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Home My WebLink AboutBUSINESS PLAN 1/30/2002 Per it Operate to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF ·PERMIT ON REVERSE SIDE Permit ID #:: 015-000-001911 WALGREENS #3360 LOCATION: 4100 WHITE LN Issued by: ft.:.::,.':;,: .'.,',J ; '~~~l" ~.' ". " 1;', ...., ! ! ~.,...t ìJ ". ' '.. .'¡ L' .... 'cJ r-:t .\'.~..'..'-'.l\ * n '-"" .,~ " \ ~ '. . \\ V~'\·l . ~:~~\ \:~'" ~.._,.,,- Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX(661) 326-0576 Approved by: Issue Date , , Expiration Date: :. June 30, 2003 , " .. ~ . ~ . . t N . - -" ~r . \ ~\ SITE DIAGRAM r 1 Business Name: Business Address: FACILITY DIAGRAM f 1 f?- E-S I .f)L~' A. L- ç:; Re' cÞ ~VD,uL.N'Í I "(¿life" T'~¡J ]j -.&L 0 ~ ~ l~ pNVi(,v& V) ~) éJ L.A>-r ~ ä: Bl U <l... ~ @M-~~" 7- (( (.IN IT W ;' {¡ w(..(; "TE ¿¡J .~------- REs I {)00 T' AL Store: WI\LW.f;€NS I \A ~ ~ « .. 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L____________~--------~-------------___~____~_______-_____________~_____________________~__________________.__~ e ~. ~ ~ ~ \) Q o o o ~ w ...;) - e ~ !i' (11 I...) o 'It !..:} ~ -~ e e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + Manager : BRAD HAGGARD Location: 4100 WHITE LN City BAKERSFIELD BusPhone: Map : 123 Grid: 14A (661) 396-0341 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 SIC Code:5912 EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency Contact / Title BRAD HAGGARD / MANAGER CHRS NELSON / ASSIST MANAGER Business Phone: (661) 396-0341x Business Phone: (661) 396-0341x 24-Hour Phone : (661) 665-9456x 24-Hour Phone : (661) 665-9374x Pager Phone : () x Pager Phone : () X +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire Press ImmHlth I +------------------------------------------------------------------------------+ Contact : Phone: (661) 396-0341x MailAddr: 4100 WHITE LN State: CA City : BAKERSFIELD Zip : 93309 +------------------------------------------------------------------------------+ Owner WALGREENS Phone: (847) 940-2500x Address: 200 WILMONT RD State: IL City : DEERFIELD Zip : 60015 +------------------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No +------------------------------------------------------------------------------+ Emergency Directives: +==============================================================================+ += Hazmat Inventory ========================================= One Unified List + +== Alphabetical Order ================================= All Materials at Site + +--------------------------------+-------+-----------+-----+----------+----+---+ I Hazmat Common Name... I SpecHazIEPA Hazards I Frm I DailyMax IUnitlMCpl +--------------------------------+-------+-----------+-----+----------+----+---+ FIXER L 40.00 GAL Low HELIUM F P IH G 434.00 GAL Min PHOTO CHEMICAL CONTAINING SILVE L 10.00 GAL Min PHOTOGRAPHIC STABILIZER IH L 4 G(90-e- GAL Mih' ;(~ ~ I~ tV _ ,¡ yí) o 1/ /, ßMtJ Jj/~A¡I.¡J Do hereby certify that i hav^ (Type or print O'Ima) '0' reviewed the attached hazardous materials manage- ment plan for--114.k~.s and that it along w~lh (i\:i'!()b 01 Buslomss) '", any corrections constitute a complete and correct man- agement plan for my facility. +--------------------------------~.- ------------------------------------+ ------------------------------------ --- ------------------------------------ y - .~ I /lD/o-Z- 01/25/2002 s' . [lJra . Date i' ;- e e + WALGREENS #3360 += Inventory Item +== COMMON NAME / FIXER FILM FIXER Location within this Facility INSIDE PHOTOPROCESS STORAGE RM ===================================== SiteID: 015-021-001911 + 0002 =============== Facility Unit: Fixed Containers at Site + CHEMICAL NAME ==============================+================+ I Days On Site I 365 +----------------+ I CAS # I Unit Map: Grid: +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Liquid I Mixture I Ambient I Ambient I PLASTIC CONTAINER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 1.00 GAL 40.00 GAL 40.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ %Wt . RS CAS# 15.00 Ammonium Thiocyanate No 1762954 10.00 Ammonium Thiosulfate No 7783188 5.00 Sodium Sulfite No 7757837 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ I TSecretI RSIBioHaz Radioactive/Amount I EPA Hazards I NFPA I USDOT# I MCP I No No No No/ Curies / / / Low +=======+===+======+====================+=============+=========+========+=====+ 0003 =============== Facility Unit: Fixed Containers at Site + CHEMICAL NAME ==============================+================+ I Days On Site I 365 +----------------+ I CAS# I 7440-59-7 +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 217.00 GAL 434.00 GAL 217.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt. I IRS I CAS# I 100.00 Helium No 7440597 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ Tsecret RSBioHaz Radioactive/Amount I EPA Hazards I NFPA I USDOT# I MCP I No No No No/ Curies F P IH / / / Min +=======+===+======+====================+=============+=========+========+=====+ += Inventory Item +== COMMON NAME / HELIUM Location within this Facility Unit INSIDE PHOTOPROCESS STORAGE AREA Map: Grid: -2- 01/25/2002 e e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + += Inventory Item 0004 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ==============================+================+ PHOTO CHEMICAL CONTAINING SILVER I Days On Site I HAZARDOUS WASTE W/SILVER 365 Location within this Facility Unit Map: Grid: +----------------+ INSIDE PHOTOPROCESS STORAGE AREA I CAS# I +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Liquid I Waste I Ambient I Ambient I PLASTIC CONTAINER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 10.00 GAL 10.00 GAL 10.