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Home My WebLink AboutBUSINESS PLAN Operftte Waste Unified Permit Ît to Materials/Hazardous . . Per Hazardous CONDITIONS,-OF.:PEBMIJ ·ON REVERSE SIDE \ " -' " 0:'<1 " i ~->r~,.;r~'~;\!i¿f;,· . : : . . ." . . ;... .' '-.' ¡' ~ - .". . Issue Date Approved by: , . ;: ExpÍ!8Íion Date: 7:'L:"~~i' ff:~~~~t;"~; Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326~3979 FAX (661) 326-0576 ¡;~ .~; i ....'- Permit ID #:: 015-000-001702 ALL MEDICAL SUPPLY ': LOCATION: 2001 WESTWlND DR #15 Issued by: ":",. \. (D c...c_n t -.....~... AI4.... /Y100J;.tor~J B.,: :i:...par;~ I AlAA'" Co. 11n-. ,"Oo.JCI1.Cn: .....~~ All ME-OICAI. s...pply 2o,,. lA1e~t....;~o 'ik It,S e..~rs+;dc.l, CA Q3"301 ; ~ ....~ 1!U.¡Øf iiViSiõ 'I51'T; ~ N 10' 77" oJ ~J, .< 1? '-' 11: H, 11 7'1: i.~ ='" ~ <!I ~. r.~. ~~ t // r...-T~ /' -t/¥ ShowrooM. (t.T' C(:I;~) f, "..1 ~ I <:Ð ~FT I .FI .-! 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I-< I <1 I ~ ~ ~ ~ . - I-< It: 0 ~] ~ 'B ¡..;; (/J tI) Q) Lf'\;3: .-< .-< 10 o .-< N êo c:: Q) 0 u CIS Q) 0..1-< Cl)CIS PARCEL ! L - DRIVEWAY - - - 1#2~ - #14 I #13 I #12 1#11 1#10 I #9 #8 I #7 ~ #6 I #5 1#4 #3 KIP 'AR EL PARKING #11 1 ·1 I ~ ~ t- t3 s: ~ ~ ij: ~ ~~ µ: E-< H ¡:¡¡ H :r: x µ: ~.. -..... 4; U·P·P·L·Y JOHN PRIVETT Home Oxygen· DME (Beds, W/C, Ect.) UrologicaVlncontinence Supplies Wound Management 2001 Westwind Dr" #15 Bakersfield, CA 93301 (661) 322-1496 Fax (661) 322-7151 Operil.te to Ît Per Waste Unified Permit Materials/Hazardous Hazardous CONDITIONS OF PERMIT ON REVERSE SIDE This ermit is issued for the followin :tlt~rdous Materials Plan '''.·'·it. round Storage of Hazardous Materials ~tlagement Program , Waste PERMIT ID# 015-021.Q01702 ALL MEDICAL SUPPLY ¡\. 2001 LOCATION Approved by: Expiration Date: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Issued by: "'''á< . éNO{(." ¿ 'Do...b It Doo.-$ 0 Oo RDø.. \ RoII1'tl-- btl".J '- :;¡ - ~"Gloss b"or~ Do.t~ L.~ \ 6Fr.~ ¡.\:"IJ<-~/ IT I , f?rJ d~ J3rr c.c""A.£..TE. VrJAL.... u.h r(. hO\4~f.. (10 ~T C.¿,I,~ 'l5F!. J~IT ,-- ,""...~~ W'~"1hIrI) ..../ A~"R'" ,...PE Showroom (¡.... Ct:I;')) ....¡t t // r........~ /. +/41 0" e' ~3"", 1 : ~"~~:: -11· ¡--- . 4H !\~'f~-- ~"'< {"'. (. , ...'", S , , /'.,. ROOM ~n-,Doo(, " ~ ¡..~ 1"'-. <'T CT( ""'ILL CoIIJCA. í, ",I ~ I <:D 'ðFT 1 .1"'1 ,;1 I &51 1: &>T. t- Ke-..+roof'f\ <1', ¡~ !I ~~ ?~ ;:.. ø_ ~~ .., .. . 1 u 10'" 'I 77 :J1FT. ~;ft. ~ e ""~"II.:t...£11" ~ Il~. LO"'-'C.Il.C-T£ ""'A"'~ All (\/I£OltAL $...pply '1(>,,, w~~tlo\l;~~ ík ~s ß<.1(e.~+;dcll CA Q3301 SC4LE:¡¡ ".=, ~ õATT C.-Nellt...,. t ..AU.. i¡SÇT; Rio.... /I'I.,J;.tor..J Bot: :t...p&";' I ALRR'" Co. CD :1 i ( " J \ . ~ ..." n . " / - e- CITY OF BAKERSFIEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd I'loor, Bakersfield, CA 93301 ~ 'l.\}\ß \\C\1 INSPECTION DATE /ð /~"t 103 PHONE NO, 3;).d..- I Y <t" BUSINESS ID NO. 15-210- (!)IS--ð'd-I -00110:;1, NUMBER OF EMPLOYEES ¿. FACILITY NAME. An 1'J\.~~I'C~ Suppl", ADDRESS .:M\(') I n}l~.