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HomeMy WebLinkAboutBUSINESS PLAN 7/23/2007•~ ' -' ,~ ~ ~ ~. ® RANDY J. JELMINI DMD ~t '%'~t}:" ' ,' 4801 WILSON #C _ 0~+ •l .,. J JELMINI DMD RANDY J SiteID: 015-021-002360 Manager DEBBIE MORRIS Location: 4801 WILSON RD C City BAKERSFIELD BusPhone: (661) 832-1877 Map 123 CommHaz Minimal Grid: 11A FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8621 DunnBrad: Emergency Contact / Title Emergency Contact / Title RANDY J JELMINI DMD / OWNER DEBBIE MORRIS / OFFICE MANAGER Business Phone: (661) 83 2-1877x Business Phone: (661) 832-1877x 24-Hour Phone (661) 80 5-0895x 24-Hour Phone (661) 834-8974x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact RANDY J JELMINI Phone: (661) 832-1877x MailAddr: 4801 WILSON RD C State: CA City BAKERSFIELD Zip 93309 Owner RANDY J JELMINI DMD Phone: (661) 832-1877x Address 4801 WILSON RD C 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 ENT°D J U ~. 2 5 2 ~~T ~a~'d on rr'' inryuiry of those individ~~als res~cnt;y!e for ^,taining +he i:,formati und + er ~er:.ItY or,, i ccrfify cf ia~:~ that I have Personally QxBmined and am familiar with ±h S e infcrmation ~omi`ted and beiiere the infor a mation is true, ccurate, and comclete. Sig ah re ~ ~'Ct°°- ~~%~ Date --"~ -1- 07/12/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ 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- 07/12/2007 -3- 07/12/2007 ~i F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ 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: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Waste ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# Silver No 7440224 iltiGtiRL HJ ~J I:+iJ J1°1r+1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 r F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/18/2006 ~ CALL OSHA 916-486-0429 Employee Notif./Evacuation VERBAL TO EXIT. 03/19/2007 Public Notif./Evacuation CAL-OSHA 916-486-0429 04/18/2007 Emergency Medical Plan 05/18/2006 DESCRIBED IN OFFICE OSHA MANUAL. MERCY HOSPITAL 632-5000, 911, CAL OSHA 916-486-0429 -5- 07/12/2007 r F JELMINI DMD RANDY J SiteID: 015-021-002360 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 05/18/2006 SELF-CONTAINED UNIT THAT DRAINS DIRT FROM X-RAY MACHINE. THEY SIT INSIDE A PLASTIC PAN INSIDE THE CONTAINER. NEW FIXER IS STORED UNDER MACHINE. USE RUBBER GLOVES AND SAFETY GLASSES WHEN CHANGING OR ADDING TO MACHINE. THERE IS NOTHING ELSE STORED IN THIS AREA. 9 Release Containment 06/01/2006 WE ONLY HAVE THIS FIXER AS HAZARD WASTE IN THE OFFICE. IT IS STORED UNDER THE X-RAY MACHINE IN THE DARKROOM. NO OTHER PRODUCT IS STORED THERE; THEREFORE, WE DO NOT MOVE IT AROUND UNLESS WE ARE USING IT WHEN CHANGING SOL. OUR X-RAY MACHINE HAS AN AUTOMATIC INFILL LINE AND DIRECT RELEASE ILINE TO EMPTY STRAIGHT INTO THE CONTAINER, SO WE HANDLE THE FIXER ONLY ABOUT ONCE A MONTH. Clean Up 05/18/2006 CLEAN UP WITH SPONGE. EMPLOYEE WILL USE GOWN, RUBBER GLOVES, AND