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HomeMy WebLinkAboutBUSINESS PLAN Per -- it to Operftte Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the following: 621 Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment LOCATION: 4100TRUXTUN A tt, Issued by: CA 93309 Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES· 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30, 2003 Per - LOCATION: e Issued by: It to Operil.te Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment CA 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: Issue Date I June 31», 2003 ~.I?,'.. . .- ~::i:··' '.,. . '..",;:,,' .\ , " :.' JAN-10-1900 18:07 P.06 --e "'" - SITE DlAGRAM ~ L ~. ~ 8.,...... N " J I } L I 0 ;pt ;;l\ cL T'\ 8''-: (L... FACILITY í \J _ AcIdress" l' ''''' It'" ...c! t>Ot" I ~ DIAGRAM r ~ r...~~ ,1...e .74 ð ' ~./. '- L lJ.¡o-.t...-. ,W d ff :L -:sµ Sty.l \I fJ.. 7 'Ó~ l'-'\ J- \p.(...~~ ("G'- I"~" \ - ..-À.~ 4. ~ +-'--~ ~ ~~ k~Ð- ~ N j ~ : 91 i ' ~---~ - - '. ~ Þ-''f+-- ~, ø 1,Ç'l ~ ó> ct~ ¡~ (3) [....~ .(U!~~~k t. N :if S"þç~\~ \~ ~. <s.r t-c-~ r-. IIM ° MARTIN G wIARTZ, DDS ^~^o ~ j~~ 4100 TRUXTUN AVE #300 _~~. -- t I ~~7~~ ~ ~~ :,:, -~.0~ J, ~~ II ~~ io MARTZ DDS MARTIN G Manager ~r~~~~U~ 4~ Location: 4100 TR AVE 3d0 City BAKERSFIELD CommCode: BFD STA Ol EPA Numb : P.,4 L [1f1t1 f t ~ SiteID: 015-021-002139 BusPhone: (661) 327-8220 Map 102 CommHaz Minimal Grid: 26D FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title ~ ~ Emergency Contact / Title MARTIN G MARTZ DDS / OWNER ~ ~ebbtie ~vtar~"z- / Ot~Jtlets w+~e Business Phone. (661) 327-8220x Business Phone: (fit ) `~q -~bzbx r~^Tre r_T r.~ 24-Hour Phone (661) '.'-~' `-"~'~- `i 24-Hour Phone (~,~1`) 3a4 -~"~ x Pager Phone ( ) ZQ~{ -~ -~x ~; Pager Phone ( ) - x Hazmat Hazards: f React Contact ~~ t ~tj Phone: (661) 327-8220x MailAddr: 4100 TRUX AVE 30d ~ State: CA City BAKERSFIE Zip 93309 Owner MARTIN G MARTZ DDS Phone: (661) 327-8220x Address 4100 TRUXTUN AVE 300 State: CA City BAKERSFIELD Zip 93309 Period to ~ TotalASTs: = Gal Preparers i TotalUSTs: = Gal Certif'd: i RSs: No ParcelNo: ' ' j Emergency Directives: ~ ~ PROG H - HAZ WASTE GEN I ~ ~ ; ; 91`, V ' ENT'D MAY ~. ~ 2007 i3ased on my inquiry o€ those individ~ `ela responsible for obtaining the information, 1 c ~f under penalty of laur that {have perso Ily examined and am familiar with the informo~ ~jion submitted and believe the information is ~ 4~ue, accurate, and complete. . j Signature Date f ! I ~ i ~ 1 ~ ~fl- 02/02/2001 1 1 S ~ MARTZ DDS MARTIN G SiteID: 015-021-002139 ~ ~ Hazmat Inventory ~. By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... ~Spec~az~EPA Hazards Frm ~ DailyMax ~Unit~MCP~ HARVEY CHAMBER CLEANER ~ L 5.00 GAL Hi WASTE FIXER ~ R L 5.00 GAL Min -2- 02/02/200' t F MARTZ DDS MARTIN G SiteID: 015-021-002139 ~ ~ Inventory Item 0002 'Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HARVEY CHAMBER CLEANER Days On Site 365 Location within this Facility Unit; Map: Grid: SPRAY DEVELOPING RESTROOM CAS# STATE TYPE PRESSURE ;.TEMPERATURE CONTAINER TYPE Liquid Mixture AmbientAmbient GLASS CONTAINER AMOUNTS A'L' THIS LOCATION Largest Container Dail:' Maximum Daily Average 5.00 GAL ~ 5.00 GAL 5.00 GAL tlliGHKLVU.7 1.V1~1Y!'J1VI;1V1J $Wt. RS CAS# 85.00 Water Glass ? No 1344098 li.LjGF1K1.J} Ha SL' w7~1~1L"1V 1-J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site q COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site a 365 Location within this Facility Unit_i Map: Grid: SPRAY DEVELOPING RESTROOM CAS# STATE TYPE PRESSURE Liquid TWaste -Ambient AMOUNTS Largest Container Dai 5.00 GAL ~Wt. Silver HAZARDOUS TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER THIS LOCATION Maximum I Daily Average 5.00 GAL 5.00 GAL S RSI CAS# No 7440224 21HGAtCiJ~ A~~La'SS1~1~1V"1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curie's R ~.. / / / Min -4- ~ 02/02/200 F MARTZ DDS MARTIN G -- -- - __ ~ Notif./Evacuation/Medical `'- Agency Notification ~= C(p(p)) ~Z a - 11 ~i $ wilt of ~ Ise cJSn fa-G~cc~.' T~.~.~1.- 0109`1 ~^~ ~~ -1~ -~~l e~ Employee Notif./Evacuation SEND STAFF TO CENTRAL VALLEY OCCUPA MERCY HOSPITAL 632-1540. CALL FIRE SiteID: 015-021-002139 ~ Fast Format ~ Overall Site ~ e ~~-~ar~tnet~-t' w311 be cad\;.~t . Uov.o~ Lo:lscn, 4t e 3 ~tke ~~o pec~ wtR-~, ~e,c ~,r 1~.e,,cY• build+~. 05/19/2006 4100 TRUXTUN AVE 200, AND/OR CALL TMENT AND EMS SERVICE 911. Public Notif./Evacuation 'Pal~'te+tis f~no ace rn~+t6cs,and a« no{- apan,te~ b '' a- ~asenfi,w~tl nee.cl s~~~.f~uEstcti -~ exii- the buyicl7v~y. '~ stn ,ce s~%~~-nernbec will be. G~Si sn~~ ~o u~de -~Ine chilelren e,~ °"f }~e bc~ilc~i~n~ ~ ~'r~' ~ 9 ~ ;;~ ~}I,e. ~cWy"~ lb~, phr~ i+. ~'lne ~ark.~ny la}-~ ~Id+~~r 1,o;1t be assecnbie.d ~ il~.~l~cge c~Or-ps-Er-~ ~usi- r~ci~- 9A3 ~ '~- ~u~0~1~(1q. Mvtxb~(5. lpr(l 5vporv~se ~tt~a'exi cxn~i\ ~~~ '~~cen.'t5 3~-cive cC b~A~r ~C~n~~'1's wee made ~r -l-~-e~~ L~-c'~ Emergency Medical Plan CENTRAL VALLEY OCCUPATIONAL, 4100 T. HOSPITAL. CALL FIRE DEPARTMENT AND HOSPITAL: MERCY HOSPITAL. 07/24/2006 = N AVE 200, AND/OR CALL MERCY SERVICE 911.. TO GO THE NEAREST -5- 02/02/200 a } ' F MARTZ DDS MARTIN G ~ Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-002139 ~ Fast Format ~ Overall Site ~ 04/03/2002 ~ ~,S~d ~koh~gr0.ph-~ fixes '~s pla.ced i n ~ h~ a ~-k~ ~.~~ ~ag~-e. i~a~u.l of C p~.k~- ~~~ a ~ia5-~-- ~ -3vb ~oY a~ dec~ ~ccv¢~ Release Containment . ba-F..~-iQs ~-~- s~~. ~,~-.(~c rc.r-~.mvee~ ~e.,~-~ ~uppt~).'$~-~~~~= are ~`~'~ec~ o~ lea%.ac~e. c~i(~;11e~ ~hlcer Can b~. ~ourcc~ ~M ~~ Ct~n~`~~n~ -}~~ ba.~k ti,`i-o t~-~ waS-~e ~Jo'~+le. tls ~ ~ 9 ~. '~n h ~e-' p e-~vic~led ~ r ~-1-~-a~ `~v.~ pas ~ . Clean Up ~Itiau~c~ cl~a~, vp arty 5~~1<<cl ~X~ Other Resource Activation -6- 02/02/200' C T F MARTZ DDS MARTIN G -~~ Site Emergency Factors ;` ~ Special Hazards Utility Shut-Offs ~1or~h~ Bask cam. ~ ~-h ~ b Ui lc~ 1~ . Shu~~^~j tke. gas ~ ~ ~s s-f armed a~~ o~-ice 1 a b4 Fire Protec./Avail. Water ~¢, ~ave ~n }~PeS a~ ~~S ~e.,X~"tti-9U1 S~-~^~ p~uz p~; ~l~,ncl held ice -eaci=t~9,~ishe~ ('drry dn~ 'r„ -~~ o~ice lab ~x~~9uis~ers ire Mnou $. Aca~aana.~'i~. -}ec~,Qe~a}~rz a~iv~le.c~ ~ Wait \S Rva~lab~e in ~yrks in -~1ne Building Occupancy Level = Marc 6eeupancy 5a ~c-sonS SiteID: 015-021-002139 ~ Fast Format ~ Overall Site ~ wt.cce.~ a t,~c~,~1n -Fer ~~c put pose a~ --~ 'fie fi`rc eXi~~ 5uW h~ Zn tine n~-'~ ~ ~t`~° a~ peg l oc;~}~ `~n -~.e ~"~n oQev a-4or~ ar,c~ bn e u~l ~A c~eac-lM lalj of ed S~: ~nkl~ts loc~5~l ~~~^ o~ +hg b~-N+c~rn , ~+~ ~ lab ~- 02/02/200 F MARTZ DDS MARTIN G ~ Training ~ Employee Training BRIEF SiJNII~1ARY OF TRAINING PROGRAM: AID. Page 2 Held for Future Use Held for Future Use SiteID: 015-021-002139 ~ Fast Format. Overall Site ~ 05/19/2006 ~ Merwbecs ~,T ~ STAFF ~S"TRAINED IN CPR AND FIRST s- 02/02/200; T. .. 