 1 Facility Unit: WEST TOWER 1ST FLOOR 1 Days On Site 365 Location within this Facility Unit DIETARY CLEANING SUPPLY CAS# [: STATE --- TYPE Liquid ~ixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container Daily Maximum Daily Average GAL 48.00 GAL 24.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL AMOUNTS AT THIS LOCATION %Wt. I HAZARDOUS COMPONENTS ~ CAS# -45- 07/23/1997 , . F MERCY HOSPITAL I p= Notif./Evacuation/Medical Agency Notification Employee Notif./Evacuation SiteID: 215-000-000628 ~ Fast Format ~ Overall Site ~ 10/20/19921 10/20/1992 CALL 911 NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN EVENT OF INTERNAL DISASTER DECLARATION. Public Notif./Evacuation 10/20/1992 REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY). Emergency Medical Plan 10/20/1992 MERCY HOSPITAL EMERGENCY DEPARTMENT -46- 07/23/1997 , ~ F MERCY HOSPITAL I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-000628 ~ Fast Format ~ Overall Si te ~ 10/20/1992 ON GOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY WHICH INCLUDES MONTHLY FIRE DRILLS - FIRE EXTINGUISHER INSPECTIONS MONTHLY INSPECTIONS OF FIRE SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC. AVAILABLE 24 HOURS TO ALL EMPLOYEES. HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, Release Containment 10/20/1992 SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS AVAILABLE IN ENGINEERING DEPT. Clean Up 10/20/1992 MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED WITH CALPI INC. MINOR CLEANUP BY INDIVIDUAL DEPARTMENTS. CLEAN-UP AND DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. Other Resource Activation 10/20/1992 AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL SERVICES. WASTE DISPOSAL BY CONTRACT PFS INC. -47- 07/23/1997 '.:. . , . F MERCY HOSPITAL I f= Site Emergency Factors Special Hazards SiteID: 215-000-000628 1 Fast Format 1 Overall Site 1 10/18/1995 RADIOISATOPES ON HAND RADIATION HAZARD Utility Shut-Offs 10/18/1995 A) GAS - SOUTH WALL EXTERIOR BOILER ROOM B) ELECTRICAL - SOUTH WALL INTERIOR BOILER ROOM C) WATER - SOUTH OF SOUTH EXTERIOR WALL ADJACENT TO BOILER ROOM D) SPECIAL - NONE E) LOCK BOX - NO . Fire Protec./Avail. Water 10/18/1995 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS THROUGHOUT ENTIRE FACILITY. WEST TOWER AND TREATMENT DIAGNOSTIC BUILDING FULLY SPRINKLERED. MAIN BUILDING PARTIAL SPRINKLERED. DRY STAND PIPES IN MAIN BUILDING - WEST TOWER AND TREATMENT/DIAGNOSTIC BUILDINGS. IN HOUSE RESPONSE TEAM TO ALL AREAS. WET STANDPIPES IN SKILLED NURSING FACILITY. FIRE HYDRANT - CITY FIRE HYDRANTS SURROUND ENTIRE FACILITY. FIRE DEPARTMENT CONNECTIONS ON SOUTH WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG NEAR OLD MAIN ENTRANCE TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE LOCATED ON A STREET PARKING LOT ENTRANCE. FIRE DEPT SPRINKLER CONNECTION FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS LOCATED ON 16TH ST MOUNTED ON CORNER OF BOILER ROOM BLDG NEXT TO SERVICE ENTRANCE BY TRASH COMPACTOR. Building Occupancy Level 10/18/1995 276 PATIENT BEDS 1100 EMPLOYEES ROTATING SHIFTS -48- 07/23/1997 · . I · F MERCY HOSPITAL I F Training Employee Training SiteID: 215-000-000628 l Fast Format l Overall Site l 10/18/1995 WE HAVE 1320 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND DEPARTMENT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION DAY (8 HRS). Page 2 r I I Held for Future Use Held for Future Use -49- 07/23/1997 :) ,; ~ .~e F MERCY HOSPITAL F Fast Format I SiteID: 215-000-000628 1 Type+Category+Sub-Category+8 CharID Order ~ One Unified List 1 Reference Dates Summary Description CROSS 09/20/1995 OK CROSS 09/20/1995 OK STEWART 03/08/1994 OK Reference Dates Summary Description STEWART 06/19/1991 OK STEWART 02/27/1992 OK STEWART 09/08/1993 FOLLOW UP Reference Dates Summary Description HUEY 09/15/1993 DELETE XYLENE FROM INV. UNDERGROUND STORAGE TANK PROGRAM COMBINED PROGRAM INSPECTION Reference Dates Summary Description 2215TRUX 06/08/1995 UST inspection. INSPECTIONS -50- 07/23/1997 ,I ·-'~' " -~ ~- -. . BAKERSFIELD CITY FIRE DEPARTME~T 2130 "6" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY 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 TJNIT# 02 FACILITY UNIT N~~: 3rd floor - third floor SECTION 1: MITIGATION, PREVENTION. ABATEME~ì PROCEDL~ES Small aIIDunt of office' supplies such as liquid paper and xerox toners for copy machines. SECTION 2: NOTIFICATION ~VD EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activating fire alarm system and utilizing overhead paging system. - 3A - . . ,,.. ...... SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLY A. Does this Facility Unit contain Haz<lrdous Materials?.., .. YESG 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 ma~ked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes. complete a hazardous materials invento~y 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 - Fire extinguishers throughout floor Exterior dry stand pipe Fire alarm system/srroke detectors Emergency response team SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant Truxtun and B STreets City fire hydrant 16th Street at C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS ú~IT O~LY. A. XAT. GAS/PROPANE: South wall, exterior, adjacent to boiler room on 16th street 8, ELECTRICAL: South wall, interior, in boiler room. C. t'ÌÁTER: South of south exterior wall adjacent tö boiler room on 16th Street D. SPECIAL: E, LOCK BOX, YES .:§) IF YES, LOCATIO~, IF YES, SITE PLANS? YES / NO FLOOR PLANS? YES! NO ~SDSs? 3:EYS? YES NO YES ' NO - 3B - OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS ,HAZARDOUS MATERIALS INVENTORY ~, I Page ~ of Ï-¡ J 1. D. # I I BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP: Bakersfield, CA 93301 PHONF. #: (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adel,ine Drive FACILITY CITY,ZIP: Burlinqame. CA 94010 PHONE #: (415)' 340-:--7410 FACILITY UNIT #: 27 UNI T NAME: 3rd floor 1 2 3 4 5 6 7 8 TYPE MAX ANNUAl, CONT USE LOCATION, IN THIS % BY CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. Nothing on this floor 9 10FFICIAL USE CFIRS I ONLY 10 HAZARD CODE CODE CHEMICAL OR COMMON NAME D.O.T GUIDE I , I ., I i /Î I ~J /? I NAME: Jack Resendez TITLE:Dir.Sp.cl1r;t-~/SafpSIONATU~ '::::Lr:?~V ;¿>.~d _.1.-' -- DATE: ! E~ERGENCY CONTACT: Jack Resendez TITLEPir.SecuritfiSaf~'- PØ'ONE~!UJ.8"HOURS:327-3371 7:30-4:00 , , . ~ ~ AFK1f BUS HRS: 327-337J!j¿j-~/:Jl, I EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty PHONE' BUS HOURS:327-3371 7:30-4:09 , PRINC~rAL nUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7-3371 - 4A-l - . "- ~·.~c-·: ...;...._..........._......_. .çr. e '), j'. . . SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS DrESS NA\!E: FLOOR: 3 OF 5 Mercv Hospital DATE: / / FACILITY ~A.'1E: UNIT =: OF 1,Ç East wing (third floor) 2 , (CHECK ONE) SITE DIAGRA..\[ FACILITY DIAGRA'1 attached ·1 , (rnspecto~ls Comments): -OFFICIAL GSE ONLY- - 5A - I. 'r' " -- e ,- BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~IE: BUSINESS PLAN SINGLE FACILITY 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# ,02 FACILITY UNIT N~~: Fourth Floor SECTION 1: MITIGATION, PREVENTION, ABATEME~~ PROCEDURES Formalin kept in special containers for pouring process. Spill kit available for control of small spills Ventilating system in mixing room . Large am:mnts of absorbent material available from Security/Safety department SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activating fire alarm system and uçilizing overhead paging systems. - 3A - e e ), -- ,. SECTION 3: HAZARDOUS MATERIALS A. Does this Facility Unit FOR THIS UNIT ONLY ~ contain Hazardous Materials?. ...~ NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardoo. materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous materials inventory form ma~ked: 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 - Fire eXtinguishers throughout floor Fire alarm system/smoke detectors Exterior dry stand pipe. Emergency response team. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant Truxtun and B Streets City fire hydrant 16th Street at C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS t~IT OXLY. A. XAT. GAS/PROPANE: South wall, exterior, adjacent to boiler room on 16th Street B. ELECTRICAL: South wall, interior, in boiler room. C. \oJATER: South of south extèrior wall adjacent to boiler room on 16th Street D. SPECiAL: E. LOCK BOX: YES / GJ rr YES, LOCATION: ., IF YES, SITE PLANS? FLOOR PLANS? YES ,I NO YES / :\0 ~SDSs? KEYS? Y2S NO :\0 YES - 3B - , , , . Page ~ Of:Jj 1.0. # FORM 4A-l NON-TRADE SECRETS' , . I HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic Healthcare West FACILITY UNIT #:D2' ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adel.ine Drive FACILITY UNIT NAME: east wing, CITY, ZIP: Bakersfield, CA 93301 CITY, ZIP: Burlinqame. CA 94010 4th floor, endoscopy , PHONE #: (80S) 327-3371 PHONE #: (415) 340-7410 IOFFICIAL USE CFIRS CODE ONLY , 1 2 3 4 5 6 7 8 9 10 , I TYPF. MAX ANNUAl, CONT USE LOCATION, IN THIS % BY HAZARD D.O.T , AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT liT. CHEMICAL OR COMMON NAME CODE GUIDE I CODE Rms 439,440,441 & M 1 10 gal 10 27 cleaninq room 37 Fonnalin f1RM¡:¡' M 10 384 gal 10 08 cleaninq room 2 Cidex ORMP. M '-d ~ 6 240 gal 10 OS' cleaning room 70 Alcohol )\luO,O\ FT.T () Rms 439,440,441 M 6 18 2 óz 13 04 storage closet room 20 Hurricane (benocaine) ORMA i Rms 439,440,441 , , M 6 18 20z 13 04 storage closet roam 14 Cetacaine ORMA Room 438 & storage I M 6 60 120z 13 08 closet room 55 Dust-off FT ,T () Housekeepillg storage W 4 48 6.9 qt 10 40 storage closet robm 100 Infectious waste ORME 1<rnS439, 440, 441 M 6 6 20z 10 04 storage closet room 10 Xvlocaine ORMA I I I e , , I 0#/ /7 I I NAME: Jack Resendez TITLE:Dir_Sp.~l1ritÏ5/S;:¡fPSIGNATU~ "'~/7)"#_ (./':- DATE: i EMERGENCY CONTACT: Jack Resendez TITI,E ir.Securitvl af ~ 1J.Íf0~~ HOURS:327-3371 7:30-4:001 - " f\ R BUS HRS: 327-3371/ 323-9751 ! RAKERSFIEJD CITY FIRE DEPARTMENT l EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'P~!NC~PAL BUSINESS ACTIVITY: Healthcare PHONE # BUS HOURS:3¿7-3371 7:30-4:09 AFTER BUS HRS: 3L7-3371 - ð.n.-1 - I . ..." .-'.- ,': .-.< ..--...."..-.......... .-, .., e '. \ . . ,¡' SITE/FACILITY DIAGR~~ FORM 5 ... . NORTH SCALE: BUSI:-;ESS NA\Œ: FLOOR: 4 OF 5 Mercy Hospital DATE: / / FACILITY :-iA."fE: UNIT =:2 OF~ East wing (fourth floor) , (CHECR ONE) SITE DtAGRA.\I FACILITY DIAGR.~~ attached / (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - ,. " . . ,. . . .t. BAKERSFIELD CITY FIRE DEPART~E~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. An9wer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 02 FACILITY UNIT NA.'fE: Fifth floor (5th) SECTION 1: MITIGATION. PREVENTION, ABATEME~~ PROCEDL~ES Very small am:mnt of office' supplies stored on this floor. SECTION 2: NOTIFICATION fuVD EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activating fire alann system and util~zing overhead paging system. - 3A - , . - e ~ ~ SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY 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 ma~ked: 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 - Fire extinguishers throughout floor. Fire alarm system/srnáke detectors Exterior dry stand pipe Erœrgency response team. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrantTruxtun and B Streets City fire hydrant 16th Street at C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT O~LY. A. ~AT. GAS/PROPANÈ: South wall, exterior, adjacent to boiler room on 16th Street B. ELECTRICAL: South wall, interior, in boiler room C. WATER: South of south exterior wall adjacent to boiler room on 16th Street D. SPECiAL: E. LOCK BOX, YESG IF YES, LOCATION, <.- IF YES, SITE PLANS? FLOOR PLA;..!S0 YES / NO YES ;' XO :'<fSDSs? KEYS? YC:S NO YES / :':0 - 3B - OAKERSFIEtD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY ~ I! Page ,,8 Jor ' , I ----¡ I. D. # ,; BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave B k f' ld CA 93301 27 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: ADDRESS: 2300 Adel.ine Drive FACILITY UNIT NAME: 5th floor l' 94010 CITY, ZIP: a ers le , CITY,ZIP: Bur lnqame, CA ! PHONE # : (805) 327-3371 PHONE # : (415) 340-:-7410 10FFICIAL USE CFIRS CODE ONLY [ ! 1 2 3 4 5 6 7 8 9 10 I I TYPE MAX ANNUAl. CONT USE LOCATION· IN THIS % BY HAZARD D.O.T I CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE I , Nothing stored on thi floor , , , " I I i " NAME: Jack Resendez TITLE:Dir.Sp~l1rir.y/S;:¡fpSIGNATURE:. .EMERGENCY CONTACT: Jack Resendez TITLE Dir.Security/Safety EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRINC~PAL ßUSINESS ACTIVITY: Healthcare DATE: PHONE ~ BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 327-3371/323-9751 PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3¿7-3371 - 4A-l - . ,> ~-'..-,.: ..;-.........--.-.--...- ~ - ~" è" SITE/FACILITY DIAGR~~ FORM 5 . NORTH SCALE: BUS I:-iESS NA'Œ: FLOOR: 5 OF 5 Hn<::.n;t-",' DATE: .I / FACILIT1f'1t~:fl ) UNIT =: 2 OF 15, East wlng 1 oor , (CHECK ONE) SITE DIAGRA.'[ FACILITY DIAGRA~ attached / (rnspecto~'s Comments): -OFFICIAL GSE ONLY- - SA - ',-- . ~ :¡ :!'~ } .. e e , - .~ . " BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NA.'fE 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 Mercy Hospital (Main Building-55 Building) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (805 ) 327 - 3371 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 DURING BUS. HRS. AFTER BLS. HRS. A. Jack Resendez Dir. Securi ty /Safe~ 327-3371 PhI 327-3371/323-9751 B. Administrator/Engineer on Call PhI 327-3371 PhI 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: South wall, exterior, adjacent to boiler room on 16th Street B. ELECTRICAL: Soutli waLL, illterlor, ln b01Ler room C. WATER: South of south exterior wall adjacent to boiler room on 16th Street D. SPECIAL: ' E. LOCK BOX: YES /@§Y IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ~O KEYS? YES / ~O - 2A - - SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE e . , -~ I . .'1; , .f Errergency response by engineering and security deparbænt employees on duty. Emergency cleanup bu housekeeping deparbœnt SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTAJ.VCE FOR YOUR BUSINESS AS A WHOLE Mercy hospital erœrgency department. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. :~~~~~L;~~. ~~~~. ~~~~~~~~. ~~. ~~~~~~~~~.... .'...... GDNO B. PROCEDURES FOR COORDINATING ACTIVITIES I', WITH RESPONSE AGENCIES:.......................... NO C. PROPER USE OF SAFETY EQUIPMENT:. ,... ... .......... NO D. EMERGENCY EVACUATION PROCEDURES:................. Y , ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. E NO SECTION 7: ,HAZARDOUS MATERIAL NO NO NO NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~F A SOLID. 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A COMPRESSED GAS:... ...~ NO I. Jack Resendez . certify that the above information is accurate. I understand that this 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. .~ SrGN~~E~ . #' Director <? TITLE Security/Safety DATE ~/- /3 ./ ¿-7 - 2B - '. e . ¡; ;: BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NMIE: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned hy: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 01 FACILITY UNIT NA.'fE: First Floor SECTION 1: MITIGATION, PREVENTION, ABATEME~~ PROCEDL~ES All compressed gas cylinders chained or on carts, all welding carts equipped with fire extinguishers. " venniculi te stored in hemodialysis unit for emergency cleanup. SECTION 2: NOTIFICATION k'~ EVACUATION PROCEDURES AT THIS L~IT O~LY Notification and evacuation procedures initiated by activation of fire alarm system and overhead paging system. Areas not covered by overhead paging system Contacted via land line. - 3A - · -- SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLY A. Does thi s Fac i Ii ty Unit con tai n Hazardous Mater i a1 s7. . . . .. 8 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 ma~ked: 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 . Fire extinguishers throughout floor. Fire sprinklers throughout floor/FD connections on Truxtun ave front of hospitaL Fire alann system/srroke detectors Dry standpipes interior- Wet standpipes, exterior SECTI~~: ~~~~ OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner of Truxtun and B Streets City fire hydrant at 16th Street and C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS t~IT O~LY. A. ~AT. GAS/PROPANË: South wall, exterior, adjacent to boiler room. B, ELECTRICAL: South wall, interior, inside boiler room area C. WATER: South of south exterior wall adjacent to boiler roan. D. SPECiAL: E. LOCK BOX, YES /6j) IF YES, LCCATlO~, IF YES, SITE PLANS? FLOOR PLANS') YES / NO YES / NO YES YeS NO NO ~SDSs? KEYS? - 3B - " , I' . - - - , I\AI<ERSFIEJ.D CITY FIRE DEPARTMENT . I I. D. #: FORM 4A-1 Page L- or.1r- NON-TRADE SECRETS' HAZARDOUS MATERIALS INVENTORY . BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 01 ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adeline Drive FACILITY UNIT NAME: First Floor CITY, ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlinqame, CA 94010 ... . , -, A-.L&ð PHONE # : (805) 327-3371 PHONE #; (415) 340~7410 IOFFICIAL ust CF I Rs' CODE ONLY 1 2 3 4 5 6 7 8 9 10 , TYPE MAX ANNUAl, CONT USE LOCATION, IN THIS % BY HAZARD D.O.T I CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIcAL OR COMMON NAME CODE GUIDE I , P \~ ~~Õ 'T!Þ ( ~3 \á6<.o 270 04 09 Boiler Room 100 Dichlorodifloromethane EXPL . P ,11) <Ï;o ~ .£.,..3 tt Trichlorom:mofluoromethane qo 1 ) I ~ 04 09 100 EXPL ~ fg"JD .3~ -Z I -Ø'3 ,^o0c p6 00 :1b'" 04 09 ¡t. 100 Freon 22 OO>L P ¡Ii '\\~ ~\~ ~ uðif I ~50 50 04 09 ,t 100 Chlorodiflourorrethane Þ(PL i P\1J 6080 6080 ft3 04 09 It 100 Nitrogen 304 ~ 3.;1 4 þœL ! i pß) 5620 5626 ft3 04 42 a' 100 Oxygen 281 8351 ÞœL , ¡ Q \~ }aLq I 1300 1300 ft3 04 42 1\ 100 Acelylene 130 ÞœL I M~ 45 450 gal 10 27 Hem:xlialysis storage 58 Formalin \ l<gC1 10 I ~ & treatment- ;:¡rp;:¡!": M ::$) 45 450 gal 10 27 d 37 Fonna-lin Il9fl·O \ ''LIJJ M~ 10 100 gal 10 08 Respiratory Therapy 70 Alcohol '1 \1.00 -0\ 'LIJJ e i ! I i I M 1 1 gal 10 36 " Soncide ( RMA I M 1 10 gal 10 36 ,I Coleo ( RMA , il I " I 'i M~ 160 760 gal 10 27 I' 100 be . \õ1:~ \ g9'jQ XPL Car n DJ.oxJ. e USP 5%, OxygenUSP 95%1 M 2000 2000 lb 04 27 Radiology storage north 100 Used X-ray Fil1n 1 LSL I side, east hallway I I ~ ~ I NAME: Jack Resendez TITLE: Dj r. SpclJri t-15/S;:¡fPS I GNATURE ý - -.;;;:~- ~ DATE: ! I EMERGENCY CONTACT: Jack Resendez TITI,E ir.Security/SëÍfe'l::.?" \Dït~E l.1fus HOURS:327-3371 7:30-4:00 I . AFTER BUS HRS: 327-3371 , EMERGENCY CONTACT: Administrator or EngineerrITLE: On Duty PHONE , B,US HOURS:327-3371 7:30-4:00 f'R1 NC I,PAL ßUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3;'0-3371 I, - 4A-l - - I\^JŒRSF I EJ.D CITY FIRE DEP^RTMENT Page X- Of~ 1. O. # FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY . , BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic Healthr.are West FACILITY UNIT #: ~ I ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adeline Drive FACILITY I UNIT NAME:(Laundry) ;" t~¡. CITY, ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlinqame, CA 94010 PHONE tt: (805) 327-3371 PHONE # : (415) 340~7410 10FFICIAL USE CFIRS CODE ONLY . ¡ 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUM. 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 M 5 10 LB 07 08 Laundry storage room 35 Servant PSNB M 42 208 LB 12 08 Laundry storage room 35 Sodium Silicoflouride :tS3Y,,0\ PSNB e I M 120 312 LB 12 08 Laundry storage' room 18 Pierce 11 PSNB ! ,I , I I'! I i I , ! I , i , ! :_r,~,; ~v? I I NAME: Jack Resendez TITLE:Dir_f;pr.l1ritÏ>/~.::!fPSIGNATURE:r.~ ~~ ~ DATE: EMF¡RGENCY CONTACT: Jack Resendez TITI.E ir.Securitv/Saxe-t:V -PJt(NE (""'"BUS HOURS:327-3371 7:30-4:00 I ~ EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty , }'J'RI;NCI,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 327-3371/323-9751 r PHONE' BUS HOURS:327-3371 7:30-4:0q AFTER BUS HRS: 3¿1-3371 i I - 4A-l - 1. O. # OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfie1d, CA 93301 PHONE #: (805) 327-3371 , ¡ 1 TYPF. CODE M M I .1 I ¡ , M M M M M M M P NAME: EMERGENCY 2 MAX AMOUNT 1 3 ANNUM, AMOUNT 1 1 1 UNIT 1b gal gal gal 1b gal gal 1b gal gal 4 5 CO NT CODE 09 6 USE CODE 10 09 10 09 09 27 Page ~ of· 3 9 FACILITY UNIT #: (!)I UN I T NAME: F/~f ¡:"/Øð",(¿ ~:~.;:. ØI:' _ A-'.......-· . IOFFICIAL USE CW1RS CODE I ONLY 10 HAZARD D.O.T CODE GUIDE 1 1 10 27 OWNER NAME: Catholic Hea1thcare West ADDRESS: 2300 Adeline Drive FACILITY CITY,ZIP: Bur1inqame. CA 94010 PHONE #: (415) 340-7410 27 7 LOCATION IN THIS FACILITY UNIT Phannacy cabinet 8 % BY WT. 100 1 1 09 27 27 phannacy cabinet 1V:rm 1 1 09 27 27 Phannacy cabinets east 100 1 1 09 27 27 I , 100 1 1 I' 27 It 100 1 1 it Ii II 89 1 1 II II 100 1 1 h 100 I( I. II 100 CHEMICAL OR COMMON NAME Acetic Acid Glacial ORMA If I ( 100 95 Ethyl Alcohol FLLQ EMERGENCY CONTACT: Administrator or EngineerrlTLE: On Duty 'PRINCI.PAL BUSINESS ACTIVITY: Hea1thcare Hydrochloric Acid ORMA Hydrogen Peroxide ORMA Iodine Sodium Granules ORMA Phenol ORMA Propylene Glycol Silver nitrate crystals ORMA ORMA Borate Sodium ORMA I , I ¡ Camphor ORMA I I I i I ! ! 'J ~ .J ~ _ n/J I Jack Resendez TITLE:J)ir_!=;F>~l1rit¥-/!=;~f'pSIGNATU~:~' ~,-"-- ~ _.- DATE:/....../......:7... ó/ ' CONTACT: Jack Resendez 'TITI.EPir.Securitv/Safet)(' '.PHON) ~~HOURS:327-3311 7:30-4:0q ""--"" ~FTER BUS HRS: 327-3371/323-9751' ! I PHONE # BUS HOURS:327-3371 7:30-4:0q AFTER BUS HRS: 3~7-3371 I - 4A-l - ·. .'.. .-.." '.. ~ '. ..-.-..: .';'-".'---"~--'- - " '> .,.' SITE/FACILITY DIAGR~~ FORM 5 . NORTH SCALE: BUS DiESS NA)IE: FLOOR: 1 OF 5 Mercv HosDital DATE: .I / MaFAC:bLIId' ~A"!r:r. t Fl (Basement) UNIT =:1 OF - 1.n iU1. 1.ng, 1.rs ' oor 15 (CHECK ONE) SITE D rAGR.ð,.,'[ attached FACILITY DrAGRk"! attached / (rnspecto~ls Comments): -OFFICIAL GSE ONLY- - 5A - ~~ ". ..-,..... e . BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NMIE: BUSINESS PLAN SINGLE FACILITY 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 U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 01 FACILITY UNIT N~~: Second Floor SECTION 1: MITIGATION, PREVENTION, ABATEME~~ PROCEDURES Radiology equipment in Cath Lab Area Radioactive procedures in Nuclear Medicine area Film developer in Cath lab. . / / /\ ¡!Øl~F~/ ~~~~S ,ç~A!- ßq¿'p,.&~;"'¿; ~....//s- (///Ad~ ~ SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activation of fire alarm system and overhead paging system. Areas not covered by overhead paging system notified via land line. - 3A - - e ,,' ~"'-,," " > ." , "'''"'~n - . --.. SECTION 3: HAZARDOUS MATERIALS FOR THIS UX!T ONLY A. Does thi s Fac.i 1 ity Unit con tai n Hazardous Ma teri al s7 . . . . .. YES' NO 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 ma~ked: 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 ~o the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION - Fire extinguishers throughout building. Fire alarm system/smoke detectors Fire sprinkler system in cath lab area only Dry stank pipes (interior) West stand pipes (interior) SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant cQrner Truxtun and B Streets City fire hydrant 16th Street at C SECTIO~ 6: LOCATION OF UTILITY SHUT-OFFS AT THIS lmIT O~LY. A. XAT. GAS/PROPANÈ: South .wall ,exterior, adjacent to boiler room. B. ELECTRICAL: South wall, interior, in boiler room C. \VATER: South of south exterior wall adjacent to boiler room. D. SPECì:AL: E. LOCK BOX, YES /~TF YES, LOCATTO~, IF YES. SITE PLA~S? FLOOR PLA;\S? YES ! ~O YES / :\0 ~SDSs? ;{EYS? y;::s ~O YES i :\0 - 3B - BUSINERS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP: Bakersfield, CA 93301 PHONE t: (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adeline DrivET FAC I LITY CITY,ZIP: Burlingame, CA 94010 PHONE #: (415) 340-7410 111 Page L ~f~ it 1 ! , 1~ \' FACILITY ~~àT f1.L~: ' UNIT NAME:J' L1 caL oLd.\'; \,;Q l BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY 1. D. # 1 TYPE CODE M 2 MAX AMOUNT 7 3 ANNUAl. AMOUNT 48 4 5 CONT CODE 10 6 USE CODE 13 7 LOCATION, IN THIS FACILITY UNIT fi&~í@~~ closet in 8 % BY WT. 9 . 10FFICIAL USE CFIRS ONLY 10 HAZARD CODE CODE : UNIT gal CHEMICAL OR COMMON NAME Kodak, 81neflure developer and 8-25 replenishèr part a Kodak, cineflure déveloper and 1~_?1 replenisher partb , '/ Q/A/L'/vA<. .F/¿'~~ _ 5-20 ~µ,......,~ P""'~e "" "" D.O.T GUIDE' CRMT M 7 48 pt 10 13 storage closet In 'h:> 1 1 t.7:> " 48 qt 10 13, storage closet hall 52 gal 10 40 Hot, laboratory nucle~r medicine 52 mel " " II. curiE s14 27 8000 ßt3 09 27 " " " 5000 11 27 " " " , 5 reI ~ies 10 27 " " II 2 gal 10 08 " 1\ ,1,1 CRMT M 6 ¡), 2 fJ 1 M~ 250 WI 500 -I' 5 /ht 2 radioactive infectious waste CRMT ORME Cènerator 99 ,Mo-TC99M1. SCi RADI RADII PSNA RADI Xenon, XE 133 Gas 01,lo d- 60 Silver nitrate video imagining film Cobalt 57 RADI 100 Radiowash WATR -. i N'A-ME: \EMERGENCY I -. ¡EMERGENCY , PR ¡,NC ¡,PAL Jack Resendez TITLE: D:i r: SF'r.llr1 tt/S;:¡ fpS I GNA TUl1 E: CONTACT: Jack Resendez TITLE ir. Securi tv Xc t/}/// ~ ~/ ~-- ~ DATE: I . '- ~'tÓNEr* ~ HOURS :327-3371 7: 30-4: 00 AFTER BUS HRS: 327-3371 /323-9751 PHONE f BUS H9URS:327-3371 7:30-4:09 AFTER BUS HRS: 3¿7 3371 CONTACT: Administrator or EngineerrITLE: On Duty BUSINESS ACTIVITY: Healthcare . .- .:--- e " -, .' . '.' ,...-~.., .';-'-'~--'-'--'-' I . . SITE/FACILITY DIAGR~~ FORM 5 . NORTH SCALE: BUS I:-;ESS NA\{E: FLOOR:'- OF :) Mercy Hospital DATE: ! / FACILITY ~A.'..{E: UNIT ::: 1 OFJS Main Building , (CHECK ONE) SITE DIAGRA'I FACILITY DIAGRA'..{attached / , . (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - ,1¡i.~~"~è~~~'~g{)'i,;o";"~"~I'f5{1~';:'i"";t"~t;'"":~;"""'J~,';~(, r;',:fi},/,[~.~;~~::::;~~~~!~'¡':'~j ----.¡~ - .<"'.:~""!'-'~""<.''''-. . . ,", . "',; '--~"':~.:.:., ;-,-¿.- .' "~~:~" ~ <~¡J);:::?'~~ ;~:. '.,.,- .~.~. , J , ~ ,~ '1 j . " ~, . Þ.. J " ,": ,;..... '(,) :1 11; i ~ ;1 J " " ~~ EHEF.GENCY PROCEDURES FOR Rl~)rOACTIVE SPIlLS ... ,L, ~~mR SF ILLS 1. Notify perso~s in the ir.~;eåiate area that a spill has occurrcd. 2 ~ Cover the s-µill with absorr;:cnt paper ~ ,. ,< .~' t 3. Limit access to the ar~a to only those persons dealing with th~ s?ill. ,I , , ~ ¡ J I ;~ 4~ Survey (G.N. suney ne.ter) potentially cant.a."l1inated persom1el before they disperse and dacontaminate as necessary. 5. Notify the Radiation Safety Officer of th~ incident. t'}) II. \.~:/ MAJOR SPILLS 1. Notify all persons !lot i!''i.'101ved in the spill to vacate the room at once. Limit the m~vement or displaced persons to confine the s?read of contamination. 2. Cm.rer the spill 'vith absorbent p,:lpe~. 3. S.....<itch off all fans. Close ,dndows. 4. \:Pacate roomlt ~ ,¿. Clase tàe door to ""h~ \......- r;xn:¡ . Prevent entry into the :rOO:!l. 6. "t& th~ ~_·f 11 ~- t'iv~ . . flush thc:rcughly. ...... i»l·"-...i..~ .;..:;) on ~~~Cl.~, ... T~ ~he spill is ¡'"\.... cl~t.hi':1g j-. ¿i.s~ard octz= or protectiv~ I . ...... ~.. clot~ing at o~ce. t, s. Notify the Radj..~tion. S~::':e.ty Office-:- i:!:"~eð.ia.tr.~1:1. ~ 9. S~!Yey (G.}!. St~rvey 4:1e.t~r) pe~sDnnel í,¡-:ol'Ted. Immediately initiate decont~irraticn of per90~n~1 as necessary. usin~ mild soap and l~kcwarm water. , ·1 c··,'··'· . . , -' \ \. ., . :,,~...... ..' ......~- , , .... _",,__..__~_....-. _~.__ o~_' .,. .,+, . ' , ' ~. 0·0.·.....· .'~ . , . ,::\ ' ,'. '~~;.' ¡ i~ '~ ~ d ~ .,~ j i j {.~ '",j \ I I · , · ~, r 1". ~: r~ m tt.: .~~ ...~ I , I ~ · \ ,,', ~ \ .~ " x ~.' :t :g: \ ,¡¡: ,,! .i ¿;- ( ~' '- -. .;... ~: ~... .~; ',. ~;" .: r l;rl/l1 ',v .:rllin~ l.1pC anù si\i!\s plastic b:1~. sm::ll Di~po.s;1ù:e gto\'~s ~b~l;ing tJ.¡>e fur;:eps, ton~s ~¡.~~ p!;J.5tic: bags ~pon¡;~~. -1 )( 4. r:.:>ef lOWf~ls n:."di¡¡:: wz:¡h or delerge ~t S~:Juri!l¡¡; p<Jwd::r T:1bS -:;¿s~..;"'S What man No. 1 fiht:r ¡~p,er Chw: G-M survey meter PI..'Tf'OS!! Po,tillg nf thð area Shoe co,ers. wet con!'...inen lbnd protection F~t=:!I¡ng !ihoe coven and the like Safe h:mdU"g :01 cont::.minatcd 1YUtt~al· s.'Wing up matting ;¡nd Jryir.g Detergen: Friction !ùen:ifkation Cutting :tb¡urbcr.t ¡;i':po!.'r. :;¡ther uses T~:i.~b s\vipes anc:' d~~fnt:unin~:.th')n t Covering. are... after ;:kccn t;:¡mim:!ion Monitoring 8 AU C'Jntaminated mate.¡:Ù wilJ h~ stored until radiation l¡xet: reach 0.1 I/IriM on COt1l:1ct "1Iith. a C-M survey meter. tAn :¡re:;. is considered dec;:¡nt2m¡nated when r::.diation levels re1.ch 0.1 mrlht on contact measured with a G-M survey me~er. / -~ .... ! ¡ / / / ... ~- '- .,;.... .!~; " a .. '. . P^"'~' ) \l~~?'-- ',¡y .;¡' t ~ ~ é~" r"," . '",~ ': C" .; -.,\. .~ ~ ._.__". _.... ,i, , ' . ~ ¡. ;~- ~ >", ,. . .':..;~'~~;..~..,.~,..;. "··.-~~_'..L .>.:\..' '4IIÞ ' , ,~"'Qr~~~~~~~iibt:";œf!:~~~~~~.~~;,;1ft~~;i~··~~·,:,'p.:;~:"~.- ~~...:~.~..;~!'~:~:¿~_ ' ", , , --,'", ,.-.,-. " '. ..... :1 I ,34 DECDNTAMJNATfON Contamination, pn:c,~\Ü¡ons ,md dec'J!i:amination procedi.m:=~ :::.re maintained for tIlt' protection of the peopk: adminis(t:rìng mdicaçtivc sub:;tu.nœs .md for those caring [CI' t[I\' p:ltient duri:'!ß treatment. Rigid techniqucs help control contamination; however, whell ill people ::.re g¡...~m r::ùbnuc!jc1es the probJ~1O of contamioatiü\l <:O¡;t¡-o! mounts. Equip- mer:t. linen, e;(crcl~" ;md w~;;;tc m.1tcrds ill"C uU.lvoil:bbly cop.taminatccÏ. The patient m;¡\' become :',Ctìt~:¡y i!1, timJ m~y cont:uninatìat! precaution:: may beco':":1t.' secondary to saving hi.~ life. Accident; wi1ì blppen from ~i.:t1e to time. It ban unv.'!'it~en Jaw for personnel worki:1¡': "h d' t· . , .' d ' 1. . .. ·1'" d d \. wn r<1wnUCJiues t¡:¡¡¡t UH~)' e('ÇIr;tam¡;-:ate tnelf own $pl.S an an;·a.s, un er tue super· \;5ion of the .Radiation Safety Offir.:er. it b'?-comes oecessa..."')' for someone to do this f.)'¡" the pa.tfent in the 'ward or in the operating room situ.ation. Ordinarily, t.;'e Hadia~km Safl:ty Officer "...·ould assume rcsponsibì!ity fÒrthis procedu:-e. However, in some situations the nurse may he delegated the responsibiìi0, of decontaminating or at least assisting with such a procedU'i"e. It is advisable to h,rve a written, step-by-step procedure meeting all the requirements of IOCfJ :mthorities. Fo¡bwing are a few suggestions: . 1. Put on rubber or pbstic gloves (also boots if necessary) before cnteling the room or . ' area. 2. Prßvent liquids ftOm spreading; contain by pJacing any absorbing material over it. 3. Mcmltcr the spHl, ~quipment, or people invohred to determine the amount of radia- tion b~ing emitted, 4. All persons not involved and not contaminated shoüld rêmove themselves from the area. 5. Coot:lm.inated dothjng, induding ó;hoc$, :;hould be removed before the indiviclua! leaves the area. Thorough '.vashïng, preferably showers, should be accompli.Óed jmmediJ.teJy~ 6, Monitor P{o'!':iv:1I1el aft~r washing. Hep~at if ncC'essa.."')'. Ex~!':ssive scrubbing of the bo..-1)' ;:;~Jo':,!d h~ ..voided. Use or hol water :shon}:.! be av::.:ctcd bec;:;use it iI1cre:t:;e:; ...·::....,,1·..H. ~ ",! ~ r t-- ·':"1,,,l.~,..J. ,..... ,- r..l., t "d ~ !'O'''b ~ t'- ,·,h.u, t·~. t" ~l!,._,.~..\Ìn .0 .n".œ.I.J.n111......,·,,"" .:,..;,a O. u.e DC y an... "'.¡ .2.:l~es He ........rp.lo.¡ lh ~clio.:l~ti·...lty :nt'J th~ circut.1ting bloc(L "\r~/:1:rn t~v:J.ter is recod!rnended. 7. Il.:ldjo~~:t¡T/e p:l:t~cle5 ~-:.re l"';l{}re- C':.LS:!y removed frern h:l!"'d $urf~ces;. su(:~h ~ 5t:l!nJcS:i st::el bJ,Sfns} thn¡; ffern more ~~{)rous r:13:C'ri¡)JS~ Ö. ;\!¡no;- C~t3 should be encour:~;~d tü l:t!eed, thereby r~~d!Jcing nbsorp~:on cz,pa!:i!i~'ic~}. __11 t t ...."". t fro ....,.. ",'r "1,, -..!r' I ~ N'·, ',J, ,,"; 1, r.c ....\ de^Ont"~!ìl' ,~Hon .H~ re:J. I,,_.) 0 ¡"~Jor ...u." ~ .(",.... ),~ ~"I.SJ,.'.er.;.u Lie. r _ " ... ,.. . I..... . 9. Bm.:;1:e:; :lre not good far ;l?r:l~.ir:g fríCt~O:1 to a $urfac::-. The bristles C:lU5e splatter- ing :m¿ ;;r~'e:ld¡ng cf cont~~min>ltion. Place aa tr~sh :md w:15te in m9¡s~urc.proof :-ont;ùne,s for removal [:T;/TI the ward. \Vash and monitor yat:rse!f t~:or()l10;;]j'; this is e$s~:1tj¡¡1. Cont~ìfl1jnation :.mder thc fbgcm:.lils l:.'~C(lt!1C the ma.ior probiem in the clec~H1taminr.tion of hands. R~r')ort the incident ;lS rc::mirecl bv reculatory bodies. t· .... .., .. 10. H. 1" ..... DECCNTÁMIt~AT:ON KIT "\ " TIle Cl.:cont::min;,¡tion kit :;~o!J!d be kept. supp1ied ¡md ready fur U~I'; at all times. 11w following Hems should be uscù in e;~ch im;tanc~ of a contamil¡¡ltion :lre~¡: 1$4 . "-"... :-'. '-. .' .' ç~ :., -.,.1 '-J J:Fy' '~7' ~. .-", ~,,~:;- Y,,,-:",:~ , .,' . .'~ ," . ,-.~" - .: - ..... - -- .. f .eR'· BL Ap Rulas er Hand11ng ~d101sotopas y .aborat~ arsonnel 1. "Good Housekeeping" will be maintained. The area will be kept neat. Waste or contaminated materials will not be allowed to accumulate. 2. No food will be eated or stored in the area. 3. No smoking will be allowed while handling radioactivity. 