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HomeMy WebLinkAboutBUSINESS PLAN 2/1/2003 Per it Operate to Hazardous Materials/Hazardous Waste Unified Permit e CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-5lte Treatment PERMIT ill # 015-021-002137 INAS I MICHAEL DDS LOCATION: e Issued by: \\ ",: FIELD CA \", t '_1\~' r"i r-<; ~ 'i t: -:t E r '-~ ¡4i * lJ 93309 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30, 2003 ".,'II-- . ,-" ,~ .'~ ~J ' rr'- ~~'.. .::;- <g I ±. iffi - ~--' ---- -~._- . e, ._-+-1 . (- 5ITé(¿rt:!.~(37 SITE DIAGRAM ~ J F"'~ DIAGRAM [ I Business Name: 'I. It- J.1 {CftAE. L ,D. 5 .' Business Address: '110 (-~m+1 T£ LA-N ¡;, # ~ [I ELD I CA- Cf'?3o '7 S ,.Je /. b. :t± 2(37 11 f N ~~ ï~ C3 - r-~ ~t '?" . - - ~- ~ - ~ --.... _.=::::",,.-..; - - - -.- , - - § j~ JJ @ 1ß .-~ cf.Cò r..:. )- \- 1 - 1 ~ ;f, f. 1 ~ '1 i ~~ ~t cgl@4 ®~ * ® iP[- JV) ~-- PROJECT: 11 acre neighborhood shopping, center located in the heart of rapidly growing southwest Bakersfield. _OCATION: Stine Rd. and White Lane Bakersfield, California TENANT MIX: Builders Emporium Lucky Food Center Additional Shop and Pad Space TOTAL 28,500 SF 42,792 SF 38,700 SF 109,992 SF (11.42 acres) Proposed Parking-576 Spaces _ICINITY MAP .. 1 , <~ tp ,1- 1 2 3 4 ,.~¡:., ò 3,200 SF 2,000 2,000 1,400 .. SF SF SF SF SF 2~0' 20' 40' 25' 2~ SHOP BUILDING NO.1 )rl'E Center Properties 11726 San Vicente, JG70 Los Angeles, CA 90049 213/207-2017 < Figures show'n are based on anticipated squar~ footages, Actual square footages may change in the final plans. N" ~ EñiBuilders ponum ~ FOOD CENTER 42,778 SF. 2I,5DOSF 4' ~ ¡ < (fffffft) ~t 1,200 SF 3 ò :. N< " .. 1,200 SF 2 b !,' N c GttttH IIIIIIIUIIIIII SHOP BLDG. NO.1 ''',200 SF ¡~~~i ~~:.~.~. . Q cI: o a: w Z I- en '-, ' . " '. ~. ',' Per . ... .. -t' . 't"':':::"::'" "0 t i·O peril. e PERMIT ID # 015-021-002137 INAS I MICHAEL DDS ;/ " ' LOCATION Issued by: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ~ Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment 4701 Issue Date Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: /.;2-/ ¡-Òò . June 3J), 2003 :- ...., . -.. .." ~ c. ~ ~m J~ Uj e . . SITE DIAGRAM ~ . FðCILITY DIAGRAM r 1 Business Name: :¡1JA-~).1/ cltA-F--L ( f)JJ5 Business Address: 410 ( 'JJHI -rr¿ LItN~1 #ß ~ PI êLD I (.4 q?3ð i !~ ~ <.~ C3 ---, ~~ ~'Z ~ \L\ . ~ , -;?' > -~ - - ~ -- ----.." -=--- -" - --- v j @ ~ j~ ~ ! jJ @ _:___ -11-1!J1 i r-:- )- \- 1-ð . --'.~~ - . - - . - ffi G}--~· -- --.- ---- ~, ~ U t N ~[ JV\ --.- e (3 INAS I MICHAEL DDS SiteID: 015-021-002137 Manager : Location: 4701 WHITE LN B City BAKERSFIELD BusPhone: Map : 123 Grid: 14D (661) 833-1500 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title INAS I MICHAEL DDS / OWNER MARGARET KOOP / OFFICE COORD Business Phone: (661) 833-1500x Business Phone: (661) 833-1500x 24-Hour Phone : (661) - x 24-Hour Phone : (661) - x Pager Phone : (. ) - x Pager Phone : ( ) - x Hazmat Hazards: React -.