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt. I I RSI CAS # I 0.50 Silver No 7440224 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ Tsecret RSBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP I No No No No/ Curies / / / Min +=======+===+======+====================+=============+=========+========+=====+ += Inventory Item 0001 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ==============================+================+ PHOTOGRAPHIC STABILIZER I Days On Site I FILM STABILIZER 365 Location within this Facility Unit Map: Grid: +----------------+ INSIDE PHOTOPROCESS STORAGE RM I CAS# I +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Liquid I Mixture I Ambient I Ambient I PLASTIC CONTAINER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 1.00 GAL 40.00 GAL 40.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ %Wt. RS CAS# 1.00 Hexamethylenetetramine No 100970 1.00 Sodium Dodecylbenzene Sulfonate No 25155300 1.00 Dipropylene Glycol No 106627 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ Tsecretl RSBioHaz Radioactive/Amount I EPA Hazards I NFPA I USDOT# I MCP I No No No No/ Curies IH / / / Min +=======+===+======+====================+=============+=========+========+=====+ -3- 01/25/2002 e e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + +================================================================= Fast Format + += Notif./Evacuation/Medical ==================================== Overall Site + +== Agency Notification =========================================== 01/13/1999 + NOTIFICATION OF THE PROPER AUTHORITIES IS THE RESPONSIBILITY OF THE PHOTO LAB MANAGER, STORE MANAGER, OR DESIGNATED ALTERNATE IN CASE OF EMERGENCY. +==============================================================================+ E I N 'f /E t' 12/20/1999 +=== mp oyee ot~. vacua ~on =================================== + PHOTO LAB OPERATORS ARE NOTIFIED OF THE PRESENCE OF AN EMERGENCY REQUIRING EVACUATION BY VERBAL COMMUNICATION OR WITH THE STORE ALARM SYSTEM IF ONE EXISTS. ALL PHOTO LAB EMPLOYEES WILL EVACUATE IMMEDIATELY FOLLOWING THE WARNING. THERE ARE NO CRITICAL OPERATIONS WHICH WILL BE PERFORMED IN THE PHOTO LAB PRIOR TO EVACUATION. +==============================================================================+ P bl' 'f /E ' 2/20/1999 +==== u ~c Not~. vacuat~on ==================================== 1 + AFTER EVACUATION, PHOTO LAB OPERATORS WILL CONGREGATE IN THE PARKING LOT, A SAFE DISTANCE FROM THE FRONT OF THE STORE. ALTERNATE CONGREGATION POINTS MAY BE SPECIFIED IN THE STORES SITE SPECIFIC EMERGENCY ACTION PLAN. THE PHOTO LAB MANAGER OR STORE MANAGER WILL BE INFORMED OF PHOTO LAB OPERATORS SAFE EVACUATION. +==============================================================================+ +===== Emergency Medical Plan =================================================+ I I +==============================================================================+ -4- 01/25/2002 e e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + +================================================================= Fast Format + += Mitigation/Prevent/Abatemt =================================== Overall Site + +== Release Prevention ============================================ 01/13/1999 + TO MINIMIZE SPILLS IN THE PHOTO LAB, OPERATORS PRACTICE GOOD HOUSEKEEPING. PHOTOPROCESSING CHEMICALS ARE TYPICALLY STORED IN DELIVERY CONTAINERS AND KEPT IN THE DELIVERY CONTAINERS PRIOR TO USE TO AVOID ACCIDENTAL SPILLS. PHOTOPROCESSING CHEMICALS ARE STORED AWAY FROM HEAVY TRAFFIC AREAS. SPILLS THAT DO OCCUR IN THE PHOTO LAB ARE USUALLY VERY SMALL IN VOLUME AND CAN BE READILY CLEANED UP. +==============================================================================+ +--- Release Contal'nment ------------------------------------------ 01/13/1999 + --- ------------------------------------------ IF A SPILL DOES OCCUR, OPERATORS PUT ON PERSONAL PROTECTIVE EQUIPMENT (GLOVES, GOGGLES, AND APRON) PRIOR TO INITIATING CLEAN-UP ACTIVITIES. CLEAN-UP PROCEDURES VARY DEPENDING ON WHETHER ON-SITE SILVER RECOVERY PERFORMED IN THE STORE OR IF THE USED PHOTOPROCESSING CHEMICALS ARE TRANSPORTED OFF-SITE FOR TREATMENT. THE IS +==============================================================================+ +---- Clean Up ---------------------------------------------------- 01/13/1999 + ---- ---------------------------------------------------- WASTE HANDLED BY COMMODITY RESOURCE ENVIRONMENTAL 1-800-943-2811. +==============================================================================+ +===== Other Resource Activation ==============================================+ I I +==============================================================================+ -5- 01/25/2002 ~ e e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + +================================================================= Fast Format + += Site Emergency Factors ======================================= Overall Site + +== Special Hazards ===========================================================+ I I +==============================================================================+ +--- Utl.'ll.'ty Shut-Offs -------------------------------------------- 01/13/1999 + --- -------------------------------------------- A) GAS OUTSIDE SE CORNER OF BLDG B) ELECTRICAL OUTSIDE SW CORNER OF BLDG C) WATER - OUTSIDE SW CORNER OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO +==============================================================================+ F' P / '1 / / 9 9 +==== l.re rotec. Aval. . Water =================================== 01 13 1 9 + PRIVATE FIRE PROTECTION - SPRINKLERED BLDG, PORTABLE EXTINGUISHERS. NEAREST FIRE HYDRANT - OUTSIDE NE CORNER OF PROPERTY. +==============================================================================+ +===== Building Occupancy Level ===============================================+ I I +==============================================================================+ -6- 01/25/2002 ~ " '" . e + WALGREENS #3360 ===================================== SiteID: 015-021-001911 + +================================================================= Fast Format + += Training ===================================================== Overall Site + +== Employee Training ============================================= 01/13/1999 + WE HAVE 15-20 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN A BINDER IN PHOTO AREA. BRIEF SUMMARY OF TRAINING PROGRAM: MANAGERS OFFICE. RECORDS MAINTAINED IN A BINDER IN THE +==============================================================================+ +=== Page 2 ===================================================================+ I I +==============================================================================+ +==== Held for Future Use =====================================================+ I I +==============================================================================+ +===== Held for Future Use ====================================================+ I I +==============================================================================+ -7- 01/25/2002 ¡ .~ ..._ .~, .ë:: -- - WALGREENS #3360 Manager : BRAD HAGGARD Location: 4100 WHITE LN City BAKERSFIELD BusPhone: Map : 123 Grid: 14A SiteID: 215-000-001911 ~lUl (&&5) 396-0341 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code:5912 DunnBrad: Emergency Contact / Title Emergency Contact / Title BRAD HAGGARD ~\.D~ MANAGER CIUA MNfIIISChriSNdson/ ASSISTANT MGR Business Phone: (-&&5-) 3 96 - 03 41x Business Phone~l( 1*15) 396-0341x 24 -Hour Phone U\,O\ (8"&5) 665-9456x 24-Hour PhoneWI(~ 665-~X Pager Phone : ( ) - x Pager Phone : ( ) - ' 1 x Hazmat Hazards: Fire Press ImmHlth Contact : 'ßY'~d JtÀ~ayGi Phone: (~I 396-0341x MailAddr: 4100 I LN State: CA City : BAKERSFIELD Zip : 93309 ;'I,i._ Owner WALGREENS Phone: ,9'3' C\ 40 '00 ,:.V.J (8-&5) ~_¿~~v~-~l Address : 200 WILMONT RD State: IL City : DEERFIELD Zip : 60015 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì ~ Hazmat Inventory p== Alphabetical Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP FIXER L HELIUM F P IH G PHOTO CHEMICAL CONTAINING SILVE L PHOTOGRAPHIC STABILIZER IH L I. tà.~:~f~~-'- Do hereby certify that I have , . ,';. Is manage- I ,o,"'! ò.....o ø,¢oO; ,...";'.;, b\~;r.:.;rdÖ4.JS m3(~aru~ ff!;'If!J ew\SlU tH... ....\\'..:""",,~. I ,... " j <!' l (n\11 t.J'ffl1'5 a!t~ ~hat i~ ai©lí'%@ w~th m~nt p~~ u©ú"~- any c©rrr~å©li1$ ©©úî$~ñ~~~® ~ oomplste and COi'i'ê~ Mario agsmant ~!@i"i ~©rr B'jjY ~mw· 40 GAL 434 GAL 10 GAL 40 GAL Low Min Min Min 08/25/1999 .. .. e e F WALGREENS #3360 f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME FIXER FILM FIXER Location within this Facility Unit INSIDE PHOTOPROCESS STORAGE RM SiteID: 215-000-001911 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 1. 00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 40.00 GAL Daily Average 40.00 GAL %Wt. RS CAS # 15.00 Ammonium Thiocyanate No 1762954 10.00 Ammonium Thiosulfate No 7783188 5.00 Sodium Sulfite No 7757837 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low HAZARD ASSESSMENTS f= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME HELIUM Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit INSIDE PHOTOPROCESS STORAGE AREA Map: Grid: CAS # 7440-59-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 217.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 434.00 GAL Daily Average 217.00 GAL %wt. I 100.00 Helium HAZARDOUS COMPONENTS ~ CAS # I 7440597 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -2- 08/25/1999 ~ e e F WALGREENS #3360 f= Inventory Item 0004 = COMMON NAME / CHEMICAL NAME PHOTO CHEMICAL CONTAINING SILVER HAZARDOUS WASTE W/SILVER Location within this Facility Unit INSIDE PHOTOPROCESS STORAGE AREA SiteID: 215-000-001911 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 10.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 10.00 GAL %wt. I 0.50 Silver HAZARDOUS COMPONENTS ~I CAS # I 7440224 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min HAZARD ASSESSMENTS f= Inventory Item 0001 ~ COMMON NAME / CHEMICAL NAME PHOTOGRAPHIC STABILIZER FILM STABILIZER Location within this Facility Unit INSIDE PHOTOPROCESS STORAGE RM Facility Unit: Fixed Containers at Site 1 Days On Site 365 Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 1. 00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 40.00 GAL Daily Average 40.00 GAL %Wt. RS CAS # 1. 00 Hexamethylenetetramine No 100970 1.00 Sodium Dodecylbenzene Sulfonate No 25155300 1. 00 Dipropylene Glycol No 106627 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Min HAZARD ASSESSMENTS -3- 08/25/199~ .. . e e F WALGREENS #3360 I f= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-001911 1 Fast Format ì Overall Site ì 01/13/1999 NOTIFICATION OF THE PROPER AUTHORITIES IS THE RESPONSIBILITY OF THE PHOTO LAB MANAGER, STORE MANAGER, OR DESIGNATED ALTERNATE IN CASE OF EMERGENCY. Employee Notif./Evacuation 01/13/1999 PHOTO LAB OPERATORS ARE NOTIFIED OF THE PRESENCE OF AN EMERGENCY REQUIRING EVACUATION BY VERBAL COMMUNICATION OR WITH THE STORE ALARM SYSTEM IS ONE EXISTS. ALL PHOTO LAB EMPLOYEES WILL EVACUATE IMMEDIATELY FOLLOWING THE WARNING. THERE ARE NO CRITICAL OPERATIONS WHICH WILL BE PERFORMED IN THE PHOTO LAB PRIOR TO EVACUATION. Public Notif./Evacuation 01/13/1999 AFTER EVACUATION, PHOTO LAB OPERATORS WILL CONGREGATE IN THE PARKING LOT, A SAFE DISTANCE FROMTHE FRONT OF THE STORE. ALTERNATE CONGREGATION POINTS MAY BE SPECIFIED IN THE STORE'S SITE-SPECIFIC EMERGENCY ACTION PLAN. THE PHOTO LAB MANAGER OR STORE MANAGER WILL BE INFORMED OF PHOTO LAB OPERATORS SAFE EVACUATION. Emergency Medical Plan -4- 08/25/1999 " . e e SiteID: 215-000-001911 ì Fast Format ì Overall Site ì 01/13/1999 F WALGREENS #3360 I p= Mitigation/Prevent/Abatemt Release Prevention TO MINIMIZE SPILLS IN THE PHOTO LAB, OPERATORS PRACTICE GOOD HOUSEKEEPING.. PHOTOPROCESSING CHEMICALS ARE TYPICALLY STORED IN DELIVERY CONTAINERS AND KEPT IN THE DELIVERY CONTAINERS PRIOR TO USE TO AVOID ACCIDENTAL