4. All containers for radio nuclides and other materials will be appropriately labeled, i.e. kind, quantity, assay, symbol. S~ Available lead, lead glass and other shielding and disposable waterproof gloves will be used when radionuclides are transferred to or withdrawn from stock containers. 6. Work surfaces w¿~l be covered with disposable absorbant paper and all possible setups made on easily cleanable trays. 7. film badges will be worn in the unit and in addition, persons eluting generators will wear a finger or wrist monitoring device. 8. Work areas will be monitored regularly as directed in the Survey Record Book, and results recorded. 9. Temporary disposal containers for radionuclida contaminated syringes, paper, dressings etc. will be labeled, with warning signs. 10. When the temporary disposal container is full or radiation exceeds 2.0mr/hr at contact materials will be taken to the decay bin. 11. Contaminated counters or tables will be decontaminated to less than 0.1 mr/hr with a survey meter. 12. Contaminated floor will be decontaminated to less than 0.1 mr/hr at contact with a survey ,meter. The area will be covered and marked off. 13. Hands wilL be tota11y decontaminated to background levels (less than O.OS-mr/hr) measured at contact with survey meter. 14. Potential hazards, unexpected higher than usual exposure and spills of radioactive material will be reported to the Radiation Safety Officer. 15. An area of radioactive spill will be blocked off immediately except thm~e monitoring and decontaminating, and a Decontamination Kit will always be kept available with step by step instructions. ..' Radiation Safety Officer as of April 1976: Gail W. Haut, M.D. (Home Phone 324-4184) . .....- .~_._-~,--._._--_._. . l' ' 4 :~ , i ./"." 40~/ I: ~~ :f;j ) "- . . ....;,. 00 ... on_ e e ',:-:-:: DISPOSAL OF RADIOACTIVE WASTE SOLID RADIOACTIVE WASTE Generators are stored in the Radioactive Waste area. After,IO-15 weeks the generators are taken apart, the lead is sold and the molybdenum columns are placed intoaa~plasic waste bag, sealed closed, labeled with the date of disposalo These spent molybdenum columns are stored at the bottom of the elevator shaft one story below aQY patient or employee traffic. They will be stored an estimated 2-years or until the activity is twice background. LIQUID RADIOACTIVE WASTE Liquid radioactive waste is stored intthe room with the generator, and shielded wi th lead bricks. After 2 -3 weeks of decay the individual bottles ¡¡¡,œ ompticdíri th a 3y:ringo 3.RQ difJp030d intG-th&--5:Ï:Rk-and :¡ewer wi-th g.onerans él.ITlOUlltõ:> vI w~. These emptied bottles are then placed into a plastic bag and sealed and inturn into a cardboard box, sealed and labeled with the date of disposal. These boxes are then placed into bhe Radioactive waste closet and stored until disposal into the general trash. Each box is monitored and SIDo~d until the acti vi ty has diminished to twice backgr lound. USED RADIOACTIVE SYRINGES , Used syringes are takeñ from the syringe shield immediately after use and placed into à lead container. At the end of the day or the next morning those syringes are emptied into a lead lined trash cano When the trash contained is filled the contents are placed into a plastic bag and sealed and in turn placed into a cardboard box and sealed. The box is labeled with date of dispsal. It is then stored in the Radioactive waste closet until the activity has been reduced tm twice background. Then it disposed into the general trash. , . ,) '"0'"" 0 I ~,/ Hattori ... ~~" o' .. ,. :;0 e - " BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS i 1. To avoid further action, this form must be returned hy: 2. TYPE!PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 01 FACILITY UNIT NA.'IE: Third Floor SECTION 1: MITIGATION. PREVENTION, ABATEME~! PROCEDURES Infectious waste collected in utility closet until rerroval daily to hazardous waste storage area daily. . SECTION 2: NOTIFICATION k~ EVACUATION PROCEDURES AT THIS U~IT ONLY Not>ification and evacuation procedures initiated by activation of fire alann system and overhead paging system. Areas not covered by overhead paging system contacted via land line. - 3A. - e e ~ SECTION 3: HAZARDOUS MATERIALS FOR THIS UXIT ONLY If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardoos materials a bona fide Trade Secret YE~ If No, complete a separate hazardous materials inventory form ma~ked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SEeRETS ONLY (yellow form #4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. (9 NO A. Does this Facility Unit contain Hazardous Materials?. . .. , SECTION 4: PRIVATE FIRE PROTECTION Fire extinguishers throughout building. Wet-, Standpipes (interior) Dry standpipes (interior) Fire alarmsystern/srnoke detectors .. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner Truxtlm and B STreets City fire hydrant 16th Street at C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS 1mIT O~LY. A. XAT. GAS/PROPANÈ: South wall, exterior, adjacent to boiler room B. ELECTRICAL: South wall, interior, in boiler room C. WATER: South of south exterior wall adjacent to boiler room. D. SPECIAL: E. LOCK BOX, YES :~F YES, LCCATIO~, IF YES, SITE PLANS? FLOOR PLANS? YES ,I NO YES ;' XO :'1SDSs? ;{EYS? Y2S XO XO YES - 3B - I. D. # RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY . Page 3 of~ BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave ZIP:Bakersfield, CA 93301 #: (805) 327-3371 CITY, PHONF: I 1 TYPE ! CODE W M P ~S OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adel.ine Drive FACILITY CITY,ZIP: Burlinqame, CA 94010 PHONE #: (415) 340-7410 FACILITY UNIT #: 01 UN I T NAME: 3rd floor 2 3 4 5 6 7 8 9 MAX ANNUM. CONT USE LOCATION, IN THIS % BY AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR 10/12 40 Center of main hall Infectious waste 10 500 lbs adiacent 0 nurses sta 100 1 1 gal 09 27 Med storage roam 2 ¡Xylocaine 46 120 ft3 04 27 Med storage room 100 þxygen 6l. 359 , 10FFICIAL USE CFIRS ONLY 10 HAZARD CODE D.O.T GUIDE CODE COMMON NAME ORME ORMA 01LQ , , f~\ft7 /? ~,-, I NAME: Jack Resendez TITLE: Dir _ Sp.r.nri t:1!/S;::¡fPS IGNATURK . f.L1/ ~ DATE: -Yr /~ /() / i "EMERGENCY CONTACT: Jack Resendez ' TITLE ir.Securitv/s'a!.:!v/ ~:T:R ~~~:~:~~~=~~~i/~d3~~;:iOO II F;.MERGENCV CONTACT: Administrator or EngineerrITLE: On Duty PHONE # BUS HOURS:327-3371 7:30-4:00;1 'PRINCJPAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7-3371 - 4A-l - .. .: ~ _." 4_··.. ~ '." ._.._ ~".: .,;_. .·~"_"""4_-"·"'" ~. - ~ " ' e ,\, -, .' SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUSI:-iESS NA'IE: FLOOR: 3 OF 5 Mercy Hospital ~ DATE: ! / FACILITY ~A.'<tE: UNIT :::.1, OF .!J» Main Building '(CHECK ONE) SITE DIAGRA.'I FACILITY DrAGR.~'<t attached /,., (rnspecto~ls Comments): -OFFICIAL GSE ONLY- - 5A - ~ ri .!.o . ~ e e { BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returneå by: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY u~IT# 01 FACILITY UNIT NA.'Œ: Fourth Floor SECTION 1: MITIGATION. PREVENTION, ABATEME~! PROCEDURES Infectious waste/chemo-therapy waste collected in utility closet and removed daily to hazardous waste storage area. SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activating of fire alarm system and vocal alert via overhead paging system. Areas not covered by overhead paging system contacted via land line. - 3A - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous MaterialS?.....(3 NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a hona fide Trade Secret YE~ If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Ves, 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 - Fire extinguishers throughout building. WètStandpipes (interior) Dry standpipes (exterior) Fire alarm system/smoke detectors. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner Truxtun and B Streets City fire hydrant 16th Street at C SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT O~LY. A. ~AT. GAS/PROPANÈ: South wall, exterior, adjacent to roiler room B. ELECTRICAL: South wall, interior, in roiler room. C. W.~TER: South of south exterior wall adjacent to roiler room. D. SPECJ:AL: <:, E. LOCK BOX: YES ; ~ IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLA~S') YES / NO YES / :\0 :'v[SDSs? ~EYS? YêS xo XO YES - 3B - I- ; /If. .. RAKERSFIEtu CITY FIRE UEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page ~ Of~.-L I. D. # BUSINESS NAME: Mercy Hospital 2215 T t A OWNER NAME: Catholi? Healthcare West 2 FACILITY UNIT #: 01 4th fl I I ADDRESS: rux un ve ADDRESS: 300 AdeLlne Drive FACILITY UNIT NAME: oar CITY. ZIP: Bakersfield, CA 93301 CITY.ZIP: Burlinqame. CA 94010 PHONE #: (805) 327-3371 PHONE , : (415) 340-:-7410 IOFFICIAL USE CFIRS CODE , ONLY 1 2 3 4 5 6 7 8 9 10 TYPF. 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 W 15 800 lbs 10/12 40 Utility room next to Elevator 100 Infectious Waste ORME I I I r-~ ~ ~/ NAME: Jack Resendez TITLE:Dir_Sf>C!nrit-t/SAfPSIGNA~.ff:E:" ~~-~- 1 DATE:/' /,-ð/ -EMERGENCY CONTACT: Jack Resendez TITl.E ir.Securit /SafEæý' ýHON~#. Bt!.§....-itOURS:327-3311 7:30-4":00 ~ '-'" AFTER BUS HRS: 327-3371/323-9751 EMERGENCY CONTACT: Administrator or EngineeI:TITLE: On Duty PHONE , BUS HOURS:327-3371 7:30-4:00 , PR I NC I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7 3371 - 4A-l - . "." L.·... ....; .¥_. ..............._._-........ ;, e \ -- .. SITE/FACILITY DIAGR~~ FORM 5 ... . NORTH DATE: / BUS DiESS NA.,',Œ: Mercy Hospital / FACILITY ~A~E; 'ld' FLOOR: 1 025 SCALE: UNIT =:1 OF 1 , (CHECK ONE) SITE DIAGRA.'I FACILITY DIAGRA~ attached / (Inspector's Comments): -OFFICIAL GSE ONLY- - SA - , . .j¡¡ e e BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD. CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY 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 NA.'fE: Fifth Floor FACILITY UNIT# 01 SECTION 1: MITIGATION, PREVENTION, ABATEME~! PROCEDURES Infectious waste collected in utility closet and removed daily to hazardous waste storage arèa. SECTION 2: NOTIFICATION ~\~ EVACUATION PROCEDURES AT THIS l~IT ONLY Notification and evacuation procedures initiated by activating fire alarm system and vocal alert via overhead paging system. Areas not covered by overhead paging system contacted via land line. - 3A - e e SECTION 3' HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility uoit cootaiO 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 for" 04A-l) If Yes. complete a hazardous materials inventory form marked' TRADE SECRETS ONLY (yelloW form .4A-2) in addition to the non-trade secret fnrm. List onlY the trade secrets on form 4A-2. ~ECTION 4: PRIVATE FIRE PROTECTIO~ Fire extinguishers woughout facility wet.standpipes in the hallway (interior) Dry stankpl.pes in hallway (interior) Fire alarm system/Sll'Oke detectors SECTION 5' LOCATION OF WATER Sù~PLY FOR USE BY EMERGENcY RESPONDERS City fire hydrant corner of Tr\]><tUD. and B streets city fire hydrant 16th street at c. SECTION 6' LOCATION OF L~ILITY SHUT-OFFS AT THIS UNIT O'LY. A. :\AT. GAS/PROPANí:::: South wall, exterior, adjacent to boiler room B. ELECTRI CAL : South wall, interior, in boiler room south of south eXterior wall adjacent to boil"" roc!t\. C. \'ÌATER: D. SPECiAL: E. LOCK BOX' YES~ IF YES. LOCATION' IF YES, SITE PLANS? FLOOR PLANS') YES ! NO YES ./ ~o ~SDSs'? KEYS? - 3B - \'r:s :.:0 YES ):0 .0 ., .< :: OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY I I! ,..1 ~I ¡ ,? 0 f ' l "'-'1 I. D. # Page BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONE tt: (805) 327-3371 OWNER NAME: Catholic Heal~hcare West FACILITY UNIT #:01 ADDRESS: 2300 Ade1,ine Drlve FACILITY UNIT NAME: 5th floor CITY,ZIP: Burlinqame, CA 94010 PHONE ,: (415) 340-:-7410 I , I 10FFICIAL USE CFIRS CODE I ON LV 1 2 3 4 5 6 7 8 9 TYPE MAX ANNUM. CONT USE LOCATION, IN THIS % BY CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME W 5 200 lbs 10/12 40 Utility Closet 100 Infectious Waste \. p ;l,\u 46 100 ft3 02 27 Supply closet 100 Oxygen ~sG¡ 10 HAZARD D.O.T CODE GUIDE ORME CMLQ . NAME: E~ERGENCY /7~ ~ '"-_ Jack Resendez TITLE:Dir_S~cnrir¥-/S;:¡fpSIONATJJiŒ: ~~.... ~ "DATE:"'7/..... -tX/ CONTACT: Jack Resendez TITl.EPir.Securit~/Saf.2'tv 7,H'ONE t.::ÞUS HOURSi327-337:f 7:30/4:00 I ~ ..- AFTER BUS HRS: 327-337Y 232-9751 ' CONTACT: Administrator or EngineerrITLE: On Duty PHONE' BUS HOURS:327-3371 7:30-4:00 BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7-3371 - 4A-l - EMERGENCY . PRINCI,PAL . '.' ....~~.: ...-.............,...--..... . e ~" -, - . . . SITE/FACILITY DIAGR~~ FORM 5 . NORTH SCALE: BUS DiESS NA.\Œ: FLOOR :5 OF 5 Mercy Hospital DATE: ! / F AC I L IlY ~A.'.{E: UNIT -. 1 OF 1!Þ - . malll bui ding , (CHECK ONE) SITE DIAGRA.'r FACILITY DIAGRAZ,r attached // (Inspector's Comments): -OFFICIAL rSE ONLY- - 5A - ...:. a., :; e e .. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (80S) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NA.\fE 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: Mercy Hospital (WEST TOWER) (81 BUilDING) B. LOCATION I STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (805 ) 327 - 3 3 71 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 DURING BUS. HRS. AFTER BGS. HRS. A. Jack Resendez Dir. Security /Safe~ 327-3371 Ph# 327-3371/ 323-9751 B. Administrator/Engineer on Call Ph# 327-3371 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: Southwall exterior"adjacent to boiler room on 16th STreet B. ELECTRICAL: South wall interior, in boiler room C. WATER: Soutþ of south exterior wall adjacen t to boiler room on 16th Street D. SPECIAL: ~ E. LOCK BOX: YES / ,TO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES I ~o KEYS? YES / ~O - 2A - - e i. ~ SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE Emergency response by engineering and security department employees on duty. Emergency cleanup response by housekeeping department. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital emergency department. 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 B. ~~~~~~~~~. FÔR' CÔÔROÍNÁTÍNå' ÁCTÍŸÍTÍÉŠ' ... .'. . . . ..(§) NO WITH RESPONSE AGENCIES:.......................... Is ~O C. PROPER USE OF SAFETY EQUIPMENT:.................. ES NO D. EMERGENCY EVACUATION PROCEDURES:......... .... .... ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: . . ., .. Eg NO REFRESHER @~O ~s ~O Œ NO Œ!S- NO ~NO SECTION 7: ,HAZARDOUS MATERIAL CIRCLE YES OR NO 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 COMPRESSED GAS:... '" YES NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. Director LE Security/Safety DATE ,:;:7--/-5/ Y7 - 2B - ·,,:,-' :¡ ..¡ e e . BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 I ' OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY 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 U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY L'TNIT# 03 FACILITY UNIT NA.'Œ: Firs.t Floor SECTIO~ 1: MITIGATION. PREVENTION, ABATEME~! PROCEDURES Minimum of cleaning materials stored in dietary area. Absorbent materials available from secur:í.ty,' and safety department. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT O~LY Notification and evacuation procedures initiated by activating fire alarm system and overhead paging system. - 3A - · e e SEcTION 3: HAZARDOUS MATERIALS FOR THIS uNIT ONLY A. Does thi s Foe il i ty Unit con tei n Hazardous ¡.I a teria 1 s1 . . .' . ·6,0 If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES Ð If No, complete a separate hazardous materials inventory form marked: NON-TRAUE 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 oolY the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION - - Fire extinguishers through out floor. Fire e¡ctingUishing hOod systemS in Jd.tchßno . Fire sprinklers thrOll<)bOUt floOr/FD connection SOUth wall of ER on 16th street Fire alarm systerolsrroke detectors. Dry stand-pipes. SECTION 5: LOCATION OF WATER Sù~PLY FOR USE BY EMERGENCY RESPONDERS city fire hydrant on 16th street at B. CitY fire nydrant on TruJ<tun and B streets SECTION 6: LOCATION OF I~ILITY SHUT-OFFS AT THIS ù~IT ONLY A. :\AT. GAS/?ROPANt:·: South wall, exterior, ai1jacent to boiler rOOJ\\ on 16th street B. ELECTRICAL: south wall, Interior, in bOiler room C. \>iATER: SoUth of south exterior wall ai1jacent to boiler rOOJ\\ on 16th street O. SPECi.AL: E. LOCK BOX. YES ;8' YES, LOCATION. IF YES, SITE PLANS? FLOOR PLA~S') YES / NO YES / :;:0 ~SDSS? KEYS? T¿S NO YES ):0 - 3B - nAKERSFIE~D CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page i of I ~I II , I II 1. D. # BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave Bakersfield CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 03 ADDRESS: 2300 Ade1,ine Drive FAC I L I TY UN I T NAME: ¡::¡iésI P/rð,e, B l' CA 94010 D ~ CITY. ZIP: , CITY,ZIP: ur lngame, .I. ~A1~ "'"'" - ~ PHONE # : (805) 327-3371 PHONE # : (415) 340-:-7410 10FFICIAL USE CFIlfs CODE "'~:1 ONLY 1 2 3 4 5 6 7 8 9 10 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 M 10 100 dal 10 Dietary cleaning 20 Mikro-quat 08 Q"nnl'T CRMT Dietsrry èleaning , M 10 100 gal 10 08 Supply storeroom 33 Lìme~A-way CRMl' M 6 100 gal 10 08 , Dietary cleaning supplv storeroom 27 FFI!';t- ,..1",,;::,n r'PM'T' M 6 100 gal Dietary cleaning 10 08 supplv storeroom 12 ¡I, 11 ,..' CRMI' M 6 2SB gal 10 08 Dietary cleaning SUDDlv sto 1q .T""t--rh"'lT CRMI' M 8 144 gal 10 08 Dietary cleaning ~1 lnnlv !';t-orproom Clorox bleach CRMI' Dietary cleaning M 12 144 aal 04 08 SUDDlv storeroom 11 Sprav cleaner EX1?L MX\j 48 96 qal 10 08 dietary cleaning 11 S11n Gloh ~l1nn 1 v CRMI' Dietary cleaning 100 Carbon dioxide liquified EXPL M 4 48 lb 04 01 supply storeroom í:)~ ~/ NAME: Jack Resendez TITLE: Di r. SpC!11ri tÌ>/SFlfpS IGN~~RE: ~ r- ...ú7 ~ -'" ~~ - DATE: 7- ~3,..'t7 EMERGENCY CONTACT: Jack Resendez TITI.E ir. Securi ¡SafE rtV / I PH9ÑE ~ 'I'H1'O" nOURS:327-337f 7:30-4:00 ~ . - /323-9751 EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRINCJPAL ßUSINESS ACTIVITY: Healthcare AFTER BUS HRS. 327 3371 PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3L7-3371 - 4A-l - · .." ....~ ~-., ...~. ........-.-.--.- ~;r e -, ...... ~" ., .. SITE/FACILITY DIAGR~~ FORM .5 NORTH SCALE: BUS I:-;ESS NA\Œ: FLOOR: 10C" S MerCV Hospital DATE: ! / FACILITY ~A"IE: UNIT :: :ð30F ,S West Tower , (CHECK ONE) SITE DIAGR.'\.\[ Attached FACILITY DIAGR.~"I Attached / , . (Inspector's Comments): -OFFICIAL ÇSE ONLY- - SA - t - ~~. '"' -:",";' .. e e I' ~ · BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~IE: BUSINESS PLAN SINGLE FACILITY 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# 03 FACILITY UNIT N~~: Second Floor SECTION 1: MITIGATION, PREVENTION. ABATEME~l PROCEDL~ES Infectious waste contained in utility closet and removed daily to hazardous waste storage area. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS L~IT O~LY Notification and evacuation procedures initiated by activating fire alann system and overhead paging system. - 3:\ - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this FacUlty Unit contain Hazardous MateriaIS?.....(3 NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YESQ If No, complete a separate hazardous materials inventory form ma~ked: 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 Fire extinguisher throughout floor Fire sprinklers throughout floor Fire alarm system/smJke detectors Dry stand pipes SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner of Truxutn and B Streets City Fire hydrant 16th and A Streets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT O~LY. A. XAT. GAS/PROPANÈ: South wall, exterior, adjacent to boiler roOm on 16th Street B. ELECTRICAL: South wall, interior, in boiler room. I C. WATER: South of south exterior wall, adjacent to boiler room on 16th Street D. SPECIAL: E. LOCK BOX, YES;' ÐIP YES, LOCATION, IF YES, SITE PLANS? FLOOR PLA?\S? YES ,I NO YES ;' XO YES :'YfSDSs? KEYS? y;::s ~o :\0 - 38 - '.. ~ ..:. RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page i of 1 I. D. # - .: BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY ZIP Bakersfield CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 03 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: Second Floor P B 'I' CA 94010 , : , CITY,ZI : ur lnqame, PHONE #: (805) 327-3371 PHONE #: (415) 340~7410 10FFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAJ~ 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 W 20 800 lbs 0/12 40 North hallway soiled utility closet 100 infectious waste ORME p~~ Nurses station :2 3s1 46 120 Fl'3 04 27 supply room 100 oxygen CMLQ supply room M 1 1 Gal 09 27· nurses station 2 xylocaine OREMA ~ rJ0/ ~/ -----' NAME: - Jack Resendez TITLE:Dir.SP-cl1r;t:ï/s~fPSIGNAT~~~.- ~ DATE: EMERGENCY CONTACT: Jack Resendez TIT liE ir.Securityl SafeÆ''l r.- PJt6NDßS HOURS:327-3371 7:30-4:00 . "'--'" . - - EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRINC~P^L BUSINESS ACTIVITY: Healthcare AFTER BUS HRS. 327 3371'323 9751 PHONE # BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3L7-3371 - 4A-l - " .. '" ,- .-- '.. ... -'." ."~.-~-.: ..;....'......__......~.......- J '" e ') -, e' ~ ~~'; ~ , . . . SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS DiESS NA;'rIE: FLOOR:2 OF 5 Mercy Hospital DATE: ! / F AC I L rTY :-lA..\fE: UNIT ={)3 OF1,( West Tower '(CHECK ONE) SITE DIAGRA.\[ FACILITY DIAGR.~\f attached ""," , . (Inspector's Comments): -OFFICIAL GSE ONLY- - SA - ~--~ -!-. :t e e BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~IE: BUSINESS PLAN SINGLE FACILITY 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# 03 FACILITY UNIT N~~: Third' floor SECTION 1: MITIGATION, PREVENTION. ABATEME~l PROCEDL~ES Infectious waste contained in utility closet and reTIDved daily to hazardous waste storage area. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT O~LY Notification Qnd evacuation procedures initiated by activating fire alarm system and overhead paging system. - 3A - e e , SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does th I s Fac! Ii ty Unit CO" tal" Hazardo"s Material s? . . . . . . G NO If YES. see B. If NO, continue with SECTION 4. ~ B. Are any of the hazardous materi~ls a bona fide Trade Secret YES~ If No. complete a separate hazardous materials inventory form ma~ked: 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 - Fire extinguishers throughout floor Fire sprinklers throughout floor/FD coooections south wall of ER on 16th Street Fire alarm system/SIroke detectors Dry Stand pipes. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner Truxtun !and B Streets Cith fire hydrant 16th at B Street SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS ù~IT OXLY. A. XAT. GASíPROPANÈ: South wall, exterior, adjacent to lx>iler room on 16th Street B. ELECTRICAL: South wall, interior, in boiler room C. WATER: South of south exterior wall adjacent to lx>iler room on 16th Street D. SPECiAL: E. LOCK BOX, YES ! ~TF YES, LCC'TTO~, IF YES, SITE PLANS? FLOOR PLANS? YES ,I NO YES / XO :vrSDSs? :<:EYS? Yê.S XO YES i XO - 38 - .:.:'to ~.... . . "AKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY I Page _..-1 of ,~ \. I. D. # BUSINESS ADDRESS: CITY, ZIP: PHONE #: NAME: Mercy Hospital 2215 Truxtun Ave Bakersfield, CA 93301 (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adel,ine Drive FAC I L ITY CITY,ZIP: Burlinqame, CA 94010 PHONE #: (415) 340~7410 FACILITY UNIT #: 03 UN I T NAME: 3rd floor 1 2 3 4 5 6 7 8 TYPE MAX ANNUAJ~ CONT USE LOCATION, IN THIS % BY CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. W 25 1,000 lbs 10/12 40 utility closet in north 100 ~ 9 10FFICIAL USE CFIRS I ONLY 10 HAZARD CODE CODE CHEMICAL OR COMMON NAME D.O.T GUIDE Infectious waste ORME p ~\) 23 100 FI'3 CÌ4 27 Supply roam by nursing 100 Oxygen - ;¿3stj CMLQ MM 1 1 gal 09 27 supply roam by nursing station 2 Xylocaine ORMA o (/ ~ /7______.- Jack Resendez TITLE: Di r _ SPr.llri t-~/S;:¡fpS I GNATU~: ')(. 71/ /~ /- {.L!!Þ DATE: CONTACT: Jack Resendez T ITI.E Pir. Securi tyVSaf~\""" 1'_-pïfoNEr~/B'"u§....-H'ÓURS :327-3371. 7: 30-4: 00 , . ~ '- ~FT~S HRS: 327-3371/ 323-9751 CONTACT: Administrator or EngineeqITLE: On Duty PHONE # BUS HOURS:327-3371 7:30-4:00 nUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3LI-3371 - 4A-l - NAME: EMERGENCY EM&RGENCY , PR I Nt I,PAL " .' '"' _.... '" . '.' ~..~...: ..;.·.·___·_4__·..... '~;.' ~ e ,\, j" ~ .. <'ó. SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS DiESS NA.\IE: FLOOR:3 OF 5 Mercv HosDital DATE: ! / ~AC'¿ ~ ~A.'1E: UNIT ~3 OF l~ es er '(CHECK ONE) SITE DIAGRA.\[ FACILITY DIAGRA.'1 attached // (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - .'\'" ' e e i' -' " t' BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NMIE: 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 L~IT# 03 FACILITY UNIT NA.'IE: Fourth Floor SECTION 1: MITIGATION, PREVENTION, ABATEME~Jr PROCEDL~ES Infectious waste contained in utility closet and rerrüved daily to hazardous waste storage area. SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS t~IT O~LY Notification and evacuation procedures initiated by activating'fire alann system and overhead paging system. - 304 - e e .;., ~ " .. >, ! SECTION 3: HAZARDOUS MATERIALS FOR THIS ~~IT ONLV A. Does thi s Faci Ii ty Un it con to i n Hazardous Ma ter ia I s? . . . . . @ 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 ma~ked: 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 Fire extinguisher throughout floor fire sprinklers throughout floor Fire alann systern/srroke'detectors Dry stand pipes/FD connections south wall of ER on 16th Street SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner Truxtun and B Street City Fire hydrant 16st at B SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS 1mIT O~LY. A. XAT. GAS/PROPANÈ: South wall, exterior , adjacent to boiler room on 16th Street B, ELECTRICAL: South wall, interior, in boiler room I C. WATER: South of south exterio wall adjacent to boiler room on 16th Street D. SPECiAL: E. LOCK BOX, YES / ~IF YES, LOCATION: IF YES, SITE PLA~S? YES / NO FLOOR PLANS? YES / XO :'v!SDSs? \'2S KEYS? YES ~O \0 - 3B - \>., .:.-;., RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HA~ARDOUS MATERIALS INVENTORY " I. D. # Page 1·' 1: _Of1"o_1 , : 'oJ,1 BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave B k f' Id CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: ADDRESS: 2300 Adel.ine Drive FACILITY UNIT NAME: 4th floor B l' 94010 , ì CITY, ZIP: a ers le , CITY,ZIP: ur lnqame, CA PHONE # : (805) 327-3371 PHONE , : (415) 340-:-7410 10FFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAJ. 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 " P -3D) equipment room west 100 ~3f;1 ¡ 92 120 ft3 04 27 n;:::¡ 11 tA7;:::¡U oxygen CMLQ M 2 2 gal 10 27 Med room/nurse station zepheran chloride ORMA W 24 1300 lbs 10/2 40 Utility room/N hallway 100 infectious waste ORME e --- :;'''1 fdr/ - ./" - NAME: Jack Resendez TITLE:Dir_spr.l1rit:¥/S;:¡fPSIGN~c;RE: \ ~.ff~_ ..... ~ DATE: ~/-r:-=?-Y- EMERGENCY CONTACT: Jack Resendez ' TITI,E ir.Securi /Sa,2élv/ JJlONE~ HOURS:327-337r 7:30-4:0LJ . ' , , . ' --- '- AFTER BUS HRS: 327-3371 /323-9751 EMERGENCY CONTACT: Administrator or EngineeqITLE: On Duty PHONE , BUS HOURS:327-3371 7:30-4:00 , PR I lYC I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3:¿7-3371 - 4A-l - ., .'. ."........ '.' ....-~.":..;_...-.......'-"'-............ . ~. e . ... -- e' re . ..' SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS DiESS NA)£E: FLOOR: 4 OF ::> Mercy Hospital DATE: .I / F AC I LI TV ~A..'1E: UNIT :::3 OF I' West Tower '(CHECK ONE) SITE DIAGRA.'f FACILITY DrAGR.~"'f attached / r (Inspecto~ls Comments): -OFFICIAL GSE ONLV- - SA - ~ ,~ . - . \."'" - e e BAKERSFIELD CITY· FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRIXT YOUR ANSW8RS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 03 FACILITY UNIT NMtffi: Fifth Floor SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDL~ES Infectious waste collected in utility.room and removed daily to hazardous waste storage area. SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS l~IT O~LY Notification and evacuation procedures initiated by activating fire alarm system and overhead paging system. - 3;\ - e e .:"..; SECTION 3: HAZARDOUS MATERIALS FOR THIS UXIT ONLY A. Does this Facility Unit contain Ha"rdous Materials?..... c9NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YESG) If No, complete a separate hazardous materials inventory form ma~ked: 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 Fire extinguishers throughout floor Fire sprinklers throughout floor Fire alarm system/smoke detectors Dry stand pipes/FD connection south wall ER on 16th Stree SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner Truxtunand B Street City fire hydrant 16th Street at B SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS lmIT OXLY. A. XAT. GAS/PROPANÊ: South wall, exterior, adjacentt. to boiler room on 16th Street B. ELECTRICAL: South wall, interior, in boiler room. C. WATER: South of south exterior wall adjacent to boiler room on 16th Street D. SPECJ:AL: E. LOCK BOX, YES !~rF YES, LOCATrO~: j /' YES ,I NO YES ' :':0 ~SDSs? KEYS? y;::s XO \"0 ,.' IF YES, SITE PLANS? FLOOR PLANS? YES - 3B - RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page J .~ of" ,I -.........,.- - 1. D. # ;¡ , BUSINESS NAME. Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONE, #: (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adeline Drive FACILITY CITY,ZIP: Burlinqame, CA 94010 PHONE': (415) 340-:-7410 FACILITY UNITt: c - _ ð J ' UN I T NAME: 5th Floor IOFFICIAL USE CFIRS CODE I ONLY 1 2 3 4 5 6 7 8 9 TYPE MAX ANNUAJ~ CONT USE LOCATION, IN THIS % BY CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME W 25 1,000 lbs 10/12 48 North hall utility- closet 100 Infectious wa!'\rp p?\) 23 100 Nurses station supply bl3sC¡ ft3 04 ' 27, room 100 Oxvaen M 1 1 gal 09 27 supply rm/nurses statior 2 xvlocaine 10 HAZARD D.O.T CODE GUIDE ()RMR rMTn ()RM~ e , NAME: 'EMERGENCY , ,.-/ -.-l/Þ7 /' -;, --- '"'- Jack Resendez TITLE:Dir.Spcnrir¥-/S;:¡fpSIGNAT)fRE: ~_ //:,§ L1?~ - ~ DATE: /---. ~ n/ CONTACT: Jack Resendez TITI.EPir.SecuritÝ/Safe~ {1>HOWE ~ BMS IW\JRS:327-3371. 7:30-~OO ~ ~AFTER Büš- HRS: 327-3371 /323-9751 CONTACT: Administrator or Enginee~ITLE: On Duty PHONE' BUS HOURS:327-3371 7:30-4:00 BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7-3371 - 4A-l - EMERGENCY , PR I NC I,PAL 4 '.' ._'.~ ,;~. ..~. ........ ..._.............._._ . - "- e . ~" -- . .?- . . SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS DiESS N.~'[&: FLOOR: OF 5 Mercy HospJ.ta 5 DATE: .I / ~AC I L,gV ~A.\{E: UNIT ð3 OFl~ est wer '(CHECK ONE) SITE DIAGRA.\[ FACILITY DIAGRAN attached /~,. (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - .. e - . '.., ~~r. -¡ BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NA.\fE 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 Mercy Hospital (MRI) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS.PHONE: (805 ) 327-3371 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 NOTIFV IN CASE OF EMERGENCY: NA.\fE AND TITLE DURING BUS. HRS. AFTER 81;S. HRS" A. Jack Resendez Dir.Security/Safe~ 327-3371 PhI 327-3371/323-9751 B. Administrator/Engineer on Call PhI 327-3371 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: N/A B. ELECTRICAL: off 16th Street North of MCRC C. WATER: N/A· D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES I NO FLOOR PLANS? YES / NO KEYS? YES / ~O - 2A - e e .. ~-~- SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE Response personnel from radiology department .~':-',' Emergency response from engineering and security department. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy hospital emergency department. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES E~PLOYEES WITH I~ITIAL A~D 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:.......................... I ~O C. PROPER USE OF SAFETY EQUIPMENT: . . . . . . . . . . . . . . . . .. I NO D. EMERGENCY EVACUATION PROCEDURES:................. E ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. ~ NO SECTION 7: HAZARDOUS MATERIAL REFRESHER @> NO ~NO I3E-5, NO NO ES' NO CIRCLE YES OR NO 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 COMPRESSED GAS:.. .... YES NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. Director }t-G-E-Security/Safety DATE ~ /3---- J;? / - 2B - " e e , .. BAKERSFIELD CITY FIRE DEPART~E~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~IE: 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. :f FACILITY UNIT# 15 FACILITY UNIT N~~: MRI SECTION 1: MITIGATION, PREVENTION. ABATEMENl PROCEDL~ES Chain link fence surrounds building warning signs. SA-..If¡;¿ ~/&k,v~ #/~¿ SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT ONLY They would contact Mercy Hospital switchboard who would notify responsible and responding personhel to thi~ location. - 3A - e e .. - A. Does this Facility Unit FOR THIS UKIT ONLY ~ contain Hazardous Materials?.... .