- ---. ~ - - ~. Contact : Phone: (661) 833-1500x MailAddr: 4701 WHITE LN B State: CA City : BAKERSFIELD Zip : 93309 Owner INAS I MICHAEL DDS Phone: (661) 833-1500x Address : 4701 WHITE LN B State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì p= Hazmat Inventory f== Alphabetical Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP WASTE FIXER R ,~ 'I.fJft-~P3~~~ Do hereby certify that I have reviewed the attached hazardous materials m~mage.. ment plan for.Dl\. J:NÞr s Ii ¡ ~dLthat it alOfñ11fll with .' (Name of Bu8ineas) . .. any corrections constitute a complete andcorred man- agement plan for my ~œ~~ö1ty. L 5.00 GAL Min ~~ ~ 2-~/-ù.3 - -1- 01/30/2003 ....j,.;ß; ~~ /' ,. · CITY OF BAKERSFIELD .- OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 1. 2. 3. 4. 5. HAZARDOUSMATEIDALS~AGEMENTPLAN .,~C bf'a ~V~ð ~All?~ 0 ¢ <'01' r)A, tlO \'~ ~~C - ~8 INSTRUCTIONS: To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the ql,lesti()ns b~lo~ for th_~ business as a whol~. ~ ~ ___ , Be as brief and concise as possible. ~ ' --- .. .,- You may also attach Business Owner / Operator Form and Chemical Description Formes) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: If J1t5 Þi/clfAf=.L . [).0.5. , will í£ LANE:-. $U/íE- 1ÞB , .5A+'\ E.: LOCATION: 4-iol MAILING ADDRESS: CITY: ßA-K£.RsFI EL-D STATE: ~ZIP: r3:S0)ÞHONE:~'I) Y3?-/5"ðð PRIMARY ACTMTY: Deniz¡ ( ofh'ce OWNER: Dr. J:V\tlS Mìch.~el PHONE: MAILING ADDRESS: - ~ tL~~ -,~. , .-' ~ - '- -. --~ --....-- -- ---=-~.,..-,.....----- ---,.- -,- - .- - ...~ ---- . ..~ -- -- _._._~ -~ - -~.- - EMERGENCY NOTIFICATION CONTACT BUS. PHONE 24 HR. PHONE TITLE !JwY1U' (ZG¡}'F?,3-/5Jò ßC;r) ~!12- /'Sió '£I IJ3-/5'ðcJ 'hb/) ?~?-/5òcJ 1 ~. - . . HAZARDOUS MATERIALS MANAGEMENT PLAN (0 ....~~ '- SECTION II.I: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: ~ Dit-€A- ~~ ~ itjAli¡ ~. . eøJ-~ I W~ u... ~ .;, ~ JA.. <1? ~. . . B. - -, EMPLOYEEAND-AÒENCY NOTIFICATION: -- ?~. f1/w. If 4 .t;- - IiAwJ<i.lÆt'1'¡! ~ìakuJd U\ -MIS 0 fP'csL . .JfíW.e ~ -&oJ¿o.øe. vi ¡-k lj.~ if ¡'s (};t<./mluu/¡'¡u ~__ M- ~ 'f/te_1f-aq¿ifù' IJ1kA.I1JUld~ if ¡'S ct /IiI'\ _ ~'j.eAA 'Jj ~'fII^. . :;;I....lf,pff'(L '1 .WI VI' (o~ $VtV1'(e.ð wi1u1t/ ~ cd/erI· . ." . - - . - . .. . .. c. ENVIRONMENTALRESPONSEMANAGEMENT~ -- - - - - :J/le ~;jee..- wÁo c-ÁJu;'ØM fh jt/.&t ¿vi 1/ J/ð/Jê:; ~, tIu.. ~ I ao.wdß fLt) ~ ~ -f c~~ 1~ ~~-tAfi~·· --- - _.~.... -".~ ---~ - -"." D. EMERGENCY MEDICAL PLAN: _ ~_ h.. _1 / ' II' /~ J ___ // _1 -;u- I ~ /Cd - --P"V.ACi..£ZJ' If tf /1 - --0' --7V'---p.e -~f e£«. dlt k ~ -k/ff!¡'þt/S : ¡¿µC I .5:'a.., Jaar't....I rÞM ).(ew.plllo) ksjt/-ztls .)