SPILLS. PHOTOPROCESSING CHEMICALS ARE STORED AWAY FROM HEAVY TRAFFIC AREAS. SPILLS THAT DO OCCUR IN THE PHOTO LAB ARE USUALLY VERY SMALL IN VOLUME AND CAN BE READILY CLEANED UP. Release Containment 01/13/1999 IF A SPILL DOES OCCUR, OPERATORS PUT ON PERSONAL PROTECTIVE EQUIPMENT (GLOVES, GOGGLES, AND APRON) PRIOR TO INITIATING CLEAN-UP ACTIVITIES. THE CLEAN-UP PROCEDURES VARY DEPENDING ON WHETHER ON-SITE SILVER RECOVERY IS PERFORMED IN THE STORE OR IF THE USED PHOTOPROCESSING CHEMICALS ARE TRANSPORTED OFF-SITE FOR TREATMENT. Clean Up 01/13/1999 WASTE HANDLED BY COMMODITY RESOURCE ENVIRONMENTAL 1-800-943-2811. Other Resource Activation -5- 08/25/1999 · ..t' .' ; e e F WALGREENS #3360 I p= Site Emergency Factors ¡== Special Hazards Utility Shut-Offs SiteID: 215-000-001911 ì Fast Format ì Overall Site ì I 01/13/1999 A) GAS - OUTSIDE SE CORNER OF BLDG B) ELECTRICAL - OUTSIDE SW CORNER OF BLDG C) WATER - OUTSIDE SW CORNER OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/13/1999 PRIVATE FIRE PROTECTION - SPRINKLERED BLDG, PORTABLE EXTINGUISHERS. NEAREST FIRE HYDRANT - OUTSIDE NE CORNER OF PROPERTY. Building Occupancy Level -6- 08/25/1999 ....., ,þ.... If. rJ '. e e í WALGREENS #3360 ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë SiteID: 215-000-001911 íëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Fast Format íë Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë Overall Site íëë Employee Training ëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëëë 01/13/1999 ¡ o 0 o WE HAVE 15-20 EMPLOYEES AT THIS FACILITY. o o o o o o WE DO HAVE MSDS SHEETS ON FILE IN A BINDER IN PHOTO AREA. o o BRIEF SUMMARY OF TRAINING PROGRAM: RECORDS MAINTAINED IN A BINDER IN THE 0 o MANAGERS OFFICE. 0 o '0 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 J. INSTRUCTIONS: 1. 2. 3. 4. . -' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 /:. @ ~7. \Uc ~ \ '~J .- tÚ To avoid further action, return this form within 30 days of receipt. TYPEIPRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. o SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: WAL-(!#..6ÞJ 'S ~ 33Gð LOCATION: 4 ( 00 Wl-t (r(¿ '-~ MAILING ADDRESS: CITY: ~é STATE: ZIP: a? PHONE: 376-0341 SIC CODE: S."<]fZ- DUN & BRADSTREET NUMBER: PRIMARY ACTIVITX: R..(..~ L í>R-tJCs>- <5 ~ OWNER: W~-C-tJS MAILING ADDRESS: ?ðO WI U'vID,,)T áZ-D D ff.-f2.h áD , tt- GxJt~ , SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. ~ð.D (~Zf) M6tC.. :!<76 - 03q I 66S- -945~ 2. ß..t Af\A fVll1- í f.( I .s M'( ¡../1G.fL ¿...( 1 e . f~~ i HAZARDOUS MATEWALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: It;; .r 'U) MATERIAL SAFETY DATA SHEETS ON Fll.E: (N ~/N~(,V¿ (,0 f(..(d\b ¡;IL6A BRIEF SUMMARY OF TRAINING PROGRAM: ~tNDC:::fL (,J , M"~ S 0'f+1 æ J SECTION 4: EXEMPTION REOUEST 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 TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TInS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2 · , .f '. e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: Notification of the proper authorities is the responsibility of the photo lab manager, store manager, or designated alternate in case of emergency. B. EMPLOYEE NOTIFICATION AND EVACUATION: - Photo lab oper~tor~ are no!ified of the presence of an emergency requiring evacuation by v~rbal comm~nJcatl~n or with th~ store alar~ system if one exists. All photo lab employees wIll evacuate ImmedIately following the warning. There are no critical operations which will be performed in the photo lab prior to evacuation. C. PUBLIC EVACUATION: After evacuation, photo lab operators will congregate in the parking lot,. ~ s~fe distance, from the front of the store. Alternate congregation points may be specifIed In the ~tore s site-specific Emergency Action Plan. The photo lab manager or store manager will be informed of photo lab operators' safe evacuation, D. EMERGENCY MEDICAL PLAN: 3 - - HAZARDOUSMATE~LSMANAGEMENTPLAN \ .' ¡ SECTION 7: MITIGATION. PREVENTION AND ABATEMENT PLAN A. To minimize spills in the photo lab, operators practice good housekeeping. ~ Photoprocessing chemicals are typically stored in delivery containers and kept in the delivery containers prior to use to avoid accidental spills. Photoprocessing chemicals are stored away from heavy traffic areas. Spills that do occur in the photo lab are usually very small in volume and can be readily cleaned up, B. RP.T.FA~F. C.ONTAINMENT AND/OR M1NTMT7ATTt"\'N'· If a spill does occur, operators put on personal protective equipment (gloves, goggles, and apron) prior to initiating clean-up activities. The clean-up procedures vary depending on whether on-site silver recovery is performed in the store or if the used photoprocessing chemicals are transported off-site for treatment. C. CLEAN-UP PROCEDURES: uJ A<;TE 1~r::.¿"('O ß ~ L.O"","""oð (TY' ~u~ 6Vvt/u~""'-C~t... f-<;sOO - 44~ - 2~n SECTION 8: UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ðu'\s'oé sw CJ2.,J/L cr' 63 LO&- ELECTRICAL: ðU 1$ (D G $.w c.JÙJR. c:x= 63> L!) '" WATER: cY"'r> cf) E SL..J c~ ~ <ß '-0 &- SPECIAL: LOCK BOX: YESINO IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/W ATER AVAILABILITY A. PRIVATE FIRE PROTECTION: S'f>(l, ,J')(.GCJZ.ép ~-t..DG- /' tfor¿T4ßl.E éjz:¡írlÓl/I51tét/6 B. WATER AVAILABILITY (FIRE HYDRANT): CrJ~S(J)¿ tJe (f?·^-lfL oC p{2c>fC.Q.T}/ 4 , , ¡ 4 Business Name WARDOUS MATERIALS INVENWY Address Page_of_ . . CHEMICAL DESCRlPTION I) INVENTORY ST A ruS: New [ ] Addition [ ] Revision [ ] Deletion [ 2)Coaunon Name: fiLM.. S7Aß ref ~ Check if chenúcal is a NON Trade Secret [ ] Trade Secret [ ] 3) DOT # (optional) Chenúcal Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL 111 Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic)C{ä:'L 5) WASTE CLASSIFICATION (3-d.igit code 1ì'om DHS Fonn 8022) 6) PHYSICAL STATE Solid [ Liquid [~ Gas [ ] Pure [ USE CODE ~ Waste [ ] Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c) Temperature 7) AMOUNT AND TIME AT FACll..ITY ~ Maximwn Daily AmOW1t Average Daily AmOW1t Annual AmOW1t 1~ Largest Size Container # Days on Site '3 (00- UNITS OF MEASURE Lbs [ ] Gal ~ ft3 [ Curies [ ] tD ( 4- Circle Which Months: All Year, I, F, M. A. M. I, I, A. S, 0, N, D 9)~: Li~ the three mo~ hazardous chemical components or any AHM components COMPONENT CAS# 1) #f&Art.1erf-\.