~NO SECTION 3: HAZARDOUS MATERIALS 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 :i/:4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) in addition to the norr.~trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION Fire extinguishers SECTIO~ 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner of 16th street and A SECTION 6: LOCATION OF UTILITY SHUT~OFFS AT THIS l~IT ONLY. A. ~AT. GAS/PROPANÈ: 16th Street south of MCRC B. ELECTRICAL: N/A C. 'tvATER: N/A D. SPECiAL: E. LOCK BOX, YES@ IF YES, LOCATION, IF YES, SITE PLANS? FLOOR PLANS? YES ,I 1'10 YES / XO ~SDSs? I\EYS? VèS XO XO YES - 3B - I. D. , RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page , .L o/L-' BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP: Bakersfield, CA 93301 PHONE, #: (805) 327-3371 1 2 3 4 TYPE MAX ANNUAL CODE AMOUNT AMOUNT UNIT p5S 3~~fP )~~~~ 1b '-., ptjo ~~~1Šv "33~~710ÙUP1b P SÎ J ) ~ ~ 1b gl,; (~ - Š600 1b 5 6 CONT USE CODE CODE 03 27 03 27 03 27 03 27 I "< ! - : , I i OWNER NAME: Catholic Hea1thcare West FACILITY UNIT #: 15 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME:MRI Unit CITY,ZIP: Burlingame, CA 94010 PHONE #: (415) 340-7410 7 LOCATION,IN THIS FACILITY UNIT MRI unit Truxtun and A Street 8 % BY WT. 100 100 10FFICIAL USE CFIRS CODE I ONLY 9 10 HAZARD D.O.T CODE GUIDE 100 100 CHEMICAL OR COMMON NAKE~ Non - f l'ammab1e he 1. i u&-,.Jfê:Ér ige rated lialJià non-f1alJ1IDab1e nitrogen 'Î3;;:l~ refriaerated 1; ('f1l i rì ,r;;t. 7 Hydrogen;;:W~ rI.,,'""l"] non flammable he1iu~cy1inder RXPT. , e I I , , , i RXPT. EXPL EXPL I ., , ! (/ J.-¿ ) /I _ __ ,/,-, I NAME: Jack Resendez TITLE:Dir.Spr.1Jrit-¥-/S;:¡fpSIGNATURE¡f / '.ß/ A - -?-~ -D-ÃTE:..../-/.::;>/ð /: EMERGENCY CONTACT: Jack Resendez TITI.EPir.Securitv/Så.fetv \ttrõN§l~ B.J1'S:JJ.O.Y-RS:327-337Í. 7:30-4:00! , . - '---1("FTER -BUS HRS: 327-3371/323-9751 I EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty PHONE' BUS HOURS:327-3371 7:30-4:0Q 'PRINCIPAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3~7-3371 I - 4A-l - · '.' ~.·a·.·: ...;..................'_._.-........ e '\ -- -- SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS r:-iESS NA\[E: FLOOR: OF Mercv Hospital 1 0 DATE: .I / F ~þ.¥, TJJ i ~A\{E : UNIT =is OF 15 , (CHECK ONE) SITE DIAGRA.\I / FACILITY DIAGR.~\{ attached ",/" , . (Inspecto~'s Comments): -OFFICIAL GSE ONLY- - 5A - - e SAFETY GUIDE LINES FOR 0.35 T DIASONICS MAGNETIC RESONANCE IHAGER MAGNET 0.35 T super conductive magnet. Niobium, titanium wire coils surrounded by liquid helium surrounded by liquid nitrogen. Saddle shaped RF coils. Radio frequency waves 15 mHz. Ferromagnetic: Iron, cobalt, nickel and alloys of these metals. (30G - series stainless steels not magnetic, used in orthopedic devices, suture material, surgical clips, and other metallic implants). Paramagnetic: Platinum, iridium, and titanium Diamagnetic: Mercury, gold, copper and zinc BIOMAGNETIC HAZARDS No harmful biological effects have been demonstrated at the magnet field and RF intensities and exposure times used in the Diasonics lmager. BIOHAZARDS Pre MRI patient screening process should include identifying patients exposed to: 1. Fragments of metal including microscopic metal fragments remaining in their eyes without their knowledge (Sheet metal workers) 2. Eye cosmetic (makeup) usually contains ferromagnetic materials (e.g. iron) that can cause irritation in patient's eye during or after the imaging session. '~ 3. House/3M cochlear implant system. The RF pulses affect the external signal processor and the devices susceptability to magnet fields, both of which can cause extreme discomfort to the patient (false auditory and temperature sensations). The patient should be warned of the possibility of such interference before entering the magnetic fields of 5 and 10 gauss. _. I , COLLISION HAZARD Ferromagnetic objects: KEYS TOOLS ROUTINE HOSPITAL EQUIMENT CRASH CART EQUIPMENT OXYGEN AND OTHER COMPRESSED GAS TANKS PAPER CLIPS STAPLES PINS NOTE BOOKS, NOTE PADS, OTHER BUNCHES OF PAPER, AND PATIENT CHARTS OTHER ITEMS MADE WHOLLY OR IN PART OUT OF IRON, STEEL, STAINLESS STEEL, NICKEL, COBALT, RARE EARTH CERAMICS, OR ANY OTHER COMPOUND WHICH CAN HAVE A PERMANENT OR INDUCED MAGNETIC MOMENT. e tit =-- ~ ~uipment Sensitivity to Magnetic Fields ,'arious types of equipment may be affected by the field. The most common of these jevices are listed below, along with the magnetic field strength that should not be '.\cceded in order to ensure proper opere tion of the device. X-ray iml1GinG equipment CT PET 0.5 gauss* Cathode ray devices CRTs Video cameras Crash cart Emergency equipment Patient monitoring equipment 2 gauss Pacemakers Hearing aids Electronic implants 5 gauss Computers Magnetic storage media 5 gauss Analog watches Electric motors 10 gauss Credit cards 10 gauss . (The Earth's magnetic fieJd strength is approxi ma tely 0.5 gauss). ;ce figures 2 and 3 ! . ~heck with the manufacturer of these)r other devices if, any question of operating vi thin a magnetic field exists. Diasonics can assist by providing da ta about the imaging i ;ystem that may be required to evaluate other manufacturer's equic:>ment. '~1' I I 'iOTE '- \11 ar0ilS surrounding the van must be surveyed for the presence of equipment within the :Idicared magnetic field ~trength boundaries. This includes areas above and below the , ',' 111 . ;AfETY GUIDELINES ;ccurity Zone II accordance with FDA instructions, the customer must estabIi~h a security zone and ,uitable screening p 'ocedures to pl'event hazards to patients and personnel that arise ¡'om the inadvertent introduction of ferromagnetic objects inte the proximity of the nagnet. ,c< '~? I I ' \ ,\ I t. I, i ¡: I: .....".. " e e ~~.~{¡.. ;:;:;I The high magnetic field strengh exhibits a force on such an object proportional to its mass, Near the magnet this force is strong enough to pull in objects both large and small and cause them to fly down the axis of the magnet. Such objects become projectiles that can cause severe injury, death or property damage. Preventative measures: All ferromagnet objects must be kept out of the magnet room. A reasonable test: 1. Whether a small permanent magnet is attracted by it. 2. Whether it will set off a metal detector. Pockets on shirts, lab coats and other clothing must be screened. MAGNETIC INTERFERENCE WITH ACTIVE IMPLANTS Cardiac pacemaker inference in fields as low as 5 to 10 gauss. Patient, operator position, service technician, janitor, guard wearing an implant should not come inside the 5 gauss limits. " , MAGNETIC EFFECTS ON METALLIC IMPLANTS Surgical or aneurysm clips may move relative to the tissue they present within. In the case of a large implant, conditions can arise under which electric currents are induced in the metal by the magnetic fields, (eddy currents are induced by the pulsed gradient fields) and produce some local heating. In this case the metal does not have to be ferromagnetic. >.:; ""'"1' '¡--", Persons with metallic implants should not go beyond the 5 gauss proximity of the magnet at any time. -.:~, .~: :::'::J: .'!~j RF INTERFERENCE WITH ACTIVE IMPLANTS Active implants contain electronic circuitry whose operations can change due to ~~ference from radiofrequency electromagnetic radiation. (Anyone wearing ECG leads or other wires must never be brought near the imaging coils of the magnet). .....,. RF ANTENNA EFFECTS RF energy is radiated by the imaging coils of the magnet. Metal wires, such as ECG leads behave like antennae and readily picked up energy from the RF fields. These leads can pick up enough energy so that the person wearing the leads would be caused to suffer: ." -,." l. Electric shocks, from the electric current induced in the wires. 2. Burns from the RF energy focused on the wires wherever the leads touch the patient's skin. When a gated protocol is In normal operation the liquid helium and liquid nitrogen are venting into the ducting in the magnet room. When the magnet quenches, the boil off rate suddenly becomes very high. If the ventilation in the magnet room 1S inaquate the vented gases can fill the room with extremely cold dense gaseous helium and nitrogen. It would take 5 to 10 minutes for these cryogens to fill the magnet room. These gases are colorless, odarless and nontoxic but they can displace the oxygen within the room. I I ¡ I \. I I I ':' , c~ . . . ~,. . I f· _/1 performed w1th the D1aSOD1CS 1mager a speè1a 1beropt1c aser ECG system is used to detect the patient's heart beats. The fiberoptic cable is noOto'flallic. ASPHYXIATION HAZARD CRYOGENIC BURN HAZARD Skin contact with liquid cryogens or boiled gases can cause burns. Breathing gases at cryogenic temperatures;can cause injury to the air passages and lungs. .. EXPOS ION HAZARD Vapors of certain anesthetics can be ignited by electrical sparks and arcs. The use of acetone, ether and other organic solvents to clear electrical equipment can lead to fire and explosion. Maintenance of vents and neck tube is critical to avoid internal pressure build-up. ELECTRICAL FIRE HAZARD Conductive liquids such as soap, water and coffee, soft drinks, soup and saline can seep into the equipment, resulting in short circuit which can cause a resulting fire. PATIENT DISTRESS/CODE BLUE Equipment on a standard crash cart includes items that include _ ferromagnetic material. The crash card must be located outside the '~agnet room. The crash cart must never be brought into the magnet room. ,j - " " " e . BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD. CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA.'E 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: Mercy Hospital (Personnel/Employee Health Trailers) B. LOCATION / STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (80S) 327-3371 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 NOTIFV IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER Bes. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 Ph# 327-3371/323-9751 B. Administrator/Engineer on Call Ph# 327-3371 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: No Gas B. ELECTRICAL: Rear ot Trallers C. WATER: 16th Street D. SPECIAL: E. LOCK BOX: YES I~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES I NO MSDSS? YES I NO KEYS? YES / NO - 2A - . SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE . . e f. -,. Emergency response by engineering and security employees on duty. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR VOUR BUSINESS AS A WHOLE Mercy Ðnergency department SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM.WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE VES OR NO INITIAL A. ~~~~~¡L~~~.~~~~.~~~~~~~~.~~.~~~~~~~~~. ... .,......~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:.......................... "NO C. PROPER USE OF SAFETY EQUIPMENT:.................. Y NO D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . " . E~) ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. ES- NO SECTION 7: ,HAZARDOUS MATERIAL REFRESHER c@) NO ~XO ~NO ~NO ~NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 PO~F A SOLID. 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:......~ NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. . /'~ : ; Director srGN~ ~ÍìtE Security/Safety - 2B - DATE {~ B -- 'J/7 -. -. . e . I' BAKERSFIELD CITY FIRE DEPART~E~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS Þ 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# 13&14 FACILITY UNIT NA.'Œ: Trailers SECTION 1: MITIGATION. PREVENTION, ABATEME~l PROCEDL~ES No hazardous materials stored in this area except for small quanti ties of office suppl;ies which MSDS's are kept on file. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT ONLY Made by telephone as overhead paging system does not reach this area. - 3A - · e -~ SECTION 3: HAZARDOUS MATERIALS FOR THIS ù~IT ONLY 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 ma~ked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SÐCRETS 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 Fire alarm system/smoke detectors Fire extinguishers SECTION 5: LOCATION OF WATER ,SUPPLY FOR USE BY EMERGENCY RESPONDERS 16th Street adjacent to trailers SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS ù~IT OXLY. A. XAT. GAS/PROPANÈ: No gas Area between trailers- ELECTRICAL: , lQ4.~~g!l!'.!!.et C. WATER: D. SPECIAL: E. LOCK BOX, YES~F YES, LCCATIOX, IF YES, SITE PLANS? FLOOR PLANS') YES / NO YES ./ :\0 ~SDSs? KEYS? 'i?S NO YES i \'0 - 38 - RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY 1 - Page _ of 1; I. D. # ~I 'I BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave ITY ZIP Bakersfield CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT It: 13&14 ADDRESS: 2300 Adel.ine Drive FACILITY UNIT NAME: Trailers B l' CA 94010 , I ! C , : , CITY,ZIP: ur l.nqame, PHONE # : (805) 327-3371 PHONE It : (415) 340,:",7410 10FFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPF. 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 NONE AT THIS ", r.c:cATION , e (M'7 - ,.,/1 - .-7 NAME: Jack Resendez TITLE:D:ir_Sf>~l1r;t:13/s;:¡fPSIGNA:tJE: ~/.> . ~ DATE: /:L; -"'7/ EMERGENCY CONTACT: Jack Resendez TITI,E ir.Securit /Saf..etv ~ON~~~?URS:327-33í1 7:30-~:OO .. ' , "-"'" AF~ uvS HRS: 327-337~~?~-q7I:)J ' EMERGEN'CY CONTACT: Administrator or EngineerrITLE: On Duty , PHONE' BUS HOURS :327-337 7: 30-4: 00 , PR I NC I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3:.0-3371 - 4A-l - .. ~.. "'r.~-··· . '... ,_.,,_,~: .~_..'__....._.__..... . '\ -, . SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: FLOOR: 1 OF 1 DATE: ! UNIT =: lth Trailers , (CHECR ONE) SITE DIAGRA.\[ attached FACILITY DIAGR.~\attached ,,/. (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - . ~, - . . '. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD. CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA.'tE 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 Mercy Hospital Skilled Nursir1.g Facility A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (805 ) 327 - 3371 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 DURING BUS. HRS. AFTER BLS. HRS. A. Jack Resendez Dir . Security /Safelt:t1# 327-3371 Ph# 327-3371/323-9751 B. Administrator/Engineer on Call Ph# 327-3371 PhI 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE .. A. NAT. GAS/PROPANE: South wall of boiler room, exterior B. ELECTRICAL : South waLL 0:1: 'ooJ.ler room, illterJ.or C. WATER: south side adjacent to boiler room D. SPECIAL: E. LOCK BOX: YES / '~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ~O KEYS? YES I ~O - 2A - · e >. SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE Emergency response by engineering and security employees on duty. Housekeeping departrœnt for cleanup. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTkVCE FOR VOUR BUSINESS AS A WHOLE Mercy hospital Emergency room. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES E~PLOYEES WITH INITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE VES OR NO I~ITIAL A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:................................ .'...... @ NO B. PROCEDURES FOR COORDINATING ACTIVITIES , WITH RESPONSE AGENCIES:.......................... ~O C. PROPER USE OF SAFETY EQUIPMENT:.................. ' ~ NO D. EMERGENCY EVACUATION PROCEDURES:................. . ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. YE - NO REFRESHER ct!V ~O ~~O ~ES NO NO ES 0 SECTION 7: ,HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL I~ QUANTITIES LESS THAN 500 PO~ A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:...... ~NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. SI Director t¡ T-ITLE Security/Safety DATE /'7-ß - - 2B - .. e . BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY 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 L~IT# 06 FACILITY UNIT N~~: Skilled Nursing Facility SECTION 1: MITIGATION. PREVENTION, ABATEME~! PROCEDL~ES Infectious waste stored in utility closet Until removed fram building daily by housekeeping department. . Release and spills prevented'by double bagging of all infectious waste and removing in leak proof and covered cart. Spills are cleaned by utilizing absorbant materiqls as needed. Clean up handled by housekeeping department. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS l~IT O~LY Notification procedures follow the Mercy hospital fire plan and are set in IIDtion by the activation of the fire alann system in this, building. Evacuation orders would be given to entire facility via overhead paging syste.'1l. - 3A - · e SECTION 3: HAZARDO~S 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 :t4A-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 - West standpipes in ~llways Fire extinguïshers throughout facility Fire alarm system Srroke detectors Inhouse emergency response team. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant on 16th Street to the south City fire hydrant on Truxtun and C Streets to the, north. SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS u~IT O~LY. A. XAT. GAS/PROPANÈ: South wall of boiler room, exterior B. ELECTRICAL: South wall of boiler room, interior C. WATER: South side adjacent to roiler room. D. SPECIAL: E. LOCK BOX, YES /~IF YES, LOCATro~, IF YES, SITE PLAKS? FLOOR PLANS? YES ! NO YES / :\0 YES ~SDSs? KEYS? YES - 38 - NO :\0 þ '. 1. D. # RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY 1 - .,1 Page of BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave B k f' 1d CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 06 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: skilled nursing l' CITY. ZIP: a ers le , , CITY. ZIP: Bur lnQame. CA 94010 PHONE # : (805) 327-3371 PHONE # : (415) 340-7410 IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 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 W 15 700 lbs 10/12 40 Infectious Waste Infectious Waste/Sharps ORME - .......... LJ-/£/ -- --'~~ , - NAME: Jack Resendez TITLE:Dir.SP~l1ri'¡-15/s;:¡fPSIG~~URE:'- ~'/~ --- ~ DATE: EMERGENCY CONTACT: Jack Resendez TITI.E ir.Secur tv/Sa£€'tv\.... ~Ho~g~:~:?IOURS:327-3371 7:30-4:00 . , , . ~ A-.!ER. S HRS: 327-3371/323-9751 EMERGENCY CONTACT: Admlnistrator or Enginee~ITLE: On Duty 'p~INC~rAL BUSINESS ACTIVITY: Healthcare PHONE # BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3L7-3371 I I I - 4A-l - . '.' ..'.- .-': ..... ......~........_.__....... .. e \, _. .'. SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS I~ESS NA:r£E: FLOOR: OF Mercy Hospital 1 1 DATE: / / FACILITY )lA.'4E: UNIT -. OF 1$ -, Skilled Nursing Facility 6 '(CHECK ONE) SITE DIAGRA.\! attached FACILITY DrAGR.~'4 attached / . . (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - ·..~ ~~ .. e . BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA.\fE 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 Mercy Hospì tal (COnference Center) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 1600 D Street CITY: Bakersfìeld, CA ZIP:93301 BUS. PHONE: (805 ) 327-3371 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: NA.\fE AND TITLE DURING BUS. HRS. AFTER BeS. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 Ph# 327-3371/323-9751 B. Admìnìstrator/Engineer on Call Ph# 327-3371 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: North side of building B. ELECTRICAL: Inside south wall ~n ut~l~ty room C. WATER: South· s~de ot bru.ldJ.ng D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES I ~O KEYS? YES I ~O - 2A - e SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE e , , ' . Response by Mercy Hospital engineering and security departrœnts persormel on duty. - SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy hospital emergency department. 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. :~~~~¡L~~~. ~~~~. ~~~~~~~~. ~~ .~~:~~~~~~. . . . .'. . . . .. G;;J NO B. PROCEDURES FOR COORDINATING ACTIVITIES I WITH RESPONSE AGENCIES:.... .,~.:.................., YES NO C. PROPER USE OF SAFETY EQUIPMENT................... NO D. EMERGENCY EVACUATION PROCEDURES: . . . . . . . . . . . . . . . .. Y , -NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. ES NO SECTION 7: ,HAZARDOUS MATERIAL REFRESHER ð§;) NO Iv XO E / NO , NO ES NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS ~ SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:... ... YES ~ I I Jack Resendez I certify that the above information is accurate. I understand that this 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. Director TiTLE Security/Safety - 2B - DATE 7- /3----ó7 , , ~, -- . r¡ . , . BAKERSFIELD CITY FIRE DEPART~E~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUS INESS NA~[E: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action. this form must be returned by: 2. TYPE/PRINT YOUR ANSWBRS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNITN~~: Mercy Conference Center FACILITY ù~IT# 07 SECTION 1: MITIGATION. PREVENTION. ABATEME~l PROCEDL~ES No hazardous materials are. stored or;' :used in this building. SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS UNIT O~LY Notification and evacuation procedures would be made by person discovering incident. By aler;'ting all occupëillts and notifying Mercy Hospital PBX Operator who notifiedpublic/inhouse emergency response units. - 3A - · e ;;-.' SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLV A. Does this Facili ty 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 ma~ked: 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 PROTECTIO~ Fire extinguisher throughout roth floors SrrDke detectors throughout roth floors SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant southwest corner of 16th & D STreèts SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT OXLY, A. ~AT. GAS/PROPANÊ: Northeast corner òf building, exterior B. ELECTRICAL: South wall in utility closet interior C. WATER: South side of building, exterior D. SPECiAL: E. LOCK BOX, YES Ð IF YES, LOCATION, IF YES, SITE PLANS? FLOOR PLANS? YES ! NO YES / :\0 ~SDSs? KEYS? Y;::S NO YES / :\0 - 38 - nAKERSFIE~D CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY II Page ~ of 1· I I. D. #: BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONF. #: (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adel,ine Drive FACILITY CITY,ZIP: Burlinqame. CA 94010 PHONE #:: (415) 340-:-7410 FACILITY UNIT #: 07 UN I T N A ME: Mercy Conterence center CODE 1 TYPE CODE 2 MAX AMOUNT 3 ANNUAI~ AMOUNT 456 CONT USE UNIT CODE CODE 7 LOCATION,IN THIS FACILITY UNIT 8 % BY WT. 9 10FFICIAL USE CFIRS ONLY 10 HAZARD CODE D.O.T GUIDE CHEMICAL OR COMMON NAME NONE Nr THIS IDCATION NAME: E \fERGENCY ~ ~ -........ ....""- Jack Resendez TITLE: Dir _ Spcllr; t:t/S;¡fPSIGNATURJY'( ~,/~ ~- -- -~ ,- - DATE :/-/..;¡ -/1 :; CONTACT: Jack Resendez ' TITLE ir.Securitv/Safe2V \: PMNE ~ ~HOURS:327-3371 7:30-4-!'o0 .....--- EMERGENCY CONTACT: Administrator or EngineeqITLE: On Duty 'PRINCIPAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS. 327-337]/323-9751 , PHONE' BUS HOURS:327-3371 7:30-4:00 I' AFTER BUS HRS: 3L7-3371 ì - dA-1 - ·- " ' ,.'., ~ e . "," : BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NA.'tE 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: Mercy Hospital (Child Ca:r:-e Center) B. LOCATION I STREET ADDRESS: ¡90g 16th Street CITY: Bakersfield, CA ZIP:93301 BUS.PHONE: (805 ) 327-3371 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 DURING BUS. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 B. Administrator/Engineer on Call Ph# 327-3371 AFTER 81;S. HRS. Ph# 327-3371/323-9751 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: East side of building, exterior B. ELECTRICAL: South s1de 1n, ut1lity roam C. WATER: North side in sidewalk D. SPECIAL: ~ E. LOCK BOX: YES /~ IF YES. LOCATION: IF YES. DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ~O KEYS? YES / ~o - 2A - · - ~ " .. SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE Response by engin.eering and security department persormel on dùty. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital emergericy room. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH I~ITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. :~~~~¡L~~~. ~~~~. ~~~~~~~~. ~~. ~~~~~~~~~.... .'...... ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:.......................... ~ NO C. PROPER USE OF SAFETY EQUIPMENT:.................. ~ NO D. EMERGENCY EVACUATION PROCEDURES:.... .... ... ...... ~ ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... ., ~ NO REFRESHER I~NO J, NO f NO , - NO YES NO SECTION 7: ,HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POCNDS OF A SOLID. 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:... ... YES~ I, Jack Resendez , certify that the above information is accurate. I understand that this 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. Director TITLE Security/Safety DATE - 28 - ., -¡ - . ~. . BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD. CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA)[E: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS '" 1. To avoid further action, this form must be returñed by: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 08 FACILITY UNIT NA.'fE: Mercy Child Care Center SECTION 1: MITIGATION, PREVENTION, ABATEMENJr PROCEDL~ES No Hazardous materials kept in tl1,is building. Small am:>unts of cleaning products may be used. Spills of clorox would be handled by dilution and absorbing materials and airing of building if necessary. SECTION 2: NOTIFICATION ~\~ EVACUATION PROCEDURES AT THIS UNIT ONLY Notification art.devacuation procedures are begun by activating the fire alann system art.d taking normal fire evacuation. Procedures as required by established fire plan. - 3A - e - SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLY A. Does this Facility Unit contain Hazardous Materials?...., If YES. see B. If NO, continue with SECTION 4. YE~ 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 inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) fh addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION L Extinguishers throughout automatic fire sprinklers Fire alarm m:mitored by alarm company SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant south side of 16th Street at F STreet SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS ù~IT OXLY. A. XAT. GAS/PROPANÈ: East side of building exterior. 8. ELECTRICAL: South side of inside utility room. C. WATER: North side in sidewalk D. SPECIAL: E. LOCK BOX: YES / ~ IF YES, LOCATION: IF YES, SITE PLA~S? FLOOR PLANS'? YES / NO YES / NO YES ~SDSs? KEYS? YES - 3B - ::0 NO .';' .'t' . , I RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page 1 - " ..., ' of - -'![ I. D. # BUSINESS NAME: Mercy Hospital ADD~ESS: 2215 Truxtun Ave B k f' Id CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT I: 08 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: Child Care B l' C 94 0 CITY. ZIP: a ers ~e , CITY,ZIP: ur ~nqame, A 01 Center , PHONE #: (805) 327-3371 PHONE , : (415 ) 340~7410 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 D.O.T I I CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE , NOI'HING AT THIS LOCATION ! , ! ¡ " :' ! ! :1 , i : ( M/ I "y /1 ---.. NAME: Jack Resendez TITLE:Dir_F;p~l1rit:~/F;;:¡fPSIGNA'&Ifil":: ~/ ¿'f7~_- l --- nATE: I, EMERGENCY CONTACT: Jack Resendez TITI.E ir.Secu~ftv/Saf.etv ~ PßóN~~HOURS:327-3371 7:30-4:00 I , , ~ - AF BUS HRS: 327-3371/323-9751 EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRINC~P^L nUSINESS ACTIVITY: Healthcare PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3l7-3371 - 4A-l - !-, ~- :": :\ - {" -- e BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA.'v[E 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 Mercy Hospital/Medical Records/Business office (Maric3l1 Building) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfield, CA ZIP:93301 BUS.PHONE: (805 ) 327-3371 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 DURING BUS. HRS. AFTER BGS. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 Ph#: 327-3371/323-9751 B. Administrator/Engineer on Call Ph#: 327-3371 Ph#: 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: Off A Street north of MeRe Building B. ELECTR I CAt: OFF A Street north of MCRC Building C. WATER: au A Street north of MCRC Building D. SPECIAL: E. LOCK BOX: YES /~ IF YES. LOCATION: IF YES. DOES IT CONTAIN SITE PLANS'? YES / NO MSDSS'? YES / NO FLOOR PLANS'? YES / NO KEYS,? YES / NO - 2A - e e .. " ~~ SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE Emergency response by engineering and security errployees on duty. Housekeeping department for emergency cleanup. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTkVCE FOR YOUR BUSINESS AS A WHOLE MercY Hospital Emergency department. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE VES OR NO INITIAL REFRESHER A. :~~~~~L~~~. ~~~~. ~~~~~~~~. ~~. ~~~~~~~:~. .. . .'. .. . ..~ NO @ NO B. PROCEDURES FOR COORDINATING ACTIVITIES ~ WITH RESPONSE AGENCIES:...... .................... Y NO C. PROPER USE OF SAFETY EQUIPMENT:.................. ,Y NO D. EMERGENCY EVACUATION PROCEDURES:................. ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:. "0 .. NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 PO~F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: o.....~ NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. .~ SIGN é URE. '~ Director TITLE Security /Safety DATE /-/$ -;:f';? , - 2B - ~. .:; .. it '; e e BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE O~LY ID# ------ BUSINESS NA~IE: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned hy: 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 {¡'"NIT:#: 09 FACILITY UNIT NA.'IE: Marian Building SECTION 1: MITIGATION, PREVENTION, ABATEME~Jr PROCEDL~ES Small amounts of hazardous materials such as cleaning agents. Restriction of large amounts of hazardous substances. Spills c:eaned up b<t absorbent mate:dals such as vermicili te. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS U~IT ONLY Notification and evacuation procedures follow the Mercy Hospital fire plan procedures and is activated by the fire alarm system in this building. Signal is received at Mercy Hospital switchboard who notifies fire department of emergency and' inhouse response team. - 3A - e e , SECTION 3: HAZARDOUS MATERIALS FOR THIS u~IT ONLY A. Does this Facility Unit contain Hazardous MateriaIS?.....@ 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 ma~ked: 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 Fire extinguishers throughout building. Fire alarm system/srroke detectors Fire sprinkler system throughout building. Fire department cormection off A Street near driveway. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS . City fire hydrant comer Truxtun and A Streets City fire· hydrant comer Truxtun and B Streets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS 1mIT O~LY. A. ~AT. GAS/PROPANÉ: Off A Street north of MCRe Building #10. B. ELECTRICAL: Off A Street north of MCRC Building #10 C. WATER: Off A Street north of MCRC Building #10. D. SPECIAL: E. LOCK BOX: YES/~ IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLA~S? YES / NO YES / XO ~SDSs? KEYS? 'rES NO XO YES - 38 - I . ¡I 1.0. . , ! I OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page 1 of.J BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave Bake sf' ld CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 09 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: Marian Bldg B I' C 94010 CITY, ZIP: r le , CITY,ZIP: ur lnqame, A PHONE #: (805) 327-3371 PHONE , : (415) 340-:-7410 10FFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAJ~ 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 secona !.Lr souro wa.L.L M 24 240 lb 10 99 xerox room Dry ink plus p 6 6 ~O oz 10 26 2nd floor south wall Fuser lubricant rnnm M 3 6 lbs 10 01 2nd floor south wall 95 Developer EXPL rf'V'm"l M 1 1 gal 10 02 2nd floor supply room 100 Liquid paper thinner FLLQ , ! I - (~/ /'"7'5 I NAME: Jack Resendez TITLE:Dir.secl1rit:t/S;:¡fPSIGNATU~ \.....;...::?7 p?\", ¿> - ~ DATE: EMERGENCY CONTACT: Jack Resendez ' TITLE ir.Securityj¡ afet)j ~I'. ~ Buå-KOURS:327-3371 7:30-4:00 . \...../ AFTER BUS HRS: 327-3371 /323-9751 I ,I EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PPINCJPAL BUSINESS ACTIVITY: Healthcare PHONE' BUO HOU80:327-3371 7:30-4:00,1 AFTER BUS HRS: 3LI-3371 - 4A-l - i.l.:- ... , e . BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY lO# BUS INESS NAr.'tE 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: Mercy Hospital Mercy Cardiac Rl=hab Center B. LOCATION / STREET ADDRESS: 16th & A Streets CITY: Bakersfield, CA ZIP :9330 1 BUS. PHONE: (805 ) 327 - 3 3 71 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 DURING BUS. HRS. AFTER 81;S. HRS. A. Jack Resendez Dir . Security /Safe~ 327-3371 PhI 327-3371/323-9751 B. Administrator/Engineer on Call PhI 327-3371 PhI 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: Nrl1::-t-n nr þnjlr'1ina n~r.Z\ !