HomeMy WebLinkAboutBUSINESS PLAN
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd I-loor, Bakersfield, CA 93301
10225'D
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FACILITY NAME :be¿ 1\.1~ A- ~1~5UJ bfloto
ADDRESS 2~'30 ï1WX"fU1\J M UllFlt .ß
FACILITY CONTACT ~s GNU-¡"
INSPECTION TIME
INSPECTION DATE I (/~/ol
PHONE NO. TZ;' ~ ~~
BUSINESS ID NO. 15-210- ¡V6.J
NUMBER OF EMPLOYEES 3
Section I:
Business Plan and Inventory Program
o Routine
GtCombined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERA TION C V COMMENTS
Appropriate pennit on hand ¡Vc;t-J pc.-'Z.ItA¡ -r ARPl1c.Aèrí¿"/
Business plan contact infonnation accurate
Vi5:ible address
Correct occupancy
Veri fication of inventory materials ~TC- f=¡ )C ec-..
Verification of quantities 12 GAL- W1t 4: ~ An-t
Verification of location II'I;;'ID£ ?~,J';;;' R""
Proper segregation of material
V erification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Em;:rgency procedures adequate
Containers properly labeled ?t.C4-sE USE c:A$C-"t..> f'/l.èJ,D60
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance
V=Violation
Any hazardous waste on site?: ø Yes 0 No
Explajn:~'1lk-5Tt F I'X GR.-
White· Env, Svcs.
Yellow· Station Copy
Pink - Business Copy
~~
Business Site Responsible P;ty /
Inspector: vJ t I\.fES /
Questions regarding this inspection? Please call us at (661) 326-3979
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME ù!L. (2.ta.øa.o~
INSPECTION DATE
It!?..h!ð/
Section 4:
Hazardous Waste Generator Program
EP A ID #
o Routine ~ Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made
EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #)
Authorized for waste treatment and/or storage
Reported release, fire, or explosion within 15 days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames
Containers in good condition and not leaking
Containers are compatible with the hazardous waste
Containers are kept closed when not in use
Weekly inspection of storage area
Ignitable/reactive waste located at least 50 feet from property line
Secondary containment provided ¡/ ?LC...o.s~ ~ wJ..., ~~«
Conducts daily inspection of tanks
Used oil not contaminated with other hazardous waste
Proper management of lead acid batteries including labels
Proper management of used oil filters
Transports hazardous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazardous waste analysis for 3 years
Retains copies of used oil receipts for 3 years
Determines if waste is restricted from land disposal
C=Compliance
V=Violation
Inspec:tor:
Office: of Environmental Se¡vices (661) 326-3979
White - Env. Svcs.
w (,..¡ES
'-~.~
~~ AO
Business Site Responsible Party
Pink - Business Copy
e
e
Dr. Mark A. Richardson
(661) 323-2003
(661) 328-0253 Fax
Family Dentistry
1M] Therapy
~, - 2:330 Truxtun Avenue, Suite B
(Across from Mercy Hospital)
Bakersfield, CA 93301
I CITY OF BAKERSFIEa
o ICE OF ENVIRONMENTAL ~RVICES
1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
~W
D REVISE
200
DADD
D DELETE
---_.~-----_._-----_.__.__.__.,---, .--_. -- "--->--- --.-.---.-- ...--.------.-...
, '~ ;,
. :~ ::* .t·~~/,f<·~i'~~·:·':h~',. '~
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAMËorDBA: Doing BusiiïëSsÃs)--'--- -
~l... tV\, A/lK. A ._ ___ ß~_~ ~~~c)J"L _ , _ _______ ___ __ _ _ ,
(one form per material per bui'ding or area)
Page of
:":?':'-':1'-
"
.------.. ---
3
.... ...... no .__... . ...' '.'.'........__.__.__
. -..C.HEMICAL LOCATION (N '> t Or:: P(Wc..t:~~ t<f\lO ~"""1 2011 g~~~llg:~~~E~~~~) 0 Yes 0 No 202 ,
FACILITY ID~rrl---T---:-;--IMAP#TõPi1Öñãi)------ - -- --- - ------ - ---"203 --iG-RíÔ II (op'tlonal)-- - 204
I CH""":~~=! :' .. .._L~---"~C~~';~~"~~~=~~-~ i ,,,",:0:; 0 'œ 0" '"
A,<;. 1"l2- ¡:::., ')( et- i If Subject to EPCRA, refer to instructions
,
".-- --~--~-~. -- ·----Žëf7-·-t----
i EHS'
I
------.. ---,----.--------
COMMON NII.ME
..---...,,- -.------------,
DYes 0 No 208
.:·t.~\ ,,:. ,,-,--,.::... ,: "> ~
209 ·If EHS:1,í2Y~'~ á118IIlO1I1I1!~lIelow,must be in,ibs.