~.\'\V\À hr FACILITY CONTACT :rðh~· ~r-\ve.\\:" INSPECTION TIME rS- Section 1: r Business Plan and Inventory Program r:sf Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appf.opriate permit on hand V Business plan contact information accurate V I v Visible address Correct occupancy V Verification of inventory materials V' Verification of quantities 1/ Verification of location v . Proper segregation of material r/ Verification of MSDS availability v Verification of Haz Mat training V Veri fication of abatement supplies and procedures v Emergency procedures adequate ;/ Containers properly labeled ,/ Housekeeping V / Fire Protection ,- r/ V/ Site Diagram Adequate & On Hand ,/ V\ / v C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes (3"'No usiness Site Responsible Party Inspector:\:~ ~ ~ )~ Questions regarding this inspection? Please call us at (661) 326-3979 While· Env, Svcs, Yellow· Station Copy Pink - Business Copy /' '; ,,/ .. .~- ALL MEDICAL SUPPLY . Manager : Location: 2001 WESTWIND DR #15 City BAKERSFIELD CommCode: BAKERSFIELD STATION 01 EPA Numb: ~ 3 iUß3 V .SiteID: 015-021-001702 BusPhone: Map : 102 Grid: 26B (661) 322-1496 CommHaz : Low FacUnits: 1 AOV: SIC Code:5047 DunnBrad: Emergency Contact JOHN PRIVETT Business Phone: 24-Hour Phone : A Pager Phone : (' -L H Hazmat Hazards: / Title / OWNER (661) 322-1496x ( ) - x (661) 121 502.1x ;.¿O\- 3Ðól-" Contact : MailAddr: 2001 WESTWIND DR #15 City : BAKERSFIELD Owner Address : City JOHN L PRIVETT 2001 WESTWIND DR #15 : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to Emergency Directives: Emergency Contact / Title SUSAN PRIVETT / MANAGER Business Phone: (661) 322-1496x 24-Hour Phone : ( ) - x Pa2 e:r Phone : (661) ~21 75:1~~ c... t\ ë1Ø t - 3.0 Fire ImmHlth DelHlth Phone: (661) 322-1496x State: CA Zip : 93301 Phone: (661) 322-1496x State: CA Zip : 93301 TotalASTs: = Gal TotalUSTs: = Gal RSs: No o - -rt-- DO! hsr~by ciSu1i~ ~h~ ~ ~æ9$ I ;:rt>~^ In'''t-l.L -- , (1~ or prim nSII'M) . I na(/"~ M !,q.od hazardous materia s ma~ - rs'\?i®~1S1d ~hs auaCIII<;ii _ ^ \ \ ,,^~J \ vlt-\ ~~ol.4and ~hat ¡~ along wiiV'ü ment plan forn (Name of BuoinGlW) "1-- any corrections cO!1f;titute a complete arid cúmact man~ agement plan 10r my iacì\iW, ~~~~tt Jß(~~ - - -1- 06/16/2003 ; F ALL MEDICAL SUPPLY f= Hazmat Inventory p== MCP+DailyMax Order . .SiteID: 015-021-001702 By Facility Unit Fixed Containers at Site 9 9 9 DailyMax UnitMCP Hazmat Common Name... specHazEPA HazardS Frm I OXYGEN F IH DH G 3000.00 FT3 Low -2- 06/16/2003 s F ALL MEDICAL SUPPLY p= Inventory Item 0001 === COMMON NAME / CHEMICAL OXYGEN . · SiteID: 015-021-001702 9 Facility Unit: Fixed Containers at Site 9 NAME Days On Site 365 Location within this Facility Unit Map: WHERE IS THIS MATERIALS STORED?????????????????? Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 249.