9' MARTZ DDS MARTIN G Manager MARTIN G MARTZ Location: 4100 TRUXTUN AVE 300 City BAKERSFIELD SiteID: 015-021-002139 BusPhone: (661) 327-8220 Map 102 CommHaz Minimal Grid: 26D FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: CAL000112545 SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARTIN G MARTZ DDS / OWNER DEBBIE MARTZ / OWNERS WIFE Business Phone: (661) 327-8220x Business Phone: (661) 589-5626x 24-Hour Phone (661) 204-8123x 24-Hour Phone (661) 304-8575x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact MARTIN G MARTZ Phone: (661) 327-8220x MailAddr: 4100 TRUXTUN AVE 300 State: CA City BAKERSFIELD Zip 93309 Owner MARTIN G MARTZ DDS Phone: (661) 327-8220x Address 4100 TRUXTUN AVE 300 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 - ~~~ ~~V, Based on my inquiry of those individuals responsible for ot?taining the information, I certify under penalty of lau~~ thaf I have personally exarrEined and am familiar writh the information submitted and heiieve the information is true , accur a te a nd complete. ~ a ~ ~ ~ Signature Date -1- 07/12/2007 r '~ F MARTZ DDS MARTIN G SiteID: 015-021-002139 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP HARVEY CHAMBER CLEANER WASTE FIXER L R L 5.00 5.00 GAL GAL Hi Min -2- 07/12/2007 -3- 07/12/2007 ,~ F MARTZ DDS MARTIN G SitelD: 015-021-002139 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HARVEY CHAMBER CLEANER Days On Site 365 Location within this Facility Unit Map: Grid: SPRAY DEVELOPING RESTROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ~ GLASS CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL titi~tircl~vua uvl~irvlvl~,ly t ~ %Wt. RS CAS# 85.00 Water Glass No 1344098 t1AGHKL 1~~~~5.71~1L" 1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi ~ 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: SPRAY DEVELOPING RESTROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL I1tiGKKUVUJ ~.V1~lYV1V1:,1V 1.7 %Wt. RS CAS# Silver No 7440224 I1tiGtiRL H~ 7~7r+J.71"1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 F MARTZ DDS MARTIN G SiteID: 015-021-002139 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/16/2007 IN CASE OF AN EMERGENCY, THE LOCAL FIRE DEPT WILL BE CALLED. DOUG WILSON 325-1798 WILL ALSO BE CONTACTED. HE IS THE PROPERTY MANAGER FOR KERN RADIOLOGY AND FOR THE EMERALD CENTER BLDG. Employee Notif./Evacuation 05/19/2006 SEND STAFF TO CENTRAL VALLEY OCCUPATIONAL, 4100 TRUXTUN AVE 200, AND/OR CALL MERCY HOSPITAL 632-1540. CALL FIRE DEPARTMENT AND EMS SERVICE 911. 9 Public Notif./Evacuation 05/16/2007 PATIENTS WHO ARE MINORS, AND ARE NOT ACCOMPANIED BY A PARENT, WILL NEED SUPERVISION TO EXIT THE BLDG. AN OFFICE STAFF MEMBER WILL BE DESIGNATED TO GUIDE THE CHILDREN OUT OF THE BLDG TOWARD THE PARKING LOT. ONCE IN THE PARKING LOT, CHILDREN WILL BE ASSEMBLED AT THE LARGE DUMPSTERS JUST NORTHWEST OF THE BLDG. STAFF MEMBERS WILL SUPERVISE CHILDREN UNTIL THEIR PARENTS ARRIVE OR OTHER ARRANGEMENTS ARE MADE FOR THEIR CARE. Emergency Medical Plan 07/24/2006 CENTRAL VALLEY OCCUPATIONAL, 4100 TRUXTUN AVE 200, AND/OR CALL MERCY HOSPITAL. CALL FIRE DEPARTMENT AND EMS SERVICE 911. TO GO THE NEAREST HOSPITAL: MERCY HOSPITAL. -5- 07/12/2007 F MARTZ DDS MARTIN G SiteID: 015-021-002139 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/16/2007 ~ USED PHOTOGRAPHIC FIXER IS PLACED IN PLASTIC BOTTLES FOR STORAGE UNTIL REMOVED BY A CERTIFIED WASTE HAULER (PATTERSON DENTAL SUPPLY). BOTTLES ARE STORED IN A PLASTIC TUB FOR ADDED PREVENTION OF LEAKAGE. Release Containment 05/16/2007 SPILLED FIXER CAN BE POURED FROM THE CONTAINMENT TUB BACK INTO THE WASTE BOTTLE USING A FUNNEL PROVIDED FOR THAT PURPOSE. Clean Up 05/16/2007 PERSONS WEARING PROTECTIVE GLOVES SHOULD CLEAN UP ANY SPILLED FIXER. Other Resource Activation -6- 07/12/2007 F MARTZ DDS MARTIN G SitelD: 015-021-002139 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~c~:lu.L na~ai u~ Utility Shut-Offs 05/16/2007 GAS: ADJ TO GAS METERS NEAR NE CRNR OF BLDG A WRENCH FOR THE PURPOSE OF SHUTTING THE GAS OFF IS STORED ADJ TO THE FIRE EXTINGUISHER IN THE OFFICE LAB. Fire Protec./Avail. Water 05/16/2007 AUTOMATIC TEMPERATURE ACTIVATED WATER SPRINKLERS AND FIRE EXTINGUISHERS. Building Occupancy Level 52 05/16/2007 -7- 07/12/2007 ,~ , : ., F MARTZ DDS MARTIN G SiteID: 015-021-002139 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/16/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: ALL STAFF MEMBERS ARE TRAINED IN CPR AND FIRST AID. rays ~ nC.~.u ivi ru~uiC use riciu tvi r Ul.lA1C u.5'C -8- 07/12/2007 r~ .1 + MARTZ DDS MARTIN G __________________________________ SiteID: 015-021-002139 + Manager Location: 4100 TRUXTUN AVE 300 City BAKERSFIELD BusPhone: (661) 327-8220 Map 102 CommHaz Minimal Grid: 26D FacUnits: 1 AOV: CommCode: BFD STA Ol EPA Numbs SIC Code: DunnBrad: +______________________________________________________________________________t Emergency Contact / Title Emergency Contact / Title MARTIN G MARTZ DDS / / Business Phone: (661) 327-8220x Business Phone: ( ) - x 24-Hour Phone (661) 703-5633x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 327-8220x MailAddr: 4100 TRUXTUN AVE 300 State: CA City BAKERSFIELD Zip 93309 Owner MARTIN G MARTZ DDS Phone: (661) 327-8220x Address 4100 TRUXTUN AVE 300 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: +--------------------------------rl-(=~ - ---------------------------------------+ Emergency Directives : ~ ~ ~ / ~-W PROG H - HAZ WASTE GEN I ENT'D ~ U L 2 4 2006 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 and believe the information is true, acs ate, and complete. ~r nature Date 1° ~"0~~ ~ 5~ -1- 05/19/2006 ROBERT E REED DDS ~ . ~ SiteID:' 015-021-002140 Manager : Location: 4100 TRUXTUN AVE 390 City BAKERSFIELD ~ ~~\\ ()~\ ~ BusPhone: Map : 102 Grid: 26D (661) 327-7497 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 EPA Numb: SIC Code: DunnBrad: Emergency Contact ROBERT E REED Business Phone: 24-Hour Phone : Pager Phone : Hazmat Hazards: / Title / DDS (661) 327-7497x (~/ ) 3J7 -11{~7x ((¡fal) S'1/ -7Jq 1fox Contact : MailAddr: 4100 TRUXTUN AVE 390 City : BAKERSFIELD Owner Address City ROBERT E REED DDS : 4100 TRUXTUN AVE 390 : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to Emergency Directives: Emergency Contact / Title / Business Phone: ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x React Phone: (661) 327-7497x State: CA Zip : 93309 Phone: (661) 327-7497x State: CA Zip : 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No I ~~~. fi (L.e¿)CIJL D© Ù"Isr~b)J ©®fâí~ ~~®~ ~ hðV@ (T\I¡¡S C1 prlnt i'lS'IIO) . i"¡g¡'\1i~W®d ~h~ ~~©h~tQ1 ~aæa~d©l\$ M~~~n~l~ M~I11!fà.