¡~& ~~ .]Ae/IL ¡'S tU1 "£-~Á <¡;MdY¡ þ /,eased úJ~ ~1é0 udI /UJ tU1 ~~ ¡'/¡;;v44f. :J1u.. J1~ (')1\ ~ Ill15'Ì)S 'I 7zfJn1 ~S' ß ~ &/101 ' If 2 I "- " /~ . . HAZARDOUSMATEIDALSMANAGEMENTPLAN -.'< -:- SECTION 11.2: RELEASE RESPONSE PLAN . A. HAZARD ASSESSMENT ~ PREVENTION MEA~~S: C~n.i~ ~f-aM¡LV-ð tVlJL r°F'1 ¡~de.Ø. . [r>'c~~œL> ClAA- ~tAcf<ei <À FF:'- fvu..dt~'! "6 ~àh ~ ~'0 /1J (~ )vlÇb); j¿-¡J4ItA ./~ tÄSJ~ ¿fP1ew- I ~¡'a.I· c~'ca.! ~ ~ ~-e ~ .itA ~CC/)(-dOA<:.o {D v~ ~clJiA Q Ý I S ¿ÞVJt;ui~ . RELEASE C6NTAINMENT AND/OR MITIGATION: . ~etW -C/.Æ<L ,jo.sÍïudul- ~ fŒCaJJJ1'6v\C>.. r;j µM/I.IIQ.o b a¡¡Úél ~Sa/vL, -rt.,A Me. 10 W{of~ID~ I Scf.t¡ . ~ I ~ pÚO/-ecJ,,:;}J cJO~· wk tJ-A/1'ß <'1 e~, B. c. ~E;-:=VE~O~~~ ~ ~ W1J k &vJ-o.k.J . v U ~_¿Ct:.Ni.;().,.O ¡,~e (ß~LM4 W-R4,' _X-~ .Ço~hÓY\ ~ V~, k, --I (j ~70pv~ DI). rfl¡.$ ~ I CA- q:33o 9 UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) NATURAL GAS/P.F.OP ELECTRICAL: Urn W ÄT~R:'-' e! SPECIAL: L~CK ~OX: YES~ ,__ ---~..-- - . ..- - - - ...--- - ~ - -. .. - -. . -.- "- --... -. -- --- --- .---.- -- - - PRIVATE FIRE PROTECTION/W A TER AVAILABILITY A. PRIVATE FIRE PROTECTION: h Ie .e.Xh~ u/)),. ~ I aJvz "fA-. , B. WATER AVAILABILITY (FIRE HYDRANT): tulu;J-ft¿ Cily i ~/;. 'ell r.tIld-;fi tf/u-. ~, ~ t1N-. ~ ~ .ø4 :J~ dJ1 ~I ~ f A .bw:U;y ~ -tdz ~u-h èb. , ~ ;¡ ¡ '~ . . .:t " ~ HAZARDOUS MATERIALS MANAGEMENT PLAN " SECTION III: TRAINING NUMBER OF EMPLOYEES: lalD MATERIAL SAFETY DATA SHEETS ON FILE: - ..1-~ the /a i> ð raÁ:rCj BRIEF SUMMARY OF TRAINING PROGRAM: . . f I _ _ _ . J__~ S' ~s/vA~ . I_ ¡;~1&D ~ Sk!Ø1 fk. /d-ù N~~ LJSd (Iv ~ òPf;'ú.. ~ kw !o dßkc/- /edÞf7'e.. ClA4' ~ ro~~h;;~~ t. g~';þl' 01rk._ ~kt'Y 1;~~~' , I~(/ "&J a/<-,H>;{ðtu71 r'(J) .Io(an~ -() fPUL /'7~ V 3· bý!f0 LU1.LI A ttJ jj fed f,{ e /Il · 6Y\ ß~ 0 'o/~Íi¡jcld Ìil ¡b t/.S£ ð! pro kcJ-r'1/-'L q. t'^fl!J1jeð ¿ute LA, ~çµ ~ fV'..etlS'~1 ~ tt8 c:;4 . I ~/ I fWl~ < )'('- ~ ~) w~ iG " GditM ,. cat.s . .. ' .. s .£ff0tJ~, o/e-, ùl<lÞ¡iAcfed ¿I H#~US~ ..c1 ~~e;¡s~lI -~ f· (: ðìt h/WfjU~l\e#Lh~, tlYtrL.. ~1fJ"J.vt d:f5"f¿fflll?J ed7i1(JS. CERTIFICATION I, ::c /J A-S N { CI-I-A-E-t . CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGA TrONS 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. . -- - - , ' ~_ ~ òb f OI/.JNlA- . I SIGNATURE .. TITLE /1- é)Lf -- 2<:>0 ¿) DATE 4 ,.~ -4 ..--1 - ',~ . e . CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITYNAME lrJ^S J, ADDRESS A7() f ¿N~'TC:: FACILITY CO NT ACT R. T ð INSPECTION TIME f'A fC"i4fL t.rJ a-ß (;;)....." ,.- \0 \£<..::""1 INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES I tÁ !