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 3000.00 FT3 Daily Average 500.00 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 IH DH / / / Low HAZARD ASSESSMENTS Ag.Defined1: MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Define10: - Ag. Define11 -3- 06/16/2003 ¡ i F ALL MEDICAL SUPPLY I f= Notif./Evacuation/Medical Agency Notification e . SiteID~ 015-021-001702 9 Fast Format =¡ Overall Site ì 02/22/2000 Employee Notif./Evacuation 02/22/2000 CALL 911 IF AN EMERGENCY WERE TO OCCUR. CALMLY TELL THE EMPLOYEES TO PORCEED TO THE NEAREST EXIT OF THE BLDG. MAKE SURE THERE ARE NO OTHER EMPLOYEES IN THE BLDG. Public Notif./Evacuation 02/22/2000 HAVE THE PUBLIC GO TO THE NEAREST AND SAFEST EXIT AND TO STAY CLEAR OF THE BLDG. Emergency Medical Plan 02/22/2000 CALL 911 IF A MAJOR MEDICAL EMERGENCY WERE TO HAPPEN. PROVIDE FURTHER MEASURES OF CPR IF NECESSARY. -4- 06/16/2003 . . SiteID: 015-021-001702 ì Fast Format ì Overall Site ì 10/16/19951 1 1 I 10/16/1995 F ALL MEDICAL SUPPLY I p= Mitigation/Prevent/Abatemt r=: Release Prevention C??????? [:?::::::: Clean Up Containment 10/16/1995 ????????????? Other Resource Activation -5- 06/16/2003 . SiteID: 015-021-001702 ì Fast Format ì Overall Site ì I f ~ . ~ . ~ ~ F ALL MEDICAL SUPPLY I f= Site Emergency Factors r== Special Hazards Utility Shut-Offs 02/22/2000 A) GAS - OUTSIDE BACK DOOR. B) ELECTRICAL - IN UTILITY CLOSET ABOVE REFRIGERATOR C) WATER - OUTSIDE BACK DOOR D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 02/22/2000 PRIVATE FIRE PROTECTION - NONE. FIRE HYDRANT - CATYCORNER TO FRONT DOOR OF BUSIENSS. Building Occupancy Level -6- r 06/16/2003 , r. I è "F' ALL' MEDICAL SUPPLY I F Training Employee Training . . SiteID: 015-021-001702 9 Fast Format 9 Overall Site 9 02/22/2000 WE HAVE 4 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: READ CAL OSHA REGULATIONS DISCUSSED WITH EMPLOYEES MEANS OF EMERGENCY EVACUATIONS PLAN. Page 2 I I I Held for Future Use Held for Future Use -7- '06/16/2003 .. - ~ - e ALL MEDICAL SUPPLY SiteID: 215-000-001702 CommCode: BAKERSFIELD EPA Numb: RECEIVED .. / \ //fE8/1 ·6 . / . STATION 01 , INYIRON. QERV'CES BusPhone: Map : 102 Grid: 26B (805) 322-1496 CommHaz : Low FacUnits: 1 AOV: Manager : Location: 2001 WESTWIND DR #15 City BAKERSFIELD SIC Code:5047 DunnBrad: Emergency Contact JOHN PRIVETT Business Phone: 24-Hour Phone : Pager Phone / Title / OWNER (~ft(:¡ 322-1496x () x (~(gl') 321-5824x E~ergency.pcontact / Title :5lÁs~ ~ IVETl / MANAGER Business Phone: ('lil~) 322-1496x 24-Hour Phone () x Pager Phone ("li(,-)3~' - ì Sf '? Hazmat Hazards: Fire ImmHlth DelHlth Contact : MailAddr: 2001 WESTWIND DR #15 City BAKERSFIELD Phone: ( State: CA Zip 93301 x Owner Address City JOHN L. PRIVETT 2001 WESTWIND DR #15 BAKERSFIELD Phone: ( State: CA Zip 93301 x Period Preparer: Certif'd: to TotalASTs: TotalUSTs: RSs: No Gal Gal Emergency Directives: I, JDl4 rJ L. PR;v-t-t{- IDa h~r~by C®i1ify ~h!a~ ~ h!avs (TyP3 or print namo) reviewed the !attached hazardous ma~sritals manag(8)o ment plan forAI ( IAA~J.,~ I ~pdl4 ê1nd ~h2t it aioi1~ with f¡Q¡me of Businal3ll) + ~ any corrections consmu~s a complete and oomad man- agement plan for my mciliiy. ) / ¡r; /;)rJJo Datå -1- . 