\('LENf:'1l:-rtZ41lAltVE (OO - 97 -0 2) Sc'>Dtu¡",\ OODEc..Y/..ßENZ6VE" sULr-ë.N4'Æ' ;a.~'S-S--.3ð-C 3) ?' PRðfVL&\JE ~Ü'c...ø1.- Z~ 2ló$"' - ïl - g. %Wf I ( ( AHM [ ] [ ] [ ] lO)LOCATION IN ,.. 'íÞ/ t..oc:'Y\DnA Sf DC "~I""p....,C£S5 >ië><2A.6E ~ 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: .ç::¡ LM.. ç::-( K. 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL 111 Hazard Categories FireJø7] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic)~ 5) WASTE CLASSIFICATION (3-d.igit code ûom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ Liquid ~ Gas [ ] Pure [ Mixture ~ Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FAC~ ..1"\ Maximwn Daily AmOW1t ~ Average Daily AmOW1t 4e) Annual AmOW1t 17....C>iJ Largest Size Container Ä # Days on Site '< ~ UNITS OF MEASURE Lbs [ ] Gal ~ ft3 [ Curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature to , 4 Circle Which Months: All Year, I, F, M, A. M, I, I, A. S, 0, N, D 9)~: Li~ the three mo~ hazardous chemical components or any AHM components COMPONENT 1) ÁM""'ONltJ.v\ îJ-{loc..<¡JAN'A;:rE 2) Ärt1,M.ON, VIV'\ '"T\-\ r os () (..F.ð.:ïE 3) .soD,vl'Vt S'u.:..F.TCË CAS# t762-~-4- "'7~3- 19-~ ?7S'7-~n -? %Wf (S- Iê) ~ AHM [ ] [ ] [ ] lO)LOCATION (IOS,Oe- 6'~~~s 5~ ~ r certitÿ W1der penalty ofJaw, that I have personally examined and am familiar with the infonnation on this and all attached docwnents. I believe the submitted infonnation is true, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date HAZARDOUS MATERIALS INVENTOjy e . Address . .' Business Name Page_of_ , CBEN.nCALDES~ON 1) rNVENTOR Y STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: +lEL1U~ 3) DOT ## (optional) Chemical Name: AHM [ ] CAS ## 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure £2a.- Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code &om DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ Liquid [ Gas P1] Pure~ Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILlTY 4 Maximum Daily Amount 43 Average Daily Amount"Z... , Î Annual Amount '2- ( ..., Largest Size Container 2.. , ì ## Days on Site 56~ UNITS OF MEASURE Lbs[ ]Gal[ ]~ Curies [ ] 8) STORAGE CODES 4 a) Container: _ b) Pressure: z.. c) Temperature 4- All Year. J. F. M. A. M. J. J. A. S. O. N. D Circle Which Months: 9)~: Li~ the three most hazardous 1) chemical components or 2) any AHM components 3) COMPONENT CAS# %Wf AHM [ ] [ ] [ ] lO)LOCATION 11\1<;,\)(; ?~q-öp~S <;.~ ~ I) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: ¡.JÞtl.Þt?.OOJS 0J.A-YTC 3) DOT # (optional) Chemical Name: s: ( L VC~ AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL rn Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) fe1 5) WASTE CLASSIFICATION DOl ( (3-digit code &om DHS Form 8022) USE CODE 40 6) PHYSICAL STATE Solid [ ] Liquid ~] Gas [ ] Pure [ Mixture [ ] Waste~ Radioactive [ 8) STORAGE CODES a) Container: b) Pressure: c ) Temperature 10 7) AMOUNT AND TIME AT FACILITY Maximum Daily Amount 10 Average Daily Amount 10 Annual Amount !eoo Largest Size Container lð ## Days on Site 3"-S" UNITS OF MEASURE Lbs [ ] Gal [€,,] ft3 [ ] Curies [ ] f 4 Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D 9)~: Li~ the three mo~ hazardous 1) chemical components or 2) any AHM components 3) COMPONENT Sf (.uC~ CAS# %Wf ARM [ ] [ ] [ ] IO)LOCATION ¡N$ftX. P«&rof(l.()c.c:-ss S~ ~ I certiJÿ under penalty of law. that I have personally examined and am familiar with the infonnation on this and all attached documents. 1 believe the submitted infonnation is true. accurate and complete. PRINT Name & Title of Authorized Company Representative Date Signature ý. ~. e State of California - California E~vironme~tal Protectio~ Age~cy e Department of Toxic Substances Control Page 1 of -¡ ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION FORM o Initial ~ Amended FACILITY SPECIFIC NOTIFICATION For Use by Hazardous Waste Generators Performing Treatment Under Conditional Exemption and Conditional Authorization, and by Permit By Rule Facilities Please refer to the attached Instructions before completing this fonn. You may notify for more than one permitting tier by using this notification form, DTSC 1772. You must attach a separate unit specific notification form for each unit at this location. There are different unit specific notification forms for five of the categories and an additional notification fonn for transponable treatment units (ITU's). You only have to submit forms for the tier(s)/category(ies) that cover your unites). Discard or recycle the other unused forms. Number each page of your completed notification package and indicate the total nUlliber of pages at the top of each page at the 'Page _ of _'. Put your EPA ID Number on each page. Please provide all of the information requested; all fields must be completed except those that state 'if different' or 'if available', Please type the information provided on this form and any attachments. The notification fees are assessed on the basis of the highest tier the notifier will operate under and will be collected by the State Board of Equalization. DO NOT SEND YOUR FEE PAYMENT WITH THIS NOTIFICATION FORM. I. NOTIF1CATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific notification forms you must ,attach. Conditionally Exempt Small Quantity Treatment operators may not operate units under any other tier. Number of units and attached unit specific notifications for each tier reported. A. Conditionally Exempt-Small Quantity Treatment (CESQT) D. B. --'- Conditionally Exempt-Specified Wastestream (CESW) E. C. Conditionally Authorized (CA) F. Permit by Rule (PBR) CEo-Commercial Laundry (CE-CL) Conditionally Exempt-Limited (CEL) n. ' GENERATOR IDENTIFICATION EPA ID NUMBER CA'K -º Q Q. .Q .Q!fl¿ 7 L BOE NUMBER (if available) H_HQ_ -...:. _ _ _ _ __ COUNTY JJA~Æ.f!.e.Ai5· -::#r'd'ðC4 0 41DO WHITt:.. LAAlé "8Ak'êJ!