-z..OeJI:) . ^Çc,.J IJV c:. l~)~ Section 1: Business Plan and Inventory Program -~'- - ~--- '""- -- --~--~~--=----- ,~:'Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate penn it on hand ¡...J tx-> p«(¿~ ,.,.... Business plan contact infonnation accurate ? ~A .. ~ (J( ('ïé (} (. c.. "'>t' 1-1....4/ «- 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 V eriftcation ,of abatement-supplies-and procedures ,- - - - - - -- --- -- ----"--~- Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand ?t..c-:^s6 cc.>"'-t f'( C--nE ..:\ Mt.\,c...... C=Compliance V=Violation Any hazardous waste on site?: µtYes 0 No Explain: I/JA ') "f('.- PI x m .:- "- ,/ ç '_AI,....) Questions regarding this inspection? Please call us at (661) 326-3979 White - Env, Svcs, Yellow - Station Copy Pink - Business Copy ~. ~:)l~ '----r>r-:-, í,_' /¡¡\ r: I,' I: Business Site Responsi1Jle Party Inspector: &J / .....rC-",> . ~.,~ , . . CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INAs. :¡:, JV1tC.f.(AéL, DDS , INSPECTION DATE l ,/7 12..c:WV , I to/k Section 4: Hazardous Waste Generator Program EP A ID # ~Routine o 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 v ((L<=Me f>@.ð\J, r:> é ,,. It r/ rR.A'fJ 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 trom land disposal ---- ~- C=Compliance V=Violation Inspector: W/~ Office of Environmental Services (661) 326-3979 White - Env. Svcs, ~~·bl Busmess lte esponSl e Party Pink - Business Copy e e INAS I MICHAEL DDS SiteID: 015-021-002137 Manager : Location: 4701 WHITE LNB City BAKERSFIELD BusPhone: Map : 123 Grid: 14D (661) 833-1500 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code: DunnBradi Emergency Contact / Title Emergency Contact / Title INAS I MICHAEL / DDS / Business Phone: (661) 833-1500x Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: React Contact : Phone: (661) 833-1500x MailAddr: 4701 WHITE LN B State: CA City : BAKERSFIELD Zip : 93309 Owner INAS I MICHAEL DDS Phone: (661) 833-1500x Address : 4701 WHITE LN B State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì p= Hazmat Inventory p== As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP WASTE FIXER R L 5.00 GAL Min -1- 12/04/2000 e e SiteID: 015-021-002137 ì Facility Unit: Fixed Containers at Site ì F INAS I MICHAEL DDS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit INSIDE REAR OF OFFICE UTILITY ROOM Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 5.00 GAL Daily Average 5.00 GAL HAZARDOUS COMPONENTS CAS # I 7440224 %Wt. I Silver ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS -2- 12/04/2000 ,~- þ Inas L Michae~ D.J. ,'"" General Dentistry 4707 White Lane Suite B Bakersfield, CA 93309 (805) 833-1500 ." " e I ?-J-- ,~1J 7A-' F\~ CITY OF BAKERSFIELD FIRE RTMEN OFFICE OF ENVIRONME ÄL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME (,.J'A..S ;r,. (V\ (cl-fAEL- ADDRESS 476 ( Wl-ffTTE- W 4- .B FACILITY CONTACT 12--' TA fbiE-e-r- INSPECTION TIME INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES ll/¡ I~ , , ¡JLCvJ 4- Section 1: Business Plan and Inventory Program )3-Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate permit on hand NG..J ?