=:t-r~~t- B. ELECTRICAL: North wall of bUllding ëxterlor C. WATER: A street ad-jacent to northwest corner of buiJ,ding D. SPECIAL: ~ E. LOCK BOX: YES 1, ~O IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / ~O MSDSS? YES / NO KEYS? YES I ~o - 2A - . SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE e .. ' . .. Emergency response by engineering and security employees on duty. Housekeeping department personnel for cleanup. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTkVCE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital Einergency deparbnent. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL A. ~~~~~~L~~~.~~~~.~~~~~~~~.~~.~~~~~~~~~.... .,......~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES I WITH RESPONSE AGENCIES:.......................... Y ~O C. PROPER USE OF SAFETY EQUIPMENT:.................. E NO D. EMERGENCY EVACUATION PROCEDURES:................. ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. ES? NO SECTION 7: ,HAZARDOUS MATERIAL REFRESHER &J~o ~O NO NO NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POÇ~F A SOLID. 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:......~ NO I. Jack Resendez . certify that the above information is accurate. I understand that this 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. Director TITLE Security /Safety - 2B - DATE -?-/.~-- r;7 ;' ''\- ~ e . BAKERSFIELD CITY FIRE DEPARTME~T 2130 "6" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~Œ: BUSINESS PLAN SINGLE FACILITY 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 U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY LTNIT# 10 FACILITY UNIT NA.'fE: Mercy Cardiac Rehab Center SECTION 1: MITIGATION, PREVENTION, ABATEME~~ PROCEDL~ES Small amounts of hazardous materials such as cleaning agents and isopropyl rubbing alcohol. . Spills cleaned up by absorbent materials 'such as ver:micylite. Housekeeping departme.nt utilized for cleanipg operai ton. SECTION 2: NOTIFICATION ~\~ EVACUATION PROCEDURES AT THIS UNIT ONLY Notification procedures follow the Mercy Hospital fire plan which is activated by using the fire alarm system. Signal received at Mercy Hospital switch]:x)ard who I).otifies public agencies and inhouse response. - 3A - · - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does thi s Fac 11 ity Unit con to i n Hazardous Ma t erial s1. . . . . . ® 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 ma~ked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form ~arked: 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 Fire extinguishers throughout building. Fire alarm system/smoke detectors. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant at northeast 'corner of 16th & A STreets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS u~IT ONLY. A. XAT. GAS/PROPANÈ: North of building off "A" Street B. ELECTRICAL: North wall of building I exterior C. WATER: A Street adjacent to northwest comer of building. D. SPECiAL: E. LOCK BOX, YES ,@ iF YES. LCCATlO~, IF YES, SITE PLANS? FLOOR PLANS? YES ,I NO YES ' XO YES )1SDSs? :<EYS? 'YES - 3B - NO XO , ' " OAKERSFIEtD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY II P age -:=..:1 0 f ...J. I I 1. D. # BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONE #: (805) 327-3371 OWNER NAME: Catholic Healthcare West ADDRESS: 2300 Adel.ine Drive FACILITY CITY,ZIP: Burlinqame, CA 94010 PHONE I: (415) 340-:-7410 FACILITY UNIT 1:10 UNIT NAME: MCRC M 1 18 100z ' 10 lbs 10 10 0'1 7 LOCATION'IN THIS FACILITY UNIT north wall counter &'rol,..,C:At- Xerox roam, data Drocessinq xerox roam, data 99, Drocessinq xerox room, data processing 8 % BY tiT. 70 9 IOFFICIAL USE CFIRS I ONLY 10 HAZARD CODE 'I CODE I I D.O.T i GUIDE i I 1 2 TYPE MAX CODE AMOUNT M~) 3 ANNUAl. AMOUNT 60 4 5 6 CONT USE UNIT CODE CODE CHEMICAL OR COMMON NAME 8 pt 10 08 " Alcohol, Isopropyl lI(PO' oj FLLO 95 Developer EXPL M 12 24 Dry ink plus p 1 3 26 Fuser Lubricant , " e , NAME: E~ER6ENCY ........,. ~ I J~ / I --¡--Y/./ ~- Jack Resendez TITLE:Djr.Spcl1rir¥-/S;::¡f'pSIGNAJ»IfE: (~/ #~.." ~ DATE: 9--/3-K./ CONTACT: Jack Resendez ' TITLEPir.Securi.¡Ey/Safj2"Cy tr'(PHOjI-É I. Bú.s-1IOURS:327-3371 "':30-4:00 , . "---/ -AFTER BUS HRS: 327-3371/323-q75/ CONTACT: Administrator or Enginee~ITLE: On Duty PHONE 1 BUS HOURS:327-3371 7:30-4:00 BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3¿7-3371 - 4A-l - EMERGENCY , PR I-NC l,PAL ~ . ~ ~~ :1 , ~ e e BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA..'o[E 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 Mercy Hospital (Security Building) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 2301 16th Street CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (805 ) 327 - 3371 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 DURING BUS. HRS. AFTER Bes. HRS. A. Jack Resendez Dir. Security /Safe~ 327-3371 Ph# 327-3371/323-9751 B. Administrator/Engineer on Call Ph# 327-3371 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: West side of bQ-ilding B. ELECTRICAL: East side of building C. WATERNorth of building D. SPECIAL: ~ E. LOCK BOX: YES Ii ~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / NO MSDSS? YES / NO KEYS? YES / NO - 2A - e e .,.,. ~ ... SECTION 4: PRIVATE RESPONSE TE~~ FOR BUSINESS AS A WHOLE Response team consists of all security and engineering personnel on duty. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital Emergency Department. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL A~D 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 ~NO INO NO 'NO E' NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 PO~NDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: . . . . .. YES NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. Director ,? UJ TITLE Security/Safety DATE / -' /3./ ~ - 2B - !. ... e e >i' , . I BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA.'IE: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned hy: 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# 11 FACILITY UNIT NA.'Œ: Security bldg/ medical records warehouse SECTION 1: MITIGATION. PREVENTION. ABATEME~l PROCEDL~ES Limited amount of adhesive used in carpentry work. Kept with cover on at all times and stored in cabinet. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS t~IT O~LY Notification of emergency action would be by activating alarm system and notifying employees of hazard. - 3A - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLV A. Does this Facility Unit cnntain Hazardnos MateriaIS?.....Q NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardnos materials a bona fide Trade Secret YES~ If No, complete a separate hazardous materials inventory form ma~ked: 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 " Fire extinguishers in all areas of building. SECTIO~ 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant across street on north side of 16th Street SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS l~IT O~LY. A. XAT. GAS/PROPANÊ: West side of building B. ELECTRICAL: East side of building, C. WATER: North side of building. O. SPECIAL: E. LOCK BOX, YES /@ IF YES, LOCAT10~, IF YES, SITE PLANS? FLOOR PLA~S') YES .I NO YES / XO YES ~SDSs? ;{EYS? YES :\0 :\0 - 38 - .0: c< .t ,,;f .'.');~:" .' '".' , . . ~"'I.' l.. . ~. , " -\' I I I. D. t I: 'I I R^KERSFIELD CITY FIRE DEP^RTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page _ of..~ BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP: Bakersfield, CA 93301 PHONE #: (805) 327-3371 ~ - OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 11 ADDRESS: 2300 Ade~ine Drive FACILITY UNIT NAME: Security bldg 'CITY,ZIP: Burlinqame, CA 94010 PHONE #: (415) 340-:-7410 1 TYPE CODE M 4 7 LOCATION'IN THIS FACILITY UNIT 8 % BY WT. 9 10FFICIAL USE CFIRS I ONLY 10 HAZARD CODE CODE 2 MAX AMOUNT 5 3 ANNUAl. AMOUNT 15 5 6 CONT USE UNIT CODE CODE gal 13 02 CHEMICAL OR COMMON NAME D.O.T GUIDE west wall storage shelf Contact Cement F M 5 15 gal 13 29, west side storaqe shelf Mis oil base paint F :1 I, I I NAME: EMERGENCY G,~ ~ ~_¡, Jack Resendez TITLE: Dir _ Sp-cl1r; t-~/s;: fpS IGNA'ftU1Œ :~/ ¿?::;;JÞ.. ........ ~ 'DATE: 7~./ 3-£/1, CONTAr.T: Jack Resendez TITI,EPir.SecuritV'l.safeM ' R.!!.Q!iE' t. ~OURS:327-3311 7:30-4{OOI AFTER BUS HRS: 327-3371/323-9751 II PHONE , BUS HOURS :327-3371 7: 30-4: 001 AFTER BUS HRS: 3l1-3371 i EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRINC~PAL ßUSINESS ACTIVITY: Healthcare - 4A-l - i '! ,-. i . , ~ e e ~, BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUS INESS NA.'fE 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 Mercy Hospital/Continuing Care A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: . 1909 16th Street CITY: Bakersfield, CA ZIP:93301 BUS. PHONE: (805 ) 327-3371 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 NOTIFV IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 B. Administrator/Engineer on Call Ph# 327-3371 AFTER BeS. HRS. Ph# 327-3371/323-9751 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: !=:nnt-hwP!'::.+ ronrn¡::.:r nT,'hlljlr1jÞ1'] B. ELECTRICAL: Snnrhwp.sr r.nrnpr nf h,;1~in1 C. WATER: Nny'r@"PinSiÒPW;:¡1k D. SPECIAL: __ E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES. DOES IT CONTAIN SITE PLANS? YES / NO FLOOR PLANS? YES / ~O MSDSS? YES / NO KEYS? YES / ~O - 2A - / e SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE Mercy Hospital engineering and security employees on duty. e ,. ,.. . ...- SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTk~CE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital emergency roam. SECTION 6: EMPLOVEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH I~ITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO I~ITIAL A. ~~~~~~L~~~.~~~~.~~~~~~~~.~~.~~:~~~~~~.... .'...... ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES ~ WITH RESPONSE AGENCIES:.... .:. ....... ............ Y ~O C. PROPER USE OF SAFETY EQUIPME~T:.................. NO D. EMERGENCY EVACUATION PROCEDURES:................. 'Y ':'<l0 E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. YES- NO SECTION 7: ,HAZARDOUS MATERIAL REFRESHER ~:'<l0 cs,.~ ~~ Øi NO ES--' NO CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL I:'<l QUANTITIES LESS THAN 500 P~OF A SOLID. 55 GALLONS OF A LIQUID. OR 200 CUBIC FEET OF A COMPRESSED GAS:..... ~~ NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. Director TITLE Security /Safety - 2B - DATE ~8 47 / - ;# ."> , ... ~ 4~... e e BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA:\lE: BUSINESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS 1. To avoid further action. this form must be returneà by: 2. TYPE/PRr~T YOUR ANSWE:RS'IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 12 FACILITY UNIT N,MofE: Mercy Continuing Care SECTION 1: MITIGATION. PREVENTION. ABATEME~l PROCEDL~ES anI y small anpunts of hazardous materials stored or used in this building ( infectious waste disposed of on a daily basis). Infectious waste cöntained in utility rbom. SECTION 2: NOTIFICATION fu\~ EVACUATION PROCEDURES AT THIS l~IT ONLY In case of emergency the receptionist would be responsible for alerting all persons. in building, calling Mercy Hospital PBX Operator who notifiE;l response both inhouse and city fire department. - 3A - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY 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 :t4A-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 Fire extinguishers throughout building. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner of 16th & F Streets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS 1mIT O~LY, A. XAT. GASíPROPANÊ: Southwest corner of building B. ELECTRICAL: Southwest corner of building C. WATER: North side of building sidewalk. O. SPECi:AL: E. LOCK BOX: YES /e IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLANS') YES ,I NO YES / XO 'tIES XO :':0 ~SDSs? KEYS? YES - 3B - .. . .... I. D. # O^KERSFIEtD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY 1 - 1 Page _ 0 f .,r--1 I' I BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY ZIP Bakersfield CA 93301 ~ OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 12 I ADDRESS: 2300 Adeline Drive FACILITY UNIT NAME: Mercy Continuing Y ZIP B l' CA 94010 C 'I "},I, ERÔENCY , pIINCI,PAL \i- : , CIT . ur lnQame. are . , . PUONE , : (805) 327-3371 PHONE # : (415) 340-7410 IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 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 W 15 1 SO lh~ In Lln Utility closet east 100 Infectious waste ORMF I Hr11 Iway ¡ i \' 1\ I \ 1\ - , ~ I I i I , I , I /~7 I ¡ .--? Nil. ME: Jack Resendez TITLE: Dj r _ Sp.C!l1ri t:t/S~fPSI~"ü: \"" ~f~ ~.. DATE: r E ERGENCY CONTACT: Jack Resendez TITLE ir.Secu tv/Sa£etv ~ ~ONE~~ HOURS:327-3371 7:30-4:00 I ' , . ~ A(tTgR BUS HRS: 327-3371/323-9751 CONTACT: Administrator or Enginee~ITLE: On Duty BUSINESS ACTIVITY: Healthcare PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3¿7-3371 - 4A-l - ~ ..\ - .~ ...: , ~"', '. e e BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# !Bus INESS NA..'IE HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A '< ;of: 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 Mercy Hospital (Pathology lab/Radiology) A. BUSINESS NAME: B. LOCATION / STREET ADDRESS: 232316~~ Street CITY: Bakersfield, CA ZIP:93301 , BUS. PHONE: (805 ) 327-3371 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 DURING BUS. HRS. A. Jack Resendez Dir.Security/Safe~ 327-3371 AFTER BeS. HRS. Ph# 327 - 3 371/ 1 ~n - q 7 C) 1 B. Administrator/Engineer on Call Ph# 327-3371 PhI 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: North wall (exterior) off 16th Street B. ELECTR I CAL : Sou the as t corner 0 f bui lding C. WATER: . North ot bUl1dlng on 16th Street D. SPECIAL: ~ E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ~O KEYS? YES / ~O - 2A - e e '- SECT ON 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE Emergency response by engineering and security department employees on duty. SECTI N 5: LOCAL EMERGENCY MEDICAL ASSISTAJ.~CE FOR YOUR BUSINESS AS A WHOLE Mercy Hospital emergency department. :i! SECTIO EMPLOYEE TRAINING EMPLOYE S ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES E~PtOYEES WITH I~ITIAL A~D REFRESH R TRAINING IN THE FOLLOWING AREAS. CIRCLE ES OR NO INITIAL A. HETH DS FOR SAFE HANDLING OF HAZARDOUS MATE IAtS:.. .'............................. .'. .'....@ NO B. PROC DURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:.....~.................... ~NO C. PROPE USE OF SAFETY EQUIPMENT:.................. ~NO D. EMERG NCY EVACUATION PROCEDURES:... ...... ........ ~~O E. DO YO MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. ~ NO REFRESHER ~NO ~NO ~NO S - NO - NO ,HAZARDOUS MATERIAL CIRCLE Y S OR NO DOES YOU BUSINESS HANDLE HAZARDOUS MATERIAL I~ QUANTITIES LESS THAN 500 POG~F A SOLID, GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:......~ NO I, J ck Resendez , certify that the above information is accurate. I underst nd that this information will be used to fulfill my firm's obligations under the new C lifornia Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 2550 Et AI.) and that inaccurate information constitutes perjury. Director 7~ ~ Tr;ESècurity/Safety DATE ;."r~ ,,/ - 2B - .... -' e e .. BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS ¡'A'IE: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTH NS 1. To avoid further action, this form must be returned by: 2. TYIE/PRIXT YOUR ANSWERS IN ENGLISH. 3. An wer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 04 FACILITY UNIT NA.'Œ: Mercy Pathology Lab/Radiology SECTION 1: MITIGATION PREVENTION ABATEME~l PROCEDL~ES To prevEnt the release or spill; procedures done under mixing ventilated hoods. Spills ~ould be contained in hood unit work area. Accidental spills elsewhere would be handled with spill kits. Emergency shower for decontamination in this area. SECTION 2: NOTIFICATION ~VD EVACUATION PROCEDURES AT THIS UNIT ONLY Notifica~ion and evacuation would be by activation of fire alarm system to entire building. Notification by land line to Mercy Hospital PBX operator who would alert both in-house and publ c agency response units. - 3A - - e - . .. SECTION 3: HAZARDOUS MATERIALS FOR THIS L~IT ONLY A. Does this Facili ty 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 ma~ked: 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 Fire extinguishers throughout. Fire sprinklers throughout. Fire alarm system. Dry standpipes - Fire dept. connections on north exterior wall off 16th Street SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant across from 2301 16~h Street City fire hydrant northeast corner 16th & A. SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT O~LY. A. ~AT. GAS/PROPANÈ: North side of building, exterior. B. ELECTRICAL: First floor utility room, north side of hallway C. WATER: North of building. D. SPECiAL: E. LOCK BOX, YES /ÐF YES. LOCATION, IF YES, SITE PLANS? FLOOR PLANS') YES / NO YES / XO ~SDSs? KEYS? 'lëS NO XO YES - 38 - - - I\AJ<ERSFIEJ.D CITY FIRE DEPARTMENT 1. D. # FORM 4A-1 Page ~o~~ NON-TRADE SECRETS' HAZARDOUS MATERIALS INVENTORY " .. BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic FACILITY 04 Healthcare West UNIT # : ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 AdeLine Drive FACILITY UNIT NAME: Mercy Plaza CITY, ZIP.: Bakersfield, CA 93301 CITY,ZIP: Burlingame, CA 94010 Lab PHONE #: (805) 327-3371 PHONE # : (415) 340~7410 IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUM. 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 220 gal 13 26 south wall storage C6H4 Xylene FLLQ M '- 5 ,..,1r-,,,,,,,+- M~ 450 gal 10 27 south wall storage 1\~O,O) 10 (",'()~p'¡- 99 Alcohol. Isopropyl FLLQ 1 1 qt 09 27 . west wall storage M , ro;oninet 100 Acetic Acid CRMT 1 1 qt 09 27 west wall storage CRMT M cabinet 100 Hydrochloric acid 220 gal 10 40 south wall storage W 3 cabinet 100 Xylene FLLQ .....---- - - /:d/f/ /7 . I NAME: Jack Resendez TITLE: Di r _ !=;pC:l1ri t:f/S;:¡ fpS IG~TURE':- /L.-F/~ .A ~ DATE: I EMERGENCY CONTACT: Jack Resendez TITI.E ir.Secur'tY/Sa߀ t~" ~NE~US HOURS:327-3371 7:30-4:00 ~ AFTER BUS HRS: 327-3371 /323-9751 EMERGENCY CONTACT: Administrator or EngineeqITLE: On Duty PHONE , BUS HOURS:327-3371 7:30-4:00 PR I NC I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 31.7 3371 - 4A-l - · '-: ì: .. e e '. ;. r BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# ßUS INESS NA.'vtE 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 Mercy Hospìtal (Treabnent/Diagnostic Buìldìng, 76 Buìldìng) A. BUSINESS NAME: B. LOCATION 1 STREET ADDRESS: 2215 Truxtun Avenue CITY: Bakersfìeld, CA ZIP:93301 BUS. PHONE: (805 ) 327 - 3 3 71 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 DURING BUS. HRS. A. Jack Resendez Dìr.Security/Safe~ 327-3371 B. Admìnìstrator /Engìneer on Call Ph# 327-3371 AFTER BeS. HRS. Ph# 327-3371/323-9751 Ph# 327-3371 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: South wall, exterio~, adjacent to boiler room B. ELECTRICAL: South wall, interior, in boiler room C. WATER: South of south exterior wall adJacent to boiler room D. SPECIAL:, ~ E. LOCK BOX: YES 1\ NO IF YES. LOCATION: IF YES. DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ~O KEYS? YES / ~o - 2A - e - ~ .. "" , SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE Emergency response by engineering and security department employees on duty. Emergency cleanup by housekeeping department. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTfu~CE FOR YOUR BUSINESS AS A WHOLE Mercy hospital emergency deparbœnt SECTION 6: EMPLOVEE TRAINING EMPLOYERS ARE REQUIRED XO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL A~D REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO IXITIAL A. :~~~~~L~~~. ~~~~. ~~~~~~~~. ~~. ~~~~~~~:~. .. . .'. . . . .. Q) NO B. PROCEDURES FOR COORDINATING ACTIVITIES I WITH RESPONSE AGENCIES:.......................... '~O C. PROPER USE OF SAFETY EQUIPMENT: . . . . . . . . . . . . . . . . .. Y NO D. EMERGENCY EVACUATION PROCEDURES:................. ~O E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:.... .. YES NO REFRESHER GD~o ~O NO NO NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL I~ QUANTITIES LESS THAN 500 POU~_~F A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:. . . . . . ~ NO I, Jack Resendez , certify that the above information is accurate. I understand that this 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. _ __ DirectoI:' TITLE Security /Safety DATØ~.r p;? - 2B - · ... e e .'t BAKERSFIELD CITY FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NA~[E: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returneà by: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT~:~'Ç "5 FACILITY UNIT NA.'Œ: First Floor SECTION!: MITIGATION. PREVENTION, ABATEME~~ PROCEDURES All compressed gas cylinders chained or on portable carts. Central services equipped with alarms that are activated if the level of ethylené oxide exceeds the setting of the alarnl- emergency plan avàilable fQ~ this area. Emergency procedures posed in department. Vermiculite available for spills of any small liquid substance. SECTION 2: NOTIFICATION kVD EVACUATION PROCEDURES AT THIS UNIT ONLY Notification and evacuation procedures initiated by activation of fire alann system and overhead paging system. - 3A - e e SECTION 3: HAZARDOUS MATERIALS FOR THIS UXIT ONLY· ~ A. Does this Facility Unit contain Hazardous Materials?... ¡.~ If YES, see B. If NO, continue with SECTION 4. NO B. Are any of the hazardous materials a bona fide Trade Secret YEG If No, complete a separate hazardous materials inventory form ma~ked: 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 Fire extinguishers throughout building Fire sprinklers throughout building Fire alann system/SITDke detectors Dry standpipes/FD connections south wall of ER room on ~6th Street SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant corner 16th And A STreets City fire hydrant on 16th at B SECTIO~ 6: LOCATION OF UTILITY SHUT-OFFS AT THIS lmIT O~LY. A. ~AT. GAS/PROPANÊ: South wall, exterior, adjacent to boiler room B. ELECTRICAL: South wall, interior, in boiler room C. tiATER: South of south exterior wall adjacent to boiler room on 16th Street D. SPECiAL: E, LOCK BOX: YEs/B IF YES, LOCATION: IF YES, SITE PLANS? FLOOR PLA?\S? YES / ~O YES / XO YES ~O YES ' :\0 ~SDSs? KEYS? - 3B - ". .' 'Ii,'. RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page 1 - . III _otf;~ . \1 1. o. , " . íl BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave k f OWNER NAME: Catholic Healthcare West FACILITY UNIT ,: 05 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: first floor CITY. ZIP:Ba ers ield, CA 93301 CITY.ZIP: Burlinqame, CA 94010 lLlA/UhpP$' A/lUI PHONE #: (805) 327-3371 PHONE , : (415) 340-7410 ¡OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPf. 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 M 3" 30 aal 10 08 PUrchasing warehouse C CO2 absorbent granules CRMI' . M ,l, 40 aal HI 08 Klenz Glide 10 ..""- ,1 .... .~ M 12 120 aa 10 08 . All Purpose Cleaner M 24 240 qal 10 08 Compound cleaning liquid M 16 160 qal 10 08 Jet-Dry M 4 40 qal 10 08 Mildro-Quat M0' 324 3240 qal 10 08 Solid Power M~' 120 1200 qal 10 08 Soilmaster -' M '? 'ëJ 61 610 gal 10 08 Cidex plus M~ 54 540 gal 10 08 ^^^ Betadine Solution M ?J~ 32 320 gal 10 08 99% Alcohol l \ loO .0 I FLLQ M~~ 48 '480 gal 10 08 70% Alcohol 1\loO'0 I FLI.Q M 16 160 gal 10 08 Betadine Whirlpool concentrate M 16 160 gal 10 08 BAR Germicidal solution M 4 40 gal 10 08 D~~"?y I, Arnnonia Choricles NAME: Jack Resendez TITLE:Dir.Sp.cl1rir¥/S;:¡fPSIGNAT~~: ~ DATE: -.:;¿/"=t-Y,/ EMERGENCY CONTACT: Jack Resendez TITI.E ir. Security Saf.è:tv ~HONISi? BUS HOURS:327-3371 7:30-4:'50 " EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRH(CI.PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 327-3371/323-9751 PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3~7-3371 - 4A-l - OA){ERSFIELD CITY FIRE DEPARTMENT ~Of:4Í I . D. # FORM 4A-1 Page NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic Healthcare West FACILITY UNIT It: 05 ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: Fir~t f~90r I CITY, ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlingame, CA 94010 aU/A5IPJ . ,AA'~ "" PHONE #: (805) 327-3371 PHONE It: (415) 340-7410 (OFFICIAL USE C1n RS CODE , ONLY , 5 1 2 3 4 6 7 8 9 10 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 M 30 300 gal 10 27 Purchasing warehouse Betadine surgical scrub M 16 160 gal 10 08 " Phisohex , M 8 80 gal 10 08 If Acetone FLLQ , M 30 30 gal 10 08 ,I 5.25 Clorox Bleach , i M 32 320 gal 10 08 ,. 25 Septisol Solution MiA VVì 52 520 gal 10 08 II 25 Septisoft Solution P9b 1080 10800 lb 04 27 storage room n.side ¡~~ decontamination room 100 Ethv leri.e Oxide H'VDT p3~ 1250 storage room n.side , tHelium Non-flammablF' ::< 677-7 12500 ft3 04 27 hallway 100 H'VDT, Mt\Ò) 500 5000 lbs 04 27 II !Nitroqen Non-flammable "2 ~b1 ~ 100 RXPT, ! J.. b S";}... i I, HydŸoqen 4. 72% Carbon P L\~ 100 10000 ft3 04 27 It 100 \;1. ~l ~ ~ D\.4- Dioxide 10.3%. Nitroaen 84.98% RXPT. , " P~ð 2500 25000 ft3 04 27 II 100 Oxyqen COIIDressed 250cf ;)3S7 RXPT. P~?;' 1500 15000 ft3 04 27 II 100 Compressed qas non-flammable 250cf EXPL P~~ 2000 20000 ft3 04 27 " 100 Compressed Air 250cf ~?:¿ I~ EXPL PL\~ 200 2000 ft3 04 27 It 100 Nitro1J.S -Epdde_ d--':J~S EXPL NAME: Jack Resendez TITLE: Di r _ SF'r.l1r; t:f,/SrI fpS IGNATURE:r . ..,. .....~ ~'=' DATE: þ/ ~-)J / EMERGE,NCY CONTACT: Jack Resendez TITLE ir.Security/Sa~ "P1f 0 N E 'Ir1fU S HOURS:327-337f 7:30 4:00 AFTER BUS HRS: 327-3371 /323-9751 EMER'GENCY CONTACT: Administrator or EngineeqITLE: On Duty PHONE , BUS HOURS:327-3371 7:30-4:00 PR I N'C I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3:¿7-3371 - - 4A 1 - 10' OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A 1 p 3 r6 :1 II - age 0 - ------ NON-TRADE SECRETS' HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: Mercy Hospital OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 05 ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Ade~ine Drive FACILITY UNIT N ~ E: First floor CITY, ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlinqame CA 94010 ~I Sà.t..v/ct's- AAUJ PHONE , : (805) 327-3371 PHONE ,: (415) 340-7410 IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUM, CO NT 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~ 270 2700 ft3 04 Sterilization i'!n:"i'! 1 nn ~, >c~ _" ~~ ." \~()~ I /Xl riP W 20 200 IDs 10 Sterilization area 100 ~ ~ 1iJ M 4 40 qal 10 08 ' Sterilization area 25 ~ ~, RadioloQV storaqe X-Rav film usro FT,~T, , íL~<'7 ~ NAME: Jack Resendez TITLE:Dir.spcnrit1S/SAfPSIGNATUREV r: / DATE:/- ~--}57 EtlERG~NCY CONTACT: Jack Resendez TITI.E ir.SecuritY/Sa~ ~ONE-~ BUS HOURS:327-3371 7: 30-4'!00 EMERGENCY CONTACT: Administrator or EngineerrITLE: On Duty 'PRINCJPAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 327-3371/323-9751 I PHONE' BUS HOURS:3¿7-3371 7:30-4:00 AFTER BUS HRS: 3~7-3371 - 4A-l - II I 1. D. # OAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page I P 0 f,;)' (,. I ~ ~-- , ! Ii I BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONE #: (805) 327-3371 'I I , II 1 TYPE CODE 2 MAX AMOUNT 5 10 1 4 1 1 . 1 4 9 6 12· 1 2 1 2 ./"' OWNER NAME: Catholic Healthcare West FACILITY UNI¡ #: C/5 ADDRESS: 2300 Adel.ine Drive FACILITY UNIT NAME: h/l..s/ Fd?~¿ 'CITY, ZIP: Burlinqame, CA 94010 /./.- -~'¿-"~~ð PHONE I: (415) 340~7410 10FFICIAL USE CFIRS CODE ONLY 10 HAZARD D.O.T CODE GUIDE 3 ANNUAl. AMOUNT 50 456 CONT USE UNIT CODE CODE gal CHEMICAL OR COMMON NAME 100 12 40 , 5 5 4 46 90 60 124 8 21 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 09 27 7 LOCATION IN THIS FACILITY UNIT 9 11 09 27 II Ethylene Glycol 20 09 27" Toluene fh}t#J ¿, NAME: Jack Resendez TITLE: Dir. Sf"r.nri t~/S;:¡fpS IGNATURE: ,¡::;¿/ f)A .."." ~ DATE: &MERG~NCY CONTACT: Jack Resendez TITLEDir.SecuritY/Safe~ ~PR~ ~ BU§/HOURS:327-3371 7:30-4:00 I ' , ' L/ AFTER BUS HRS: 327-3371/323-9751' EMERGENCY CONTACT: Admlnlstrator or Englnee~ITLE: On Duty PHONE I BUS HOURS:327-3371 7:30-4:00 'PRINC~PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3L7-3371 8 % BY WT. Pump room south of Ammonia Hydroxide warehouse 100 Acetic Acid Glacial OR1I1A In storage lockers- access to area from , receiving dock, area chain link gate at, southeast comer it t( t' , , It 95 " Acid Fonnic Assay 88% Phosphoric Aèid 85% '" Butyl Alcohol-",: . FLLQ Mèthylene èhloride Carbon Tetrachloride Potassium Cibhromate n Nitric Acid-NNO? 71% Hydrochloridê Acid Sulfuric Acid 93% Ethyl Alcohol For:rnaldehyde - FLLQ FLLQ FLLQ - 4A-l - I ,. .. flM{ERSF I ELD CITY FIRE DEPARTMENT Page L 0(', .'6 I . D. #: FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY , _ ___ _ _ _on . Mercy Hospital /. BUSINESS NAME: OWNER NAME: Catholic Healthcare West FACILITY UNIT #: ð~ ' ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adeline Drive FACILITY UNIT NAME: {;;~~ r/¿J~ ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlinqame. CA r CITY, 94010 ú.lA~ .~~_.. .nA~.. PHONE tt : (805) 327-3371 PHONE , : (415 ) 340-7410 ·IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAl, CO NT USE LOCATION, IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE M 5 10 gal 11 27 PUMP ROOM Titrisol hydrochloric Acid C'RMI' M 4 41 09 27 I. Amyl Alcohol FLLQ M 2 19 09 27 It Dichloro-methane M 6 60 09 27 " Ethyl Acetate FLLQ M 1 10 09 27 Benzene FLLQ " M 5 . 50 09 27 Methanol GR II , -' M 5 48 09 27 Chloroform ORMA , , P 24 240 04 27 }?r9pane cylinder EXPL I II I I 09 27 I M 1 10 Mano state I, M 13 124 09 27 99 Isopropyl alcohol 99% I' FLLQ M 5 50 13 27 Acetone " FLLQ M 1 10 09 27 , , Petroleum ether FLLQ M 6 60 13 27 " Zylene FLLQ , M 12 124 09 27 II 100 Proprietary alcohOl 100% FLLQ '. " M 8 84 09 27 " 95 Alcohol anhydrous reagent 95% F:LIJ;) NAME: Jack Resendez TITLE: Dir.spr.1Jrit:r/S;:¡fPSIGNATURE: ' DATE :, E~'ERGENCY CONTACT: Jack Resendez TITLE ir.Security/Safety PHONE I. BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 327 - 3 371 13:¿3-9751 ,. Administrator EngineerrITLE: On HOURS:3:.n-3371 7:30-4:00 EMERGENCY CONTACT: or Duty PHONE , BUS PR I NC I,PAL ßUSINF.SS ACTIVITY: Healthcare AFTER BUS HRS: 3¿1-3371 I _ ,u - - -~ - - ,. I1AJ<ERSFIELU CITY FIRE UEPARTMENT 10~"~ 1.0. f FOR~t 4A-l Page NON-TRADE SECRETS I HAZARDOUS MATERIALS INVENTORY - - ~ , ¡ Mercy Hospital FACILITY UN~T #: ~~ ,I BUSINESS NAME: OWNER NAME: Catholic Healthcare West I ADDRESS: 2215 Truxtun Ave ADDRESS: 2300 Adeline Drive FACILITY UNIT NAME: ~A-~~/.ðð~ CITY, ZIP: Bakersfield, CA 93301 CITY,ZIP: Burlinqame. I 'ï¿" ~ CA 94010 PHONE It : (805) 327-3371 PHONE #: (415) 340-7410 ·IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 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 M 1 1 gal 13 27 PUMP ROOM Potassium borohydride powder CRMI' M 2 2 gal 09 '27 PUMP ROOM Propanol CRMA I I ! . .- I I I / , NAME: Jack Resendez TITLE: Dj r. Spr.nr; t"ì/S;:¡ fpS I GNATURE: ' DATE: I EM·ERGENCY CONTACT: Jack Resendez TITLE ir.Securitv/Safetv PHONE ~ BUS HOURS:327-3371 7:30-4:00 . AFTER BUS 'HRS: 327-3371/323-9751 I E~E'RGENCY CONTACT: Administrator or EngineerrITLE: On Duty PHONE # BUS HOURS:3:¿7-3371 7:30-4:00 PR I NC I,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 3l.7 3371 . ...' ....- ~..: ....,. .............._.-.-.r-..._. ... ....<t: . * ~" ., ... ,r . . SITE/FACILITY DIAGR~~ FORM 5 . NORTH SCALE: FACILITY DIAGR.~~ .------ DATE: / / (CHECR ONE) SITE DIAGRA~ /~/ (Inspector's Comments): -OFFICIAL GSE ONLY- - SA - :7 ' i .. '" -,-;' . .- . ~ '-;¡k ~~.:..- - . . '~ ' . BAKERSFIELD CIT)" FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD. CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NMIE: BUSINESS PLAN SINGLE FACILITY 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 U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 05 FACILITY UNIT N~~: Second Floor SECTION 1: MITIGATION, PREVENTION, ABATEMEN! PROCEDURES La.l:ûratory equipped with mixing hoods, spill kits, fire blankets, erœrgency shower. All cylinders equipped with chain guards. Additional absorbent material available from security/safety department. Radiology follows all safety precautions as required by NRC erœrgency plan available for this area. Oxygen Masks. SECTION 2: NOTIFICATION fuVD EVACUATION PROCEDURES AT THIS UNIT O~LY Notification and evacuation procedures initiated by activating of fire alarm system and overhead paging system. - 3A - . . SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY contain Hazardous MateriaiS?.....