01/19/2000 . .. e e SiteID: 215-000-001702 ì By Facility Unit ì Fixed Containers at Site ì specHazEPA Hazards Frm I DailyMax unitlMCP F ALL MEDICAL SUPPLY f= Hazmat Inventory f== Alphabetical Order Hazmat Common Name... OXYGEN F IH DH G 3000.00 FT3 Low -2- 01/19/2000 .. e e SiteID: 215-000-001702 ì Facility Unit: Fixed Containers at Site ì F ALL MEDICAL SUPPLY p= Inventory Item 0001 F= COMMON NAME / CHEMI CAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container ~L/q cr FT3 AMOUNTS AT THIS LOCATION Daily Maximum 3000.00 FT3 Daily Average 500.00 FT3 U %Wt. RS CAS # - 100.00 Oxygen, Compressed No 7782447 HAZARDO S COMPONENTS HAZ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ARD ASSESSMENTS -3- 01/19/2000 e e SiteID: 215-000-001702 l Fast Format l Overall Site l 10/16/1995 F ALL MEDICAL SUPPLY I p= Notif./Evacuation/Medical Agency Notification CALL 9-1-1 IF AN EMERGENCY WERE TO OCCUR. Employee Notif./Evacuation 10/16/1995 CALMLY TELL THE EMPLOYEES TO PORCEED TO THE NEAREST EXIT OF THE BUILDING. MAKE SURE THERE ARE NO OTHER EMPLOYEES IN THE BUILDING. Public Notif./Evacuation 10/16/1995 HAVE THE PUBLIC GO TO THE NEAREST AND SAFEST EXIT AND TO STAY CLEAR OF THE BUILDING. Emergency Medical Plan 10/16/1995 CALL 9-1-1 IF A MOFOR MEDICAL EMERGENCY WERE TO HAPPEN. PROVIDE FURTHER MEASURES OF CPR IF NECESSARY. -4- 01/19/2000 e e F ALL MEDICAL SUPPLY I p= Mitigation/Prevent/Abatemt ~ Release Prevention ???????? SiteID: Otner Resourcë-Acti v'ati6ñ-- __"_ ___--0_ _ -- 215-000-001702 ì Fast Format ì Overall Site ì 10/16/1995 1 ] 1 I 10/16/1995 t?::~:::: Clean Up Containment 10/16/1995 ????????????? -5- 01/19/2000 e e SiteID: 215-000-001702 ì Fast Format ì Overall Site ì I F ALL MEDICAL SUPPLY I p= Site Emergency Factors r== Special Hazards Utility Shut-Offs 10/16/1995 NATURAL GAS/PROPANE: OUTSIDE BACK DOOR. ELECTRICAL: IN UTILITY CLOSET ABOVE REFRIGERATOR WATER: OUTSIDE BACK DOOR. SPECIAL: NONE LOCK BOX: NO - ~ ~ -- - Fire Protec./Avail. Water 10/16/1995 PRIVATE FIRE PROTECTION: NONE FIRE HYDRANT: CATYCORNER TO FRONT DOOR OF BUSIENSS. Building Occupancy Level I -6- 01/19/2000 ~- ... e e SiteID: 215-000-001702 l Fast Format l Overall Site l 10/16/1995 F ALL MEDICAL SUPPLY I F Training Employee Training NUMBER OF EMPLOYEES: 4 MATERIAL SAFETY DATA SHEETS ON FILE: ''j es BRIEF SUMMARY OF TRAINING: READ CAL OSHA REGULATIONS DISCUSSED WITH EMPLOYEES MEANS OF EMERGENCY EVACUATIONS PLAN. r Page 2 Held_ _fo:r. Eutur_e_ Use __ -~I I Held for Future Use -7- 01/19/2000 j -::<__.. a,:;-,. ~ - -... (!kb..M z- e - _ V-ee {H ,~~'J BAKERSFIELD CITY FIRE DEPARTMENT 5d-LP~/ t-f\ ç \..Y HAZARDOUS MATERIALS DIVISION 1715 -CHESTERAVL ;y BAKERSFIELD, CA. 93301 \ r1 0, '\ = HAZARDOUS MATERIALS MANAGEMENT PLAN . . INSTRUCTIONS: 1. io avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. ta~· l\¡lqqS BUSINESS NAME: ALL MEDICAL SUPPLY R~CI2I!1~D Sfp 1 2 HAc.? 1995 . It1Ac ì - D'" I SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: 2001 WESTWIND DR., #15 MAILING ADDRESS: SAME CITY: BAKERSFIELD STATE: ~ Z!P: 93301 PHONE: 322-1496 DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: JOHN L. PRIVETT MAILING ADDRESS: 801 JANE ST., BAKERSFIELD, CA 93306 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE l. JOHN PRIVETT OWNER 322-1496 321-5824-PAGER -. BRAD CHOATE MANAGER 322-1496 329-5064-PAGER 2. , ., Bakersfield Fire Dept. _ardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN ..~ > '-. ;( -.. ~.Þ~' ::.,_,... SECTION 3: TRAINING: "'NUMBER OF EMPLOYEES: L\ MATERIAL SAFETY DATA SHEETS ON FILE,: BRI.EF.SUMMARY OF TRAIN~NG PROGRAM: (\Qed CAl Q3-\-\fi (\íLx:JJ~ , ~~ [¡.)1..Q!fY1p1o~ JYY\9(jV\-b db &<'Nr\?§mc~' ~~ 9l0'{Y\- SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT' MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. ... '-' .....)- ... OTHER (SPEC!FY REASON) SECTION 5: CERTIFICATION: I, :Tou~ L, f«ìve...1t CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~£ f~' . SIGNATURE o U 1"1\.11/\ TITLE 9(()(1c( DATE ?, Operil.te Hazardous CONDITIONS"OF"PEBM,IJ.ON REVERSE SIDE , "~;,'. _: :'. ~ . ":'," !.. : ,.~ . Î: ' ¥-~' .>::~ ;'. . :'< r,>' y'.:~:-r-~.::'.):.~.~,~{.~::~ .,". .: ' :. . : ,,: : >. -'::: : :!~. . ',' ." I Waste Unified Permit Ît to Materials/Hazardous Per .-:;.:.~. ~ ~ Hazardous MaterIals Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Slte Treatment Permit ID #:: 015-000-001702 ALL MEDICAL SUPPLY '; LOCATION: 2001 WESìWJND DR #15 .. Issue Date Approved by: ,'" Expiration Date: ~: ;-? ?t:t:~~:)?,;:.~ ~ "...:.'~. Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice .(661) 326-:3979 FAX (661) 326-0576 ';¡'''-. Issued by: - .\----- :--:-;- ,.-..,. . -. .- - Bakersñ~ld Fire Dept. . e Hazardous Materials Divisio. -, . HAZARDOUS. MATERIALS MANAGEMENT PLAN Facility Unit Name: G QJ)::(Yu1~(W~ SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: ca.U Q¡. \ '/ h . . . ~ tu CJ7..!l)JJ\ . . 'l \ LtJ O/Ý\ 12f'(¥\J(f\ ZsVhC ~ ' ß, EMPLOYEE NOTIFICATION AND EVACUATION: C~ ttUJ~ ::::rcJ~ -tv ?!,ClQQd _ To ~ !M~+ QW dt~~~~· 3hur ~CU\ ~ nr."^(\ÞÉ'j~~..·1)\o.\U V~~OvUl-m([) ~r '\rv'Vu~ VVv~ ~. C, . PUBLIC EVACUATlON:~~FlliG '>ì1ì. lD~' C\\Q ~ 0JYlc1 lYíïL ~+ n J;J- /" ^" J ;(j~ pJ ,J ^ d\J~ M~iS'-u~ ~v u¡v~ 115 µ~ ŒWvl O. EMERGENCY MEDICAL PLAN: Ca10 .{¿\ -tb ~[ffi. ~ ~0~ ~~uÕ vJfN- ~C4~. f/\&lDO ~.('(Y\Q~ c1\) CWR .~ ~CLU0~. ~ :r\1':'- ·~ ~ ..... e Bakersfield Fire Dept. e Hazardous Materials Division c, . -" _ -.....;<J;:¡ ., ....... - HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: s. RELEASE'CONTAINMENT AND/OR MINIMIZATION: r' '-' . CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: (f\T~(~ (¿ -" {ß.cJc- dcxS, ELECTRICAL: \m vidbhé) cb~+ ()..!J¡,LYf ~N'~f!í\û-fxA WATER: ~~"¿Q ~. l~(JLd öZ5\ - . SPECIAL: LOCK BOX: YE@ IF YES, LOCAï10N: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PR!V A TE FIRE PROTECTION: ~W b 8. WATER AVAILA81LlTY (FIRE HYDRANT): C~ Cc}\.f\fV'-.QI\ -tb b0CJ\;v-t d CRf\ db ~ .