$F I~LD Ke:/?JJ CA ZIPqð30~ - FACILITY NAME (DBA-Doing Business As) PHYSICAL LOCATION CITY CONTACT PERSON ðflmes (First Name) ""u~ÆI (Last Name) foS PHONE NUMBER<-)~- O~l MAILING ADDRESS, IF DIFFERENT: COMPANY NAME DUAL..E.)(;, ¡All!.., . STREET 4020 ô"" æRu,o UE:£K ""DR. 87'é., 2/1 CITY VLlt€f.t AM STATE lJe ZIP 2,7703-_ COUNTRY CONTACT PERSON (orny complete if not USA) . }l4lffl/~ (First Name) "DRISKILL.- (Last Name) PHONE NUMBER(îélJ4J'¥ -..sl405 DTSC 1772 (lJ96) Page 1 I;i '" EPA ID NUMBER f!..AÆ .ÛOS 37 I e Page 2 of;l m. RADIOACTIVE MATERIALS OR WASTE YES o ~ Does the facility use, store or treat radioactive materials or radioactive waste? IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Example;' Use either one or two SIC codes (a four digit number) that best describe your company's products, services. or industrial activity. 7218 Industrial launderers 7384 Photofinishing lab First: 59/2 'K.€l"A"~ cS"1D.é'e. Second: 7.3i~ 'P/lDTOPRÒ(!£ ßSIHG LJ4,d V. PRIOR PERMIT STATUS: Check yes or no to each question: YES o Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? o Do you now have or have you ever held a state or federal hazardous waste facility full permit or interim status for any of these treatment units? o Do you now have or have you ever held a state or federal full permit or interim statuš for any other hazardous waste activities at this location? o Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you are now notitÿing fòr at this location? o Has this location ever been inspected by the state or any local agency as a hazardous waste generator? ~ 1. g' 2. fI- 3. ri 4. ri 5. VI. PRIOR ENFORCEMENT mSTORY: Not required from conditionally exempt generators or commercial laundries. YES o ; Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders resulting from an action by any local, state, or federal environmental, hazardous waste, or public health enforcement agency? (For the purposes of this form, a notice of violation does not constitute an order and need not be reported unless it was nt)t corrected and became a final order.) , o If you answered Yes, .check this box and attach a listing of convictions, judgments, settlements, or orders and a: copy of the cover sheet from each document. (See the Instructions for more information) VU. ATTACHMENTS: Attachments are not required from commercial laundries. œ Œ( 1. 2. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. A unit specific notification form for each unit to be covered at this location. DTSC 1772 (1/96) ..~. Page 2 " " EPA ID NUMBER c..AR 10005<.37 I e Page 3 of Î VllI. CERTIFICATIONS: This form must be signed by an authoriz.ed corporate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per Title 22, California Code of Regulations (CCR) Section 66270.11). All three copies must have original signatures. Waste Minimization I certify that I have a program in place to reduce the volumc, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Pennittin!!: Certification I certify that the unit or units described in these· documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also provide the required financial assurance for closure of the treatment unit by October I, 1996. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. G-c~PON I7~Dt> Name (Print or TyJ( Signature MA I'JAC,E:R OF Pi-IOro FINISH I Nt; Title d-- çc¡ r- / Date Signed IX. REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authoriz.ed to operate 60 days after submitting a complete notification. DTSC may shorten the time period between notification and authorization when the ow~er or operator establishes good cause. !f you need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be automatically effective on the date your completed notification form is received by DTSC. (Use additional sheets, ifnecessary.) , YES o Reason: OPERATING REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the Tier-§'pecific Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION PROCEDURES: . All three forms must have original signatures, not photocopies. You must submit two copies of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section, HQ-lO Attn: TP Notifications - Form 1772 400 P Street, 4th Floor, Room 4453 (walk in only) P.O. Box. 806 Sacramento, CA 95812-0806 You must also submit one COpy of the notification and attachments to the local regulatory agency iJ,1 your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record:- PLEASE, DO NOT SEND YOUR FEE PAYMENT WITH TIllS FORM. DTSC 1772 (1/96) Page 3 " .' y e EPA ID NUMBER C.I4ROOOOQõ.3'11 e Page "-'- of J CONDITIONALLY EXEIVIPT - SPECIFIED W ASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c» The Tier-Specific Fact Sheets contain a summary of the operating requirements for this category. Please review those requirement,; carefully before completing or submitting this notification package. UNIT ID NUMBER cm)C ~ v UNIT NAME lIðflÞEI1! Y &R/L ~. Container(s)/Contaìner Treatment A;ea(s) NUMBER OF TREATMENT DEVICES: _ Tank(s) Each unit must be clearly identified and labeled on the plot plan attached to Fonn 1772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or highest amount treated in any month. Indicate in the narrative (Section II) if your operatiollS have seasonal, variatiollS. I. W ASTESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or .;¡ 0 0 gallons YÈS' D o o M' ~ 0 '1. 