HomeMy WebLinkAboutBUSINESS PLAN 7/28/2003
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CALIFORNIA DENTAL CENTER
]vonne 7Jigil
Manager
~
Mon. - Fri.
3400 Wible Road
Bakersfield, CA 93309
Office (661) 835-8672
Fax (661) 835-7529
-
'...
STATEMENT OF ACCOUNT
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PAGE
1
"
CITY OF BAKERSFIELD
POBOX 2057
BAKERSFIELD, CA 93303-2057
(661) 326,:--3658
, ,
, . . .
'.' ,','.:) ,'. ,:",->/"J DATE: 4/01/04
TO: 'CALIF~R:N.LA DENTAI¡ìqEl'J'~~E~>':'·.:De~ CCt:-teJ.~~.I-GJ)~Yy)I'ot Cen-l-ey
2:100 ~HDLJ3 RD-'," ~'-'-',7îL~ ,. .···lbi 'Î'v-v/\ I
ßAKER3FIELD, CÄ9'3309 " <:+\r_~~~~/m--fu·.Tt{AI~~ '
:2Zz 'N:~.u\"é'.d~B I \/d OJ '1r 7lfù
, ~\~UV1&ß.):c.fï.g~l).2.AÇ
CUSTOMER NO: TYPE: ES -<ENVIRONMENTAL SERVICES
HM018
3/15/04
3/31/04
"-,'
BEGINNING:BALANeE , \ :. ,
SM:'QUANTITY BAZWÄSTE' GEN' "
TH~S FEE
WÀ$':!'E.
CA STATE
'~EF- NUMBER DUE 'DATE
TOTAL AMOUNT
, .~ '. '0 -. ' ,
-~-----------------'-----------------'-'-'--'------------_..------------------------
',', " ,. , '. ~,
CHARGE
DATE DESCRIPTÌON
------ --------
--------------
.00
58.00
HAZARDOUS
SSOOl
3/31/04
" "'. ",-i
24.00
" ":
ANNUAL BILL FOR THE FIS
IF RECEIVED IN ERROR, PLEAS
/' ¡' \
\ $
,~___OATE sO:t-~l ~(G~~W~fD)
. 7 / 1 / 0 3 - 6 / 3 ~ / 04 . APR 1 9 200/'
CALL 326-3658. "íl
-------------- --------------
--------------
--------------
CURRENT OVER 30
OVER 60
_______~~~~~11~~~~~1r
-------------- --------------
--------------
82.00
DUE DATE: 5/03/04
PAYMENT DUE:
TOTAL DUE:
82.00
$82.00
..
.. ,
- '''\ !
//:;/
+ CALIFORNIA DENTAL,;aER ----------------------.--- SiteID- 015-021-~~78 + I
Manager : NOþJþTE ';:CR Lö;~~-6õ~z~{e5~ (661; 835-8672
Location: 3400 WIBLE RD~\' Map: 123 CommHaz:
City BAKERSFIELD ~~ Grid: 12C FacUnits: 1 AOV:
~J~
CommCode: BAKERSFIELD STATION 07 SIC Code:8021
EPA Numb: DunnBrad:
+==============================================================================+
+=======================================+======================================+
Emergency Contact / Title Emergency Contact / Title
OG3'f'AL{j)rrtíW / (WJ..J¡\.£(HV( /
Business ~ðone: (661) 835-86~x Business Phone: () x
24 -Hour Phone : ((Oft; ) 3'3'2- -<loçç x 24 -Hour Phone : () x
Pager Phone : () x Pager Phone : () x
+---------------------------------------+--------------------------------------+
I Hazmat Hazards: React I
+------------------------------------------------------------------------------+
Contact: GR1H,¡ 17~Lm0Y1lctU{:, Phone: (661) 835-8672x
MailAddr: 3400 WIBLE RD State: CA
City : BAKERSFIELD Zip : 93309
+------------------------------------------------------------------------------+
Owner Phone: () x
Address : 3400 WIBLE RD State: CA
City : BAKERSFIELD Zip : 93309
+------------------------------------------------------------------------------+
Period to TotalASTs: Gal
Preparer: TotalUSTs: Gal
Certif'd: RSs: No
parcelNo:
+------------------------------------------------------------------------------+
I Emergency Directives: I
+==============================================================================+
+= Hazmat Inventory ========================================= One Unified List +
+== Alphabetical Order ================================= All Materials at Site +
+--------------------------------+-------+-----------+-----+----------+----+---+
I Hazmat Common Name... SpecHazlEPA Hazards Frm I DailyMax IUnit MCP
+--------------------------------+-------+-----------+-----+----------+----+---+
WASTE FIXER RL 5.00 Min
+=================================~============================================+
-1-
07/28/2003
'-
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CITY OF BAKERSFIEl..D FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd I;'loor, Bakersfield, CA 9330J
/~/60
/23/2 c..
r021
7
F ACILlTY NAME CAc...1 ksz..^'IÄ OC""1Y-\t... CGNJ12'..
ADDRESS ~4Ðc:) WI ~u:::- (4)
F ACILlTY CONTACT ~\'j'A(.....
INSPECTION TIME
INSPECTION DATE I ( I, 3 /0 I
PHONE NO. ß"5~ - ß67 2-
BUSINESS ID NO. 15-210- IVGcJ
NUMBER OF EMPLOYEES 2 b
Section J:
Business Plan and Inventory Program
o Routine ,,a..çombined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERATION C V COMMENTS
Appropriate pennit on hand tNG-J P~I'
Business plan contact infonnation accurate
Visible address
Correct occupancy
Veri fication of inventory materials ðß"f\Oo -Jt:.O \)()Q¡"J& (N <) f&:::tt o-tJ
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 Oß 'f'ð.t¡./'C-o c>J (/\JsPG::v v-J
C=Compliance
V=Violation
Any hazardous waste on site?:
Explain: ~fG- ~~
~Yes 0 No
wt~
ite esponsible Party /
W, AJe-:> -¡
Questions regarding this inspection? Please call us at (661) 326-3979
White· Env, Svcs,
Yellow· Station Copy
Pink· Business Copy
Inspector:
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITYNAME~l~lA.- ~~ CC-oJ'fa'\.