-. BAKERSfiELD CITY FIRE DEP~TMENT HAZttiDOUS MATERIALS INVErWbRY " -. ...v_- Page~of_ ~ r; ~.. usiness Name Çi \ \ m ÞlD \ C vq L_ Address d 00 \ t ~"5lLù \ ~\ D Df<' l Þ t=: ~W+e..r 's CHEMICAL DESCRIPTION ~~ ;!~:. , ' 1) INVENTORY STATUS: ) Revision I ] Deletion I ] - New I ] Addition I Check if chemical is a NON TRADE SECRET· [ '] . mADE SECRET [ ) 2) Common Name: ð"i ~<:J jC) 3) DOT # (optional) Chemical Name: (?'J Ý \ / 0 'e N AHM I) CAS # 778'2 - 7I¿¡-7 7 "" 4) PHYSICAL & HEALTH PHYSICAL I~ HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ) Sudden Release of Pressure Immediate Health (Acute) ~laYed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid [ ) Gas [~ Pure [ ] Mixture [ ) Waste I] Radioactive I ) ŒECKALL THAT APPtY 7) AMOUNT AND TIME AT FACIUTY ~MEASURE ~ 8) STORAGE CODES 4 M",",~ Doily _"" ~. I [] f!3 [ ?, a) Container: Average Daily Amount: curies f ] b) Pressure: 2 Annual Amount: c) Temperature: ~ !.Mgest Size·Container: ' ........ # Days On Site ?,{,.,<:!.., Circle Which Months: ( All Ye~ J, F, M, A. M. J. J. A. S, O. N, D --.. I 9) MIXTURE: Ust COMPONENT ~ "- CAS # %WT AHM the three most hazardous 1) [ ] chemical components or , any AHM components 2) [ ] 3) . I) 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision I ] Deletion f ] Check if chemical is a NON TRADE SECRET I ) TRADE SECRET I ) 2) Commo~ Name: - . 3) DOT # (optional) . I Chemical Name: AHM I] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive ( ] Sudden Release of Pressu¡e [ ] Immediate Health (Acute) I ] Delayed Health (Chronic) [ ] ; \ , , 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022\ USE CODE ! i 6) PHYSICAL STATE Solid fJ Uquid f J Gas f ) Pure ( J Mixture I J Waste [ ] Radioactiw [ ] I :;HECX ALL T'kAT APPl r i 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs [ ] gal [ ] f!3 [ ] a) Container: Average Daily Amount: '. curies [ J b) Pressure: Annual Amount: , c) Temperature: !.Mgest Size Container: , # Days On Site Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D I I 9) MIXTURE: Ust COMPONENT CAS # %WT AHM ¡ the three most hazardous 1) [ ] chemical components or .. any AHM components 2) [ I 3) ( I . 1 0) Location e , , certJty unaer penBJty ot law, (tJar I have personally examinee ana am familiar w/(tJ che InfOmaOOn suomlttee on -chis and ail attached documents. I believe rne submitted information is true, accurate, and complete. - . PRINT Name & Title of Authorized Company Representative Signature Date ..... v t..IPC"',fIfIQMD fICIW ,'-~'- \ J'. - - _......~ * ~..~.. I I , - BAKER.IELD CITY FIRE DEPtRTMENT".--; HAZARDOUS MATERIALS DIVISION 1715 CHESTER AVE. . BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY . CHECK IF BUSINESS IS A FARM [] : BUSINESS NAME J~ \ \ ffit=\J ìC A~ ~ùç>pL Y I ¡ I I I ! I i i j i I. FACILITY DESCRIPTION FACIUTY NAME : S¡TEADDRESS d061 l~STl/~~\ND hQ\\J~) ~)\\'F , CITY l*\~g<~ç IEL[\ STATE C'f\ : NATURE OF BUSINESS (y\pf)\C:f\L SuPPl I C~ IS-- ZIP 9~:y:) ¡ i \ ! \1 i SIC CODE DUN & BRADSTREET NUMBER ¡OWNER/OPERATOR ~(}·\--H\--\ :p~ \ VElT ! MAIUNG ADDRESS ðð I ~ A ~)l~j ~,RFbT i : CITY -W~~\Ð_D STATE CA PHONE {~D~3loLJ -t.Dl9:].t ZIP ~?J6DLo EMERGENCY CONTACTS NAME ~)ðH~ ?f<\\)F1T BUSiNESS PHONE (~)'3~-t49lo TITLE ()'vO\\J~ 24-HOUR PHONE (Qt')~)3UJLP -( ol Q~ NAME J)ß..A\) C? t--tòAIE BUSINESS PHONE l!Jo.