@l'§¡c ~ ~ú1 ~©lf' P.J..~ fi~~ 00( 1à\01©1 ~~~ i~ ®I\©¡¡¡¡~ wi~h m®(í!~ ~ - (~~Œìucl/lQœ) ¡/lie. 1&InY OOIT®~G©!ìì!~ <oo¡¡¡¡@~ï~ßJ~® till oomjp)~®~® ~1iO©1 OOú"{¡"®ffl MSli1ø a@êm®ú1R t9J!~ú1 ~©lf' my ~1à\©ñ~iW· ~ to.r ë)-?l--(} 3 QQt9 -1- 10/17/2003 ':~.>:.:" '.' . ,:.~ . . . 'Ji;Tf···.···.·.·.· ~~:<~":,..,. ;, '. ' ' I~~r ~~~~.:::. ~?c.:>:.:' >..:'~.' ", . ~r:: .' ' :. .' ." . , , '.' . ;.... ;.' :, ':'.' . JAN-10-1900 18:06 P.02 - - CITY OF BAKERSFIELD OFflCE OF ENVIRONMENTAL SERVICES 171S Chester Ave., Bakenfield, CA (661) 326-3979 i; ,~i . L 2. 3. 4_ s. HAZARDOUS MATERIALS MANAGEMENT ~LAN 0 \ ('~-p- ~~~A¡¡tYM- v--- Iri~TR.ucrroNS: To avoid fumer action, return this fonn within 30 days of receipt. TYPElPRlNT ANSWERS IN ENGLISH. Answer me questions below for the business as a whole. Be as brief and concise as possible. You may 31so attach Business Owner I Operator Form and Chemical Description fonn(s) to the front oftbis plan instead of completing SECTION 1 below for ïnitíal submission.. SECJ:!ON I: BUSINESS IDENITFICA TION DATA BUSINESS NAME: e. Q.Ë£D D·tJS· LOCATION: 4(00 Iru~-h)r\ Av-.e... MAIllNG ADDRESS: bArn. ~ s~· 3q 0 CITY: ßK5fd) STATE: CA-. ZIP:~PHONE:W-J;).'1!Jlf~l{ PRIMARY ACTMTY: Ç\~~ OWNER: ~. RE£þ PHONE: 3:1 1]-'14. ~ 1 Av-e' 5l. ?f10 ~-5 410CJ I~f'"\ MAIL1NG ADDRESS: EMERGENCY NOTIFICATION L CONTACT \'<. ~ 0-e ~ lTILE BUS. PHONE ~ ~,;)'J. 11,,( ~ 1 24 HR.. PHONE ~ Jo...A-. s~1~;"tel,1 2. IÞ e ~~ 10- 1"7:J Ú,' /) 0 0 .r(20~P/T ~ee~ (~. 'i¡ 00 ( r "Í '/-z;~ 4 v C. ¡J, h90 . tÀ,tVdfC €. ~- '!!.2 7- 7~9 :7 ß~~N~ - (- ѧ( ....... k::: !~t::':: i: '.. ìi\;I' ¡~~,r r~'" ...: ' .',' ¡,.;\ JAN-10-1900 18:06 P.03 -e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION n.1: DISCOVERY AND NOT(F£CATIONS A. LEAK.. DETECTION AND MONITORlNG PROCEDURES: Wl\-~ L\J~ lMt r\Þ ~ß'N rv\:~, B. EMPLOYEE AND AGENCY NOTIFICATION: klt\ c. ' ENVIRONMENTAL RESPONSE MANAGEMENT~ ~ j)ìf ç, ~\LLJ ~- D.· EMERGENCY MEDICAL PLAN: t, ~ Ut--c;c- cP t.~ t ~:l ~I,A.,'~~ ~L ~~ ~:}.I ~ ~ eø-'ò<l! c:.I ~,~ "'", ð--"Ju~ r~v~-1, (¡ J w:.1v.r¡~ C,.ð..U tMt) f>t-.. t.( ( \ ~. 2 , . . :~,~.:.. " .;::. .~ ".: . fi\ '," ': . !i1f¡' . ';:¢~·d{::.':':': . ~;:" :;::¡..... , :~t:.··· ,. ..' . ','.', , '\' . ::,':'~ ,':" '. " ~~,~'~:~ ..:' :' ~:~}:.~:~' :-:':. , " ';.,", ~., tfft::: , ~fl~;"':' ~~.~':.:.;:~" ,.:." ;:',':;':::,;:., ~f~'''·}:w,.:,::'' :,' ¡~;;' . ~~.~+~':. : ',: . ¡.;:: . ¡}" . ',,', , " JAN-10-1900 18:06 P.04 e -_. - e ~ HAZARDOUS MATERIALS l\IANACEl\'IENT PLAN SECTION [[.2: R£J..~ASE RESPONSE PLAN A HAZARD ASSESSMENT AND PREVE~TION MEASURES: \A--~. (}.Io.~ ~~.. C ~~ a.....r-l) ~~ t..J...- ""-í c.IL t;...., lc- Ct,y.>( i.\'S~ -b , C'-c.-~ C;; ()'(~. B. RELEASE CONTAINMENT AND/OR MITIGATION~ t5v.,..~.c~( ~r~ $. ~ ~ .. ~ ~,J, lW iQv C-Þ- <\ (1l1( 6- - .. t ~ ~ w..\.A"A\~;..~ ð..~~r C. CLEAN-UP AND RECOVERY PROCEDURES: )' ",..'\.~( c::\~--.J v,p i ~S4 "- r~~~ ~ ð;..c:.~~ øt. L ~fI'..%Ff d... )(.'~ a.~~ ç; ~-ø. ~ ':J\.Ã-. ~('-., tmLITY SHUT-OFFS ÇI..OCATION OF SHlrr-QFFS AT YOUR FACIT..lrn NATURALGASlPROPANE~: Cq~- 6( ~l~ ~ ~ ELECTRICAL: S....,¡. - K: I ....Jo.. ,...-J <ì - -: -- - ¡. -~ ~ WATER.: M. 6, (: e.r-p,._ II ~ l ~ ~ ~ f~ SPECIAL: \ LOCK BOX: YE~ IF YES, LOCATION: PRIvATE FIRE PROTECTIONI\V A TER AVAILABILITY A. PRIVATE FIRE PROTECTION: - ~-( ~ ~ v... < f lA.v-. ~ ~L ft-- tv... UrtuJ, r ~~""í ~",-~lp B. WATER AVAILABu.rry (FIRE HYDRANT):~. ~ ~ <; l.....J oj ~...... \~ 0-... ,,~........,'.k-.. ~ 3 JRN-10-1900 18:07 P.0S ........~ ,·,e tit HAZARDOUSMAT[~SMANAGEMENTPLAN SECTION m: TRAINfNG NUMBER OF EMPLOYEES: '? MATERIAL SAFETY DATA SHEETS ON FILE: Ail l ~~l~ ~ \J., e-r-- 8RIEF SUMMARY OF TRAINING PROGRAM: An t.A..4.t- ~tø,.4!( ~ ku...~ i:...... k,~~ o! U-U.. ~~~ CERTIFICATION " I.. ~~û.ì- \~ fLe ~ CERTIFY THAT "THE ABOVE INFORMATION IS AÇCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFnL MY FlRMtS OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MA1'E.RlALS (DIY. 20 CHAPTER 6.95 SEC- 25.500 ET AL.) AND 1HAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~~ ~~·L,-Q. SIGNATURE ~~~ TITLE "·oJ ,~ Of DATE 4 -- ----- LÞtl)fG~ ~)-\-"J~ ER T E. REED. D. D. S. THE EMERALD CENTER 4100 TRUXTUN AVE., SUITE 390 BAKERSFIELD, CA 93309 661 /327-7497 FAX 661/327-7531 ---- -- - --- . -'::¡ l~\L\U~ rl~ CITY OF BAKERS -DFh",óËPARTMENT I 0;):-;)6 0 OFFICE OF ENVIRONMENTAL SERVICES /' UNIFIED PROGRAM INSPECTION CHECKLIST l \ ( L-. 1715 Chester Ave., 3" Floor, Bakersfield, CA 933;531 It ¡j~ /ðCJ INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES "" . FACILITY NAME ~~r 'E ~éC-o 'j)i)S ADDRESS 4too ì'flV'/TV,J d:ï TIC FACILITY CONTACT DE-tl)~ JOH^,~CÞJ INSPECTION TIME i\A::-c.J ~ Section 1: Business Plan and Inventory Program o Routine ~ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate permit on hand ¡VC-t.J ,fC./ûI.A. I r Business plan contact information accurate 'PL~G ~~Lt:TE ~ n.,hc-tc.... IJ Visible address Correct occupancy Verification of inventory materials Verification of quantities ðß~NW:> bV' ,l\JÇ.p Verification of location Proper segregation of material Verification of MSDS availability Verification ofHaz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand PLG4-~ é "'14,(... ,^, wi A:flf'LlCArte>.J C=Compliance V=Violation Any Rnazardops r'8ste on site?: ~ es 0 No Explain: (...AJ4'S nE: Frx~ White - Env, Svcs. Pink - Business Copy Ðød.t¿ ~ Business Sitr Responsible Party ¿J,~~ Questions regarding this inspection? Please call us at (661) 326-3979 Yellow - Station Copy Inspector: · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVJIRONMENT AL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME DEL 12o&,.."?1.'l € RE'C-:D .0 DS INSPECTION DATE 71/13/00 ~/t+- Section 4: Hazardous Waste Generator Program EP A ID # o Routine B.- Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination 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/ (lC-ASE A?øvlC£ 'I c/ 'I T'f2~\ 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 Inspector: W ¡IV 2:S Office of Environmental Services (661) 326-3979 White - Env. Svcs, ßj~ Business Sit esponsible Party Pink - Business Copy .