INSPECTION DATE ( / ((3 ~ (
EP A ID # <rA c.... 00ò( 'Z- 3 ( , cg
Section 4:
Hazardous Waste Generator Program
o Routine Ji- Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERATION
C V
COMMENTS
Hazardous waste detennination has been made
EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #)
Authorized for waste treatment and/or storage
Reported release, fire, or explosion within 15 days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames
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
( ""7/ ()
v-"" ,l.CÝJ.!>(3 f'tZdJ( Ol?
Conducts daily inspection of tanks
Used oil not contaminated with other hazardous waste
Proper management of lead acid batteries including labels
Proper management of used oil filters
Transports hazardous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazardous waste analysis for 3 years
Retains copies of used oil receipts for 3 years
Detennines if waste is restricted from land disposal
C-Compliance V-Violation
Inspector: uJ I ~GS
Office of Environmental Services (661) 326-3979
White - Env, Svcs,
/ì
( ¿ ,1,,;; hA/;JÜ
\./ B~Jl~ess· Site Responsible Party
Pink - Business Copy
. CITY OF BAKERSFIE.
OmCE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
. HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
k.w
DADD
D REVISE
200
D DELETE
-_._---_._._-~._-..._-_.._---- ...
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.--_. ---. ._.._._~..
".. -_.-----
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAMEor'EfãÄ:OO¡ôgBusiñiišSÃsj---' -.-- .-.
. ""."'.---.----.-
...-----.--.
___u...._.____..
CHEMICAL LOCATION
(one fonn per malfJrlsl per building or al'f/s)
Page of
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3
IN ,,:>d>6
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!51 _..LLi.._L.L· I
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201: CHEMICAL LOCATION
: CONFIDENTIAL (EPCRA)
n_ n,_____ '---------2õ3n,G'RiD¡;(op~ns~
o Yes 0 No 202
204
·--ë---~_:____----:-j---_._--
205
DYes 0 No 206 i
If Subject to EPCRA. refer to instructions . i
d)
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,.~ :'1. è~.~MJCAL fl~FORMA TI'ON
. :.. '<.' ~: <
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--...-----.---..-----....
¡
I
! COMMON NAME
¡
I
I
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F rX:c./2..
.-........-,.. .
. .-....- .. - --~- --.---.- -..--.
207
EHS'
o Yes 0 No 208
CAS.II
209
..... -------------..-
u _.. ., __._ ___ _
....-~._--_.
"._-..---
----------+-_._~--------------
FIRE CODE HAZARD CLASSES (Complete if requested by local fire Chief)
210 !
o m MIXTURE
oNo
212
CURIES
213
TYPE o P PURE
,
I PHYSICAL STATE
i o s SOLID
i
I FED HAZARD CATEGORIES 01 FIRE
, (Check all that apply) .
I ANNUAL WASTE . COo 217
I AMOUNT
UNITS'
..--"..------.-- -+--
~ WAST:
L . R,;,DIOACTlVE 0 Yes
-- ..-- ---." .--------.-
A.wdaulD
LARGEST CONTAINER
s
o g GAS
214
__________...J..-..-_ .___.___
o 2 REACTIVE
o 3 PRESSURE RELEASE
04 ACUTE HEALTH
05· CHRONIC HEALTH
. --"------- .-----.---.-.-.-..------..------.
MAXIMUM
! DAILY AMOUNT
-'-
218 ¡AVERAGE
L DAILY AMOUNT '
-~ _._,-~-' ---.-----.--------.------..---.----
o 93 GAt. 0 d CU FT 0 Ib LBS 0 In TONS
. If EHS. amount must be in /bs,
STORAGE CONTAINER
(Check an that apply)
De PlAsTlCINONMETALLlC DRUM
Of CAN
o g CARBOY
o h SILO
o a ABOVEGROUND TANK
Db UNDERGROUND TANK
DC TANK INSIDE BUILDING
. 0 d STEEL DRUM
o i FIBER DRUM
OJ BAG
Ok BOX
o I CYLINDER
o m GLASS BOTTLE
~PLASTlCBOTTLE
o 0 TOTE BIN
o P TANK WAGON
"'__'.n...._. _~.__. ... .___._......___
STORAGE PRESSURE
ß-a AMBIENT '
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
.-----.-- .---- .----
STORAGE TEMPERATURE
o aa ABOVE AMBIENT·
o ba BELOW AMBIENT
lENT
215
216
219 I STATE WASTE CODE 220
221 ·1 DAYS ON SITE 222
o q RAIL CAR
o r OTHER
223
224
o c CRYOGENIC
~
11 226
I
I
I
I 2 . 230
234
I 3
4 238
5 242
!;::bi1ff:'dU::: ':;:·;~:I~~[~~·ÇR~~~~E~T ..... :':~~1f':,~t!;): ''c ····;F~:Jj;;t7·J;)~~$.
227
o Yes 0 No 226
.--.--...---.--
.. -. --".---. --.------
231 0 Yes 0 No 232
-----.-,..- ---.-r:-.-.----..---
m_ 235 i oYesoNo 236 ¡
- -----~-'- - --------- ,
.. ---- . ··~fYœ¡:¡No _'"
243 0 Yes 0 No 244
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229
233
237
241
,245
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D COMPANY REPRESENTÃTIVE -SìGNATÜRE'----'--
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