SAFETY GLASSES. MATERIAL WILL BE PLACED IN THE PAN AND CALL JIM WARREN TO TAKE IT AWAY. Other Resource Activation 03/19/2007 911 -6- 07/12/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~7~JC 1:1d1 I1dGdi US Utility Shut-Offs WATER, GAS, AND ELECTRICITY: NE CRNR OF BLDG 03/19/2007 Fire Protec./Avail. Water 04/18/2007 NO FIRE HYDRANT ON SITE Building Occupancy Level 04/18/2007 15 -7- 07/12/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/18/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: THE CALIFORNIA DENTAL SOCIETY SPONSORS A 4-HR CLASS WE ATTEND EVERY JANUARY CONCERNING OFFICE SAFETY, INFECTION CONTROL, AND PATIENT PROTECTION. rays t. Held for Future Use aactu ivt ru~utc v7c -8- 07/12/2007 . J r ~ ~ \ ~~ F JELMINI DMD RANDY J SiteID: 015-021-002360 Manager DEBBIE MORNS Location: 4801 WILSON RD C City BAKERSFIELD BusPhone: (661) 832-1877 Map 123 CommHaz Minimal Grid: 11A FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8621 DunnBrad: Emergency Contact / Title Emergency Contact / Title RANDY J JELMINI DMD / ~ ~~`~ ~ DEBBIE Nf~Yd~S-~a~ aS / OFFICE MANAGER Business Phone: (661) 832-1877x Business Phone: (661) 832-1877x 24-Hour Phone (661) 805-0895x 24-Hour Phone (661) 834-8974x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact RANDY J JELMINI DMD Phone: (661) 832-1877x MailAddr: 4801 WILSON RD C State: CA City BAKERSFIELD Zip 93309 Owner RANDY J JELMINI DMD Phone: (661) 832-1877x Address 4801 WILSON RD C 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 ~ ENT D ~ P R 1 7 2007 Based on my inquiry of those indi~tidual~ resp9nsib!e for obtaining the information, 1 certify 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. ~M Date - '~ Sig atu -1- 02/01/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ 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- 02/01/2007 -3- 02/01/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ 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: DARKROOM CAS# Liquid TWaste ~ AmbRient~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL iuyc~rucLVUJ l.Vl•1rV1VAlV 1D °sWt. RS CAS# Silver No 7440224 I1tiGt1RL H.7.7~5,71~1L" 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/01/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/18/2006 ~ CALL OSHA 916-486-0429 Employee Notif./Evacuation 05/18/2006 CAL OSHA 916-486-0429 - rur.~iic.: 1VVl.1t . ~ r,Vc1C,L1dL1OII Emergency Medical Plan 05/18/2006 DESCRIBED IN OFFICE OSHA MANUAL. MERCY HOSPITAL 632-5000, 911, CAL OSHA 916-486-0429 -5- 02/01/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 05/18/2006 SELF-CONTAINED UNIT THAT DRAINS DIRT FROM X-RAY MACHINE. THEY SIT INSIDE A PLASTIC PAN INSIDE THE CONTAINER. NEW FIXER IS STORED UNDER MACHINE. USE RUBBER GLOVES AND SAFETY GLASSES WHEN CHANGING OR ADDING TO MACHINE. THERE IS NOTHING ELSE STORED IN THIS AREA. 9 Release Containment 06/01/2006 WE ONLY HAVE THIS FIXER AS HAZARD WASTE IN THE OFFICE. IT IS STORED UNDER THE