0 2. D 3. D 4. NOTE 5. ~ NOTE Is the waste treated in this unit radioactive? Is the waste treated in this unit a bio-hazardous/infectious/medical waste? Is remotely generated hazardous waste (HSC 25110.10) treated in this unit? The following are the eligible wastestreams and treatment processes. Please check all applicable boxes: Treating resins mixed or cured in accordance with the manufacturer's instructions (including one-part and pre-impregnated materials). Treating containers of no gallons or less capacity that contained haµrdous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. Drying special wastes. as classified by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. Magnetic separation or screening to remove components from special waste, as classified by the department pursuat\t to Title 22. CCR, Section 66261.124. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (To be eligible for this exemption, this waste cannot contain more than 10 percent acid or base by weight.) (Effective January 1, 1995). 6. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the food processing industry. (Effective January 1, 1996). Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. 7. Silver recovery fromphotofinishing is completely exempt from authorization requirements if the quantity treated is 10 gallons or less in any calendar month. Do not complete this f0!'ß1 if you qualify .for this exemption. (Retain documentation verifying your eligibility for this exemption, súch as developer invoices.) DTSC 1772B (1/96) Page 10 " / ~ o o o o o o EPA ID NUMBER C,A,fa005.3'71 8. Gravity separation of the following, including the use of tlocculants and demulsifìers if: a. The settling of so1ids from the waste where the resulting aqueous/Jiquid stream is not hazardous. b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less than 25 barrels (42 gallons per barrel). (NOTE: AB 483 (Ch 625, 1995) allows certain used oil/water separation under"new the CEL category. See Form 1772L and CEL Fact Sheet.) Neutralizing acidic or alkaline (basic) material by a state certified laboratory, a laboratory operated by an educational institution, or a laboratory which treats less than one gallon of onsite generated hazardous waste in any single batch. (To be eligible fot conditional exemption, this waste cannot contain more than 10 percent acid or base by weight.) Hazardous waste treatment is carried out in quality control or quality assurance laboratory at a facHity that· is not an offsite hazardous waste facility. A wastestream and treatment technology combination certified by the Department pursuant to Section 25200.1.5 of the Health and Safety Code as appropriate for authorization under CESW. 9. 10. 11. 12. e Page..?' of Î CONDITIONALLY EXEMPT - SPECIfiED W ASTESTREAMS UNIT SPECIFIC NOTIFICA nON (pursuant to Health and Safety Code Section 25201.5(c» Please enter certification number: (See Appendix 5) The treatment of fonnaldehyde or glutaraldehyde by a health care facility using a technology combination certified by the Department pursuant to section 25200.1.5 of the Health and Safety Code. Please enter certification number: II. NARRATIVE DESCRIYfIONS: Provide a"brief description of the specific waste treated and the treatment process used. m. YES ~ o ~ o o 1. SPECIFIC WASTE TYPES TREATED: S,LVER -l3éA~I1.Jb, wA&-té. So/.,u-noAlS c:::'EMEf A-""~D /!,y iwe -1/0£1,( ¡:J1/1)1Þ'pRtX!.-c;SS/Kb t-Aé. 2. TREATMENT PROCESS(ES) USED: &LVE~ let ~\JE,eý UAlrr l.rr:¡{~/~/Nt¿, Z MEïALLlQ... 'RE.PLA~EMEA1.'" C!fJr£-rRJÎ)b¡gS /N ~€;R¡(::"S . RESIDUAL MANAGEMENT: Check Yes or No to' each question as it applies to all residuals from this treatment unit. NO D æ( o 5f o , 1. Do you di!¡charge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/sewer? 2. Do you discharge non-hazardous,aqueous'wasteundeF an, NPDES permit? 3. Do you have your residual hazardous waste hauled oUsite by a registered hazardous waste hauler? If you do, where is the waste sent? Check all that apply. ~ a. " Offsite recycling " 0 b. Thermal treatment 0 c. Disposal to land 0 d. Further treatment 4. Do you dispose of non-hazardous solid waste residues at an offsite location? I 5. Other method of disposal. Specify: DTSC 1772B (1/96) ,- Page 11 ". , , " EPA ID NUMBER r.A.e~O 0.53'1/ e Page Lt of7 CONDITIONALLY EXEMPT - SPECIFlED W ASTESTREAMS UNFF SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulations adopted under RCRA ([We 40, Code of Federal Regulations (CFR)), Choose the reason(s) that describe the operation of your onsite treatment units: o œ" 2. 0 3. 0 4. 0 5. 0 6. ri o o 1. The hazardous waste being treated is not a hazardous waste under federal law although it is regulated as a hazardous waste under California state law. The waste is treated in wastewater treatment units (tanks), as defined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264.1(g)(6) and 40 CFR 270.2. The waste is treated inelemeÍltary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/seweringagency or under an NPDES permit. 40 CFR 264. 1 (g)(6) and 40 CFR 270.2. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Part 260.10; 40 CFR 264.1(g)(5). The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. 1 (c)(2)(i) , and the Preamble to the March 24, 1986 Federal Register. 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. 1 (g)(2) , and 40 CFR 266.70. 8. EmptY"'container rinsing and/or treatment. 40 CFR 261.7. 9. Other: Specify: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more infonnation. YES o fØ" Is' this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Fonn 1772E to this page. DTSC 1772B (1/96) Page 12 '~~ ~, ., ' e e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rdFloor, Bakersfield, CA 93301 FACTLlTYNAME WALGrR&JS ~%C ADDRESS 4lðO c..,J'-{I-r-e- W FACILITY CONTACT \SRAD ~ INSPECTION TIME INSPECTION DATE t30(C; fš PHONE NO. 3(~..