~)\~ -WLo TITLE ---.ffiB~'A G 1=12- 24-HOUR PHONE I<6Cl.::s ') 3àCf.-W~ '0 ct. eIV Sea.........:xI. I ggz REGION'll lS"C STANCAI'C F-: ji ~~ ~ b All Medical Supply ~ II A' / _ - . 1----- I -- - i~ +~ 1 ~ ,. ~' ~ ~~iL 3 20~ . ~~~~ ~~i U U _ ~~~' UNIFIED PROGRAM INSPECT'I®N CHECKLIST Bakers$eld Fire Dept. Environmental Services 900 Truxtun Ave., Suitell~0 Bakersfield, CA 93301 JSZ~Q$ Tel: X661) 326-3979 _ _ _ _ _ SECTION 1 Business ,Plan andlnventory Program WSPECTION DATE INSPECTION TIME FACILITY NAME ~ ~' -- --- _- - - - - __ _ ADDRESS PHONE No. No. of Employees FACILITYCONTACT Business ID Number ~'~ LI ~ ,0// /~ 'f~' 15'U21- 0 ~~7 U Z~ Section 1: Business Plan and Inventory Program Routine ^ Combined O Joint Agency ^hulti-Agency ^ Complaint ^ Re•inspection C. C V (~ uo~°'on"`~~ OPERATION COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ ~ VERIFICATION OF INVENTORY MATERIALS ,~, ^ VERIFICATION OF QUANTITIES ^ .VERIFICATION OF LOCATION B! ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE i~ ^ VERIFICATION OF HAT MAT TRAINING ~ ^ VERIFICATION OF ABATEMENT SUPPLIES ANO PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~ ,~ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING __ .._ - ^• FIRE PROTECTION -- ^ SITE DIAGRAM ADEQUATE S ON HAND ANY HAZARDOUS WASTE ON SITE?: ^ YES '~NO EXPLAIN: • QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~6G'I ~ 326-3979 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site White -Environmental Services Vellow • Station Copy sl Site esponsible Party (Please Print) 8 Pink • Business Copy ~~~ ~'~~ CITY OF BAKERSFiE1.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~~ UNIFIED PROGRAM INSPECTION CHECKLIST s . 'rip 'a~,~ 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 .3 tip03 Nov FACILITY NAME At- r-~.e..~ac~.1 Su ol~l INSPECTION DATE /o /.:~9 X03 _ ADDRESS ~~T~ ~~>> . ~t~.~.~ ~~ PNONE NO. 3aa- tyg~ FACILITY CONTACT To4..r t?.=.ve-C-C BUSINESS ID NO. 15-21U- ors-od-~ -oot7r~ INSPECTION TIME I~ NUMBER OF EMPLOYEES ~I Section 1: Business Plan and Inventory Program [Routine ^ Combined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate t/ Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability / Verification of Haz Mat training Verification of abatement supplies and procedures / Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection / Site Diagram Adequate & On Hand ~ C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ^!No Explain: Questions regarding this inspection? Please call us at (661) 326-39?9 usiness Site Responsible Party White -Env. Svcs. Yellow • Station Copy Pink - Business Copy inspeClOr:C ~ ~1/ ~~ ~- • ~ V ~---'