.,,',\'-:;.1;';,';.;".::'" .<">~~-...:~> '
CAS #
FIRE CODE HAZARD CLASSES (CompletêTiëquestedbŸ 1õêa1 fire chTêi)---------'---'------------------ ,---- ---,------
TYPE
o -;-;~-----ö-;;;__;~~-~:- WAS~-- - -~-,
R;,DIOACTIVE
DYes oNo
,..-------,--------.-- ----
--------- --,----_._--
.¡--- ------ -.---. --"---' --'-'--
----- ----
PHYSICAL STATE
214 ' LARGEST CONTAINER
o s SOLID
[#tLlQUID
o 9 GAS
--.--.,--.- --------------..-- ----~-~--- '-----.----- ,.--------------
FED HAZAR ) CATEGORIES
(Check all thut apply)
ANNUAl WASTE
AMOUNT
01 FIRE
04 ACUTE HEALTH
~ CHRONIC HEALTH
o 2 REACTIVE
o 3 PRESSJRE RELEASE
I 'L,_~ "~~;i~~~:"~~ ~w" ... . ~'n~~~~~,,=~I<= .~
·'fEHS. amount must be in Ibs,_______________ I
STORAGE CONTAINER
(Check all th<lt apply)
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
DC TANK INSIDE BUILDING
o d STEEL DRUM
De PLASTICJNONMETALLlC DRUM
Of CAN
o 9 CARBOY
o h SILO
o i FIBER DRUM
OJ BAG
Ok BOX
o I CYLINDER
o m GLASS BOTTLE
~ PLASTIC BOTTLE
o 0 TOTE BIN
o P TANK WAGON
--------.-
_.._._-~--
... -------...._----
STORAGE P ~ESSURE
~ AMBIENT
o ba BELOW AMBIENT
o aa ABOVE AMBIENT
-----.-.-.-----.-.--------.----- -.... ,----
.-------.. ...-- -----,----.-.------.-
STORAGE TEMPERATURE
S-a AMBIENT
o aa ABOVE AMBIENT
. HAZARDOU5,COMPÖNENT
o ba BELOW AMBIENT
o c CRYOGENIC
225
210
212
CURIES
213
215 ,
216
STATE WASTE CODE
220
DAYS ON SITE
222
o q RAIL CAR
o r OTHER
223
224
-----
. ~~__...;",._____--..l-__.____
I
1 I
!
,
,
2 I
I
I
3 '
I
226
227
o Yes 0 No 228
------.,-.----------------- .... -. ---.--- ---.---
--.---.---
230
231 I 0 Yes 0 No 232
-------.. --- -------r----'-'-'-----'--
235 0 Yes 0 No 236
-----~---- ----------..-
____________________________ ______________ ___~3~ ~_~~__~~~_~~~
_________ _________ ________ .______~_~Yes ~~ 244
------.---- .------------- ---.-..-.---,-. .
234
---.----.
.....--.-----.--- ----------- .. -
. -_._.~_._.-
4
238
5
242
, " (,)1~Ij~Jt
PRINT NAME & TITLE OF AUTHORIZED CðMPi\ÑŸRËÞRESENTÃTIVE
'U!,:SIGNA TURE
,..i~· ,
;.,
.' '.'
" , '
- -SïGÑAï..URÊ----~"'-------'---~-~---'----·--
-----.------- --.------- ---
-.---.-.--- --.. -- ._-,..._--,--_..~. ---.----------.------.--.--.-----
UPCF (7/99)
229
233
237
241
245
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DATE
lVU~t
246
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