- -- .P' 0V -- e + MARTIN G MARTZ DDS ---------------------------------- ---------------------------------- SiteID: 015-021-002139 + Manager : Location: 4100 TRUXTUN AVE 300 City BAKERSFIELD BusPhone: Map : 102 Grid: 26D (661) 327-8220 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency Contact / Title MARTIN G MARTZ / DDS / Business Phone: (661) 327-8220X_/lJ/ Business Phone: () x 24 - Hour Phone : ((p(o I ) ï Do -5ft;,33 X(;KA 24 - Hour Phone : () x Pager Phone : () x Pager Phone : () X +---------------------------------------+--------------------------------------+ I Hazmat Hazards: React I +------------------------------------------------------------------------------+ Contact : Phone: (661) 327-8220x MailAddr: 4100 TRUXTUN AVE 300 State: CA City : BAKERSFIELD Zip : 93309 +------------------------------------------------------------------------------+ Owner MARTIN G MARTZ DDS Phone: (661) 327-8220x Address: 4100 TRUXTUN AVE 300 State: CA City : BAKERSFIELD Zip : 93309 +------------------------------------------------------------------------------+ Period : C.u>./\ I/~_,' ro.. ~ 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... ISpecHazlEPA Hazards I Frm,l DailyMax IUnitlMCpl +--------------------------------+-------+-----------+--~--+----------+----+---+ WASTE FIXER R L 5.00 GAL Min ~ ~bu CJ.eD.J1~ X " £nt?-- ~.s -e¡¿, Do hereby certify that ~ ha,,~ t f::;}c ('r pflnt name) revicvII'ed the attached hazardous ~aterials manage- ....', -n 1M". ,_,' L.. t11tUCr~:r)·D.S. ms me, it pian for Vr .6 , r.u-nnvt· ah'd that i~ along with (Name of Business) any corrections ooi"lstituts a1 rompls~s Blfld rorrsd man- agement plan for my 1aciiijy. ' 8wc ~~ ~c?-I JO!) - +================================================_===L~========================+ Signature - 1 - Dew 01/29/2002 ---- -:- ,.. It e ~~ I;" I + ~RTIN G MARTZ DDS ================================== SiteID: 015-021-002139 + += Inventory Item 0001 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ==============================+================+ WASTE FIXER I Days On Site I 365 +----------------+ I CAS# I Location within this Facility Unit SRAY DEVELOPING/REST ROOM Map: Grid: +=============================================================+================+ += 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 5.00 GAL 5.00 GAL 5.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt. I IRS I CAS# I Silver No 7440224 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ Tsecret RS BioHaz Radioactive/Amo~nt I EPA Hazards I NFPA I USDOT# I M~P I No No No No/ Curles R / / / Mln +=======+===+======+====================+=============+=========+========+=====+ Chuni w1-- ~v H~ lf~ ~ ßh.r;JItL- InøredWìb , A tLdJ -h iriS - ~ tì-P D(i,YY'¡ ~ ~s on . D'/ 1~ ~r.en) Cb/onr:9 ~tnts 0 I ID Ó(¿e c¿-H-~ ptlfLr' W Heu-ardê7iAS br-tLL-I¿ d1Jw YL -2- 01/29/2002 _4~34149 MDT "7 Co .. .. CHAMBEWLEANER QT 32W101 new ~I CAt J1() 1-'. ~ -A !ú U,S. DEPARTMENT OF LABOR Occupational Safety and Health, AdminisCr.tion MATERIAL SAFETY DATA '~SIlEET Required under USO\. Safetv anu Health Regulations lor Ship Repairing. Shipbuilding. ånd Shipbruklng 129 CFA t9ts:\iít6. 19171 SECTION I MAHU~ACTUAER'S NAMC E..ERGENC'( TEI.E-ONE NO. (213) 321-4822 MDT Corporation Page: 001 '0'_ PoDGI'O..'" OM. No. .4.''1]'' , I ~ AOORESS (Number. SIr"r. Cit,. S""<. ilnd ZJPCode) 15025 South "lain street: Gardena, California 90248 C"'EM'CAI. NAMC ANO SYNOHVMS TAAO£.NAPIIIE ANO SYNONYMS lIarve CH£ CAL. A It..V SEc.¡.ION II . HAZARDOUS INGREDIENTS - PAINTS. PRESERVATIVES." SOI.VENTS n.v IU"i ,I ALLOYS ANO METALLIC COATINGS % "IGMENTS ',ÙA N//\ N/1\ N/A N/I\ eASE "'ETAI. CATAL.VST AI.I.OYS VEHICI.E METAI.I.IC COATINGS Ftl.l.ER ME rAI. . PI.US COATING OR CORE FI.UX OTHERS SOI.VENTS AOOITIVES nntifoam Emulsion 04 OTHERS Green Coloring AQents .1 HAZAROOUS MIXTURES OF OTHEn LIOUIOS. SOLIDS. on GASES Water Triton X-lOO Triton U-66 ., . "" ., Tetropotassium Pyrophosphate "- " 1 E E r....It....' SECTION III . PHYSICAL DATA eOILING POINT ,OF., r. SI'£CI~IC GR^VITV I~'20' II pe:"CE'"r. ""LAT'I.E BV VOI.UME ''Yo,. . e:VAPORATION RAT!! ( "II 2120 .. VAPOR PRESSURe: (mOft Hf.1 V"'''OR DENSITY IAIR"U SOLU811.ITV IN WAT1õR . "'''Pe:ARÀHCE ANO OOOR Green Color - pleasant Odor , SECTION IV . FIRE AND EXPLOSION HAZARD DATA F\..ASH I'OINT (Mo'hocl ulodl N//\ N/I\ '1..AMM.e,-& t..IMITS IlXTINGUISHINQ MEDIA SpltC:IAI. ~'RE F'O"'TlNO PROCEõUñËs N//\ UNUSUAl. FIRE ANO EXpl.OSION "'AZAROS Non Fl amln<lble 'I ~ " fLV IU""., " TLV (Unitsl 85 5.3 3 J J 1..1 UII " 483'4149 r MDT ., CHAMBER .EANER QT 32011°1 Page: 002 SECTION V . HEALTH HAZARD DATA TH"r.SHO,,",O '-''''''''T VALUe. E""Ecn 01' OVEAOCl'OSUR None EMERCENCV AHD "lAST ..10 PROCEDURES . ~. E es: Flush under runnin water for lS minutes. Ingestion: Induce vomiting. See a physician SECTION VI . REACTIVITY DATA STA81\..ITV CONOITIONS TO "VOID UNST "'I..I .:. STAII.It x None HAZAROOUS OECOM'OSITIO,. PROOUCTS None HAZAROOUS POI..VMERIZATrON MAV OCCUR CONOITIONS TO AVOIO WII.I. NOT OCCUR x SECTION VII . SPILL OR LEAK PROCEDURES STEPS TO IE TAKEN IN CASE MArERIAI. IS REI.EASEO OR SPII-LEO ~~!!. surface with water. " WASTC O'SPOSA'- MeTMOO f;afli "a~y -se"e r- SECTION VIII· SPECIAL PROTECTION INFORMATION RESPIRATOR V PROTECTION (SP~Clfll'p~1 N/I\' . VENTlI..ATION I..OCAI. x AU SPECI"'L NIA M£C:"A""CAI. (Gefteral} OTME" PROTECTIVE CL.DVES EVE I'ROTECTIO" NIA N/I\ OTMItR PROTECT'VIt eQUIPMENT None . SECTION IX . SPECIAL PRECAUTIONS "R"CAUTlONS TO Be TAKEN IN MANOI./NO AND STORI..O None OTMER PRECAUTIONS hyoid e e and sk.in contact. PAGE 121 ~"r'" "f"U~."'" e e + MARTIN G MARTZ DDS ================================== SiteID: 015-021-002139 + +================================================================= Fast Format + +- Notl'f /Evacuatl'on/Medl'cal ------------------------------------ Overall Sl'te + -. ------------------------------------ +== Agency Notification =======================================================+ I I +==============================================================================+ r~~ E~e ~if. /E~uation ~c~oTv:~~~~~~ðcc¥a1J;:;r~~i/Dci=¡r~9 +==i~~~==~==~==~~=1fÞJ;:ßJ=================~~5:4b=+ r=jô p~ :Jž;tc;;;;.!3:1=;¿=g¡¡~==~====-----==--====Î +====J:===~===============================~==============================+ Î==r;§(/tr;¡pr1f¡a~MiE=~tkL===qy¡y¿======~~lE==Î +=====~~~~==========================================~~~=~=~===========+ -3- 01/29/2002 e e SiteID: 015-021-002139 +================================================================= Fast Format += Mitigation/Prevent/Abatemt =================================== Overall Site + +== Release Prevention ========================================================+ t»JeJj-ú,YtoJI.e.L~q)'M1-~[' pJ~ In lL M 10 CJ)n~ ì~ I~~ I +==============================================================================+ +=== Release Containment ======================================================+ I &Œbú\¿{\ as ~~¿w,~ I + MARTIN G MARTZ DDS ---------------------------------- ---------------------------------- + + +==============================================================================+ +==== Clean Up ================================================================+ I ~ (Q)1 éÞb~ I +==============================================================================+ +===== Other Resource Activation ==============================================+ I +==============================================================================+ -4- 01/29/2002 e e SiteID: 015-021-002139 + +================================================================= Fast Format + += Site Emergency Factors ======================================= Overall Site + +== Special Hazards ===========================================================+ I I + MARTIN G MARTZ DDS ---------------------------------- ---------------------------------- +==============================================================================+ +--- UtJ..'lJ..'ty S~ut-OffS --------------------------------------------------------+ --- -------------------------------------------------------- I ~~ I +==============================================================================+ +---- FJ..'re Protec /AvaJ..'l Water -----------------------------------------------+ I-m ~ ~rr-~ -ey. h nø- W-~¡;y:_.ð---~--s:cl:Z-m---------m-----m-1 +==============================================================================+ +===== I Buil~ip~ Occupancy Level M /11 +==============================================================================+ ===============================================+ I -5- 01/29/2002 ;, e e SiteID: 015-021-002139 +================================================================= Fast Format += Training ===================================================== Overall Site r~~ZF¡lf~~i~=A~~;F~f~li~~;t;;fþ~;:Sf~~fulL================1 +==============================================================================+ +=== Page 2 ===================================================================+ I I + MARTIN G MARTZ DDS ---------------------------------- ---------------------------------- + + + +==============================================================================+ +==== Held for Future Use =====================================================+ I I +==============================================================================+ +===== Held for Future Use ====================================================+ I I +==============================================================================+ -6- 01/29/2002 . f , .4· ~ '¿·r. '" ~ .;,1-..- , ^ ... e CITY OF BAKERSFIELD e OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 \ . . í SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR -- HAZARDOUS MATERIALS MANAGEMENT PLANS .. These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas ber.aJISC of the complexity or size. then you will be completing and additional detail map, fàcility diagram, for each of these areas. Include instructions that show the route to your business it it is in a remote location. SITE DIAGRAM INSTRUcnONS The site diagram is used to show your busineš; and to indicate the businesses that immediately .'n surround your property, usually within 300 feet. If you will be showing specific area detail on:'~~";.., facility diagrams, use the site diagram to show an overalllayou..~ of the plant If you will not~} submitting facility diagrams, the site map must include"all of the following information: ""- "" 1. Check the box on the top left comer of the form provided that indicated "Site Diagram" . ..-- ..- ._-. - 2. Print the name of your business, as shown in your HMMP, on the top of the ':; " diagram. ..~. 3. Label the location of the hazardous materials and identify them by name and tYPe' of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. S. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. X 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). " p' (I /) (c f ' ~L.\.._ ~-I""- '- ~l.P -' j/LØ7/-~'- b- , /) y( Q.0L¡/,j,j J c- ,~ -~'r·\.. \-. . ø I ,. Map labeling must be lesiAnd easily understandable. Try to av. the use of abbreviations or -If', \ symbols. If you must use them, provide a legend explaining your system. \ Maps may be returned for correction if you fail to follow these instruction. FACIL1TY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. -- 1. Check the box in the upper right hand comer of the form provided that indiCated "Facility Diagram". 2. Print the rWne of your business as shown on your HMMP. Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of tàèility diagrams that you are including. If a map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instruction (3 -7) for site diagrams-regarding the specific details to be included on each facility diagram. 2 -. . \ .. "1 ..,-, ., ';.- , ;r , z:. () ~ ;t. ......... ~ 'f. IEXITI -f- ...~ YOU ARE HERE x~ ~ IEXITI x #' iJ v ~ ~\f\f = )( D. ~ X @t____J ¥- 'f.. . -' , . -X ~. Hazardous Chemicals Location Portable Pire EZ1IDcufsher Location Wa1er Location .. Emergency EyeYUh Statlon,Locatlon Air CoD4itioDiDg Control Location Electt1c Breaker Panel Location Emergency Pir:lt Aid leit Location Emergency Oxygen Location Exit Location ªpY-1 n !Ller-s IEXITI X FACILITY DIAGRAM r f SITE DIAGRAM t , Business Name: _ Business Address: / ~ :¡: to- ~ <) -::2 ,. -. r '" .' ,,~. ".;." .. v e e ~ e filS- ();<I () 0:2./37 '.. Bakersfield Fire Department Plan review Information Thank you for taking a few minutes to fill out this fonn, This information will greatly accelerate the plan review process. Todays date £L / I q / MDJ- Jobname 1)r,rrlCLrt/n l::1 rrlarfz) 0,1),5, ) m.s, Job Address 4-100 Tru-xf-w1 ~t 2t'é7 q 330CJ Job Suite number ..300 Occupancy classification Name of complex or strip mall where building is located ifnot a stand alone ( ie Mervyn's Plaza) ÚY>e.YafcL (!l-I7-1--eL Address of complex if different from above Is the building fire sprinklered? Yes ( No Does the building have a fire alarm ? Names of contact person ~tt 7?!iL- (hW!:k¡¿ 'if> (}£// Telephone # 589~/sI 7 - 8Zzo L 3J.. 7 - /3.50/ 7()3 -5(;33 . . I I EhCt.. -k!CLì s~r f.ùD'J(.., / 3:17-- ([~~O . (P(¡ 4- 7q 70 hm I Û7CL ¡¿CLGs-e~ Second contact, optional Telephone # Name of person filling out this fonn S:\forms\plan review questionnaire,wpd r , "" .. CITY OF BAKERSFIELD PERMIT APPLICATION PLEASE PRINT OR TYPE APPLICATION . ;~. , " I t' Project Info: _ - --.