~ NO A. Does this Facility Unit 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 ma~ked: 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 Fire extinguishers throughout building Fire blanket in lab Fire sprinklers throughout building Fire alarm system/smoke detectors Dry stand pipes/FD cormections south wall of ERon 16th Street SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS City fire hydrant on 16th Street at B City fire hydrant corner 16th and A Streets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS L~IT ONLY. A. NAT. GAS/PROPANÊ: South wall, exterior, adjacent to boiler room B. ELECTRICAL: South wall, interior, in boiler room c. tvATER: South of south exterior wall adjacent to boiler room on 16th Street D. SPECAL: E. LOCK BOX, YES ¡~IF YES, LOCATIO~, IF YES, SITE PLANS? FLOOR PLANS" YES / NO YES / XO YES ~{ê..S NO NO :'I!SDSs? ;{EYS? - 38 - ~ r'·~ ..... ~ . t J " I. D. # OAKERSFIE~D CITY FIRE DEPARTMENT FORM 4A-1 NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page Ì - 1 I oft. . I· -;I I: BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave CITY, ZIP:Bakersfield, CA 93301 PHONE #: (805) 327-3371 FACILITY UNIT 1': 05 UN I T N A ME: 2nd f ooL OWNER NAME: Catholic Healthcare We~t ADDRESS: 2300 Adel,ine Drive FACILITY CITY,ZIP: Burlinqame, CA 94010 PHONE': (415) 340-7410 1 2 3 4 5 6 7 8 TYPE MAX ANNUAl. CONT USE LOCATION, IN THIS % BY CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. Mi\l 209 627 ft3 04 27 :yab-center room 72 TIllcro room , 10 3 17.7 M~~] 4öt\ .... M~ M~ M N A ME, : EM£'RGENCY ~ 209 836 437 4370 209 627 209 836 2 30 2016 2016 100 800 ft3 04 ft3 04 ft3 04 ft3 04 gal 04 micro curie rru.cro curie 09 100 Liquid nitroqen tank 27 Lab-micro 27 Lab 27 lab-main 27 LaÞ main 27 Lab referral room 27 LaÞ RIA room 27 Lab' R¡A room 9 10FFICIAL USE CFIRS ONLY 10 HAZARD CODE D.O.T GU I DE ' EME~GENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRJNCJPAL BUSINESS ACTIVITY: Healthcare CODE CHEMICAL OR COMMON NAME compressed gas cylinders f)...~o.....S5- '.J-.l .. .- c'H ny; np -J Nitrogen r'\ ~d-'-\ _I c;I- '\~6~' \ ~~'D ~ t?- ,.h::r J_ o -5% 0 -20% N -75% 2 ' 2 '2 ooi' t'26 \ tß.tì I ófiY5~_ bl~~'i ~U2-5%, H2- 10%, N2 80% Øl :;t~~\.t 00,,-10%. N...-90% ~ ~ RXPT. EXPL EXPL EXPL EXPL EXPT J RAnT RADI - Bactec 288 micro curries I,,,,.. Radioactive Iodine ~~~ ~ I'¿/J I ~/.--:7 _ _('"';'- Jack Resendez TITLE:Dir.Sp.cl1rit-~/S;:¡fpSIGNAT\1'ÁE: ~~ - r ..... DATE:/-/"":>"'I1/ i CONTACT: Jack Resendez TITLE Pir. Securi ty\¡Safe.t"v _..E.H'6NYI. ..IU}S" HOURS :327-3311 7: 30-4: 00 I AFTER BUS HRS: 327-3371/323-9751, I PHONE # BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 327-3371 - 4A-l- . '.' ~..~,": ."_·.0-n-._,.,._--.'-" :; e ), -, . ~J' ~;. . . SITE/FACILITY DIAGR~~ FORM 5 NORTH SCALE: BUS I~ESS NA.\[E: FLOOR: 2 OF 4 Mercy Hospital DATE: .I / FACILITY ~A~E: UNIT ..... OF ¡S' -. Treatment and Diagnostic Building 5 , (CHECK ONE) SITE DrAGRA.'[ FACILITY DrAGRA.~ attached // (Inspector's Comments): -OFFICIAL GSE ONLY- - 5A - ~. "'~ e e BAKERSFIELD CITY' FIRE DEPARTME~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUSINESS NMIE: BUSINESS PLAN SINGLE FACILITY 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 N~~: Third Floor FACILITY L~IT# 05 SECTION 1: MITIGATION. PREVENTION, ABATEME~~ PROCEDL~ES No hazardous materials stored on this floor. Electrical,machinery and air handling units only. SECTION 2: NOTIFICATION ~\~ EVACUATION PROCEDURES AT THIS U~IT ONLY Notification and evacuation procedures initiated by activating fire alartn system. - 3A - · e ~ ..,", SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does thi s Fac iJ ity Unit Con ta j n Hazardous Ma ter i al s? . . . " YES ® If VES, 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 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. ~ECTION 4: PRIVATE FIRE PROTECTION Fire extinguishers throughout floor Fire alarm system Fire sprinklers throughout floor Dry standpipe - FD connections south wall (exterior) ER ramp on 16th Street SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENcY RESPONDERS City fire hydrant corner o~ 16th & A Streets City fire hYdrant 16th street at B SECTION 6: LOCATION OF UTILITY S!IUT-OFFS AT THIS WIT ONLY. A. XAT. GAS/PROPANÈ: South wall (exterior) adjacent to boiler rOOm B, ELECTRICAL: South wall (interior) in boiler room C. WATER: South of south exterior wall adjacent to boiler roan on 16th Street D. SPECiAL: E. LOCK BOX: YES /8 IF YES, LCCATIO~: IP YES, SITE PLANS? FLOOR PLANS? YES ,I NO YES / XO ~SDSs? KEYS? YES NO YES / Xo - 3B - 1. D. # RAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY !!If' Page -2-of'L-... ~ BUSINERS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave B k f' ld C 93301 OWNER NAME: Catholic Hea1thcare West FACILITY UNIT #: ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: 3rd floor 05 ,I , " CITY, ZIP: a ers le , A CITY,ZIP: Burllnqame. CA 94010 PHONE # : (805) 327-3371 PHONE # : (415) 340-7410 IOFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAJ~ 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 NONE ON THIS FLOOR . e - (M/ /J NAME: Jack Resendez TITLE:Dir.R~"'n::a¥;'R~fPSIG~RE. '- ~ ¿¿.. DATE: EMERGENCY CONTACT: Jack Resendez TITLE ir.Secur' /Sa~tv/ p ~~ HOURS:327-3371 7:30-4:00 ~ ' . \......,...-/ "'K"r 11:.1\ BUS HRS: 3~7-3371/323-9751' EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'P~INCJPAL BUSINESS ACTIVITY: Healthcare PHONE' BUS HOURS:3¿7-3371 7:30-4:00 AFTER BUS HRS: 3¿7-3371 - 4A-l - ~ .." ~~.~ ~"": 0':'_0 ..~__o__,__."" - . t. ~ "" e '\ -, .. SITE/FACILITY DIAGR~~ FORM 5 - NORTH SCALE: BUS DiESS NA'Œ: FLOOR: 3 OF 4 MrJ; n H:o!=:ni trJ 1 DATE: .I / r!AC~Tt ~~t;s, , 'ld' UNIT ¢ 5 OF1~ ea nan, lagnostlc ßU,l lng , (CHECK ONE) SITE DIAGRA.'{ FACILITY DIAGR.~~ attached '< _i: / (Inspecto~ls Comments): -OFFICIAL GSE ONLY- - 5A - .. '- 1':~. '~'~---'~..ÌOII e e BAKERSFIELD CITY FIRE DEPART~E~T 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# ------ BUS INESS NA)[E: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returneà hy: 2. TYPE/PRIXT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY U~IT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# 05 FACILITY UNIT NA.'Œ: Fourth Floor SECTION 1: MITIGATION, PREVENTION, ABATEME~~ PROCEDL~ES No flammable anesthetic gases allowed in operating rooms. Waste gas scavenger units in all OR,ts Air' sample surveys conducted armuall y All machines preventive maintenance on lIDnthly basis Absorbent materials available for spills Infectious waste collected in utility rooms and removed daily. SECTION 2: NOTIFICATION k\~ EVACUATION PROCEDURES AT THIS l~IT ONLY Notification and evacuation procedures initiated by activating fire alann system and overhead paging system. - 3A. - - e " "-..>~-. SECTION 3: HAZARDOUS MATERIALS FOR THIS ù~IT 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 . Fire extinguishers throughout floor Fire sprinkleres throughout floor Dry stand pipes/FD connections south wall, exterior, ER ramp on 16th Street Fire alarm system/smoke detectors SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS, City fir hydrant on 16th Street at B City fire hydrailt on comer 16th and A STreets SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS ú~IT OXLY. A. XAT. GAS/PROPANÉ: South wall, exterior, adjacent to boiler room B. ELECTRICAL: South wall, interior, in boiler room C. \vATER: South of south exterior wall adjacen to boiler room on 16th STreet D. SPECiAL: E. LOCK BOX: YES./'G IF YES, LOCATION: IF YES, SITE PLA~S? FLOOR PLANS? YES / NO YES / XO :'1SDSs? KEYS? ,\'2S NO XO YES - 3B - BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-l NON-TRADE SECRETS HAZARDOUS MATERIALS INVENTORY Page 1· ~,l of - - 1. D. # BUSINESS NAME: Mercy Hospital ADDRESS: 2215 Truxtun Ave B k f' ld CA 93301 OWNER NAME: Catholic Healthcare West FACILITY UNIT #: 05 ADDRESS: 2300 Adel,ine Drive FACILITY UNIT NAME: Fourth floor l' 4 10 CITY. ZIP: a ers le , CITY,ZIP: Bur lnqame, CA 9 0 PHONE #: (805) 327-3371 PHONE # : (415) 340-7410 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 D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT.. CHEMICAL OR COMMON NAME CODE GUIDE W 1b 10 40 Decon. room 100 Infectious waste ORMS 0 20 M 5 25 gal 10 27 Storage room 30 Formaldehyde CMIQ I , gal 10 27, Storage room 70 'Alcohol E'LLQ M 5 25 M 2 50 gal 10 " 27 Storage room Cidex plus PSNB M 1 25 gal 10 27 Cysto room B.A.K. solution JRMA : 60z 10 27 surgery storeroom JRMA M 5 25 pkq loC"kPi! ' Methy1methoacrylate 60z 10 27 center core locked M 5 25 pkq cabinet Zimmer JRMA , 40z 09 27 M 50 300 pkq Penthothal IT.GS 40z 09 27 M 50 300 pkg Ethrane ~ 40z' 09 27 Halothrane ~ e· M 50 300 btl , 40z 09 27 Forane ~ M ..... 50 300 btl ,. M 9) Storage room " 1b 04 27 100 Nitrous Oxide a~u:S 'lLGS ~ 70..9- 1250 pS'J 7"/ r~ 1b 27 Thru out surgery area 100 Oxygen compressed J ~sC) ~L ,- ---- ,. /~/ - - "'/- NAME: Jack Resendez TITLE:Dir_F:pC"llri+:r/F:¡:¡fPSIGNATUF E: ~~ ~ c;;;;r~ DATE: ~ /'.:"5-11/ EMERG~NCY &, "Y '- ~~NE :: -=~ HOURS :327-3371 7:30-41'00 CONTACT: Jack Resendez TITLE ir.Securitvj EMERGENCY CONTACT: Administrator or Enginee~ITLE: On Duty 'PRilNCI,PAL BUSINESS ACTIVITY: Healthcare AFTER BUS HRS: 327-3371/321-Q7S1' PHONE' BUS HOURS:327-3371 7:30-4:00 AFTER BUS HRS: 3¿1-3371 - 4A-l - ,. -. ~_o£.__- e '\ -, .'. 4 '.. ,...._:...: ...;...._..___.-.-........._ SITE/FACILITY DIAGR~~ FORM 5 ~ORTH SCALE: BUSINESS NA\{E: FLOOR: 4 OF 4 - Hnc»it-;::¡l DATE: / / Tr F~ILf7D·NA\fE:t· BId {TNIT =5 OF~ ea en ~agnos ~c g '(CHECK ONE) SITE DrAGRA.\r FACILITY DIAGRAM attached - / (Inspector's Comments): -OFFICIAL ~SE ONLY- - SA - ï' II ~-- , />' -- ":, "'~... . " I "'mill: ~~~ w ~ I <J -=f ~,'!2' WILDING 27 ~, " .i ._ .. .~ -~ '~;;~.';: ,fl;t! "{ !~ ~ ~ ¡ '" ¡¡In:' ~ ! . , 1"lr':" f: '11'!i ' ' , ·1 :,11,');;1 ,~, 1/' , Ii W Ii , è~j II f}.; 'I' ~. ]: fh;, (I ¡:. ",:;./' ".... ~/,. t~·~· .' I ¡ ,¡ \, ··..···.··;::'1 ~ ¡ . . ,.f ~ ¡.' '1 r" " f', .. Ne"ro - Intensive Cpre ~nit , Postoral Còre I ,t; f:. ffi;:Q , - ,to~1 ; .- 41h MAJt-¡ 401-.415 -~UILDING 55 "\ ) , , , ", '\ _UI.l. . \ /' .'-" ' ',- / /'~ ' '" > ' ',/ , WILDING 91 /.. ~ ' ;, . i, i i l, ! i I í: : ; I i:, I' , ~. . ¡ ¡ , i' ì',', ' r \ f; II: ~,ri< ¡' f"'; i !.}:~i;;\: II It:" \:' 'II \~!::., '¡''''('' I' t'''·" ,<' ;: (Y:<~\ :" ~ . _~_._____...i : I ¡ ' .... EOURT \-\ ..flOOR 'TR'EA TMENT AND DIAGNOSTIC BUILDING II .,' ò ,:...&........._.. ~.t ~"._; -=-_--=---_ ... _ -- ..~---~.... \ ' \~ - ; ..:~¡ e e Revised: Approved: e e e MERCY HOSPITAL BAKERSFIELD, CALIFORNIA I. EMERGENCY FIRE AND EVACUATION PLAN 11. BOMB THREAT PROCEDURES March, 1984 /ÞJ3~: ~µ Administ tor :irE: ,f~ lre Marshal City of Bakersfield FÆr. Department " ." e e e FIRE PLAN INTRODUCTION When fire strikes, the action taken duing the first few minutes may make the difference between containment and catastrophe. The Fire Plan is designed to provide everyone with the knowledge of what steps to take in the event of a fire. Each employee has the responsibility of understanding and following the procedure as detailed in the Fire Plan. Supervisors must ensure that their personnel receive adequate training of the Fire Plan procedures and that personnel with specific duties understand and follow their individual instructions. Even though a small fire may be easily extinguishable, The Fire Department Is To Be Notified Of All Fires. In case of fire, the most important thing to remember is: avoid panic, keep calm, do not raise your voice, reassure the patients, try to be casual in manner even though you may bè frightened. e All personnel will be on Fire Alert until location and extent of fire can be assessed. After the fire has been assessed and found to be confined to a particular area, the Director of Security/Safety, the Director of Engineering, Administrator or the Bakersfield Fire Department may, if no danger exists, put the rest of the hospital on stand-by until an "All Clear" is given by the Fire Department. It is through the clear understanding of this Fire Plan and the coordinated efforts by all hospital employees that the loss of lives and property can be averted. e , " e e DEFINITIONS: CODE RED ---------- STAND-BY ---------- e e e All departments will be on Fire Alert until the location and extent of a fire can be assessed by either the Director of Security/Safety, Director of Engineering, Administrator or the Bakersfield Fire Department. After the fire has been assessed and found to be confined in a particular area, the Director of Security/Safety, the Director of Engineering, Administrator or the Bakersfield Fire Department may, if no danger exists, put the rest of the hospital on stand-by until an "All Clear" announcement is given. Stand-by will mean all departments other than the department involved with the fire may return to normal routine. Continue to keep all fire doors closed throughout the hospital, until "code red completed" is announced. -1- ~ e e FIRE PLAN - CODE RED: e The following duties are done simultaneously. Each employee knowing the entire plan is thus able to work as a team to accomplish all tasks as quickly and orderly as posible. A. IMMEDIATE ACTION IF FIRE IS DISCOVERED OR SUSPECTED: (1) Remove anyone who is in immediate danger from the fire. (2) Close the door to the room where the fire is located. (3) ,Activate the nearest fire alarm pull station by pulling lever. (4) A second person should notify the hospital swithboard operator by dialing 444. In a calm voice tell the operator the exact location of the fire, indicating, if possible, the severity of the fire. If alone, you must perform all of these steps yourself. (5) Close all doors and windows in the area to confine the fire. (6) Return to the-scene of the fire with the proper extinguisher. Attempt to extinguish the fire. e (7) Take charge of directing fire procedures until arrival of supervisor, Director of Security/Safety or Fire Department. NOTE: When returning to the fire scene with a fire extinguisher, feel the door before opening it. If it's hot, do not attempt to open it, because flames and smoke will rush into the room you're now in. If the door is not hot and you decide to open it, stand to one side as you open the door. If the fire is too large, shut the door and wait for assistance. e -2- -. " e e e -- e B. GENERAL FIRE ALERT PROCEDURES: 1. Notification a. The operator will page "Code Red" (followed by a specific hospital location) over the paging system three (3) times. Example: "Code Red, 4-Main, Room 435." b. The Director of Security/Safety, Director of Engineering, or desiginee will meet and accompany the firefighters to the site of the fire. On the evening and night shifts, the engineer on duty, the security officer on duty or their designee will perform this function. 2. Action a. Always report any fire or smoke immediately by using the manual fire alarm closest to the fire. Then DIAL "444" for hospital operator and calmly report the location of the fire. b. If you are working away from your assigned department, return immediately, using the stairways. NEVER USE THE ELEVATORS. c. Close all doors and windows in your area. d. Reassure patients and visitors and REMAIN CALM. e. Do not evacuate the building unless instructed to do so by one of following: the Administrator or representative, Administrative Coordinator, Director of Engineering, the Director of Security/Safety or the Bakersfield Fire Department official in charge. f. Know where fire extinguishers are located and which type to use on different types of fires. g. "Stand-by" status may be announced when the fire has been assessed and found to be confined to a particular area and no danger exists. (See Definitions) h. The ALL-CLEAR will be announced by the operator when the fire area has been declared safe by the Bakersfield Fire Department. The operator will page "Code Red Completed" three (3) times. -3- e e e e e C. GENERAL GUIDELINES: 1. Avoid Panic -- The greatest danger in most fires is panic. Do not alarm patients. Never shout "Fire." Patients will look to you for protection. Be calm and move with assurance. 2. Prevent Fires -- Good housekeeping is the best guarantee against fire. Do all you can to maintain order and cleanliness in the interest of fire prevention. Make it a habit to watch for fire hazards and report them to your supervisor or department manager, Safety Committee or Director of Safety/Security. 3. Be Alert -- Be alert for signs of fire. If you see or smell smoke, report it immediately for investigation. Form habits of watchful care--early detection means prompt extinguishment. 4. Know the location of fire alarms and fire extinguishers in your area and how to use them -- Use the correct extinguisher for the fire. Think over the instructions you have been given in the use of fire extinguishers: Class A Fires - Wood, textiles, rubbish, etc., require cooling and quenching; water extinguishers are best. Class B Fires - Gasoline, oil, alcohol, acetone, ether and flammable liguids require C02 extinguishers or ABC type. Water extinguishers spread such fires. Class C Fires - Electrical equipment of all kinds require C02 extinguishers or ABC type. Never use water extinguishers, as they transmit electrical charges. ABC extinguishers are used for all types of fires and are so labeled. Halon extingishers can be used on all types of fires and will not ruin electrical equipment. 5. Learn the Emergency Procedures Know exactly what your duties are: memorize location of exits, fire extinguishers and fire alarm boxes. 6. Report all fires or suspected fires, regardless of size. -4- C. -1. e e e e DEPAR'lMENI' ASSIGNMENI'S FOR FIRE AlERT PROCEOORES PBX 1. Read the printout on the autœatic digitizer to verify location of fire alarm activated. 2. Notify the Fire Department (324-4542). 3. Page three (3) tiIœs "Code Red" and specific location. Example: "Code Red, 4-Main, Room 435." 4. Contact the following 8: OOAM to 4: 30PM Contact the following after normal hours, weekends and holidays. A. Director of Security/Safety #78 B. Director of Engineering #51 A. Security Officer on duty #18 B. Engineer on Duty #08 C. Administrative Coordinator on Duty #57 or #54 Notify the following if an actual emergency exists: (day or night) A. Administrator or alternate B. Director of Personnel C. Admitting Supervisor D. Others as directed by Admin. 5. Notify the following 8: OOAM to 4: 30PM A. Admitting Office Ext. 1223 B. Director of Personnel Ext. 1141 6. Special Instructions: A. Call for another PBX operator if necessary. B. I:b not leave the switchboard. C. Keep the line open in the department where the fire is located. D. Be alert for further instructions. E. I:b not permit unnecessary outside calls. G. Upon notification of all clear, Page "Code Red completed" (3 times) H. Notification of staff under item #5 of the night shift is only necessary when an actual erœrgency has been declared. I. Alternate rrethod of contacting the Fire Department in case the phones are out of order will be: 1. Using alternate phone in PBX 2. Pay phone (nearest pay phone located in hallway leading from PBX to Dietary). 3. The Fire Department phone number is 324-4542. -5- e e e e e II. NURSING DIVISION All Nursing personnel in the hospital who are away from their assigned areas should immediately return to their work areas and remain there until circumstances require they be assigned elsewhere. Close all doors and, whenever possible without endangering the patient's condition, disconnect all electrical appliances. Prepare to evacuate patients if necessary. Do not evacuate patients unless instructed to do so by your immediate supervisor, who in turn will receive instruction from Administration, the Director of Security/Safety and/or the Bakersfield Fire Department official in charge. If it becomes . necessary to move patients, every attempt should be made to evacuate patients to a safe_area on the same floor. Evacuation will begin with patients in the most threatened area. Evacuate patients according to their physical condition as follows: A. Ambulatory patients should be led in a group to a designated safe area. B. Wheelchair patients will be removed from the area next. The elevators should never be used (except as stated below). C. Stretcher and bed patients nearest to danger are to be moved first. Patients may be removed from stretchers after reaching safety,when it becomes necessary to do so. Elevators are to be used only after clearance has been given by Administration, The Director of Security/Safety and/or the Bakersfield Fire Department. Nursing Assistant Administrator is responsible for the immediate management of Nursing personnel and directs their placement until fire fighters arrive. Administrative Coordinators are responsible in the absence of the Nursing Assistant Administrator, for patients and for directing activities until firefighters arrive. He/she must delegate duties of shutting off oxygen, gas and electricity to a responsible and informed employee. Nursing Units The Clinical Manager in charge of each patient care unit will ensure that all patients have been cared for and will instruct those in his/her charge to keep track of the movement of patients. When possible, patients' charts should accompany the patients. III. DIETARY DEPARTMENT Turn off electrical and gas appliances and close all doors to Dietary. Report to Dietary office for further instructions. Ensure phone coverage. ~ IV. ENGINEERING DEPARTMENT All available Engineering personnel will report to the scene of the fire with extinguishers and attempt to extinguish the fire unitl the -6- Bakersfield FirtIÞDepartment has arrived. ~re should be taken ensure that the fire is not spread by opening doors, etc. Use proper type of extinguisher. to the e The Director of Engineering, the Director of Security/Safety or their designee shall meet the Fire Department and escort them to the scene of the fire. At night or on weekends the engineer on duty or security officer shall perform this function. The Engineering Department shuts off main oxygen and gas outlets, electrical equipment and air conditioning. All Engineering personnel have been instructed on location and procedure for shutting off these services. V. ADMITTING OFFICE The Admitting Manager or Admitting Clerk in charge will be responsible for gathering together all cash, valuables and important accounting records and ensure their safekeeping should it be necessary tò remove them to another area. He/she will direct and place personnel at old main entrance and main entrance, with orders not to allow access to the hospital until the emergency has been asses sea:- Ensure phone coverage. VI. RADIOLOGY DEPARTMENT Discontinue all electrical currents, close all doors, remove patients to a safe area and report to Radiology office for further instructions. Ensure phone coverage. e VII. LABORATORY DEPARTMENT Turn off all gas and electrical machinery, including computers, close all doors, remove patients to a safe area and report to Laboratory office for further instructions. Ensure phone coverage. VIII. SURGERY Remove any patients awaiting surgery to a safe place away from the fire. Take protective measures if surgery is underway for both patient and surgical team as follows: 1. Concentrate fire extinguishing equipment 2. Turn off electrical equipment, oxygen and anesthesia machines as soon as possible Close all doors to operating Prepare to follow evacuation Secure advice of the surgeon any new procedures until the 6. Ensure phone coverage 3. 4. 5. room suites procedures when necessary as to advisability of starting alert is ended e -7- e e e IX. HOUSEKEEPItt DEPARTMENT e Remain at assigned work stations and obey the instructions of the supervisor or individual in charge. Help close doors and windows; specifically, make sure that all fire doors are closed. Do not alarm patients. X. SECURITY OFFICERS Security officers will respond to the fire or location of an internal emergency. Asses the situation and fight the fire if necessary. Designate someone to meet Fire Department. XI. ALL OTHER DEPARTMENTS .- I Report to your assigned work areas and await instructions from your supervisor. Ensure phone coverage. Off-Duty Personnel Off duty personnel who are called at home to respond to an emergency at the hospital shall report to their department managers. Patient Information Center During major/minor disasters, a patient information center will be established in the Admitting Office to handle calls from relatives and friends. Public Information Center A control center will be set up in the Administrator's office for central collection and dissemination of all information relating to a hospital fire or internal disaster. Releases and/or statements to the media must be authorized by the Administrator, her delegate or the Public Relations Director. -8- e e e e e PLAN FOR EVACUATION: Hospital personnel will be directed by the Bakersfield Fire Department, , the Director of Security/Safety or Administrator as to extent of evacuation (mass evacuation or localized). Except when the fire is located in a patient's room, a life could be saved if the patient's room is utilized as a refuge from the fire, instead of evacuating the patient. With this concept, it is the duty of the person in charge to designate any patients who should be kept in their room with doors closed. Proper procedures should be utilized to prevent smoke and fire from entering the room. Patients will not be evacuated when a fire in the hospital is in an area which is not adjacent to patients' rooms and when fire has not been determined to be of, such a nature and extent as to endanger patients' safety. Evacuation order will be given only when it is determined that a fire is in an area which endangers patients and when the fire is of such threatening nature as to jeopardize the entire area. If conditions hazardous to patients are obvious, the Clinical Manager on the floor will order evacuation, otherwise, the order will be given by the Administrator, the Director of Security/Safety or the Bakersfield Fire Department official in charge. -9- e e e e e PROCEDURE FOR EVACUTION FOR FIRE AND OTHER INTERNAL DISATERS In case an evacuation is ordered, patients will be moved as follows: 1. Evacuation will begin with patients in the most threatened areas. 2. Patients will be moved in a horizontal pattern through the corridors to other safe areas on the same floor. 3. When necessary, vertical evacuation should be made down existing stairways, under supervision of hospital Clinical Coordinator and/or Fire Department personnel. 4. Elevators cannot be used to transfer patients during a fire or internal disaster. 5. Evacuate patients according to their physical condition, as follows: A. Ambulatory patients should be led in a group to a designated safe area. B. Wheelchair patients should be next in order. C. Stretcher and bed patients (non-ambulatory) will be moved next. One person will be designated to stand at each door to check patients off the census list or cardex file. -10- · e e e e e EVACUATION ROUTE PLANS: Evacuation route plans are posted throughout the hospital, at strategic locations, noting the following information: 1. Evacuation routes are classified primary and secondary 2. Location of fire alarm boxes 3. Location of fire extinguishers GENERAL INSTRUCTIONS: 1. All patients are to be evacuated in an orderly fashion through the proper procedure. 2. The patient cardex file will be used as a checklist. 3. One person will check patients out, using the designated exit door. When all patients have been removed and taken to specified areas, this person will again check to make sure all patients are present. The person designated as checker will not leave his/her post until all patients have been evacuated. ALL DEPARTMENTS ON STAND-BY: All departments not directly involved with the immediate emergency will remain on stand-by alert. They will be notified as to where they will be utilized, according to need. All available Engineering personnel will respond to the fire/disaster area. The security officer on duty will respond to fire/disaster area. HIGH-RISK AREAS: Likely sites for explosions or fires which would create the need for mass evacuation: 1. Oxygen Tanks - West End 2. Kitchen 3. Surgery 4. Laboratory 5. Santa Fe Railway Yard -11- · ' e e e ~ ' e e Under emergency conditions, the speed in which the patients must be removed fr,om the building may be of paramount importance. To evacuate a building in a hurry will mean using all methods available to fit the situation. The method or carry used in any particular situation will vary with the conditions surrounding the emergency. Things to consider are: l. Condition of patient 2. Nature of the emergency 3. Weight and size of patient (or nurse) 4. Height of bed 5. Number of patients to be moved 6. Number of nurses or other staff members available Evacuation can be achieved in various ways. For ambulatory patients, directions may suffice. Ambulatory patients who wish to assist others should be permitted to do so. Semi-ambulatory and non-ambulatory patients can be removed in wheelchairs, shower chairs, litters, guerneys or in their beds. When time is of essence, it may be necessary to drag patients· on blankets or carry them. Through training and drilling, it has been proven that nurses can handle any of the removals or carries listed below: 1. Blanket Carry 2. Blanket Drag 3. Pack Strap Method 4. Hip Method 5. Cradle Drop (to blanket) 6. Kneel Drop (to blanket) 7. Extremity Method (two nurses) 8. Swing Method (two nurses) \ Mass Evacuation of Hospital All patients will be transported to Franklin School grounds, 2400 Truxtun Avenue¡ Jastro Park, Truxtun and Spruce¡ or other locations as may be designated at that time. -12- " ,.¡ ,!'. ~ e e . ¡ e EMERGENCY FIRE PLAN FIRE DRILL PROCEDURES: All fire drills are to be treated as though they are real fires, unless otherwise informed beforehand. Fire drills are designed as a learning tool, to ensure that everyone is aware of the procedures in the event of a real fire. Every staff member and employee, regardless of his position and specific duties, must be familiar with the basics of coping with the fire and preventing panic. A fire drill will always begin with a simulated fire (red blanket). When you discover the red blanket, it will be labled with information as to the type of fire. You are to react as if you have discovered a real fire. The person who initiated the drill will observe and critique the actions of everyone involved. A written report will be sent to the administrative member affected and will be reviewed by the hospital Safety Committee to learn of any possible problems. e ~ -13- -. e e ".:. '4 ~ MERCY HOSPITAL BAKERSFIELD, CALIFORNIA EXTERNAL DISASTER PLAN Disasters cannot be planned with any exactness as to time, size or character. When disaster strikes a community, a health care facility is inevitably drawn to the center of it for care of casualties and for vital information on the 'extent and severity of injuries. Every hospital has a plan to deal with these situations and is required to rehearse it semi-annually. Mercy Hospital has developed a disaster plan that outlines the overall policy regarding its implementation and participation of all employees. Department Heads and Supervisors are responsible that employees under their supervision are completely informed, educated, and familiar with each of his/her duties. Overall a\.\the.rity and directioY'1 of the disaster plaY'1 rests with the President of Mercy Hospital or designee, in cooperation with the medical coordinator of 'the disaster. A department receiving disaster information will notify PBX who will immediately contact the President or designee. .The alert within the hospital will be "TRIAGE I (INTERNAL)" or "TRIAGE II (EXTERNAL)" repeated three (3) times. I ..<- /\ . -----.---.- -.----. I . - . .... . ME'R!v HOSPITAL - BAKE~FIELD EXTERNAL DISASTER .PLAN I '. ~ . '. M-H 10-86pa EXTERNAL DISASTER NOTIFICATI.ON DISASTER - EMERGENCY SERVICE RESPONSE CONTROL 5 MED-ALERT . MERCY EMERGENCY . YES NO I OTHER CH.9 HOSPITAL ER. MONITOR CH.9 . - E.R. RADIO NURSE PBX ADMINISTRATOR PBX I ALARM I CHARGE PERSON ACTIVATE : DEPARTMENT PROTOCAL \~) ~.. < . . .. ;¡, , ---, . \ .f \ .. MER. HOSPITAL - BAKE.FIELD INTERNAL DISASTER PLAN DISCOVERY - smoke fire earthquake RELOCATE - those in immediate danger CONFINE - close doors ALERT - pull fire alarm RESPONSE - return with fire extinguisher SECURITY I SAFETY - respond to scene/meet FD ENGINEERING - respond to scene ALL OTHERS - ,remain where they are at, unless paged to return to specific area. FIRE DEPT. - directs extinguishment / relocation " " DISASTER I . YES NO I CANCEL / COMPLETE REFER TO EXTERNAL FLOW CHART -.. M-H 1o-aSpa . . . .. MERCY.tI0SPITAL - BAKEIì.iFIELD CASU~TY TREATMENT S~STEM VICTIMS ." . Sorting Of Patients Under Canopy Of Elnergency Entrance ." First Aid neœlve·1h!Bt- .JI Dlmls! ~ Physk:eJ Med1clne Relative Waiting Area Cafeteria ITRIAGEI ." ." , " Definitive Holding Area lteatment _~ Recelve.:neat 1teat· Evaluate Morgue Emergency Dep8ltmønt A' I load 'Dock Outrnllel1' Wal\lng Roo," TO: Holding Area Definitive Treatment Area OR, leu or Nursing Unit DIscharge Center · . SNF - - I T nnd;nt:on MOt1aOri n 9 _ç~Jlte..r_____ Chemical Exvosures Morgue Area e e MERCY HOSPITAL BAKERSFIELD, CALIFqRNIA INDEX OF CASUALTY TREATMENT FUNCTION PRIMARY LOCATION SECONDARY LOCATION l. Triage E. R. ramp 16th Street 2. Immediate Treatment Emergency Department Other Hospital/Field Hospital 3. First Aid Physical Medicine Dept MCRC (16th and A Streets) 4. Urgent Treatment Center Surgery Department Other Hospital/Field Hospital 5. Discharge Area SNF Dining Room Dismissal Office 6. Disaster Control Center E.R. Conference Room Enterostomy Office 7. I Personnel Work Pool 3rd Floor Lecture Room 16th and D Street Building 8. Medical Staff Administration Area SNF Conference Room 9. Media Center Security/Mail Room Mercy Plaza Lobby 10. Patient Information Admitting Area Marian Building 1l. Family Center Cafeteria Trinity Chapel .. 