&l.M-I<l Business plan contact information accurate P<-CA.<s.f Q:yt...PLC..,-e ~ k.Å1 L. 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 ft..C~G ~(.l.?fC=- ~ MAt L.. C=Compliance V=Violation Any hazardous waste on site?: pt.Ves 0 No Explain: Wit¥) 'îG- Fi xCl'L. £- ~ Questions regarding this inspection? 'ase call us at (661) 326-3979 White - Env, Svcs, Yellow - Station Copy Pink - Business Copy ~~¡--r;ø~;~t) , Business Site Responsible Party Inspector: L.-J I ~ - ~ ~.._~ ""~~, ---, --- .",..-.:~,.,.'- - . I ?-)- II..\~ /4 ~\~ ,- INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES (fA I~ , FACILITY NAME , ¡JArS .:r # f\'\ (C~Ae-c..... ADDRESS 47Ò f W~T'tE: ,-"J oCt- ß FACILITY CONTACT {ttTð. fo'lE£:-' INSPECTION TIME AK-c..J 4- Section 1: Business Plan and Inventory Program ~outine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate pennit on hand NG-> "'P~.-r- Business plan contact infonnation accurate PCCAsf ~Pl C""-é ~ M..A I L - 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 f<...C-ASG ~-P(C-n:- ~ 1\01 ¡AI L- C=Compliance V=Violation Any hazardous waste on site?: Explain: Wk"Y;-(;- Ff xUè 9lYes DNo (~ 6A9 Please call us at (661) 326-3979 White - Env, Svcs, Yellow - Station Copy Pink - Business Copy ) Business Site Responsl Ie Party Inspector: ¿.-J / ;.../"'C~ Questions regarding this inspection? e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ¡tJAS J:,. /VI fC-#Aé:L-/ D 05 INSPECTION DATE U/7/~ , f tJ!4- Section 4: ~outine Hazardous Waste Generator Program EP A ID # o 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 t/ v ~L<:S.tMe .p@"ðVI t;> G tr ,t T~,A. 'r 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: W I ~ Office of Environmental Services (661) 326-3979 While - Env, Svcs, ~I_'~ J ~ !! .I Business Site Responsible Party Pink - Business Copy 226 227 o Yes 0 No 228 229 2 230 231 DYes 0 No 232 233 ¡ 3 234 235 oYesoNo 236 237 4 239 DYes oNo 240 241 5 242 243 DYes 0 No 244 245 a CITY OF BAKERSFIELQa OFIIK:E OF ENVIRONMENTAL S.VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~EW , DADD D REVISE 200 D DELETE , ,,' ,,>::¡;I~~~~l,"1~Jj~< "'<;;;~'~~::~t\r):i:;~jl~~(:ti\~~~Äêir~)N~Ó~Äffi~;';;S,f;i':~~tJ~i;"'Y" BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business AS) , ", . ., . IN 6c.S T , ;';. .-.. Iv'/ (CI-{A8- I DOS I (JJ5(DE of:' cf=fìC.E 1 MAP # (optional) (j tf"1c...l-rY ~ 203 2011 CHEMICAL LOCATION :,;:~};:if~ ,,~',! .. ;:,;.<\::~~~~)'i";".~¡. "'ìNFÓRMÃtìON :'\~Y<;~'-~Í';>'( ,;_ ,,_ .,.....~'J...!~,,;(>;:'!,,':-!c'\.' """"',,< CHEMICAL NAME ~~ ç; f..