- 34 ( BUSINESS ID NO. 15-21 0- IJ~ NUMBER OF EMPLOYEES ¡ S- - Z2) . . Section 1: Business Plan and Inventory Program " o Routine !f<=ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate permit on hand Iv .,-¡ C-IL P--C1l.M Il V ..... Business plan contact information accurate Visible address Iv' Correct occupancy '/ V' ~ 9ß'('A. rJê;;Q oN I NSPEc5cenJ Veritication of inventory materials Verification of quantities r/ 081 Pn,.Jfþ 0tJ I '-J~ P E~ 'Tr cµJ Veritication of location V u Proper segregation of material Verification ofMSDS availability V'" .- " Verification ofHaz Mat training vi ~ 'J wa 11.TC-N ""(12A,,J I ,J(; R6::øn.ð~ SiGIJél> () ...... Veritication of abatement supplies and procedures V Emergency procedures adequate V Containers properly labeled V Housekeeping / ~ f'LGt\<;€ Sf>:...(/(2..6' +{&UVfVL (y/,t NDC-a....... Fire Protection (~ 'Dé) tJoí ßLðo:: Fi f2.E ex, '( IN ß,tJ.c,t<- Site Diagram Adequate & On Hand ./ k:- C=Compliance V=Violation AnYhaz~onsite?: ~es ONo Explain: Ie.. ¡::;iCØL ~'i"t2- \Vhite - Env, Svcs. Yellow - Station Copy Pink - Business Copy ite Responsible Party Inspector~ W'AI'E.:s Questions regarding this inspection? Please call us at (80S) 326-3979 _ ~ -,~_ '1-" -.- ~". ." .', , '" J' l' .rf' '·"11 , q ...". ,.< ' , . .'."'... ,i CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 9330 I FACILITY NAME WAtkf¿W ~ ç.3%Ö ADDRESS 4fOO t..J'-<."i1:" (..A) FACILlTYCONTACT ~~() ~ INSPECTION TIME INSPECTION DATE 4/"3o(q f( PHONE NO. 3'1~..... ð 34 r BUSINESS ID NO. 15-21 0- IJ~ NUMBER OF EMPLOYEES IS;- - Z.Ò Section 1: Business Plan and Inventory Program o Routine tíCombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA nON C v COMMENTS Appropriate permit on hand V fiC--lê... Pé-~Mlr Business plan contact intormation accurate v Visible address .,¡ Correct occupancy '" V eritìcation of inventory materials ,...,. 9ß"fþ.. itJé:::I;) ðN 'lJsp&-;r~ Verification of quantities r/ ~ì A .".J(!;!> oJ , øJSPE~ 7'. cµJ Verit1cation of location Iv u Proper segregation of material Verification of MSDS availability ., ,... .... Verification ofHaz Mattraining IV ~ ') W12. ,m-AJ '"'(QA, ¡¡J f AlG R~M $rG4.lél> Verification of abatement supplies and procedures V,;-" / Emergency procedures adequate J/ Containers properly labeled ,V Housekeeping '~ t>LGAse Sf:::¡::.JJ£J€" 4£.(" ( VM~W NOC-t2....... Fire Protection ~ 'J)¿) ¡JoT &ð(t: F'ir¿e eXIT ;N ßAc-1<- Site Diagram Adequate & On Hand r.I oK:- C=Compliance V=Violation White - Env, Sves, Yellow - Station Copy Pink - Bminess Copy / 1/ ite Responsible Party . Inspector:q IC>AJ~ LJ'Né.:s Any haz~Pt!s waste. on site?:· fiÞY es 0 No Explain: ~Ic.. ¡:;J<GfL tA.l!As,,1"'éE-- Questions regarding this inspection? Please call us at (805) 326-3979 e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENT AL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor. Bakersfield, CA 93301 FACILITY NAME W'kL6æ.GJ:s. lÞ-33bê) INSPECTION DATE 4(30 Ie¡ ð Section 4: Hazardous Waste Generator Program EPA 10 # c..ÆR....OOOOO~71 o Routine ~ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made ¡/ EPA ID Number (Phone: 916-324-1 n I to obtain EP A ID #) ¡/ Authorized for waste treatment and/or storage V Reported release. tire. or explosion within 15 days of occurance AliA Established or maintains a contingency plan and training V Hazardous wastc accumulation time ti'ames Iv Containers in good condition and not Jeaking :t/ Containers are compatible with the hazardous waste .v Containers are kept closed when not in use V Weekly inspection of storage area vi" Ignitable/reactive waste located at least 50 feet from property line N(A Secondary containment provided c/ Conducts daily inspection of tanks V Used oil not contaminated with other hazardous waste AliA- Proper management of lead acid batteries including labels 01K Proper management of used oil filters ;J/Æ Transports hazardous waste with completed manifest V Sends manifest copies to DTSC V Retains manifests for 3 years V Retains hazardous waste analysis for 3 years V Retains copies of used oil receipts for 3 years ~ h- Determines if waste is restricted tì'om land disposal Å fA A I /I " C=Compliancc V=Violation i /Lç¡/ Inspector~Af/.ù ¿.J~""€5 Oftice of Environmental Services (805) 326-3979 B~~in~~Õ;ite Responsible Party \\'hite - Env, Svcs. Pink - Business Cory ,} e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME W-f\..C....6«C......) (S :lF3 "'S'-C INSPECTION DATE 4(30(c;~ Section 5: o Routine Hazardous Waste Tier Permit Treatment Program qjCombined 0 Joint Agency 0 Multi-Agency o Complaint ORe-inspection Onsite Treatment Unit Tier: o PBR 0 CA ~CESW Unit number & name: o CESQT 0 CEL o CECL OPERATION C V COMMENTS All hazardous wastes treated are generated onsite V Onsite treatment notification fonns available and complete V Onsite treatment unit tier and/or count is correct on fonn "- Unit number is correct on notification tonn '" ~ Number of tanks or containers is correct on fonn ') I.Jtw «ð C#t:ék::. ~S Treatment monthly volume is correct on fonn /v ~-c.C.-...J,\ SYs~ C~ Waste identification & treatment is correct on fonn I Complies with residual management requirements V Properly closed a treatment unit tJ!A Complies with tank and containment certification "/!Ik Developed and maintains a written inspection log pi" Meets pretreatment standards for waste discharge V ~ n(2t11 cJ/~(fV VtAs1€W"A-~ Developed and maintains a Closure Plan on site (POR) .:::::: ==-- ;" /\flk Developed and maintains a Waste Analysis Plan and Waste Analysis ( Records (POR) ") Maintains Training Records on site (POR] / Obtained local penn its for treatment operations JPOR) '- ~ Identifies and labels Treatment Units (POR) ( c~omPIi;caliOO Inspector: . L.AJ1 ¡"}6'<) Office of Environmental Services (805) 326-3979 CA=Conditionally authorized CECL=Conditionally exempt commercial laundry CEL=Conditionally exempt limited White - Env, Svcs, CESW=Conditionally exempt specified wastestream CESQT=Conditionally exempt small quantity treatment PBR=Pennit by rule Pink - Business Copy