12. Retention of Deceased Morgue Loading Dock Area " , . . MERCY HOSPITAL EXTERNAL DISASTER PLAN GENERAL INSTRUCTIONS The following instructions apply to all departments, in addition to any specific responsibilities in your Department Disaster Plan. 1. All breaks and meals a~e cancelled until rescheduled by Department Managers or supervisor, as workloads permit. 2. Personnel completing their shift are not to leave until given permission by their supervisor or department manager. This includes full alerts and drills. 3. All on-duty personnel shall report immediately to their respective departments upon activation of this plan for assignments. 4. Each department shall be responsible for their own area and shall proceed immediately with their disaster plan responsibilities when the alert is paged. 5. Department Managers or designee shall assign staff and plan work schedules to permit staffing to the extent required by the situation. 6. Assigned personnel will direct and control use of elevators by obtaining a override key from Engineering Services. 7. Department Managers or designee shall be responsible for ensuring that there is adequate recall procedures for their department. 8. Any changes in departmental staff must be reported immediately. An up-to-date department recall roster shall be submitted semi-annually (July 31 and December 31), to chairperson of the Disaster Committee, so that a current index of all staff, their home phone numbers, addresses and date of births are maintained in the master file. . . MERCV HOSPITAL EXTERNAL DISASTER PLAN TWO STAGES OF ACTION STAGE I IMMEDIATE PREPARATION FOR INFLUX OF NUMEROUS CASUALTIES Identify type of disaster. Mobilize medical staff. Staff and provide supplies to triage, first aid, and holding areas. Mobilize auxiliary. Supplement department personnel as needed. Depending upon types and degrees of injuries it may be determined that the emergency can be handled without instituting Phase II of the disaster plan. The medical coordinator or E.R. physician on duty will determine the number of staff needed to cover the emergency by obtaining from the reporting agency the approximate number of victims and nature of accident. This information will be relayed to the President or designee as soon as it is available. Only the President or designee has the authority to activate or 'deactivate any stage of the disaster plan. STAGE II - CONVERSION TO DISASTER OPERATION Initiate Disaster Plan. Determine need to suspend elective surgery and admissions. Determine need to dismiss inpatients from hospital. Determine need for intra-hospital transfer to provide concentrated areas for serious casualties. If a request is made to discharge existing patients in order to make room for more seriously injured casualties, the medical coordinator will assign physicians to evaluate patients in hospital for possible transfer or discharge. ~ RECEPTION OF CASUALTIES AND TREATMENT AREA All casualties with exception of known chemical exposure victims (chemical exposure victims will be directed through the dock area and morgue for decontamination) will be admitted through the triage area, which is located at the Emergency Department entrance. Triage will take place outside the Emergency Department, under canopy of emergency ramp. Depending on the number of emergency vehicles arriving at Mercy Hospital, it may become necessary to use· 16th Street as a triage area. (Security Department will be utilized to barricade this area off safely.) . . MERCY HOSPITAL EXTERNAL DISASTER PLAN RETURNING TO HOSPITAL 1. Off-duty personnel who hear of the disaster should be on the alert and available in case they are needed. In the event of a county-wide disaster, it may be necessary to listen to a pUblic emergency radio network for information. 2. Employees returning to the hospital shall enter via 16th Street service entrance. Employees will be asked to identify themselves by name and department shall wear their identification badges. Those employees who do not have their 1D badges available must be verified as employees. Employees should carry other identification such as a driver's license. 3. All off-shift employees called back to Mercy Hospital including Department Managers are to report to the personnel pool and sign in before reporting to their department. They shall follow the procedure outlined in their department disaster plan and utilize only those employees needed for their operation if necessary. The remainder of employees will be assigned to the personnel work pool. 4. All personnel not being utilized in their department will be assigned to the personnel work pool where they will be directed to Department Managers for' placement and reassignment of duties. 5. Employees with children who are called back to work and cannot secure care for their ch·ildren may bring them to Mercy Richards Child Care Center. The center will be staffed by employees with support from personnel pool if necessary. 6. Physicians entering the hospital shall be instructed to report to Medical Staff Office (located in the hospital administrative office area), for sign-in, verification, and await assignments. 7. Hospital administrative staff and the chief of staff or designee will verify medical staff status of the physician. For physicians who report to Mercy Hospital, but who are not on our staff, verificati~n must be made to determine that they are M.D.'s before assignment to patient care areas. All physicians will be issued a temporary badge to be work in the hospital until the conclusion of the disaster. 8. The medical coordinator or designee is responsible for the assignment of all physicians, and the overall professional care of the patients. . - , \ MERCY HOSPITAL DISASTER PLAN SUMMARY OF OVERALL PLAN As soon as the disaste~ is decla~ed, the following steps will be taken: 1. A t~iaQe a~ea will be set up on the Eme~gency ~amp o~ on 16th St~eet if necessa~v. 2. Employees will be ale~ted and called f~om home if necessa~y. . Key employees will be called by PBX ope~ato~. Othe~ employees will be notified th~ough the departments. a pe~sonnel ~ool will be established in the 3~d floo~ lectu~e ~oom/alte~nate location 16th and D St~eet BuildinQ. 3. An outpatient a~ea fo~ first aid casualties will be set up in the Physical Medicine Depa~tment/alte~nate location MCRC - 16th & A St~eets. 4. Disaster Cont~ol Cente~,: A cont~ol center shall be set up in the Eme~aencv Depa~tment Conferenceoom/alte~nate location Ente~ostomv Office (SNF). s. T~affic cont~ol will be handled by the Secu~itv/Safetv Depa~tment. 6. A familY cente~ will be established in the cafete~ia for familylf~iends of casualties. Alte~nate location T~initv Chapel. 7. A media relations will be established in the Secu~itv office and mail room/alte~nate location Me~cv Plaza lobby. ~ 8. Discha~Qe a~ea will be established in the SNF dininQ a~ea and lounQe. 9. A nu~sing sign -in a~ea will be established in the Education Depa~tment Offices/alte~nate location Nursina Administ~ation. 10. The mo~gue will be used fo~ ~etention of deceased with the loadina dock used as a temporary morgue area. 11. Medical staff will be directed to report to the Medical Staff off.ice located in 'the Administrative Areal Alternate location,SNF conference room. - e MERCY HOSPITAL EXTERNAL DISASTER PLAN TERMINATION OF DISASTER STATUS The Disaster Medical Coordi~ator will keep the Co~trol Ce~ter (Emerge~cy Departme~t Co~f~re~ce Room) advised of the disaster situatio~ at all times. He/she will advise them immediately whè~ a decisio~ is made that a disaster co~ditio~ ~o lo~ger is needed. The Preside~t will ~otify the hospital switchboard operator to a~~ounce termi~atio~ of disaster status. The switchboard operator will page overhead "ATTENTION ALL PERSONNEL CODE TRIAGE -- ALL CLEAR" (3 times). Employees should return to their ~ormal work areas as soo~ as being dismissed from disaster duties by the supervisor or departme~t ma~ager i~ their assig~ed area. -- e , I , , , MERCY HOSPITAL BAKERSFIELD, CALIFORNIA ADMINISTRATION (COMMAND POST) CHECK LIST DATE -------- TIME CALLED ------- TIME ARRIVED -------- CP SET-UP -------- 1. Obtain disaster information from__________________________~__________ A. Nature of Disaster _______________________~_____________________ B. Location _______________________________________________________ C. Estimated Number/Type of Patients ______________________________ D. Estimated Time of Arrival_______________________________________ E. Reporting Person's Name ________________________________________ 2. Contact PBX to sound alarm ------------------------------------------ 3. Ascertain if, the following tasks have been performed: TASK DEPARTMENT RESPONSIBLE A. Bed inventory Nursing B. Blood inventory Laboratory C. Personnel pool formed F1ersorlne 1 D. Traffic control Security/Safety E. Messengers assigned Housekeepi rig F. Inventory of provisions Dietary Pharmacy Central Services .. 4. Notify radio nurse of number of critical patients that can be accepted. 5. Assign call back as needed: A. Medical staff 8. Administrators c. Managers of unstaffed departments, etc. - , . ( ADMINISTRATION (COMMAND POST) CHECK LIST PAGE 2 6. Reeeive eopies of disaster tag and maintain master patient disposition list 7. Keep patient relatives/friends area updated on information via writteYI message/other communication means available. 8. Keep Community Relations informed on patients names and disposition via written message/other communication means available. 9. Conduet critique following disaster or drill exercise. It . ,./-'-', Unit: Date/Time: DISASTER PLAN - REPORT FORM During initiation of Disaster Plan - "Triage" - please fill out this form and submit to Command Center within 15 minutes of first triage. 1. Number of beds, immediately available to admit patients to 2. Number of patients which can be: a. Discharged b. Transferred 3. Number of patients which are: a. Bedridden b. Ambulatory 4. Number of patients which have: a. Special life support needs VACANT BEDS PATIENTS FOR DISCHARGE TRANSFERRABLE PATIENTS SPECIAL NEEDS 1 copy to Command Post 1 copy to Admitting MERCY HOSPITAL BAKERSFIELD, CALIFORNIA DISASTER PLAN VICTIM SIGN-IN SHEET ._ ARFA PATIENT NAME TREATMT AREA TAG # TI ME IN IF AVAILABLE AGE NATURE OF INJURY ED OR FA DISPOSITION TI ME OUl I I I ! I I 1 I . I I i/ I I I I , I .f, I I . I I I I , . , i I I I I I " .' i:. c " 0, , " I " I SEND COpy TO DISASTER CONTROL CENTER AS SOON AS POSSIBLE AND WHEN UPDATED ED - Emergency Department , OR -·Operating Room FA·-·Fir . Aid .' +, It _. MERCY HOSPITAL BAKERSFIELD, CALIFORNIA DISASTER PLAN EMERGENCY DEPARTMENT CRITIQUE GUIDE Disaster Location --------------------------------------------------------- Type of Disaster --------------------------------------------------------- Time and Date of Disaster --------------------------~---------------------- Person Performing Critique_________________________________________________ 1. Number of physicians responding? _____________________________________ .::, .... Number of casualties received? ----------.-----------------------..------ 3. Kind of casualties received? ---------------------------------------- ---------------------------------------------------------------------- 4. Time disaster alert received? 5. Time first casualties arrived? 6. Tirne first casualties were seen 7. Time last casualties arrived? --------------------------------------- -------------------------------------- by physician? ___~____________________ --------------------------------------- 8. Time last casualties were seen by physician? ------------------------ YES NO NOT OBSERVED 9. Were personnel calm? ----- ----- ----- 10. Were personnel resources adequate? ----- ----- 11. Did observers cause any problems? ----- ----- ----- 12. Were any resources lacking? ----- ----- ----- 13. Were necessary supplies available? ----- ----- ----- 14. Were necessary equipment available? ----- ----- ----- 15. Did personnel seem sincere in their i nvo 1 vemeY'lt ? ----- ----- ----- --------------------------------------------------------------------------- COMMENTS: Please use this space to make any comments that may be helpful in evaluating this exercise. ·e e MERCY HOSPITAL BAKERSFIELD, CALIFORNIA DISASTER PLAN TRIAGE CRITIQUE GUIDE Disaster Location --------------------------------------------------------- Triage Area Location ______________________________________________________ Time First Casualties Arrived --------------------------------------------- YES 1. Was the triage layout physically arranged to facilitate expedient casualty flow? ----- 2. Was only emergency first-aid administered in the triage area? ----- 3. Were casualties classified and moved quickl.y? ----- '4. Was the triage under the authority of one person? ----- 5. Was the triage area ready when the first casualties arrived? ----- G. How many physicians were seen working in the triage area? ----- 7. Number of nurses working in the triage area? ----- 8. Were personnel calm? ----- 9. Were personnel resources adequate? ----- 10. Did personnel seem sincere in their i nvo I vemeYlt ? ----- 11., Did observers cause any problems? ----- 12. Were there any problems with communi cat ic.rls? ----- 13. Were there enough patient transportation equipment? ----- 14. Were any resources lacking? ----- -MQ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- NOT OBSERVED ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- & e e " COMMAND POST CRITIQUE GUIDE PAGE 2 Y§ NO NOT OBSERVED 13. Were commercial radio/television stations monitored for information regarding disaster. ----- ----- ----- 14. Was command post secured so that unauthorized persons did not interfere with operations? ----- ----- ----- 15. Were personnel resources adequate? ----- ----- ----- 16. Were there too many personnel resources? ----- ----- ----- 17. Did observers cause any problems? ----- ----- ----- 18. What kinds of communications did you observe: a. Radio ----- ----- ----- b. Telephone ----- ----- ----- c. Portable radios ----- ----- ----- d. Messenger ----- ----- ----- 19. Were any resourc~s lacking? ----- ----- ----- --------------------------------------------------------------------------- COMMENTS: Please use this space to make any comments that may be helpful in evaluating this exercise. .a " ~ ,/' e e MERCY HOSPITAL BAKERSFIELD, CALIFORNIA DISASTER PLAN COMMAND POST CRITIQUE GUIDE Command Post Locatiòn Disaster Location ----------------------------------------------------- --------------------------------------------------------- Time and Date of Disaster ------------------------------------------------- Person Performing Critique ________________________________________________ 2. 3. (- 4. 5. 6. 7. 8. 9. 10. 11. 12. 1". Time first disaster message received --------------------------------- Was a disaster report form utilized? Was an inventory of emergency capacity of available resources taken? Was a hospital status board maintained? Did the command post effectively coordinate disaster operations? Were community resource agencies effectively utilized? Were telephone communications effectively utilized? Was hospital emergency radio system promptly put into operation? Was radio communication r.estricted to only relevant information? Were messages filtered to ensure that the Chief of Disaster Operations received only critical information? Was the command post functionally located? Was the electrical power for the command post on emergency circuit? YES ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- NO ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- NOT OBSERVED ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- .. . .~ ' .. / ( -- e MERCY HOSPITAL BAKERSFIELD, CALIFORNIA DISASTER PLAN GENERAL CRITIQUE FORM DATE OBSERVER LOCATION ----------- -------------- ----------- ACTIVITY BEING OBSERVED TIME COMMENT I I I I ST AlWARD PROCEDURE: Department: N:'RSING DIVISION :; .. ',-" -- HIER CY DUARTHENT Procedure No: Effective Date: November 1984 Date RepLI"'~ Page 1 of 2 , , Title of Procedure: HAZARDOUS WASTE - DISPOSAL OF Purpose: To provide for safe containment and disposal of hazardous waste materf.lls, both chemical and radioactive. Eaui pment: 1. Black plastic contamination bags. 2. Cloth bags. 3. Tape. 4. Marking pens. 5. Storage barrels. 6. Survey meter. (Nuclear Medicine) .. , - Procedure The Radiation Safety Officer: {/ 1. Uses survey meter to monitor all radioactive suspect wastes. 2. Determines method of disposal for body wastes, linen, clothing or trash from radioactive contamination. (C-':,' ',.:::;.: The £ounty Environmental Health Officer: 1. Determines necessity of disposal for ch~mically contaminated linell, clothing, trash. Advise method of de~ontarninating linen, clothing, rooms, without con tamina tion,. , 2. The Housekeeping Representative: 1. Handles the transportatiion and storage of chemical contamination storage barrels. The Registered Nurse, Licensed Vocational Nurse: 1. Assures all contaminated clothing, linen and waste are appropriat.> I y contained and labeled according to procedure and instruction from Radiation Safety Officer and/or Environmental Health Officer. Records on: 1. Emergency Department Nurse Observation Record. i " Previous a. Method of waste containment. b. Method of contaminated material title: Radioactive Waste D4sposal / - ~ . ~ r. /" /;" (J..1./7Iì'L(.¡¡V :£ I( disposal. c. >.' Prepared Approved Original Effective Date: .1l1n.1977 Reviewed: December 1979 October 198. Rcvi~;cd: Decemh'~r 1981. Novemhl'r 19841 ~'E.):T~1At\r.: ?rocedurefD (R)P: (HazardWas t) 09 ~ .. STANDARD PROCEDURE: Departmen t: N1JRSING DIVISION - EHERGENCY DEPARn!ENT Procedure No: . Effective Date: Novembe r 1984 Date Replace Page 2 of 2 ( Title of Procedure: HAZARDOUS WASTE - DISPOSAL OF 2. Personal property list. a. Clothing. b. Valuables The Clinical Manager: 1. Releases personal property after clearance by Environmental Health Officer, Radiation Safety Officer or Emergency Room Physician. Advise~ of cleaning methods for property. Assures acknowledgement of property by signatu~e ~~ patient, relative or significant other. Informs patient when property cannot be returned. Obtains signatures of patient to verify information that property cannot be returned. Provides information to patient regarding restitution or reimburse- ment for property. .. 2. 3. - -, - ~- 4. 5. / 6. a. Contact employer. b. Contact agency responsible for the contamination. C:.c Records on Personal Propertv list: 1. Property and valuables returned. 2. To whom released. 3. Property unreturnable and .reason. 4. Person contacted. 5. Signature of patient/significant other. 6. Signature and title. ( STA~NUAKD ~KU~LUUKL; uepa.í.. L.L.,..;Cil,~ ~ NURSING DIVISION - EMERGENCY DEPART~ŒNT :--.,,- - Procedure No: Effective ate: November 1984 Date Replace Page 1 of 5 Title of Procedure: " ! HAZARDOUS MATERIAL EXPOSURE Purpose: To decontaminate and treat patient with history of hazardous material exposure and to offer maximum protection to staff and other patients. Equi pmen t: ("", .'.'.-:.. '.'."." Separate entry (loading and docking ramp) Showers (morgue and Emergency Department) Decontamination room (Morgue) Decontamination cart (stored in 2 West utility Room) Tyvec suit -.Neoprene gloves - Neoprene boots Towels, wash clothes , Body soap Normal Saline and tubing for eye irrigation Disposable scrub suits Disposable slippers Surgical gloves Patient gowns Disposable B/P cuffs Disposable stethoscopes Contamination bags Property list and pens Egg crate mattress Drug box Duct tape - ..- -< ......- - - ~ - 1 Cardiac Monitor and Crash cart (from Physical Medicine) Keys to decontamination ;:¡re;:¡~ (narcotic cabinet in Eme-rgency Department) Respiratory equipment Survey Meter (Radiation exposure) Procedure: The Emergency Department Physician: 1. Evaluates information and determines precautions needed. Only the Emergency Department physician will make this decision. prep&r ~:~~ ?i ~.,~.. ~".::!...;4,-,~_"c~ j Date-~' / Appr _ ~d-" by: Y; . ~ ~~~ Datel ~ - ' ,. /'/ , . "h Date :/þ ,', :J<¡SDate l, .,' ~h ~,~, .~'~,~.~t.,P"~~ Revie'k-oed: Revised: Original Effective Date: Nov. 1984 :. ç;STANDARD PROCEDURE: _ Departcent: ~ ' NURSING DIVISION - EHER.CY DEPARTHENT Procedure No: Effective Date: Nove.mber 1984 Date Replace I Page : , ,2 of 5 ¡ I I ¡ " Title of Procedure: HAZARDOUS MATERIAL EXPOSURE 2. Directs patient care. The Emergency Department Registered Nurse team leader: 1. Alerts: a. Emergency Department physician and staff. b. Emergency Department Clinical Manager. c. Administrative Coordinator. (. , ,-,. ." 2. Assigns registered nurse (RN's) to incoming patients. 3. Assures contact with-- Kern Com::.ty EMS via phonE! 326-25.35 - on -county. radio- 11504. 4. Contacts Chern-Tree 800-424-9300, if additional information 15 needed. Provides following facts: ~ a. Identify as an emergency. b. Nature and location of problem. c. Name and call back number. d. Product name and/an I.D. number. e. Shipper or manufacturer, container type. f. Rail car or truck number. g. Carrier name. h. Consignee. i. Local conditions. - Asks: a. Type of material and use. b. Specific precautions. c. Decontamination procedures for patient and staff. d. Course of treatment. e. Name and phone number of manufacturer's physician. f. ~al disposition of contaminated articles. 5. Contacts if additional information is necessary. Fresno Poison Control - 209-445-1222 6. Limits personnel providing direct care to patient(s). 7. provides nursing personnel relief every four hours. 8. Arranges for definitive transfer when appropriate: . a. Assures transfer is environmentally safe. ( --- c... c_ STA!lDARD PROCEDURE: Depart~nt: ~ NURSING DIVISION - EMER CY DEPARTHENT ,. - Procedure No: Effective Date: November 1984 Date Replace Page 3 of 5 Title of Procedure: HAZARDOUS MATERIAL EXPOSURE The Clinical Manager/Administrative Coordinator: 1. Notifies supervisor of appropriate departments which may include: a. Laboratory Housekeeping O/P registration Radiology Laundry Purchasing Central Service Respiratory Therapy Sect1I'i ty Dietary Community Relations Employee Health Coordinator Pastoral Care Engineering b. c. d. e. f. g. h. i. j. k. 1. m. ~' n. 2. Assists Emergency Department Nursing Staff. 3. Consults with health department or Cal/OSHA for clearance to use contaminated areas. 4. Assures availability of survey meter and radiation safety officer if appli- cable to situation. 5. Makes available shower and clean clothing for pre hospital care providers. The Registered Nurse, Licensed Vocational Nurse assigned to patient: 1. Affirms level of protection necessary by consultation with the Emergency Department physician. A. MAXIMLm PRECAUTIONS - Indicated for known "off gassing" agents, i.e. EDB, DC PB, DD soil fumigant and/or Timer, Seven and variation of same, any unknown agent until positively identified, if patient is covered with~wdered chemical, or agent involved is acid or caustic. NOTE: Respiratory equipment not necessary for non-systemic agents. I 1. Secures keys to decontamination area. 2. Moves decontamination cart from 2W to decontamination area. 3. Moves crash cart from Rehabilitative Department to decontamination area. 4. Requests transportation department to place appropriate number of wheeled stretchers in the decontaminated area. 5. Prepares decontamination area: a. Removes all unnecessary equipment and supplies. b. Seals vault door with duct tape. c. Changes linen and trash bags to black contamination bags. ~ -- STANDARD PROCEDURE: e Department: NURSING DIVISION - EMER4IÞCY DEPARTMENT Procedure No: Effective Date: NovemJ:jer .1984 Date Replace Page'> 4 (\! 5 Title of Procedure: HAZARDOUS ~1A.TERIAL EXPOSURE 6. Dons protective clothing. 7. Readies respiratory equipment 8. Dons respiratory equipment 5 minutes prior to estimated time of arrival. 9. Meets transport ,vehicle and assumes care of the patient. c. d. e. f. g. h. i. j. (., k. l. m. n. o. a. b. Assesses patient(s). Transfers non ambulatory patient to table in decontamination room - washes entire body with soap and water for 20 minutes - irrigates both eyes with Normal Saline solution, irrigates both ears and nose if indicated. Directs and assists ambulatory patient(s) with 20 minute shower in decontamination area._ : Performs nursing intervention as indicated or ordered-oy physician. Places contaminated articles (clothing) in appropriate bags and label~ same. Assists registration clerk with necessary information. Obtains lab specimens. ~ Changes gloves everyone and one-half hours as necessary. Removes protective clothing prior to leaving area. Deposits protective clothing in contamination bags and seals same. Places respiratory equipment in contamination bag and seals same. Places contamination bags into storage barrels and seals same. Showers and changes to clean disposable scrub suit or own uncontaminaf ,~d clothing. Seals room with duct tape - labels room - Contaminated. Returns to Emergency Department. B. MAXIMUM PRECAUTIONS DURING DECONTAMINATION: .' 1. Follows procedure for Maximum Precautions until patient(s) decontaminatioll is complete. 2. Changes to disposable scrub suit, isolation gown and mask for continued patient care. C. NON-TOXIC AGENTS: 1. Uses normal hygenic measures. 2. Assists patient(s) with 20 minute shower as necessary.. 3. Provides clean clothing for patient(s). 4. Continues patient(s) care as indicated. D. RADIATION ACCIDENT: ( 1. 2. 3. 4. 5. 6. 7. Notifies Radiation Safety Officer. Dons protective clothing. Includes radiation film badge under protective clothing. Attaches dosimeter to outside clothing. Covers pathway to decontamination area with sheets (plastic or material). Proceeds as indicated in Maximum Precautions during decontamÍnation. Wears isolation mask rather than respiratory equipment. ~ --.-~---.---...-. -------_.._- S"¡ANDARD PlWCEDURE: ; .. ~~ - Title of Procedure: HAZARDOUS MATERIAL EXPOSURE - Depart~nt: : NURSING DIVISION - EMER CY DEPARTMENT Procedure No: Effective Date: November 1984 Records on Emergency Department Nurse Observation Record: 1. Triage note. 2. Pertinent clinical findings. 3. Decontamination procedures. 4. Treatments. 5. Medications. 6. Signature and title. NOTE: Check List Addendum (. " ( , :: , '1 Date Replace 1"'1~e 5 of 5 ;- - - . e 11 ~ <fd-~'ý. 3:<"7--- 52-60, J~ R QÅ_QAÆ~ 0' e e . e f I . I . I . '" Mercy Hospital Joaquin (Jack) L Director of Security & Sc' Resendez , afety P.o. Box 119 2215 Truxtun Aven ~~~)3~j~~~7~A 93~Õ2 . , I , ·1 I I " c, ;6 .... ~I'I 1. -I y2. ,.... ,-.j 3. -....J 1\1 4. \_. ~e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY ACCOUNTING DEPARTMENT " Liquid Paper P.O. Box 61 Boston, MA 02199 Xerox Developer 5225 Business Center Drive Bakersfield, CA Staphene Vestal Laboratories St. Louis, MO 63110 Xerox Silicone Fuser Oil 5225 Business Center Drive Bakersfield, CA e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY AIMINISTRATION/MEDICAL STAFF OFFICE dt~ 1. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boston, MA. 02199 ---i \~ 2. Dry Imager Nashua Corp Nashua, NH 03061 ;'e . '2. e e (e MERCY HOSPITAL SECURI1Y /SAFE1Y DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY , AIMITIING ~1II1. Staphene Disinfectant Spray Vestal Laboratories Chemed Corporation St. Louis, M) 63110 ..J,J 2. Liquid Paper Correction Fluid Liquid Paper Corp. Box 61 Boston, MA 02199 .-I Y 3. Rubbing Alcohol Isopropyl Whiteworth Inc. Gardena, CA 90248 !e ..-.J ,J 4. Silicone Oil for Ricoh Copier Ricoh 17771 Mitchell Irvine, CA 92714 --...) tJ 5. Ricoh Ff Toner 5000 Tokyo Japan Ricoh Co. 17771 Mitchell Irvine, CA 92714 "J .... 6. Markett All Purpose Marker Eberhard Faber Inc. Crestwood, Wilkes-Barre, Penn. 18703 ie 3 e e (. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZAROOUS SUBSTANCE INVENrORY 'I AMBULATORY CARE DEPARTMENT ,..,\-.1 1. Liquid Paper Correction Fluid Liquid Paper Corporation P.O. Box 61 Boston, MA. 02166 ""¡'I! Z. Felt Tip Markers-Pocket Accent Sanford Corporation Be11wood ,IL 60104 tv 3. UHU Glue Stick Mercy Purchasing .J 4. Septisol Mercy Purchasing Ie ,.; s. Comet Cleaner Mercy Purchasing ~ 6. Envy Instant Cleaner Mercy Purchasing ,) 7. Alcohol 70% Mercy Purchasing .J 8. Zephiran (aqueous) Mercy Central Service tJ 9. Zephirzn (tincture) Mercy Central Service N 10. Betadine Solution Mercy Central Service u11. Betadine Solution Mercy Central Service ~ 12. Merthiolåte (tincture) Mercy Pharmacy tJ13. Tincture of Benzoin e Mercy Pharmacy ~ 14. Iodine Mercy Pharmacy I.L tit e (e AMBUlATORY CARE Page 2 .J 15. Demop1ast Mercy Phannacy .) 16.· Ethyl Chloride Mercy PHannacy ~ 17. Phisohex Mercy Phannacy .J 18. Staphene Spray Mercy Housekeeping \J 19. Hydrogen Peroxide Mercy Central Sercies tJ 20. Dry Marker Remover Solution Mercy Purchasing. 'e e s tit e :- \., MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZAROOUS SUBSTANCE INVENTORY AUDIOLOGY ~10 1. Insta-Seal Kote Insta Mold Prosthetic 640 Hallow Road P.O. Box E Oaks, PA 19456 ,...110 2. Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston MA 02199 -.¡ ,J 3. Insta Mold-Silicone Insta Mold Prosthetics 640 Hallow Road P.O. Bin E Oaks, PA 19456 /e ,-¡ N 4. Hardner Paste Insta Mold Prosthetics 640 Hallow Road P .0. Bin E Oaks, PA 19456 .-..¡ 10 5. Tubing Cement #224 Hal Hen Co., Inc. P.O. Box 6077 Long Island City, NY 11106-9990 r-J I~ 6. Ear Tip Cement Hal Hen Co., Inc. P.O. Box 6077 Long Island City, NY 11106-9990 :...J i\; 7. Oto Set Impression Material Abacoa Labs P.O. Box 25111 Santa Ana CA, 92799 '\) 8. Hearing Aid Batteries It r '-J 9. Hard Adco Adden Adco Mold 1558 California Street Denver CO 80702 ,,) 10. Electrode Gels & Cremes , Various Suppliers ~ - . ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY AUXILLIARY , 1. Master Mechanic Elec. Glue Gun Mfg. for Tru Value Hardware Store Chicago, IL 60614 2. Gillette Right Guard Deodorant Gillette Co. Boston, MA 02199 3. Aqua Net Hairspray Faberge, Inc. New York NY 10022 4. Krazy Glue Dist. by Krazy Glue, Inc. Itasca, IL 60143 Helium Tank for balloons Hospital Engineering Department, ,e 5. ,e ..... ) e . (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENr HAZARDOUS SUBSTANCE INVENTORY BIO-MED I'll. Spragrip Chesterton A.W. Co. Stoneham, MA 02180 t~ 2. Electro Wash C240 Chemtronics Inc. Hauppauge, NY 11788 .J 3. Tuno-Power Chemtronics Inc. Hauppauge, NY' 11788 r-J Y4. Rubbing Alcohol, Isopropyl Whiteworth Inc. (e Gardena, CA 90248 ~5. Tuner and Control, Cleaner and Lube dist Wholesale Electronic Supply Bakersfield & Fresno J 6. Chemtronics 70 P. S1. Qvf 15 Chemtronics Inc. Hauppauge, NY 11788 wi 7. Super Frost Test Chemtronics Inc. dist Jack C. Arbuckle Bakersfield -J,J 8. Magna1ube=G Teflon*Grease Carleton Stuart Corp. 13-02 44th Ave' Long Island City, NY 11101 --oJ ,¡ 9. 10:1 Spray Grease C1enesco, A Division of Chemed P.O. Box 2918 Cincirmati, OH 45201 ,J 10. Chain Lure ~:e 3750 East Livingston Ave. ...., Cohunbus , . OH 43227 ¡( e . (e BIO-MED HAZARDOUS SUBSTANCE INVENTORY Page 2 J 11. Tac Up Dyna Systems P.O. Box 225326 Dallas, TX 75265 ,J 12. Epoxy Fast Setting Hardman Inc. Belleville, NJ 07109 ..)13. Epoxy Glue Resin & Hardener G. C. Electronics Rockford, IL 61101- :e 1- 7' e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY CARDIOPULMONARY oJ 1. Redux w 2. Alcohol Mercy Central N 3. Soap Mercy ,...I.J4. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 :e \>J S. Aquasonic Gel e IU e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY CENTRAL SERVICE 1. Ethylene Oxide 1Z% - 88% Freon Hopper .:-I 2 . Vesphene Vestal Labs St. Louis, MO 63110 , r_ e ,/ r e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY CHAPLAIN SERVICES DEPARTMENT t_ ,.. IV 1. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boxton, MA 02199 ,J2. Liquid Paper Thinner Liquid Paper Corp. Dallas TX 75243 ,-./ \"3. Stamp Pad Inker Sanford Corp. Bellwood, IL 60104 ~4, Silver Cream Cleaner/Polish J.A. Wright & Co. Keene, NH ·03431 ~ 5. Kerosene Sunnyside Corp. Consumer Products Wheeling, IL 60090 .1) 6. Cream Cleanser scouring compound. General Chemical Corp. 5568 Schaffer Ave. Chino, CA 91700 1~7. Gum Turpentine TR Chemicals P.O. Box 216 Clint, TX 79836 \1 8. Koppersol Destruxol Corp. Torrance, CA ie' .