-eL 207 COMMON NAME CAS # 209 FIRE CODE HAZARD ClASSES (Complete if requested by local fire chief) TYPE o P PURE o m MIXTURE 211 RADIOACTIVE DYes ONo WASTE PHYSICAL STATE LARGEST CONTAINER ~ ogGAS o s SOLID JOUID 214 FED HAZARD CATEGORIES (Check all that apply) ANNUAl WASTE AMOUNT o 2 REACTIVE o 3 PRESSURE RELEASE 04 ACUTE HEALTH o 5 CHRONIC HEAlTH 01 FIRE MAXIMUM DAILY AMOUNT ogaGAL OdCUFT . If EHS. amount must be in Ibs, S"' 217 218 AVERAGE CAlLY AMOUNT o Ib LBS o In TONS UNITS· STORAGE CONTAINER (Chack all thaI apply) ~T1C1NONMETAlLlC DRUM Of CAN o g CARBOY o h SILO Om GLASS BOmE o n PLASTIC BOTTLE o 0 TOTE BIN o P TANK WAGON o I FIBER DRUM OJ BAG Ok BOX o I CYLINDER o a ABOVEGROUND TANK o b UNDERGROUND TANK o c TANK INSIDE BUILDING o d STEEL DRUM STORAGE PRESSURE ø. AMBIENT o ba BELOW AMBIENT o as ABOVE AMBIENT STORAGE TEMPERATURE (ona form par material par building or araa) Page 01 .~. . 3 o Yes 0 No 202 204 o Yes 0 No 208 210 212 CURIES 213 215 216 219 STATE WASTE CODE 220 221 DAYS ON sITe 222 o q RAIL CAR o r OTHER 223 224 UPCF(7/99) S:\CUPAFORMS\OES2731.TV4.wpd ~~ r i INAS I MICHAEL DDS __ ~_ 4701_WHITE LN_ STE B _ ~~ ~~?~ ~.l ~~ ~, ~,~ ,~, ~~~' .. ~o~ ~~ UNfr~9'tD PROGRAM INSPECTION CHECKLISTr~ B E R S F, o _ _ _ _ -- - - ilBE SECTION ~1: Business Plan and~inventory Program !~ ~RrM ' Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301~~NN?~ ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPEC ION D TE INSPECTION TIME N ~s M i G H F~ E c_ 15 e ADDRESS PHONE NO. NO OF EMPLOYEES ~~ '~ O ( IN H / T'E L ~ `~3 3 3 - ~ ~ FACILITY CONTACT - BUSINESS ID NUMBER ~j 15-021- a l -, ./ - ~ ~ ~ Section 1: Business Plan and In en#ory Programs ~' ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliances OPERATION V=Violation COMMENTS ^ ~ APPROPRIATE PERMIT ON HAND lJcs a G ~~ ~ r o r ~ ~4 t ~.- ~ftl ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ 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 ~: s ~, ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND rcer-auis ANY HAZARDOUS WASTE ON SITE? YES ^ NO EXPLAIN: ~ C'S~ ~~?~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / ' In /Shift of Site/Station # Business Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ,~~. _~r ?` T~`" CITY OF BAKERSFIELD FIRE DEPARTMENT ~ OFFICE OF ENVIRONMENTAL SERVICES b .y UNIFIED PROGRAM INSPECTION CHECKLIST tr•~,'~gti,,~~~ 1715 C1-ester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ N obs ~ ! ~. t-t AE ~ D D S Section 4: Hazardous Waste Generator Program ^ Routine .~ Combined ^ Joint Agency INSPECTION DATE ~ 1 ~ o EPA ID # ~~'`'P ~ ^Multi-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~E c~ P ~' 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 /-J Secondary containment provided 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 ~ ~ ~ ~~ y ~ , ..