- Description of W ork t~ Perfonned Project Location: 4/DO trUj(.-fu.n 6+e-, 0aD Address Suite Number Tract Number Lot Number Arch / Eng Other Owner: rn o..rtJ LastName' kn 4100 tru.v. Address) ) H I) futÇ e,y~ ~ Vl City Zip mrLY+in First]QO ßu~e Number 4 3309 (&!ßli~~1~ 7~~O Phone Number Fax Number ({¡h ¡') 3~7 -;2 f!3) .... Contractor: Last Name (Company Name) First Name Address Suite Number City Zip Phone Number Fax Number Contractors License Number License Expiration Date Arch / Eng : Last Name First Name Address Suite Number City Zip Phone Number Fax Number Architect / Engineer License Number License Expiration Date OFF][CE USE ONLY Permit Number Date Applied / / -- -- - --- - -'- '~:_..;r-...-;:-~-.:~,~:" --.::::---- ~:::-~.~'~ .,,':"; :-~ " .::;... ./ ~,~ ,~. ! -ï " ~~- e e -,:'it >. CITY OF BAKERSFIEI.JD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd f;'loor, Bakersfield, CA 93301 FACILITY NAME fV\ fohn \J I\. \C{ \"í 2- J'Ij)=., ADDRESS t{ \ DD \'"'1-\,hl+C '0 ¡\v:; :;CD FACILITY CONTACT INSPECTION TIME 1.-( : 10 INSPECTION DATE .- (-.5 ~ l) PHONE NO. 3-;-7- 6220 BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES 'Î Section 1: Business Plan and Inventory Program rij Routiñë I " o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate penn it on hand ../ I :\/ t.--Æ::-i+-:::r TO .. í.2L. ¡-,;. I ¡ .J-J\ '1'"15'í Business plan contact infonnation accurate !/", Visible address ;/ Correct occupancy , . 1/ Verification of inventory materials / Verification of quantities V Verification of location V Proper segregation of material J/ Verification of MSDS availability /" Verification of Haz Mat training V Verification of abatement supplies and procedures V Emergency procedures adequate ¡ /' " Containers properly labeled [.,./ Housekeeping /' Fire Protection I~ V Site Diagram Adequate & On Hand ¿,.. ;' C=Compliance V=Violation Any hazardous waste on site?: Explain: rnJ -4IV^ 0 ¡JrYes No Vl10'(+~ o· mGxi-è:. ,t!,ù~{ol ¿::::ij V;Jtllr FF I ( Business Site ResponsiBle Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: · 1 e CITY OF BAKERSFIELD e OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY INFORMATION INSTRUCTIONS BUSINESS OWNER I OPERATOR FORM - I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending) for the facility information. Enter the business name and site address and phone number of your business. Do not use P.O. box numbers. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department, or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the business. This person may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making authority to call on other resources (such as hazardous waste clean-up companies) as necessary. V. CERTIFICATION: The business owner or operator must sign, date, and also identify the document preparer. e e COMMON STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODES f: · - , 0111 Wheat production 0724 Cotton ginning 5821 Eating places 0115 Com production 0541 Grocery store 5813 Drinking places (Alcohol service) 0131 Cotton production 1541 Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash 2911 Oil refineries .- -- grains 5984 LPG dealers 3441 Weldinglfabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes 7532 Auto top, body, 3443 Weldinglfabrication - upholstery repair 0173 Tree nuts boiler Auto paint shops 0174 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fruits 4222 Cold Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts 4925 Compressed gas supplier 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair crop 5169 Chemical supply 7538 General auto repair 0241 Dairy farms 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs (new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 2851 Paint manufacture 5531 Auto & home supply stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 CITY OF BAKERSFIELJ1. OAE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 \ BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION ..-. ---_.~-----------_._._------------------ Page _ Of _ ----.-----..--.--.----.--..----.--. I. FACILITY IDENTIFICATION FACILl1Y ID # tJ! I !rr:è?: /} ~J ¡:i,\i () '0; 11/! ~ fa! 1 Year Beginning D b\·¡- U!'" r;;;",·: t :~ ~)1! ¡ -- BUSINËSS NAME j;~e a;FÃciLlTY NAME or ÔBA. Doing Business As) . j---;SUSiNESS PHONE ---------- 102 -. _1).r~nJ(u- _ n_b.__illM-&-~/). D.S 7 m. 5 ,____________(j¡lR~-~~'&-~2Q _____ _______ SITE ADDRESS l I, . ,_ C' 103 _________ -rlbO /r-lAXrun uf-.¿ 300 __~~_~çU<e("0 +i e-l4. 100 : Year Ending 'Oi ~--_._----,---_.- ---..- ----.---. 104 ¡ I CA ' ZIP Q330q 105 ------- DUN & BRAOSTREET COUNTY ~~Yì OPERATOR NAME martin l:::t mart 106 i SIC CODE : (4 Digit #) 107 108 '" ~'''; :", '.;;:~':' ....~.~:~; ':'.~ ~ . " 4-" . ,',"T',' ~',;: ~; -#. '", . ,'_ _, >:.~ :~~>.;~~~/.~.~~~ 1 It OW.N"E;R INFO~MÀ îl0N OWNER NAME mQ.Y+Ú1 b, m(lY3 OWNER MAILING ' I. ADDRESS Lt 100 TrlAXhLh ~-r.L .ßOO CITY ßaJ(~rs~jd&... -. . ," .--. . :-~~~:~,~~:':,.;~;\:;~~~~f;.~· . 111 . OWNER PHONE 3;;.. 1-Fz"w 112 113 CONTACT NAME u.(, CONTACT MAILING LI. -r .h. __ ADORESS -, ¡DO I Y7.ÁX I CA.,.r CITY ...&J<er.s f; el c( i 114 i STATE .- ", . ",.. .. .~:::; ;> ~,;-<\·if~·:.' "<~':.;~~'~~:..> ." .; "" " <~~;-. ,~::,:', :.t':>~.;-·,'" >" .~:'.: ". ¡' . '.. ~ ~ "'~'~" ,/" '. 115 I ZIP 93311 116 117 ¡ CONTACT PHONE I ;;;~#E'~-H:I 18 119 300 . NAME i TITLE ¡-- 120 '.STATE fA-- 121. ZI~ . 93301 IV:· EMERGENCr.çp~!~~T~ . .... . .... ~~,Eë:~NDARY- I 123 I NAME 122 129 125 TITLE 130 126 BUSINESS PHONE 131 127 I 24-HOUR PHONE ! 128 ¡ PAGER # 132 24-HOUR PHONE PAGER # 133 ,\¡ ,::~f~~;ot~" ... ,-" '- ., -' ",' . . " .'. ,: " .':V;:'.CERTIFICATION .'" . ..':-" ..... .'(' ..".. ., .. '" i Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined i__~_nd am familiar with the information submitted in this inventory and believe the information Is true. accurate, and complete. I SIGNATURE OF OWNER/OPERATOR D(j...¡ATE / 134 NAME OF OOCU~E~T PfŒPARER 135 I ~~J 0;;"- &ntL Kcuæf- 1---- ---.--- -- --.------ ¡ NAMES OF OWNER/OPERATOR (print) 136 TITLE OF OWNER/OPERATOR 137 I.l)~c_ [{Jar fin J;¡JrlartJ ______.]. D. $~______.______ ----.