X-RAY MACHINE IN THE DARKROOM. NO OTHER PRODUCT IS STORED THERE; THEREFORE, WE DO NOT MOVE IT AROUND UNLESS WE ARE USING IT WHEN CHANGING SOL. OUR X-RAY MACHINE HAS AN AUTOMATIC INFILL LINE AND DIRECT RELEASE ILINE TO EMPTY STRAIGHT INTO THE CONTAINER, SO WE HANDLE THE FIXER ONLY ABOUT ONCE A MONTH. Clean Up 05/18/2006 CLEAN UP WITH SPONGE. EMPLOYEE WILL USE GOWN, RUBBER GLOVES, AND SAFETY GLASSES. MATERIAL WILL BE PLACED IN THE PAN AND CALL JIM WARREN TO TAKE IT AWAY. Other Resource Activation -6- 02/01/2007 F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, .~j/c~.iai nac,atu~ Utility Shut-Offs 12/13/2006 WATER, GAB, AND ELECTRICITY: OUTSIDE BLDG NE CRNR L'liC rLVI..Ctr~HVd11 Wdl.Cl I ~~ ~~'ar~j ®~ S~ ~~ tsuilaing occupancy Level -~- 02/01/200 ~ ~ t F JELMINI DMD RANDY J SiteID: 015-021-002360 ~ ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/13/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: ANNUALLY ~~ ~ c~..~ ~~~~ ~ ~ ~ ~ ~ ~ ~ ~~ Q~~~ rayc G nClu LV1 rUI.UIC U~S'C nC1U 1VL r UI.ULe Use -8- 02/01/2007 %~ ~b ~. ~ U FIED PROGRAM INSPECTION CHECKLIST ; ~~~~ ._.., .:. .SECTION 1: Business Plan and Inventory Program ~ BARERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPEC ON DA E INSPECTION TIME ADDRESS y-~ o I ~ I a_sa,., ~,,~ ~ ~ HONE NO. X32 - 1~7~ O OF EMPLOYEES FACILITY CONTACT 1~ Z? ~Iv~ 2 2 SINESS ID NUMBER 15-021- v le t S Section 1: Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( =eonipli~) OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ~7 _ ^ BUSIII@SS PLAN CONTACT INFORMATION ACCURATE '~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY % ^ VERIFICATION OF INVENTORY MATERIALS -- t: Z~ ~j ^ 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 ANY HAZARDOUS WASTE ON SITE? AYES ^ NO EXPLAIN: `~ GI S'~~ ~~'~C p f - - --- QUESTION~GARDING THIS INSPE~~CTIONT PLEASE CALL U8 AT (807) 328-3978 Inspector (Please Print) Fire Prevention / 1" In % Shift of Site/Station k White -Prevention Servieas Yellow -Station Copy Pink -Business Copy FD20~8 (Rw. 02/05) +~,. ~ ~0~~` T~" CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ ~ OFFICE OF ENVIRONMENTAL SERVICES ,~ , • ~ UNIFIED PROGRAM INSPECTION CHECKLIST ~;;~`~gti ~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 FACILITY NAME_ R may ~e L m I +o ~ INSPECTION DATE -3 ~ 1 '~ I ~ 7 Sectaon 4: Hazardous Waste Generator Program EPA ID # ~XE'~"~'fi ^ Routine `-~l Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number --~ X E +~- P 1 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 aze 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 Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste N Proper management of lead acid batteries including labels /~ Proper management of used oil filters JJ Transports hazardous waste with completed manifest Sends manifest copies to DTSC ~{- J1w ~9i/~4/1 Retains manifests for 3 years ii '' jj SGIhT`ov~ 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=violation Inspector: ~ ~~` ~" °`"' ~ ~ Office of Environmental Services (661) 326- 979 White -Env. Svcs. ~~ ~'~~ Business Site Responsible Party Pink -Business Copy ~i ~I. :.:,(""'.~7"..".'. ", ~""",, ¡ r'- lJ.::,l--" I ~ C'1J. :. '("~W" Y ì. "" ,. ',( , , ' ...., ~~."""'.,. t _:," --~- -'- - I ,- -'.... ~~ fl· ~. z,.?It. z,. General Dentistry 4801 Wilson Road, #C Bakersfield, CA 93309 O/lúe: (661J KS2-IKll· ?,u: (661J KS2-1Kl4 eett: (661J K05-0K95 " /., . // RAÑD"~ J. FELMINI, DMD' . --.--...,. ¡ r-- j ~. -'.'-':'.."" SiteID: 015-021-002360 Manager : Location: 4801 WILSON RD C City BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: 'è 't~~) ~~'\ BusPhone: Map : 123 Grid: 11C (661) 832-1877 CommHaz : FacUnits: 1 AOV: SIC Code:8621 DunnBrad: Emergency Contact / Title Emergency Contact / Title RANDY J. JELMINI / DMD DEBBIE MORNS / OFFICE MANAGER Business Phone: (661) 832-1877x Business Phone: (661) 832-1877x 24-Hour Phone : (661) 805-0895xCELL 24-Hour Phone : (661) 834-8974x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: -. Contact : MailAddr: 4801 WILSON RD C City : BAKERSFIELD Owner Address City RANDY J. JELMINI, DMD : 4801 WILSON RD C : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to Emergency Directives: React Phone: (661) 832-1877x State: CA Zip : 93309 Phone: (661) 832-1877x State: CA Zip : 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No ',tf2((utdJ_ Je-\M~~ì Do hereby certify that I have ífY}e or print namø) revi~weçi the attachsd halardous mQt~r¡Blls manage- ment P~1f'! ~Oli' ~t\~ Sc\~·.~ ~~and th@nt i~ ~~jf'ag with (NiJi"ë of Ðu0ine8ß) My œ~Dcms ronstitut~ a oomple~~ and correct man- ag~mÐurt plan ~©r my fBldlity. ~~ ?-)~/Q7 Data -1- 09/26/2003 ;~~W DADO D DELETE , e CITY OF BAKERSFI~ OFFICE OF ENVIRONMENTALSERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 j1n1())7 fI1!I () I ¡ SQD/, .5 (one orm per material per building or area) Page 'of, HAZARDOUS MATERIALS INVENTORY CHE~ICAL DESCRIPTION í\ D REVISE : 200 ,:; ~ è' I. ~ACILITY ìNFQRMA TION . "-''''''',,-'' :--ËïUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) :---K tM\. tl ~ '> I' 3 203 I 2011 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID # (optional) o Yes ~o 202 204 ". ' .,< ,'; '''\-<,~ "'~ - ,', ' .. , , . , . .- ',. ^ II. ;C.HEMICAL'INFORMA TION ' Pr~~~ (I¡'.LW\ 1'h ':Ojv. rf~~ fe <;0; ( ¡,tll1 Su. Pi tre.._ . ,I 205 : TRADE SECRET 0 Yes );;l' ·'0 206 i ~' I If Subject to EPCRA, refer to instructions 207 ' , '-I EHS' DYes 0 No -208 I 209 I ·[1 EHS i.·Y es, . all amounts below must be in Ibs. ; CHEMICAL NAME ç; -j... -tr'" - %1m_ pÿp~e~s,~¿- COMMON NAME ç: I-J... -e ("" CAS # 7 7 7 7 57 ..... ~ i FIRE CODE HAZARD CLASSES (Complete if r uested by local fire chief) , fV<ò1- bcchJ~- TYPE O. p PURE 0 m MIXTURE 210 ~ WASTE 211 RADIOACTIVE DYes ~ 212 CURIES 213 PHYSICAL STATE o s SOLID ~IQUID o g GAS 214 LARGEST CONTAINER 5' 215 FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE 04 ACUTE HEALTH ~ CHRONIC HEALTH 216 MAXIMUM DAILY AMOUNT t AVERAGE DAILY AMOUNT 3> 219 STATE WASTE CODE 220 09aGAL OdCUFT . If EHS. amount must be 'in Ibs, ' o In TONS j DAYS ON SIT 221 '5 ~S 222 STORAGE CONTAINER (Check a/l that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM ~PLASTIClNONMETALLlC DRUM Of CAN o 9 CARBOY o h SILO o i FIBER DRUM OJ BAG o k BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON o q RAIL CAR o r OTHER 223 STORAGE PRESSURE ~MBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT 224 STORAGE TEMPERATURE o a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC 225 ~F;,.'~,:~:~f,YY~'.-i>{?Xo<";~;_ ~"";,. ~ ' f: ~ "'. ". ...':: "'AZAR6ol:is"¢OMR0NENT,;;'~ ;.;~¡-, ';-._,- .:./;" - " "-"'}";'-<;~~'-sf /_:\":0, :, .,,"J"",' .:"(", q !lJfJ-)O~ CAS # , -~- ... ,',' '"~- I 2 230 i- 3 234 238 242 227 o Yes ~o 228 231 DYes rtt No 232 235 OYes~ 236 239 DYes 0 No 240 243 DYes 0 No 244 229 233 237 241 245 SIGNATURE ~- 246 s- -10-02.-, UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd I CITY OF BAKERSFIEI6 o ICE OF ENVIRONMENTAL ~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION G-S J./~Ór 0/5:- ðdl- ÓOd3foO'7~ Page _ Of : FACILITY ID # I Year Beginning i I I ¡ BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) ___ "KlA M'1 :r J" d W\(V'I ¡ D. m .1> , SITE ADDRESS LJ ð"D J L ) I /)IJY) ¡¿d ..¡{G ßCtkefS~ ._--~-~--~ t FACILlTY.IDENTIFICA TION .;¡ Dó "l....- '00 ; Year Ending 101 L-.ð:>v 3 i BUSINESS PHONE '---102" I ~6J- f"3;;l-a-ì)._________ 103 104 ¡ CA I ZIP q 3"oQ, I 106 I SIC CODE - I (4 Digit #) ---- ; CITY , 105 DUN&· I BRADSTREET , q 5" - 3 Çlo ':i'z>5'~ J~ ern 107 ' . COUNTY 108 : 109 OPERATOR PHONE ",> /"'<"', '~<.y.:: ,:_, , '~·{!~'\::·~;?~~::~{F ',-"?~'<.':':,;vy/;·:,-, rJ-'ßx!;~, JI:'OWNE:R,INFORI\1I~TIQN!;~/';:;>'; >;!,;' , ',._, -,', _ '.". ,; Y'"L ; _ ,,_ _" " y/.. ...,'-- ,,'~ .,~ ~6'- P3~ - t/lh2- 112 ¡ ; I 113 I t 116 ! OWNER NAME , "J d vy\! V\.l 111 ¡ OWNER MAILING ADDRESS ì rd e.. i CONTACT NAME I CONTACT MAILING ¡ADDRESS , i I CITY 120 STATE Co...... 121 D , , ~'}"'!;{'~ .~- "'. .,<'''. ""._ ~ -::\.:',_,:{&,~<,,·>.D',,\<».~~,,-::::.,~::;,,;--'~;:-/ yA-.--~:'"i'-\t)¡;t\<~·-:·:,-Y>€!h'i··}~þ(<<.,,· ,., . !,', , ' """:""".,,.',:,',·,'.l',:,.;...,-:",',',',.~,.:,.,.',;...~,:,',:,<,'.',;,;i.~!,t:,',.',:,'.,.",~:.',',.,.......,..p. ,.",..',R,'.·.,.,','.'",', M..·','.^~,,',A,,'r· ,.,,~,.,.y,è:,.,',_,..~.:.,'.,.'.,.,....:.'.',:...:.:,:..'.'.',;,:.{,$,',',:.',','":;.',.,:.',',:.~:".....,,:,',:,·..,.,:,...:,·:.i.":,,.;,.,~~.".",':.;::;5;JV¡.~ EMERGENCY;CONTACTS;',,· ',." ';.~;:'·r:,;'.:sECONDARY- .c >_.C~"" '" :,~.;-, . . "T~"'Yf"< _~'V_ : ' h-:::¡'_,,<':1&:-¿t',tT:Q:¡>- ·";,.Y';;Ä·i_'-\·~~"\ "~,~,-\":'-~·:z.~':~~~C;~'-~":.;..::;;:_;_,:,_~·i('';--,:-,)..;<,;;L__':'^'-i~'-'-'---'--" ".:' .','.. . '-, '. 114 STATE C4.. 115 I ZIP '¡~::i'N¥i~~~!~~ÍE~:~~~~~~t~~fti";;::·~';5;}:E;;~ :,. 117 CONTACT PHONE 119 , 123 NAME 129 i I TITLE 125 TITLE 130 126 131 :l 127 132 , 128 8AGéR # 133 : I f- , Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. ~ATU~E OF OWNER/ PERATOR DATE 134 NAME OF DOCU¥ENT PREPARER .~ 5-ID '02 1) NAMES OF 0 136 TITLE OF OWNER/OPERATOR ..:\~<' / "~",..:" :_~.,,:. ~ i";.'--; . I;..~,:· ~:~?C ..' I I 135 I 137 [ ! r- UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd 1- ;. e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATEIDALS MANAGEMENT PLAN INSTRUCTIONS: /~3 ..II {2; 7 1. To avoid further action, return this form within 30 days of receipt. 2. TYPEIPRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief ~d concise ,as possible. 5. You may also attach Business owner"! Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~ C\ 111 t\~ :~ T ~\ \1\1\ ì n ,. ~ . \ìì . D LOCATION: SCùYN (1ð h-L/ÕIA) MAILING ADDRESS: ,L{ XV J {¡) ¡' I r<;lIYì. /24 #~ CITY: gQKlli¡'f~ L STATE:~ZIP:~HONE: ~~l-fZ:;L-/ð'77 Q?,30q . PRIMARY ACTIVITY: ~~a. \ o-ft¡(.;e, OWNER: (? GWlt\ lJ J. T L.- \ W\ ; (),' LJ, tn "Ì) PHONE: b~ /i'':';?~,3jJ-t/¡/Øø:L MAILING ADDRESS lj,~6D . 'Ucié4'1i1,filJ. Clf¿J~ :~ßjjK..~;,~!{33 Q'9."~ ?)3 ~ /J ..1 EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 1. \< C\ V\ Å ~ :r f \ w\. ì(\ " 2. »e.bb L f- Yfu (n.s ()WVl~( O+tU_ ~yv g3;L·lt7? f3J-I8-77 1 " 24 HR. PHONE x> 32 - to 9~:2.- f3 ~ - 8 q 'it! ... e e HAZARDOUSMATEmALS~AGEMENTPLAN SECTION 11.1: DISCOVERY AND NOTIFICATIONS i -. .. -. , , . -. . - .. - "-.'-. A. LEAK DETECTION AND MONITORING PROCEDURES:' " :.: C (SYd-e>t:Ü"U ,'S S ~-t--t.. lÌ'\t ~ l ~ ~ 4.. PM\.¡ I J L€-LlI~~ ín~ po.tv\ CtlU 'J'~I'Y\ UClrr~ . -~--,-~~-~-....::;,..,~~~....:..~~------:;.~~~~------"----::-----::-~--- .-~~-- _..--.....,.. ;;:'--:---..--: -.- ---:;- '-~--, - - -- --"------ --~---~ -...--.,..--- --~--- B. EMPLOYEE AND AGENCY NOTIFICATION: ~; V"f' '-*..hd¡ Vy\. CQ / / Or5h~ ql¡' - '-/.Ji -óC(df C. ENVIRONMENTAL RESPONSE MANAGEMENT: JIÌ'Vt <. l.J~ ~ t;l f.tVv\ ¥ ~' f?~'1 :r el W\ It\,( ""_____:;- _-.-'..0.....- --==o:o--~ .--- -~- ~ __ - o' ._. __-.-.__=-_.____ -_ -_-=- - - - -- -- -- -..-.- .- - - - .-. ----;..::...- :--~-=- ..-~-..,.----;;:.-::::.- D. EMERGENCY MEDICAL PLAN: d -{j c-rlb-td (n o+hc..e CJShC\...J \1.)'\- e.x-c¡ '1 ~ ~.} - s-caÕ ~~ q \ , ('CI oS~ t< D¡ t Iø - l{fh - ól{.1- q 2 '" e e HAZARDOUS MATEIDALS MANAGEMENT PLAN SECTION III: TRAINING ,. 0.,.. NUMBER OF EMPLOYEES: _ "L , ': ...J. '. ~. . .. , , , . MA TERlAL SAFETY DATA SHEETS ON FILE: ì N Pr's ()M fA!.... . BRIEF SUMMARY OF TRAINING PROGRAM: It. ~(n to. Ù~eJt SOG . Ovv\ i'\ l.t& () S t) ~ e tr ~d I~nð" Col{~ .,' CERTIFICATION I, 'j)e~(V\ , 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 (DN. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. QJJ(k¿~ SIGNATURE ~~ T~ ~ ~-IO~D '- DATE HAZ MAT MNGMNT PLAN It. INSTRUC 4 _ . . 0 e -- HAZARDOUS MATEmALS MANAGEMŒNT PLAN '. - >:.. -SECTION 11.2: RELEASE RESPONSE PLAN , . I ~ .'~ ',J J :_:,.~ ,....- ,... '-.'.-'-'.'-.' .....~" A." HAZARD AS S'ESSMENTAND PREVENTION MEASURES: . '" . . , .s ~.f- : ~OvcY'le'J. ~{. ~ ~.tu.. ~ i. -f-í o.Y"d ~ ,dr r~ ~ ''I-- ('41 WI tLck, ~Nl. _ ~ S if.s J/f\.ÓrP-e. Do... plits'/-' L ~ ÅM S í ó...L ~ ~'l."'ï er \ -f ¡¡jlS, AJw ¡::¡'t-é( t s S -\or ~& ~ YY\~;< U~ ~~r ~~ ~ s-ll1s.se') L.s£LP.l'l.) wl-\eY\ ~~ D ( tlcU...tnt" _~ yhCL¿h,~ . -th €rt. ì$ ho+h./Ylt -e.l~ S-tor@! 1Y\~...s RELEASE CONTAINMENT AND/OR MITIGATION: tu\.¿ lµ-t.. ~~~ V\illM1.... %\~ ~ 'j..,£r (i~ ~ Cl'L'Li"tl u({.sk- ,-i'\ ~ 0 ~tce , tL· =_,_~~ __<, ~"j::=tfS-'s-4b7~ct -w\i\Jtr'c~- 'f::(r:J.'1W\A:L~ .tM. -dU.- -4~llLy.ð-,,,~ "IUD_~ pro tlu.c..4- l s. "ò-torallf1~, ~ ~ L.H, ~'*- ~ðW-I'+ C{ r()LiflJ ¡ lJIfl Lð~~ lJ -tQAe. 4.& I \1\6 l-t:. w~ tlttOJ{\ M- - $v l , CJù..L ~r14.-i VY\q ~ hb.o OM lL\JOW'\~0 ~ .~ CJ..M.~ J..il'~ r.J~fL Jl~ {...o ~ ò+reurgtt ~~ -tu ~~~i'\eI. So u-l. lA.tl~ ~!.-ry.e.r- CLEAN-UP AND RECOVERY PROCEDURES: (5)\.l-1 aiood- ðhIL ~~~ . ,ê-\-eQ/Y"\ v..p lù¿~ S p~ I €xc\.ploLj ~ ~¡H L<£t ~rt5WY\l -RlLl.lovçþvoc tJ.A~ S~ fkS~,). ~tLknc,.Q L-)<ll ~ pl~ 1h +u.. ~ C1no\ CLLl :r,~ 'UCt[r~ -10 +¡(1.\ú.. í+~CL~,"'" -- ~ -.' ~ ... B. C. UTILITY SHUT -OFFS (LOCA nON OF SHUT -OFFS AT YOUR FACILITY) NATURALGAS/PROPANE: /Uor-Wt £4.~_¿.~ ~~ ELECT~CAL:__tVDr..f1" ~c..~+ ßioL. [Cg(',¡,\ir ~ ß1111dl"";'J' ..w A !E~. _ " _ /IJ 0 r411 '!- Ct£1-._ S { k ( ó rn.v- ~ 4U- ,gu. ì'TJ7lr.- SPECIAL: ~ LOCK BOX: YE~ IF YES, LOCATION: "-~ --- PRIVATE FIRE PROTECTIONIW A TER AVAILABILITY A. PRIVATE FIRE-PROTECTION: +r~ ,e :Â+. ì....~&lA ",s~e~_,... lf1 4)ttr)L ~ ..,1/"' ,- .... B."" WATERA:VAILABILITY (FIRE HYDRANT): , I . >..- -. .......... -..- . 3 ~'-~ t ((1-( ---¡5ì ~ í9~ - .~\ T-e)Mfr.~ OhO ~~l Wtf ) at\- fl4¡ 11--- C- ;) ~ c,n:, -, ~!J'lSO; ( " _~~~ ~I U - - -1 " . 'j" ~ '1' ~r L "":')1' ,.. 'v ; .::..\ I; I, ' ~, ,~ e :' ,._,:..:...._..:...J., ,,':...:,' J.:~ f\<Air'l$. GC() ~1/1 ø IN~ 9' ~ s~ \<IR (' ~ G r'-..J~' ' ,,'«: E I~G+r\'c-i . /) , .' 7f --""'-'-'" I ! G'(9, ~Z'-""1 ¡ ¡ I , i 1 .;f- j ! Q- · <s-- ...~-..-' a .... <:::. A ~ - s; . - ~ - v h ~ '- ,-ð "\ ct· ~ L¡ ~, ,,' ..., ",- iJ', ~. ~ '---" c=:J \ -' ...., ~ ~ ~,~ .~... r.{~,~,~.~'~..; : '-;';.": "~'..,~..;, ~.:~.. EJ c ~ ) , ~ ~ L _J8 I," ~ ~ V:. ~MÄ. 'C9-:.\v~ .:J- ~ eL J qr". :.i=',-==--~'''17''t"; IL:]" '" . :"/"'!~ ,', " ';'" ':';: , _~. ,c~:..-.~-,_ ,. I .', 'l . I: .-; i,t ;', f - ~ :~" :'~ ; ''-'" '0 ¡, <.:J.; ._, N .,' .- !' :~ .-- " :: 'j ~¡ '8:, :, '; J' I I ~,,' ' ' j < <, !i ~.';~~; III - -~ tik ~1 tif I J ç C- ~ "5 ~ o þ, ~(""\ -.9 '>L ~ - ~,."",- tf'\ -_. G;::: G~ t:. =- ~ r=t-~ /J ~t-~ ~t*rcA 1':. f+ J.J¡- -=--- ~~:;,~.~~~~ ~-';·.~:~i·~~.~·:~. ... >- )C'-- <:. ð P- ---" \:"~"""':"""'!'!r~~" í ~ co ,. r.::J '\ '- r- -- ,-I , " ;. .7"- I~.t~ cZ: r- , it; ,~1 . . ti'+ '~:::;:;~'.:~:'.~~~,;·~i~&;~~".!~~~:~ '1 I. S d\1 ± 1 L.., -_......________ ,--- &1 I I 'I' II dL ~:..r"V~ "'1 ~'II -1 I,. c?- ,~ ,., '. ~. q... "1,.) c.- ç:;L X @¡ ~ ~SD5= ~ 1 r:7J,i ,j;, - (ft.~~'" l,W.J: ~ ()~~ ì . .~. " éS'!260/ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd f'loor, Bakersfield, CA 93301 /1)11 /) / f ¡/¡f1 0 /7 5500 I FACILITY NAME ~Y' J. J&M,N/ ADDRESS ~<:6ö I {,.JtL-SOrJ ~ c..... FACILITY CONTACT INSPECTION TIME ¡,)Os INSPECTION DATE 51 ( /07- PHONE NO. gJ<. - {ß'?7 BUSINESS ID NO. 15-210- IV'C-r...J NUMBER OF EMPLOYEES /..J. 3 - / / - C 7 S0~'J Section 1: Business Plan and Inventory Program ?b o Routine l4combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand ~ Pez.,....~r ~In;: Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials ~-TE F, ~Gt. Verification of quantities 6 G.M- M~ / ZV GAL Pet. Y'2- Verification of location INS I~E 0duL. ~ 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 I Ir~ PtC-A.')E" ~1::2.."lct at.. f2h.JG.J ~T.f\kWI5tlC-< Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: ~re Ç',JtC...Q.... /å.Yes 0 No White - Env, Svcs, Yellow - Station Copy Pink - Business Copy Q~~~~rty Inspector: L...J l"'L9 Questions regarding this inspection? Please caU us at (661) 326-3979 " . .' .. .....""~. ~ .,. i I I' I .~" £5'1260/ '. CITY OF BAKERSFIEI..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd (¡loor, Bakersfield, CA 93301 '¡lJ71 () / t ¡l1f:.~ ú /7 ()ÚI 55 FACILITY NAME ~ý .». J~(..Md\f1 ADDRESS -A<6Ö I W'«-sorJ ~ <:... FACILITY CONTACT_ INSPECTION TIME l)fX INSPECTION DA;~ 5/ ( !q-æ- PHONE NO. gJ"'{ - 1%-;, BUSINESS ID NO. 15-210- ¡..¡¡C1...) NUMBER OF EMPLOYEES /;{ 3 -/ / - C 7 SfoJ} Section 1: Business Plan and Inventory Program ?6 o Routine []:Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate penn it on hand rJ6:,.J p-~ '\ '!j\", ~ ri"G Business plan contact infonnation accurate Visible address . Correct occupancy Veritication of inventory materials u..JA<;1'fé ç ft<.C-4. Verification of quantities {; (,AI.. M~ / 2ù GAll Pet. ~ Veri tication of location IN S ¡t:)E Otn!L ~ Proper segregation of material Veritication of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection 11' ?LGA~e- ~"'2..",cI;; at fZbJGJ 6t".,.rJ6..«J¡stI6t. ~ Site Diagram Adequate & On Hand C=Compliance V=Violation , I I Any hazardous waste on site?: Explain: I ~ .,.¡::;. Ç" ,..\(::4- ~_Yes 0 No White - Env, Svcs. Yellow --:Station Copy Pink - Business Copy Q~:~~rty Inspector: k.J'IV'E-S Questions regarding this inspection? Please call us at (661) 326~3979 · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME Þ IL R- J 'f:;Lrv1,,.J I bDS INSPECTION DATE sJ l/O"L Section 4: Hazardous Waste Generator Program EP A ID # Ai/A CA£.... ~ 11l43~ o Complaint 0 Re-inspection o Routine ~ Combined o Joint Agency o Multi-Agency OPERATION C V COMMENTS Hazardous waste determination has been made Au- f '\Gvt.S OE(. 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 ¡/ ?~éf) DUfl.-¡ .Jl,.. I~('~ Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Pink - Business Copy Q.oI!&L~ Business Site Responsible Party Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs. ¿AJ { N'C--::5