~ Retains manifests for 3 years x .. ~~ S~ 1 w ~ Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal =~ompuance v=vtotanon l~ ~. ~~~ Inspector: J`~ Office of Environmental Services (66I) 326-3979 White -Env. Svcs. Pink -Business Copy Business Site Responsible arty + MICHAEL DDS INAS I __________________________________ SiteID: 015-021-002137 + Manager Location: 4701 WHITE LN B City BAKERSFIELD BusPhone: (661) 833-1500 Map 123 CommHaz Minimal Grid: 14D FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title INAS I MICHAEL DDS / OWNER MARGARET KOOP / OFFICE COORD Business Phone: (661) 833-1500x Business Phone: (661) 833-1500x 24-Hour Phone ( ) - x 24-Hour Phone ( } - x Pager~Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 833-1500x MailAddr: 4701 WHITE LN B State: CA City BAKERSFIELD Zip 93309 Owner INAS I MICHAEL DDS Phone: (661) 833-1500x Address 4701 WHITE LN B State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG H - HAZ WASTE GEN D~ ~~ ~~~ V O" ~ b ~, Based on m in uir f tho y q y o se individuals ~G~ _ ..responsible for obtaining the information, (certify /J ` -~ under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. 5- Z a -~~ ENS ~~~ a 1 Signature Date 006 t=====_________________________________________________________________________+ -1- 05/19/2006 " Jr~~ ~i ~ ~ 'r 4 F MICHAEL DDS INAS I SiteID: 015-021-002137 Manager ~~ . ~NA-S ~ < <~~ ~- Location: 4701 WHITE LN B City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 833-1500 Map 123 CommHaz Minimal Grid: 14D FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title INAS I MICHAEL DDS / OWNER MARGARET KOOP / OFFICE COORD Business Phone: (661) 833-1500x Business Phone: (661) 833-1500x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact :1~•,.f ~ !~/~G ~~~ Phone: (661) 833-1500x MailAddr: 4701 WHITE LN B ~ State: CA City BAKERSFIELD Zip 93309 Owner INAS I MICHAEL DDS Phone: .(661) 833-1500x Address 4701 WHITE LN B State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN EI~T°D ~ ~ ~ ~ s 2~0~ :..`o ,.y r, ~.~-,,~ in,~ttiry of those individuals ~r ~,t~.taining the information, 1 certify p ; y t ; ,~~~~ i, ~ ~ ,~;~,t~, la~;r,a!ty of law that I have personally ,,,an-,.rci a„,c~ am familiar with the information ; sb.,t:~p;e,s3~f and ,~~iievc the information is true, accurate, and complete. c~ ~~ Date ~i%'~r"~!Ur£' -1- ~ 02/05/2007 f' F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Min -2- 02/05/2007 -3- 02/05/2007 F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ ~= Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: UTILITY RM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL ru~~xtu~vua ~vl~ir~iv~iv'1 oWt. RS CAS# Silver No 7440224 riHGl~l[L A~5L'"7a1~11'~1V"1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/05/2007 F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/11/2000 ~ USED FIXER IS PLACED IN TIGHTLY SEALED CONTAINER, WHICH IN TURN IS PLACED IN A TUB. Employee Notif./Evacuation _ 05/19/2006 THERE ARE NO LIFE-THREATENING MATERIALS USED IN THIS OFFICE. IF THERE IS LEAKING OF THE FIXER IT IS CONTAINED IN THE TUB AND THE HAULER IS INFORMED AND IT IS A NON-EMERGENCY SITUATION. THE OFFICE OF ENVIRONMENTAL SERVICES WOULD BE CALLED. Public Notif./Evacuation 05/19/2006 THE EMPLOYEE WHO CHANGES THE FIXER WILL NOTIFY ME, THE OWNER, AS WELL AS THE HAULER FOR CHANGE OF CONTAINER AND CLEAN-UP, IF NECESSARY. Emergency Medical Plan 06/01/2006 FOR MEDICAL EMERGENCIES, 911 IS TO BE CALLED. ALL THE LOCAL HOSPITALS: KMC, SAN JOAQUIN, AND MEMORIAL HOSPITALS HANDLE EMERGENCIES. THERE IS AN EYE WASH STATION TO BE USED, WHEN NECESSARY, AS WELL AS AN EMERGENCY FIRST AID KIT. THE PHONE NUMBER ON THE MSDS FORM IS TO BE CALLED. -5- 02/05/2007 F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/19/2006 ~ CHEMICAL CONTAINERS ARE PROPERLY LABELED. EMPLOYEES ARE INSTRUCTED IN PROPER HANDLING OF MATERIALS AND HOW TO READ MSDS FORMS BEFORE USING A NEW MATERIAL. CHEMICALS ARE TO BE USED IN ACCORDANCE TO MANUFACTURERS INSTRUCTIONS. Release Containment 05/19/2006 EMPLOYEES ARE INSTRUCTED IN PRECAUTIONARY MEASURES TO AVOID EXPOSURE. THEY ARE TO WEAR GLOVES, SAFETY GLASSES, AND PROTECTIVE CLOTHING WHEN USING A CHEMICAL. Clean Up 05/19/2006 USE OF EMERGENCY SPILL KIT AND THE HAULER WILL BE CONTACTED. HAZARDOUS WASTE COMPANY USED: X-RAY SOLUTION SVC INC, 4700 EASTON DR 45. Other Resource Activation -6- 02/05/2007 F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~~ec:ldi na~arus Utility Shut-Offs 12/29/2006 A) GAS - E SIDE OF BLDG B) ELECTRICAL - CONTROL PANEL BACK CLOSET OF OFFICE C) WATER - E SIDE OF BLDG D) SPECIAL - N/A E) LOCK BOX - NO Fire Protec./Avail. Water 12/29/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER AND ALARM. NEAREST FIRE HYDRANT - CONNECTIONS FOR WATER HOSES W SIDE OF BLDG. Building Occupancy Level 05/19/2006 2 EMPLOYEES -7- 02/05/2007 ., ~~ F MICHAEL DDS INAS I SiteID: 015-021-002137 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/01/2006 ~ MSDS SHEETS ON FILE IN THE LAB. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE SHOWN THE LIST OF HAZARDOUS SUBSTANCES USED IN THE OFFICE AND HOW TO DETECT LEAKAGE AND THE PROTECTIVE MEASURES TO BE USED. EMPLOYEES ARE INSTRUCTED IN THE LABELING OF CHEMICALS. EMPLOYEES ARE SHOWN THE LOCATION OF THE MSDS ON FILE AND HOW TO READ THEM. EMPLOYEES ARE INSTRUCTED IN THE USE OF PROTECTIVE MEASURES, SUCH AS, SAFETY GLASSES, GLOVES, MASKS, AND PROTECTIVE CLOTHING WHEN HANDLING CHEMICALS. EMPLOYEES ARE INSTRUCTED IN THE USE OF EMERGENCY SPILL KIT AND CONTINUOUS REMINDERS ARE GIVEN AT STAFF MEETINGS. rayC a nciu tvi ru~u.ic vac nciu .~vi ru~.uic ~5c -8- 02/05/2007