-----.. UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd .. (. ¡ ¡¡ tit CITY OF BAKERSFIELD e OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS CHEMICAL DESCRIPTION FORM -- Make as many copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of a gas. Report any amount of any hazardous waste being generated or handled on site. I. FACILITY INFORMATION: Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Enter the business name at the top of the form. Enter the page number in the right hand corner. Describe the exact location of the hazardous waste or material being reported. NOTE: Chemical location information is considered confidential unless you check "no." If a site map is being submitted, you may refer to the map number and grid coordinates for the approximate location of the material, as shown on the map. II. CHEMICAL INFORMATION: Each of the instructions below correspond to the entry field with the same number on the chemical . description form. CHEMICAL NAME 205 Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union ofPure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture or a hazardous waste, do not complete this field; complete the "common name" field instead. TRADE SECRET 206 Check "Y" for yes if the information in this section is declared a trade secret, or "N" for no, if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by Health and Safety Code, Section 25511. Federal Requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret information is bound by Title 40 Code of Federal Regulations (CFR) and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEP A. COMMON NAME 207 Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. EHS 208 Check "Y" for yes if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 1 CAS# e e 2~9") Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures. enter the CAS number of the mixture if it has been assigned a number distinct from its components, If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the section below. FIRE CODE HAZARD CLASSES (Please !eave blank) 210 HAZARDOUS MATERIAL TYPE 211 Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. RADIOACTIVE 212 Check "Y" for yes if the hazardous material is radioactive or "N" for no, if it is not. CURIES 213 If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. PHYSICAL STATE 214 Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gaseous (gas). LARGEST CONTAINER Enter the total capacity of the largest container in which the material is stored. 215 FEDERAL HAZARD CATEGORIES Check all the physical and health hazards associated with the hazardous material: 216 PHYSICAL HAZARDS: Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents HEALTH HAZARDS: Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short tenn exposure. Carcinogens, other hazardous chemicals with an adverse effect with long tenn exposure, Chronic Health (Delayed): ANNUAL WASTE AMOUNT 217 If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. MAXIMUM DAILY AMOUNT 218 Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at anyone time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. AVERAGE DAILY AMOUNT 219 Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 2 :- 1" ~ e . STATE WASTE CODE 220 If the hazardous material is a waste. enter the appropriate California 3-digit hazardous waste code as listed on the back of the Unifonn Hazardous Waste Manifest. A list of common State Waste Codes are included on page 4 of these instructions. UNITS 221 Check the unit of measure that is most appropriate for the material being reported on this page: gallons. pounds, cubic feet or tons, NOTE: If the material is a federally detined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. Ifmaterial is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). DA YS ON SITE 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER 223 Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERA TIJRE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT I - 5 (% by weight) 226, 230, 234, 238, 242 Ifa range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1- 5 Name 227,231,235,239,243 When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1 % by weight if non- carcinogenic, or 0,1 % by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required infonnation. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT 1 - 5 EHS 228, 232, 236, 240, 244 Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "N" for no, if it is not. HAZARDOUS COMPONENT 1 - 5 CAS 229,233,237,241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: Please print name, title, sign and date each chemical description fonn, 246 If you have any questions please call us at (661) 326-3979 3 · e ~ ...... ~ CALIFORNIA WASTE CODES Code Description [norganics 111 Acid solution 2 < pH < 7 with metals (antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, silver, thallium, vanadium and zinc) 112 Acid solution without metals 113 Unspecified acid solution 121 Alkaline solution pH >12.5 with metals (see 111 ) 122 Alkaline solution without metals 123 Unspecified alkaline solution 131 Aqueous solution (2 < pH < 12.5) containing reactive anoins (azide, bròmate, éhlorâte, cyanide, fluoride, hypochlorite, nitrite, perchlorate and sulfide anions) 132 Aqueous solution with metals (see Ill) 133 Aqueous solution with total organic residues 10% or more 134 Aqueous solution with total organic residues less than I 0% 135 Unspecified aqueous solution 141 Off-spec, aged, or surplus inorganics 151 Asbestos containing waste 161 FCC Waste 162 Other spent catalyst 171 Metal sludge (see 111) 172 Metal dust and machining waste (see Ill) 181 Other inorganic solid waste Organics 211 Halogenated solvents (methylene chloride, chloroform, TCE, TCA) 212 Oxygenated solvents (acetone, butanol, MEK) 213 Hydrocarbon solvents (stoddard solvent, xylene) 214 Unspecified solvent mixture 221 Waste oil and mixed oil 222 OiVwater separation sludge 223 Unspecified oil- containing waste 231 Pesticide rinse water 232 Pesticide and other waste associated with pesticide production Code Description 241 Tank bottom waste 251 Still bottoms with halogenated organics 252 Other still bottom waste 261 PCB's and material containing PCB's 271 Organic monomer waste (includes unreacted resins) _ 272 Polymeric resin waste 281 Adhesives 291 Latex waste 311 Pharmaceutical waste 321 Sewage sludge 322 Biological waste other than sewage sludge 331 Off-spec, aged or surplus organics 341 Organic liquids (nonsolvents) with halogens n 343 Unspecified organic liquid mixture 351 Organic solids with halogens Sludges 411 Alum and gypsum sludge 421 Lime sludge 431 Phosphate sludge 441 Sulfur sludge 451 Degreasing sludge 461 Paint sludge 471 Paper sludge/pulp 481 Tetraethyllead sludge 491 Unspecified sludge waste Miscellaneous 511 512 513 521 531 541 551 561 571 581 591 611 612 Empty pesticide containers 30 gal or more Other empty container 30 gal or more Empty containers less than 30 gal Drilling mud Chemical toilet waste . Photo chemicaVphoto processing waste Laboratory waste chemicals Detergent and soap Fly ash, bottom ash, and retort ash Gas scrubber waste Baghouse waste Contaminated soil from site clean-ups Household wastes 4 I. FACILITY INFORMATION .