\1 9. Lysol Disinfectant Lehan & Fisk, Division of Sterling Drugs Montvale, NJ 07645 J 10. Jergens lotion Jergens Cincinatti, OH 95214 {2.. - e (e æAPLAIN SERVICES Page 2 ./ ,J 11. Soap Jergens Cincinatti, OH cJ 12. Comet Proctor & Gamble Cincinatti, OH Ie :e I.] - ·e (e MERCY HOSPITAL SEaJRITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY œAPLAIN SERVICES rJ 1. Liquid Paper Liquid Paper Corp. Dallas, TX 75243 ,..) 2, Liquid Paper Thirmer Liquid Paper Corp. Dallas,TX 75243 r-IJ 3. Stamp 1'ad Inker Sanford Corporation Bellwood, IL 60104 rJ 4. Kerosene Surmyside Corp. Constmler Products Wheeling, IL 60090 i'e ,J 5. Silver Cream Cleaner/Polish J.A. Wright and Co. Keene, NH 03431 ,.J 6. Cream Cleanser Scouring compound General Chemical Corp. 5568 Schaffer, Ave. Chino, CA 9170 (714) 591-8451 rJ 7. Gtml Turpentine TR Chemicals P.O. Box 216 Clint, TX 79836 ~ 8. Kopperso1 Destruxo1 Corp. Torrance, CA ¡J 9. Palmolive dishwashing liquid Palmolive 10. Ammonia :e ~ 11. Lysol Disinfectant Lehan and Fisk, Division of Sterling Drugs Montva1e, NJ 07645 \J 12. Hand Lotion Jergen's Cincinatti, Ohio 95214 1'-1- e e (e æAPLAIN SERVICES page 2 v 13. Soap Jergen's Cincinatti, Ohio 95214 rJ 14. Comet Scouring Powder Proctor and Gamble Cincinatti, Ohio 45720 :e - 1-5 e e ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY COMMUNITY RELATIONS 1. ASSOCIATED PHOTO COpy CORRECTION FLUID BOISE CASCADE P.O. BOX 92735 CHICAGO, IL 60675 ~ 2. STAPHENE - SIR SANITIZER VESTAL LABS ST. LOUIS, MO 63110 ,'~e :e I~ e e (e MERCY HOSPITAL SECURITY/SAFETY DEPAR1MffioJT HAZARDOUS SUBSTANCE INVENTORY CONTINUING CARE SERVICES ,...... ~ 1. Liquid' Paper Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 "V f>J 2. Maj or Accent Sanford Corp. Bellwood, IL ,-.J N 3. Mr. Sketch Scented Instant Water Color Markers Sanford Corp. Bellwood, IL 60104 :,e N 6. Elmer's Glue-All Borden, Inc. Dept. CP Columbus, OH 43215 ,i 7. Stabilo Boss Flourescent Markers Mercy Purchasing -J III 8. Expo Dry-erase Markers Sanford Corp. Bellwood, IL 60104 )V 9. Electro Cell Heavy Duty Batteries Jason Marketing Huntington Beach, CA 92649 111 10. Marker- Board Cleaner Weber Castello Jackson, IN 38301 II) 11. Carter's Micropore II Stamp Pad Dermison Manufacturing Co. . Framingham, MA 01701 III 12. Polaroid 600 Film Polaroid Corporation Cambridge MA 02139 'v 13. IBM Typewriter Ribbons (carbon) Mercy Purchasing :. 17 e e (. CONfINUING CARE SERVICES Page 2 '¡ I 'V 14. Sharp Toner SF-gOT Sharp Corporation Superior Copy Service 'e ~e r¿ e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY CRITICAL CARE -'1. Isopropyl Alcohol 2. Vaseline Intensive Care Baby Powder 3. Aerozoin - Tincture of Benzoin Spray 4. Hydrogen Peroxide i'. 5. Ceta~ain Throat Spray 6. Tincture of Iodine ~ 7. Staphene Spray 8. Betadine Solution 9. Cream Cleanser General Chemical Corp. 10. Oxygen '.. 11, Defibrillators Hewlett Packard '( I i_- (e :e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZAJID)US SUBSTANCE INVENTORY DATA PROCESSING -J ,J 1. Dry Ink Plus 1045/1048 Xerox Rochester, NY 14644 Developer 1048 XERXO ROCHESTER, NY 14644 XEROX LENS AND MIRROR CLEANER XEROX ROCHESTER, NY 14644 ,roJ,J 2 . .....},J 3. ';;;0 e (e e e MERCY HOSPITAL SECURI'IY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY DIETARY .. I\ 1. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 I\) 2. Clorox C10rox Co. Oakland, CA 94612 y 3. Lime-A-Way Economics Lab St. Paul, MN 55102 Ie n/4. Fast Clean (grill & oven degreaser) Ca1ien Sales Co. 1041 Via Cordova San Pedro, CA 90732 ~ 5. Soi1ax All Purpose Cleaner Economics Lab St. Paul, MN 55102 r6. Mikro-Quat I Economics Lab St. Paul, MN 55102 tJ 7. Sun Gloh Polish P.O. Box,1515 Rochester, NY 14603 ¥ 8. Oven Cleaner Dallas Chemical 26 Glen-naLitt1e Trail Road Huntington, NY 11743 !- ';2..( e e '. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY EDUCATION DEPARTMENT NO HAZARDOUS PRODUCTS IN EDUCATION DEPARTMENT \,e :e 2¿ (e -..,,,1. r-J IIJ 2. ~ "-'3. :e :e e - MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY EMERGENCY DEPARTMENT Staphene 1043-19-Ab Vestal Laboratories St. Louis MO 63110 Sanford's Marker Sanford Expo-dry Erase Marker Sanford ¿ ~ ce , ' --' 1. .-13. (e ·~e - - MERCY HOSPITAL SECURITY/SAFRTY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY EMERGENCY DEPARTMENT Expo Dry-erase Marker Sanford 2. Hemoccult Developer Smithkline Diagnostics Liquid Paper/Correction Fluid Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 2y - e (- MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY EMPLOYEE HEALTH Nl. White Correction Fluid Boise Cascade ,Corp. P.O. Box 92735 Chicago, IL 60675 r--JN2. Toner Sierra Copy 4075 New Horizon, Ste 1 Bakersfield, CA 93313 Rubbing Alcohol - Blue Whiteworth, Inc. Gardena, CA 90248 r-' cJ3. (- . Ie ~5 e e (e MERCY HOSPITAL SECURITY /SAFEIY DEPARTMENT HAZAROOUS SUBSTANCE INVENI'ORY 'I ENDOSCOPy rJ1. Cidex Mercy Purchasing ....uJ 2. Liquid Paper P.O. Box 61 Boston, MA. 02166 \'J 3. Dust Off Mercy Purchasing IV 4. Hexon Odor Antagonist Mercy Purchasing I'" 5. Polaroid Medical Film Olympus Corporation (- 2185 Fortune Drive San Jose, CA ,\I 6. Oxygen Mercy Respiratory Therapy '~7 . Alcohol 70% (Isopropyl) Mercy Purchasing 'v 8. Septisol Mercy Purchasing '/'oJ 9. UHU Glue Stick Mercy Purchasing r'I ¡" 10. Felt Tip Markers Sanford Corp. Bellwood, IL 60104 Y 11. Formalin , Mercy Pathology Dept. I'J12. Hydrogen Peroxide Mercy Central Services rJ 13. Code 17 Endoscope Deodorant re Knox Laboratories Medical Division 2335 S. Michigan Ave. Chicago, IL 60616 2.~ e e /e ENDOSCOPY Page 2 ~14. Silicone Oil Olumpus Corp. Mercy Purchasing IV 15. K-Y Gel (Lubricant) Mercy Central rllV 16. Staphene Spray Mercy Housekeeping J 17. Comet Cleaner ~ercy Housekeeping (. :e ;:;7 e e t_ MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY .I ENGINEERING CONSTRUCfION 'e ''0 1. Seam Sealer #54 Collins & Aikman 23501 Park Sorrento #208 Calabas, CA 91302 N 2. Satin Enamel #40 Sequoia Paints 711 E. 19th Street Bakersfield, CA ~ 3. Flat Acrylic #27 Sequoia Paints 711 E. 19th Street Bakersfield, CA ,J 4. Acrylic Latex Semi-Gloss #24 Sequoia Paints 711 E. 19th Street Bakersfield, CA :e 2.8 e e i. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENI'ORY ENTEROSTOMAL TIiERAPY rJ 1. D'Odor Pectin Off Leesburg, Fla 32748 \~ 2. Fordustin Sween Corporation Lake Crystal, MN 56055 ~ 3. Bard Absorption Dressing C. R. Bard, Inc. Berkeley, Heights, NJ 07922 ~ 4. Spenco Absorption Dressing Spenco Medical Corp. Waco. Texas Ie ;oJ 5. NuHope Adhesive NuHope Laboraties, Inc. Los Angeles, CA 90039 ~ 6. Sween Peri-Care Sween Corporation Lake Crystal, MN 56055 W 7. Uni Care Lotion Howmedica, Inc. Largo, FL 33540 '~8. Sodium Chloride inj. U.S.P. 0.9% IV 9. Xylocaine Solution 1% Astra Pharmaceutical Products, Inc. Westborough, MA. 01581 J 10. Xylocaine Solution 2% Astra Pharmaceutical Products, Inc. Westborough, NA 01581 J 11. Ultra Gard Protective Skin Barrier Cream Professional Medical Products, Inc. Greenwood" SC 29646 :e :¿c¡ e e Ie ENTEROSTa.1A.L THERAPY HAZARDOUS SUBSTANCE INVENTORY Page 2 r.J 12. Dansac Skin Lotion Dansac A·S Hojuangen 4 DK-3480 Fredensborg, Denmark vJ 13. PDI Nail Polish Remover Pad Professional Disposables Inc. Mt. Vernon, NY 10550-1890 1J 14. PDI Sterile Alcohol Prep Professional Disposables, Inc. Orangeburg NY 10962-1376 Mississauqa, Ontario, L4T1G5 IV IS, Berwick's Dye-external use only. (e IV 16. Puriclens Sween Corporation Lake Crystal, MN 56055 N 17. Sil vadene Cream Marion Laboratories,. Inc. Kansas City, MO 64137 rJ 18. Neosporin Ointment Burroughs Wellcome Co. Research Triangle Park, NC 27709 IJ19. K-Y Lubricating Jelly Johnson & Johnson New Brunswick, NJ 08903 IV 20. Silver Nitrate Applicators Arzo1 Chemical Co. Nijack, NY 10960 IV 21. Banish Deodorant United-Division of How Medica, Inc. Largo, Fla 33540 IV 22. Per-Wash Sween Corporation Lake Crysta, MN 56055 ,e ,~ 23, Batadine Solution Purdue Frederick Company Norwalk, CT 06856 ~24. Batadine Viscous Formula Purdue Frederick Company Norwalk, CT 06856 ~ e e- (It ENTEROSTOMAL TIiERAPY HAZARDOUS SUBSTANCE INVENTORY Page 3 N 25. Bard Incontinence Protective Barrier Film Bard Home Health Division C. R. Bard, Inc. Berkeley Heights, NJ 07922 IV 26. Medi Aire Cataline Biomedical Corp. Huntington Beach, CA 92649 fI) 27. Granulex Dew·B. Hickam, Inc. Sugarlan, TX 727247 to.) 28. 0.9% Sodium Chloride Irrigation, USP Travenal Laboratories, Inc. Deerfield, IL, 60015 ~ \.J 29. Hydrogen Peroxide Whiteworth, Inc. Gardena, CA 90248 (e ,...¡ ~ 30. Liquid Paper Liquid Paper Corporation Box 61 Boxton, MA 02199 ç ¡sJ.~~ 6 c Ie ~- , t. ¿ (' OÞ'» {' .-"., I/. Cht ".' . ;"'.ral M+NII~Col.;¡""Nt ' )I\U'-/~.Þ ~. O. ~o..J' '"2., r'" ~ 1 P . r " .. I I ".. t. 17")" ".I"t l 't t,; <J I\. , ~ t../"rW 1J ~ J "1' 1~' 0 ,....... ¢ ~I N31. Kenalog Spray E. R. Squibb & Sons, Inc. 'Princeton, NJ 08540 ,J32. Mycostatin Topical Powder E. R. Squibb & Sons, Inc. Princeton, NJ 08540 \J 33. Sween Cream Sween Corporation ,Lake Crystal, MN 56055 I\) 34 . Fleet Mineral Oil Enema C. B. Fleet Company Inc. Lynchburg, Virginia 24506 1\135. Surgical Lubricant E. Eougera & Co. ~ Byk-Gulden, Inc. Melvill, NY 11747 '- oJ 36. Collaginase Advance Biofactures Corporation 35 Wilbur Street Lynbrook New York 15563 JtJ e e re ENTEROSTOMAL THERAPY HAZARDOUS SUBSTANCE INVENTORY Page 4 /e ,J 37. Stomahesive Protective Powder E. R. Squibb & Sons, Inc. Princeton, NJ 08540 ,.J 38. Vitamin A and Vitamin D Ointment Catalina Biomedical Corp. Huntington Beach, CA 92649 I~ 39. Zinc Oxide Paste, USP Eli Lilly & Co. Indianapolis, IN 46285 ~40. United Skin Barrier Paste United Division Pfizer Hospital Products Group, Inc. 11775 Starcey Road Largo, FL 33543 1\141. Bard Skin Care Cream Bard Home Health Division C.R. Bard, Inc. Berkeley Heights, NJ 07922 ~ 42, Natural Care Catalina Biomedical Corp. Huntington Beach, CA 92649 ~43. Vaseline Constant Care~Moisture Barrier O1.eesebrough - Ponds, Inc. Hospital Products Division Greenwich, CT 06850 ,J 44. Special Care Skin Cream Catalina Biomedical Corp. Huntington Beach, CA 92649 tol 45. Vaseline Dermatalogy Formula O1.eesebrough-Ponds Inc. Greenwich, CN 06830 I . ..e ~) e e (e ENTEROSTOMAL TIIERAPY .HAZARDOUS SUBSTANCE INVENTORY Page 5 Ii 45. UniDenn United D~vision of Howmedica, Inc. Largo, FL 33540 ,.¡ 46. Hibic1ens Stuart Pharmaceuticals Division of ICI Americas Inc. Wilmington, DE 19897 ~ 47. Debrisan - Wound Cleaning Paste Johnson & Johnson Products Inc. New Brunswick, NJ 08903 oj 48. M9 Deodorant Mason Laboratories, Inc. Harsham, PA 19044 (e ~ 49. Xy10caine 2% Jelly Aptra Pharmaceutical Products, Inc. Worcester, MA 01606 1J50. Zinc Oxide Ointment U.S.P. E. Fougera & Co. A Division of Byk-Gulden, Inc. Melville, NY 11747 ,.J 51.. Myco1og Cream E. R. Squibb & Sons Princeton, NJ 08540 , ,) 52. Greer Guard Appliance Deodorant John F. Greer Company, A Corp. 530 East 12th Street Oakland, CA 94606 \'oJ 53. Skin-Bond United-Division of Howmedica, Inc. 11775 Starkey Road Largo, F1a 35540 tJ 54. Cataphil Lotion Owen Laboratories Division of Dermatological Products . San Antonio, TX 78296 re N 55. Gentle Care Skin Cleaner Catalina Biomedical Corp. Huntington Beach, CA, 92649 3~ ---..,..- e e re ENTEROSJ'QMAL THERAPY HAZARDOUS SUBSTANCE INVENTORY Page 6 IJ 56. Hollister Skin Gel Protective Dressing Wipes Hollister Incorporated 211 East Chicago Ave. Chicago, IL 60611 ~ 57. Hollister Universal Remover for Adhesive & Barriers Hollister Inc. 2000 Hollister Drive Libertyville, IL 60048 :e ,.. 58. Dignity Odor E1:iminator Humanicare International Inc. East Brunswick, NJ 08816 It 59. Duoderm Hydroactive Granules Convatec P.O. Box 4000 Princeton, NJ 08540 II 60. Medicated Soft Touch Sween Corporation Lake Crystal, MN 56055 tJ 61. Prep-Site Acme United Corporation Medical Products Division Fairfield, Conn 06430 w62. Hibiscus-Sponge/Brush Stuart Pharmaceuticals Division of ICI American, Inc. Wilimgton, DE 19897 .163. Hibistat Stuart Pharmaceuticals Division of ICI American, Inc. Wilmington, DE 19897 ., 64. Sween Surgi-Kleen Skin Cleanser & Shampoo Sween Corporation Lake Crystal, MN 56055 'e " 65. Sween Karaya Powder Sween Corp. Rapidon, MN 56079 v 66. United Skin Barrier Paste United Division, Pfizer Hopp Products Group, Inc. 11775 Starkey Road Largo, FL 33543 ]3 e e c. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY ., EPIDEMIOLOGY NO HAZARDOUS MATERIALS USED IN THIS AREA t. '. 3'-1 - e ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZAROOUS SUBSTANCE INVENTORY HEM)DIALYSIS ~1. Fonnaldehyde Med-Chem 1909 Centinela Ave Ave Santa Monica, CA 90404 dist Kern Surgical Supply 2900 Eye Street Bakersfield, CA rJ'2. Clorox C1orox Corporation Oakland, CA 94612 N 3. Blitz e Ladlaw Corporation 200 N.E. Adams Street Peoria, IL 61602 r''( 4. Alcohol , Isopropyl Whi teworth Inc. Gardena, CA 90248 f" N 5. Hydrogen Peroxide Whi teworth Inc. Gardena, CA 90248 1\1 6. Betadine Solution Purdue Evednick Co. Norwalk, eN 06856 ~ 7. Nail Polish Remover Pads Professional Disposables, Inc. Mount Vernon, NY 10550 ,.-.JtJ 8. Septisol Solution Vestal Laboratories St. Louìs, MO 63110 -,!II 9. Liquid Paper ,_ Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 sf - ·,e HEM:>DIALYSIS HAZARDOUS SUBSTANCE INVENTORY Page 2 rltJ10. Roll-On Sæ1{ford Corporation Be11wook, IL 60104 .-J tJ 11. Staphene Disinfectant Spray Vestal Laboratories St. Louis, MO 63110 rJ 12. C1initest Ames Division Miles Laboratory Inc. Elkhart, IN 46515 ,v 13. Aquasonic 100 Parker Laboratories, Inc. Orange, NJ 07050 rV 14. cepaco1 Merrell Dew Pharmaceuticals "e Cincirma ti, OH 45215 rI il/ 15. Hydrogen Peroxide ~~ s.-., "$ Whiteworth Inc. Gardena, CA 90248 N 16. Skin-Prep Pfizer Largo, FL 33540 r \~ 17. Lyso1 Vestal Lab, Inc. St. Louis, MO 63110 e 3'- - '~ - c. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY HOUSEKEEPING DEPARTMENT !,. ~ 1. Liquid Paper P.O. Box 61 Boston, MA 02199 2. Spin-Brite - 2744 Carpet Cleaner National Sanitary 13217 S. Figueroa P.O. Box 61126 Los Angeles, CA 90061 .Liquid Malgon National Sanitary 13217 S. Figueroa P.O. Box 61126 Los Angeles, CA 90061 3. 4. Clorox The Clorox Co. Oakland, CA 94612 5. Liquid Satin - Stainless Steel Polish National Sanitary 13217 S. Figueroa P.O. Box 61126 Los Angeles, CA 90061 6. RDG Lime Solvent National Sanitary P.O. Box 61126 Los Angeles, CA 90061 7. Flourish Bowl Cleaner Walton-March Inc. Highland Park, IL 60035 8. Hi-Tor Plus Huntington Lab Huntington, IN 46750 :.. 9. Image IV-Emulsifying Stripper Hudson Supply 1414 24 Street Bakersfield, CA 93301 37 . . (e HOUSEKEEPING HAZARDOUS SUBSTANCE INVENTORY PAGE 2 10. Restorit - Carpet Shampoo Best Way Products Company Salt Lake City, Utah 11. Spartan Sparquate 25b-Germicide Spartan Chemical Co. Toledo, Ohio 43607 12. R&C Spray Reed & Carnick Pescataway, NJ 08854 13. All Fabric Spotter Hudson Supply 1414 24th Street Bakersfield, CA 93301 14. Four-in-One Germicide National Supply (e 15. Glass Act Walton March Ine, Highland Park, IL 16. Hy-Strip Hysan Corporation Chicago, IL 60609 60035 'e J~ c_ A-rJ1. -..¡ AJ 2 . (e 'e e . MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY INTERNAL AUDIT Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 Nashua SD-31 Developer Nashua Corporation Office Products Division Nashua, NH 03061 3( - . (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY LAUNDRY DEPARTMENT 1. Pierce I I Fabrilite Chemicals, Inc. 4555 Lake Forest Drive Cincinnati, Ohio 45242 2. Dryorth Fabrilite Chemicals, Inc. 4555 Lake Forrest Drive Cincinnati, Ohio 45242 3. Servant Fabrilite Chemicals, Inc. 4555 Lake Forest Drive Cincinnati, Ohio 45242 (- 4. Fybrfluf Gt Fabrilite Chemicals, Inc, 4555 Lake Fo"rrest Drive Cincinnati, OH 45242 5. Sodium Sulfite Anhydrous BASF Syandette Corporation 100 Cherry Hill Road Parsippeny, NJ 02054 6. Sodium Silicoflouride Agrice IV Chemical Company P.O. Box 3454 Tulsa, OK 74101 7. Karagami Waxkleen (paste) Concord Chemical Co., Inc. 17th & Federal Streets Camden, NJ 08105 8. Buckeye Brent Chemical Corporation 95 Commerce Road Stanford, CT 08904 -e 9. Targo A.L. Wilson Chemical Co. P.O. Box 207 Kearny, NJ 07032 GO . . (. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MAILROOM ....-41\J1. Liquid Paper Liquid Paper Corp P.O. Box 61 Boston, MA 02199 ....4 1\1 2. Liquid Thinner P.O. Box 61 Boston, MA 02199 w 3. Postage Meter Ink Pitney Bowes 2536 N. Grove Industrial Drive Fresno, CA 93727 \U 4. W-D 40 (,. W-D 40 San Diego, CA 92110 ~ 5. Prestone Union Carbide Corporation Danbury, CT 06817 Ie .. l/-( · - ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MEDICAL LIBRARY ,..-J1. Sanford's Roll-On Sanford Corporation Bellwood, IL ~0104 ,..4 2, Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 3. Canon NP Toner One Canon Plaza Lake Success, NY 11402 (. 1'.- U2. . . ,e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MEDICAL RECORDS .. tV 1. Liquid Paper Liquid Paper Corporation Box 61 Boston, MA 02199 r--J f'> 2 . Xerox Dry Ink Plus Xerox Corporation Rochester, NY 14644 ..-I .J 3. Xerox Fuser Lubricant Xerox Corporation Rochester, NY 14644 --J J 4. !e Liquid Paper Liquid Paper Corp. Box ·61 Boston, MA 02199 rl tJ s. Staphene _ Vestal Laboratories, Inc. St. Louis, MO 63110 ~ c..Q" ',... / - 4] - ...-..J '\J 1. ,-.I \11 2 . ~ ~ 3. 'e ,e . - MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MEDICAL TRANSCRIPTION Xerox Fuser Lubricant Xerox Dry Ink Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston MA 02199 l..L'-f' - .' (e, MERCY HJSPITAL SECURI1Y /SAFE1Y DEPARTMENT HAZAROOUS SUBSTANCE INVENTORY MERCY CARDIAC REHAB CENTER rJ /II 1.. Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 ...A ¡J 2. Expo Dry- Erase Markers Stanford Corp. Bel1wood, IL 60104 tJ 3. Ho1 ter Scanning Paper Del Mar Avionics 1601 AI ton Ave. Irvine, CA 92714 (e ~ ,.I 4. Cleaning Solutions Housekeeping ~ Ý 5. Rubbing Alcohol- Isopropyl Whi teworth, Inc. Gardena, CA 90248 ,J 6. Redux Cream Hewlett Packard - Medical Products Group Waltham, Mass 02154 N 7. Compound Benzoin Tincture Eli Lilley & Co. Indianapolis; IN 46285 N 8. WD-40 WD- 40 Coinpany San Diego, CA 92110 ~ 9. Lyspl-Basin/Tub/Tile Cleaner Lehn & Frank Products Division os Sterling DrUg Inc. Montvale, NJ 07645 r/,.J 10. Staphene Disinfectant Vestal Laboratories Inc. St. Louis, MO 63110 I\J 11. Schul tz- Instant Liquid Plant Food Schul tz Company St. Louis, MO 63043 e L/5 It . Ie MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MERCY CENTER - ADULT DAY CARE I"J 1. Maid O'Metal Asphaltum Remover and Luster Thinner St. Louis Crafts, Inc. St. Louis, MO 63119 ,0 2. Mod Pdge Gloss-Lustre Plaid Enterprises, Inc. Norcross, Georgia 30091 IV 3. DEFT Vinyl Wood Stain DEFT Alliance Torrance, CA (e dist Builders Emporium Bakersfield, CA ,J 4. Flecto Varathane Liquid Plastic The Flecto Company, Inc. Flecto International, Ltd. Oakland, CA 94604 dist K-Mart Bakersfield, CA \j 5. Symphony Spray Enamel Samson Paint & Chemical Co. & Stacoat Paint Co. Los Angeles, CA 90040 ,¡ 6. Advantage Decorator Cork Adhesive Standard Brands Paint Co. Torrance, CA 90509-2956 ~ 7. . Sears Hot Melt Clear Glue Sticks Sears Roebuck & Co. Chicago, IL 60684 ,j 8. Liquitex Acrylic Binney & Smith Inc. Easton, PA 18042 i~ 9. Clorox Bleach The Clorox Company Oakland, CA 94612 dist Safeway Stores Ming & Ashe, Bakersfie~d 'e 4~ \ e e (e MERCY' CENTER ADULT DAY CARE HAZARDOUS SUBSTANCE' INVENTORY Page 2 ~ 10. Kleen-Tee Cleaner Fiber-Seal International, Inc, Dallas, TX. 75243 rJ 11. Tri-Kleen Solvent Cleaner Fiber-Seal International, Inc. Dallas, TX. 75243 IJ 12. Soilax Spray Cleaner Economica Laboratory Inc. St. Paul, MN 55102 N 13. 3M Stainless Steel Polish & Cleaner 3M Building Service & Cleaning Products St. Paul MN 55101 ,:e ~ 14. Behold Furniture Polish Drackett Products Co. Cincinnati, OH 45232 \0 15. Endust Dusting & Cleaning Spray Dracket Products Co. Cincinnati, OH 45232-1988 \~ 16. Comet Cleaner Proctor & Gamble Cincinnati, OH 45202 I.) 17. Wet Clay and Ceramic Glaze Materials Westwood Ceramic Supply Co. Industry, CA 91746 "e Lq e - (- MERCY HOSPITAL SECURITY/SAFETY DEPARTMENf HAZARDOUS SUBSTANCE INVENTORY ~ ~æILDREN'S PROGRAM \J 1. C1orox Bleach C1orox Co. Oakland, CA 94612 I-J 2. Twin Sol Brent Chemicals Corp. 95 Commerce Road Stamford, cr 06904 ,.) 3. Soilax - Spray Cleaner Economics Laboratory Inc. St. Paul, MN 55102 J 4. Soi1ax - All Purpose Cleaner Economics Laboratory Inc. (- St. Paul, MN 55192 ,j 5. Scour Pow'r Liquid c1enaser National Sanitary Supply Co. 13217 Figueroa St. Los Angeles, CA 90061 tJ 6. Mïcrotec - Glass & Plastic Cleaner National Sanitary Supply 13217 Figueroa St Los Angeles, CA 90061 rJ 7. Mint & Powder mist (air deoderizer) National Sanitary Supply 13217 Figueroa Los Angeles, CA 90061 y8. Regulate (detergent Bleach) Fabri1ite Chern, Inc. Cincinnati, OH 45243 IV9. Lyso1 Disinfectant Lehn & Fink Products Montva1e, NJ 07654 ",e It-8 e e ie MERCY HOSPITAL SECURITI /SAFETI DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY KITCHEN-MERCY CENTER tJ 1. C10rox Bleach Clorox Company, Oakland, California 94612 y 2. Lime Away Corporate Park Drive White Plains, New York, NY 10602 Economics Laboratory, INC. Mercy Hospital yo 3. 'Stain1ess Steel Polish Continental (_ Chicago, IL 60606 ,J 4. Soi1ax All Purpose Cleaner General Offices St. Paul, MN, 55102 E1 Economics Laboratory, INC. 16360 Rasco Blvd #109 Van Nuys, CA 91406 ~ 5. Sterno Choice Products 1401 W. Lomita Blvd Harbor City, CA 90710 CFS-Continenta1 2300 East 57th Street Los Angeles, CA 90058 Y 6. Solid Powder Economics Laboratory St. Paul, MN 35102 Mercy Hospital, INC. 'I 7. Jet-Dry e Economics Laboratory, INC. St. Paul, MN 55102 . Mercy Hospital 1.../..'1 e e le MERCY CENTER-KITCHEN Page 2 y 8. Soil Master Economics Laboratory, INC. St. Paul, MN 55102 Mercy Hospital Y 9. Solitaire EIConoamics Laboratory St. Paul, MN 55102 ,J 10. Scour Pow'r National Sanitary Supply 13217 S. Figueroa P.O. Box 61126 Los Angeles, CA 90061 Mercy Hospital (- /tt 6'0 e e (- MERCY HOSPITAL SECÙRITY /SAFETY DEPARTMENT HAZAROOUS SUBSTANCE INVENtORY MERCY RICHARDS ŒILD CARE CENTER \V 1. Aj ax Cleanser Colgate-Palmolive New York, NY 10022 ,J 2. Cascade Dishwasher Detergent Proctor & Gamble Cincinnati, OH 45202 (e rJ 3. Sun Colash Rochester Midlant P.O. Box 1515 Rochester, NY 14603 ,J 4. Schultz Plant Food Schultz Company St. Louis, MD 63043 ,J 5. Purge III Insect Killer Cline Bockner Cerritos, CA 90701 ~ 6. Bleach-Liquid Clorox Oakland, CA 94612 ,J 7. Laundry Soap Huish Chemical Salt Lake City, Utah 84125 J 8. Cleaner Housekeeping ,J 9. Liquid Starch-Vano Purex Corporation Lakewood, CA 90712 rJ µ 10. White Outl..J,rcl~ ~~ p~(.¡c(. Liquid Paper Corporation P.O. Box 61 Boxton, MA 02199 J-- .e SI e e Ie MERCY RICHARDS mILD CARE CENTER HAZARDOUS SUBSTANCE INVENfORY Page 2 1~ 11. Powder Tempera Paint ' Lakeshore 2695 E. Dominique P.O, Box 6261 Carson CA 90749 III 12. Soap Liquid and Air Freshner Housekeeping !~e . S.2... e e (. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY MERCY SERVICES MERCY SERVICES CORPORATION DOES NOT STORE ANY HAZARDOUS SUBSTANCES. (e ,~ .~. '53 (e rltil. ,fA, '. ,'- .W' e e MERCY HÓSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY J NURSING ADMINISTRATION & STAFFING Liquid Paper Correction Fluid Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 '5'-1 e e te MERCY HOSPITAL SECURITY/SAFETY DEPAR1MENT HAZARDOUS SUBSTANCE INVENTORY OCCUPATIONAL THERAPY IJ 1. Elmers Glue Borden Borden Inc. Columbus, Ohio 43215 J 2. Tacky Glue Atis Inc./Aleene Salvang, CA 93463 ,J 3. Vaseline Intensive Care Cheesebrough Ponds Greenwich, Conn 06830 "J 4. Therapy Putty Fred Sammons, Inc. '.'- e -<" ~- ~-:; e e ~ MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY OR THO DEPARTMENT 1. Fiberglass Scoth Cast 3M St. Paul, MN 55144-1000 /-,. \. 2. Plaster Johnston & Johnston New Brunswick, NJ 08903 ,.-I 3. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 .-14. Expo Dry Erase Marker Sanford Corp. Bellwood, It 60104 5. Aerozoin Aeroceuticals Health Care Products Southport CT 06490 ce jt;. (e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY OUT-PATIENT/EMERGENCY ~1. Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 2. Thinner Liquid Paper Corporation D~llas, TX 75243 r--I 3. Silicone Oil Ricoh Comp LTD Tokyo, Japan Sierra Copy Systems Sanfords Roll-On Stamp pad ìnker Sanford Corporation Bellwood, IL 60104 c. r--I 4. r-I5. ~6. ---v 7. Ricoh FT Toner Ricoh Comp Ltd. Sierra Copy Systems Bakersfield, CA Xerox Formula A Cleaner 43P48 Howard & Bowen Corp. Sanfords Solvene Sanford Corp. Be11wood, IL 60104 ~8. Major Accent Marker Sanford Corp Be11wood IL 60104 e ,:: 7 e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PATIENT TRANSPORTATION NO PRODUCTS USED IN PATIENT TRANSPORTATION DEPT. (e Ie é. e e (e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PEDIATRICS IV 1. Ethyl Oùoride Gebauer N 2. Collodion Flexible LabGuard ,..... tJ 3. Iodine Whi teworth Whiteworth, Inc. Gardena, CA 90248 ::. ,.., tV 4. Compotmd Benzoin Tincture Whiteworth Whiteworth, Inc. Gardena, CA 90248 ") 5. Aeroplast Dressing Parke Davis & Company Detroit, Michigan \V 6. Zephiran Oùoride Mercy Pha11llacy .../ 7. Tincture of Iodine Mercy Pha11llacy rJ 8. Tincture of Zephiran Chloride Mercy Phannacy ,e / e e ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PERSONNEL DEPARTMENT r-/ r/l. Toner for Ricoh FT 3050 Sierra Copy Systems Bakersfield, CA r'~. Liquid Paper P.O. Box 61 Boston, MA 02199 . _yt)3. Silicon Oil for Ricoh FT 3050 Sierra Copy Systems Bakersfield, CA (e (e .'(.1 ,- e e e ~ e 7hazard 3/87 --- ...-'~... ~~::-:--::- ~ e PHARMACY HAZARDOUS SUBSTANCES LIST acetic acid, glacial borate,sodium camph,:,r ethyl alcoh,::tl hydrochloric acid hydroºe~ peroxide iodide, sodium granules iodirle sc,lutic,rl ic,dirre t irlct1..l1·~e Mercurochrome powder ph enc. 1 pr.:,py ~ erle g 1 ycc,l silv~r nitrate crystals zi~c oxide powder :0:;, .....~ " ANTINEOPLASTIC MEDICATIONS Y asparagi~ase(Elspar) bleomyci~ sulfate(Ble~oxane) v busulfa~(Mylera~) carmustine (BiCNU) ~ chlorambucil(Leuker~ cisplati~(Plati~ol) cyclophosphamide (Cytoxan)/ cytarabi~e(Cytosar-U) dacarbazi~e(DTIC-Dome) dactinomyci~(Cosmegen) dau~orubicin hcl(Cerubidine) doxorubicin(Adriamycin) etopc1side (VePesid) /' floxuri~ine(FUDR) f 1 uórc'1..l1·~ac i 1 hydroxyurea (Hydrea) lomusti~e(CeeNU)~ mechlorethamine hcl (Mustargen) mephala~(Alkera~) mercaptopurine(Puri~ethol) methc,trexate ý'- / mitomyci~(Mutamycin) mitotane(Lysodren) ~ plicamycin(Mithracin) procarbazine hcl(Matulane) thioguanine thicltepa virlblast ine viY"lcrist irre sUlfate(Velban)~ sul~ate(Oncovin) -- Spectrum Chemical McKess'::tn ./ Úpectrum Pat~ke Dav i s Ma 11 i rlkt~,:,dt 0/ ./ Mall irlkt~I:ldt Humco v v / MSD Bristol-Meyers Oncology Burroughs-Wellcome Bri stcll Burroughs Bt~istc,l Bristol UPJohn Miles Laboratories MSD Wyeth Laboratories Adria Laboratories. Bristol Roche - Roche Squibb Brist,:,l MSD Burroughs Burroughs Lederle Laboratot~ies Bristol Bristol Miles Laboratories Roche Burroughs ,Lederle Lilly Lilly (" .. .., , .. ,. it__ .~ (, ~:. .1 ~I Þ/:" 'I . ~ .,,~, ~~ .' , f ! r [ ~ ~ t ;: ,- - .. r: "~" ¡ . .'" e Bristol-Meyers-Oncology Division e ==E~~;~ïü¡~=ñV==~lz~========== Hoffman LaRoche Laboratories -------------------------------- -------------------------------- Burroughs-Wellcome Company _~30_~Y-o~~Ui~__~~_________ _.&~(M"~:r::r:¡'~.lLt-f-.N.l!L-.;):n.fl..q- Mercl< S~rpe arid D':lhme Labc.ratories -~qaq___~~~~--~~ðÕ-------- _.k22-¥th_¡-'M_____ qO______ UpJclhn compa~ __g~D_~~_i+J____~-ß..œ~-:------ __~~tI~_þ.~----~~3j[------ Miles Laboratories ___~ª_~t~_fo~_______________ __ ~l!:iL lfMl!1.f _ _C--r.___f)j¡¿tqLfJl______ Adria Laboratories ___P~·_ß~K_J~q_______________ __~l~~r-ClL---~~~-------- / e Wyeth Laboratories _ýS~O_lU~~~M~_______________ -f¡/J.UJJ1...-P~IL.";'r..ß./L _g~¡,.aJL_________ , - E.R. Squibb and Sons ' -~q~~~-~1Ã~--n--------------- . .,-:-t::tJ.J1IirAd.dJ_¡-I.J:l__ï...t¿k.=?9._________:..._ _r<. -. . Lederle Laboratories _~ß~_~~_~g~_________________ _~~~~_~___q~~2L_________ ,~~.. .. Eli Lilly and Company _iL'I:f¿_g:..JrI_C_&r.~_~.:.___________ _"It:td.i4kltJ.{)~~-I_tIL__.!JÆ./¡zf.S:_____ Spectrum Chemical Company ---f9!z-4:J~--~~-~-.P.:Øl"-º-~.------ ---~d~-r~ß--q~~~-------- McKesson Drug Company-Chemical Division -------------------------------- -------------------------------- e HUMCO Laboratories __LfLº-~_P2bitt!I1~-ß.-t(...-Ælt.-12(4J.!}V ~?'50 __Ta.4CJ~_-¡-;--::r...x._.:.LI2~/L1/:..--:...~~- -" , .. . ~ . - ..~ - ..." - t2c~(., 'Jr........· \~if X:: """.>: I i - b J V t4- /4DCf(Ytlù1 ~ IVa+lØtJ 1 N·J. 07ltO ,; r ~ ¡; I I ~ ~- f m ~ JL!'5~ 'lA.hs PO ØðK d-d-ÎÎ Du.hlJÅv)ea,. Qq.5lofp '. . . -.. . ~ e e e . ,', .,..--.-,' I , - e Mallinckrodt Chemical Works _~1Q_~~Qna~ll__~W~___PQ_ßç!_~~ __~~_~~_~JîUl__~21~~_________ ~ 'i~ ',\ ~ I / , e e (. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PHYSICAL MEDICINE r_ --J y 1. Rubbing Alcohol Whi teworth Whiteworth, Inc. Gardena, CA 90248 loJ 2. Glass Plus . Texize Greenville, SC 29602 II) 3. Foam Cleaner for Hospital Use Aeroceuticals Aeroceuticals Health Care Southport, cr 06490 N 4. Hibiclens Stuart Pharmaceuticals Stuart Pharmaceuticals Division of ICI Americas, Inc. Wilmington, DE 19897 ,.,) 5. Dl tra Sound Lotion Birtcher Corporation Birtcher Corporation El Monte, CA 91731 tV 6. Skin Prep United Division of Howmedica Inc. Largo, Florida 33540 IV 7. Nail Polish Remover Professional Disposables Inc. Orangeburg, NY 10962 N 8. Spectra Electrode Gel Parker Laboratories Parker Laboratories Inc. Orange NJ 07056 1,_ \ lV 9. Adherent Ace Beckton Dickinson Company 1912 E. Randal Mill Rd. Arlington, TX 76011 dist Professional Specialties 1919 E. Randal Mill Road Arlington, TX 76011 t" I :/ ." - (e PHYSICAL MEDICINE HAZARDOUS SUBSTANCE INVENTORY Page ? ,... t..¡ 10. Liquid Paper Liquid Paper Corporation Box 61 Boì(ton, MA. 02199 \J 11. Ethyl Chloride Gebauer Phannaceuticals Gebauer Chemical Company Cleveland, Ohio 44104 ....,¡J 12. Staphene- Dis infect ant Vestal Laboratories Chemed Corporation St. Louis, MO 63110 N 13. Neosporin Ointment Burroughs We 11 come Co. Research Triangle Park, NC 27709 . ,..¡ 14. Betadine Whirlpool Concentrate Purdue Frederick Company Norwalk, Conn. 06856 rJ 15. Soft Scrub Clark Company Oakland, CA 94612 ,J 16. Ultra Sound Gel Burdick Corporation Mï1ton, Wisconsin 53583 N 17. Toshiba Toner Toshiba dist.Sierra Copy Systems 705 New Horizon Suite 1 Bakersfield, CA 93313 J 18. Betadine Surgical . Scrub Purdue Frederick Co. Purdue Frederick Co. Norwalk, Conn. 06856 Ñ 19. Cidex Plus Johnson & Johnson Arlington, Texas 76010 Ie 62.. ) - e (e PHYSICAL MEDICINE HAZAROOUS SUBSTANCE INVENTORY Page 3 J 20. Virix S.C. Johnson & Son S.C. Johnson Racine, Wisconsin 53403 ~ 21. Mïnera1 Oil ce ,.) 22. Satin Cleaner National Sanitary Supply 13217 Figueroa P .0.- Box 61126 Los Angeles, CA 90061 IV 23. Detergent Lubricating Oil A. W. Chesterton o. Stoneham, Mass 02180 rJ 24. Envy Gennacidal Cleaner Johnson & Johnson S. C. Jolmson & Son Racine, Wisconsin 53403 N 25. Sun Gloh Polish Rochester Midland P.O. Box 1515 Rochester, NY 14603 N 26. True Blue Glass Cleaner -.J N 27. Septi-Soft Solution Vestal Laboratories Vestal Laboratories St. Louis, MO 63110 ....¡ rJ 28. Septisal Solution (hexachloraphene) Vestal Laboratories St. Louis MO 63110 ,j 29. Bleach C10rox C10rox Corporation P.o. Box 24305 Oakland, CA 94623 re ,J 30. Action 2 Detergent Cleaner (:>3 e I " e ~ (e PHYSICAL TIiERAPY HAZAROOUS SUBSTANCE INVENTORY Page 4 ~ 31. Comet Cleaner Proctor & Gamble Cincinnati, OH 45202 iJ 32. Zepherime Chloride Winsthrop Laboratories 1\133. Olive Oil Purepac Corporation Elizabeth, NY tV 34. Castile Soap Ipco Hospital Supply Piscataway, NY 08854 IV 35. Aspirin Mediqu Products Skokie, IL 60076 0,) 36. Merthiolate (_ Eli Lilly & Co. Indianapolis, IN 46285 IV 37. Efadine Ointment E. Taugera & Co. Melville, NY 11747 '-iN 38. Hydrogen Peroxide .:T. T ß4,,(ð'e eJ.lc-hllrll¡, J c..o Whiteworth Inc. Gardena, CA 90284 "2.2...1- '<t>d ScAcol ¿.~, e, '7.) . I rv ) ~ I I I ¡:; ~ h u~1 ,," ~ 39. Stomahesive I ,'"", Squibb 08865 E. R. Squibb & Sons Princeton, NJ 08540 IJ 40. Keri Lotion Westwood Pharmaceuticals Buffalo, NY 14213 1\1 41. Silver Nitrate Arzal Chemical Co. North Haver hill, NH 0377 4 ,., 42. Iodized Salt (- CFS Continental Chicago, IL 60605 6~ e - (e PHYSICAL MEDICINE HAZAROOUS SUBSTANCE INVENTORY Page 5 N 43. Sodium Chloride TravenalLaboraties oJ 44. Vaseline Intensive Care Lotion Cheesebrough Ponds Greenich, CN 06830 ,J 45. Lipal Spray disinfectant Lehn & Link Products Division of Sterling Drug Montvale, NJ 07645 :e ,e (;;,s e e . MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PLANNING & MARKETING OFFICE IV 1. Toner ~ tV 2. , Liquid Paper P.O. box 61 Boston, MA 02199 N3. Inked stamp pads Mercy Purchasing ~4. Liquid or felt tipped marking pens Mercy Purchasing . '. (.,6 c. r-Il. --., 2 . ---J 3 . v 4. ---l 5 . (e ~6. --.; 7 . (e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY PRINT SHOP Lens and Mirror Cleaner HB-X2 Xerox Corporation Rochester NY 14644 Platen Belt Lubrication Xerox Corporation Formula A Cleaner Xerox Corporation Fuser Agent Xerox Corporation Photoreceptor Pumice Xerox Corporation Deve1oper/9900 Xerox Corporation Dry Ink/9900 Xerox Corporation 8. High Strength Padding Adhesive NCR Appleton Paper Inc. General Offices Appleton Wisconsin 54912 9. R-41 A.B. Dick 1200 18th Street Bakersfield, CA 93302 10. Copier Dispersant 92-2285 A.B. .Dick 1200 18th Street Bakersfield, CA 93302 11. Toner Solution 4-3792 A.B. Dick 1200 18th Street Bakersfield, CA 93302 12. Offset Etch 4-1015 A.B. Dick 1200 18th Street Bakersfield, CA 93302 (,7 e e ce HAZARDOUS SUBSTANCE INVENTORY PRINT SHOP Page 2 13. Precision Oil 191511 A.B. Dick 1200 18th Street Bakersfield, CA 93302 14. Glaze Remover 4-4968 A.B. Dick 1200 18th Street Bakersfield, CA 93302 15. Roller Conditioner 4-4976 A.B. Dick 1200 18th Street Bakersfield, CA 93302 16. Chrome Cylinder CLeaner 4-4965 A.B. Dick 1200 18th Street Bakersfield, CA 93302 ce 17. Electrostatic Conversion Solution 4-1067-1 A.B. Dick 1200 18th Street Bakersfield, CA 93302 18. Fountain Concentrate 4-1115 A.B. Dick 1200 18th Street Bakersfield, CA 93302 19. Hand Cleaner 4-4939 A.B. Dick 1200 18th Street Bakersfield, CA 93302 20. Automatic Blanket Cleaner Solution 4-1235 A.B. Dick 1200 18th Street Bakersfield, CA 93302 21. Roller Cleaner & Blanket Wash 4-4315 A.B. Dick 1200 18th Street Bakersfield, CA 93302 (e 22. Tri-F1ow Tri-F1ow Division Richardson - Vicks Inc. Memphis TN 38117 68 e (- ,. HAZARDOUS SUBSTANCE INVENTORY PRINT SHOP PAGE 3 23. Tri-Flow Tri-Flow Division Richardson-Vicks Inc. Memphis, TN 38117 24. Foaming Cleaner Certified Laboratories P.O. Box 2493 Ft. Worth, TX 76113-2493 25. Offset Ink 3-2020C A.B. Dick. 1200 18th Street Bakersfield, CA 93302 26. Van Sant Ink Fitzgerald G. Street Bakersfield, CA 93302 ce 27. Z. Starter Commungraphics 16440 Manning Way Cerritos, CA 90709 28. Z-Finisher Commugraphic 26440 Manning Way Cerritos, CA 90701 (e GC( e e e ce MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY ,. PURCHASING DEPARTMENT 1. Aluminum Acetate 2. Acetic Acid, Glacial 3. Propylene Glycol (~ '.. (e 70 e e ;e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY QUALITY ASSURANCE/RISK MANAGEMENT NO HAZARDOUS SUBSTANCES IDENTIFIED IN QA/RM. 'ie- :e 71 · yl. (. (e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY RADIOLOGY Autex Chemical Allied Chemicals Universal Radiographies Bakersfield, CA 7~ '" e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY RESPIRATORY THERAPY yl. Sonacide Ayerst Laboratories New York, NY 10017 tV 2. Alcohol Mercy Central Service rJ 3. Dawn Detergent Mercy Central rJ'V 4. Whi te Out ( .þ ~ f¡u..¡J ~(..~ ç:~,~¿) Liquid Paper P.O. Box 16 Boston, MA 02199 ,e "- 73 e e . MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY SKILLED NURSING FACILITY -JAil. Liquid Paper P.O. Box 61 Boston, MA 02199 y2. Alcohol - 70% Mercy Central ¡- (e ì if e e e MERCY HOSPITAL SEQJRI1Y /SAFE1Y DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY e :e SOCIAL SERVICES ~,J 1. Liquid Paper (Correction Fluid) Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 ,.; 2. Photo-copy Correction Fluid Boise-Cascade Corp. P.O. Box 92735 Chicago, IL 60676 N 3. Correction Fluid Thinner Boise Cascade Corp. P.O. BOX 92735 Chicago, IL 60676 . ~ ,oJ 4. Staphine Disinfectant Spray and Air Sanitizer Vestal Laboratories Division of Chemed Corp. St. Louis, MO· 63110 '/s · ,.J~1. iii 2. "'3. ;e ,-..I, ,J 4. /. - e MERCY HOSPITAL SECURITY/SAFETY DEPAR1MENT HAZAROOUS SUBSTANCE INVENTORY SOCIAL SERVICES Liquid Paper Liquid Paper Corporation Box 61 Boston, MA. 02199 Photo-Copy Correction Boise Cascade P.O. Box 92735 Chicago, IL 60675 Correction Fluid Thinner Boise Casecade P.O. Box 92735 Chicago, IL 60675 Staphene Disinfectant Spray and Air Sanitizer Vestal Laboratories St. Louis, MO 63110 7(Þ ce (e 'e e e MERCY HOSPITAL . SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY 'I SPEEŒ & LANGUAGE TIffiRAPY ,...., y 1. Rubbing Alcohol Whiteworth, Inc. Gardina, CA 90248 IV 2. Elmers Glue Borden Borden Inc. Dept DP Columbus, Ohio 43215 J 3. Cepacol Mouth Wash Merrell Day Pharmaceuticals Cincinnati, Ohio 45215 .,,-J,.J 4. Liquid Paper Liquid Paper Corporation Box 61 Boston, MA 02199 r-/ N s. Iodine Whiteworth Whiteworth Inc. Gardena, CA 90248 77 · e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY SURGERY ~l. Cidex Plus Surgikos/T&T Arlington, TX 76010 ~2. Formaldehyde Ricca Chemical Arlington, TX 76012 -.. y3. tV 4. Rubbing Alcohol Whiteworth Inc. Gardena, CA 90248 B.A.K. Medical Chemical Corp. P.O. Box 445 Santa Monica, CA 90404 ~5. Methylmethacrylate' (bone cement) Howmedica Surgical Simplex 359 Veterans Blvd. Rutherford, NJ 07070 ce v 6. Zimmer (bone cement) Warsaw, Ind 46580 rV 7. Liquid Paper Liquid Paper Corp. P.O. Box 61 Boston, MA 02199 ~8. Tincture of Iodine Humco Lars Texarkana, ARK 95501 1\J9. Hibiclens Stuart Pharmacy Wilmington, DE 19897 ~10. Merker-Board Cleaner Weber Costello Chicago, 11 60639 ~11. Tincture of Benzoin Spray Schuco Division ACI Williston Park, NY 11596 (e ì'1f e e . HAZARDOUS SUBSTANCE INVENTORY SURGERY PAGE 2 N12. Skin De-greaser American Pharmaseal Gelndale, CA 912e>9 1\113. Vi-Drape Deseret Medical Park Davis Co. Sandy, UT 84070 1114. Pewthothal Abbott Labs, Chicago, IL 60064 115. Ethrane Ohio Medical Madison, Wise. 53713 ~16. Halothane Ayerst Lab New York, NY 10017 (- 1\117. Forane Awaguest Madison, Wise 53713 Y18. Nitrous Oxide Portable Tanks and wall recepticles Hooper Medical Bakersfield CA (e 79 e e - MERCY HOSPITAL SECURITY/SAFETY DEPAR1MENT HAZARDOUS SUBSTANCE INVENTORY illILIZATION REVIEW tJ 1. Desk & Office Cleaner 3M Commercial Office Supply Division St. Paul, MN 55144 ,J 2. Rubbing Alcòhol Rexa1 Rexa1 Drug Co. St. Louis, MO 63115 c-.l v 3. Just for Copies Liquid Paper P.O. Box 61 Boston MA 02199 ¡- ~ ~ 4. Liquid Paper Liquid Paper P.O. Box 6' Boston, MA 02199 ~ 5. Hi-Liter The Carter's Ink Company Cambridge, MA 02142 {- [(ð e e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY UI'ILIZATION REVIEW IV 1. Desk and Office Cleaner 3M , Conunerce Office Supply Division of 3M St. Paul MN 55144 íe .....4,oJ 2. Correction Fluid Liquid Paper P.O. Box 61 Boxton, MA. 02199 J 3. Elmer's Glue All Borden Inc. Dept. CP Columbus, Ohio 43215 (e &1 · e e MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY 2 - WE S T , I J. ~ cJ¡ Pø..ruv ) ~~n ~ Ink Correction Fluid Liquid Paper Corporation P.o. Box 61 Boston, MA 02199 Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 ~3. Hemoccu1t Developer Smith Kline Diagnostics, Inc. P.O. Box 61947 Sunnyvale,.CA 94086 .-I wI. ~ ,.J2. re 1'14. ~ Y5. IV 6. OW,? v 8. ..-IV9. Merthiolate Lilly & Co. Indianapolis, IN 46285 Rubbing Alcohol - Isopropyl Whiteworth, Inc. Gardena, CA 90248 Betadine Solution Purdue Frederick Co. Norwalk, CT 06856 Compound Benzoine Tincture USP Lilly Co. Indianopolis, IN 46285 C1initest Tablets Mi1es-Amer Division P.O. Box 70 Elkhart, IN 46515 Iodine - Tincture Whiteworth Inc. Gardena, CA 90248 ~lO. PDI Nail Polish Remover Professional Disposables, Inc. Orangeburg, NY 10962 (. ~2- e . HAZARDOUS SUBSTANCE INVENTORY 2-WEST PAGE 2 ~11. Zephian Chloride Winthrop Laboratories New York, NY 10016 ~12. Betadine Surgical Scrub Purdue Frederick Co. Norwalk, CN 06856 . ie f"3 e · " e e , MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZARDOUS SUBSTANCE INVENTORY 3 WEST .-I rv 1.. Liquid Paper Liquid Paper Corporation P.O. Box 61 Boston, MA 02199 Felt Tip Markers Sanford Corporation Bellwood, IL 60104 Zepherin (tincture) Mercy Central Service Betadine Scrub Mercy Cent~al Service Merthiolate (tincture) Mercy Pharmacy Betadine Solution Mercy Central Service tV 13. . Tincture of Benzoin Mercy Pharmacy ---J~2. rv 3. tJ 4. (. \J 5. '" 6. Y 7. ~ 8. \I 9. 1"1 0 . IV11. Ñ12. fA ~., U-H-U Glue Stick Mercy Pur.chasing Septisol Mercy Central Service Comet Cleaner Mercy Central Service Envy Instant Cleaner Mercy Central Service Alcohol - 70% Mercy Central Service Aqueous Zephiran Mercy Central Service &-'1 -- e . HAZARDOUS SUBSTANCE INVENTORY 3 WEST Page 2 \~14. Iodine Mercy Pharmacy Department N15. Ethyl Chloride Mercy Pharmacy Department ·(e "'16. Phisohex Mercy Pharmacy Department tJ 17. Dermoplast Mercy Pharmacy ~ N 18. Staphene Spray Mercy Housekeeping Department ~19. Hydrogen Peroxide Mercy Central Service ~ 20. Dry Marker Remover Solution Mercy Purchasing Department ~- S~ . ~",'~ . '~' . (. MERCY HOSPITAL SECURITY/SAFETY DEPARTMENT HAZAROOUS SUBSTANCE INVENTORY 5 WEST rJ (J 1. CORRECTION FLUID LIQUID PAPER CORP. P.O. BOX 61 BOSTON, MA 02199 ,J 2 . PERI -WASH ~ 3. SEPTO SOFT rJ 4. ALCOHOL C. rJ s. OXYGEN I , .) 6. CLEANING SUPPLIES LOANED BY HOUSEKEEPING t\l GRIMEX ? t-> MALGON ? \..,) CLEANSER ~ ¡-, ..,. ~~ '-' e '7!' ö I~ò Date e BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREVENTION APPLICATION tl.- - 3 ¥- '1 Application No, In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by: '---J¡c<.. YL ['-'Ó~ [2~fA., , Name of Company '7 ~D6 () lc~-tf; 4h-µ: / 1; Address to display, store, install, use, operate, sell or handle materials or processes involving or creating con- ditions deemed hazardous to life or property as follows: /U>n'-fJ'U'¿ (I) 5 6- 0-0 - %.k r. (I) / "'-YJ ' I J -. / Itt.,~.~" ~.P' .2.:)./S ( ) ./ '~ .c-~¿.-f 'r /I"..J ~.. X-Û:r" r;__~~A~_~~~_______ Authorized Representative 0~/V By ..rclf).........Fi;;..¡,¡;;~¡,;;ï...................._.. - -...... 7l1:S' /7/) ......... ......--. .........:":.............. ..... Date .~ ~ JAb ~. , - , , .' ~_..::-..~-¿.- / RANDALL L. ABBOTT Director 'SOURCE MANAGEMENT 'GENCY Envírnnm,>,}{.,1 H".,llh Sl'r\'ln'~ l),·p.ulllh"11I STEVE McCAlLEY. REHS. DlRECfOR Air Pollulion l\mhtll nl~lfld WIll.1AM J. RODIN. AI'('O PI.'nnìn~ & ()"V,ohllH1U'nl S"rvi,',,!'I I )",,,,rlll14'nt TED JAMES, AICI', DIRl-rrOR PERMIT FOR' PERMANENT CLSBURE- OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY ENVIRONMENTAL HEALTIi SERVICES DEPARTMENf Q¿1ì'--6~ A l-- PERMIT NUMBER ~ 1 "'.7 ~ _ 1 '1 ¡ , , ..~--- FACILITY NAMEI ADDRESS: OWNER(S) NAMEI ADDRESS: CONTRACTOR: Mercy Hospital 2215 Truxtun Avenue Bakersfield, CA 93301 Mercy Hospital 2215 Truxtun Avenue Bakersfield, CA 93301 McNabb Construction Co. 7808 ,Olcott Avenue Bakersfield, CA 9330ö Phone: (805) 327-3371 License #474331 Phone: (805) 399-4742 PERMIT FOR CLOSURE OF PERMIT EXPIRES October 18, 1990 l. T ANK(S) AT ABOVE APPROVAL DATE LOCATION APPROVED BY ..... .......................................................................... P OS TON PRE MI S ES................................................................................ CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e" City Fire and Building Departments). 2. Permittee must notifY the Hazardous Materials Management Program at (805) 861-3636 two working days prior to tank removal or abandonment in place to arrange for requircò inspections(s). 3, Tank closure activities must be per Kern County Environmental Health anò Fire Department approved methods as described in Handbook UT-30. 4. It is the contractor's responsibility to know and adhere to all applicable laws regarding the handling, transportation or treatment of hazardo;.:: ~~. ' ' S. The tank removal contractor must have a qualified company employee on site supervising the tank removal. The employee must have tank remon' experience prior to working unsupervised. 6. If any contractors other than those listed on permit and permit application arc to be utilized, prior approval must be granted by the s eci~!i,¡ listed on the permit. Deviation from the submitted application is not allowed. 7. Soil Sampling:· , a. Tank size less than or equal to 1,000 gallons - a minimum of two samples must be retrieved from beneath the center of the tank at depth of approximately lwo feet and six feet. b. Tank,size greater than 1,000 to 10,000 gallons - a minimum of four samples must be retrieved one-third of the way in from the ends 0 each tank at depths of approximately two feet and six (eet. c. Tank size greater than 10,000 gallons - a minimum of six samples must be retrieved one-fourth of lhe way in from the ends of each tan' and beneath the center of each tank at deplhs of approximately two feet amI six fcct. 8, Soil Sampling (piping area): A minimum of two samples must be retrieved at depths of approximately two fect and six feet for every 15 linear feet of pipe run and under III dispenser area. 2700 "M" STREET. SUITE 300 BAKERSFIELD, CALIFORNIA 93301 RECYCLED PAPER (H05) H61-3636 FAX: (805) 861·3429 ., ~; ,~----.. . ~f't\- ð~ Ai.-. t'ERMIT FOR PERMANENT CLOSURE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACll.ITY . PERMIT NUMBER A 1275-17 ADDENDUM 9. Soil Sample analysis: a. All soil samples retrieved Crom beneath gasoline (leaded/unleaded) tanks and appurtenances must be analyzed Cor benzene, toluene, xylene and total pelroleum hydrocarbons (Cor gasoline). b. All soil samples retrieved Crom beneath diesel tanks and appurtenances must be analyzed Cor tolal pelroLeum hydrocarbons (for ":'_: and benzene. c. All soil samples rctrieved from beneath waste oil tanks and appurtenances musl be analyzed for total organic halides, lead, oil and :;~e'-, d. All soil samples retrieved Crom benealh crude oil tanks and appurtenances must be analyzed for oil and grease. e. All soil samples retrieved from beneath tanks and appurtenances that contain unknown substances must be analyzed for a Cull range 0: substances that may have been stored within the tank. 10. The following timetable lists pre- and post-tank removal requirements: ACTIVITY DEADLINE " Complete permit application submitted to Hazardous Materials Management Program At least two weeks prior to closure Notification to inspector listed on permit of date and time of closure and soil sampling Two working days \ Transportation and tracking forms sent to Hazardous Materials Management Program. All hazardous waste manüests must be signed by the receiver oC the hazardous waste No later than 5 working days for transportation and 14 working days for the tracking form after tank removal Sample analysis to Hazardous Materials Management Program No later than 3 working days after completion of analysis 11. PurginglInerting Conditions: a. Liquid shall be pumped from tank prior to purging such that less than 8 gallons of liquid remain in tank. (CSH&SC 41700) b. Tank shall be purged through vent pipe discharging at least 10 feet above ground level. (CSH&SC 41700) c. No emission shall result in odors detectable at or beyond property line. (Rule 419) d. No emission shall endanger the health, safety, comfort or repose of any person. (CSH&SC 41700) e. Vent lines shall remain attached to tank until the inspector arrives to authorize removal. RECOMMENDATIONS/GUIDELINES FOR REMOVAL OF UNDERGROUND STORAGE TANKS 1 This department is responsible for enforcing the Kern County Ordinance Code, Division 8 and state regulations pertaining to underground storage tanks. Representatives from this department respond to job sites during tank removals to ensure that the tanks are safe ìo remove/close and that the overall job performance is consistent with permit requirements, applicable laws and safety standards. The following guidelineS are offered to clarify the interests and expectations for this department. 1. Job site safety is one of our primary concerns. Excavations are inherenlly dangerous. It is the contractor's responsibility to know and abide by CAL-OSHA regulations. The job foreman is responsible for the crew and any subcontractors on the job. As a general rule, workers are nOI permitted in improperly sloped excavations or when unsafe conditions exist in the hole. Tools and equipment are to be used only for their designed function. For example, backhoe buckets are never substituted for ladders. 2. Properly licensed contractors are assumed to understand the requirements of the permit issued. The job foreman is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a sto:?-work order. 3. Individual contractors will be held responsible for their post-removal paperwork. Tracking forms, hazardous waste manifests and anaiys.::i documentation are necessary for each site in order to close a case file or move it into mitigation. When contractors do not follow through on necessary paperwork, an unmanagC3ble backlog of incomplete cases results. If this continues, processing time for completing ncw closures wiil increase. 7L~ö MD:cas \1275-17.ptc 08/05/2003 08:07 FAX 310 312 3646 - .. RBB ARCHITECTS INC Joseph A. Balboni!,. AlA Arthur E. Border. AlA Joel A. Jiffe. AlA Dene)lli Purcell. AlA 10980 Wilshire Boulevard Los Angeles, California 90024-3905 Telephone 3104733555 Facsimile 3103123646 "^,,^,,,.rbblnc.çom RBB ARCHITECTS INC Date: To: Company: Facsimile: Telephone: August5,2003 Dave Welrather Bakersfield Fire Department (661) 852w2172 (661) 326-3979 TomPel~ Copies: John K. Ruffner CHW Jimmie Shetters lOR Robert VonGerichten P/J Purcell, Deneys RBS From: Re: Mercy Hospital, Truxtun 5th Floor Guarding Unit, Increment No.1 RBB # 0212601 08HPD 88-030973-15 Page 1 of 13 IaI 0011013 FACSIMILE (661) 763-1107 (661) 663-6335 (310) 998-8703 Attached documentation Is provided to address items outlined in Bakersfield Fire Department letter dated 6/24/03. Item 1) Fire sprinkler heads in Inmate Bed and Toilet Rooms will be replaced as defined on OSHPD approved Change Order #4. Item 2) Facility complies with California Building Code requirements for a passive smoke control system as summarized on attached Memorandum. M·E Engineers July 29,2003. Operable security screens at windows require a special key to unlock from both inside and outside. Item 3) Fire alarm annunciators have been installed In elevator lobbIes In accordance with BFD approval dated 7/8/03. Item 4) Fire Response and Evacuation Procedures are defined in Department of Corrections letter dated July 11, 2003. Architectural plans will be dissem ¡nated to local engine company for Emergency Operations use. Please call with questions. Thank you- RBB ARCHITECTS INC The infQm'lalion e:ontainad in this facsimile message is confidential Information Intended for the use of the Individual or entity named above. If the l'e8der of this; mKUl9Q is not thQ inœndoo rcdpient. or the employee or agem re$ponsìble to deliver It to the Intended recipient, you are hereby notified that any dissemination. distribution or copying of this oornmunìœtion Î$ $ttictly prohibited. If you have received this communication in error, plea~e immediately notify us by telephone. and retum the orlgln81 message to us at the above address via U.S. Postal Service. Thank you. P:\MHT\0212601\FAX\60505001.doo ~¥'I "~~ 08/05/2003 08:07 FAX 310 312 3646 RBB ARCHITECTS INC ~UH-25-2eø~ lalZ4 AM JUN 24 200S 14,21 I'dII! Off.. RON =~ ~~ .,01 "H' .... IIIIIaIIMIII. CA GSØ1 voce (IIn):llllNM1 FAXt.'1U.1M1 ..,..~ U"VICII lnG' "HI 1111111 .....,eJd, or. 1\JI01 VØIICE .,) ""'1 ~ (G81)-'1IG IMVBltlaNIEI\¥ICØ 11U'o-IBr .... ....... OAtr:Qln WIICI! CItI'....at fNC CDII1) IIIIoIIIN ~ALOI!IWIC&8 '7'18 ClrlIIII'., ........" C4111G1 VOIœ (..,) u.... PAX.."..... ~...-oI _ '4IIIIar_ .....OABNOI IIOIC& <-t).......w 11M (Ntt IIIIIM?III BKSFlD FIRE PRE~ENTJaN net 1882-2172 June 24. 2003 Jinurd. Slmtm Woñ.d CocsWCUon SlMOOI Ie: CH\V 5* Ploof ModlficdOlll TdIUDie, Thank you for t1w oppommity to c:;oDIIDImton this pmjc:sçt undet yout :ra'\IiðW. J bavo four IIIHI cI oonccm: 1. Pite øprinklDt' bøad chAnae- ùould be dOne m chc fint phase=. 2. SIt10Ø contml. 1111.11& be eattbli.Md. for tbBt Soar when lack of adaqUIÛC evaeuatioo jJ posaib1e _ to ICCWity CO~. 3. Pite 5)'1= Anm.mc:ìaUlr in tho lobby af the elevator which provideI terViœ to thBt floor as we11 85 III ~conùttl center on that floor aøcl the: hcspitaI DIàÍII pmcL 'Jbcœ should also be a map of ~ &or poated in lobby to m the alarm notiCe- ùtfotmation. 4. When Jln'ject i. c:ompleled emergeacy OpemIiOOIll plm1s mua be dilseØlÌnøb5d to the fire alUhodcy ao4 lb. fløt In Engine Campam,. þlDøe fet:l he to cøntaot our af8ce with any que,lions. David A. Wcira&hcr Fire Piml ExllllÙnet Qj~kL:~~___ ""~~~~~~~.A~~"t? IaJ 002/013 P.02 p.1 08/05/2003 08:08 FAX 310 312 3646 RBB ARCHITECTS INC I4J 003/013 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGfNCY OFFiCe OF STATEWIDE HEALTH PLANNING'AND, DEVELOPME=: ;,AT FACIUTI!S DEVELOPMENT DIVI$JON 1æ1 9U1 Stroot Sacramanto. CA ~1 +Gna (916) 324-Q090 Fex (916) 324-9145 GRAY DAVIS. Gowmor PLAN REVIEW DATA Deneys Purcell Rochlin, Baran, Balbona Inc. 10980 Wilshire Boulevard Los Angeles, CA 90024 C13720 DATE 7/1512003 OSHPD NO 85030973-15 SUB 0 PAD CO 004 Facility Name: Facility Location: Project Description: Mercy Hospital- Bakersfield~10214 Bakersfield, CA 93301 5TH FLOOR GUARDING UNIT As requested we have reviewed the project listed above to determine confonnance with the standards of the Title 24, California Code of Regulations (C.C.R.). By ropy of this transmittal we are advising you that the items listed above were found to be in accordance with the applicable provisions of Title 24. C.C.R. [ ] We have received one copy of the stamped documents. [ ] Please send a copy of the reproducible documents that we can stamp and return to you. [ ] REVIEWED BY ARCHITECT: STRUCTURAL; MECHANICAL: ELECTRICAL; FLSO: NAME Keith Rishell X James Blodget X Sharon Willíams ...-..--.,......... .- PHONE DATE RESULT (916) 324.9097' '7715hoo~f·" ... "..",' ···Äppi~ovË[r,..."-· (916) 324~9099 7/1512003 APPROVED (916) 32+9086 7/1512003 APPROVED Please contact the appropriate reviewer(s) for any questions that you may have. Than~ K¿:~II Senior A itect Ph. (916) 324-9097 cc: Project File lOR 3ti1/AP Approved Review7 v1 1 01 02 08/0ð/2003 08:08 FAX 310 312 3646 RBB ARCHITECTS INC IaJ 004/013 ~ATF nil' r.^II¡;-C~I\IIA. HFAI TH AN ') HilMA'" SFRVICFS Aé';FNrW OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILmes DEVELOPMENT DIVISION . www.O$hpd.state.ca.usJfdd 16()O ff" Street. Room 4¡O - SOCl'omento. C3Uromla 95814 Phone (916) 654-3362 FAX (!il1S) 654-2973 1831 fi" Street - 5atramen!o, California 95814 Phone (916) 324-9090 FAX (916) 324-9145 (North ."d Cent...' Region) 311 Soutll Spring Slreot. Suite 1001, Lo¡¡ Angele$, CA 90013 Phone (213) 897-0166 FAX (213) 897-0168 Post Approval Documents Name of Facility: Merc HO$ ita!. Bakersfield Address . Street: 2215 Trux\un Avenuet_._____~~_~~_.,.. City: County. B~~fle.I,d..,_._._, Kern Yide 01 Project (45 Characters max.) 51h Floor Guarding Unit· Increment 1 B ~ Change Order COli rM o Instruction Bulletin ' 1811 16 must be confirmed by change o(de( OSHPD t# S~0973·15 .. .,....---... Zip: 93301 Applicant Job #: RBB '# 0212601 o Addendum Office Use Only FACIlITY 1.D. .. 10214 bAY!: AD# o Deferred Item DA# o DÐ8cl'lption/ScopeorChengl!: ~ To;;>' e RBB Bulletin No. 04: Repla~ e)(is~i"~ fire sprin\ller head; in 'm}'a~e f\edrOOm$~h security \yþe heads. He;'d loca\ioos do not change. t::"t.~::lm'~.:j ~e~.Å":t ~\-oL ~êv-.o\~~ ~-e~~.e:, S.4- \C.f-::.~{.()r-: tJ<l'+( ~e~ ~, ~>~,..JõÞo....J.... ~C'v-~~.c... 5.~~. e~é!.~~ Reason for Change: CDC Requiremenl LIsI of Enclosures: Rev\&ed Sheets: None \ Rerorencaattached prOdUCT ctalasheets. ". c-(;> "",-oJe. !f r--f' \-\ t:t.. r -n=~~A...')t ~\ f'"S TfP t14."i: f"~=> , ~\.cO~\o.. ð J I TOIaI conlracl emounl prior to this d1311ge '.............,........ S Amount of this change ......................................................$ CHANGE ORDER ONLY 1 SO 000 By reason of this modification tho contract complot/on dÐté Is changed: 10.000 EJ Add 0 Deduct Revised contfact amount to date ..................................$ 170000 Owner: Paul Luehrö, C . S;gnature: . -", . E Signature: from: No Change TO: Contr9Ctor: 'ÑÖT RËÖUIRIËD fOR Ö~ Signature: S1r\1clUral Engineer (II appllcablo): Signature: Firll'! Name: N/A Addre$S: Slate: Zi : OFRCE USE ONLY Date: Page 1 of2 08/0~/2003 08:08 FAX 310 312 3646 RBB ARCHITECTS INC IaJ OO~/013 MEMO Date: July 29,2003 To: Tom Penon From: Marvin Ng Copy To: Project & No: Mercy Hospital 5th FlooT Guarding Unit, LA03028.00 RE: Passive Smoke Control System This memorandum is written to confinn that the above-referenced project complies with CBC Section 420A. 7 .2: (I) Patient Rooms have operable windows, and (2) the key for opening the windows is retained at the Nurse Station. Per 2001 cae Section 905, the existing passive smoke control system using combination smoke/fire dampers installed in compliance with CBC Section 713 would be acceptable. Please feel rree to contact our office should you have any questions. R:\project\LA03028\oortes\072903smokwonlrulmemo-mn.doo "q'::"~- :',~ ~~t¡jl~~PßW , ,,.,. W5 mæ\.t:~ CA900~~ ~" F'lH~IO) ~~~'·(./£100 f,4.1(: (~IO) ~~!i',':>·4~!.' ~os .'f>Iœ~~S t1f.t-.M~ c:o..oooo ~Na.. VAl~ L(Jl.Vál 08/05/2003 08:09 FAX 310 312 3646 RBB ARCHITECTS INC ~UL U~ ~uu~ ¡U1U~ HK~~Lü ~!~~ PN~V~N'LUN l661J85Z-217Z III 006/013 p.Z JUL-C7-2003 HON i2:02 I'rt SI11PlEXGRIHHELL FAX NO. :.....d 348 1281 P. ot 'tqcø n;:& Set:ur/ly ..",..."..." ~I.P J' 1fHJN.~Awmw.o$IiIlt fO' I ffIIØIIQ. CA 93727 ~ 68tJ.S4S.D814 ~M w.348.1281 WNW~ TfI/IIh»t 'Ð'lInsm/øIøIJ n.~~/~~-vor~~~,lK1ItIfrþør J .-.or. ""~Ì!; œWfIN'lh1_tJf.~f1T~tltM1IBIItIf rI*lI\~ --'lfrOI,¡lICfIlJflMtttrntkifI~Qf.~"'IIpIfII~.rhtti1DMllJd'''''''' re<I $bø(.¡ ,..,.raM/ll1fJt'~ WIu..h/IIflbrlltJlii¡¡rJrhI/l"'~ ~~<I'"'" ....,gf""'Brlrnn.--iMtMamoaof_~~/s~PfJ1Itibi-l Fax Nø. 071a7Jl1J BiIbtI&Id Citt Fuc Dope. Ð.w W)AIMt oJaÄn-.........- (661) 15202113 ünt,1I øø ~ AIIMflM FfMt 0\riIItIIphcr S. Dem\isða Bub,iIId StlJllb ,... S6Ja6 t Aft1r1m1 of AnnulllJiliDd úx:II&WD5 Mmçy Hospiþl) sm fir. 14M1096'~R9 No.. fII~ ~""-J 4 Mr. ~, MadIId Ire tIz aammdBlCd tocadonI iW yo1J~. P1eaac ~w. appov8,8Dd 1&1. back atywr earI~ cánve/lÏåU)O. Itaøy additioullafonDa&loa t; requßd pbIe calL. 'Ibaøk)'OliJ very DmCh fDt )Ult be1p. 08/05/2003 08:09 FAX 310 312 3646 RBB ARCHITECTS INC ~UL uu ~uu~ lU;U~ HK5fLD FIRE PREVENTIoN (861)852-2172 ...... JA o,øø I ~ /. ~J ,..,.--.1/ -- Ii1.EVATOR LOBBY 2ND F1..OOR 1~ MI!RCY HOSPITAl.ðTH FLOOR -;~3 ~ ~dI,NE" 9¡ 1TE "Of MERCY KOSPITAL. -- ... ~ "IDU: ~ œ:m=filt -=~~ ~~ JUL-07-2003 MOO 12:03 t't1 SIMPI.EXGRINNELL FAX NO. ,,~348 1281 lOBBY ~ os ~ ~ 11 I {~~ ~JD J::-~: .. -.... ~~....... .......-......... ...- .. ,..-._....-.....-~- ..... ... . ...... . ... .. .. . at ...... - - ..... .. ........ ,. .... in ..... 'II" - -~= IaJ 007/013 p.3 P. 02 ~.:;~~;;;:;¡:. 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Unauthorized release of personal ond/or eonfldentic:al inforl'l\Cltion is punishable by eMI or criminal penalties, Date: July 241 2003 Numbe,. of pages including cover sheet: 3 TO: FROM: T, PEU..ON Project Architect RBB Architects C.J.CHRONES Operations Captain Wasco Sta1'e Prison-Reception Center Phone (310) 473·3555 Fox Phone (310) 312..3646 Phone Føc Phone (661) 758..8400 ext. 6000 (661) 758-7049 REMARKS: Urgent X For your re.view Reply ASAP Please Comment Memo regarding "'Fire Response and Evacuation Procedures· at Mercy Hospital 5Th floor Medical Guarding Unit. If you did not receive the complete flU( or if you have any questions. please contact Jessica Albiar at (661) 758-8400. extension 6004. 08103/2003 08:10 FAX 310 312 3646 RBB ARCHITECTS INC . JlL-24-2Øæ 11!';H!52 WASCO STATE PRISON ~011/013 P.1?J2 ""',.~ ......,."',""""".v-....,., II1II....... 'U """V""'IU .a.VIIUI "'... .law.... UUlt'-""tiYl.' "~"¡'IU" iLQU...... r ....UI.. If" DEPARTMENT OF CORRECTIONS WASCO STATE PRISON - RECEYI10N CENTER P.O. BOX l1li00 WASCO. CALIfORNIA 93Z80-88OQ (661) 758·8400 Date: July 11, 2003 To: TOM PELLON Project Architect RBB Architects &1Jbj1act: FIRE RESPONSE AND EVACUATION PROCEDURES ;~..'\ !- ~ ,I ,._',\ 0:". .~ '.." . This letter is being forwarded to your firm as requested. The Mercy Hospital 5111 Floor Medical Guanting Unit (MGU) will. be operated by COIrectiona1 Bmployees from Wasco State Prison.-Reoeption. Center (WSP-RC). This unit wiD be staffed 24-hours a day, seven-days a week. This unit will be operated pursuant to the Califoroia Department of Corrections (CDC) California Code of Regulations (CCR) , the Departmental Operations Manual (DOM), and the WSP-RC Operational Procedure (OP) #WSP-098. The following information was extracted :ftom the WSP-RC Operational Procedure.. which governs the operation of the MGU. This infonnation was cxtractcd from Section L, titled Emergenoi~sasters; and Section M, titled Emergency Evacuation. 4. Fire Respo!Ule . ;',, a. In the event of a the) hospital custody staff will activate the Fire Alarm System by nsins the manual pull station lo~ated throughout the corridors. b. The alanns can also be activated by smoke or heat detectors and by sprlDkler aotivation. c. Custody staff w1ll dial "7" and adVÍ$e !be PBX operator of the exact location of the fire. d Instruct staff, visitors~ and inmates to stay in rooms off the conidor until an Hall ~lear'" messa¡e is announced. unless directed otherwise by the person in c:harge. e. The Hospital ¡\dminjRtrative Coordinator or designee makes the decision for evacuation. The switchboard will be instructed to announce if ass:istance ia needed for evacuation. ~ ~ 08/05/2003 08:11 FAX 310 312 3646 RBB ARCHITECTS INC . JlL-24-20Ø3 09:53 WASOJ STATE PRISCt-I 141 012/013 P.B3 Fil'e RespoDSe and Emergency Evac:aatiou Procedures Pal~e 2 ' f. When the Fire Department anives. they take command of the fire scene. g. Wet blankets C8t1 be used to minimize smoke from coming under the doors. Wet towels can be used to breathe through to mfnimize smoke ÌJ:Iha1ation. h. Do not use elevators duri:D.g a tire unless directed by the Fire Department. i. Do not tom off oxygen outside of the :fire area wÙess În$b;ucted to do so by the Fire Department. j. To avoid poisonous gasses and smoke, crawl along the floor. k. All tires must be reported regardless of size. J. Know locations of fire extinguishers, fire pull stations, evacuation routes, and oxygen shut off controls. m. Evacuation maps are in strategic conidor locations on the :floor. M. EMBRGBNCY BV ACUATION IT an emergency or natural disaster occurs at Mercy Hospital and the emergency does not threaten the MOO. the imnates will remain in their assigned rooms. If it becomes unsafe to occupy the MOU. the inmates will be moved to a safe location on the fifth floOt'. Tn the event there are no safe locations on the fifth floor to temporarily house the inmates, the inmates will be moved to a safe location wít1ún the hospital. If there are no safe llXòations within the hospital, the inmates will be moved outside to a safe are:L The primary evacuation loea.tion ia the CDC Outpatient Services Clinic (corner of 1611\ Str:eet and "An Street). If the primary location is unavailable, the seconda!y location is the parking lot south of 1hs hospita11ocated next (west) to the Mercy Meðiœ1 Plaza at 2323 Itf' Street. If determined that the inmates arc to be moved from the MOU to a location outside the hospital, there are three evacuation routes_ The primary evacuation route should be used unless this route is blocked and/or would endanger the safety of staff and inmates. · The stairwell at the Southwest end of the MGU (outside the MGU sallyport eQtrance) will be used as the primaIy evacuation route. · The secondary route is the Northwest staì'rW'eIl (adjacent to room 5511). this stairwell is secured from the inside and requiœs an MOO Officer to unlock the door and supervise the evacuation. 08/05/2003 08:11 FAX 310 312 3646 RBB ARCHITECTS INC - JLL -24-2003 eg: 53 WRSaJ STRTE PR I SON raJ 013/013 P.Ø4 .-' Fire Response and ~cy Evacuadou ProccdQRJ Pane 3 . The third evacuation route is located outside the MGU Eas.t door. This emergency exít door i5 secured from the inside and requires an MGU Officer to unlock the door and supervise the evacuation. Contact will be made to the Bakersfield Police Department at (661) :327-7111) or telephone 911; and to the WSP-RC Watch Commander at (661) 758-7027. 'rb£ Control Room Officer is responsible to ens\ttC the seourity of the MGU. the safety of staff and inmAtes, and the security of the weapons and equipment within hïslher contro1. If the MGU is evacuated. the MGU Sergeant is to be issued the in:ø.er saUyport door key and the key to the appropriate emergency exit door used. during the evacuation; the Control R. oom 0 fficer will retain the key(s) to the C0ntr01 Room; and the Search and Escort Officer (S&B) #1 is. to be issued the outer sallyport door key. The MOO Sergeant, and Control Room Officer, and the S&E #1 will be armed. Should YOUf ñtm or the Pire Marshal ha.ve questions regarding this information, please contact me at (661) 758-8400j extension 6000. . ~qJ~NES -~ Operations Captain Wasco State Prison-Reception Center TorR.. P.12I4