~. aUSINESS-ÑÄME (Same as FACILITY NAME or DBA· DOing BUSiness As) ----- --. ,"~~~~~~i r}~,-s-~ar't7 D.'D S J--()')- $.~ -----~---;,;;_c;;;;;;.;... """,,";-,--- -~ 0 --LnSrat. ut11CÆ ~ t.. iT room ! CONFIDENTIAL (EPCRA) Yes No 202 -'FAèlLl1YiD,J¡,' -/~O' 'I: Il~.~: 0: Q: ;f: I :3.q 1! MAP # (optionaf) 203 GRIO # (opoonal) (1 ~~ /',J.' : .01+ I , a CITY OF BAKERSFIELIa OFl'If:E OF ENVIRONMENTAL sill VICES 1715 Chester Ave., CA 93301 (661) 326-3979 ..c~" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION DNEW DADD 200 o DELETE D REVISE . -.-.,.-. .__._-'._..~_.._-----------_..- _··___·______..._____..__._......___.__...n.... II. CHEMICAL INFORMATION \ (one form per malerial per bUIlding or area) Page or ....-..-.-.......,-.--. .-...----.-.....----- 204 CHEMICAL NAME 1. 'J} <'- L fl ' ,17 __ (µ(þQ-1'l TI x.-erv : COMMON NAME X ~ au -(l ì X-le. CAS # /440·;:{ FIRE CODE HAZARD CLASSES (Compl te it requested by local fire chief) 205 TRADE SECRET 0 Yes 0 No 206 It Subject to EPCRA, ret", to instructions 207 EHS· ------ o Yes 0 No 208 209 ·If EHS is·Ves.· all amounts below must be inlbs. . TYPE Mw WASTE I o Yes œf No 215 o P PURE o m MIXTURE 211 RADIOACTIVE PHYSICAL STATE ri, LIQUID 214 LARGEST CONTAINER 5j'LLl~ o 5 CHRONIC HEALTH Os SOLID. OgGAS FED HAZARD CATEGORIES (Check all that apply) 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE o 4 ACUTE HEALTH :-;:ÑNUAL WASTE AMOUNT ga GAL 0 d CUFT . If EHS amount must be in Ibs. 210 212 CURIES 213 216 218 ¡AVERAGE I DAILY AMOUNT :) 219 STATE WASTE CODE 220 MAXIMUM DAILY AMOUNT 5 3ã - L/O o Ib LBS o In TONS STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK o c TANK INSIDE BUILDING o d STEEL DRUM o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o P TANK WAGON e PlASTICINONMETAlllC DRUM t CAN o g CARBOY o h SILO 221 DAYS ON SITE l.Jç 222 o q RAIL CAR 223 fIit- in sId{, STORAGE PRESSURE ~ a AMBIENT o ba BELOW AMBIENT 224 o aa ABOVE AMBIENT STORAGE TEMPERATURE o aa ABOVE AMBIENT o ba BELOW AMBIENT a AMBIENT i I ¡ 1 .' %wi~!tf~~f:r';7Æ~'~þ~~r;~~~i,::';:;;;:;~':,;;:q~f;~¥ÀAó6lJŠ;~~Ël?~~fÐ- :;i{;~t~~;:2~::;~~. .-' sìJ Vw '127 o Yes rï.i No 228 231 o Yes 0 No 232 235 o Yes 0 No 236 239 o Yes 0 No 240 243 o Yes 0 No 244 226 , ' ~ 2 230 ¡ 3 234 238 /~,:: '";.-r~~r~>:=&~"... ,-:.f'< ~, ';::: ;'~,,;¿I,I~:.SIGNA:rURE '.~~:-( ';.' '~r; :~;'~:i:-~ " .....~~.t:-, ¡'f.'" '.~ o c CRYOGENIC 225 ::";)'~'~CAS #'1 '7 4-'-1 DZ-~t/ 229 233 237 241 245 DATE 246 ~~I/~ UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd , , ...... ' American Association of Orthódontisls~ _ '.... ~Ï'\ .' ...r '," \:TV , \.... V ' . - DDS . 1'1' 5 -. Ó R Tit -0- 0 Q N T I- ç S ,.41 00 ~ ~~nAv~!1~,!~OO_~~~':f'$~iel~, C_~,~3:0~~_: O~~7:8:20~~~~~5:3~i.~~50 :¡ .. i" ,'~ e ~71iDt~~ l Dd---?bO fC, CITY OF BAKERSFIELD FI ARTMENT OFFICE OF ENVIRONMENTAL SERVICES ".- \ c..! UNIFIED PROGRAM INSPECTION CHECKLIST r- \ Ò 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAMEf1I{M.-YII\.1 &-IVlARTG.-.I P()5 ADDREssAtct) \fW)tfU'/ -:tÞ3ðO' FACILITY CONTACT INSPECTION TIME INSPECTION DATE I if? 1= PHONE NO. ~ '2..7- 2.'Zò BUSINESS ID NO. 15-210- ¡..JC-c.J NUMBER OF EMPLOYEES I/J Section 1: Business Plan and Inventory Program o Routine Øcombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate permit on hand ¡JG-J Business plan contact information accurate .p(ß4-SE=-~Œrc ~ 1Lt.I.i, l.- i V Visible address Correct occupancy Verification of inventory materials Verification of quantities ~S T4-t.../Co eMf ( 1IJ<s.,ø _ Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C(¿"~sé ~~ rt ~At(... '''\I C=Compliance V=Violation Any hazardous waste on site?:ß'(Yes 0 No Explain: LA..f\4;<;" rv:5. Fi PI. ~ 8n£L~ White - Env, Svcs, Yellow - Station Copy Pink - Business Copy Business Site Responsible Party Inspector: ~l~ 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 fI.1JY'(;¡IIJ G - 1Vf~ ~ DOS INSPECTION DATE u ;;3/õd ( Section 4: Hazardous Waste Generator Program EP AID # o Routine y(, Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste detennination 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 Ir f~\./ /ð£ I("-RA Y l[ Secondary containment provided V ?t..Ei!iç € 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 DISC 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 ITom land disposal C=Compliance V=Violation £¡jJ¡J&S Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs. t)(UL~ Business Site Responsible Party Pink - Business Copy ... CITY OF BAKERSFIELq.¡ OFPlt:E OF ENVIRONMENTAL slit VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION 1fœw ..'., ,<)~ :;,~:¡~~;¡~~~;.~P;>:;:·,~~;:~;~f~~~F;~:~~iFi: BUSINESS NAME (Same as FACILITY NAME QI' DBA· Doing Business lVld::ß-ì(,J &_ o ADD o DELETE o REVISE 200 :..-~;!j~í1fi~afíf)Úij~8it'¡ÅTìó¡;:;~Ztri~~'1:f~";.·"0.-', .. (one form per material per budding or area) Page of ~,>: "< .. 3 ,:;.,"tc"':;. '"0', é" CHEMICAL LOCATION M 1\(1. rz.... 'f)GJéWPl~ 201) CHEMICAL LOCATION I CONFIDENTIAL (EPCRA) GRID # (optional) Dyes D No 202 204 I CHEMICAL NAME ¡;,.JA:~'\G P, ~'Gf2- D Yes D No 206 If Subject to EPCRA. ref ( to instructions 207 D Yes D No 208 COMMON NAME CAS # 209 FIRE CODE HAZARD CLASSES (Complete if requested by local fire dlieI) TYPE D p PURE D m M1X1URE 210 D w WASTE 211 RADIOACTIVE Dyes ONo 212 CURIES 213 I D g GAS 214 LARGEST CONTAINER S- 215 PHYSICAL STATE D s SOLID D I LIQUID FED HAZARD CATEGORIES D 1 FIRE (Check all that apply) ANNUAL WASTE "71"\ AMOUNT ~ D 2 REACTIVE o 3 PRESSURE RELEASE 04 ACUTE HEALTH 05 CHRONIC HEALTH 21~ STATE WASTE CODE 216 217 MAXIMUM DAILY AMOUNT s 218 AVERAGE CAlLY AMOUNT 220 UNITS" ~GAL OdCUFT . It EHS. amount must be in Ibs, o Ib LBS o In TONS 221 DAYS ON SITE 222 STORAGE CONTAINER D a ABOVEGROUND TANK ~ PlASTlCINONMETALlIC DRUM OJ FIBER DRUM D m GlASS BOTTLE D q RAIL CAR 223 (Check all that apply) Db UNDERGROUND TANK DfCAN DjBAG o n PlASTIC BOTTLE Dr OTHER Dc TANK INSIDE BUILDING o 9 CARBOY o k BOX Do TOTE BIN o d STEEL DRUM o h SILO o I CYLINDER o p TANK WAGON STORAGE PRESSURE ~a AMBIENT o sa ABOVE AMBIENT o ba BELOW AMBIENT 224 STORAGE TEMPERATURE ø a AMBIENT o sa ABOVE AMBIENT D ba BELOW AMBIENT o c CRYOGENIC 225 I 2 230 231 Dyes ONo 232 233 ) 3 234 235 OYesONo 236 237 4 238 239 o Yes 0 No 240 241 245 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd